Fighters Only

Issue 021

January 2007

When we discuss ‘safety’ in combat sports, what exactly do we mean? Physical injuries such as broken noses are a given and are written off by most as nothing more than the price of participation. Breaks and bruises can be painful for a while, but generally cause no long-term ill effects. The real risk comes from damage you can’t see and generally won’t notice until it is too late.

Dementia pugilistica literally means boxer’s dementia, more commonly referred to as ‘punch drunk’ syndrome. It is a medical term describing the condition of someone who has sustained brain damage through taking one too many shots to the head. Typical symptoms are similar to those of Parkinson’s disease and include slurred speech and loss of motor skills, resulting in difficulty performing even simple physical tasks.

In our September issue Dr Rosi Sexton wrote an article about a report that appeared in the British Journal of Sports Medicine. The report claimed that the knockout rate in Mixed Martial Arts (MMA) was statistically much higher than in other combat sports such as professional boxing. If this were true, it would mean that MMA fighters are at a greater risk of sustaining traumatic brain injury (TBI) than boxers. The implications were not good. With many national and local authorities already viewing MMA contests as a throwback to the medieval era, this report seemed to provide more evidence to justify their preconceptions.

In a way, it seems pointless to differentiate between the risk of TBI in boxing and MMA. Whilst one may be more risky than the other, the fact is that participants in either sport must accept the possibility of suffering a debilitating brain injury. However, MMA is still in the process of trying to validate itself as a ‘proper’ sport. Events in the early years played on brutality in their marketing material, promising broken limbs and buckets of blood. The negative effects of this publicity still persist.

In contrast, boxing enjoys widespread acceptance, despite the fact that there are many who lobby for it to be banned as a brute sport that poses a serious risk to the health of the athletes involved. With this in mind, the argument as to the relative safety merits of MMA and boxing become important. If MMA can be proven to be ‘safer’ than boxing in terms of TBI, it will have received a tremendous boost to its credibility as a genuine sport. Advocates of MMA have long argued that it must be a safer pursuit than boxing, because it does not place as much emphasise head contact and knockout blows. This argument seemed to have been blown out of the water by the report featured in the BJSM.

A few months later, a new report was published in the Journal of Sports Science & Medicine. Headed up by Professor Gregory Bledsoe, a team of American researchers based at the John Hopkins University School of Medicine (JHUSM) had set out to research the incidence of injury in MMA fights. They analysed data collected by the Nevada State Athletic Commission (NSAC) on all professional MMA events that took place in Nevada between September 2001 and December 2004. The NSAC also regulates professional boxing and they have overseen some of the biggest combat sport events in the world.

Previously, the JHUSM team had produced a report on professional boxing in Nevada. When they compared statistics, they noted that the knockout rate in the MMA matches (6.4%) was well below the rate of that in the boxing matches (11.4%). The MMA data covered 171 fights in total and featured 220 different fighters. A variety of information was recorded, including the nature of the injuries sustained and the way the fight ended. According to the official statistics, the most common conclusion to an MMA fight was a TKO (39.8%). The second most common was a tap out (30.4%). A TKO is anything that prevents one fighter from continuing, such as cuts or injury. The tap out is generally a response to a choke or submission hold that the fighter cannot escape from. Crucially, both of these outcomes can routinely be achieved in MMA without a single blow being landed to the head of a fighter. A similar percentage of boxing matches also ended in TKO but of course would have involved much more head contact.

After analysing the various ways the fights ended, the team looked at the type and number of injuries the fighters had sustained. It was clear that there were a lot of injuries incurred in MMA fights, although Professor Bledsoe points out that “For the purpose of this study the injury just had to be serious enough for the ringside physician to make a note of it on the post-fight evaluation”, so both minor and major injuries will have been recorded without distinction. Reports on other striking arts, such as kickboxing and Taekwondo, show that any sport that involves full contact striking will have a high rate of injury. Bledsoe’s team compared these reports to their own data on boxing and MMA. They noted that although injuries occurred in all striking sports, the rate was notably higher in MMA. The figures on professional boxing in Nevada showed 17.1 injuries per 100 fights, whereas MMA produced 28.6 injuries per 100 fights.

