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How will combat sports handle concussions in the future?

By Zach Arnold | May 3, 2012

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For more information on The Lou Ruvo Cleveland Clinic Center in Las Vegas, click here to read.

When I watched Ron Kruck’s piece on HDNet about The Lou Ruvo center last December, it was a segment that reminded me just how little we know about the issue of concussions in combat sports. Despite technological advances with MRIs & CT scans, that technology also has a ways to develop from what experts say is currently a ‘black & white’ standard of determining just how much damage a person’s brain has suffered. Eventually, technology will give us a clearer picture of how the brain works, how much damage a concussion really causes, and the full-ranging effects of CTE. Anyone who has had the chance to watch Charlie Rose’s Understanding the Brain TV series knows that we have quite a ways to go.

It is this hunger for knowledge that both excites and scares athletes across all major contact-based sports. American football is the highest profile American sport to deal with the concussion issue — more out of necessity than out of desire. Concussions in soccer is also a growing concern, but the legal stakes have been raised to enormous levels for the National Football League. They are dealing with massive lawsuits from over 1,500 former players who are suing the league on the claim that the league knew about the potential damage of concussions but hid such information from the players. Whether the lawsuits are successful or not, they have certainly proven to be effective in raising awareness about concussions in sports. Roger Goodell, the Godfather of the NFL, is a lawyer. He understands just how much of a liability concern the NFL is facing here. There’s no doubt that concussions, under the umbrella term of ‘player safety,’ will continue to change American football for decades to come.

The suicide of former Chicago Bears player Dave Duerson and the revelation that he suffered from CTE came as little surprise. However, Wednesday’s death of American football player Junior Seau shook up the entire football fraternity. Seau, since retirement, faced various personal issues. In the Fall of 2010, Seau drove his car off the road and it immediately led to speculation about the former football great suffering from the effects of brain damage suffered during his illustrious career.

Seau’s death on Wednesday led to an immediate & swift reaction from former football greats, who sought out medical diagnosis about whether or not they, too, are suffering from brain damage and if they are going to suffer the same fate as Duerson & Seau. Read the Daily News article.

Dan Wetzel of Yahoo Sports:

Already received pathetic PR emails offering doctors to discuss concussions and Seau’s death, like anyone knows anything at this point.

Randy Cross issued this warning to the press:

“Members of the media that cover FB, on all levels, need to educate themselves on concussions or TBI, MTBI and their lasting effects. Whether Seau death had anything to do with depression etc the head trauma issue is a giant ticking time bomb for Football. Be educated.”

Jim Trotter, currently a writer at Sports Illustrated and former San Diego Union-Tribute writer, proposed an idea of a national database of concussions throughout various levels of American football (high school, college, and NFL/CFL).

The news of Seau’s death, along with Dave Duerson’s death, reminded me about the recent efforts of The Lou Ruvo Cleveland Clinic center to give free testing to fighters in order to study the impact of brain damage in combat sports. The efforts are to be commended and applauded.

It also reminded me of a former colleague of mine, Ivan Trembow, whom I knew well for many years. He quit writing about MMA because of growing concerns he had over the issue of concussions in combat sports. When Ivan announced his decision, he was met with some cheers but mostly jeers. Hey, fighters are punching each other in the face, so why should they complain about brain damage once they’re retired? They know the inherent risks of being a fighter, right?

On Wednesday night, I brought up the death of Junior Seau and wondered whether or not some of the issues his death highlights (medical testing advances, lawsuits, suicide, behavioral changes) would soon become issues down the road in combat sports, especially Mixed Martial Arts. The response I received for bringing this topic up was nothing short of nasty & vulgar.

“Why are concussions a bigger deal now than they were 10 years ago? Concussions happened in the past and they’re going to happen in the future, so why should people care?”

What I think is illustrative about the negative reaction when one brings up the issue of concussions in MMA is that it reveals the fault lines between the fans, promoters, doctors, and fighters. Fans don’t care how the sausage is made, they just want the sausage. Many didn’t care that PRIDE was engulfed with a yakuza scandal, they just wanted to see PRIDE. The initial reaction many fans first had about the drug usage crisis in MMA was less about health & safety and more about, ‘whatever it takes for fighters to fight, let them do it.’ That perception has changed somewhat but is still prevalent.

The difference now versus the past is that those who are actually making the sausage, the fighters, are starting to find out more about the side effects of the sausage making and their range of emotions extends from concerned to scared. For some, they are pursuing a legal remedy. For others, they simply want better medical testing & health care.

