Injury trends in sanctioned mixed martial arts competition: a 5-year review from 2002 to 2007

Care of The Older Fighter: Position Statement of the Association of Ringside Physicians

Older Fighters are defined as combat sports athletes older than 35 years, based on heightened medical risks and historical classification. Age-related changes to the neurological, cardiopulmonary, endocrinological, thermoregulatory, osmoregulatory, and musculoskeletal systems increase these athletes' risks for injury and may prolong their recovery. These age-related risks warrant special considerations for competition, licensure, prefight medical clearance, in-fight supervision, post-fight examination, and counseling regarding training practices and retirement from combat sports. Neurological considerations include increased risk of intracranial lesions, intracranial hemorrhage, and sequelae from traumatic brain injury (TBI), warranting more comprehensive neurological evaluation and neuroimaging. Increased risk of myocardial ischemia and infarction warrant careful assessment of cardiac risk factors and scrutiny of cardiovascular fitness. Older fighters may take longer time to recover from musculoskeletal injury; post-injury clearance should be individualized.

Eye Trauma in Mixed Martial Arts and Boxing

PURPOSE

To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing.

DESIGN

Retrospective cohort study.

METHODS

Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted.

RESULTS

In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury.

CONCLUSION

Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.

An epidemiological study of martial arts injuries in patients presenting to US emergency rooms

INTRODUCTION

With the advent of mixed martial arts (MMA) growing in popularity, there has been a described increase in its participation. The term MMA generally describes the hybridization of combat disciplines including but not limited to: karate, judo, jiu-jitsu, wrestling, taekwondo, boxing, kickboxing, and Muay Thai. With increased participation in MMA and martial arts, differing physical demands are placed on participants. Due to the physical nature of combat sports, there are injuries associated with participation. The purpose of this study is to report the incidence and characteristics of injuries seen from various martial art disciplines presenting to United States Emergency Rooms in order to educate participants and providers alike about risks assumed with participating in martial arts.

METHODS

The National Electronic Injury Surveillance System (NEISS) database was queried for martial arts-related injuries from 2009 to 2019. Cases were examined and data including patient age and gender, injury type and location, hospital disposition, and type of martial arts practiced were extracted.

RESULTS

A total of 8,400 injuries were recorded, leading to a national estimate of 310,143 martial-arts related injuries over the 11 year period of 2009-2019 (95 % CI 239,063-381,223). The most common types of injuries were strains/sprains (n = 2664, 31.7 %), fractures (n = 1,575, 18.8 %), and contusions/abrasions (n = 1,698, 20.2 %). There were 260 dislocations, with shoulder dislocations being most common (n = 96, 36.9 %). Lower extremities were affected more frequently than upper extremities (n = 3566, 42.5 % versus n = 3026, 36.0 %), with the knee being the single most common location of injury (n = 811, 9.7 %). Males more commonly sustained fractures (19.7 % versus 17.4 %, p = 0.03) and dislocations (3.5 % versus 2.4 %, p = 0.01) when compared to females. Ankle injuries were more common in females than males (10.4 % versus 6.0 %, p < 0.001). Only 2.2 % of patients required admission to the hospital. Risk factors for admission included patients >35 years of age and male sex.

CONCLUSION

Martial arts injuries are a significant source of musculoskeletal injuries among patients presenting to US emergency rooms. Lower extremity injuries are seen most frequently, with patients rarely requiring hospital admission. Using this information, both providers and participants may be better equipped to make educated decisions on injury prevention and treatment.

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.

Upper limb injuries in mixed martial arts

OBJECTIVE

Mixed-Martial-Arts(MMA) is a worldwide growing sport that incorporates different fighting styles and disciplines and is often associated with the Ultimate Fighting Championship(UFC) . The aim of this study is to explore the patterns and trends of upper limb injuries in MMA.

METHODS

Ringside physician reports of the UFC fights between 2016 and 2019(inclusive) were extracted and screened from the Nevada State Athletic Commission(NSAC). The following variables were included: sex, weight division, injury mechanism, injury type, injury location, and type of finish. Injury rates were calculated and expressed per 100 athletic exposures (AE). An independent t-test, a one way analysis of variance(ANOVA), and a Joinpoint regression analysis were conducted to explore any significant differences or trends among variables. P-values<0.05 were considered significant(95% CI).

RESULTS

A total of 81 upper limb injuries in 408 fights were recorded between 2016 and 2019. The injury rate was 9.9 injuries per 100 athletic-exposures(AE). Striking opponents was the most common mechanism of injury(p < 0.001). The hand was the most commonly injured location with an injury rate of 6.61 per 100AE(p < 0.001). Females had a higher upper limb injury rate than their male counterparts, but the difference failed to reach significance(p = 0.454). Similarly, no significant differences existed between rates of different types of injures. Matches ending with decision had the highest number of upper limb injuries with a rate of 12.6 per 100AE; however, no significant difference was determined between the rates of different ways of finish(p = 0.115). The strawweight(20.5 per 100AE), female flyweight(19.2 per 100AE), and male flyweight(13.8 per 100AE) divisions had the highest upper limb injury rates.

CONCLUSION

The hand was the most commonly injured upper limb location in MMA, and 'striking opponent' was the most common injury mechanism. Increasing padding in gloves and implementing medical examinations during bouts can help reduce injury rates.

Alexithymia and Impulsivity in Combat Sports - A Tale of Three Measures

The purpose of this study was to compare the psychometric properties of two measures of alexithymia - the Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ) - as well as the Barratt Impulsiveness Scale 11 measure of behavioural impulsivity because the psychometric properties of these scales have not been established in athletes. As part of a larger study, 298 participants completed an online survey that included the TAS-20, PAQ, and BIS 11, as well personal- (age and gender) and sport-specific (primary combat sport and level of competition) demographic measures. A unidimensional model was retained for the TAS-20. A unidimensional model with the possibility of multidimensional measure was retained for the PAQ, with the viability of a subscale for Generalised Externally Orientated Thinking supported. The only versions of the BIS that were retainable were unidimensional models for the BIS-15 (a 15-item version of the BIS 11) and the BIS-Brief (an 8-item version of the BIS 11). As expected, the measures of alexithymia were highly correlated. The associations between impulsivity and alexithymia as well as age and alexithymia were small in nature, with none these associations moderated by level of gender, level of competition, or primary sport for the participants. No differences in alexithymia or impulsivity according to gender, level of competition, or primary sport were noted for the participants. Implications of these findings for the measures of alexithymia - the TAS-20 and PAQ - and impulsivity - the BIS-15 and BIS-Brief - examined in the present study with athletes (as well as with other populations) are discussed.

Injuries Common to the Brazilian Jiu-Jitsu Practitioner

BACKGROUND

Brazilian jiu-jitsu (BJJ) is a martial art that focuses on ground combat, emphasizing skill over strength and submission over striking. The purpose of this study is to evaluate the nature of injuries affecting practitioners of BJJ in the settings of competition, training, and conditioning.

METHODS

An online survey was created to collect demographic and injury-specific information. This survey was distributed to the 234 schools in the United States registered with the International Brazilian Jiu-Jitsu Federation (IBJJF). The survey was also distributed to local BJJ schools and at local tournaments in the Greater New York City area. Data from a total of N=56 participants were recorded for this survey.

