Heads Up!

Sports are finally waking up to the long-term effects of concussions.  Judo is no exception.  The United States Judo Association, for example, has prominently displayed on its website an online course entitled Heads Up!.  This course is the work of the U.S. Center of Disease Control, which tells us how important this issue is.

I took the course, and completed it in 45 minutes.  While it’s informative and addresses how to recognize the signs of a concussion, it isn’t sport-specific enough to tackle what we must do to minimize the potential for concussions.

Contrary to what we might think, ukemi and kuzushi are not always the problem in Judo, nor do they solve all our problems.  When it comes to head injuries, we can focus on proper pairing of training partners, training methods, and age-appropriate techniques, but the real elephant in the room is this: the landing surface!  Thin puzzle mats, hard wrestling mats, folding gymnastic mats that separate, even good foam tatami…laid down on a concert floor…this is Judo’s greatest risk for injury, and where our first preventive measure against all injuries needs to be.

If our insurance carrier had any idea of what goes on in Judo clubs, and how injuries can be minimized, it would require spring-loaded platforms, rather than some nebulous course on concussions.  Our Judo organizations should develop “position statements” that encourage clubs to install spring-loaded platforms when possible.  Platforms are “forgiving,” and help clubs retain members, minimize injuries, and train more efficiently.  They are a win-win proposition for everyone involved in Judo

Our next red flag is not ukemi, but with the way ukemi is taught traditionally.  I’m referring to the solo “mat bashing” method.  The problem with solo practice is that tori has a vote in how uke will fall, no matter how many trillions of solo mat bashing repetitions he does.  Tori’s speed, technical accuracy, angle of attack, follow through, sidedness, grips and technical variation all affect uke’s landing.  There’s a huge difference between a solo back fall and a back fall via O soto gari, or between a zempo kaiten and being slammed with a drop Seoi nage.  Therefore, ukemi training should be done in conjunction with many different Judo techniques, starting in low positions, i.e. squatting or kneeling, before moving to a standing position.  There, the use of a forgiving crash pad while learning ukemi will further make the practice more realistic and safer.  By the way, according to statistics provided to me by a Japanese colleague, O soto gari caused the most head injuries among junior high school students early in the season, in spite of the thousands of back falls they performed.

The strength of the neck and its range of motion are often an afterthought when it comes to injury prevention.  How often are we told in our coaching education and within the “fitness industry” that neck bridges are contraindicated, and just plain bad for us?  Dr. Hiroshi Takei, a Judo coach and orthopedic surgeon specializing in the spine, scoffs at the idea that front and back neck bridges are bad for you.

Unfamiliarity with a technique can also cause injuries.  Here, we need to differentiate between the techniques we want our players to perform, and the techniques we want our players to be able to recognize so they’ll know how to defend against or take a fall.  My players are not allowed to perform drop seoi nage, but they recognize the skill because I perform it on them in randori, and they practice turnouts or proper ukemi from the drop position.

We should ask ourselves if what we teach is age- or skill-appropriate for our membership.  A 13-year old with three years experience in Judo should be capable of learning and performing Uchi mata.  Would a 13-year with little experience in Judo be in the same boat?  Would he have the required leg strength and balance to execute an injury-free Uchi mata?  Or would this lead to a head injury for him or uke?  According to statistics compiled in Japan, among self-inflicted injuries that caused paralysis, Uchi mata was responsible nearly 60% of the time.

Finally, some common sense mat management procedures need to be adhered to.  Manage the number of  players on the mat or actively involved in practice based on what they are practicing.  Tomoe nage takes up more space than Ippon seoi nage.  By grouping the students by threes instead of pairing them up, fewer people are throwing at the same time.  Also, it’s a good idea to have all your players throw in the same direction on the mat, either north-south or east-west.  When it’s time for randori, further limit the number of players on the mat.  Using weight is a good way to keep the training area safe.  For example, first up, players under 85lb.  Next round, players over 85lb, etc.

Organize your mat space by putting the heaviest players the farthest away from the lightest players.  Know which players can work safely with others, while still paying attention to size, age, sex and skill differences.  It’s more than OK to minimize what each player can do with another for safety reasons.  For example, 8-year old Ralph loves to do O soto gari, but you have him doing randori with a child with two weeks of Judo.  Ralph has been taught how to take care of junior and younger partners.  Still, you may want to tell Ralph to knock off the O soto gari, and try something more appropriate and safer for his training partner.

Here are some additional statistics from Dr. Takei.  While they deal with paralysis, they also have a strong connection to concussion rates.   When paralysis was caused by a partner, drop seoi was the main culprit 44% of the time.  Paralysis occurred 58% in shiai, 37% in randori, and 5% in uchi komi/nage komi.

