With the continued popularity of mixed martial arts, driven by televised competitions
like Ultimate Fighting Championship, a Philadelphia College of Osteopathic Medicine (PCOM) expert in forensic pathology is raising awareness that chokeholds could become a
more common form of injury or homicide and is encouraging police investigators and
medical examiners to be more alert of signs of strangulation originating from fighting
techniques.
His perspective is not only informed by his profession. Gregory McDonald, DO, dean of the School of Health Sciences and chair of the Department of Forensic Medicine and Pathology, has trained in various martial arts—including karate, judo and Brazilian jiu-jitsu—and will soon take his second-degree black belt test in the Israeli martial art Krav Maga.
“With more and more people training in mixed martial arts as a form of exercise and self-defense, forensic pathologists are likely going to see more deaths by chokeholds in a variety of cases, such as street fights or domestic violence incidents,” McDonald said. “These scenarios may also include a change in the common assumption that victims of chokeholds are smaller and weaker than their perpetrator. Because chokeholds can be quick and efficient, you can have a smaller person potentially killing a larger person.”
McDonald recently presented a research seminar, titled “The Pathology of Chokeholds in Mixed Martial Arts,” to help inform the medical community about ways to identify effects from chokeholds (which, McDonald clarified, are actually vascular neck restraints, a form of strangulation to restrict blood flow to the brain and induce unconsciousness).
Chokeholds work primarily by compressing one or both of the carotid arteries in the neck. This only takes about 10 pounds of pressure—the equivalent of a firm handshake, McDonald said—and can cause unconsciousness in about 10 seconds. In two minutes, permanent neurologic damage can occur. At three to four minutes, death can result. The jugular veins can be compressed with even less pressure—just four to five pounds. This pressure can cause veins to rupture, leading to pinpoint hemorrhages known as petechiae, or discolored spots on the skin due to blood clotting, which can be telltale signs of strangulation.
Chokeholds can be applied manually, using the hands, forearms, or legs, or with a ligature, such as a rope, belt, or clothing. Chokehold attacks can come from any direction, and there are myriad types. At his recent seminar, McDonald described a few: the air choke (pressure on the larynx and trachea instead of the carotids), the arm or leg triangle, and the collar or sleeve choke.
Strangulation symptoms are as varied as chokehold types, some of which leave subtle signs due to how they’re applied. McDonald encourages investigators to examine the victim’s clothing and, if possible, the alleged perpetrator’s, for potential evidence such as tears, stretches, missing buttons or damaged zippers. Or, if the clothing is loose, it could be more easily manipulated to strangle or throw a victim.
In addition to trace evidence that could indicate a struggle (dirt, gravel, grass stains on the body or clothing), strangulation symptoms include dissections of the carotid or vertebral arteries. There are also various neurologic symptoms: visual field loss, fine motor deficits, or coma, and these symptoms may occur hours or even days after strangulation. Delayed-onset symptoms and results—a stroke caused by a choke may contribute to a delayed homicide, for example—may make the link to a chokehold even more of a challenge.
McDonald added that physical findings could be even less visible on larger victims, especially if the duration of the assault is short. Chokeholds “may leave a paucity of injuries,” he said, increasing the importance of awareness among authorities about MMA techniques, how they can be applied, and what could happen as a result.
Established in 1899, Philadelphia College of Osteopathic Medicine (PCOM) has trained thousands of highly competent, caring physicians, health practitioners and behavioral scientists who practice a “whole person” approach to care—treating people, not just symptoms. PCOM, a private, not-for-profit accredited institution of higher education, operates three campuses (PCOM, PCOM Georgia and PCOM South Georgia) and offers doctoral degrees in clinical psychology, educational psychology, osteopathic medicine, pharmacy, physical therapy, and school psychology. The college also offers graduate degrees in applied behavior analysis, applied positive psychology, biomedical sciences, forensic medicine, medical laboratory science, mental health counseling, physician assistant studies, and school psychology. PCOM students learn the importance of health promotion, research, education and service to the community. Through its community-based Healthcare Centers, PCOM provides care to medically underserved populations. For more information, visit pcom.edu or call 215-871-6100.
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