RESULTS

The majority of participants were male (n=44, 78.6%) and amateur competitors (n=29, 51.8%) with an average duration of BJJ training of 6.9 ± 5.9 years. The majority of participants (82.1%) train at least six hours per week and compete in an average of 4.6 ± 2.5 competitions per year. The most common injuries were to the finger/hand (78.6%) and knee (61.5%). The most commonly reported fracture was of the hand/fingers (n=6). Of the 156 total injuries reported, 133 (85.3%) occurred during practice or training rather than in competition and 76 (48.7%) required medical attention. Few injuries required surgical intervention.

CONCLUSIONS

This study provides novel information regarding injury characteristics of BJJ practitioners with respect to the level of training and use of protective equipment that can guide expectations and management for this unique group of athletes. Amateur BJJ practitioners are the most commonly injured, and largely experience injuries of the upper extremities during training or conditioning rather than during competition.

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.

Head Trauma Exposure in Mixed Martial Arts

Combat sports training involves a high risk of head injury. Previously published research on head trauma exposure in MMA evaluated only the knockouts (KO), without calculating all head strikes. The aim of the research was to evaluate the total head trauma exposure during MMA competitions among male and female fighters. Two thousand four hundred and eighty-eight MMA fights from all numbered UFC events between 2000 and 2021 were analyzed. A database containing the results from officially published scorecards with information such as the outcome of a fight, its duration, number of strikes (significant and total amount of hits) depending on location and knockdowns was created. Additional video verification of the knockout technique was carried out. The athletes received an average of 2.41 significant head strikes out of a total of 6.30 head strikes per minute. Head strikes were more common in female fights than in male. Women executed more total and significant head strikes per minute than men. Head trauma caused the ending of 31.6% of all fights-more often in male fights (32.2%) than female (23.1%). It was the most common cause of knockouts-88.1%. Professional fights in mixed martial arts involve high exposure to head trauma. A careful evaluation of the risk involved in training in such a discipline is necessary to provide adequate prevention methods.

Performance and return to sport after injury in professional mixed martial arts

BACKGROUND

Mixed Martial Arts (MMA) is an increasingly popular combat sport incorporating striking and grappling that results in a high incidence of injuries.

OBJECTIVES

The purpose of this study was to analyze the impact of injuries on the return to sport and post-injury performance of professional MMA athletes. We hypothesize that increased age is associated with lower probability of return to sport and diminished post-injury performance.

METHODS

Publicly available data (obtained from ESPN.com/MMA, UFC.com, Rotowire.com/MMA) from professional MMA fighters who resigned from fight cards due to injury from 2012 to 2014 were analyzed. Injury history, match history and outcomes, and duration of time to return to professional fighting were recorded and compared to a cohort consisting of uninjured opponents.

RESULTS

454 fighters were included in the analysis. The mean age at the time of injury was 30.0±3.9 years. 94.4% of injured athletes were able to return to professional MMA, and athletes required a mean duration of 6.8±6.7 months between injury and their next professional fight (range 0.3-58 months). There was no significant difference in winning percentage in the post-injury period between the injured group and the uninjured group (p = 0.691). Increased age at the time of injury was associated with the odds of being able to return to professional fighting after injury (OR = 0.822, p = 0.001).

CONCLUSION

In this analysis of publicly available injury data on MMA fighters, there was a high rate of return to professional sport and no evidence of an associated decline in performance following major injury requiring withdrawal from a fight card. Older age at the time of injury was associated with decreased odds of being able to return to professional fighting. With increasing popularity of combat sports, sport-specific prognostic information will help guide and treat specific injuries associated with MMA participation.

Concussion vs. resignation by submission: Technical–tactical behavior analysis considering injury in mixed martial arts

This research study verified the technical–tactical actions during the mixed martial arts (MMA) fights to generate serious enough injury to stop the MMA round, determining technical-tactical potential risk factors for injury in official MMA combats, according to Concussion or Resignation per Submission. A total of 990 rounds with concussions and 627 resignations per submission were considered with severe injury (i.e., a fight ended by a doctor or referee). All injuries were diagnosed and managed by attending ringside physicians during the MMA fights and rounds and had a continuous technical–tactical behavior analysis, p ≤ 0.05. The leading cause of concussion was due to head trauma (~90%), with higher dependence on head strikes scored actions. Comparisons between Concussion and Resignation per Submission combats demonstrated differences between distance head strikes actions [13(6,25) vs. 9(4,18) frequencies], clinch head strikes actions [1(0;4) vs. 1(0;3) frequencies], ground head strikes actions [1(0;8) vs. 2(0;10) frequencies] and takedowns actions [0(0;1) vs. 1(0;2) frequencies]. This information may provide significant evidence regarding the doctor stoppage in concussion combats and when it could be called by officials supervising MMA.

A brief descriptive outline of the rules of mixed martial arts and concussion in mixed martial arts

Mixed martial arts (MMA), a combat sport consisting of wrestling, box-ing, and martial arts, is a popular activity associated with danger and vi-olence. Of concern are the repetitive head impacts, both subconcussive and concussive, sustained by MMA athletes. The rules of MMA en-courage head strikes, but there was no formal concussion protocol in the Ultimate Fighting Championship (UFC) until 2021. Because the UFC was established less than 30 years, the long-term consequences of these repetitive concussive head blows are lacking. In this review, we focus on current literature sought to summarize the current knowledge of repetitive head impacts and concussions in MMA. The objectives were to outline (a) the rules of MMA; (b) the postconcussion protocol for UFC athletes; (c) current behavioral and biochemical diagnostic measures; (d) epidemiology and prevalence of concussion in MMA; (e) long-term effects of subconcussive repetitive head impacts; (f) biome-chanics of head impacts; and (g) considerations and research topics that warrant future research.

Exploratory Systematic Review of Mixed Martial Arts: An Overview of Performance of Importance Factors with over 20,000 Athletes

This review aimed to analyze the findings in the literature related to Mixed Martial Arts (MMA) through an exploratory systematic review and to present the state of the art from a multifactorial perspective. The review was conducted in accordance with the PRISMA statement, with a search performed in the Scopus, PubMed, and Web of Science databases. Participants were competitive athletes (amateurs or professionals) of regional, national, or international levels. Of the 2763 registries identified, 112 studies met the eligibility criteria. The pooled sample size and age were 20,784 participants, with a mean age of 27.7 ± 6 years for male and 28.9 ± 3 years for female, with the vast majority of athletes being male (94.9%). MMA athletes were 17.2% amateurs, 73.8% professionals, and 9% were not reported. The scientific literature related to MMA reported injuries (n = 28), weight loss (n = 21), technical and tactical analysis (n = 23), physical fitness (n = 8), physiological responses and training characteristics (n = 13), psychobiological parameters (n = 12), and interventions applied to MMA athletes (n = 7). Therefore, this exploratory systematic review presents practitioners and researchers with seven broad summaries of each facet of performance of importance in this population of athletes.

