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Prevalence of Injuries during Brazilian Jiu-Jitsu Training

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Brazilian jiu-jitsu (BJJ) is a martial art that focuses on groundwork, joint locks, and chokeholds. The purpose of this study is to determine the prevalence of injuries sustained during BJJ training. A 27-question research survey was e-mailed to 166 BJJ gyms in the United States. Demographic information, belt level, weight class, training hours, competition experience, and injury prevalence data were collected. The majority of respondents were Caucasian (n = 96) males (n = 121) with an average age of 30.3 years. Overall, the most common injury locations were to the hand and fingers (n = 70), foot and toes (n = 52), and arm and elbow (n = 51). The most common medically diagnosed conditions were skin infections (n = 38), injuries to the knee (n =26), and foot and toes (n = 19). The most common non-medically diagnosed injuries occurred to the hand and fingers (n = 56), arm and elbow (n = 40), and foot and toes (n = 33). In general, athletes were more likely to sustain distal rather than proximal injuries. Athletes reported more frequent medically diagnosed injuries to the lower extremity and more frequent self-diagnosed injuries to the upper extremity. Upper extremity injuries appear to be more frequent but less severe than lower extremity injuries with the opposite being true for lower extremity injuries.
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Sports 2017, 5, 39; doi: 10.3390/sports5020039 www.mdpi.com/journal/sports
Article
Prevalence of Injuries during Brazilian Jiu-Jitsu
Training
Alex R. McDonald 1,*, Fred A. Murdock Jr. 1, Josh A. McDonald 2 and Christopher J. Wolf 1
1 Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO 65212, USA;
murdockf@health.missouri.edu (F.A.M.J.), wolfch@health.missouri.edu (C.J.W.)
2 Department of Biology, University of Wisconsin, Madison, WI 53706, USA mcdonald4@wisc.edu
* Correspondence: armz8b@health.missouri.edu; Tel.: +1-573-882-3101
Academic Editor: Eling Douwe de Bruin
Received: 17 April 2017; Accepted: 8 June 2017; Published: 12 June 2017
Abstract: Brazilian jiu-jitsu (BJJ) is a martial art that focuses on groundwork, joint locks, and
chokeholds. The purpose of this study is to determine the prevalence of injuries sustained during
BJJ training. A 27-question research survey was e-mailed to 166 BJJ gyms in the United States.
Demographic information, belt level, weight class, training hours, competition experience, and
injury prevalence data were collected. The majority of respondents were Caucasian (n = 96) males
(n = 121) with an average age of 30.3 years. Overall, the most common injury locations were to the
hand and fingers (n = 70), foot and toes (n = 52), and arm and elbow (n = 51). The most common
medically diagnosed conditions were skin infections (n = 38), injuries to the knee (n =26), and foot
and toes (n = 19). The most common non-medically diagnosed injuries occurred to the hand and
fingers (n = 56), arm and elbow (n = 40), and foot and toes (n = 33). In general, athletes were more
likely to sustain distal rather than proximal injuries. Athletes reported more frequent medically
diagnosed injuries to the lower extremity and more frequent self-diagnosed injuries to the upper
extremity. Upper extremity injuries appear to be more frequent but less severe than lower extremity
injuries with the opposite being true for lower extremity injuries.
Keywords: Brazilian jiu-jitsu; martial arts; combat sports; training injury
1. Introduction
Brazilian jiu-jitsu (BJJ) is a martial art that focuses on groundwork, joint locks, and chokeholds
instead of kicks and punches. The sport has Japanese roots, and is specifically influenced by the
technical aspects of Kodokan judo [1]. BJJ came into the spotlight when Royce Gracie won the 1st and
2nd Ultimate Fighting Championship (UFC) tournaments in the early 1990s [1,2]. Today, BJJ
tournaments continue to increase in popularity [3]. The graduation system in BJJ rewards athletes
with different colored belts to represent their progress in experience and knowledge. According to
the International Brazilian Jiu-Jitsu Federation (IBJJF), the belt progression after the age of 17 is as
follows: White, Blue, Purple, Brown, Black, Red and black, Red and white, and Red. Each belt has a
minimum age requirement, and after receiving a blue belt, adults must hold each belt for a specified
amount of time before progressing to the next. The maximum weight allowed in each weight class
depends upon the athletes’ age and sex. The IBJJF weight classes for adults are as follows: Rooster
(Male = 57.6 kg, Female = 48.5 kg), Light Feather (M = 64.2, F = 53.5), Feather (M = 70.1, F = 58.5), Light
(M = 76.2, F = 64.2), Middle (M = 82.3, F = 69.2), Medium Heavy (M = 88.5, F = 74.2), Heavy (M = 94.3,
F = 79.4), Super Heavy (M = 100.7, F = No maximum), Ultra Heavy (M = No maximum) [3].
