At last excellence in a karate magazine

[Victor Smith]

Wow, almost a lifetime following the magazines and finally a truly good article. In the current issue of J.A.M.A, (Journal or Asian Martial Arts) vol 18 no. 3 2009, there is an article "The Carotid Choke: To Sleep, Perchance to Die?", by Marc Bowe M.D. and Lee Wedlake.

The article goes back and forth on the medical implications of the Carotid Choke, and the martial presentation how to execute it. It sxplains the underlying mechanism of the choke(s) involved, the risks attendant and the likelihood behind them, and presents several different ways to affect those chokes (though not every approach). Very balanced IMO. It runs 20.

It parallels discussions I had with Dr. Harper, M.D. FACS 15 years ago.

As this group has an excellent leader such as Glasheen Sensei and others with strong medical credentials, I'd be interested in their view of the article.

thank you,

[Bill Glasheen]

Hello, Victor!

First... I agree with JAMA being one of the finer martial arts magazines. My only beef is that it panders way too much to the tai chi crowd. But I guess that's where the intellectuals are, so... whatareyagonna do, eh?

As for the "carotid choke", well... My first inclination is to say that's an oxymoron. The proper terminology is lateral vascular neck restraint. The vernacular is blood choke, and the judo terminology is shime waza (constriction technique).

The primary mechanism is NOT to restrict blood flow TO the brain (via carotid occlusion) but instead to restrict blood flow FROM the brain (via jugular occlusion). Either way, the goal is cerebral ischemia, which leads to loss of consciousness. The way to demonstrate the primary mechanism is to do the technique on a fair-skinned individual and note how the face turns beet red rather than ashen.

But like most things, it's often more complicated than a very simple mechanism. This is particularly true of this technique as there is also the issue of the mindset of the victim, direct and indirect stimulation of the carotid sinuses, etc.

I will read the article and let you know what I think. In the mean time, thanks for the heads up.

- Bill

[mikemurphy]

Victor and Bill,

As I haven't read the article, the title seems to imply what I've been telling people for a long time and what I teach my students. All of the Shime Waza (choking techniques) we do in Nihon Jujitsu deal with the carotid (just depends on how I'm holding the person). However, in working with Shiyuza Sato Sensei (10 dan Jujitsu, 9th dan Judo), he's the first to tell his students that once you knock the person out, it's not a definate that you can bring him back. I know he's not a medical person, but for a person of his pedigree and lineage, you have to respect his openess when the world of Judo, MMA, and other competitions accept it as legal techniques.

mike

[IJ]

I'm not going to advocate that we go around knocking each other out with blood chokes, but I think it's a stretch to say it's not certain you can bring the guy back. That's true, on some level. I mean, punch someone in the chest and their heart may stop forever because of an R on T phenomenon. But is that a serious risk, enough that we should stop allowing all contact to the body, in karate, football, lacrosse, etc? Or at least with children/adolescents, whose rib cages allow more transfer of energy to the heart? Let's just say I haven't heard of that movement.

When you do a blood choke someone fails to get enough blood to the brain for long enough that consciousness fails. We're talking 6-8 seconds here usually. Meanwhile, almost nothing happens to the heart (there may be some vagal effect because of pressure on the carotid bodies in the major arteries). The heart keeps beating, blood keeps pumping, etc. When the choke is released flow resumes and people usually way right up--we see this all the time in MMA, and the longer the choke is held (say, the person isn't recognized as out immediately) the longer it takes. But they usually come around about as fast as the KO victims, right?

Meanwhile, it takes MINUTES to actually injure neurons with ischemia. They say 4-6 minutes without blood, right? 6-8 seconds? The heart is arrested far longer than that getting a transplant harvested, never mind the transport, implantation, and restart process there, and that goes really really well, admittedly under different circumstances (eg, with a heart surgeon and anesthesiologist present, but then, they've got to shock the thing back to life, too). What about a seizure? We get really worried when they go on for > 5 minutes because that means insufficient flow to meet needs may occur if we can't stop the event. A seizure for 8 seconds is a serious yawner.

