Understanding concussion knowledge and behavior among mixed martial arts, boxing, kickboxing, and Muay Thai athletes and coaches

Concussion history and knowledge among top-level youth karate athletes

OBJECTIVE

To examine concussion experiences and knowledge among top-level youth karate athletes.

METHODS

This cross-sectional study collected data during the 12th World Karate Championships for cadets, juniors and under-21 athletes (held in Konya, Turkey, 2022). All 1414 registered athletes from 95 countries were invited to complete a 16-item paper-based questionnaire assessing demographic data, concussion history and concussion knowledge prior to the competing at the tournament. χ2 and Fisher's exact tests were used to analyse differences by sex, age group and continental karate federation.

RESULTS

A total of 654 athletes (46.3% response rate), including 286 (43.7%) females and 368 (56.3%) males, participated in the study, with 29.9% reporting one or more concussions during participation in karate training or competition. Older age groups (under 21 years) reported significantly higher concussion rates than younger athletes (56.9% vs 31.1% juniors and 24.7% cadets; p<0.001). Concussion knowledge revealed considerable gaps, with only 24.5% of athletes correctly identifying a concussion and 68.9% believing loss of consciousness was required for a concussion diagnosis. Misconceptions varied significantly across geographical regions, with Asian and African athletes demonstrating the greatest need for targeted education. Female athletes demonstrated better concussion reporting attitudes than males (60.4% vs 48.9%, p=0.004).

CONCLUSIONS

This study highlights the prevalence of concussions and significant knowledge gaps among top-level youth karate athletes, emphasising the need for tailored educational interventions to improve concussion recognition and management within the karate community.

Does gender equality in sports matter? examining the socio-economic impact on public perceptions

Introduction

Gender equality (GE) is increasingly becoming a key point on modern political agendas. While governments and civil societies strive to achieve this goal, we may be far from "perfect" equality between women and men. Sport is a good example of some of the inequalities that men and women face, such as pay, discrimination, and unequal opportunities.

Methods

The study uses data from the Special Eurobarometer 525 (April-May 2022) to understand attitudes towards GE in sports (ATGEQS). By applying Fuzzy-Hybrid TOPSIS approach, and other methods like Latent Profile Analysis and Multinomial Logistic Regression, I investigate how gender, age, income, education, political beliefs and nationality affect these attitudes.

Results and Discussion

The Nordic countries have the highest ATGEQS, while support for EU GE policies, left-wing views, and life satisfaction is positively related to favourable attitudes. The findings highlight the need for awareness and policies for sports participation to be created, with greater emphasis on disadvantaged groups.

Incidence of maxillofacial trauma related to kickboxing and the efficacy of protective equipment

Introduction Kickboxing is a heavily participated combat sport within the UK. With the sport involving striking opponents, it is widely perceived to be associated with an elevated risk of maxillofacial injury. However, the research is limited, with gaps that require further investigation. This study aimed to assess the frequency and distribution of these injuries and whether protective modalities, including headgear and mouthguards, help reduce them.Materials and methods In total, 92 kickboxers completed an electronic questionnaire from 11 October to 11 November 2021.Results There was an incidence rate of 71.7% where participants had experienced at least one maxillofacial injury. The lip was the most affected (26.1%; p <0.05). Injury rates per participant for headgears, mouthguards and no protection were 2.1, 2.6 and 4.7, respectively.Conclusions Maxillofacial injuries in kickboxing have a prevalence of 71%. Protective equipment successfully reduced the frequency of maxillofacial injuries (p <0.05). Experience levels are a major contributor in the incidence of these injuries. Updated regulations to mandate protective equipment may significantly reduce incidence of injury. More research is required in relation to variables such as ethnicity and bone density to identify high-risk groups.

Brain Punch: K-1 Fights Affect Brain Wave Activity in Professional Kickboxers

BACKGROUND

Kickboxing is a popular striking combat sport, and K-1 is a type of kickboxing. Direct head blows can cause significant long-term injury and affect brain wave activity.

OBJECTIVES

We aim to compare the changes in brain wave activities of fighters during a K-1 kickboxing contest to those in a control group, who were striking a punching bag and were not hit by another K-1 athlete.