Athletes within the same weight class and belt level compete against one another. During
competition, matches are overseen by a referee who enforces the rules and regulations of the sport
while simultaneously awarding points. Athletes can score points via takedowns, sweeps, and
obtaining positional control over their opponents. Matches last 210 min depending on athlete age
Sports 2017, 5, 39 2 of 9
and belt level. These matches may end early via submission, loss of consciousness, athlete
disqualification, referee stoppage, or random pick (if both athletes become injured). If no winner is
determined before the match ends, victory is awarded by point score or referee decision [3].
Prior studies in similar grappling sports, such as wrestling and judo, have shown the impact of
injuries to practitioners [4,5]. Despite an increased interest in BJJ, minimal research regarding the
prevalence of injuries during competition has been conducted [6,7], and no research to our
knowledge has evaluated the prevalence of injuries during training. The purpose of our study is to
add to the available knowledge of injury prevalence in BJJ by investigating injuries that occur during
training.
2. Materials and Methods
The Institutional Review Board at our academic center reviewed and approved this project. A
27-question research survey was e-mailed to 166 BJJ gyms publicly listed as members of the IBJJF
and/or the Gracie Academy. Athletes over the age of 18 with or without injuries sustained in the last
year were included in this study. Eight participants were excluded from the study for not meeting
this inclusion criteria. Demographic information, belt level, weight class, training hours, competition
experience, and injury prevalence data were collected. Athletes were asked to select injuries sustained
within the prior year that occurred during BJJ specific training but not competition or conditioning.
Respondents could indicate more than one injury but were asked to list each individual injury only
once. Survey participants were incentivized by entrance into a random drawing to receive one of four
$25.00 pre-paid credit cards.
3. Results
To analyze the training injuries of BJJ athletes, we reviewed questionnaire results from 140
survey participants who reported 487 total injuries; 120 of 140 (85.7%) participants reported an injury
while 20 denied being injured. Complete athlete demographic information is shown in Table 1. The
majority of the respondents were Caucasian (n = 96, 68.6%) males (n = 121, 87.1%) with an average
age of 30.3 years and age range from 18 to 55 years. The distribution of athletes by weight class is
shown in Figure 1. The two most common weight classes were Light (n = 30, 21.4%) and Middle (n =
25, 17.9%) weight. The distribution of athletes by belt level is found in Figure 2. Individuals with less
experience were more likely to respond, with most athletes having White belts (n = 60, 42.2%) and
Blue belts (n = 45, 32.4%). No respondents had obtained a Red and black, Red and white, or Red belt.
Table 1. Athlete demographics.
Demographic n Percentage (%)
Age
1829 72 51.4
3039 54 38.6
4049 12 8.6
5059 2 1.4
Sex
Male 121 87.1
Female 19 12.9
Race
American Indian or Alaska Native 0 0
Asian 14 10
Black or African American 3 2.1
Hispanic or Latino 12 8.6
Native Hawaiian or Other Pacific Islander 1 0.7
White 96 68.6
Sports 2017, 5, 39 3 of 9
Other Race 2 1.4
Two or More Races 6 4.3
Prefer not to answer 6 4.3
Figure 1. Distribution of athletes by weight class.
Figure 2. Distribution of athletes by belt level.
