Most Common BJJ Injuries

Which BJJ Injury do you see the most in the clinic? This is a question that I’ve been asked many times. Hint: this photo is somewhat misleading.

Second hint: For those who were confused by the first hint, the most injured body part is not a kimura nor a displaced tongue.

So what is it? I am finally ready to answer this question!

For those of you who aren’t familiar with my background, I am a physiotherapist and BJJ (and formerly Muay Thai) practitioner who treats a large number of combat sports athletes, both recreational and competitive; amateur and professional. In fact, as of April 2020, I have treated over 200 athletes in our local combat sports community. This includes 178 BJJ athletes, 11 boxing athletes, 10 kickboxing (only) athletes, and 2 judo (only) athletes. The reason that I included “only” in brackets is because many of my BJJ clients actually also participate in kickboxing or judo as well, and a few are actually either amateur or professional MMA athletes.

Weird flex, I know, but this is actually a great sample size for a niche group, which is exciting in terms of research and statistics potential!

My instinctive response to the question has always been, “neck, then shoulder, then knee”. I decided to finally investigate so that I could provide an answer based on actual numbers.

(Please note that I did not use a formalized process to analyze my data; I simply made a list of injuries by body part, then cruised down the list of athletes and checked off boxes for the injuries that they have seen me for over the years. I also decided to focus on only the BJJ athletes for this investigation since they are 89% of my combat athlete caseload.)

What I discovered, among my sample size of 178 BJJ athletes and 343 injuries, is that my hypothesis was correct that the neck was by far the most frequently injured body part, with 71 of the 178 athletes having come to see me for a neck injury. The shoulder, as also predicted, was second, with 49 athletes having attended the clinic for shoulder pain. These were of no surprise to me because the neck and shoulder are often both used offensively (eg. driving pressure, posting, framing) while simultaneously always having to act defensively since the opponent is (or at least should be) usually trying to control the head and often attacking chokes/arms.

I did not officially analyze the specific mechanisms of injuries, but I have treated both body parts injured in a variety of ways. Based purely on recollection, I have found neck injuries to be occasionally from submissions (eg. guillotines), but more frequently from transitional movements (eg. shooting in for a double leg or pressure applied while inverted) or resistive forces (eg. head snaps, being sprawled on, opponent pushing the head away). The primary shoulder injuries (again, simply based on recollection) have been to the rotator cuff or AC joint, usually from kimura positions (both submissions and sweeps) and falls onto the shoulder, respectively.

However, surprisingly even to me, lumbar (low back) injuries was a very close third. In fact, the shoulder was only more prevalent by lumbar (low back) by one incidence of injury. The number of athletes who have seen me for shoulder issues is 49 and the number who have sought treatment for low back pain/injury is 48. Although I knew I had treated a number of lumbar injuries among BJJ athletes, I did not realize the prevalence of it, likely because the severity was not as high compared to some of the shoulder and knee injuries that I had recalled treating. Knee injuries came in at a close fourth with 45 athletes having seen me to help rehabilitate their knees. Contrary to what some of you may think, the knee injuries that I can recall have more frequently been from transitional movements (eg. having the guard passed, moving inside 50/50) than from heel hooks or knee bars.

Here is the chart of body parts injured and athletes affected, if you are interested!

Pretty cool, hey?

It was also interesting to see how this compares to other research already done on the topic. My findings of neck and shoulder being two of the main injuries were consistent with a fun study by Valleser involving 35 18 year-old (+/- 1.7 years) males who were all trying no gi BJJ for the first time for a 16 week study.

I called this a fun study because almost three dozen fresh white young white belts trying a new sport like BJJ together for four months sounds like the background for an interesting social experiment! A BJJ version of Lord of the Flies, perhaps? 

Anyway, already within that time, the neck and shoulder were the primary strains, comprising 6 of 13 reported injuries. However, this new group was actually most afflicted by mat burn, with 54 reported abrasions. I would love to know how many of these young lads are still training!

My findings were also consistent with a study done by Silva Jr. et al that surveyed 108 Brazilian BJJ athletes and found shoulder and knee to be the main injury locations in both novice and advanced athletes.

Moreover, Silva et al. delved further into the timing of the injuries, and found that the advanced athletes reported a higher injury rate during competition than during practise. Although I can say with certainty that most of the injuries I treated occurred during training and not competition, I did not differentiate between these injury sources in my caseload scan. However, I should because I believe that the results would certainly differ.

Based solely on my recollection of clinical cases, the main injuries that I have treated after BJJ competitions have been elbow injuries (typically from arm bars and Americanas), followed by ankle/foot injuries, typically from toeholds and foot locks.

 Third most commonly injured (or perhaps first, I admit I haven’t clarified), was likely the ego.

Jokes aside, consistent with my clinical experience treating tender joints after competitions are two large-scale studies on BJJ injuries from tournaments, both of which also reported the elbow to be a primary injured body part. Kreisworth et al. recorded injury prevalence among male BJJ athletes at the World Jiu-JItsu No Gi Championship in 2009 and found the elbow and knee to have the highest rate of injury at 12 incidences each, which calculates to each body part contributing 19.4% of the 62 injuries reported. Similarly, Scoggin et al. collected injury data from 8 BJJ tournaments in Hawaii between 2005 and 2011 and found the elbow to be the most commonly injured body part (14 out of 43 orthopedic injuries) with arm bar being the primary mechanism of injury.

