849112

research-article2019
SPHXXX10.1177/1941738119849112Petrisor et alSPORTS HEALTH

Petrisor et al Sep • Oct 2019

Injury in Brazilian Jiu-Jitsu Training

Brad A. Petrisor, MSc, MD, FRCSC,*† Gina Del Fabbro, BPH,† Kim Madden, PhD,†
Moin Khan, MD, MSc, FRCSC,† Jeff Joslin,‡ and Mohit Bhandari, MD, PhD, FRCSC†

Background: Brazilian jiu-jitsu (BJJ) is a grappling-based martial art that can lead to injuries both in training and
in competition. There is a paucity of data regarding injuries sustained while training in BJJ, in both competitive and
noncompetitive jiu-jitsu athletes.
Hypothesis: We hypothesize that most BJJ practitioners sustain injuries to various body locations while in training and
in competition. Our primary objective was to describe injuries sustained while training for BJJ, both in practice and in
competition. Our secondary objectives were to classify injury type and to explore participant and injury characteristics
associated with wanting to quit jiu-jitsu after injury.
Study Design: Descriptive epidemiology study.
Methods: We conducted a survey of all BJJ participants at a single club in Hamilton, Ontario, Canada. We developed a
questionnaire including questions on demographics, injuries in competition and/or training, treatment received, and whether
the participant considered discontinuing BJJ after injury.
Results: A total of 70 BJJ athletes participated in this study (response rate, 85%). Ninety-one percent of participants were
injured in training and 60% of competitive athletes were injured in competitions. Significantly more injuries were sustained
overall for each body region in training in comparison with competition (P < 0.001). Two-thirds of injured participants
required medical attention, with 15% requiring surgery. Participants requiring surgical treatment were 6.5 times more likely
to consider quitting compared with those requiring other treatments, including no treatment (odds ratio [OR], 6.50; 95% CI,
1.53-27.60). Participants required to take more than 4 months off training were 5.5 times more likely to consider quitting
compared with those who took less time off (OR, 5.48; 95% CI, 2.25-13.38).
Conclusion: The prevalence of injury is very high among BJJ practitioners, with 9 of 10 practitioners sustaining at least
1 injury, commonly during training. Injuries were primarily sprains and strains to fingers, the upper extremity, and neck.
Potential participants in BJJ should be informed regarding significant risk of injury and instructed regarding appropriate
precautions and safety protocols.
Clinical Relevance: Clinicians should be aware of the substantial risk of injury among BJJ practitioners and the
epidemiology of the injuries as outlined in this article.
Keywords: martial arts; Brazilian jiu-jitsu; injuries; fractures; orthopaedic surgery

B
razilian jiu-jitsu (BJJ) is a grappling-based martial art with
roots in prewar Kodokan Judo.8,13 BJJ has undergone
modifications and refinements over the years and has
been increasing in popularity within North America and globally
over the past 20 years.8,13 As a grappling-based sport it involves
submission wrestling, including chokes/strangles and joint
locks. Additionally, BJJ incorporates aggressive takedowns from
standing and self-defense techniques to cause the opponent to
submit or exit the situation if in a state of self-defense.
A number of studies exist regarding the epidemiology of
injuries sustained while training in judo, karate-do, taekwondo,
mixed martial arts, and BJJ competitions2,7,9-11,15; however, there
is a paucity of data on injuries sustained during training in BJJ
both in the competitive and noncompetitive athlete. Previous

