Top 10 Reasons for Studying Medicine or Dentistry in Eastern Europe

This review article on street fighting emergency department data with a mapping to training curriculums is an abbreviated version of Chapter 1 of a book published in 2011 by the same author (Ref #1).

In the last decade I have been on a journey comparing traditional impact mainland Japanese karate (distance oriented strike fighting & sweep/take-down techniques) to close in fighting approaches. “Close in fighting” has more recently been broadly labeled as “more practical”, therefore, I have been exploring this world by expanding my understanding of kata bunkai and revisiting a little of my judo/grappling skills (which is where I started my martial arts over 25 years ago). This journey has lead me to begin authoring a book, along with a number of clinicians, identifying which injuries are actually recorded from street fights by hospital emergency departments, and based on that extrapolate which techniques seem more practical to train versus others. Follow-on chapters in the book then dissect the anatomy and physiology of techniques most likely to produce medical outcomes based on the data.

The goal is to facilitate thought about what may be regarded as “practical fighting training” so one can train the right techniques to protect oneself from serious injury should a street encounter arise. Even if one chooses not to practice the techniques that eventuate in street based injuries, understanding how others are likely to damage you provides the best insight for defense against any attack.

This excerpt article is not concerned with dominating an opponent in a fight (ego based outcomes), or submissive techniques for law enforcement – as such encounters have no serious medical outcome. But one does want to identify techniques which have an incredibly low probability of occurring based on police and hospital admission data. For the purpose of this article a serious injury from fighting is defined as one needing urgent medical treatment – anything less than that is certainly not worth training night after night, year after year to avoid.

Often when I have taught martial arts seminars I poll the participants on:

• why they train (the data below represents what I see as an answer in such seminars i.e. the largest % answer is self defense (Ref #1)

• how many have actually been in a fight?

• further more, of those who had been in a fight how many considered the situation to be in a category related to “serious bodily harm”? As ripped t-shirts, gashes from rolling on the ground and general bruising all relate to ego, not to self defense against serious bodily harm.

To preface the topic of “practical fighting training” I will discuss the medical practice acronym “EBP” which stands for evidence-based practice. Medical practitioners use “evidence-based practice” as a practice pathway that involves a doctor analyzing data to establish a path of treatment, or future practice. In contrast, very few martial artists have looked at the medical facts related to people’s fighting injuries and why they present at a hospital after fighting. To ensure we are studying the correct type of techniques for self defence (avoiding serious injury in a fight) if that is the aim of most karate-ka we should be looking at what is potentially damaging and combining that with a balance of the probability that such an injury will actually occur. As opposed to blindly practicing techniques year after year that according to medical and police data rarely cause an injury in a street fight today.

In the martial arts world all sorts of claims fly around about this technique, or that approach, being more practical than another. Let’s start by reminding ourselves of what practical means to be sure we do not start down a delusional argument path:

Macmillan Dictionary definition of practical:

“involving or relating to real situations and events that are likely”

Some keywords to note in this definition are “real situations” and “likely” i.e. we should be training for techniques that are probable and lead to injury – otherwise we are living in a delusional world, or one of paranoia, possibly training for a situation which statistics show are incredibly rare.

The data should also define whether a given technique or style of martial art really is:

1. only sports scenario given its low incidence of leading to injury on the street

2. a vestige from feudal times (i.e. practicing something not relevant to today’s medical injury statistics)

3. something that does not cause bodily harm with any degree of probability and, therefore, it is not justified spending many nights/years training to avoid (if the aim is to practice “practical” martial arts)

Using choking techniques as a first example. The reality of a street fight involving grappling that actually leads to strangulation (a medical outcome) is less than 0.001 percent of the population. Comparing the practicality of training for the 0.001 percent probability of strangulation implies someone feels training 3-5 nights a week is worth it for something that is 100 times less likely than getting hit by car while walking.

It is also worth noting that many of those rare strangulation cases are often elderly and women. Therefore young men focusing on choking techniques arguably fall somewhat further into the realm of impractical as their odds are far lower than 1 in 100,000 of ever needing it to create/prevent a medical outcome.

Another data point to put the risk of death by choking in a modern street fight into perspective is comparing the likelihood an average 35 year old male being afflicted with cancer (the odds are near 1 in 100; Modeling The Probability Of Developing Cancer in Germany by Breitscheidel & Sahakyan and published in The Internet Journal of Epidemiology. 2006 Volume 3, Number 2). That is to say that cancer is 1,000 times more likely than strangulation – yet do many 35 year old males go to a training center multiple nights a week for a few hours to engage in cancer preventative research and anti-cancer diet options?

Of course in most pre-1800 societies one would guess this technique was more practical as something to learn, or to learn to defend against. However, with the evolution of modern rigorous law systems, forensics and arguably a general higher regard for human life this technique really has a place in the past and the statistics point to that.

Grappling techniques and their probability of leading to medical outcomes. The data presented in detail in the upcoming book highlights that impact injuries (e.g. a head punch leading to hospitalization) as a result of street fighting are ten times more likely than grappling related injuries. Obviously gaining a high level of expertise at blocking, or staying out of distance of a fast incoming blow is the key technique of all to develop timing skills around (which is the very definition of karate’s core skill set as long as one includes hook and straight punches). Unless you are in law enforcement you are ten times more likely to need this than a grappling skill to protect yourself in the street (as a note one must remember even the odds of needing the punch aversion skill is low for the average citizen).