I think the way people would get into trouble is if they dislodged plaque from neck arteries and this floated north causing a stroke. That can happen with any neck contact, choke not required. Otherwise its very hard to imagine a death occurring from a blood choke that's stopped shortly after it KO's someone. What would the mechanism be? Unlike with the heart, which is transplanted silent, nonbeating, usually cold, the brain cells are unable to carry out the symphony of consciousness but they're ok. Imagine occluding the axillary artery so your arm goes numb in 6-8 seconds. You release it 3 seconds later. You think those nerve cells are gonna die and your arm will be numb and paralyzed forever? Hardly.

Again, because we're talking about brains/people here, I'm not recommending you complete your chokes because everyone might die!!!

[Bill Glasheen]

You folks may be familiar with this classic article.

Deaths Allegedly Caused by the Use of "Choke Holds" (Shime-Waza)
E. Karl Koiwai, M.D.

ABSTRACT: Shime-waza or the "choke hold," when property applied, should not cause death; therefore, its primary purpose should be to subdue violent suspects. When properly applied, the choke hold causes unconsciousness in 10-20 seconds. No fatalities as a result of shime-waza have been reported in the sport of judo since its inception in 1882. Among the methods of "control holds" taught to law enforcement officers is the choke hold similar or identical to shime-waza used in judo. Using the choke hold, officers may afford themselves maximum safety while subjecting the suspect to a minimum possibility of injury. The author has reviewed 14 fatalities with autopsy findings where death was allegedly caused by the use of choke holds.

The rest of the article can be found here

Bottom line is that you don't find deaths from shime waza in judo. Juxtapose that to a rare but known phenomenon called commotio cordis in contact sports where death can and has occurred from blows to the chest (particularly in kids).

Shime waza is an entirely different phenomenon in the field where you have hacks who may apply the technique badly against people not necessarily in the best of health and sometimes drugged or intoxicated. Things can happen.

- Bill

[Halford]

But then, they did publish MARTIAL MUSINGS by R. W. Smith, but Mike DeMarco does a great job. He founded the journal and then sold it and is now back running it. I also like CLASSICAL FIGHTING ARTS which used to be DRAGON TIMES. For another take on carotids, read Michael Janich's article in TACTICAL KNIVES, latest issue, in the column,STREET SMARTS in which he makes an attempt to 'debunk' Fairbairn's TIME TABLE OF DEATH and after ou read this please make some comments on it. I tried to start a discussion on FACEBOOK but so far, no takers,despite the martiala rtists and knife fighters there.

[IJ]

"Tachycardia hypertension, and mydriasis (dilated pupils) are caused by stimulation of the sympathetic nervous system (vagus nerve). The systemic pressure rises 30-40 mm of Hg. After release the blood pressure returns to normal in 3-4 minutes."

Hmmm, the vagus delivers the output of the parasympathetic nervous system and causes bradycardia, vasodilation, hypotension, and smaller pupils. But other than that the article is decent. Interesting that references were excluded for space. The internet is full!

Common themes here are: poor health, intoxication, violent struggles, aspiration of vomitus, and eventually cardiac arrest. As before, the heart doesn't really know if the brain isn't getting blood flow. Cessation of blood flow is used to confirmed brain death; hearts beat happily not for seconds but for hours to days as organ harvesting is planned. However, people who are struggling can become acidotic due to buildup of lactate, and CO2, especially if an AIR choke is in place, and their violent / drugged state enhances this. Acidity especially if paired with hypoxia (altered mentation, face down in police car, aspiration) leads to cardiac irritability and erratic, poorly conducted extra beats and eventually or suddenly, a fatal rhythm such as ventricular tachycardia or fibrillation (VT/VF).

Details are lacking here in a truncated article based on reports about fights with the police (eg, ECG doesn't show "cardiac arrest," that's what the ECG was done for. They show sinus rhythm, atrial arrythmias, VT/VF, asystole, etc.

Time to follow Chris Rock's advice!