“We Both Know Why You Don’t Like Combatives”

Basketball, Warzone Medical Evacuations, and the Myth That Combatives Is “Too Dangerous”

When I was the Commandant of the United States Army Combatives School, we used to sell t-shirts that said:

“We both know why you don’t like Combatives.”

The phrase spread through the Army because soldiers immediately understood what it meant. Not that Combatives was inconvenient. Not that it was ineffective. Not that it required resources or scheduling effort. It meant that fighting exposes people.

Combatives strips away rank, excuses, verbal confidence, and carefully managed self-image. It forces soldiers to confront a brutally simple question in front of their peers: can you physically dominate another determined human being in a violent encounter, or will you be dominated by them?

Many people are uncomfortable discovering the answer.

Over time, the socially acceptable way to avoid that discomfort became the language of “safety.”

“Combatives is too dangerous.”

At first glance, that sounds responsible. Military leaders absolutely should care about injuries and readiness. Injured soldiers cannot train, deploy, or fight. But if safety is truly the concern, then the Army should apply the same evidence-based standard to all physical training activities rather than selectively applying it to the one directly connected to interpersonal violence.

That is where the argument against Combatives begins to collapse.

The modern Army already accepts substantial orthopedic injury risk throughout military culture. Running and Road marching produces injuries. Airborne operations produce injuries. Obstacle courses produce injuries. Weightlifting produces injuries. Recreational athletics produce injuries. The Army accepts those risks because leaders believe the benefits outweigh the costs. The real issue, therefore, is not whether the Army accepts injury risk. It clearly does. The real issue is why Combatives is so often treated as uniquely unacceptable despite data showing injury profiles comparable to or lower than many culturally accepted activities.

The deployment medical literature from Iraq and Afghanistan is especially revealing. Studies examining medical evacuations during Operations Iraqi Freedom and Enduring Freedom found that approximately 75–83% of evacuations were due to disease and non-battle injuries rather than direct combat wounds (Cohen et al., 2011; Knapik et al., 2013). This surprises many people because public imagination associates wartime medical evacuation primarily with gunshot wounds and explosions. The reality was far different. Modern deployments generated enormous numbers of orthopedic injuries, musculoskeletal disorders, sports injuries, overuse injuries, and training-related injuries severe enough to remove soldiers from theater entirely.

Among these non-battle injuries, sports and physical training consistently ranked among the leading mechanisms associated with evacuation from theater. Importantly, the literature tracked “physical training” and “basketball” separately. Physical training referred to organized conditioning activities such as running, calisthenics, and unit PT. Basketball was categorized independently. And among sports-related evacuation injuries, basketball accounted for approximately 24%, making it the single largest identified sports-related mechanism associated with evacuation from theater. All regular organized physical training accounted for only approximately 19%, weightlifting approximately 17%, and football approximately 16% (Knapik et al., 2013).

These were not minor injuries treated at sick call. These were injuries serious enough to require transportation through the evacuation system, consume surgical resources, require rehabilitation, and reduce operational manpower. The most common injuries included sprains, fractures, dislocations, and major knee injuries. The knee alone accounted for roughly 26% of evacuated injuries.

Yet despite this, nobody seriously proposed removing basketball from military culture.

Why?

Because everyone intuitively understood that the Army accepts injury risk from activities believed to contribute to morale, cohesion, fitness, aggression management, and competitive spirit. Basketball’s benefits were perceived to outweigh its costs, so the injury burden was culturally accepted.

Combatives, however, is judged differently.

The numbers become even more surprising when examined carefully. If approximately 75–83% of medical evacuations were non-battle injuries, and sports and physical training represented a substantial portion of those injuries, and basketball alone accounted for approximately 24% of sports-related evacuations, then basketball-related evacuations represented a surprisingly large burden within the wartime medical system.

Using conservative assumptions illustrates the point clearly. If approximately 80% of evacuations were non-battle injuries, and sports and physical training represented roughly 20% of those non-battle injuries, and basketball accounted for 24% of sports-related evacuations, then the calculation becomes:

0.80 \times 0.20 \times 0.24 = 0.0384

Under this conservative model, basketball would account for approximately 3.8% of all medical evacuations from theater.

