Knee Injury in Competitive Brazilian Jiu Jitsu Athletes: Implications for Training

Area of Science:

• Sports Medicine
• Orthopedic Surgery
• Martial Arts Research

Background:

• The heel hook is a common and effective submission in Brazilian jiu jitsu (BJJ).
• Concerns exist regarding the potential for severe knee and ankle ligamentous damage from heel hook application.
• Definitive data on the incidence of injuries specifically attributed to the heel hook in competition are limited.

Purpose of the Study:

• To compare the incidence of knee and ankle injuries in International Brazilian Jiu Jitsu Federation (IBJJF) competitions where the heel hook was permitted versus banned.
• To assess the safety of the heel hook technique in a competitive BJJ setting.

Main Methods:

• A cross-sectional study design was employed, analyzing data from IBJJF competitions.
• Injury data from 2021 (heel hook legal) and 2009 (heel hook banned) were collected for adult and masters division brown and black belt competitors.
• Injury frequencies, incidence rates per 1000 matches, and incidence rate ratios were calculated, focusing on submission holds and the heel hook.

Main Results:

• In 2021, competitors exposed to the heel hook had a significantly higher knee injury incidence rate (26.5 per 1000 matches) compared to unexposed competitors (2.2 per 1000 matches), with a relative risk of 12.0.
• No significant difference in ankle injury incidence was observed between exposed (19.8 per 1000 matches) and unexposed (8.8 per 1000 matches) competitors.
• No significant differences in knee or ankle injury incidence were found when comparing data from 2009 and 2021.

Conclusions:

• The heel hook submission technique is associated with a significantly increased risk of knee injuries in competitive BJJ.
• While ankle injuries were not significantly different, the elevated knee injury risk highlights a safety concern.
• Competitive BJJ athletes are advised to enhance their skill training to mitigate the risk of knee injuries associated with the heel hook.