Jiu jitsu and "the choking game" - so just how safe is it to be choked unconscious?

I recently watched an alarmist news clip about "the choking game," a trend among adolescents in which they choke each other to the point of unconsciousness in order to get a good-kid, drug-free high.  

I wasn't able to find the clip of the specific news program I watched, but a Google search of "the choking game" pointed me toward dozens of similar news shows. Here is one conveying a similar message to the one I watched:

 abc news "The Choking Game."

Here's the gist of what's been happening: Kids are choking each other out in order to experience a "good kid" high. And their parents are flipping out. 

According to the DB Foundation, an organization dedicated to education about the risks of the choking game, "the object of the 'game' is asphyxiation, as in, to apply pressure restricting oxygen and/or blood flow to the brain. This is accomplished through several methods. Diminishing oxygen to the brain produces a sensation or 'high' and the beginning of permanent cell death. When the victim is rendered unconscious, the pressure is released and the secondary 'high' of the oxygen/blood rushing to the brain is achieved. If the victim is alone upon unconsciousness there is no one to release the pressure and the victim's own body weight continues to tighten the ligature usually resulting in death."

When kids play this game in a group, they release the choke when the person goes unconscious, just as we do in jiu jitsu. When they play alone, however, they basically hang themselves. Tragically but not surprisingly, deaths are occurring in the later scenario. According to the DB Foundation, it is impossible to know just how many deaths result from the "choking game" because these deaths are often ruled as suicide. Obviously, the risks are quite different whether this game is played solo vs. in a group, but they are being lumped together as singular, deadly activity.

In jiu jitsu, we play our own "choking game." Being choked out happens all the time and we take it pretty lightly. Sometimes we fight a choke a little too long or sometimes a choke happens so fast that we don't have time to tap. Some people even allow themselves to be choked unconscious out of pure curiosity. Andrew Smith, a BJJ black belt instructor, competitor, and tournament ref, says that "being choked out at a BJJ or judo competition is certainly nothing unusual, although it might only happen on average once per hundred matches or so." He describes his own first experience being choked unconscious.  "[My training partner, Trey] caught me with a tight cross choke from half guard bottom," he recalls. " I distinctly remember thinking that it was virtually impossible to choke someone out from half guard bottom, and then I remember Trey asking me if I was okay.  I wondered why he was in my living room." 

As to what happens when people wake up? "It's common...to wake up and continue trying to grapple or fight," Andrew says. "I think the longest anyone stayed out under any of the above circumstances was 4 or 5 seconds and that felt like an eternity. Most awoke in about 3 seconds."  

No big deal, right? But it has me thinking -  just how safe IS it to be choked? I asked Jason Goldsmith, a pharmacology Ph.D. who is finishing his MD and also runs a martial arts school. "Any strong choke (that can generate a tap), has roughly the same risk whether it makes someone go unconscious or not," he says. "The big risk is causing a stroke, from a cholesterol plaque being dislodged from your carotid artery and wedging itself in your brain." He refers to this as a caratoid embolism leading to an ischemic stroke. "This is a "normal" mechanism of stroke," he continues. "It occurs outside of grappling. With chokes there is some very small increase in risk of this occurring...as for going unconscious there is no added risk from that, unless someone holds the choke for 30+ seconds after they pass out. Then you worry about brain damage."


I sought out a second opinion from Michell Gall, a Ph.D. in virology, former EMT, and Judo instructor of 30 years. "When you are doing a Judo choke,"  she confirms, "what you're doing is cutting off the supply of blood to the brain. This also cuts off the supply of oxygen to the brain, so what you're doing is technically hypoxia. It's very quickly reversible, just let go of the choke and get the blood flowing again, and it shouldn't lead to any tissue damage. Maybe you lose a brain cell or two, but, I mean, so what, I think we lose more off of the throws." 
 
Blood chokes are pretty safe, then. But what about wind chokes, like guillotines? "As for wind chokes," Jason says, "not really a difference. You mash around on the neck, which is the stroke risk. It's super hard to crush a trachea."

Here, Michelle has a different opinion. "Now, there's a difference between shime waza, which is a strangle, and a choke, which goes against the windpipe." She argues that a wind choke "doesn't knock somebody out as quickly, but has a worse chance of actually doing damage, because you're pressing on that bone that's supposed to be protecting your airway." She argues that you are in more "danger of damaging the throat or windpipe than you are of knocking someone out and inducing hypoxia that way." 

I also wondered about the so-called seizures, as ABC news described them. What does it mean when a body starts twitching after it goes out? Michelle answers, "those are convulsions, not related to a seizure in terms of epilepsy. It is an emergency response on the part of the body to try to stop whatever is causing the hypoxia. The term seizure can be misleading, because what you're seeing - foot twitches or shaking after going out - isn't caused by a brain synaptic overload, like an epileptic seizure."

  

Choking each other on the mats, it seems, carries a minimal risk.  There is a slight risk of death from stroke or damage to the trachea, but there is probably a greater risk of death from a car accident while driving to the gym. 

So what about kids? Playing the "choking game" solo is disastrous, for obvious reasons. But what about in a group? Is it safe for kids to choke each other out, BJJ style?

Michelle says no. "In KIDS, the developing brain needs more oxygen because it's growing. So, YES, it's stupid for people under 13 to be choking each other, because the first brain cells that are going to get affected when you get choked out, just like when you drink alcohol, are those ones that are still growing. And those last ones to develop are those really important ones right at the front of your brain that let you do decision-making."

While I am relieved to learn that getting choked in jiu jitsu is a low risk activity, the "choking game" is not. It is most deadly when played solo, but it is certainly a dangerous activity for kids in any form. Untrained and unsupervised kids choking each other for fun is certainly a recipe for something to go wrong. I fully support campaigns to end this practice, despite bits of misinformation they may contain. If I were a parent, I would be freaking out about this too.