Athletes selected their level of participation in BJJ as one of the following: non-competitor who
uses BJJ as a form of exercise (n = 36, 25.7%), non-competitor who trains for defense (n = 21, 15.0%),
amateur competitor (n = 77, 55.0%), and professional competitor (n = 6, 4.3%). The average athlete
participates in BJJ-specific training 3.7 days per week (StDev 1.56, median 4, range 7), totaling 7.63
hours per week (StDev 4.87, median 6.25, range 39), and competes in 2.18 competitions per year
(StDev 2.57, median 2, range 14).
Injuries were differentiated as medically diagnosed or self-diagnosed. Medically diagnosed
injuries are those evaluated by a medical professional. Self-diagnosed injuries are self-reported
injuries the athlete did not seek medical attention for. Self-diagnosed injuries were only included in
this study if they prevented the athlete from participating in BJJ training for at least one week. This
Sports 2017, 5, 39 4 of 9
was done to separate minor injuries from more clinically significant injuries affecting their
participation in sport.
Each individual reported injury can be found in Table 2. The overall distribution of injuries is
shown in Figure 3 and the distribution of medically and self-diagnosed injuries can be found in
Figures 4 and 5, respectively. Additionally, the distribution of injuries by age, belt level, and weight
class can be found in Tables 35, respectively.
Table 2. List of all injuries reported by athletes.
Medically Diagnosed Injury Injuries (n) Self-Diagnosed Injury Injuries (n)
Head and Face (n = 32, 6.6%)
Concussion 3 Black Eye 13
Eye injury 1 Cauliflower ear 11
Other 1 Broken tooth 1
Other 2
Neck (n = 21, 4.3%)
Muscle injury 5 Cervical pain 9
Disc injury 4
Ligament/tendon strain 2
Vertebral fracture 1
Trachea injury 0
Back (n = 43, 8.8%)
Disc injury 5 Lower back pain 13
Muscle spasms 3 Muscle spasms 9
Other 3 Upper back pain 6
Muscle injury 2
Vertebral fracture 1
Spondylolysis/-listhesis 1
Torso (n = 27, 5.5%)
Fractured ribs 6 Chest pain 13
Other 4 Abdominal pain 3
Abdominal muscle injury 1
Clavicle fracture 0
Shoulder (n = 41, 8.4%)
Rotator cuff injury 7 Shoulder pain 25
AC joint separation 3
Dislocation 3
Other 2
Labrum tear 1
Elbow (n = 51, 10.5%)
Elbow hyperextension 4 Hyperextension 26
Arm/forearm muscle 2 Elbow pain 12
Strain/sprain 2 Arm/forearm pain 2
Elbow fracture 1
Bone fracture 1
Ligament/tendon tear 1
Dislocation 0
Wrist (n = 9, 1.8%)
Bone fracture 1 Wrist pain 7
Sprain/strain 1
Sports 2017, 5, 39 5 of 9
Hand and Finger (n = 70, 14.4%)
Jammed finger 4 Jammed finger 28
Other 4 Finger hyperextension 22
Bone fracture 3 Finger pain 6
Finger hyperextension 2
Dislocated finger 1
Ligament/tendon tear 0
Hip and Groin (n = 15, 3.1%)
Other 1 Hip pain 8
Bone fracture 0 Groin pain 6
Dislocation 0
Ligament/tendon 0
Muscle injury 0
Leg and Gluteal (n = 11, 2.3%)
Quad/hamstring injury 2 Leg pain 5
Bone fracture 1 Gluteal pain 1
Calf injury 1
Gluteus injury 1
Knee (n = 45, 9.2%)
Meniscus tear 12 Knee pain 19
Ligament/tendon tear 7
Knee sprain/strain 5
Patella dislocation 1
Other 1
Ankle (n = 30, 6.2%)
Sprain 4 Sprain 22
Bone fracture 2 Ankle pain 1
Ligament/tendon tear 1
Achilles tendon 0
Foot and Toes (n = 52, 10.7%)
Bone fracture 7 Jammed toe 15
Turf toe 5 Toe hyperextension 13
Jammed toe 2 Foot or toe pain 5
Toe dislocation 2
Lisfranc injury 1
Toe hyperextension 1
Other 1
Ligament/tendon tear 0
Skin (n = 40, 8.2%)
Laceration requiring stitches 2
Folliculitis/carbuncle/furuncle 2
Impetigo 3
Cellulitis 1
Staph infection (unsure) 5
Molluscum Contagiosum 3
Verrucae 3
Ringworm 15
Other 6
Sports 2017, 5, 39 6 of 9
Figure 3. Overall distribution of injuries by anatomic location.
