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There is one thing that everyone who has ever watched MMA can agree on—it is a brutal sport that takes a heavy physical toll on the people involved. Unless you’re a member of a fight team, either as a competitor or part of the support personnel, you only tend to see the immediate post-fight damage. The ubiquity of social media over the past decade has allowed fans to see this physical impact to a greater extent than previous generations. Even this, however, only tends to stay in the newsfeed for a few weeks after the fight. The next time we see the athletes in question, they’re looking fully healed and virtually untouched at a press conference or in a pre-fight build-up training video. This makes it very easy to forget or ignore the long-term damage that fighters experience, both from competition and the daily grind of training that’s needed to become a world-class ninja.
So it was a welcome change to read the opinion piece published on Sherdog last week about the chronic neck and back pain that is common in MMA and grappling inclusive sports in general. This piece highlighted the debilitating and life altering injuries to the neck and back that many fighters suffer and live with, both during their careers and their lives after retirement, which tends to be a lot longer than the time they spend in the spotlight. Unfortunately, this piece compared these injuries to chronic traumatic encephalopathy (CTE) in MMA, arguing that the aforementioned joint injuries are of greater concern than concussion induced trauma. In doing so, the author made several statements that, whilst commonly accepted amongst MMA people, are unfortunately not true. Without downplaying the seriousness of neck and back injuries in any way, it’s important to dispel some of the common misconceptions that surround CTE in MMA. This needs to be done so younger people looking to start a career in fighting do so fully aware of the risks involved, but also so we as fans can better appreciate what the athletes are going through to entertain us on a weekly basis.
The first misconception is that the grappling in MMA reduces the rate of concussions and therefore damage to the brain. Research conducted by Dr. Charles Bernick and colleagues over the past decade suggests that this isn’t the case, at least not to the extent assumed and often perpetuated by MMA fans and promoters. The Professional Fighters Brain Health Study has produced several papers tracking changes to boxers’ and MMA fighters’ brains and cognitive abilities over time. The group’s research is ongoing, but their findings generally show that while there do appear to be some differences between sports, both groups show impaired cognitive processing and reduced brain matter. Though they are cautious about claiming their findings can predict or guarantee CTE in either population, the results do show that any exposure to fighting leads to likely irreversible brain damage. They have also developed a measurement called the fight exposure score (FES), which represents the number of competitive fights someone has per year. The higher a person’s FES, the more markers of brain damage they display, especially if the person has a higher FES at a younger age. As last week’s opinion piece states, boxers do have more fights over their amateur and pro career than MMA. With the increasing organization of MMA at the amateur level, however, how long will this be the case for? We are probably not a long way from fighters having tens of amateur bouts before they’re out of their teens, bringing us closer to boxing in terms of participant exposure to concussive blows. It is for this reason in particular that the world amateur governing body, the International MMA Federation, have a no-headshot rule in their youth tournaments.
A big difference between MMA and boxing that is commonly highlighted is the effect of the standing eight-count. While this rule allows a clearly concussed boxer to take further damage, there is no evidence that MMA fighters do not suffer equal damage from situations unique to our sport. We have all seen MMA fighters on the receiving end of a flash knockdown proceed to endure numerous further strikes on the ground – sometimes with the fight being ended soon after, sometimes with the beating continuing for the rest of the round. We are also far too familiar with the sight of an already unconscious fighter being hit with multiple unanswered blows to the head before the referee has time to intervene. Do these cause equal, more or less damage than the standing eight-count in boxing? Currently, we have no idea, but it’s unlikely to be less. It also seems to be much more common for boxing referees to stop a bout with a fighter “out on their feet,” a very rare occurrence in MMA, despite clear signs that the losing fighter is unable to defend the strikes coming their way. The concussive effects of these fight-ending situations are added to by the indirect impact of MMA fighters landing on the canvas during takedowns—more on this later—and the potential effect of blood chokes on brain health, which is currently unknown and under debate. The truth is, MMA is probably too young at this point, with too small a sample size in terms of older ex-fighters, to truly see the effects of these extra shots, or the long-term effects of MMA in general.
The second misconception is that concussions don’t tend to happen in training due to coaching practices moving away from the “gym war” era. While the reduction in sparring and smarter training does seem to be the case in most gyms, there is absolutely no reason to believe that this means concussions are rare. Injury reporting in the scientific and medical literature tends to focus on competition injuries and short term injuries such as cuts, bruises or muscle damage. There is currently no data showing the occurrences or severity of concussions in training, but if you currently train, or have trained in the past, think about every session that you went home from with a headache, or developed a headache a couple of hours afterward. Chances are, you had a concussion. From an anecdotal perspective, this is an extremely common occurrence, potentially happening hundreds—thousands?—of times over the course of a career. These are often caused by minor impacts to the head, jabs for instance, and even by the acceleration and subsequent deceleration of the head during takedowns and throws. Due to the lack of noticeable symptoms, (there is still a widespread, but mistaken, belief that concussions only occur with a KO/TKO), these tend to get ignored, build up over time and are likely a key cause of CTE. This is not just true of professional fighters, but also for anyone who trains for fun or fitness. If, like me, you fall into that latter category, again, think about how many headaches you’ve had after your Tuesday night sessions at your local gym.
The third misconception is related to the second: that equipment or training methods can negate concussions. This is missing the cause of concussions in the first place. It is not the impact on the head or the body that causes trauma to the brain. It is the cascade of events following the brain impacting upon or shearing along the inside of the skull when the head is accelerated and decelerated that causes the damage. It is for this reason that no amount of padding, headgear, gloves, mouthpieces or any other equipment will ever prevent or reduce brain trauma. It is not anatomically possible to prevent the brain from impacting the inside of the skull when the head is accelerated, either from a strike or a takedown. This means that brain trauma is almost a guaranteed side effect of taking part in MMA (and all other contact sports). Once a concussion has occurred, the only way of “training around concussions” is to not train at all. Though there is developing work around the management of issues once they are diagnosed, these are treatments, not preventions. Conversely, the original opinion piece that this article is responding to claimed that neck and back injuries cannot be prevented by training. This is also untrue, as using an effective strength and conditioning plan (with an actual strength and conditioning coach, not a scam “movement coach”) year round, alongside targeted and planned recovery periods, can help protect against the effects of MMA training on the back, neck and all other joints. But no amount of training will protect the brain.
In conclusion, the aim of this opinion piece is not to downplay the debilitating effects of neck and back injuries. They are long-term and life affecting, but to state that these are a bigger issue for MMA than concussions and CTE is to misunderstand just how common concussions are in our sport, and how easily they occur. That we’ve not seen a wide range of people suffer with the most obvious signs of CTE in MMA points more to the incredibly young age of the sport, and the still very low numbers of people taking part globally in comparison to boxing, American football and rugby. To pretend that concussions are not an issue in our bubble would be a disservice to current fighters and the kids who are right now signing up to MMA classes in the hope of one day being a pro fighter. Equally, the aim here is not to scare people or to spread doom and gloom. Systems and practices can be put in place by coaches, governing bodies and promoters in an attempt to minimize, rather than normalize, CTE in MMA. Being open and truthful about the effects of our sport is the only way of protecting and helping the people involved, which should surely be a goal for the future of MMA.
Christopher Kirk is a sport scientist specializing in the physiological effects of training and competing in MMA. He is an associate lecturer at the University of Derby and PhD researcher at Liverpool John Moores University, and an active strength and conditioning coach through his private practice, Altius Sports Performance. TW: @ChrisKirk_ASP