That is an extraordinary burden for a recreational activity inside combat zones.

Now compare this to gunshot wounds. Combat casualty literature from Iraq and Afghanistan consistently found that explosive injuries dominated combat trauma, while gunshot wounds represented only one subset of combat injuries. Typical combat injury distributions showed blast injuries accounting for approximately 70–80% of combat trauma, while gunshot wounds accounted for approximately 15–25% (Belmont et al., 2010; Cross et al., 2011). If combat injuries represented approximately 20% of total evacuations, and gunshot wounds represented approximately 20% of combat injuries, then gunshot wound evacuations estimate to:

0.20 \times 0.20 = 0.04

or roughly 4% of all evacuations.

This comparison must be understood carefully. It does not mean basketball was “more dangerous than combat.” Combat trauma included blasts, fragmentation wounds, burns, crush injuries, multiple fatal injury categories, and devastating polytrauma. But it does strongly suggest something many people will find deeply uncomfortable: basketball-related medical evacuations may have approached the same general order of magnitude as gunshot wound evacuations during portions of the Iraq and Afghanistan wars.

The idea that grappling-based Combatives is uniquely dangerous is also not supported by the sports medicine literature. Studies examining Brazilian Jiu-Jitsu, wrestling, and other grappling arts consistently show injury profiles comparable to, and often lower than, many conventional athletic activities. A recent systematic review examining Brazilian Jiu-Jitsu injury epidemiology found injury rates around 5.5 injuries per 1,000 training hours, with most injuries involving orthopedic problems such as knee injuries, shoulder injuries, elbow injuries, neck strains, and joint sprains (Freitas et al., 2025). Most importantly, the overwhelming majority of injuries were musculoskeletal rather than catastrophic neurological trauma.

The mechanism of injury also differs substantially between grappling and sports such as basketball. Basketball injuries are frequently accidental, explosive, and non-consensual in timing. They result from awkward landings, sudden directional changes, collisions, falls, and non-contact ACL ruptures. Nobody taps out before tearing an ACL.

Grappling-based training, by contrast, possesses several built-in safety mechanisms. Properly supervised grappling environments rely on graduated resistance, positional control, instructor supervision, controlled intensity, and tap-based stopping mechanisms that allow participants to stop exchanges before catastrophic injury occurs. This is one reason why concussion exposure in grappling sports is dramatically lower than in striking sports and often lower than in many contact team sports.

The argument that Combatives is “too dangerous” therefore often functions less as a scientific argument and more as a cultural one.

Combatives uniquely exposes fear, competitiveness, physical inadequacy, aggression, dominance hierarchies, and emotional discomfort under pressure.

And because of that, discussions surrounding Combatives often become emotionally distorted in ways not consistently applied to other military activities. The Army does not eliminate every activity that produces injuries. Road marching, airborne operations, obstacle courses, field exercises, and unit athletics all generate orthopedic injury risk. In each case, the institution debates, mitigates, modifies, and manages that risk because the activity is believed to contribute to readiness. Combatives should be evaluated by the same standard: not whether injury is possible, but whether the readiness value justifies the risk and whether the program is designed intelligently enough to control it.

The real debate, therefore, is not about safety.

It is about whether the institution values controlled training in interpersonal violence enough to tolerate a level of risk it already routinely accepts elsewhere.

Combatives does not merely teach techniques. Routine Combatives training is one of the few leadership tools available that can systematically inculcate a unit with a genuine warrior ethos rather than a performative one.

It develops confidence under pressure, aggression management, emotional control during violence, resilience during chaotic physical struggle, and comfort with physical dominance contests. These are not abstract psychological traits. They are trainable behaviors directly connected to battlefield performance.

More importantly, Combatives creates an environment where competence and courage become difficult to fake. A soldier can cosplay warrior culture through uniforms, tough talk, tattoos, motivational language, and carefully managed professional identity. But live grappling exposes reality very quickly. It reveals who remains calm under pressure, who can impose their will physically, who quits under stress, who can continue functioning while exhausted, uncomfortable, embarrassed, or dominated, and who possesses the confidence to engage another human being aggressively at close range.

