Concussion Discussion - Brain Injury in MMA

As a fan, I have come to enjoy highlight reel knockouts featuring dazzling head kicks, spinning back fists, or even ground and pound. The doctor part of me in contrast often feels somewhat uneasy when I see a fighter take a bit of time to regain consciousness or “eat a few too many shots” than were necessary before a referee stoppage.

Sometimes we must wonder what happens beyond the bell. Not when the fighter goes home, but in the months and years following a brutal knockout or after years and years of hard training, and particularly punching to the head.

MMA is a new, exciting sport with its own dangers and health consequences for fighters. Concussions and traumatic brain injury (TBI) are common occurrences, just as they are in high impact sports such as football and hockey.

What is a concussion?

Defining and diagnosing a concussion is based on many factors. A concussion is a brain injury that can often occur as the result of a direct blow to the head or body. The athlete is often confused, disoriented and has temporary memory loss. It can occur with or without the person losing consciousness (passing out). The brain often has to be imaged (using a CT scan or MRI) to ensure there are no skull fractures or bleeding within the brain immediately after a fight especially if a serious brain injury is suspected. For a simple concussion these tests are usually normal and the fighter needs a standardized assessment of concussion (called SAC for short) be performed by a physician that checks if their memory, alertness and orientation, and motor skills. The athlete with a concussion may have clinical impairments – such as headaches, dizziness, emotional changes, or memory issues. 90% of these post concussion problems go away completely within 10 days of the injury but for 10-15% of  athletes, they can persist for much longer. Long term problems with concussions can include: trouble walking, sleeping, memory loss, mood changes, vision changes or being bothered by noise or light.

The treatment of concussions is simple – the brain needs time to heal. Sleep, avoiding alcohol, mild pain killers for headaches are part of it.  The most important thing is to avoid physical activity or training until all symptoms of the concussion are gone.

Enter the Knockout

Being knocked out results in a loss of consciousness. By definition this would be considered a type of TBI (traumatic brain injury) or concussion. A TKO results from defenselessness when a fighter cannot “intelligently defend himself”. This disorientation and loss of awareness technically meets the criteria for a concussion.

Recently a group of investigators at the University of Toronto published a study that reviewed over 800 UFC fights and found that 12.7% of matches ended by KO, and 19.1% of matches ended by TKO due to repetitive strikes. The study lacks scientific rigor in that it is based solely on watching fight tapes and not on clinical assessments or neurological imaging. However there were several observations noted from the study:

1.    KO’s were more likely to occur during the first minute of the fight, in heavier weight classes, and in fighters who had received prior KOs

2.    54% of KO’s occurred from contact in the mandibular region (jaw or chin)

3.    Matches were stopped an average of 3.5 seconds after the KO strike during which the fighter suffered an additional 2.6 strikes

4.    For TKOs secondary to strikes, the fighter took an average of 18.5 strikes in the 30 seconds before stoppage, with 90% of these being head shots

This study has spread like wildfire within mainstream media, being covered in most major newspapers and on ESPN. The study authors state that the “trauma rate” is higher than in boxing and hockey. The authors suggest that boxing-like rules be in place such that a fighter receives a 10 second count after a knockdown (but not a takedown). They also suggest that MMA be banned in the youth because of the potential for long term harm.

Personally I am not in favor of changing the way MMA matches are carried out. MMA is a full contact sport. Comparing KO rates to boxing is really not appropriate as MMA has several different methods for obtaining a KO or TKO. I will say that I feel very strongly against a fighter taking unnecessary shots to the head, especially after a KO or TKO has already been achieved. This is where the referee becomes the most important person in the fight, and must be able to detect the moment a fighter cannot continue.

The issue with knockouts and TKO’s is that we still do not know enough about the long term potential for harm. There has been a described association between repeated brain trauma and CTE (chronic traumatic encephalopathy) and pugilistic dementia, two types of brain diseases with dementia that occur later in life. Muhammad Ali’s parkinsonism is likely in some way linked to what he did for a living (LINK: "Muhammad Ali and Parkinson's Disease: Is it fair to blame boxing?").

MMA is the fastest evolving, and most exciting sport on the planet. As fans we must always cheer when a fighter goes down, but also when he gets up and leaves the match safely. Brain health and safety will always be central to this sport, and we must always do our best not only in diagnosing injury, but also in rehabilitating it and preventing it. Let the dialogue begin….