26 April 2011

The Importance of a Good Left Hook

Outside of work, I practice martial arts -- in particular, karate. We run a dojo which focuses on the traditional elements of the fighting system but also on real-world applications. By which I mean we do all the stereotypical karate "stuff" -- punching the air, conditioning, kata forms, that sort of thing -- but we also try to teach a more holistic self-defense approach including practical street fighting techniques, grappling, and personal safety and security. This differs a bit from many martial arts schools in that we are not sport oriented at all. Our students don't go to tournaments, and we don't teach techniques which are flashy but which would not be useful in a real fighting situation.

Don't get me wrong -- I love to watch the shotokan guys performing their kata with their incredibly athletic low stances, and I love to see the tae kwon do guys with their acrobatic spinning kicks. I mean no disrespect for their styles, and I know many practitioners of these arts are also excellent fighters. But the reality of a street fight is that they are fast, messy, frantic, and incredibly emotional. They do not have the elegant distance and measured timing that a tournament sparring match has, with the complex back and forth of feints, footwork and tactics. If you can pull off a leaping kick in the heat of a real altercation, well, that would be quite an accomplishment. But it would be difficult, since the distance for that sort of thing gets real close, real fast. They say any street fight that lasts more than ten seconds, you're probably losing.

So when I teach self-defense, I focus on close-in techniques: hooks and uppercuts, elbows and knees, wrist locks and arm bars. Simple, easy, high-yield stuff. Not as devastating as a lovely roundhouse kick, but lower risk and more likely to land. 

As you close distance, the punches you can effectively use change. The long straight punch is great from middle distance, as is the back-fist punch. When you're really close, you want your punches to arc under or around your opponent's guard. If you can get your hip into it, a hook to the temple or the jaw can be devastating.

Case in point: I recently saw a young man from the local MMA (mixed martial arts) club. As an aside, I love MMA. It's still a sport, but it's pragmatic and authentic and intense. It's not what I do, but I can really appreciate its virtues. Anyway, this young fellow had taken a roundhouse to the right temple and had dropped like the proverbial sack of potatoes. His mates had not been alarmed by this, perhaps because knockouts are common in some dojos, but they really should have done something when he had a seizure. I guess it was a brief seizure, because they didn't call 911. They propped him up, gave him an ice pack and he started to come around after a while. (I swear, you can't make this stuff up.) In fairness, they were all pretty young, in their late teens and early twenties, and I guess they didn't know any better. 

Our fellow went home and had a restless night's sleep. His headache kept him awake. The next afternoon he was still feeling poorly, with some nausea and a bit off balance. Finally he decided to come in and get checked out. His scan, as I am sure you have now guessed, showed a bleed:

subdural apex
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You can see the subtle enhancing rim of bright blood along the left side of the skull around the edge of the brain (remember, the CT image is reversed). More strikingly, the midline is shifted from the left to the right and the dark slits of the left ventricles are compressed. This indicates fairly severe swelling of the brain. 

This patient, fortunately, did great. He did not require surgery -- the amount of bleeding was actually minimal. It was the swelling that was making him so sick. He did not have any more seizures, and neurologically made a complete recovery. (Whether he will have long term cognitive problems from the head injury is an open question.)

The teaching point here, applicable whether you are medical or martial in your interests, is that the vector, the direction, of applied force matters a lot to the brain. The skull is strongest in the forehead and the back of the head, and the brain is designed to rock back and forth in the front-back axis without too much damage. This is not surprising! Evolution is smart, and humans have been falling forward and backwards for eons, so there's a good survival advantage to being able to withstand the most common head injuries. But when the force is directed from the side, the risk of injury goes up dramatically. The brain is closer to the skull in the temporal area, and is tethered in a way that it gets rattled much more violently from an impact to the side. The skull is thinner and weaker there, and the major blood vessels run along the temple. One good whack along the ear can induce anything from a concussion to a lethal hemorrhage.

The take-home points are:

  • If you teach a dojo, I would not allow hooks to be used in practice, or perhaps only very cautiously with mandatory headgear.
  • If you are in fear for your life and wish to inflict injury, this is a great place to hit.
  • If someone in your dojo/ER does take a shot to the temple, you need to have a high suspicion for serious injury.

Also, I suppose I would add that if your buddy has a seizure after a head injury, you should go ahead and call an ambulance. But that's just common sense, right?


  1. Hello Shadowfax,

    If you're interested in practical self-defense issues, I strongly
    recommend checking out Marc "Animal" MacYoung's site, No Nonsense Self Defense.

    Hint: By far the best self-defense information says nothing about any punches, kicks, blocks or other physical moves (except that the "Nike Defense" is an excellent physical move for self-defense).


    Jeff Deutsch

    PS: Word verification - Danes. Don't pay 'em "their" geld!

  2. Enjoyed the post!

    How long have you been doing the martial arts for? I've been kicking around the idea of giving it a shot, but have just never pulled the trigger.

  3. My dojo does self defense courses/mini-lessons in addition to regular karate...tonight, for instance, we did augmented blocks as a way to get out of someone grabbing your wrist. Seems like it would work.

    This dood I know that is like 500/10 badass who does tae kwon do and aikido (studied martial arts for 25 years, including a couple of years in Japan), but looks like a Regular White Guy actually was attacked once outside of a bar and he said he just reflexively threw the guy up and over his head.

  4. ER Jedi: If you have an ER blog, you have to also do martial arts. It's an unwritten rule.

  5. Never knew you taught, and had a Dojo. Fits though. Very cool.

    I wish there were a dojo like that around me, all that's near by is TKD. My girls are having fun and learning, but it's really taught as a sport and in the long run sport is not why I have them in martial arts. They're young now so this is fine, but as they get older I'll have to move them to a farther away school to learn how to fight properly. I think martial arts is an important part of their education, and also of course I want boy to be afraid of them when they get into their teens.

    Martial arts training is unfortunately very useful for an ER nurse too. How many incidents have we all seen where a little situational awareness and a little quick action might have prevented an injury to a staff member?


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