It should be noted that heel hooks and knee bars were not permitted in the tournaments in Hawaii. Had these submissions been allowed, the results would perhaps be different, especially with an increasing trend towards lower limb submissions in recent years. I recall seeing results posted on Instagram by @schoolofgrappling from the ADCC 2019 North American trials that listed heel hooks to be as common of a submission as the rear naked choke, with 31 and 30 finishes of each, respectively. Times are changing!

In some contrast to all of the above, McDonald et al. surveyed 140 athletes across 166 BJJ gyms in the USA and found the most common injury locations to be the hand and fingers, followed by foot and toes, then arm and elbow, with knee injuries coming in a close fourth. Interestingly, McDonald et al. also categorized the injuries into medically diagnosed and non-medically diagnosed (ie. self-diagnosed). The most common medically diagnosed injury was found to be the knee, followed by foot and toes (actually, the most common medical diagnosis was skin infections, but orthopedically the most common was the knee). The most common non-medically diagnosed injuries were found to be to the hand and fingers, followed by the arm and elbow, then foot and toes.

Medically diagnosed vs. non-medically diagnosed is an interesting distinction that might explain why this study’s findings were different from the others as well as my own findings; the injuries in my chart are based on athletes coming to the clinic seeking diagnoses, advice, and treatment ( ie. medical). There is a strong likelihood that many of them have experienced finger or toe injuries that were not considered significant enough to seek treatment for.

I can attest to the likelihood of this simply based on the number of fingers and toes that I see taped in class and the avoidance of eye contact when I asked about these bandaged body parts...

The most intriguing part of this study to me is that of the 140 athletes surveyed, 20 reported having NO history of injury from the sport! ….yet, I say! I cannot decide whether I should find these people to discover their secrets, or hide them to keep my job (just jokes…not a stalker nor a kidnapper).

One more article to discuss today is a study of 126 BJJ athletes in Brazil by Barreto et al. This one differs slightly from the rest in that they evaluated the mechanisms of injury as opposed to the specific body parts injured. They found that injuries were more prevalent in training than in competition, which makes sense given that we spend significantly more of time training than competing. Barreto et al. also found that most injuries were caused by the opponents (probably those darn leg lockers), or as much more elegantly phrased in the translation: “injured by an adversary blow”. More specifically, approximately 69% of the injuries were the result of immobilizations and joint blocks, with the primary lesion found to be a ligament sprain.

The most impressive part of this study was the average BJJ training time: 11.01 +/- 1.74hours per week. Very impressive; very Brazilian! 

That concludes the comparison of my data versus some of the other data available in the world. I say “some” because the research is scant, but there is likely more than what I have found; I simply looked for relatively recent studies where I could access the entire article.

I must say that I now feel inspired to both delve further into my own database of injuries to collect more details and to collect more refined data in the future. It would be great to keep a record of which injuries happen more from competitions versus training (though I have an idea, it would be nice to have a concrete set of numbers); which injuries happen the most at which belt level; how many injuries happen from submissions versus takedowns versus falls; how many injuries happen when rolling with same-sized opponents versus smaller or larger; what would happen if we put 35 purple belts in a 16 week camp of a random sport? (there would definitely be no warm-up, obviously) or 35 black belts? (so much storytelling)... the questions are endless!

Also endless are the possibilities for using the data to help identify and create specific strategies for injury prevention!

Perhaps we need to include more targeted mobility in the warm-up, or perhaps demonstrating a proper break fall needs to be mandatory.

Perhaps we just need to eat more acai.

Hopefully I can one day publish the data or at least be able to share them with the global community in an influential academic fashion to help promote health and safety in the sport. In the meantime, I plan to continue collecting injury data from my combat sports athletes, and I will to the best of my ability continue to use the information to help promote health and injury prevention in the sport and community of BJJ! This will likely be in the form of prehab/injury prevention videos and programs.

Thank you SO MUCH for reading, hope you found the information as interesting as I did!

Oss.

References

Valleser, CWM. Common injuries of recreational jiu jitsu. Journal of Physical Education Research. 2016. 3(4). 52-63.

Silva Jr. JN, Kona RL, Dellagrana RA, Detanico, D. Injury prevalence in Brazilian jiu-jitsu athletes:comparison between different competitive levels. Rev Bras Cineantropom Hum 2018; 20(3): 280-289.

Kreiswirth, EM. Myer, GD. Rauh, MJ. Incidence of injury among male Brazilian jiu jitsu fighters at the world jiu-jitsu no-gi championship. Journal of Athletic Training 2014; 49(1): 89-94.

Scoggin III, JF. Brusovanik, G. IZuka, BH. van Rilland, ED. Geling, O. Tokumara, S. Assessment of injuries during Brazilian jiu-jitsu competition. The Orthopaedic Journal of Sports Medicine 2014; 2(2) 1-7.

Andy [@schoolofgrappling]. (2019, May 16). [2019 ADCC North American Trials]. Retrieved from https://www.instagram.com/p/Bxh2B1UCwn_/.

McDonald, AR. Murdock Jr., FA. McDonald, JA. Wolf, CJ. Prevalence of injuries during Brazilian jiu-jitsu training. Sports 2017. 5(39).

Barreto, AP. da Silva, WM. Santos, NVS. de Matos, DG. de Lima, DJL. Santos, CRR. Costa, EB. Silva, LP. de Vasconcelos, JL. Aidar, FJ. Evaluation of mechanisms and types of injuries in jiu-jitsu athletes. Journal of Exercise Physiology 2017. 20(2).10-14.