Head injury in mixed martial arts: a review of epidemiology, affected brain structures and risks of cognitive decline

Background: The popularity trend of mixed martial arts (MMA) is steeply increasing, especially in the very young population. Unfortunately, MMA carries an enormous risk of head trauma.Purpose: The aim of this article is to provide review of studies on the association between head injuries and cognitive functions in MMA fighters.Methods: A systematic literature review was performed. Web of Science, PubMed, Springer, and Scopus databases were used. A total of 30 studies were identified. The inclusion criteria were as follows: studies with MMA fighters and head injuries and/or TKO/KO and/or reduction of cognitive functions in these fighters.Results: The results indicate that the incidence of head traumas ranges between 58% and 78% of all injuries. The King-Devick test seems to be a suitable rapid tool used in the studies to assess the extent of cognitive impairment. Among the detected studies, the post-fighting scores were significantly worse for fighters with head trauma during the match. We also found anomalies in MMA fighters in different brain structures, but it seems that the thalamus and caudate are the most affected. The impaired performance in processing speed, verbal memory and psychomotor speed is regularly confirmed in studies with MMA fighters. In addition, head traumatization seems to be a risk factor for the development of neurodegenerative disorders and it may be one of the possible causes of chronic traumatic encephalopathy (CTE). Several global medical societies have identified MMA as a violent and dangerous sport and have called for its ban - but unsuccessfully.Conclusion: Therefore, possible recommendations should include increased medical supervision of the fighter (during his career, but also after it) and the introduction of practical safety instructions for fighters to reduce the risk of developing CTE. With the increasing popularity of MMA, the risk of CTE should not be underestimated.

Prevalence, Patterns, and Characteristics of Eye Injuries in Professional Mixed Martial Arts

Purpose

To describe the frequency and type of eye injuries in fighters in mixed martial arts (MMA) competition.

Methods

Fight result data were collected from the Nevada Athletic Commission database from 2001 to 2020. Any fighters in a professional mixed martial arts (MMA) contest with an eye injury were included. Main outcome measures included frequency and rate of eye injuries per fight and the types of eye injuries. Secondary outcome measures were gender, laterality, decision type, and length of no-contact recommended.

Results

Of the 256 MMA events in the database, 187 events (73.3%) had at least one eye injury. Of a total 2208 fights at these events, there were 363 fighters who sustained 369 eye injuries, with the yearly rate of eye injuries per 100 fighters ranging from 2.56 to 12.22. The most common injuries were eyebrow and eyelid lacerations (n=160, 43%), lacerations around the eye (n=98, 27%), and orbital fractures (n=62, 17%). Most eye injuries were right sided (n=197, 53.3%) and the majority of fighters with eye injuries lost their match (n=228, 62.8%). Fifty-seven fighters were recommended for further ophthalmology clearance after the match. The most common reasons for recommended ophthalmology follow-up was orbital fracture (n=25, 44%) and retinal injury (n=7, 12%). Forty-three fighters received no-contact requirements relating to their injury for an average of 8.9 weeks (range 1–24 weeks).

Conclusion

Ophthalmic injuries in professional MMA were prevalent, were most often lacerations surrounding the eye, and often accompanied the fighter losing their match.

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.

The role of salivary vesicles as a potential inflammatory biomarker to detect traumatic brain injury in mixed martial artists

Traumatic brain injury (TBI) is of significant concern in the realm of high impact contact sports, including mixed martial arts (MMA). Extracellular vesicles (EVs) travel between the brain and oral cavity and may be isolated from salivary samples as a noninvasive biomarker of TBI. Salivary EVs may highlight acute neurocognitive or neuropathological changes, which may be particularly useful as a biomarker in high impact sports. Pre and post-fight samples of saliva were isolated from 8 MMA fighters and 7 from controls. Real-time PCR of salivary EVs was done using the TaqMan Human Inflammatory array. Gene expression profiles were compared pre-fight to post-fight as well as pre-fight to controls. Largest signals were noted for fighters sustaining a loss by technical knockout (higher impact mechanism of injury) or a full match culminating in referee decision (longer length of fight), while smaller signals were noted for fighters winning by joint or choke submission (lower impact mechanism as well as less time). A correlation was observed between absolute gene information signals and fight related markers of head injury severity. Gene expression was also significantly different in MMA fighters pre-fight compared to controls. Our findings suggest that salivary EVs as a potential biomarker in the acute period following head injury to identify injury severity and can help elucidate pathophysiological processes involved in TBI.

Injury Profile of Mixed Martial Arts Competitions in the United States

Background:

The popularity of mixed martial arts (MMA) continues to grow in the United States. Although prior work has provided valuable insight concerning injuries in the sport, much of the available literature is limited by factors such as small sample sizes, varying athlete demographics, and inconsistent data collection methods.

Purpose:

To report injury rates and types in MMA and analyze potential variance between competition and match variables.

Study Design:

Descriptive epidemiology study.

Methods:

We performed a retrospective review of injuries sustained by fighters during MMA contests between 2018 and 2019 using ringside physician postmatch injury reports from Wisconsin and Arizona. The prevalence of overall injuries and specific injury types was compared by location (Arizona vs Wisconsin), competition level (amateur vs professional), match result (decisions vs any other result), and match winners versus losers.

Results:

In 503 contests, 285 (57%) had at least 1 injury. In these 285 matches, participants experienced 401 injuries: 197 (49%) in professional bouts and 204 (51%) in amateur bouts. The match injury rate was higher in professional bouts than in amateur contests (68% vs 51%; P < .001). Amateur fighters had more contusions and hematomas (31% vs 22%; P < .001), while professional fighters had more lacerations (39% vs 23%; P < .001). Losers exhibited a higher match injury rate than winners (48% vs 24%; P < .001). Winners experienced a higher proportion of fractures (19% vs 9%; P = .005), and losers experienced more concussions (17% vs 2%; P < .001).

Conclusion:

Professional fighters and losers of MMA bouts exhibited higher injury rates relative to amateurs and winners. The prevalence of specific injury types varied by competition level, match result, and match winners versus losers. The results of this study may be used to better understand the current injury profile in MMA and to develop targeted strategies for injury prevention.

Effect of Weight Class on Regional Brain Volume, Cognition, and Other Neuropsychiatric Outcomes among Professional Fighters

Traumatic brain injury (TBI) is a common source of functional impairment among athletes, military personnel, and the general population. Professional fighters in both boxing and mixed martial arts (MMA) are at particular risk for repetitive TBI and may provide valuable insight into both the pathophysiology of TBI and its consequences. Currently, effects of fighter weight class on brain volumetrics (regional and total) and functional outcomes are unknown. Fifty-three boxers and 103 MMA fighters participating in the Professional Fighters Brain Health Study (PRBHS) underwent volumetric magnetic resonance imaging (MRI) and neuropsychological testing. Fighters were divided into lightweight (≤139.9 lb), middleweight (140.0–178.5 lb), and heavyweight (>178.5 lb). Compared with lightweight fighters, heavyweights displayed greater yearly reductions in regional brain volume (boxers: bilateral thalami; MMA: left thalamus, right putamen) and functional performance (boxers: processing speed, simple and choice reaction; MMA: Trails A and B tests). Lightweights suffered greater reductions in regional brain volume on a per-fight basis (boxers: left thalamus; MMA: right putamen). Heavyweight fighters bore greater yearly burden of regional brain volume and functional decrements, possibly related to differing fight dynamics and force of strikes in this division. Lightweights demonstrated greater volumetric decrements on a per-fight basis. Although more research is needed, greater per-fight decrements in lightweights may be related to practices of weight-cutting, which may increase vulnerability to neurodegeneration post-TBI. Observed decrements associated with weight class may result in progressive impairments in fighter performance, suggesting interventions mitigating the burden of TBI in professional fighters may both improve brain health and increase professional longevity.

