Part 1- BJJ Most Common Injuries Based on Different Competitive Levels

Article based on the study “Injury prevalence in Brazilian jiu-jitsu athletes: comparison between different competitive levels.” Original title in Portuguese: “ Prevalência de lesões em atletas de Brazilian jiu-jitsu: comparação entre diferentes níveis competitivos.

The purpose of this study was to identify body regions affected by injury, the environmental setting of occurrence, and the mechanism and severity of injuries in novice BJJ compared with advanced ones.

This study aimed to identify types and sites of body injury, the location of injury occurrence, and the mechanism and severity of injuries in novice and advanced Brazilian jiu-jitsu (BJJ) athletes. One hundred and eight BJJ athletes took part in this study separated into two groups: advanced (n = 53) and novice (n = 55). Athletes answered a questionnaire concerning regions of injury, locality of occurrence, injury severity, and mechanism. A chi-square test and a logistic regression analysis were used with the level of significance set at p < 0.05. The main results showed that shoulders and knees were the most injury location reported by novice and advanced athletes.

Brazilian jiu-jitsu's (BJJ) primary goal is to apply strangleholds and joint keys (e.g., wrist, elbow, knee, and ankle locks) to force an opponent into submission and loss of the match(2). While BJJ athletes begin combat in the standing position, most of the combat eventually ends up taking place during groundwork.

Novice athletes demonstrated a higher prevalence of injuries during training sessions (54.5%), whereas advanced athletes reported more injuries during competitions (66.1%). Significant associations between novice and advanced athletes were observed for major joints (p < 0.05). The odds ratio of having injury was 70-87% less for novice versus advanced athletes for the major joints cited. We concluded that BJJ athletes demonstrate a high prevalence of injury mainly at the knee and shoulder. While the risk of injury appeared less in novices, the advanced demonstrated a higher number of injuries during competitions as a consequence of injured joint keys. By contrast, novice athletes reported a higher number of injuries associated with training sessions as a consequence of overuse.

A common characteristic of BJJ is intermittent combat(3,4) (e.g., typical matches consist of high-intensity intermittent efforts, demonstrating effort: pause ratios from 6:1 to 13:1 and effort periods of 85–290 seconds and pauses of 5–44 seconds(5-7). Because of the high intensity of matches, body strain imposed by an opponent during application of key techniques, and rapid body falls and shocks the BJJ athlete is continually exposed to increased risk for injury throughout training sessions and competitions. A recent study reported the rate of incidence associated with joint injuries is 24.9 per 1000 BJJ athlete exposures during an official BJJ tournament8.

For example, elbows and knees followed by ankles are the most commonly injured joints in BJJ athletes(8,9). While the rate of injury has been reported as more common during training sessions compared with competitions in other combat sports such as karate, judo(10), wrestling(11) boxing(12), and taekwondo(13), differences in the rate of injury incidence during training sessions compared with competition have not been explored in BJJ athletes.

Tournaments featuring BJJ consist of a spectrum of competition levels, including amateur, professional, novice, and/or advanced athletes. Supporting evidence suggests BJJ athlete experience (e.g., from purple to black belts) directly relates to higher levels of muscle power in lower limbs and handgrip strength compared with novice athletes (e.g., white and blue belts) (14). By contrast, any association between the level of BJJ experience and the rate of injury is still unclear. A single study recently reported that during an official BJJ competition, experienced athletes demonstrated a higher risk of injuries compared with less experienced athletes8.

Increased understanding of injury prevalence associated with BJJ may aid coaches and physical trainers in identifying important information about types and locations of common body injuries, mechanisms of prevalence (e.g., joint keys, overuse, etc.), and environmental setting where injuries occur (i.e., competition versus training sessions). Preventative care strategies tailored for each level of BJJ experience may also be devised based on an improved understanding of the rate of injury incidence.

Therefore, this study aimed to identify the different types of body injuries associated with BJJ, the environmental setting of the highest injury incidence, and the underlying mechanisms and severity of injuries in novice compared with advanced athletes. We hypothesized, 1) elbows and knees will be the most injured joints for both novice and advanced athletes(8,9), and 2) compared with novice athletes, advanced athletes will demonstrate a higher rate of injury(8).

Participants

The study sample consisted of adult BJJ athletes (N=260) who had participated in two national tournaments that occurred in Florianópolis (Santa Catarina, Brazil) from July to December 2016. The body injury-based questionnaire used to test the aims of this study was sent to all athletes, but only 108 responses were returned (41%). The necessary sample size, performed post hoc (sample error of 5% and confidence interval of 90%), showed 133 athletes would be considered as representative of the population, which is similar to what was demonstrated in this study.