From †Department of Surgery, McMaster University, Hamilton, Ontario, Canada, and ‡Joslin’s Mixed Martial Arts, Hamilton, Ontario, Canada
*Address correspondence to Brad A. Petrisor, MSc, MD, FRCSC, Department of Surgery, McMaster University, 237 Barton Street East, Hamilton, Ontario, L8L 2X2, Canada
(email: petrisor@hhsc.ca).
The following authors declared potential conflicts of interest: B.A.P. is a consultant for and received research support from Stryker, owns stock in Pfizer, and studies Brazilian
Jiu Jitsu at Joslin’s Mixed Martial Arts; G.D.F. is an assistant instructor for the children’s program at Joslin’s Mixed Martial Arts; K.M. is a consultant for OrthoEvidence;
Jeff Joslin is the owner of Joslin’s Mixed Martial Arts; and M.B. is a consultant for Smith & Nephew, Stryker, Amgen, Zimmer, Moximed, Bioventus, Merck, Eli Lilly, Sanofi,
Conmed, Ferring, and DJO, and received grants from Stryker, Zimmer, Amgen, Smith & Nephew, DePuy, Eli Lilly, and Bioventus.
DOI: 10.1177/1941738119849112
432 © 2019 The Author(s)
vol. 11 • no. 5
studies in other martial arts have identified that injuries are
more commonly sustained in training than competition.4,5,14
Additionally, the vast majority of injuries (78%) sustained in BJJ
competitions are orthopaedic injuries, many of which require
medical attention or surgical intervention.15
We undertook a survey of jiu-jitsu practitioners to understand
the injury patterns and prevalence of injuries sustained in BJJ
training, practice, and competition. Our primary objective was
to determine the prevalence of injuries sustained during jiu-jitsu
training and competition. Our secondary objectives were to
describe the types of injuries, to determine which participant
and injury characteristics are associated with desire to
discontinue jiu-jitsu after injury, and which characteristics are
associated with requiring surgery for an injury.
Methods
Questionnaire Development
We developed a questionnaire using focus groups, key
informants, and the previous literature. Focus groups consisted
of jiu-jitsu practitioners as well as orthopaedic surgeons treating
jiu-jitsu injuries. We also generated items from a Medline search
of articles published from 1966 to 2017 using text words
“Brazilian jiu-jitsu,” “submission wrestling,” “jiu-jitsu,” “judo,”
“martial arts,” and “mixed martial arts.” These were used to
improve the data from our focus group item generation. We
used a sample to redundancy approach until no new items for
the questionnaire emerged.
We pretested the questionnaire with an independent group of
2 orthopaedic surgeons and 3 martial artists, including 2 jiu-jitsu
practitioners for face and content validity. This involved
evaluation of whether the questionnaire as a whole appeared to
adequately capture the range of potential injuries sustained
while undergoing jiu-jitsu training and competition and whether
individual questions adequately affected the 4 broad domains of
jiu-jitsu training and experience (beginner, advanced beginner,
midlevel, and advanced practitioner). The informants also
commented on the clarity and comprehensiveness of the
questionnaire.
The final questionnaire contained 26 questions regarding
demographics, timing of injuries, injury characteristics, treatment
received, and whether participants considered quitting BJJ after
injury (see the appendix, available in the online version of this
article).
Questionnaire Administration
We surveyed all jiu-jitsu practitioners of a single club in
Hamilton, Ontario, Canada, during 2016. Members of the club
each received a package with a copy of the survey, a
personalized cover letter, and a return envelope. No monetary
incentives or prenotification telephone calls were used for this
survey, and attempted follow-up of nonresponders was done on
2 occasions via email or in-person. This study was reviewed and
SPORTS HEALTH
approved by the Hamilton Integrated Research Ethics Board
(No. 2007). All practitioners surveyed received a letter of
information and consent form. Signed consent was obtained for
all surveys, questionnaire completion was voluntary, and
individual responses were kept anonymous and confidential.
Statistical Analysis
Our primary analysis was descriptive. We summarized
categorical and dichotomous variables as frequencies and
percentages. Overall prevalence and characteristics of injuries
occurring in training and in competition were assessed.
Chi-square test was performed to compare prevalence of
injuries sustained during competition versus training as well as if
injury location differed between competition and training.
Additionally, we conducted unadjusted logistic regression
analyses to evaluate the association between selected
demographic and injury patterns and those who considered
quitting jiu-jitsu as a result of their injuries as a dependent
variable. Exploratory binary logistic regression analyses were also
performed to evaluate the association between selected
demographic and injury patterns and those who required surgical
treatment for their injury as a dependent variable. Findings were
reported as unadjusted odds ratios (ORs) with 95% CIs.
To detect a 20% difference in injuries sustained during
competition versus training, 73 participants (2-tailed α = 0.05;
80% power) were required.
Results
Participant Characteristics
Of the 82 jiu-jitsu practitioners approached to complete the
survey, 70 participated and returned their completed survey
(response rate 85%). The majority of respondents were male
(90.0%), older than 30 years (58.5%), and junior trainees (white
belts [37.2%] or blue belts [42.9%]). Please see Table 1 for full
demographic information.
Injuries Sustained
Training Injuries
Of those completing the survey, 64 (91.4%) were injured while
in training (Table 2). The majority of injuries were sprains
(61.4%) or strains (57.1%). Significant injuries, including
fractures (18.6%), lacerations (12.9%), dislocations (11.4%), and
concussions (7.1%), were also relatively common.
Competition Injuries
Of the 35 participants who participated in BJJ competitions,
60.0% were injured in competition (Table 2). Similar to injuries
sustained in training, sprains (31.4%) and strains (25.7%) were
the most common injuries sustained in competition. See Table 2
for further injury details. In contrast to injuries sustained during
training, shoulder injuries were the most common specific injury
location (28.6%), followed by fingers and elbows (both 14.3%).
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Table 1. Participant characteristics for recreational and competitive jiu-jitsu athletes