Brazilian Jiu Jitsu, Judo, and Mixed Martial Arts Injuries Presenting to United States Emergency Departments, 2008-2015

Limited research has systematically examined injuries resulting from Brazilian Jiu Jitsu (BJJ), Judo, and mixed martial arts (MMA), especially when compared to more well-known or -established martial arts. These three combative sports differ substantially regarding their rules and techniques. BJJ emphasizes ground positioning and submission, Judo rewards throwing an opponent on their back with submission ending the match, and MMA emphasizes knocking out or forcing the submission of one's opponent. We examined injuries, among people of any age, experienced from participation in BJJ, Judo, and MMA. We analyzed data from the United States (U.S.) Consumer Product Safety Commission National Electronic Injury Surveillance System to create estimates of injuries presenting to U.S. emergency departments (EDs). We compared injury profiles between sports, including estimated numbers of injuries, their site, type, and mechanism. Participation in BJJ, Judo, and MMA resulted in an estimated 39,181 injuries presenting to U.S. EDs from 2008 through 2015. Strains and sprains were the most common diagnoses for BJJ and Judo participants, whereas abrasions/contusions were the most commonly diagnosed MMA injury. Being struck resulted in the majority of injuries for all three sports. The head was the most injured body region for BJJ and MMA, whereas the leg was the most injured body region for Judo. Finally, the majority of BJJ and Judo injuries occurred during noncompetitive grappling, whereas most MMA injuries occurred during competition. Our study adds to the limited literature examining injuries from BJJ, Judo, and MMA using data from a probability sample and is an initial step towards understanding the national burden of injury from participation in these sports. Given the quantity and severity of injuries sustained by participants, additional research is needed to assess the riskiness of participation and the effectiveness of interventions, such as improved personal protective gear and mats, as a means to prevent commonly occurring injuries.

Anthropometric and Physiological Profile of Mixed Martial Art Athletes: A Brief Review

The aim of this review was to analyze the existing knowledge of the anthropometric and physiological characteristics of MMA (mixed martial arts). A computerized search was performed in the PubMed and Google Scholar databases for English-language, peer-reviewed investigations using the term "mixed martial arts" or "MMA" alone and in combination with "physiological characteristics", "physiological profile", "body composition", "strength", "power", "endurance", "aerobic", and "anaerobic". The main findings of this review suggested an overall profile of low body fat, high flexibility, muscle strength, muscle endurance, and anaerobic power, and average cardiovascular endurance. Nevertheless, no differences in anthropometric and physiological characteristics by performance level of the athletes were observed. Based on the studies analyzed in this review, several limitations were reported. First, the subjects in each paper were limited in number, as is MMA literature itself, and it is impossible to make a generalization regarding the anthropometric and physiological profile for male athletes. Second, no studies included female MMA athletes; therefore, there was no evidence for what their profiles might be. Last, the majority of the above-mentioned studies used different tests, or the same tests with different protocols, and as a result, it is difficult to compare their results. The similarity observed between the levels of the athletes might be a result of the different tests and protocols used by the researchers or might be evidence that the anthropometric and physiological profile of an MMA athlete did not vary among high-level athletes. Considering the increasing number of those engaging in MMA training and sport events, the findings of the present study provided strength and conditioning trainers working with MMA athletes a valuable tool for monitoring training and performance.

Injury in Brazilian Jiu-Jitsu Training

BACKGROUND

Brazilian jiu-jitsu (BJJ) is a grappling-based martial art that can lead to injuries both in training and in competition. There is a paucity of data regarding injuries sustained while training in BJJ, in both competitive and noncompetitive jiu-jitsu athletes.

HYPOTHESIS

We hypothesize that most BJJ practitioners sustain injuries to various body locations while in training and in competition. Our primary objective was to describe injuries sustained while training for BJJ, both in practice and in competition. Our secondary objectives were to classify injury type and to explore participant and injury characteristics associated with wanting to quit jiu-jitsu after injury.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

We conducted a survey of all BJJ participants at a single club in Hamilton, Ontario, Canada. We developed a questionnaire including questions on demographics, injuries in competition and/or training, treatment received, and whether the participant considered discontinuing BJJ after injury.

RESULTS

A total of 70 BJJ athletes participated in this study (response rate, 85%). Ninety-one percent of participants were injured in training and 60% of competitive athletes were injured in competitions. Significantly more injuries were sustained overall for each body region in training in comparison with competition (P < 0.001). Two-thirds of injured participants required medical attention, with 15% requiring surgery. Participants requiring surgical treatment were 6.5 times more likely to consider quitting compared with those requiring other treatments, including no treatment (odds ratio [OR], 6.50; 95% CI, 1.53-27.60). Participants required to take more than 4 months off training were 5.5 times more likely to consider quitting compared with those who took less time off (OR, 5.48; 95% CI, 2.25-13.38).

CONCLUSION

The prevalence of injury is very high among BJJ practitioners, with 9 of 10 practitioners sustaining at least 1 injury, commonly during training. Injuries were primarily sprains and strains to fingers, the upper extremity, and neck. Potential participants in BJJ should be informed regarding significant risk of injury and instructed regarding appropriate precautions and safety protocols.

CLINICAL RELEVANCE

Clinicians should be aware of the substantial risk of injury among BJJ practitioners and the epidemiology of the injuries as outlined in this article.

A 12-Year Cohort Study of Doc-Stoppage in Professional Mixed Martial Arts

Purposes: To determine actions during bouts that generate serious enough injury to stop the bout; verifying the injury incidence, types, and prevalence of doctor stoppages (doc-stoppage); and identify potential risk factors by analyzing technical-tactical profiles for injury in sanctioned mixed martial arts bouts taking place over a 12-y period. Methods: This research analyzed 440 paired mixed martial arts matches separated by doc-stoppage (n = 220) and no doc-stoppage (n = 220) from 2002 to 2014. Technical knockouts for doc-stoppage were diagnosed and managed by attending ringside doctors, and the time–motion variables were categorized into total combat time separated by low- or high-intensity activities per round, stand-up, or groundwork actions, P ≤ .05. Results: The main cause of injuries in doc-stoppage situations was due to facial injuries (>90%), with 87.1% occurring after striking actions during the second round. Lacerations were the leading type of injury, which occurred with 80% frequency. The results showed differences between doc-stoppage and no doc-stoppage for standing combat with low-intensity actions (130.6 [8.5] s vs 83.3 [6.9] s for first round; 115.7 [10.5] s vs 100.1 [9.6] s for second round, and 121.5 [19.5] s vs 106.3 [11.7] s for third round) and total strike attempts (34.5, 23.0–51.8 vs 25.0, 12.0–40.8); in standing combat, head strike attempts (21, 10–33 vs 11, 4–21) and body strikes (2.5, 1.0–5.8 vs 1.0–2), and in groundwork combat, head strikes landed (0.0–3.0 vs 0.0–5.0). Conclusions: This research showed higher values of strike attempts with 2 main orientations, namely the head (on the ground and in stand-up actions) and body (in stand-up actions), and may provide important information regarding the technical knockout and when it can be called by officials supervising mixed martial arts bouts.