METHODS

A total of 100 professional Polish K-1 kickboxers were split evenly into experimental (n = 50, age 25.5 ± 4.63 years) and control (n = 50, age 26.6 ± 5.22 years) groups. We used quantitative electroencephalography (QEEG) to assess the spectrum of brain wave activity (delta, theta, alpha, sensorimotor rhythm (SMR), beta-1 and beta-2) before and after an intervention (experimental: K-1 contest, control: simulated contest), with eyes open and then closed. The number of direct blows to the head was also recorded for all bouts. Comparative and statistical analyses between selected variables were performed.

RESULTS

K-1 fighters showed elevated baseline brain activity for the entire delta band (p < 0.001). There was significant variation in brain activity among the experimental group following the intervention and compared with the control group for all wave types (p < 0.001). No significant variation in activity was found in the control group. The number of direct head blows was positively correlated with brain activity, at delta and beta-2 wave frequencies.

CONCLUSIONS

K-1 kickboxing is associated with detectable changes in brain wave activity. It is presently unclear what the long-term effects of these changes in brain wave activities are, and longitudinal studies are necessary to study the brain health of kickboxers.

Brain trauma characteristics for lightweight and heavyweight fighters in professional mixed martial arts

Mixed martial arts (MMA) is a sport where the fighters are at high risk of brain trauma, with characteristics, such as the frequency, magnitude, and interval of head impacts influencing the risk of developing short- and long-term negative brain health outcomes. These characteristics may be influenced by weight class as they may have unique fighting styles. The purpose of this research was to compare frequency, magnitude, and interval of head impacts between lightweight and heavyweight fighters in professional MMA. Frequency, interval, event type, velocity, and location of head impacts were documented for 60 fighters from 15 Lightweight and 15 Heavyweight professional MMA fights. Head impact reconstructions of these events were performed using physical and finite element modelling methods to determine the strain in the brain tissues. The results found that LW and HW fighters sustained similar head impact frequencies and intervals. The LW fighters sustained a significantly higher frequency of very low and high magnitude impacts to the head from punches; HW a larger frequency of high category strains from elbow strikes. These brain trauma profiles reflect different fight strategies and may inform methods to manage and mitigate the long-term effects of repetitive impacts to the head.

Cranio-Maxillofacial Injuries in Mixed Martial Arts

PURPOSE

To describe a case of a maxillofacial trauma that occurred during a mixed martial arts (MMA) match and to perform a literature review of maxillofacial injuries related to MMA match to determine whether preventive models are applicable.

METHODS

The authors described a maxillofacial injury with orbital and optic nerve involvement that happened during a professional MMA match. A literature review on maxillofacial trauma in MMA was conducted on Scopus and Pubmed with specific keywords.

RESULTS

Open reduction and internal fixation of the maxillofacial complex fractures with right eye optic neuropathy following an MMA match is described. Six articles were selected for the description of trauma in the maxillofacial complex associated with MMA fights.

DISCUSSION

Literature has paid little attention to injuries during MMA matches. The most common injury locations that emerged from the literature review were the head, face, and neck. Middle facial third injuries were the most common type. Frequently the injury involved the ophthalmic area.

CONCLUSIONS

The timing of maxillofacial trauma in MMA is critical. Protective devices should be strongly promoted to prevent catastrophic consequences.

Examining the occurrence and outcomes of concussion and mTBI in mixed martial arts athletes: a systematic review

INTRODUCTION

Mixed martial arts (MMA) is a sport growing in popularity around the world. However, many individuals participate in the sport with little understanding of the potential short- and long-term consequences of injuries sustained while participating. Specifically, individuals are placed at a high risk of minor traumatic brain injury (mTBI) and concussive episodes as a result of head injuries incurred during training and competition.

AIMS

The current review aimed to examine the literature surrounding the occurrence and outcomes of mTBI in MMA athletes to gain a better understanding of these consequences.

METHODS

Twenty-five studies were identified within the current review, of which 14 examined occurrence of mTBI within the sport setting, and elevenidentified outcomes of injury.

RESULTS

Overall, studies found that MMA athletes experienced mTBI and concussion to a greater extent than athletes in other sports. Deficits in memory, reaction time and processing speed were identified following occurrence of mTBI; however, several gaps in outcome measurement were identified within the current literature, including a lack of focus on speech and language outcomes.