This matters because the Soldier’s Creed does not say:
“I stand ready to discuss conflict in a collaborative professional environment.”

It says:
“I stand ready to deploy, engage, and destroy the enemies of the United States of America in close combat.”

That statement implies more than technical proficiency with weapons systems. It implies psychological comfort with controlled violence, physical dominance, and aggression under life and death pressure.

Combatives training gives leaders a practical mechanism for developing and evaluating those attributes inside a controlled training environment. It creates a culture where warrior ethos becomes tied to demonstrated behavior rather than performance theater.

A military culture increasingly uncomfortable with controlled interpersonal aggression will eventually struggle to produce soldiers psychologically prepared for violent confrontation.

That baseline matters because close combat is not a rare cinematic contingency that occurs only after weapons fail or ammunition runs dry. Modern Combatives engagements occur primarily because soldiers fight in confined spaces where human bodies physically collide. Buildings, trenches, vehicles, alleyways, stairwells, detainee operations, and crowded urban terrain compress violence into grappling range almost immediately.

When soldiers enter an 8-by-10-foot room occupied by a determined enemy, it isn’t a marksmanship contest. It’s a fight. The question is not simply who can shoot more accurately. It is who can even bring their weapons to bear inside a chaotic, compressed, rapidly entangling human collision.

That fight will involve creating opportunities to shoot, weapon retention, controlling the enemy’s ability to access or employ their weapons, striking, grappling, positional dominance, and the ability to continue functioning aggressively while another human being is physically resisting often within arm’s length.

The post-deployment research from Iraq and Afghanistan strongly reinforces this reality. In one of the most important studies conducted on the subject, Peter Jensen of the Center for Enhanced Performance at West Point analyzed 30 post-combat surveys administered to U.S. Army soldiers returning from deployments between 2004 and 2008. Out of 1,226 soldiers surveyed, 216, approximately 19%, reported using hand-to-hand combat skills during at least one combat encounter (Jensen, 2014).

That finding should not be surprising. Modern militaries do not send soldiers into buildings, compounds, tunnels, vehicles, and densely populated urban terrain because they intend to kill everyone they encounter. If that were the objective, cruise missiles and air strikes would often suffice. Soldiers are sent because modern warfare, even in a peer to peer engagement, requires discrimination, restraint, physical control of human beings, and the ability to dominate complex environments occupied by civilians, detainees, noncombatants, and actively hostile enemies simultaneously.

And once human beings are compressed together inside confined spaces, violence rapidly becomes physical. Weapons become entangled with bodies. Access to angles and lines of fire becomes contested. Soldiers lay hands on people because controlling human beings physically is an unavoidable component of modern close combat.

This is why Combatives engagements occur so frequently in urban operations, detainee handling, vehicle extractions, room clearing, crowd control situations, and other confined-space encounters. The forcing factor is not usually the absence of weapons. The forcing factor is proximity.

That number alone, 19% of Infantry Soldiers reporting using hand-to-hand combat skills, should permanently end the myth that Combatives is some exotic “last resort” skill irrelevant to modern warfare. If anything, several major trends suggest the importance of close combat skills is likely increasing rather than disappearing.

The world is becoming increasingly urbanized, concentrating conflict into dense cities, apartment complexes, industrial zones, subterranean infrastructure, and crowded human terrain where violence naturally compresses into confined spaces. At the same time, the proliferation of drones, persistent surveillance, precision fires, and networked battlefield sensors is making movement in open terrain increasingly dangerous. Modern soldiers spend more time concealed, moving through structures, using cover, operating in restricted spaces, and attempting to avoid detection from above. Those conditions repeatedly force human beings into sudden, chaotic, close-range encounters where physical control, weapon retention, grappling, and the ability to dominate another person at arm’s length become critically important.

In many ways, modern technology is not eliminating close combat. It is channeling it into tighter and more physically entangled environments.

