ᵝFig 1. Untreated auricular hematoma after rupturing
Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993. It was a syncretic sport, showing off hundreds of different types of martial arts and its practitioners performing against each other to see which form was superior. In 2001, individual states sanctioned MMA events after a new series of rules have been established. Despite it being 15 years old in the United States, it is still a fairly young sport and because of this, very little knowledge has been recorded on the level of injuries that occur and what can be done to prevent them. The purpose of this article is to determine, from major studies pertaining to MMA, if more research on the incidence of injury in the sports’ fighters is needed. If possible cause of injury is researched, then health professionals such as neurologists, orthopedics, physical therapists, and athletic trainers can establish injury prevention and treatment techniques.
In the study, “Incidence of Injury in Professional Mixed Martial Arts Competitions” by Bledsoe, Hsu, Grabowski, Brill, and Li, data from all professional MMA events that took place between September 2001 and December 2004 in the state of Nevada were obtained from the Nevada Athletic Commission. The study included 220 fighters participating in 171 1-on-1 matches. The overall injury rate was 28.6 injuries per 100 fight participations or 12.5 injuries per 100 competitor rounds. Facial laceration was the most common injury accounting for 47.9% of all injuries, followed by hand injury (13.5%), nose injury (10.4%), and eye injury (8.3%) (2 pg 1). A second study, “No holds barred sport fighting: a 10 year review of mixed martial arts competition”, has also taken some data from 1284 men competing in 642 consecutive televised matches in the United States and Japan from November 1993 to November 2003. 182 (28.3+/-3.4%) were stopped because of head impact, 106 (16.5+/-2.9%) because of musculoskeletal stress, 91 (14.1+/-2.7%) because of neck choke, and 83 (12.9+/-2.6%) because of miscellaneous trauma (3 pg 1). In a third study titled “Injury trends in sanctioned mixed martial arts competition: a 5-year from 2002 to 2007”, data from all regulated MMA competitions during the study period from March 2002 to September 2007 (1270 fight exposures) was obtained in the state of Nevada. 300 of the 1270 athletes sustained documented injuries with an injury rate of 23.6 per 100 fight participations (1 pg 1). The result of all 3 studies states that 21.49% out of the 3838 fights had an injury with the conclusion to an MMA fight due to head impact. The injury assessments performed, during each study, occurred immediately after each individual match by the present doctor only. This did not include radiological examination or any other examinations that may have occurred when the injured athlete left their competitions. The sport does have similarities in mechanisms of injury but its statistical difference is much more significant.
ᶲFig 2. Complete fractured metacarpal of the index finger
The mechanisms of injury (MOI) from MMA are quite different from other sports. The reasons for this are due to the fact that inefficient protective equipment is worn during competition. For example, football players are categorized in what is called a collision sport but since it has been well established, there has been an advance in the safety equipment used by each player. The player will wear enough equipment to protect his back, neck and head in case of a collision occurs (eg: tackle). The football helmet designed with a breakaway face mask has been created by James T. Hayden. After noticing that studies pertaining to specific angles of impact upon a player, the mask were to respond to a force “which impinges on [it] in a direction toward the wearer's face, but permit the mask to break away from the helmet in response to excessive forces in other directions, as when the mask is pulled forward or twisted sideways” (5 pg1). This is an example of research that has observed mechanisms of injury, specifically to the head and neck, in the sport of football. The MMA athlete does not wear any equipment pertaining to his/her spine nor has it been properly noticed by health communities and have a created category labeling its increased physical intensity compared to other collision sports. The standard MMA gloves only cover partial wrist support and knuckles and there is no sport specific cup that can be worn. Even though the gloves are meant to protect the hands of the athlete, the athlete is still prone to a Boxer’s fracture and articular fractures around the thumb. The glove’s lack of sufficient design may also contribute to other types of fractures (Fig 2). Not only the decreased padding in MMA gloves causes more damage to the opponent, it can also increase the chance of injury of the hands that are wearing them. The hand wraps that are placed under the gloves may also be poorly designed since the wraps cannot run over the fighter’s palms, decreasing the ability to grapple, a crucial strategy in MMA. Many athletes apply the boxer’s wrapping technique which has evolved enough to provide a strong support of the hand. However, MMA cutmen (the people who wrap the athlete’s hands) also cut out the tape covering the palms after applying the boxer’s technique, causing the structural integrity be compromised. In this case, research needs to be done on the anatomy of the hand and its strong point, weak points, the areas of most to least impact, and the breaking point of the average hands soft tissue. If further data is collected on the sport and its impact on the upper extremity, then constructing more successful protective hand wrap techniques (eg: how much tape should be used) can be pursued.
ǂFig 3.