Figure 4. Distribution of medically diagnosed injuries by anatomic location.
Sports 2017, 5, 39 7 of 9
Figure 5. Distribution of self-diagnosed injuries by anatomic location.
Table 3. Distribution of injuries sustained by age group.
Age
Injured
Athletes (n)
Injured
Athletes (%)
Most Common Injury (n)
1829 62 51.7 Hand/fingers (26)
3039 44 36.7 Hand/fingers (24)
4049 12 10 Neck (6)
5059 2 1.7 Skin infection (1), Foot/toes (1), Hand/fingers (1), Torso (1), Laceration (1)
Table 4. Distribution of injuries sustained by belt level.
Belt Level
Injured Athletes
(n)
Injured Athletes
(%)
Most Common Injury (n)
White 51 42.5 Hand/fingers (21)
Blue 39 32.5 Hand/fingers (18)
Purple 16 13.3 Knee (10), Hand/fingers (10)
Brown 6 5 Knee (4), Hand/fingers (4)
Black 8 6.7 Hip/groin (4)
Table 5. Distribution of Injuries Sustained by Weight Class.
Weight Class
Injured
Athletes (n)
Injured
Athletes (%)
Most Common Injury (n)
Rooster 4 3.3 Shoulder (4)
Light feather 6 5.0 Hand/fingers (5), Skin infection (5)
Feather 18 15.0 Hand/fingers (11)
Light 26 21.7 Knee (15)
Middle 22 18.3 Hand/fingers (10), Arm/elbow (10)
Medium heavy 9 7.5 Hand/fingers (5)
Heavy 8 6.7 Shoulder (4)
Super heavy 6 5.0 Hand/fingers (5)
Ultra heavy 8 6.7 Torso (4), Skin infection (4)
Unsure 13 10.8 Arm/elbow (5), Hand/fingers (5), Foot/toes (5)
Sports 2017, 5, 39 8 of 9
4. Discussion
BJJ is an increasingly popular martial art but little is known about the incidence and prevalence
of injuries in the sport [3]. Prior research has identified the incidence rate of injury in competition but
has not addressed training injuries [6,7]. This is the first study to our knowledge that addresses the
prevalence of injuries during BJJ training. Discovering the prevalence of injuries in training is
important because athletes spend more time in training than in competition. As evidenced by our
study, the average athlete participates in BJJ specific training approximately four days per week but
only competes in two tournaments per year. Athletes, coaches, and medical professionals may use
this information to better understand what injuries are more likely to occur in training.
Overall, the most common injuries occurred to the distal extremities. The two most common
injuries occurred to the hands and fingers and the foot and toes. The third and fourth most injured
locations were slightly more proximal and occurred to the arm and elbow and the knee. This pattern
of increased distal injury potentially has a sport-specific etiology. The hands and fingers have much
contact time with the opponent and are used to grasp the opponent’s clothing and body to maintain
control, increasing the potential for injury. The feet and toes of the BJJ athlete may be at an increased
risk of injury because athletes are barefoot when they train. Moreover, both fingers and toes can get
caught in the opponent’s clothing or the gym mat the athletes train on.
Skin infections were the most common medically diagnosed injury. We hypothesize that athletes
tend to seek medical treatment for skin infections more frequently than other injuries due to concern
of spreading a potentially contagious infection to their training partners; other injuries would not
directly affect other athletes. However, skin infections may simply be more prevalent.
Our study indicates that athletes were more likely to seek medical attention for lower extremity
injuries. Injuries to the knee and foot/toes were the second and third most common body parts to be
injured. In contrast, the most common self-diagnosed injuries involved the upper extremities:
hands/fingers, and arm/elbow. Injuries to the upper extremities occur more frequently in training but
are not significant enough to warrant medical attention, while lower extremity injuries occur less
frequently but are more severe. However, athletes may perceive lower extremity injuries as more
significant causing them to seek medical care.