The findings become even more significant when the type of fighting employed is examined. Among the soldiers reporting close combat engagements, grappling techniques accounted for approximately 72.6% of reported techniques used. Weapons-based strikes such as muzzle strikes accounted for approximately 21.9%, while striking alone, punching and kicking, represented only about 5.5% of reported techniques (Jensen, 2014).

In other words, the battlefield overwhelmingly pushed soldiers toward grappling problems. There must be a reason why we didn't shoot them from across the room, or they didn't shoot us, and that reason is why we grabbed them, or they grabbed us. That is why Combatives always involves grappling.

The soldiers’ descriptions further indicated that these engagements occurred across a wide variety of operational contexts, including close combat inside urban terrain, detainee operations, crowd control situations, and confined-space encounters where bodies, weapons, and terrain became physically entangled (Jensen, 2014).

Subsequent combat feedback studies involving Army Combatives instructors reinforced the same themes. Experienced instructors with combat deployments consistently emphasized the importance of automatic fighting skills, adaptability under stress, and large volumes of live training. They repeatedly identified the psychological dimensions of close combat, fear management, aggression control, functioning under pressure, and confidence during physical violence, as central to battlefield success. (Jensen, 2017)

This is one reason virtually every military force in the world continues to maintain some form of close-combat training despite dramatic advances in technology. The battlefield repeatedly compresses human beings into physical contests for control of space, weapons, and bodies.

Combatives training prepares soldiers for that reality while simultaneously giving leaders a mechanism for building a genuine warrior culture grounded in demonstrated behavior rather than symbolic performance. A unit that routinely trains together under controlled physical pressure develops a fundamentally different relationship with fear, aggression, accountability, and confidence than a unit that merely discusses warrior ethos abstractly.

The evidence is clear. The Army already accepts substantial orthopedic injury risk from recreational athletics and conventional physical training. During Iraq and Afghanistan, basketball alone accounted for approximately one-quarter of sports-related evacuation injuries from theater, making it the single largest identified sports-related evacuation category in the deployment injury literature. The cumulative evacuation burden associated with basketball may even have approached the same general order of magnitude as gunshot wound evacuations during portions of the wars.

Yet basketball remained universally accepted because the institution believed its benefits outweighed its risks.

The same evidence-based standard should apply to Combatives.

The data do not support the claim that properly supervised grappling-based Combatives training is uniquely dangerous.

What Combatives uniquely does is expose fear, weakness, competitiveness, and physical inadequacy in a public way.

Which is why the old t-shirt slogan still resonates years later:

“We both know why you don’t like Combatives.”

References

Belmont, P. J., Goodman, G. P., Zacchilli, M., Posner, M., Evans, C., & Owens, B. D. (2010). Incidence and epidemiology of combat injuries sustained during Operation Iraqi Freedom. Journal of Trauma, 68(1), 204–210.

Cohen, S. P., Brown, C., Kurihara, C., & Plunkett, A. (2011). Diagnoses and factors associated with medical evacuation and return to duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom. The Lancet, 378(9798), 1431–1438.

Cross, J. D., Ficke, J. R., Hsu, J. R., Masini, B. D., & Wenke, J. C. (2011). Battlefield orthopaedic injuries cause the majority of long-term disabilities. Journal of the American Academy of Orthopaedic Surgeons, 19(Suppl 1), S1–S7.

Freitas, T. T., et al. (2025). Epidemiology of injuries in Brazilian Jiu-Jitsu athletes: A systematic review. Sports Medicine Review.

Jensen, P. R. (2014). Hand-to-hand combat and the use of combatives skills: An analysis of United States Army post-combat surveys from 2004–2008. Center for Enhanced Performance, United States Military Academy, West Point, NY.

Jensen, P. R., & Goodman, S. (2017). “Combat Feedback from U.S. Army Combatives Instructors.” Infantry, July–September 2017, U.S. Army Maneuver Center of Excellence, Fort Benning, GA.

Knapik, J. J., et al. (2013). Nonbattle injuries during U.S. military operations in Iraq and Afghanistan. Military Medicine, 178(5), 495–502.