Recreational Athletes Competitive Athletes All Athletes

Demographic Variable (N = 35), n (%) (N = 35), n (%) (N = 70), n (%)
Age (years)
18-25 8 (22.9) 12 (34.3) 20 (28.6)
25-29 4 (11.4) 5 (14.3) 9 (12.9)
30-34 6 (17.1) 5 (14.3) 11 (15.7)
35-39 7 (20.0) 5 (14.3) 12 (17.1)
40-44 5 (14.3) 4 (11.4) 9 (12.9)
45-49 3 (8.6) 2 (5.7) 5 (7.1)
50-54 1 (2.9) 0 1 (1.4)
55+ 1 (2.9) 2 (5.7) 3 (4.3)
Sex
Male 30 (85.7) 33 (94.3) 63 (90.0)
Female 5 (14.3) 2 (5.7) 7 (10.0)
Belt rank
White belt (0-6 months) 10 (28.6) 0 10 (14.3)
White belt (6+ months) 9 (25.7) 7 (20.0) 16 (22.9)
Blue belt 11 (31.4) 19 (54.3) 30 (42.9)
Purple belt 3 (8.6) 4 (11.4) 7 (10.0)
Brown belt 0 3 (8.6) 3 (4.3)
Black belt 2 (5.7) 2 (5.7) 4 (5.7)
Years trained
0-1 10 (28.6) 3 (8.6) 13 (18.6)
1-3 10 (28.6) 6 (17.1) 16 (22.9)
3-5 4 (11.4) 8 (22.9) 12 (17.1)
5-7 5 (14.3) 8 (22.9) 13 (18.6)
8+ 6 (17.1) 10 (28.6) 16 (22.9)
Hours spent training per week
0-2 2 (5.7) 0 2 (2.9)
3-5 24 (68.6) 17 (48.6) 41 (58.6)
6-8 9 (25.7) 11 (31.4) 20 (28.6)
9-11 0 2 (5.7) 2 (2.9)
12+ 0 5 (14.3) 5 (7.1)
Injured in training 30 (85.7) 34 (97.1) 64 (91.4)
Injured in competition 0 21 (60.0) 21 (60.0)

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Table 2. Injury characteristicsa

Injury Characteristic Training Injury (N = 70), n (%) Competition Injury (N = 35), n (%)
Any injury 64 (91.4) 21 (60.0)
Head/Neck/Face injury 45 (64.3) 7 (20.0)
Neck 33 (50.8) 3 (8.6)
Ears 22 (33.8) 1 (2.9)
Face 16 (24.6) 3 (8.6)
Mouth 10 (15.4) 2 (5.7)
Cranium 7 (10.8) 1 (2.9)
Nose 6 (9.2) 1 (2.9)
Eyes 5 (7.7) 1 (2.9)
Upper extremity injury 52 (74.3) 15 (42.9)
Fingers 34 (52.3) 5 (14.3)
Shoulder 32 (49.2) 10 (28.6)
Elbow 25 (38.5) 5 (14.3)
Wrist 18 (27.7) 2 (5.7)
Forearm 4 (6.2) 2 (5.7)
Palm 3 (4.6) 1 (2.9)
Arm 2 (3.1) 1 (2.9)
Core injury 34 (48.6) 6 (17.1)
Ribs 26 (40.0) 3 (8.6)
Chest 7 (10.8) 2 (5.7)
Pelvis 6 (9.2) 0
Abdomen 5 (7.7) 2 (5.7)
Spine 5 (7.7) 1 (2.9)
Lower extremity injury 50 (71.4) 10 (28.6)
Knee 33 (50.8) 3 (8.6)
Ankle 24 (36.9) 4 (11.4)
Toes 21 (32.3) 4 (11.4)
Groin 12 (18.5) 1 (2.9)
Foot 11 (16.9) 2 (5.7)
Hip 11 (16.9) 1 (2.9)
Thigh 2 (3.1) 1 (2.9)
Midfoot 2 (3.1) 1 (2.9)
Injury type
Sprain 43 (61.4) 11 (31.4)
Strain 40 (57.1) 9 (25.7)
Contusion 32 (45.7) 3 (8.6)

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Table 2. (continued)

Injury Characteristic Training Injury (N = 70), n (%) Competition Injury (N = 35), n (%)
Unspecified joint injury 31 (44.3) 5 (14.3)
Fracture 13 (18.6) 5 (14.3)
Laceration 9 (12.9) 1 (2.9)
Dislocation 8 (11.4) 6 (17.1)
Concussion 5 (7.1) 1 (2.9)
a
Participants can select more than 1 response; percentages do not add to 100%.

