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On the way to the Tokyo Summer
Olympic Games (2020). Prevention of
severe head and neck injuries in judo:
it’s time for action
Takeshi Kamitani,1,2 Nikolaos G Malliaropoulos,3 Masaki Omiya,2
Yohei Otaka,4 Kosei Inoue,5 Natsuko Onidani2
Severe head and neck injuries resulting in
death or serious sequelae in judo have
been recently reported in Japan,1 2 reaf-
firming the importance of establishing
effective measures to reduce such serious
injuries. We describe how and in whom
the severe head and neck injuries occur in
judo and outline the potentially preven-
tive strategies.
Injuries in judo
Judo is a whole-body sport; however,
injuries of the knee, shoulder and fingers
are common.3 Head and neck injuries are
rarer, with incidences of 2.44 and 1.47
cases per 100 000 judokas per year, respec-
tively, but they tend to be more serious.1
According to accident reports submitted
to the All Japan Judo Federation’s System,
there were 30 cases of head injury and
19 cases of neck injury reported between
2003 and 2010.1
Young players aged <20 years
accounted for 90% (27/30) of cases of
head injury. Many of the victims of these
injuries had <1 year of experience. Head
injuries occurred while being thrown
in approximately 70% (21/30) of cases
during osoto-gari. Osoto-gari is a common
leg throw in which judo players sweep
their opponent’s leg out while throwing
them backwards. The back of the head is
impacted in approximately 60% (14/23) of
cases, with the most commonly reported
head injury being an acute subdural
haematoma.1
1
Department of Orthopaedics, Japan Community
Healthcare Organization, Tokyo Shinjuku Medical
Center, Tokyo, Japan
2
Department of Mechanical Engineering, Faculty of
Science and Technology, Keio University, Kanagawa,
Japan
3
Center of Sports and Exercise Medicine, Queen Mary
University of London, London, UK
4
Department of Rehabilitation Medicine, Keio University
School of Medicine, Tokyo, Japan
5
Department of Physical Education, Tokai University,
Kanagawa, Japan
Correspondence to Dr Takeshi Kamitani, Department
of Orthopaedics, Japan Community Healthcare
Organization, Tokyo Shinjuku Medical Center, Tokyo,
Japan; t​ akeshikami0806@​yahoo.​co.​jp
Copyright Article author (or their employer) 2017. Produced by BMJ Publishing Group Ltd under licence.
Editorial
In cases of neck injuries, young players
aged <20 years account for approxi-
mately 58% (11/19); these players were
more experienced, with 68% (13/19)
having at least 5 years of judo experience.
Approximately, 63% (12/19) of judokas
are injured while throwing an opponent.
The most common technique involved
in neck-injured players is uchi-mata,
followed by seoi-nage. In uchi-mata, judo
players rotate their body and use their leg
to kick their opponent’s inner thigh. Neck
injuries may occur when judo players dive
head first in a flexed neck position while
throwing an opponent. In all but one indi-
vidual, the diagnosis was cervical spinal
cord injury.1 Severe head and neck injury
in judo carries a poor prognosis. Of 30
judokas with head injuries, 15 died, 11
had severe sequelae and only four expe-
rienced full recovery. Of 19 judokas with
head injuries, seven had complete quadri-
plegia, seven had incomplete paralysis and
five experienced full recovery.1
Head injury prevention
Judo beginners practise ukemi first to miti-
gate the impact of being thrown and to
prevent injury. The most common cause of
head injuries occurs with osoto-gari; thus,
backwards ukemi should be appropriately
performed.4 When practising backwards
ukemi, beginners are instructed to look at
the knot in their belt or curl their body to
keep the neck flexed. Although the precise
mechanism of head injuries by osoto-gari
remains unclear, rotational and shearing
forces between the brain and dura from
the impact to the back of the head may
have a key role in bridging vein ruptures.5
When players cannot keep the neck flexed
while being thrown backwards, the neck
extends and the head rotates backwards
and then rebounds after hitting the mat.
The brain, however, continues to rotate
backwards because of inertia, resulting
in a gap between rotational movements
of the brain and skull.5 To avoid this
situation, it is important for players to
suppress neck extension while being
Kamitani T, et al. Br J Sports Med Month 2017 Vol 0 No 0
thrown backwards. Thus, increasing neck
muscle strength and mastering ukemi are
important, though scientific evidence of
the effectiveness has not been established
yet. Additionally, head protectors have the
potential to attenuate impact to the head
in judo, although official rules do not
permit them. What can be done to prevent
beginners sustaining head injuries? Since
the All Japan Judo Federation has engaged
in educational campaigns for safety,
including safety guidance to coaches and
parents from 2012,6 the number of serious
injuries has decreased. These initiatives
should be extended worldwide. Finally,
physicians should pay attention to concus-
sion symptoms in judokas who are hit to
the head, because repeated injuries have
been reported in several cases with severe
head injury.7
Neck injury prevention
Neuromusculoskeletal examinations,
X-rays and neck muscle training and
stretching have been suggested for
preventing neck injuries. However,
considering that neck injuries occur when
experienced judo players are putting all
their effort into throwing their opponents,
such training may be futile. Although
the action of diving head first when
performing a technique is currently listed
as a grave infringement by the rules of
judo, referees are reluctant to apply this
rule because it decides the winner and
ends the match. However, this rule must
be strictly enforced for safety purposes.
In American football, spearing tackles
have been penalised since 1976; this
rule successfully reduced neck injuries by
80%.8
Future perspective
Along with implementing all potentially
preventive measures, in-depth analysis of
the injury mechanisms in the actual situ-
ations as well as laboratory tests would
help to develop more effective prevention
programmes. Meticulous registration of
all serious judo injuries both at national
and international levels and video
analysis of these injuries are strongly
recommended.
Funding  None.
Competing interests  None declared.
Provenance and peer review  Not commissioned;
externally peer reviewed.
© Article author(s) (or their employer(s) unless
otherwise stated in the text of the article) 2017. All
rights reserved. No commercial use is permitted unless
otherwise expressly granted.
   1
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Editorial
References
1 Kamitani T, Nimura Y, Nagahiro S, et al. Catastrophic
head and neck injuries in judo players in Japan from
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2 Uchida R. Judo deaths in school: cases and analysis in
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5 Nagahiro S, Mizobuchi Y. Current topics in sports-
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6 All Japan Judo Federation. The safety instruction of
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On the way to the Tokyo Summer Olympic

Games (2020). Prevention of severe head and
neck injuries in judo: it's time for action
Takeshi Kamitani, Nikolaos G Malliaropoulos, Masaki Omiya, Yohei
Otaka, Kosei Inoue and Natsuko Onidani

Br J Sports Med published online August 17, 2017

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