There are a lot of issues to be raised in the near future for major sports organizations like the NFL and for fight promoters in regards to liability. I can’t see how there won’t be future concussion lawsuits filed by former athletes. Whether those lawsuits are successful or not, they will impact the way sports are played for decades to come.

When I addressed this issue (briefly) on Wednesday night, the standard boilerplate response was the same one I always got when I was covering PRIDE’s implosion.

“Do you even like MMA? Are you so cynical about everything MMA? Do you like the fighters? Are you just saying this to be part of the ‘me first’ crowd?”

The answers, of course, are simplistic. I’m not the first person to raise the issue of concussions nor will I be the last. I am a fan of combat sports and will always be a fan. However, I am a believer in everyone knowing more than just what takes place inside a ring or cage. You can be a supporter of the fight game and still gain knowledge of what the pros and cons are for the promoters & the participants. When it comes to discussing concussions & drug usage in MMA, I think it’s a sign of maturity to be open & candid about everything related to medical issues that impacts the health & safety of fighters. Discussing these issues doesn’t make a person morally superior… but it does make them better-informed. I have great respect for those who put their health at risk and compete in the combat sports arena. Don’t those competitors deserve to know what the potential risks are for competition? There should be no fear to learn and discuss uncomfortable truths here. Let the chips fall where they may.

However, let’s not hide in a cocoon and pretend that the issue of concussions in combat sports is going to fade away. With a wave of MMA fighters retiring, we will have a better understanding in the decades to come in regards to what kind of brain damage fighters are having to live with. We will also have a better understanding of what kind of impact these health issues will have on the way MMA is promoted & any future rule modifications. MMA is still a young sport and changing the way the sport is regulated is not out of the question. There is a big picture here and it is a good discussion to have. It is not a discussion to be afraid of nor is it a discussion that should be mocked based on intellectual laziness. Discussing the quality of life for retired fighters is no joke.

Topics: Media, MMA, UFC, Zach Arnold | 25 Comments » | Permalink | Trackback |

25 Responses to “How will combat sports handle concussions in the future?”

  1. Wonderjudas says:

    Zach: this reminds me of Ivan Trembow’s final article on his blog ( It’s worth reading still.

    • Megatherium says:

      Yes, who could forget Ivan Trembow’s personal crisis when he came to the realization that a man could get hurt fighting in a cage.

      He was the Conscience of the sport.

    • ttt says:

      i was thinking of this too but couldn’t remember his name. thanks for bringing this back.

  2. Rob says:

    If you get a chance read the text of the Johns Hopkins study from Doctors Hsu, Brill, Li, Bledsoe and Grabowski. It was published in a peer-reviewed publication in 2006. It can be found here:

    They looked at a sample size of 171 professional, sanctioned MMA bouts.

    “Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993. In 2001, Nevada and New Jersey sanctioned MMA events after requiring a series of rule changes. The purpose of this study was to determine the incidence of injury in professional MMA fighters. 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. Medical and outcome data from events were analyzed based on a pair-matched case-control design. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. A total of 171 MMA matches involving 220 different fighters occurred during the study period. There were a total of 96 injuries to 78 fighters. Of the 171 matches fought, 69 (40.3%) ended with at least one injured fighter. 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%). With adjustment for weight and match outcome, older age was associated with significantly increased risk of injury. The most common conclusion to a MMA fight was a technical knockout (TKO) followed by a tap out. The injury rate in MMA competitions is compatible with other combat sports involving striking.”

    One additional quote from the study’s conclusion:

    “The lower knockout rates in MMA compared to boxing may help prevent brain injury in MMA events.”

  3. […] From Zach Arnold, What I think is illustrative about the negative reaction when one brings up the issue of concussions in MMA is that it reveals the fault lines between the fans, promoters, doctors, and fighters. Fans don’t care how the sausage is made, they just want the sausage. Many didn’t care that PRIDE was engulfed with a yakuza scandal, they just wanted to see PRIDE. The initial reaction many fans first had about the drug usage crisis in MMA was less about health & safety and more about, ‘whatever it takes for fighters to fight, let them do it.’ That perception has changed somewhat but is still prevalent. […]

  4. 45 Huddle says:

    If I ever had a son and he was great at sports (highly highly highly highly unlikely)…. I would steer him away from boxing, MMA, or Football. And concussions are the reason I would do this. Actually, if you are looking at the biggest money for the least chance of long term health issues, you probably want to stick to a baseball player (besides catchers & pitchers) or a tennis player. Sure they have injuries, but most can live long healthy lives without all of these horrible things that we are seeing happening to combat sports or football players.

    And don’t forget Pro Wrestling. All of those head shots probably turned Chris Benoit crazy.