CONCLUSION

Future research should examine a wider variety of outcomes to provide a clearer understanding of the consequences of participating in the sport.

Combat Sports as a Model for Measuring the Effects of Repeated Head Impacts on Autonomic Brain Function: A Brief Report of Pilot Data

Automated pupil light reflex (PLR) is a valid indicator of dysfunctional autonomic brain function following traumatic brain injury. PLR's use in identifying disturbed autonomic brain function following repeated head impacts without outwardly visible symptoms has not yet been examined. As a combat sport featuring repeated 'sub-concussive' head impacts, mixed martial arts (MMA) sparring may provide a model to understand such changes. The aim of this pilot study was to explore which, if any, PLR variables are affected by MMA sparring. A cohort of n = 7 MMA athletes (age = 24 ± 3 years; mass = 76.5 ± 9 kg; stature = 176.4 ± 8.5 cm) took part in their regular sparring sessions (eight rounds × 3 min: 1 min recovery). PLR of both eyes was measured immediately pre- and post-sparring using a Neuroptic NPi-200. Bayesian paired samples t-tests (BF₁₀ ≥ 3) revealed decreased maximum pupil size (BF₁₀ = 3), decreased minimum pupil size (BF₁₀ = 4) and reduced PLR latency (BF₁₀ = 3) post-sparring. Anisocoria was present prior to sparring and increased post-sparring, with both eyes having different minimum and maximum pupil sizes (BF₁₀ = 3-4) and constriction velocities post-sparring (BF₁₀ = 3). These pilot data suggest repeated head impacts may cause disturbances to autonomic brain function in the absence of outwardly visible symptoms. These results provide direction for cohort-controlled studies to formally investigate the potential changes observed.

Comparison of Head Strike Incidence under K1 Rules of Kickboxing with and without Helmet Protection-A Pilot Study

BACKGROUND

Kickboxing is a combat sport that encompasses various forms of competition. K1 kickboxing is conducted without any restrictions on the force of strikes, and the bout can end prematurely through a knockout. Headgear has been introduced in amateur kickboxing to safeguard the head. However, scientific studies have shown that despite their use, serious head injuries can still occur. The aim of this study was to evaluate the temporal structure of the bout by calculating the number of head strikes in K1 kickboxing bouts with and without headgear.

METHODS

Thirty K1 kickboxing bouts were analyzed, with 30 participants included in the study. The fights were conducted according to the World Association Kickboxing Organization (WAKO) rules. The bouts consisted of three rounds of 2 min each, with a 1 min break between rounds. Sparring pairs were arranged according to weight categories. The first bouts were conducted without headgear, and two weeks later, the fights were repeated with WAKO-approved headgear. The number of head strikes was assessed retrospectively by analyzing video recordings of the bouts, categorizing strikes as hand or foot strikes, and differentiating between strikes that hit the head directly or indirectly.

RESULTS

The results showed statistically significant differences between bouts with and without headgear in terms of the number of strikes to the head (p = 0.002), strikes directly to the head (p < 0.001), all hand strikes to the head (p = 0.001), hand strikes directly to the head (p = 0.003), and foot strikes directly to the head (p = 0.03). Higher values were observed in bouts with headgear.

CONCLUSIONS

Headgear increases the probability of direct strikes to the head. Therefore, it is important to familiarize kickboxers with the use of headgear in their sport to minimize head injuries.

SYSTEMATIC TRAINING IN TRADITIONAL MARTIAL ARTS CHOREOGRAPHY IN COLLEGE

ABSTRACT Introduction Martial arts choreography is a sporting event of high intensity and speed. The energy metabolism of its practitioners is characterized mainly by anaerobic consumption, complemented by aerobic metabolism. Martial arts routines have particular movement rules, and the systematic training method has played a positive role in developing martial arts routines. Objective This paper explores the role of eight-week systematic training in martial arts routines. Methods 36 martial arts choreography players from colleges and universities were selected by random sampling. The above research subjects were randomly divided into experimental and control groups. The experimental group adopted an exclusive training protocol. The control group was trained traditionally. Results Significant differences were found between the two groups in the test results of eight-speed indicators. A significant difference was also found between the two groups in the test data of the three endurance indicators. Conclusion The personalized training method used in this paper significantly improved athletes’ speed and endurance levels. The research results of this paper can provide a reference for routine martial arts staff in improving the professional athletic technical level. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