Competition Injuries Compared With Training Injuries

The setting of the most severe injury for 59 (90.8%) of the
injured jiu-jitsu practitioners was while in training or practice in
the jiu-jitsu club, while only 6 (9.2%) sustained their most severe Table 3. Treatment characteristics
injury while in competition. There was a significantly higher
Treatment Number (%)a
prevalence of injuries in training in comparison with
competition (P < 0.001). Additionally, there was a significantly Required medical attention 44 (67.7)
higher prevalence of injuries in training for each body region
Surgery 10 (15.4)
(head/neck/face P < 0.001; upper extremity P = 0.0016; core
P = 0.0018; lower extremity P < 0.001). Physical therapy/Rehabilitation 38 (58.5)
Immobilization 17 (26.2)
Treatment
Chiropractic care 11 (16.9)
Forty-four of 65 respondents with injuries (67.7%) required
medical attention for their injury (Table 3). Ten respondents Prescribed medication 31 (47.7)
(15.4%) required surgery for their injury. Over half (55.4%) of NSAID 17 (26.2)
injured respondents were advised by a physician to take time
off of BJJ training. Nearly half (46.1%) stated that the injury has Acetaminophen 8 (12.3)
had a negative impact on their life. Thirteen (20.0%) of injured Marijuana 3 (4.6)
BJJ practitioners thought about quitting BJJ as a result of their
Narcotic analgesic 3 (4.6)
injury but did not. See Table 3 for full details on types of
treatment. Nonprescribed medication 42 (64.6)

Factors Associated With Desire NSAID 23 (35.4)

to Stop BJJ After Injury Acetaminophen 9 (13.8)
Treatment type and amount of time required off training were Marijuana 9 (13.8)
significantly associated with desire to quit after injury.
Participants requiring surgical treatment were 6.5 times more Narcotic analgesic 1 (1.5)
likely to consider quitting compared with those who had other Medically advised to take time off BJJ 36 (55.4)
treatments, including no treatment (OR, 6.50; 95% CI, 1.53-
Time off from BJJ 55 (84.6)
27.60). Participants taking more than 4 months off training were
5.5 times more likely to consider quitting compared with those <1 month 25 (38.5)
who took less time off (OR, 5.48; 95% CI, 2.25-13.38). There 1-3 months 16 (24.6)
was no statistical relationship between level of training, number
of years training, or age associated with desire to discontinue 4-6 months 6 (9.2)
training after injury (Table 4). 8-12 months 3 (4.6)
Factors Associated With Requiring >12 months 5 (7.7)
Surgical Treatment After Injury
BJJ, Brazilian jiu-jitsu; NSAID, nonsteroidal anti-inflammatory drug.
Participants taking more than 4 months off were 19 times more a
N = 65 participants with injuries.
likely to have had surgical intervention for their injury (OR,

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Table 4. Binary logistic regression of characteristics associated with considering quitting BJJ (unadjusted)

Characteristic Unadjusted OR (95% CI) P

Level of BJJ
Beginner (White) REF
Advanced (Blue-Black) 2.26 (0.56-9.09) 0.253
Training years
1-3 REF
>3 2.80 (0.70-11.2) 0.148
Age (years)
18-29 REF
30-44 0.404 0.368
45+ 1.167 0.864
Injury type
Fracture 2.94 (0.79-10.88) 0.107
Any othera or none REF
Treatment
Surgery 6.50 (1.53-27.60) 0.011
Any otherb or none REF
Time off of training
≤4 months REF
>4 months 5.48 (2.25-13.38) <0.001

BJJ, Brazilian jiu-jitsu; OR, odds ratio; REF, reference category.

a
Other injury types include sprain, strain, contusion, laceration, and joint injury.
b
Other treatments include physical therapy, rehabilitation, chiropractic care, and immobilization.