Concussion management in combat sports: consensus statement from the Association of Ringside Physicians

Various organisations and experts have published numerous statements and recommendations regarding different aspects of sports-related concussion including definition, presentation, treatment, management and return to play guidelines. 1-7 To date, there have been no written consensus statements specific for combat sports regarding management of combatants who have suffered a concussion or for return to competition after a concussion. In combat sports, head contact is an objective of the sport itself. Accordingly, management and treatment of concussion in combat sports should, and must, be more stringent than for non-combat sports counterparts.The Association of Ringside Physicians (an international, non-profit organisation dedicated to the health and safety of the combat sports athlete) sets forth this consensus statement to establish management guidelines that ringside physicians, fighters, referees, trainers, promoters, sanctioning bodies and other healthcare professionals can use in the ringside setting. We also provide guidelines for the return of a combat sports athlete to competition after sustaining a concussion. This consensus statement does not address the management of moderate to severe forms of traumatic brain injury, such as intracranial bleeds, nor does it address the return to competition for combat sports athletes who have suffered such an injury. These more severe forms of brain injuries are beyond the scope of this statement. This consensus statement does not address neuroimaging guidelines in combat sports.

DA VIOLÊNCIA NO COMBATE: O QUE DIZEM OS LUTADORES DE MMA

Resumo Cumpre-se uma análise fenomenológica da representação que lutadores(as) de MMA -Mixed Martial Arts- têm acerca de seu significado e da violência em sua prática, a partir de suas respostas às perguntas: “Você considera o MMA uma modalidade violenta?” e “O que significa o MMA para você?”. Foram entrevistados presencialmente 43 lutadores profissionais, residentes em 8 capitais brasileiras, entre os anos de 2016 e 2017. A análise, baseada no cruzamento intencional, explicita os estratos de base das representações próprias aos sujeitos da prática do MMA, indicando que a perspectiva de um corpo objeto sensível é compatível com a atribuição de violência, mas a perspectiva do corpo sujeito operativo não, possibilitando a compreensão dos significados existencialmente positivos que o MMA tem para eles.

Martial Arts as a Form of Undertaking Physical Activity in Leisure Time Analysis of Factors Determining Participation of Poles

Background: The aim of this paper was to analyze selected sociodemographic and economic factors that determine practicing martial arts (MA) in Poland. Our hypothesis states that MA constitute a niche sport, which is a result of conditions shaping the decision to undertake them: perception through the lens of the media/entertainment business (rather than primary values), insufficient space for practicing, as well as high costs. Methods: The study was based on a survey conducted on a representative sample of Poles (n = 12,183). Results for 470 participants declaring some level of proficiency in MA were presented (including 124 declaring active participation). In order to verify statistically significant differences, a Chi-Square test, single-agent logistic regression analysis, and adds ratio were applied. Results: 3.0% of respondents declared basic skills in MA, while advanced skills were declared by 0.9% participants. Only 1% were active practitioners. The leading motivation was “pleasure” (62.1%), followed by “keeping fit and maintaining healthy body shape” (21.8%) and “health” (7.3%). The probability of participation in MA decreased with age (40 years of age being the turning point). As for young people, there is a 15 times lower chance of married individuals undertaking MA, while possessing advanced skills doubles the probability. School provides a place to practice MA during school years, but there is a problem with continuation at a later age (18.8% declaring classes organized at school vs. 5.4% organized at work). Conclusions: Reversing the trend of decreasing popularity of MA requires promotion on each level of education and creating opportunities to continue participation after graduation. There is a need to increase the availability of cheap sport facilities in the vicinity of the place of residence or work. In case of adults, it is important to build platforms facilitating contact with MA centers.

Risk factors associated with injury and concussion in sanctioned amateur and professional mixed martial arts bouts in Calgary, Alberta

Background

There is limited literature that examines risk factors for injury and mild traumatic brain injury (mTBI) in mixed martial arts (MMA). An examination of previously unstudied bout and athlete characteristics that may pose health risks while partaking in this sport is warranted.

Hypothesis/purpose

To determine the incidence of injury and concussion, along with the identification of risk factors that contribute to injury and mTBI in amateur and professional MMA bouts in Calgary, Alberta.

Study design

A retrospective cohort study with case–control design.

Methods

Calgary amateur and professional MMA records were examined from 1 January 2010 to 31 December 2015. Descriptive statistics were used to describe the incidence of injury and concussion, along with univariate and multivariable logistic regression to identify risk factors for injury and mTBI.

Results

The injury rate per 100 athlete exposure (AE), the injury rate per 100 min of exposure and the concussion rate per 100 AE were 23.6 (95% CI 20.5 to 27.0), 4.1 (95% CI 3.48 to 4.70) and 14.7 (95% CI 11.8 to 17.2), respectively. The most common location of injury was the head and mTBI was the most common type of injury. Athletes whose bout was finished by a knockout/technical knockout, corner stoppage, draw, no contest or physician, and those whose country of origin was non-Canadian, were more likely to sustain an injury. No risk factors for concussion were shown to be significant.

Conclusion

Engaging in MMA exposes athletes to inherent risk and several recommendations are proposed to reduce these risks. Future prospective investigations are necessary to better delineate the findings in this study.

Systematic review of injuries in mixed martial arts

OBJECTIVES

To assess injury rates in all mixed martial arts (MMA) studies.

METHODS

Six online databases were searched until November 2017 including MEDLINE, EMBASE, CINAHL, Web of Science, PubMed, Google/Google Scholar and conference proceedings. All included studies were entered in Pub Med Single Citation Matcher and all citation chains followed. Abstracts and titles were assessed for relevance, data independently abstracted and risk of bias for all competition studies evaluated independently by two reviewers.

RESULTS

There are data for 5,374 male and 108 female MMA fighters. For 2407 males the weighted average injury rate/1000Athletic Encounters (AE) was 246.4 and for one study of 108 females 101.9. One study provided data by professional status: professionals 135.5/1000AE and amateurs 71.0/1000AE. Reasons for stopping matches were knockout/technical knockout 173.9/1000AE for males and 175.9/1000AE for females, submission 228.6/1000AE, and referee's decision 98.2/1000AE. Losers can experience large amounts of trauma especially head trauma as matches terminate. Two studies of competitions provided personally conducted ringside assessments and both pre- and post-match examination results. The other studies reported retrospective assessments of fight records or videos or videos and scorecards. There are no studies of training injuries of professionals or injuries of amateurs or long-term follow-up of musculoskeletal injuries or neurological damage. Studies are limited to the US and Canada. There are no systematic reviews of newspaper or media accounts of fights to assess rates and numbers of injuries or mortality. The few published surveys and case reports markedly understate the worldwide situation.