Scoggin et al. found elbow injuries to be the most prevalent orthopedic injury during BJJ
competition [7]. Similarly, Kreiswirth et al. found elbow and knee injuries to have the same rate of
injury in competition [6]. However, our study found that the hand/fingers followed by foot/toes were
the most commonly injured body locations in training. The difference is likely due to the differing
goals of training and competition. In competition, athletes can win a match via submission. Athletes
apply extreme stress to their opponent’s joints to force them to “tap-out” and resign the match. This
may result in injury especially if the opponent refuses to tap-out. In contrast, during training athletes
are less likely to put equivalent stress on their opponent’s joints via submission to avoid injuring their
training partner.
Wrestling and judo are grappling sports similar to BJJ. Agel et al. found the most common
injuries in collegiate wrestling practice to be skin infections (17.2%), knee injuries (14.8%), and ankle
injuries (7.3%) [4]. This is comparable to our finding that skin infections and knee injuries are the most
common medically diagnosed injuries. In the sport of Judo, Green et al. found finger and knee injuries
to be the most prevalent injuries in competition; data on training injuries is not available[5]. This
finding is consistent with our data that hand and finger injuries were the most common overall
injuries in BJJ training.
The goal of this research is to help practitioners of BJJ prevent injury. Coaches can focus their
education and develop their athletes with our results in mind. They can emphasize teaching students
how to avoid the most common injuries with proper technique. Similarly, the athlete can better
recognize the potential for injuries if a certain body part is being manipulated by an opponent. For
example, the athlete can tap-out faster while training to avoid injury. Also, skin infections were the
most common medically diagnosed condition; spread of such infections can be reduced if awareness
is increased.
Sports 2017, 5, 39 9 of 9
This study has potential limitations. We sent our survey to BJJ gym directors via publicly
available e-mail addresses and asked them to forward our survey to their adult students. Therefore,
we do not know how many athletes ultimately received our survey and are unable to calculate a
response rate. Recall bias may have affected this study because respondents were asked to list injuries
that occurred within the last year. Determining the etiology of each individual injury was beyond the
scope of this study. A prospective study following a cohort of BJJ athletes would be helpful in
determining both the etiology and incidence rate of injuries in practice. Despite the limitations of this
study, we believe it contributes useful information on training injuries in BJJ athletes across the
United States.
5. Conclusions
The goal of this epidemiological study is to determine the prevalence and most common injuries
sustained during BJJ training. Respondents were allowed to report medically diagnosed and self-
diagnosed injuries. Overall, the most common injuries occurred to the hands, fingers, feet, and toes.
This finding indicates athletes were more likely to sustain distal rather than proximal injuries. Skin
infections were the most common medically diagnosed condition, while the most common self-
diagnosed injuries were to the hands and fingers. Athletes reported more frequent medically
diagnosed injuries to the lower extremity and more frequent self-diagnosed injuries to the upper
extremity. Upper extremity injuries appear to be more frequent but less severe when compared to
lower extremity injuries in the BJJ athlete.
Acknowledgments: We would like to acknowledge the contribution of Shawn Hemelstrand for lending his
expertise in Brazilian jiu-jitsu and Kimberly Jasmer-McDonald for reviewing the manuscript. The University of
Missouri Department of Physical Medicine and Rehabilitation provided funding for the survey incentive. We
did not receive funding to cover the costs of publishing in open access.
Author Contributions: A.M. contributed to the concept and design of the study, data collection, statistical
analysis, and drafted the manuscript. F.M. contributed to the design of the study, data collection, and reviewed
the manuscript. J.M. contributed to data collection and analysis, and reviewed the manuscript. C.W. contributed
to the design of the study and reviewed the manuscript.
Conflicts of Interest: The authors declare no conflict of interest. The funding sponsors had no role in the design
of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the
decision to publish the results.
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wrestling injuries: National collegiate athletic association injury surveillance system, 19881989 through
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© 2017 by the authors. Submitted for possible open access publication under the
terms and conditions of the Creative Commons Attribution (CC BY) license
(http://creativecommons.org/licenses/by/4.0/).
... Seventy-five percent of shoulder injuries in BJJ athletes occur during sweeping and tumbling [9]. However, sweeping and tumbling can lead to scoring and winning matches [10,11]. Therefore, BJJ athletes are willing to use those techniques, and they are at risk of sustaining shoulder injuries [9]. ...