    In America (and I assume other parts of the world too)…. We love to glorify athletes. But when you take a step back and really look at what their lives become…. It’s a few years of unbelievable glory…. Typically followed by many more years of agony.

    • edub says:

      Pro wrestling might be the worst. Wrestle night after night following concussions, and completely destroying your body. Then repairing it with a cocktail of steroids and painkillers. So many untimely deaths

      It makes you respect a guy like CM punk so much.

      As for sports for kids (Im having my first in October), mine will do whatever he likes. However, golf will be on the forefront.

  5. David M says:

    This is hypocritical of me, but I find it easier to stay a fan of mma and boxing than to be a fan of the NFL at this point. I feel that the latter is much more dangerous, especially for the brain. Football should honestly be banned. There is no equivalent to having a 300 pound man launch his body into you like a missile, with no fear of injury to his own head due to wearing a helmet.

    One of the reasons mma is safer than boxing is that there is no 10 count to recover; if you get knocked down, your opponent will jump on you and finish you, whereas in boxing, you have time to recover a bit from your concussion to take further damaging brain blows. In the NFL (and football on all levels) it is even worse, as there are constant breaks in the action, for minutes at a time, to recover enough to pretend to be ok. There is no referee to tell a player he is not well and cannot come back in the game; the doctors are employed by the teams, and thus have an inherent conflict of interest (compare to fight doctors, who aren’t employed by either fighter and thus don’t have the same desire to influence the outcome of the contest). I have heard (although haven’t done any research) that there is a class action suit against the NFL by 1500 former players complaining about the head injuries, and that the NFL knew of the dangers but never told the players/hid the truth.

    I personally find ESPN to be a particularly abhorrent network; they promote the big hits in the NFL, glorify the violence, and pretend there are no victims of the incredible pounding those guys take. It is getting harder and harder to glorify the violence; I hope there is a serious culture shift in the way the media promotes the sport.

    • edub says:

      There are actually multple class action suits by groups of former NFL players now. The 1500 is one group but they’re are actually many more.

      As a fan I fear the day when sports like these won’t be present anymore. However, it’s odd that the one with the best argument to stay around is MMA.

    • Chuck says:

      “One of the reasons mma is safer than boxing is that there is no 10 count to recover; if you get knocked down, your opponent will jump on you and finish you, whereas in boxing, you have time to recover a bit from your concussion to take further damaging brain blows.”

      That is extremely iffy. Punches to the head are punches to the head. I’m not saying that there isn’t any merit in this, but that really can’t be a big determining factor.

      For one thing, I would not use the term “safer”. That is very misleading. “Less Dangerous” has more merit (seems like I am splitting hairs, but if you really think about it, they are different concepts) than “safer” in this context.

      I think better examples of MMA being less dangerous than boxing when it comes to head injuries would be the smaller gloves deterring fighters from throwing more punches (more of a risk of breaking your hand(, whereas the bigger boxing gloves are more padded for better protection, hence more punches being thrown/landed. The aspect of grappling (takedowns, wrestling, submissions, transitions, guard work, etc.) definitely helps here. Back to the grappling, the threat of takedowns so fighters are sometimes more worried about getting taken down than being hit in the head (depends on the opponent and the way he/she fights of course).

      Hey, there are debilitating injuries in MMA that pretty much never happen in boxing. Like broken bones, sprains, tears, etc. If you get heel hooked and you don’t tap in time….you probably won’t walk correctly ever again.

      Here’s another thing to think about…..what if the referee doesn’t stop the fight in a timely manner? At least in boxing, a fighter goes down, the opponent can’t rush him when he’s down. And the referee starts a count at that time. How many MMA fights have their been where there was a fighter taking a HELLACIOUS beating and the ref waits way too long to stop it? Just check out the Pat Curran/Joe Warren fight. There isn’t a count or anything like that for the ref to determine if the fighter can or can not continue. Hence why there are premature stoppages in MMA (usually more so than late stoppages).

      • edub says:

        Just a few things:

        -The smaller gloves do more damage to the hands yes, but there’s actually research out there that shows blows connect on with a boxing glove carry just as much concussive force as ones with a bare knuckle (or smaller glove). The reason is the added weight. Another reason (that is disagreed on by some) is that people can put their full force into punches with such a padded fist. Kinda like the foot ball argument of the more protection you have the more you can treat yourself like a human missile.

        -Of course MMA has many more injuries on the entire body. That’s not really the conversation here though, as were talking about concussions in sports.