19.33; 95% CI, 2.91-128.50). We did not find evidence that belt
level, number of years training, age, injury type, or training
versus competition injury was significantly associated with
requiring surgery; however, this analysis was exploratory in
nature (Table 5).
Discussion
The primary finding of this survey was that the majority of
injuries in BJJ are sustained while in training rather than in
competition. We identified that over 90% of jiu-jitsu practitioners
surveyed suffered injury while in training and the most severe
injuries for the majority of practitioners occurred during training.
The most common injuries identified involved the fingers, neck,
knee, and shoulder, with the majority of respondents seeking
medical or surgical treatment, physical therapy, or rehabilitation.
This is in keeping with studies assessing injuries of BJJ athletes
that were sustained in martial arts competition. In a descriptive
epidemiological study, Scoggin et al15 identified that most
injuries in competition were orthopaedic (78%) and most
involved the upper extremity—specifically, the elbow.
Kreiswirth et al7 found that both the knee and elbow had an
equal risk of injury in those BJJ competitions that they observed.
A systematic review of judo injuries also identified that most
injuries were sprains and strains with the knee, shoulder, and
hands/fingers being the most commonly injured body parts.12
However, judo injuries were most commonly associated with
standing throws,12 whereas most BJJ matches take place
grappling on the ground. With regard to finger injuries, it is very
common practice for practitioners to tape their fingers; however,
cadaveric studies suggest that this may not prevent flexor
tendon injuries.17

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Table 5. Binary logistic regression of characteristics associated with requiring surgery for an injury (unadjusted)

Characteristic Unadjusted OR (95% CI) P

Level of BJJ
Beginner (White) REF
Advanced (Blue-Black) 6.43 (0.77-54.03) 0.087
Training years
1-3 REF
>3 7.88 (0.94-66.09) 0.057
Age (years)
18-29 REF
30-44 1.24 (0.25-6.07) 0.158
45+ 4.33 (0.70-27.01) 0.116
Injury type
Fracture 2.97 (0.72-12.34) 0.134
Any othera or none REF
Time off of training
≤4 months REF
>4 months 19.33 (2.91-128.5) 0.002
Setting of injury
Training REF
Competition 3.19 (0.50-20.35) 0.220

BJJ, Brazilian jiu-jitsu; OR, odds ratio; REF, reference category.

a
Other injury types include sprain, strain, contusion, laceration, and joint injury.

One in 5 BJJ practitioners considered discontinuing BJJ as a
result of their injury but did not. This is despite the fact that
46% indicated that their injury resulted in a negative impact on
their quality of life. Furthermore, most respondents required
physical therapy or rehabilitation after injury. This was not
significantly associated with a desire to discontinue training.
However, an injury that required surgery or more than 4
months off of training did predict those who wanted to quit. It
may be that there are positive psychological or physical health
benefits inherent in training in BJJ that supersede the negative
impact of having an injury.6,13 Using the Well-being
Questionnaire, Szabo and Parkin16 have identified that in
Shotokan karate practitioners, even 1 week off of training can
result in mood disturbances such as depression and anxiety. As
well, a systematic review of general effects of martial arts on
health status identified a number of studies observing the
positive health effects associated with martial arts training.3
Similarly, Ardern et al1 reported that practitioners often
returned to their sport after an injury due to a low fear of
return and a need to maintain motivation and confidence. This
may be indicative of the positive psychological benefits of
martial arts training for the practitioner’s overall quality of life
and well-being.
Limitations
This study has limitations primarily involving the respondent
sample, which came from a single club of BJJ practitioners.
Thus, generalizability may be limited to similar settings.
Similarly, generalizability may be limited due to the majority of
respondents being male (90%). We are also limited by a small
number of respondents in this survey, and the self-reported
nature of the outcomes. The results of the regression analyses

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were exploratory in nature and are underpowered. Future larger
studies should be conducted that are adequately powered to
further explore characteristics associated with wanting to
discontinue BJJ and with requiring surgical treatment for an
injury. It is possible that recall bias affected some of the
respondents’ answers given the retrospective nature of the
survey. Also, practitioners who had discontinued BJJ and not
returned were not surveyed, which may potentially bias our
conclusions. This would have allowed further comparisons of
factors associated with wanting to quit and indeed quitting.
Strengths of this survey include a large range of trainee skill
level, age range, and amount of time performing jiu-jitsu. Other
strengths include that our sample comprised BJJ practitioners
who both compete and train on a regular basis, as well as those
who are noncompetitive, for comparison purposes; and finally,
that our survey achieved a high response rate (85%).
Conclusion
The prevalence of injury is very high among BJJ practitioners,
with 9 of 10 practitioners sustaining at least 1 injury, commonly
during training. Injuries were primarily sprains and strains to the
fingers, upper extremity, and neck. Potential participants in BJJ
should be informed regarding significant risk of injury and
instructed regarding appropriate precautions and safety protocols.
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