In conclusion, take Heads Up!, the CDC’s online course.  Recognizing the signs of head injuries is important.  And do pay attention to the Judo-specific preventive measures listed below.

Preventive Measures

  • Spring-loaded platform
  • Crash pads
  • Little or no solo mat bashing
  • Partner-assisted ukemi training
  • Use a variety of throws to learn ukemi
  • Strengthen the neck
  • Minimize unfamiliarity of techniques
  • Age- and skill level-appropriate learning
  • Pay attention to your mat management

10 thoughts on “Heads Up!

  1. Coach Lafon great info I will take the on line course. As you know Sensei Huntley has gotten me involved in “medical Judo” at the dojo and at tournaments. I agree with the training surface issue and would emphasize that we really don’t need a “spring floor” but rather a surface which compresses we when load is applied. We do ‘t need a reverberation or so called contracoup effect after the first impact.
    Also this would reduce the number of concussion assessment at the tournament center which in my experience slows down the tournament and I fact does achieve its goal reay as concussion is a neurophysiological event in evolution over time.
    Most interesting, would love to discuss further with you have some engineering ideas for an under surface for our ayers.

  2. “…but rather a surface which compresses we when load is applied. We do ‘t need a reverberation or so called contracoup effect after the first impact.”

    OK, I’m game for hearing you out.

  3. I have become concerned regarding two issues pertaining to injuries to judo players. My experience at tournaments has been that the competition becomes quite spirited and one player in the spirit of competition fails to perform a safe ukemi and live to fight another match instead and uncontrolled contact onto the mat and a concussion to recover from. For the most part we practice and train in a controlled environment often with less shall we say enthusiasm and “first do no harm”. A compressive surface like sprung floor in from compressor hose for example would permit some absorption of the initial impact of the body hence then less as the head and neck gets levered down on to the mats. Secondly due to legal apprehension a number of neck strengthening exercises have become “contraindicated” with the result being doing no exercises to strengthen the neck muscles to prevent or counteract the forces transferred from the body to the neck to the head. Are we contributing to our juniors and juveniles concussions by avoiding neck strengthening exercises due to liability fears? Given the greater weight to strength ratio of the head and neck in children and juniors perhaps we are predisposing them to concussion suseptability. Also the greater water to brain parenchyma in juniors and children means that the first impact gets transferred to the opposite side of the skull where the brain hits the rigid skull again! I wonder if we return to neck strengthening exercises, good choice of ukemi and all training surfaces suspended or better cushioned we would see a reduction in concussion assessment and concussions in general?
    What do you think?
    J Cleland MD

  4. I forgot something! If a period of unconsciousness in not a requisite for concussion, but if unconsciousness did occur then a concussion did occur what about a strangle where the player is out and needs resuscitation or kappo is this also a concussion?
    J Cleland

  5. I agree with your suggestion to return to the “contraindicated” neck strengthening exercises. Wrestling seems to manage neck injuries much better than we do. Their bridging and head rolls in competition are very dynamic and forceful, yet it doesn’t appear that the sport needs or wants to ban such neck bridging acts in competition, unlike the IJF. Of course, wrestling uses neck strengthening exercises extensively in practice.

  6. I conferred with Gary Berliner, a medical doctor and an international referee. This is what he says:

    “The rule in the US, is any junior player U-17 rendered unconscious by Shime-waza is out of the tournament. This is to encourage submission before unconsciousness, as it looks bad for children to do the ‘funky chicken” as their body revives. There is however, a big difference between a Concussion, and Shime-waza.

    In a Concussion, the Brain, which floats within the Calvarium (the skull), is contused, and bruised by an impact which causes the floating gray and white matter, to rock back and strike the opposite inner skull wall (Coupe, Contra-coupe). Sometimes there is a double Concussion, where the sloshing brain, impacts the opposite Calvarium wall, then, is contused in the front as well as the back of the impact site.

    Depending on the force of impact, and the area of the brain suffering the contusion, the player may, or may not, be rendered unconscious, and may, or may not, have a variety of neurological sequelae as a consequence, most often those sequelae are : confusion, in-coordination, visual changes (blurriness, or field losses), and antero-grade or retro-grade amnesia. Intra-cranial bleeding or hemorrhage, either in the sub-arachnoid tissue, epidura, dura-matter, or within the brain itself, from burst blood vessels, as a result of the bruising, or shearing from the angle of impact in the Concussion, can also be a consequence. While the degree of bruising and bleeding is most often slight, and quickly stopped, then reabsorbed by the body; it may continue bleeding, either slowly over 72 hours, or more rapidly, to create a mass effect which can be life threatening.

