Chokes In Grapplıng And Mıxed Martıal Arts: Types, Mechanısms Of Actıon, Consequenses And Management. A Systematıc Revıew

Abstract

Chokes constitute a fundamental component in certain hand-to-hand combat systems. From a medical standpoint, most correspond to vascular strangulations, whose primary mechanism is external compression of the carotid arteries, resulting in transient reduction of cerebral perfusion pressure and loss of consciousness generally within a few seconds. Unlike striking sports, in which injury occurs through direct mechanical trauma with a well-established association with concussion and chronic traumatic encephalopathy (CTE), strangulations act through reversible hemodynamic alteration and, to date, have not demonstrated a consistent link with CTE.Studies in high-performance grapplers demonstrate neurophysiological adaptations, including increased baseline cerebral blood flow and preserved cognition, suggesting a possible phenomenon of ischemic preconditioning. However, although generally safe in supervised sporting environments, strangulations are not without risk. Cervical artery dissections, ischemic strokes, and structural laryngeal injuries have been documented, particularly in improperly applied or prolonged maneuvers.Early recognition of warning symptoms -focal neurological deficits, severe headache, dysphonia, dysphagia, or dyspnea- is crucial, and neck CT angiography is the diagnostic study of choice when vascular or structural injury is suspected. Understanding the physiology, risks, and differences compared with impact-related trauma is essential to optimize safety, clinical practice, and decision-making in grappling sports.