These figures might seem alarming, but the breakdown of the type of injuries sustained can explain them. The most common injury was lacerations to the face, such as cuts and contusions (47.9%). The second most common injury was to the hands, accounting for 13.5% of all injuries. Two factors may explain these numbers. First, MMA fighters wear 4 ounce gloves, less padded than the 8 to 10 ounce gloves worn by professional boxers. Simply put, MMA gloves cut people a lot more than boxing gloves. Second, professional fighters of any discipline generate a lot of force in their strikes. One report famously compared the punch of a professional boxer to ‘a padded wooden mallet weighing 13lbs being swung at 20mph’. That kind of power behind a fist that isn’t carrying much padding will often be enough to damage the hands as well as the opponent.

The JHUSM report did not class knockouts as injuries, though many would argue that these are the most serious injuries of all. Brain injury can be subtle and not manifest itself until long after it is originally inflicted. The only way the effects can be studied is to monitor fighters consistently during their careers. Professor Bledsoe agrees: “The best way to protect the fighters is to have some means of following them long term even when they change from state to state or country to country and fight. We need more research done in order to sort through all the issues and try to develop objective means to evaluate the fighters”.

NSAC statistics show lower knockout rates in MMA than boxing. This suggests a reduced risk of TBI in MMA participants. On the other hand, the injury rate is higher in MMA, although many would call that a fair trade. Suffering TBI is a frightening thought for anyone. Nobody is trying to argue that MMA is as ‘safe’ a sport as cricket or tennis. At the same time, it is only fair that the preconceptions are cast aside. If people can participate in MMA and be at less risk of suffering TBI than if they were taking part in the hugely popular sport of boxing, there must be a case for redressing the balance. It is also worth noting that there have as yet been no deaths attributed to MMA in Britain or the USA. Many of the supposedly safer pastimes, such as rugby and American Football, claim dozens of lives worldwide each year, some at youth level. Nobody seriously calls for these sports to be banned.

The problem with MMA is one of image. To the outsider it looks savage, even though it has undergone sweeping reforms since the early years. From the no-holds-barred nature of its early days, the UFC is now fought under NSAC rules that have evolved with fighter safety in mind. Certain techniques, such as head butts and knees to the head of a downed opponent, are banned, along with strikes to vulnerable areas such as the throat and spine. Matches are made by weight class and fighters are allowed only one fight per night. These changes make all the difference. Professor Bledsoe is impressed with the NSAC and its regulations:

“It's really not one rule that makes it a safer environment for the fighters, but the entire ability of the NSAC to follow the fights and fighters. The NSAC has well-trained ringside physicians, good medical coverage at the events, and experienced people at every level. I feel better about having the events there due to this level of experience.

My concern would be for fighters in the smaller venues where they might not get good pre-fight screening, might not be under the care of experienced ringside physicians, or might not be followed as well after the fights. As we have seen with boxing, even with all the precautions in place there can still be problems, but having experience at all levels and the extra precautions in place helps minimize the risk of these potential problems.”

This is a good point. With MMA keen to improve its public image, it doesn’t help that there are a plethora of organisations promoting events with different rules. Some of these organisations don’t come anywhere near the standards of safety and medical care that are found at an NSAC regulated event. Consistency would add to the credibility of the sport, as Professor Bledsoe points out:

“There needs to be a recognized governing body with a uniform set of rules…the public does not understand the difference between the variations in MMA rules. If someone gets seriously hurt in a smaller promotion due to lax rules, it will be a problem not only for the involved fighter but the entire sport. Having a regulating body could help minimize this risk”.

The JHUSM report concludes by calling for further detailed research to be done into the rates and cumulative effect of knockouts on individual MMA fighters. A lengthy in-depth study is essential as the next step towards establishing MMA as a legitimate sport. If studies can show that the sport is relatively safe and/or safer than boxing, then authorities may be convinced by the weight of evidence and start to it more seriously. Public opinion also remains to be swayed, and the best way of doing this is with an immaculate safety record. MMA is never going to go away, but if the sport is to be recognised rather than just tolerated, all involved must show themselves to be serious about safety.

Results of MMA Competitions in Nevada: September 2001 through December 2004