QUALITY IN BALANCE SENSITIVITY THROUGH MARTIAL ARTS APPLIED TO CHILDREN

ABSTRACT Introduction: Martial arts training focuses on science, methodology, and practice. Martial arts are a symbol of physical fitness. The academic analysis of the influence of martial arts training on children’s physical health is of great importance for promoting traditional Chinese culture. It can enrich sports intervention programs to improve children’s physical health. Objective: Analyze the effect of sensory quality training on martial arts balance training in children. Methods: Children aged 8 to 12 years were selected as research subjects. After repeated deliberations, a children’s martial arts set was designed and implemented. The pilot project analyzes the importance of sensory quality in the essential stage of children’s martial arts training. Results: After the experiment, there was a significant difference in balance quality in the experimental group (p<0.01). After the experiment, the difference in balance sense between the experimental and control groups was significant (p<0.01). Conclusion: In the basic training phase of children’s martial arts, coaches should require athletes to master basic martial arts skills more comprehensively. All movement combinations in martial arts require comprehensive physical fitness and balance sensitivity, including speed, flexibility, and coordination. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Epidemiology of musculoskeletal injuries in combat sports practitioners

Study aim: The purpose of this study was to determine the impact of the type of combat sport and the degree of athletic proficiency on the specificity of musculoskeletal injuries suffered by Muay Thai and Mixed Martial Arts practitioners.

Material and methods: The study involved 64 practitioners of two combat sports, MT (age 26.9 ± 8.1, experience 7.4 ± 5.8 years) or MMA (age 26.2 ± 6.4 years, experience 6.6 ± 4.1 years). The research was conducted using a Google Forms survey.

Results: The groups did not differ significantly (p < 0.05) in terms of risk of injury (average 3.1 in MT, 2.6 in MMA). Injuries (mainly fractures 21% and 7% of practitioners) affected the lower limb (44% and 33% practitioners) and were significantly higher in MT, p < 0.05. There were significant (p < 0.05) correlations between training experience and the number of training hours per week compared to the frequency and severity of injuries in both groups.

Conclusion: Injuries to athletes who mainly use striking techniques are more common in the lower limbs and they are more likely to be fractures. Longer training experience, more training hours and a higher level of athletic proficiency significantly increase the risk of injuries and their severity among people practicing both types of combat sports.

Cervical spine characteristics differ in competitive combat athletes compared with active control participants

BACKGROUND

Injury to the head and neck are common in combat sport athletes. Impairments of the cervical spine have been found in some athletes who participate in sports with high forces and collisions. There is a lack of research on the effects of combat sports on the cervical spine.

OBJECTIVE

The primary study aim was to investigate differences in cervical spine characteristics between combat athletes and a similarly aged active control group. The secondary aim was to investigate the relationship between symptom-based outcome measures and characteristics of the cervical spine.

DESIGN

Cross-sectional.

METHOD

40 male adult combat sport athletes and 40 male adult control participants were recruited from 4 combat sport clubs and a university campus, Australia. Cervical spine assessments were conducted at a private physiotherapy clinic. The Neck Disability Index and the Post-Concussion Symptom Scale were used as symptom-based outcome measures.

RESULTS

Combat sport athletes had a reduced range of cervical motion, but greater isometric strength and endurance compared with a control group (p < 0.05). The Neck Disability Index and Post-Concussion Symptom Scale were negatively correlated with cervical spine range of motion and isometric strength, meaning that higher scores correlated with a reduction in function.

CONCLUSIONS

Differences were observed in characteristics of the cervical spine in combat sport athletes compared with a control group. Higher symptom-based outcome scores correlated with reduced range of motion and strength of cervical spine muscles. Further investigation to establish clinical cut-off scores for functional impairment may be warranted.

Availability and content of concussion guidelines in Australian combat sports

OBJECTIVES

To examine the availability and content of publicly available concussion information published by peak amateur and professional combat sport governing bodies in Australia.

DESIGN

Cross-sectional study; document analysis.

