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.
LundbergGD. Blunt force violence in America – shades of gray or red. Ultimate/extreme fighting. JAMA1996; 275: 1684–1685.
2.
RaineyCE. Determining the prevalence and assessing the severity of injuries in mixed martial arts athletes. N Am J Sports Phys Ther2009; 4: 190–199.
3.
TainskySSalagaSSantosCA. Determinants of pay-per-view broadcast viewership in sports: the case of the ultimate fighting championship. J Sport Manage2013; 27: 43–58.
4.
BledsoeGHHsuEBGrabowskiJGet al.Incidence of injury in professional mixed martial arts competitions. J Sports Sci Med2006; 5(CSSI): 136–142.
MezJSternRAMcKeeAC. Chronic traumatic encephalopathy: where are we and where are we going?Curr Neurol Neurosci Rep2013; 13: 407–407.
12.
OmaluBIDeKoskySTMinsterRLet al.Chronic traumatic encephalopathy in a National Football League player. Neurosurgery2005; 57: 128–134; discussion: 128–134.
13.
HazratiLNTartagliaMCDiamandisPet al.Absence of chronic traumatic encephalopathy in retired football players with multiple concussions and neurological symptomatology. Front Hum Neurosci2013; 7: 222–222.
14.
McKeeACSternRANowinskiCJet al.The spectrum of disease in chronic traumatic encephalopathy. Brain2013; 136(Pt 1): 43–64.
BolelliD. Mixed martial arts: a technical analysis of the ultimate fighting championship in its formative years. J Asian Mart Arts2003; 12: 40–51.
17.
ScogginJF3rdBrusovanikGPiMet al.Assessment of injuries sustained in mixed martial arts competition. Am J Orthop2010; 39: 247–251.
18.
NgaiKMLevyFHsuEB. Injury trends in sanctioned mixed martial arts competition: a 5-year review from 2002 to 2007. Br J Sports Med2008; 42: 686–689.
19.
HutchisonMGLawrenceDWCusimanoMDet al.Head trauma in mixed martial arts. Am J Sports Med2014; 42: 1352–1358.
20.
McClainRWassermenJMayfieldCet al.Injury profile of mixed martial arts competitors. Clin J Sport Med2014; 24: 497–501.
21.
KarpmanSReidPPhillipsLet al.Combative sports injuries: an Edmonton retrospective. Clin J Sport Med2016; 26: 332–334.
22.
BanksSJMayerBObuchowskiNet al.Impulsiveness in professional fighters. J Neuropsychiatry Clin Neurosci2014; 26: 44–50.
23.
BanksSJObuchowskiNShinWet al.The protective effect of education on cognition in professional fighters. Arch Clin Neuropsychol2014; 29: 54–59.
24.
ShinWMahmoudSYSakaieKet al.Diffusion measures indicate fight exposure-related damage to cerebral white matter in boxers and mixed martial arts fighters. Am J Neuroradiol2014; 35: 285–290.
25.
BernickCBanksSJShinWet al.Repeated head trauma is associated with smaller thalamic volumes and slower processing speed: the Professional Fighters' Brain Health Study. Br J Sports Med2015; 49: 1007–1011.
26.
MayerARLingJMDoddABet al.A longitudinal assessment of structural and chemical alterations in mixed martial arts fighters. J Neurotrauma2015; 32: 1759–1767.
27.
GalettaKBarrettJAllenMet al.The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology2011; 76: 1456–1462.
28.
FieldsJDMcKeagDBTurnerJL. Traumatic tympanic membrane rupture in a mixed martial arts competition. Curr Sports Med Rep2008; 7: 10–11.
29.
SloweyMMawGFurykJ. Case report on vertebral artery dissection in mixed martial arts. Emerg Med Australas2012; 24: 203–206.
30.
WhiteC. Mixed martial arts and boxing should be banned, says BMA. BMJ2007; 335: 469–469.
DonaldsonLAsbridgeMCusimanoMD. Bodychecking rules and concussion in elite hockey. PLoS One2013; 8: e69122–e69122.
34.
NathansonJTConnollyJGYukFet al.Concussion incidence in professional football: position-specific analysis with use of a novel metric. Orthop J Sports Med2016; 4: 2325967115622621–2325967115622621.
35.
KrolikowskiMPBlackAMPalacios-DerflingherLet al.The effect of the “Zero Tolerance for Head Contact” rule change on the risk of concussions in youth Ice hockey players. Am J Sports Med2017; 45: 468–473.
36.
HutchisonMGComperPMeeuwisseWHet al.A systematic video analysis of National Hockey League (NHL) concussions, part I: who, when, where and what?Br J Sports Med2015; 49: 547–551.
EmeryCAHagelBDecloeMet al.Risk factors for injury and severe injury in youth ice hockey: a systematic review of the literature. Inj Prev2010; 16: 113–118.
39.
RobertsAH. Brain damage in boxers, London: Pitman Medical and Scientific Publishing Co Ltd, 1969.
