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Brain Injury in Combat Sports

For a long time boxing was the only accepted combat sport in our culture.  The risk of long term brain injury caused by boxing is well known and was first described in 1928 as “punch drunk syndrome”.  Since then this condition has been well studied and we know that sufferers have chronic traumatic encephalopathy (CTE) caused by repeated blows to the head.  CTE is caused by lesions in parts of the brain as a result of repeated trauma, concussive and sub-concussive.  CTE in other sports such as football and rugby is now being recognised.  Symptoms of CTE include:

  • learning and memory impairment
  • depression
  • poor impulse control, and
  • dementia, in advanced stages

In the last twenty years or so there has been a massive growth in the popularity of non-traditional combat sports, such as muay thai and mixed martial arts (MMA).  The latter exploded into public consciousness with the advent of the Ultimate Fighting Championship in 1993.  Since then MMA has gained notoriety, popularity and respectability, with the biggest stars becoming household names – everyone knows Conor McGregor.

Combat sports have never been more popular in terms of viewers and participation.  Everyone who takes part in it, from keep fit enthusiast to professional, is aware of the risk of acute injury.  What is worrying is the lack of awareness of the risk of CTE. Although this is beginning to change as CTE awareness is increasing through other sports such as football and rugby.  Recently the shadow of CTE has been discussed in MMA in an excellent and poignant article about Spencer Fisher, an early and popular UFC fighter.

When I was younger I trained in muay thai and there was a common belief in the gym that boxing is more dangerous.  Some of the reasons for this are: in boxing the head is hit more often; in boxing the overall length of the bout is longer; boxers are better punchers and hit the head harder; and boxing gloves and wraps let boxers punch with more force.  Due to the relative youth of non-traditional combat sports, there have been few scientific studies on the risks of injuries.  Below is a summary of some studies that have been carried out.

The first major review of previous studies was carried out in 2014 in Australia.  This showed that the risk of some kind of injury was higher in MMA than in other combat sports, such as judo, taekwondo and boxing.  This review noted a study which reviewed 642 televised MMA fights and found the proportion of bouts stopped because of head trauma exceeded that documented in other studies of boxing and kickboxing.

Another review in 2015 carried out in Australia compared taekwondo, kick boxing, MMA, judo, boxing and karate.  The top three highest rates of injury (injury per 1,000 athlete exposures) were in MMA (85.1-280.7) then boxing (77.7-250.6) and then kickboxing (109.7-155.4).  Interestingly this study looked at the total number of injuries by area of the body (table shown below).

Table showing proportion of injuries to each area of the body, separated by combat sport

Credit: https://canadianmmalawblog.files.wordpress.com/2015/09/epidemiology-of-injuries-in-full-contact-combat-sports.pdf

Table showing proportion of injuries to each area of the body, separated by combat sport

The study showed that the head and neck was most frequently injured in boxing (84%), followed by karate (74%), then MMA (64%) and kickboxing (55%).  Concussion comprised a greater proportion of total number injuries in kickboxing (19%) and boxing (14%) compared to taekwondo (6%), MMA (4%) and karate (4%).

A Canadian study in 2016 compared data from post-fight medical examinations involving 1,181 MMA competitors and 550 boxers.  They found that injury incidence in MMA competitors is slightly higher than for boxers, but MMA fighters experience more minor injuries.  Boxers are more likely to experience serious injury such as concussion or head trauma involving loss of consciousness or eye injury such as retinal detachment.

Boxing has been around for a long time and we know it’s dangerous and causes CTE.  The younger combat sports have not been around as long; and studies on its risks are not as conclusive on the issue of brain injury.  What we can assume is newer combat sports are just as dangerous.  Participants and promoters should be as switched on to this risk as their counterparts in boxing.  Viewers should be aware of the risks combat sportspeople accept in the name of entertainment.

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