CONCLUSIONS

There are high rates of trauma in MMA. The authorities who regulate MMA and referees and physicians who monitor MMA fighters have an inadequate database to guide their work. Researchers need to adopt the same set of complete definitions of all possible injuries and measure the high and early rate of neurological damage.

Safety in Mixed Martial Arts: a 7-Year Review of Cancelled MMA Bouts in Calgary, Alberta, During the Pre-bout Medical Examination Period

BACKGROUND

Presently, there is no literature that examines the reasons for the cancellation of amateur or professional mixed martial arts (MMA) bouts. The purpose of this study was to review the circumstances that lead to the cancellation of MMA bouts by Calgary ringside physicians during the pre-bout examination period and to identify any emerging patterns that may guide the regulatoin of this sport.

METHODS

The case-series  was constructed from the Calgary Combative Sports Commission pre-bout examination records and the medical records submitted by each athlete from January 2010 to December 2016.

RESULTS

Cancelled bouts in the pre-bout examination periods represented 5.4% of all MMA bouts in Calgary. A total of 25 reasons lead to bout cancellation and included the following: failure to obtain required neuroimaging (28.0%), neuroimaging abnormalities (24.0%), incomplete routine screening investigations (16.0%), exceeding maximum weight differential between the two athletes (16.0%), injury in the pre-competition period (8.0%), dehydration (4.0%), and ECG abnormalities (4.0%). The abnormalities on neuroimaging (n of 6) included the following: post traumatic gliosis on MRI (n = 1, 16.7%), flares diffusely and findings consistent with microhemorrhage on MRI (n = 1, 16.7%), chronic orbital fracture with fat pad extrusion on CT (n = 2, 33.3%), lacunar infarct on MRI (1), and unspecified MRI abnormality (n = 1, 16.7%). Twenty-two athletes had bouts cancelled and of these three athletes had their bouts stopped for two reasons.

CONCLUSIONS

The following recommendations are presented and include: the creation of guidelines regarding pre- and post-bout neuroimaging, the implementation of industry-wide minimum medical screening standards, the adoption of a longitudinal approach to weight monitoring, the development of competent ringside physician groups, and active oversight by the Combative Sports Commission during the matchmaking process.

Traumatic brain injuries in mixed martial arts: A systematic review

Introduction

Mixed martial arts is an emerging combat sport that is gaining popularity worldwide. We systematically reviewed the literature regarding the prevalence, severity and risk factors of head injuries sustained in mixed martial arts activities.

Methods

We conducted a comprehensive systematic review of Ovid MEDLINE, Embase, PsycINFO, EBM Reviews, CINAHL, SPORTDiscus, and Web of Science from 1990 to 2016 for studies of any design that reported associations of acute or chronic head injuries in persons participating in mixed martial arts activities.

Results

The initial database search yielded a total 472 citations, including 264 unique citations after duplications were removed. A total of 18 articles, primarily of observational data, showed ‘technical knockouts’ and ‘knockouts’ are prevalent in this sport (range: 28.3–46.2% of all matches) with other studies showing the lifetime average of 6.2 technical knockouts or knockouts in a career. Studies used inconsistent reporting methods for concussion, and no information regarding long-term follow-up was available.

Conclusion

Mixed martial arts fighting may be associated with repetitive head injuries and potential long-term neurological consequences; however, data on this topic are poor. Larger studies and stringent medical oversight are needed to improve the management and understanding of mixed martial arts head injuries, with implementation of harm reduction strategies and/or rule modifications to prevent long-term neurological sequelae. Systematic Review Registration: PROSPERO – CRD42014010019.

Evidence of dynamic visual acuity impairment in asymptomatic mixed martial arts fighters

AIM

The purpose of this study was to determine the amount of visual acuity loss with head movement in actively training mixed martial arts (MMA) fighters.

METHODS

Vestibulo-ocular reflex function of 22 asymptomatic, male MMA fighters (age = 29.2 ± 5.1) was assessed by taking the difference between static visual acuity and the dynamic visual acuity test, in both yaw and pitch planes.

RESULTS

The mean static visual acuity testing logMAR was -0.173 (standard deviation [SD] = 0.114). Mean dynamic visual acuity test values decreased with head movement to 0.196 logMAR (SD = 0.103) in yaw; p < 0.001, and to 0.283 logMAR (SD = 0.133) in pitch; p < 0.001.

CONCLUSION

MMA fighters had a decay, beyond normal ranges, in visual acuity during head movement. These decreases may suggest vestibulo-ocular reflex impairment and were unrelated to self-reported concussion history. These results should be cautiously interpreted since there was not a control group.

Youth Participation and Injury Risk in Martial Arts

The martial arts can provide children and adolescents with vigorous levels of physical exercise that can improve overall physical fitness. The various types of martial arts encompass noncontact basic forms and techniques that may have a lower relative risk of injury. Contact-based sparring with competitive training and bouts have a higher risk of injury. This clinical report describes important techniques and movement patterns in several types of martial arts and reviews frequently reported injuries encountered in each discipline, with focused discussions of higher risk activities. Some of these higher risk activities include blows to the head and choking or submission movements that may cause concussions or significant head injuries. The roles of rule changes, documented benefits of protective equipment, and changes in training recommendations in attempts to reduce injury are critically assessed. This information is intended to help pediatric health care providers counsel patients and families in encouraging safe participation in martial arts.

Significance of Concussions in Hawai'i: From Land to Sea

Head injuries are a particular concern in Hawai'i given the large military population, the presence of many land and water sports such as football and surfing, and the lenient helmet laws for motorcycle and bicycle riders. Physical, psychological, and cognitive symptoms from single or repeated concussions can affect an individual's reentry to society and activity. Current literature indicates that repeated head injuries are associated with chronic traumatic encephalopathy (CTE) which is thought to lead to dementia. This paper reviews literature discussing causes of concussion including its incidence and prevalence in Hawai'i. Furthermore, the neurophysiological and neurobiological etiologies are discussed followed by an overview of methods for identification and management of concussion. The paper serves as information for professionals in the community such as educators, military personnel, and healthcare workers to identify risks of concussion, management of symptoms, and to connect with resources and programs available in Hawai'i.

Injuries Sustained by the Mixed Martial Arts Athlete

Context:

Mixed martial arts (MMA) is rapidly growing in popularity in the United States and abroad. This combat sport joins athletes from a wide variety of martial art disciplines, each with characteristic and distinguishing injury profiles, together in competition. Because of increasing participation by professionals and amateurs alike, injuries sustained by MMA athletes have been on the rise.

Evidence Acquisition:

A review of relevant publications using the search term mixed martial arts and each of its component combat sports (eg, Muay Thai, Brazilian jiu-jitsu) from 1980 through 2015 was completed using PubMed and Google Scholar.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

The majority of studies on MMA injuries evaluate those sustained during competition, which range in incidence from 22.9 to 28.6 per 100 fight-participations. Striking-predominant disciplines such as boxing, karate, and Muay Thai have high rates of head and facial injuries, whereas submission-predominant disciplines such as Brazilian jiu-jitsu, judo, and wrestling have high rates of joint injuries.