METHODS

Publicly available concussion information was retrieved from the websites of eleven peak Australian amateur and professional combat sport governing bodies. Data on type of source material, concussion definition, provision of medical services, concussion evaluation, and return-to-sport information were extracted. The quality of the information was assessed using a modified version of the Global Rating Scale.

RESULTS

Eight out of eleven combat sport governing bodies provided concussion information in source documents ranging from competition rules to position statements to specific policies. Five governing bodies provided information on post-contest concussion evaluation or testing, four of which mentioned the Sport Concussion Assessment Tool. Eight governing bodies provided information on return-to-sport, of which six stipulated mandatory minimum rest periods and four indicated that athletes should complete a graduated return-to-sport protocol. The provided concussion information was generally of low quality, with a median score of 3 out of 9 (range: 1-4).

CONCLUSIONS

There is substantial scope and an urgent need for improving concussion guidelines across peak combat sport governing bodies in Australia to improve the health and safety of their athletes.

Concussion Reporting and Safeguarding Policy Development in British American Football: An Essential Agenda

The objective of this study was to examine concussion reporting and safeguarding policy in British American Football (BAF). Data were collected via an online survey tool. The data presented are part of a broader study that examined injury profiles, concussion reporting behaviors, and medical provision in BAF. Concussion-like symptoms were found in over half (58.8%) of the participants. Of those, 36.4% reported they had previously been formally diagnosed with a concussion while playing BAF. Just under half of the participants (44.7%) had suspected they had had a concussion, although it was not formally diagnosed, and 23.5% of the participants had previously hidden concussion symptoms. Fifty-eight percent of the teams reported they did not have a regular game-day medic, with a range of hired medical personnel who attended the games. Prominent barriers to hiring a medic included budget, institutional support shortfall, and lack of medic reliability and game knowledge. BAF is a developing sport with a clear vision for growth of participation. Yet, the current concussion and medical provision policies do not address the sport's welfare needs. Through discussion of these policies in the context of this study's findings, we highlight vital areas of concern in policy and practice that the British American Football Association needs to address in their medical and concussion policies.

Athletes' and Coaches' Attitudes Toward Protective Headgear as Concussion and Head Injury Prevention: A Scoping Review

The purpose of this article is to map existing research literature on athletes and coaches' attitudes toward protective headgear in sport in relation to concussion and head injury prevention, and to identify and analyse knowledge gaps in the field. A scoping review was conducted in three databases; PubMed, Scopus, SportDiscus, and reference lists were searched to identify relevant grey literature. This process lead to an in-depth analysis of 18 peer-reviewed journal articles. Of the 18 studies identified, the majority focused on athletes (n = 14), only two studies focused on coaches, and two studies included a sample of both athletes and coaches. The findings in this scoping review suggests that there is a discrepancy between attitudes and beliefs about the protective effects of headgear, athletes' behaviour as far as wearing protective headgear, and coaches' behaviour in terms of recommending use of protective headgear to their athletes. The majority of athletes in most of the reviewed literature believed that headgear had protective effects against concussion and other head injuries, however relatively few athletes report wearing this protective headgear unless it was mandatory by competition rules.

Concussions, cuts and cracked bones: A systematic literature review on protective headgear and head injury prevention in Olympic boxing

In 2013, the International Boxing Association (AIBA) prohibited the use of headguards for elite male Olympic boxing competitions. Could the removal of the headguard from elite male boxing competitions potentially cause increased injury risk for boxers? The aim of the literature review is to analyse current knowledge about the use of protective headgear and injury prevention in boxing, in order to determine if there are increased injury risks associated with headguard use. Peer-reviewed studies (language: English, Norwegian, Swedish, Danish and Dutch) published from 1980 and onwards were considered. Five academic databases and grey literature sources were searched, and articles were assessed for methodological quality. Only studies that included boxers as the study population with headguards as a factor were considered. A total of 39 articles were included in the review. The analysis of the reviewed literature indicates that headguards protect well against lacerations and skull fractures, while less is known about the protective effects against concussion and other traumatic brain injuries. Most of the analysed studies however use indirect evidence, obtained through self-report or observational techniques with relatively small non-representative samples. There are almost no randomised control trials, longitudinal research designs or samples from recreational boxing. Therefore, AIBA's decision to remove the headguard has to be seen with caution and injury rates among (male) boxers should be continuously evaluated.