... Therefore, BJJ athletes are willing to use those techniques, and they are at risk of sustaining shoulder injuries [9]. Rotator cuff injury and acromioclavicular joint separation are the most common shoulder injuries in BJJ athletes [11]. Seventy-three percent of acromioclavicular (AC) joint separations showed scapular dyskinesis (SD), which is a malfunction of the scapula [12]. ...
... Neck pain alters scapular motion during arm elevation [22]. BJJ has a higher neck injury rate than judo or kickboxing [11,23]. Therefore, BJJ athletes are more exposed to SD; however, research on this topic is lacking. ...
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BACKGROUND AND OBJECTIVES A notable gap persists in understanding the prevalence of pain and musculoskeletal injuries in combat sports. This study offers a comprehensive exploration of the most affected anatomical regions. Such an investigation is pivotal for refining clinical strategies involving preventive measures and physiotherapeutic interventions. METHODS This is a cross-sectional observational study. Individuals aged 18 years or over, combat sport modalities practitioners, of both genders, and capable of answering the questionnaire were included. Data were analyzed using descriptive statistics and the Chi-square test. RESULTS The final sample consisted of 71 athletes. Female athletes practiced 12.65% Judo and 21.51% practiced Jiu-jitsu, while 26.58% of male athletes practiced Judo and 39.24% Jiu-jitsu. The mean age was 31.14±11.75 years, and body mass index of 27.69 kg/m2 (±5.31). The average time of practice was 8±10.59 years. The regions most affected by pain in the last 12 months were the lumbar spine (90%), knees (90%) and wrists/ hands (60%). Female Judo presented a significant index of pain in the last 12 months in the upper limbs, and the neck was the region identified as most responsible for limiting activities. In the last 7 days, the thoracic and lumbar spine regions were more significant. In female Jiu-jitsu, in the 12-month and 7-day analyses, the ankle/foot were the most affected regions when compared to the male gender, and the knees were identified as most responsible for limiting activities. CONCLUSION A comprehensive description of the main regions affected by musculoskeletal disorders and pain is of fundamental importance for the development of prevention and physiotherapeutic treatment strategies. Keywords Athletic injuries; Martial arts; Pain
... BJJ utilizes a variety of takedowns, submission attacks, and positional control to submit, and subdue opponents while grappling, thus exposing practitioners and opponents to potential injury. Recent studies utilizing surveys have reported a high prevalence of musculoskeletal injuries involving elbows, shoulders, knees, hands, and fingers [2][3][4]. Fewer studies have examined national databases associated with martial arts injuries, including BJJ injuries, which highlighted most involving the head, neck, and trunk, and were most commonly the resultant of an opponent falling on the participant or accidental strikes [5]. Case reports have highlighted less common and severe injuries sustained during BJJ, such as carotid artery dissection and flexion-distraction injuries of the spine [6,7]. ...
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To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's wrestling and identify potential areas for injury prevention initiatives. From 1988-1989 through 2003-2004, 17% of NCAA schools sponsoring varsity men's wrestling programs participated in annual Injury Surveillance System (ISS) data collection. Patterns of injury were consistent with the person-to-person, combative contact between wrestlers. The musculoskeletal system and head were the most vulnerable areas during competitions; skin infections are a continuing concern in the practice environment. The incidence of injuries in practices exhibited no significant increase over time, a positive trend that may be consistent with the influence of the recent NCAA weight management rules. Expansion of the present ISS to include indirect causes of injury, such as weight loss practices, would strengthen the analysis of data. Efforts by referees to be vigilant for potentially dangerous holds and by athletic trainers to improve wrestler and mat hygiene should be continued.
Available online: http://www.ufc.com/fighter/Royce-Gracie?id= (accessed on 13
  • Royce Gracie
Royce Gracie. Available online: http://www.ufc.com/fighter/Royce-Gracie?id= (accessed on 13 September 2016).
Available online: http://www
International Brazilian Jiu-Jitsu Federation. Available online: http://www.Ibjjf.com (accessed on 13 September 2016).