Conclusion:

Numerous studies have evaluated injuries in athletes who participate in MMA and its component disciplines during competition but much remains to be discovered about injuries sustained during training and in specific patient populations such as adolescents and women.

Combative Sports Injuries: An Edmonton Retrospective

OBJECTIVE

Mixed martial arts (MMA) is an increasingly popular combative sport involving aggressive techniques that present substantial injury risk. We examined the incidence and types of injuries sustained in MMA fights and compared this with injuries sustained in boxing matches.

DESIGN

Consecutive Case Series.

SETTING

We used data from post-fight medical examinations on all bouts in Edmonton, Canada, between 2000 and 2013.

PARTICIPANTS

The participants were 1181 MMA competitors and 550 boxers.

MAIN OUTCOME MEASURES

The attending physician conducted a mandatory post-fight examination of all fighters and documented the nature of injuries sustained.

RESULTS

Boxers were significantly more likely not to experience injury (49.8% vs 59.4%, P < 0.001), whereas MMA fighters were significantly more likely to experience 1 injury (typically contusion/bruising, P < 0.001). Boxers were more likely to experience loss of consciousness (7.1% vs 4.2%, P = 0.01) and serious eye injury (1.1% vs 0.3%, P = 0.02).

CONCLUSIONS

The overall injury incidence in MMA competitors appears slightly higher than for boxers, but MMA fighters experience more minor contusion/bruising injuries. Boxers are more likely to experience serious injury such as concussion/head trauma involving loss of consciousness or eye injury such as retinal detachment.

Repetitive cryotherapy attenuates the in vitro and in vivo mononuclear cell activation response

What is the central question of this study? Acute and repetitive cryotherapy are routinely used to accelerate postexercise recovery, although the effect on resident immune cells and repetitive exposure has largely been unexplored and neglected. What is the main finding and its importance? Using blood-derived mononuclear cells and semi-professional mixed martial artists, we show that acute and repetitive cryotherapy reduces the in vitro and in vivo T-cell and monocyte activation response whilst remaining independent of the physical performance of elite athletes. We investigated the effect of repetitive cryotherapy on the in vitro (cold exposure) and in vivo (cold water immersion) activation of blood-derived mononuclear cells following high-intensity exercise. Single and repeated cold exposure (5°C) of a mixed cell culture (T cells and monocytes) was investigated using in vitro tissue culture experimentation for total neopterin production (neopterin plus 7,8-dihydroneopterin). Fourteen elite mixed martial art fighters were also randomly assigned to either a cold water immersion (15 min at 10°C) or passive recovery protocol, which they completed three times per week during a 6 week training camp. Urine was collected and analysed for neopterin and total neopterin three times per week, and perceived soreness, fatigue, physical performance (broad jump, push-ups and pull-ups) and training performance were also assessed. Single and repetitive cold exposure significantly (P < 0.001) reduced total neopterin production from the mixed cell culture, whereas cold water immersion significantly (P < 0.05) attenuated urinary neopterin and total neopterin during the training camp without having any effect on physical performance parameters. Soreness and fatigue showed little variation between the groups, whereas training session performance was significantly (P < 0.05) elevated in the cold water immersion group. The data suggest that acute and repetitive cryotherapy attenuates in vitro T-cell and monocyte activation. This may explain the disparity in in vivo neopterin and total neopterin between cold water immersion and passive recovery following repetitive exposure during a high-intensity physical impact sport that remains independent of physical performance.

Analysis of injury types for mixed martial arts athletes

[Purpose] The purpose of the present study was to examine the types of injuries associated with mixed martial arts and their location in order to provide substantial information to help reduce the risk of these injuries during mixed martial arts. [Subjects and Methods] Data were collected from 455 mixed martial arts athletes who practiced mixed martial arts or who participated in mixed martial arts competitions in the Seoul Metropolitan City and Gyeongnam Province of Korea between June 3, 2015, and November 6, 2015. Questionnaires were used to collect the data. The convenience sampling method was used, based on the non-probability sampling extraction method. [Results] The arm, neck, and head were the most frequent locations of the injuries; and lacerations, concussions, and contusions were the most frequently diagnosed types of injuries in the mixed martial arts athletes in this study. [Conclusion] Reducing the risk of injury by establishing an alert system and preventing critical injuries by incorporating safety measures are important.

The physiological and mononuclear cell activation response to cryotherapy following a mixed martial arts contest: a pilot study

Cold water immersion is thought to reduce the inflammatory response to injury. Using cultured mononuclear cells and human subjects in a mixed martial arts (MMA) contest, we examined the effect of cryotherapy on 7,8-dihydroneopterin and neopterin generation. Urine was collected from 10 elite male mixed martial artists before, immediately post and 1, 2, 24 and 48 h following a contest. Myoglobin was analysed by reverse-phase high performance liquid chromatography, and urinary neopterin and total neopterin (neopterin+7,8-dihydroneopterin) were measured by strong cation exchange high-performance liquid chromatography. Cold water immersion and passive recovery were compared using changes in these markers, while cryotherapy tested total neopterin production in γ-interferon and phorbol myristate acetate (PMA)-stimulated blood-derived mononuclear cells (monocytes/T cells). Myoglobin significantly increased (p<0.05) at 1 h post-contest, neopterin significantly increased at 1 and 24 h (p<0.05), total neopterin significantly increased (p<0.05) at 1 h post for the passive group only, and significant individual variation was observed for all markers (p<0.01). Cold water immersion attenuated total neopterin production (p<0.05), while cryotherapy significantly reduced total neopterin production in PMA-stimulated mononuclear cells (p<0.01). Cryotherapy attenuates the post-exercise inflammatory response following an MMA contest. The evidence also suggests that the mechanisms responsible for this may be related to direct immune cell suppression.

Injury profile of mixed martial arts competitors

OBJECTIVE

To provide an updated comprehensive profile of mixed martial arts (MMAs) injuries.

DESIGN

Correlational and multivariate analyses were conducted on cross-sectional data to examine injuries sustained during 711 MMA bouts. One physician diagnosed any injuries occurring during the bouts.

SETTING

Various sports venues in Kansas and Missouri holding MMA competitions.

PARTICIPANTS

Male and female and amateur and professional MMA competitors contributing to 1422 fight participations (fight participations = 711 bouts × 2 fighters/bout).

INDEPENDENT VARIABLES

State, level (amateur or professional), gender, number of rounds, and bout outcome (knockout/technical knockout [KO/TKO] vs other outcomes [eg, decision]).

MAIN OUTCOME MEASURES

Injuries/fight participations, injury sustained (yes vs no), and fighter referred to emergency room (ER; yes vs no).

RESULTS

The overall injury rate was 8.5% of fight participations (121 injuries/1422 fight participations) or 5.6% of rounds (121/2178 rounds). Injury rates were similar between men and women, but a greater percentage of the injuries caused an altered mental state in men. The risk of being injured was significantly greater for bouts held in Kansas, at the professional level, lasting more rounds, and ending in a KO/TKO. Fighters also were more likely to be referred to the ER if they participated in longer bouts ending in a KO/TKO.

