Does practising judo increase the likelihood of sustaining a brain injury?

Question

Judo is a sport which involves throws. Most throws in shiai are not very clean. In Judo, the uke (throw receiver) may land head first.

I am concerned that such head first landings may potentially cause long term brain injury. However, brain injuries are not my expertise.

In judo, break falls are very important techniques used to prevent injuries including those to the head. The uke tucks in their chin to prevent direct impact to the back of their head.

In judo, a clean throw puts the uke directly onto their back for ippon. I do not know a single judo throw that lands uke head first on the ground.

These are techniques applied during practice. However, in shiai uke defends forcefully which may make tori unable to execute a clean throw. Uke may lands on his shoulders or even head first. Thus it is obvious that injuries are more likely to happen during shiai then in training.

I haven't really heard any news about brain injuries in Judoka which makes me wonder if this is true.

Question

Assuming that one trains regularly and is physically fit, does practising judo increase the likelihood of sustaining a brain injury?

Answer 1

Yes, playing judo introduces the risk of brain injury.

Judo is a contact sport. Competitive judo is a very contact sport. If you play rough and don't take ukemi properly, you risk concussion. The risk is not as great as in boxing or striking arts. The risk is manageable for nearly all trainees, especially people who don't compete at the elite levels or who compete recreationally.

The recommendations for doctors who treat head injuries are to be judicious in restraining athletes who want to return to training (or even competition!) too soon:

Neurosurgeons should take the initiative to prevent severe brain injury of young athletes through collaborations with the athletes themselves, fellow athletes, family members, coaches, teachers, athletic directors, and other physicians. They should pay close attention to headaches and other signs and symptoms of concussion and prohibit the athletes from returning to play until they are confirmed to be symptom free for recommended periods, insisting that safety comes first.

Answer 2

Based on this NYTimes article: The frequency of judo deaths in Japan gives 108 deaths since 1983. I will not paraphrase the article but other nationality report no deaths in the last decade or so. I am going to assume that those deaths were directly resulting from judo and not just happened while judo was going on.

Thus your risk of dying are increased if you practice judo. However, those are very rare events and you will most likely find that any sport as similar deaths/injuries. Some sport, I suspect, will have much higher risk.

The question on long term consequences of practising judo might be relevant as well.

Answer 3

According to the following paper, Injuries in judo: a systematic literature review including suggestions for prevention:

1. severe injuries in judo are rare, but when they do occur they are mostly to the brain and spine, mostly occur during throws (as opposed to chokes), and mostly occur due to 'bad falling'
2. repeatedly being thrown (as a competitive judoka) does not result in chronic brain injuries

1. Severe brain injuries in Judo

Severe injuries were quite rare and usually affected the brain and spine, whereas chronic injuries typically affected the finger joints, lower back and ears. The most common types of injuries in young judo athletes were contusions/abrasions, fractures and sprains/strains.

Severe injuries

The main locations of catastrophic injuries in judo are the brain and the cervical spine.

Kamitani et al³⁵ reported being thrown as the leading injury mechanism of severe head injuries (70%) among judo practitioners, who were mainly younger than 20 years (90%) and practicing judo for less than 3 years (60%).³⁵ The authors assumed lack of falling skills as the prominent cause for severe head injuries among inexperienced judokas.³⁵

Generally, choking in judo induces only subclinical electroencephalographic perturbations,⁵³ but could also lead to brain damage when the ‘choker’ maintains the pressure on the opponent's neck, with blood flow interruption lasting a sufficient time to be harmful to the central nervous system⁵⁴; in the worst case, this could lead to death.³⁴

In Japan, 26 judokas sustained a spinal cord injury during a 3-year period⁵⁵ and 19 a neck injury in 8 years.³⁵ Sixty-three per cent of neck injuries occurred while performing a throwing technique, for example, Uchi Mata.³⁵

Note that severe head/spine throwing injuries tend to be the result of single incidents (non-chronic), and that risk of injury is associated with lack of falling skills:

Injury causes

Being thrown seems to be the most frequent situation leading to judo injuries, comprising about 70% (range 42–90%) of cases,^{3 ,25} including also a few severe and catastrophic injuries^{34 ,35} (see online supplementary table S5). Additionally, it was indicated that the lack in falling skills is also associated with injuries,³⁶ including acute as well as chronic ones.^{3 ,34}

2. Effect of repeated throwing and choking

Chronic injuries

...

Rodriguez et al⁵⁸ found competitive active judokas having no chronic brain damage induced by the repetitive application of judo-specific throwing and choking techniques.

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Citations from review:

<sup>3. Epidemiology of injury in Olympic Sports. Oxford, UK: Wiley-Backwell, 2010:161–75.
25. Pediatric martial arts injuries presenting to emergency departments, United States 1990-2003. J Sci Med Sport 2007;10:219–26.
26. Causes and injuries during ippon-seoi-nage throw. Arch Budo 2011;7:17–19.
34. Deaths during the judo classes and activities conducted under the supervision of schools in Japan; from 1983 to 2009. All cases listed and analyzed. Aichi University of Education.
35. Catastrophic head and neck injuries in judo players in Japan from 2003 to 2010. Am J Sports Med 2013;41: 1915–21.
55. Sports-related spinal cord injury in Japan (from the nationwide spinal cord injury registry between 1990 and 1992). Spinal Cord 1996;34:416–21.
58. Long term effects of boxing & judo-choking on brain. Ital J Neurol Sci 1998;19:367–72.</sup>

Supplementary tables:

Answer 4

The All Japan Judo Federation basic instructor course is 2 days of lectures followed by essay questions (at least when I took it last year). There is an extensive section on head injuries, as almost all the deaths mentioned above were as a ressult of head trauma. Primarily multiple blows to the back of the head by unsupervised children, but also, rarely by abusive adult instructors. The biggest worry is secondary blows - you get a fairly strong strike without apparent serious injury or concussion, but folllowed by even a fairly light blow can cause a serious concussion.

In general judo is a very safe sport. In Japan you can get annual sports insurance for 14 year olds or under for less than US$10, adults for less than US$20, and those insurance companies have decades of data.

Answer 5

The highlighted concerns is

head first landings may potentially cause long term brain injury

Chronic traumatic encephalopathy (CTE)

Wikipedia give a general idea of CTE. It is a progressive degenerative disease found in people who have had a severe blow or repeated blows to the head. CTE has been most commonly found in professional athletes participating in American football, rugby, ice hockey, boxing, professional wrestling, stunt performing, bull riding, rodeo, and other contact sports who have experienced repeated concussions or other brain trauma. The primary symptoms of CTE are similar to dementia (memory loss, aggression, confusion and depression). CTE cases in NFL.

Here is the medical journal on CTE by Bennet Omalu.

Answer 6

I'm a sankyu in Judo and absolutely love the sport. I've been been doing it since I was 5 years old. However, I've seen a lot; I can tell you for sure in Judo there are a lot of undiagnosed concussions. I've probably had more than a few. Judo can possibly cause brain injuries in the long term. If it can cause physical ailments, it can cause neurological ailments also.