The participants were divided into two groups according to the graduation level (belt color): 1) novice athletes – white and blue belt (n = 55, age 25.64 ± 6.31 years, height 176.6 ± 6.24 cm, body mass 82.83 ± 13.50 kg and time of practice 3.67 ± 2.27 years); and 2) advanced athletes – from purple to black belt (n = 53, age 31.0 ± 6.51 years, height 178.6 ± 6.19 cm, body mass 82.83 ± 8.35 kg and time of practice de 10.0 ± 5.59 years).

This criterion of belt graduation was previously used by Del Vecchio et al5. Time of experience was also considered and it was significantly higher in advanced athletes compared to novice athletes (p < 0.01). All participants had already participated in several national and state BJJ tournaments. They had been training (technical and tactical training) 4–5 days per week, with training each session on average lasting 2 hours. Ethical approval was obtained from the local Human Research Ethics Committee (protocol number: 119.014). All aspects of this protocol were written in accordance with standards set by the Declaration of Helsinki.

Procedures and measures

A questionnaire adapted from Santos et al. (15) consisting of ten questions including athlete identification (e.g., age, body mass, height, belt color, years of experience in BJJ, and frequency of training) and injuries history (e.g., injury location, place of injury occurrence, mechanism of injury, and injury severity). Prior to answering the questionnaire, athletes were given an explanation of the procedures and objectives of the research. Questionnaires were filled out under the supervision of a researcher.

For injury location, specific joints including shoulder, elbow, handle, hip, knee, ankle, and hand fingers were considered. Athletes were also asked to report if the last injury occurred in training or competition as well as what was the injury mechanism (e.g., excess of training, falls, joint keys, or others). The degree of injury severity identification was described according to the international injury registry severity scale(16). This scale takes into account training time missed due to injury as a classification of severity as follows: light (with no time lost training), light to moderate (one to two days), moderate (two weeks), moderate to severe (two to four weeks), or severe (four weeks). A similar instrument has been used in previous studies of BJJ athletes(8,9,16,17).

Statistical analyses

Data were reported as mean, standard deviation, and relative frequency. Chi-square tests were used to assess associations between injury location (shoulder, elbow, handle, hip, knee, ankle, and hand fingers) and places of injury occurrence (training and competition) with regard to differences between novice and advanced athletes. Logistic regression was used to examine if injury location and occurrence were associated with competitive level (i.e., novice or advanced). All statistical analyses were performed using IBM SPSS Statistics for Windows, version 21.0 (IBM Corp, Armonk, NY, USA) software. To determine significance, the alpha level was set at p < 0.05.

Results

All participants in this study had previous injury histories associated with BJJ practice. Shoulders and knees were the most common injury location in novice (shoulder = 50% and knee = 50%) and advanced athletes (shoulder = 77.4% and knee = 81.1%). Advanced athletes also demonstrated injury to ankles (67.9%) and fingers (60.3%). Significant associations between novice and advanced athletes were observed for shoulder, elbow, knee, ankle, and hand fingers (p < 0.05). Additionally, novice athletes demonstrated higher injury prevalence during training sessions (54.5%), whereas advanced athletes demonstrated more injuries during competitions (66.1%) (Table 1).

With regards to experience level (novice and advanced), logistic regression demonstrated the odds ratio of having injury in the shoulder, elbow, knee, ankle, and hand fingers were 71, 77, 77, 87, and 70%, respectively, lesser for novice compared with advanced athletes. Novice athletes demonstrated an odds ratio of training session injury approximately twice that of advanced athletes. By contrast, the odds ratio associated with injury during competitions was 58% less for novices compared with advanced athletes (Table 2).

The main injury mechanism in novice athletes was overuse (excess of training) (66%), which was followed by joint keys (29%), falls (27%), and other (18%, sprains and beats). In contrast, the main injury mechanism in advanced athletes was joint keys (75%) followed by overuse (47%), falls (26%), and other (39%, sprains and beats) (Figure 1).

Novice athletes demonstrated more severe (35%) and light injuries (33%), whereas advanced athletes showed more moderate to severe (31%) and severe injuries (49%) (Figure 2).

End of Part 1

Authors:

Jorge Nelson da Silva Junior

Rafael Lima Kons

Rodolfo André Dellagrana

Daniele Detanico

Original Study: https://periodicos.ufsc.br/index.php/rbcdh/article/view/1980-0037.2018v20n3p280