Be prepared at ringside I
Mixed martial arts (MMA) competition, also known as cage fighting, extreme fighting and no holds barred sport fighting, has attracted attention in recent years for its violence. Competitors wear minimal protective equipment and attempt to win the bout by: concussing an opponent into defencelessness through blunt head trauma; disabling an opponent through joint subluxation, dislocation, or soft tissue trauma; causing unconsciousness through a neck choke; or forcing an opponent into submission through a variety of the above techniques.
To date there has been limited research into the incidence and aetiology of injuries in MMA competitions. Recently Dr George Buse undertook a study to identify the primary medical issues that may be associated with MMA competition by determining the types and proportions of match stoppages (‘No holds barred sport fighting: a 10-year review of mixed martial arts competition’, British Journal of Sports Medicine2006: 40, 169-172). Dr Buse reviewed video footage of 1,284 men competing in 642 televised matches between November 1993 and November 2003. Based on the legal techniques and target areas, Dr Buse expected that there would be four key categories of match stoppage:
* Head impact (blunt force to the head).
*Musculoskeletal stress (joint lock, blunt orthopaedic trauma or other apparent musculoskeletal trauma).
* Neck choke (submission or stoppage due to the afflicted competitor being asphyxiated or unconscious).
* Miscellaneous trauma (other mechanisms of match stoppages not included in above categories).
Of the 642 matches, 182 (28%) were stopped because of head impact (punch, knee strikes, elbow strikes, kicks, slam to ground or head stomp), of which 62 (34%) involved a knockout and 120 (65%) a technical knockout. One hundred and six (16%) of the bouts were stopped because of musculoskeletal stress (elbow, ankle, shoulder and knee locks causing hyper-mobilisation of the joint through forceful distraction, hyperextension and/or rotational manipulation; and neck cranks – forceful manipulation of the opponent’s head on neck). Ninety-one (14%) were stopped through the application of a neck choke and 83 (13%) because of miscellaneous trauma. The rest of the matches ended because the match time was up or competitors were disqualified.
While mixed martial arts fighting is not a modern sport (its roots can be traced to the 33rd Olympiad in 648BC), the growth of MMA competitions in recent years has led to concerns about competitors’ safety. Yet the current research is one of only a handful of studies that have looked at the mechanisms of injury during MMA bouts.
Competitors who lost as a result of one of the four key mechanisms were significantly older than their opponents, which supports the findings of previous research in which martial arts injury incidence is proportional to age. This study identified head impact as a salient medical issue in MMA competition and the proportion of matches stopped because of head impact was higher than has been documented in other full-contact combat sports (eg, boxing, kick-boxing).
Be prepared at ringside II
As seems to happen, a dearth of research is followed by a crop of studies in swift succession. A US team based in Maryland has recently completed another study investigating injury in professional MMA competitions (‘Incidence of injury in professional mixed martial arts competitions’, Journal of Sports Science and Medicine2006: 136-142). The study design differs from our first review and throws up some interesting conclusions.
Data was collected between September 2001 and December 2004 from all professional MMA events taking place in the state of Nevada, US. A total of 171 MMA matches involving 220 different competitors took place during the study period, producing 96 injuries to 78 fighters. The overall injury rate was 28.6 injuries per 100 fight participations or 12.5 injuries per 100 competitor rounds. The main findings of the study were:
* Of the 171 matches fought, 69 (40%) ended with at least one injured fighter.
* The majority of recorded injuries were to the facial region. Facial cuts were the most common injury (48%), followed by hand injury (13%), nose (10%) and eye (8%).
* After adjusting for weight and match outcome, older age was associated with significantly increased risk of injury.
* Competitors who lost a match by knockout or technical knockout ran a greater risk of injury.
* Incidence of injury increased with the length of the fight; matches lasting four or five rounds were more likely to include a fighter who suffered an injury.
In conclusion, with an overall injury rate of 28.6 injuries per 100 fight participations, MMA competitions demonstrate a high overall rate of injury, but in keeping with other combat sports involving striking.
Is a modern non-contact form of karate a safer alternative to some of the more supposedly high risk forms of martial arts? Karate is often cited as a sport with a high risk of injury. In 2000 the World Karate Federation changed the rules of competition in an effort to promote the sport, decrease injury rates, and make competitions more dynamic and attractive. The purpose of this study was to evaluate the incidence and distribution of injuries in Karate before and after the implementation of the new rules and safety standards (‘Effects of new karate rules on the incidence and distribution of injuries’, British Journal of Sports Medicine2006: 40, 326–330).
The study covered 887 karate matches during 1997 and 1,604 in 2002. In 1997 the overall injury incidence was 10.28 per 100 exposure minutes. In 2002 the incidence was 9.82 per 100 exposure minutes. In both periods women over 18 years of age showed the highest injury incidence while men over 18 years of age showed the lowest injury incidence. In 1997 there was a higher risk of sustaining a head injury but in 2002 there was a higher risk of leg injury.
It was thought that women were more vulnerable to injury because of their generally lower levels of technical and tactical skills and lesser competition experience. The increase in leg injuries can be linked to changes in the scoring system that placed an increased emphasis on kicking techniques. The study concluded that the relative risk of injury for young competitors was significantly reduced, and this could be related to the implementation of the new rules and safety standards, including protective equipment (compulsory gum shields and standardised size and shape of gloves), light contact rules of engagement and mandatory medical supervision.
Female competitors and younger competitors in other sports, both martial arts and other contact sports, have been shown to be at higher injury risk, so governing bodies could use these findings to take stock of the potential to improve their own rules and safety standards.