CONCLUSIONS

The observed injury rate was lower than previously reported suggesting recent regulatory changes have made MMA a safer sport. Increased clinical awareness and additional research should be extended to head-related injuries in MMAs especially those associated with KOs/TKOs.

Interrater agreement of an observational tool to code knockouts and technical knockouts in mixed martial arts

OBJECTIVE

Interrater agreement evaluation of a tool to document and code the situational factors and mechanisms of knockouts (KOs) and technical knockouts (TKOs) in mixed martial arts (MMA).

DESIGN

Retrospective case series.

SETTING

Professional MMA matches from the Ultimate Fighting Championship-2006-2012.

PARTICIPANTS

Two nonmedically trained independent raters.

MAIN OUTCOME MEASURES

The MMA Knockout Tool (MMA-KT) consists of 20 factors and captures and codes information on match characteristics, situational context preceding KOs and TKOs, as well as describing competitor states during these outcomes. The MMA-KT also evaluates the mechanism of action and subsequent events surrounding a KO.

RESULTS

The 2 raters coded 125 unique events for a total of 250 events. The 8 factors of Part A had an average κ of 0.87 (SD = 0.10; range = 0.65-0.98); 7 were considered "substantial" agreement and 1 "moderate." Part B consists of 12 factors with an average κ of 0.84 (SD = 0.16; range = 0.59-1.0); 7 classified as "substantial" agreement, 4 "moderate," and 1 "fair." The majority of the factors in the MMA-KT demonstrated substantial interrater agreement, with an average κ of 0.86 (SD = 0.13; range = 0.59-1.0).

CONCLUSIONS

The MMA-KT is a reliable tool to extract and code relevant information to investigate the situational factors and mechanism of KOs and TKOs in MMA competitions.

Survey of upper extremity injuries among martial arts participants

PURPOSE

To survey participants at various experience levels of different martial arts (MA) about upper extremity injuries sustained during training and fighting.

MATERIALS

A 21-s question survey was designed and utilised. The survey was divided into four groups (Demographics, Injury Description, Injury Mechanism, and Miscellaneous information) to gain knowledge about upper extremity injuries sustained during martial arts participation. Chi-square testing was utilised to assess for significant associations.

RESULTS

Males comprised 81% of respondents. Involvement in multiple forms of MA was the most prevalent (38%). The hand/wrist was the most common area injured (53%), followed by the shoulder/upper arm (27%) and the forearm/elbow (19%). Joint sprains/muscle strains were the most frequent injuries reported overall (47%), followed by abrasions/bruises (26%). Dislocations of the upper extremity were reported by 47% of participants while fractures occurred in 39%. Surgeries were required for 30% of participants. Females were less likely to require surgery and more likely to have shoulder and elbow injuries. Males were more likely to have hand injuries. Participants of Karate and Tae Kwon Do were more likely to have injuries to their hands, while participants of multiple forms were more likely to sustain injuries to their shoulders/upper arms and more likely to develop chronic upper extremity symptoms. With advanced level of training the likelihood of developing chronic upper extremity symptoms increases, and multiple surgeries were required. Hand protection was associated with a lower risk of hand injuries.

CONCLUSION

Martial arts can be associated with substantial upper extremity injuries that may require surgery and extended time away from participation. Injuries may result in chronic upper extremity symptoms. Hand protection is important for reducing injuries to the hand and wrist.

Head Trauma in Mixed Martial Arts

BACKGROUND

Mixed martial arts (MMA) is a full combative sport with a recent global increase in popularity despite significant scrutiny from medical associations. To date, the empirical research of the risk of head injuries associated with this sport is limited. Youth and amateur participation is growing, warranting investigation into the burden and mechanism of injuries associated with this sport.

PURPOSE

(1) To determine the incidence, risk factors, and characteristics of knockouts (KOs) and technical knockouts (TKOs) from repetitive strikes in professional MMA; and (2) to identify the mechanisms of head trauma and the situational factors that lead to KOs and TKOs secondary to repetitive strikes through video analysis.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Competition data and video records for all KOs and TKOs from numbered Ultimate Fighting Championship MMA events (n = 844) between 2006 to 2012. Analyses included (1) multivariate logistic regression to investigate factors associated with an increased risk of sustaining a KO or TKO secondary to repetitive strikes and (2) video analysis of all KOs and TKOs secondary to repetitive strikes with descriptive statistics.

RESULTS

During the study period, the KO rate was 6.4 per 100 athlete-exposures (AEs) (12.7% of matches), and the rate of TKOs secondary to repetitive strikes was 9.5 per 100 AEs (19.1% of matches), for a combined incidence of match-ending head trauma of 15.9 per 100 AEs (31.9% of matches). Logistic regression identified that weight class, earlier time in a round, earlier round in a match, and older age were risk factors for both KOs and TKOs secondary to repetitive strikes. Match significance and previously sustained KOs or TKOs were also risk factors for KOs. Video analysis identified that all KOs were the result of direct impact to the head, most frequently a strike to the mandibular region (53.9%). The average time between the KO-strike and match stoppage was 3.5 seconds (range, 0-20 seconds), with losers sustaining an average of 2.6 additional strikes (range, 0-20 strikes) to the head. For TKOs secondary to strikes, in the 30-second interval immediately preceding match stoppage, losers sustained, on average, 18.5 strikes (range, 5-46 strikes), with 92.3% of these being strikes to the head.

CONCLUSION

Rates of KOs and TKOs in MMA are higher than previously reported rates in other combative and contact sports. Public health authorities and physicians should be cognizant of the rates and mechanisms of head trauma. Preventive measures to lessen the risks of head trauma for those who elect to participate in MMA are described.

Assessment of Injuries During Brazilian Jiu-Jitsu Competition

Background:

Brazilian jiu-jitsu (BJJ) is a unique style of martial arts with rapid growth in the United States and internationally. Although studies have examined injuries in other martial arts and combat sports, to date, no published medical study has examined injuries in BJJ competitions.

Purpose:

(1) To estimate the incidence of injuries in BJJ competitions and (2) to identify and describe the types and mechanisms of injuries associated with competitive BJJ.

Study Design:

Descriptive epidemiology study.

Methods:

Injury data were obtained from records of on-site medical coverage at 8 statewide BJJ tournaments in Hawaii, USA, between 2005 and 2011.

Results:

The identified injury incidence on the day of matches was 9.2 per 1000 exposures (46 injuries out of 5022 exposures, ie, match participations). Orthopaedic injuries were the most common and accounted for 78% of all injuries (n = 36), followed by costochondral or rib injuries (n = 7) and lacerations requiring medical care (n = 3). The elbow was found to be the joint most commonly injured during BJJ competitions, with the arm bar being the most common mechanism. We propose that this BJJ-specific injury mechanism, the “arm bar,” be recognized as another mechanism of hyperextension injury to the elbow in sports.

Conclusion:

Comparison of the BJJ injury data with injury data reported for judo, taekwondo, wrestling, and mixed martial arts showed that BJJ competitors were at substantially lower risk of injury compared with these other sports. With orthopaedic injuries being most common and the elbow being the area most vulnerable to injury in BJJ, it is important that participants, referees, and physicians be properly educated about the unique mechanisms of injury that can occur, particularly to the elbow.