The journal article, “Incidence of Injury in Professional Mixed Martial Arts Competitions”, showed that the first round of competitions had the highest frequency of concluding with a winner. However, the matches that did not stop during the first round usually ended during the 3rd-5th rounds as opposed to the second. Due to the fact that different leagues establish that fights last for 3 to 5 rounds before making a decision shows the possibility those fights lasting the last round. With the possibility of overly cautious (lack of offensive strategy) opponents aside, fatigue in the competitors may have played a factor in the inability to finish the fight earlier. Also if the fighters were fatigued, then they’re likely to have lacked strength & conditioning which may be the cause of a significant number of injuries recorded (from muscle strain to facial laceration) as well.
‡Fig 4. 250 lbs of force to the head is the general limit for a concussion to occur
However, because of its syncretism, there are possibly hundreds or even thousands of combat systems involved with the sport, all with different striking and submission techniques which make the mechanism of injury vary greatly. For example, National Geographic’s “Fight Science” produced an episode in which it determined the amount of force created by several martial arts’ most powerful punches. The results varied with a Kung Fu punch producing 612 pounds of force, which would at most break facial bones, whereas the boxer’s punch produced almost a thousand pounds of force, causing a severe concussion. This episode showed the variety of punches performed by different techniques but they also displayed how more research is needed to cover many other strikes that may potentially be an MOI. “Incidence of Injury in Professional Mixed Martial Arts Competitions” does however show how different forms of martial arts can change the frequency and severity of injuries in Figure 3, but the study did not go over what technique caused each individual injury. It showed that the knockout rates of MMA are significantly lower than boxing. This shows that further use of health researchers may be needed to establish which form of martial arts is more damaging to certain parts of the body whether it be Brazilian Jiu-Jitsu, boxing, wrestling, or any other form that collaborates with the sport of MMA. However, before going into more specific fight systems, establishing what could be the baseline of how much impact the human body can both generate and receive before injury occurs can help label the level of harm that offensive moves can cause. For example, in the Fight Science episode, an MMA fighter demonstrated a basic elbow strike against a dummy’s head (Fig 4). The dummy contained instruments that measured the amount of force from the strike. The technicians recording the dummy’s readings declared that the strike happened to generate just enough force to cause a concussion to the receiver. More baseline research, such as this, needs to take place in order to properly understand the injuries that take place in MMA. In conclusion, the results from the research have shown that more professionals need to be involved, who have their expertise in neurology as well as orthopedics, physical therapy and strength & conditioning. This sport needs the help of health professionals, but in order for that to occur, further research needs to be conducted. Before a mixed martial arts athlete walks you’re your office, prepare yourself with more information on the sport. Ask your colleagues or the health organization that you’re associated with and ask if they can help conduct further studies on the sport. If you’re a neurologist, ask for studies of body slams. If you’re a physical therapist, call for research on overuse syndrome associated with a certain type of kick. MMA may be 15 years old, but the number of participants is still growing significantly. Remember, although this increases the chances of you treating one, if you understand the sports’ MOI and how to treat/prevent them, then you’ll have more costumers feeding your wallet.
ᵝ Cropped Sherdog.com picture from fiveouncesofpain.com (7)
ᶲ Thales Leites’ x-ray (6)
‡ Tito Ortiz in National Geographic’s Fight Science (4)
ǂ Table1 from “Incidence of Injury in Professional Mixed Martial Arts” (1 pg 137)
1) Ngai, KM Levy, F Hsu, EB.“Injury trends in sanctioned mixed martial arts competition: a 5-year from 2002 to 2007”. Br J Sports Med.Vol 42, Ed 8.2008 Aug.pg686-689.< http://0-search.ebscohost.com.ilsprod.lib.neu.edu/login.aspx?direct=true&db=aph&AN=34258002&site=ehost-live>2008 28 Sept.
2) Bledsoe, GH Hsu, EB Grabowski, JG Brill, JD Li, G.“Incidence of injury in professional mixed martial arts competitions”.Journal of Sports Science and Medicine. 2006 01 July.pg136-142.
3) Buse, GJ.“No holds barred sport fighting: a 10 year review of mixed martial arts competition”.Br J Sports Med.Vol40(2).2006 Feb.pg169-72.
4) Brenkus, John(Director/Producer).“Fight Science”.National Geographic. 2008 27 Jan.
5) Hayden, James T.“Football Helmet with Breakaway Mask”.United States Patent.14 Aug 1990.
6) “Leites’ X-Ray”.MMAWeekly.08 Jan 2008.
7) Jardine, Keith.“James Thompson’s Cauliflower Ear”.Five Ounces of Pain.6 June 2008.
1 comment:
THIS IS WHY I NEVER DO MARTIAL ARTS
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