A comprehensive systematic review published in the Nortis Journal of Sports Sciences has revealed that repeated strangulation techniques in grappling sports appear to lack a connection to chronic traumatic encephalopathy, the degenerative brain disease increasingly linked to contact sports.
The paper, titled “Chokes In Grappling and Mixed Martial Arts: Types, Mechanisms Of Action, Consequences And Management,” examined peer-reviewed literature on the safety and risks associated with competitive strangulation techniques. The findings suggest a striking contrast between the brain effects of being rendered unconscious through compression holds versus impact trauma.
“To date, scientific literature has not established a relationship between repeated transient strangulations and the development of chronic traumatic encephalopathy (CTE),” the authors wrote. “Unlike impact trauma (strikes), brief hypoxic mechanisms do not appear to generate the same degenerative damage.”
The distinction centers on how each method affects the brain. Striking sports cause direct mechanical trauma with a well-established association with concussion and CTE. Strangulation techniques, by contrast, work through what the researchers describe as “reversible hemodynamic alteration” and have not demonstrated a consistent link with the disease.
Most competitive chokes function as vascular strangulations, where external compression of the carotid arteries creates a transient reduction in cerebral perfusion pressure. This typically results in loss of consciousness within seconds, but the mechanism differs fundamentally from the repetitive impact trauma that leads to CTE.
Research on high-performance grapplers has documented noteworthy neurophysiological adaptations. Studies show increased baseline cerebral blood flow and preserved cognition among these athletes, suggesting what researchers believe may be a phenomenon of ischemic preconditioning, where the brain adapts to brief periods of reduced blood flow.
However, the review emphasizes that these techniques are not entirely without risk, particularly when improperly applied or prolonged. Documented complications include cervical artery dissections, ischemic strokes, and structural laryngeal injuries. The authors stress that early recognition of warning symptoms is essential, including focal neurological deficits, severe headache, dysphonia, dysphagia, or dyspnea. When vascular or structural injury is suspected, neck CT angiography is the diagnostic study of choice.
The research indicates that in supervised sporting environments with properly trained participants and referees, strangulation techniques appear to be generally safe. The key lies in understanding the physiology and differences compared with impact-related trauma.
This systematic review provides important context for ongoing discussions about athlete safety across combat disciplines. While striking sports continue to grapple with the long-term consequences of repetitive head trauma, grappling arts may offer a different risk profile. The findings suggest that the path to unconsciousness, whether through strikes or submission holds, matters significantly when considering long-term neurological health.