        -I’m glad you brought up that last point, because I think it is something that needs to be addressed. Stopping fights too late is definitely not a good thing. They most certainly hurt the brain. However, those instances do not carry as much damage as one-sided beatings in full fights (or even close long brutal fights). For the example the Warren vs. Curran fight was bad (eventhough I didn’t think it was that bad until I rewatched it), but that palesin comparison to tragedies like Mancini-Kim or more recently Kennedy-Rodriquez.

        MMA holds may dangerous possibilites in competition, but the repetitve blows to the head from boxing puts it in another league when thinking about how brutal the sport is.

        • Chuck says:


          About the gloves; that what I was going for. Because the boxing glove has more padding, that leads to fighters throwing more punches, hence more concussions and death via concussions. I have also heard about the extra weight of bigger gloves determining that the punches are heavier. I also heard about the head gear in amateur fights being worse for fighters wearing them because of the weight adding more force to punches from their opponents.


          Most fights (and no title fights) do the three knockdown rule, so fighters can still get dropped more than three times in one round, hence taking more damage. And remember, the three knockdown rule is for three knockdowns in one ROUND, not the entire fight.

        • Chuck says:

          Crap, I meant to say most boxing fights (especially title fights do NOT do the three knockdown rule. My bad.

    • Nepal says:

      The 10 second rule in theory works to MMA’s favour. After suffering a KO, you have 10 seconds to recover and can have a 2nd KO and 10 more seconds before the 3-knock down rule kicks in and the fight is stopped.

      This is all true but what you don’t get in boxing, and this seems to be ignored when the boxing/MMA KO/safety issue comes up – is the multiple blows to the head of a KO’d fighter that we see in MMA frequently. Sometimes it’s one single shot after the fighter is KO’d like Hendo on Bisping, the other end of the spectrum is Curren/Warren and there are many many instances in between.

      The MMA guys only reference the boxing 10 second rule and just ignore the beatings KO’d MMA fighters experience.

      We know concussions are terrible for the brain, it is only a matter of time… some years I suspect but I really don’t see a future for MMA or boxing as we know it as we gain more insight into head trauma.

      BTW, it’s nice to see Zack put up a piece like this. If you follow NHL for example, the issues of concussions are openly discussed and have been for years. Hockey players that are concussed go into detail on the post-concussion experience. The dizziness, the vomiting, the head aches, the depression experienced, the amount of exercise they can do before the symptoms recur etc etc. In MMA, when was the last time you heard a concussed fighter say he had even one of this symptoms? I’ll answer that. NEVER.

    • Megatherium says:

      Football will have to reduce the body armor, scale down the helmets, get rid of the face guards, take the head out of principal contact, and go back to playing the game the way it was originally conceived if it wants to survive.

  6. Kyle says:

    The Kruck piece suggests that we’re moving toward a future in which a professional fighter will have to get regular brain scans and if early signs of CTE are detected he’ll lose his license. In that future, a fighter will have a hard limit on the amount of head trauma he can take before his career is cut short.

    Expect to see a lot fewer guys going for Fight-of-the-Night slugfests and boasting about how they want to make every fight a stand-up war.

    That said, the best thing they could do to reduce CTE in MMA would be to get rid of the gloves and go back to bare fists.

    • 45 Huddle says:

      Removing gloves actually makes a lot of sense. Which is why it will never happen. Somehow people somehow always think that the more padding the “safer” the athletes are.

      Removing Gloves:

      1) Less Overall Punching.

      2) Less Brain Trauma.

      Just like in the NFL if they removed all of the pads, the game would hurt the athletes much less. But then again, the world already has a sport like this. It’s called rugby.

  7. […] How Will MMA Deal with Concussions in the Future? ( […]

  8. Norm says:

    Finally!!!! Zach, this is the topic you should have been digging deeper into instead of droning on about TRT for weeks on end. Concussions are infinitely more dangerous to athletes than TRT will ever be.

    Concussions will end up completely changing the game of football as we know it today. I wouldn’t be the least bit surprised to see football go away entirely, along with hockey, soccer, boxing, mma, etc. after more studies and research are conducted on the effects of concussions.

    Huge violent blows to the head are terrible. An accumulation of pitter patter blows to the head are terrible. Non-contact sports will be the only sports left standing.

    My arm chair diagnosis of Junior Seau’s situation leads me to believe he had frontal cortex trauma along with damage to his limbic system. He played the game for about 30, there is no way that didn’t have a detremental effect on his health.

    • RST says:

      You dont think that athletes swelled up on TRT hitting each other harder and absorbing more punishment then they could naturally is related?

  9. […] Concussion reform on the horizon for combat sports. Get the details on Fight Opinion. […]


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