The police stats from the UK for the top 10 assault activities (which differ in only a minor way to the top 10 medical outcomes) are below (male-on-male data only):

1. Attacker pushes, defender pushes back, attacker throws a swinging punch to the head.

2. A swinging punch to the head

3. A front clothing grab, one handed, followed by punch to head

4. Two handed front clothing grab, followed by headbutt

5. Two handed front clothing grab followed by knee to groin

6. Bottle, glass or ashtray to the head, swinging

7. A lashing kick to groin/lower legs

8. A bottle, glass jabbed to face

9. A slash with a knife, usually 3-4 inch lockblade or kitchen knife

10. A grappling style headlock

Note: the top 9 of the 10 listed are all impact oriented forms of assault.

As case and point in regards to the importance of head punches in the street, in the month of writing this article we unfortunately had two adult members of our network in two distinct street fights. One was a kyu rank and the other fight involved one of our black belts. It is a shame whenever such a thing occurs but as a credit to their training both instances saw a block and single punch counter incapacitate their opponents where head punches were the issue at hand. Of course a single counter may not be defining outcome every time, but the key point here is the head shots and the probability of injuries resulting from technique over another.

There is no data to show that once two fighters “go to ground” regardless of whether they are trained or untrained that there is any reason to believe an injury is more/less likely to result (i.e anyone can “bear hug” another individual without years of grappling training and the result via the medical statistics is once they do so the likelihood of a medical injury is essentially gone). The grappler may get the better of person who is not trained but the statistics still show no significant medical outcomes – hence one must ask is it worth training for something with no outcome other than ego protection? We must come back to true self defense against serious bodily harm as a reason to train not an emphasis on ego related issues.

Break-Fall Techniques and the probability they protect one from medical outcomes. Reflecting on break-fall training (ukemi in Japanese), the data shows that serious concussion (traumatic brain injury [TBI]) from falls in an assault scenario results in hospitalization at a rate of 1 in 3,000 for Australian males around the 35 year age bracket (Australian Institute of Health and Welfare Canberra, Hospital separations due to traumatic brain injury, Australia 2004-05 by Helps, Henley & Harrison). One must also note that this data includes fall injuries after being punched or kicked as well as from throws – so the actual grappling related injuries from falls/throws is lower than 1 in 3000. So the justification for break fall training is at least 35,000 times higher than strangulation techniques. Throws/falls are in fact the primary event that may produce an injury if a street fight moves from an impact scenario to a grappling event, so break fall training in ones curriculum is key if you are looking to address the top ten injury scenarios.

USA data mirrors the Australian results (Ref #1) in relation to concussion (TBI = traumatic brain injury) and the USA data conclusions state that:

“Most physical assault related injuries were caused by a person being struck by another person. The next largest category involved falls/throws etc. leaving less than 10% of injuries related to grappling.” – U.S. Department of Justice Office of Justice Programs Violence-Related Injuries Treated in Hospital Emergency Departments.

“Arm bars” or reverse joint breaks and the incidence of a medical outcome ina street fight. Joint hyperextensions (e.g. arm bars) had incidences at levels so low in USA and Australian studies that comments in a variety of reports given included:

• “too low to accurately report”

• “so low not recorded”

In talking with emergencies doctors I come across through my work or friend connections highlighted the reality of the emergency department surveys. For example, in interviewing 4 emergency consultants each with approximately 20 years experience (cumulatively that is 80 years of 8 hours a day hanging around emergency departments) none could report a fighting related incident involving hypertension of joint (e.g. arm bars) causing a dislocation and a need for medical treatment. So while those Steven Segal movies with reverse elbow breaks look great and bunkai from such kata as Seipai involving reverse breaks exist, injuries from such techniques never seem to present at hospitals.

Budo training – “All roads lead to Rome”

Extrapolating from the above data one could list the following summary:

1. The probability of an assault leading to a serious medical injury for the average citizen is very low

2. If by chance you are one of the few who suffers a serious injury in an assault, medical admission statistics and police assault data show that very few serious injuries result from grappling compared with strikes (an approximate ratio of 1 to 10).

The data make it very hard to justify spending many nights a week for many years in a dojo for self defence given the likelihood of using the techniques to prevent injury are far below such other remote possibilities causing bodily harm such as cancer, and even pedestrian car strikes (i.e. other things we would never think to spend so much time training for via preventative measures). Yet when practitioners are surveyed (above poll data) they indicate their primary desire for training is self defence against serious injury – this seems to be a mismatch, or imply a state of paranoia humans tend to have that is out of proportion relative to other health/life threatening events.

One must remember that martial arts encompass at least the following:

1. Self Defense

2. Health/Fitness

3. Character Development (confidence, stable emotion, clarity of thinking)

As per the Macmillan Dictionary definition of “practical” given earlier in this chapter the “Self Defence” component of the above list really does may not fit into the realm of practical regardless of one’s training style or emphasis. However, “Fitness” and “Character Development” are things we will all use every single day of our lives to be the best we can be in life, work and family. Therefore, the emphasis, and rationale for training must lie in the two items listed above that we use every day rather than the one item we will according to statistics probably never use. These issues should provide a compass for sensei to consider their curriculum and student outcomes.

In many ways, over so many decades and by so many of the martial arts masters an emphasis has been placed on the “zen” or character development side of the martial arts. The idiom “All roads lead to Rome” is very appropriate as no matter how one analyses martial arts inevitably discussions of Budo return to the inward journey to better oneself. The statistics and likelihood of medical outcomes from fighting also point to that same answer.



Source by Dr. Jason Armstrong

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