    All individuals suffering such head contusion in Judo, should be assessed for signs of Concussion. The Initial assessment, and Observation in the first 12 hours, is key to concussion safety. A brain CT if there is any progression of symptoms, prolonged unconsciousness, or confusion, or if the individual becomes obtunded and poorly responsive, is an absolute must.

    The general safety rules guiding sport participation following a Concussion should be :
    Grade 1 concussion, no contact sports for 1 week. A second Grade 1 or a Grade 2 concussion, no contact sports for 1 month. A second Grade 2 or a Grade 3 concussion, no contact sports for 6 months.

    In Shime-waza however, there is no concussive brain injury. Unconsciousness is a result of one, or a combination, of three mechanisms :

    Direct bilateral Vaso-vegal stimulation :
    where unconsciousness occurs in less than 1.8 seconds.

    A Carotid block which restricts blood & glucose to the brain : unconsciousness occurs usually in about 8 -20 seconds.

    A Tracheal block with asphyxiation, which restricts oxygen exchange, and builds up C02 in the circulating blood, creating metabolic alkylosis and rendering unconsciousness in more than 40 seconds…

    The shaking which occurs as the unconscious player revives is not a seizure, it is the brain jump-starting consciousness, but the jerking can be disturbing.

    However, strangling is not without potential consequence. Bleeding can occur in the brain from momentary increases in blood pressure, during the constriction of the neck, which causes small blood vessels to burst, most often in the sclera of the eyes, but can be within the brain as well. This bleeding is usually seen only in susceptible individuals, with thin vessel walls, or who are on blood thinners like aspirin, and is not usually accompanied by more dangerous shear forces. So most often the bleeding is light, rapidly stopped and reabsorbed by the body, and leaves no mass effect or lasting damage, although the eyes may remain ‘red’ for a few days, or a burst vessel may show a red patch on the eyeball for up to a week.
    More seriously though, a rare occult (unknown) internal brain vessel malformation, may burst, causing massive bleeding and a hemorrhagic stroke. Also, especially in the elderly, a piece of plaque may break off the arterial wall in the neck and produce an embolic, or thrombo-embolic stroke.

    Other consequences of strangling may also occur due to underlying illnesses of the player :
    Vegus Nerve stimulation may produce a cardiac dysrhythmia (irregular heartbeat) which can be life threatening in itself, or can also cause a small blood clot to form in the back wash within the heart, which may then proceed to the eye or brain and produce a stroke.
    True seizures can also be induced in susceptible individuals with low low seizure thresholds, either by Vegus Nerve stimulation, or by restriction of brain glucose, or by metabolic stress from increased blood CO2 levels.
    Tracheal cartilage rings, and the hyoid bone in the neck, may be injured by improper application of a strangle, or by application of a strangle in children (usually under 12) whose elastic bony structures in the neck are more vulnerable to damage. This may then result in direct airway obstruction, or subsequent swelling, with resultant airway constriction. Either circumstance can cause asphyxia, and death.
    Anoxia (lack of oxygen), and brain damage may occur when a strangle is allowed to persist for too long a period, either by an inattentive coach, or applying player, in the Dojo, or by a referee in a match.

    Unconsciousness as a result of Shime-waza should be assessed. Junior players should rest for 24 hours due to systemic safety concerns with the exercise of good judgement during training. However, this transient, Vaso-vegal, Carotid, or Tracheal induced unconsciousness, does not usually require a physical down period before resuming the playing of contact sports, unless there are ongoing symptoms, in which case a brain scan (CT or MRI) may be necessary.

  7. This is very useful information. Not every one is aware or take the matter seriously about the potential dangers of long term effects of concussions.

  8. As an Occupational Therapyst with 25yrs experience in medico-legal work, I would like to say Great points except for 3 things
    1. Solo Ukemi allows the individual to control the timing of movements as they develop the coordination needed, so is needed until this is mastered. Use of throws from kneeling, crash mats, slow motion throws etc… is a way if gradiually working up to full speed throws
    2. As eluded to, the level exercises should match the level of the student and be graded to gradually increase demand. Neck strengthening can be developed through a sequence of exercises such as holding the head up in ukemi and prone extension drills.
    3. The Biggest white elephant of all is the level of education and professionalism of coaches in our sport – the single biggest factor that determines what happens on the mat. Many people in Australia at least think that “keeping judo cheap” is a good thing when all that does is lower the ability to buy quality equipment and lower the standard of professionalism of the average coach.

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