Current Review of Injuries Sustained in Mixed Martial Arts Competition
ORIGINAL RESEARCH
The prevalence, risk factors predicting injury and the severity of injuries sustained during competition in professional mixed martial arts in Africa
S VenterI; D C Janse Van RensburgII; L FletcherIv; C C GrantV
IMSc. Section Sports Medicine, Faculty of Health Science, Academy of Pretoria, Pretoria, South Africa
IIMD Section Sports Medicine, Faculty of Wellness Science, University of Pretoria, Pretoria, South Africa
IIIInstitute for Sports Inquiry, University of Pretoria, Pretoria, South Africa
IVPhD. Department of Statistics, Faculty of Natural & Agronomical Sciences, University of Pretoria, Pretoria, South Africa
VPhD. Section Sports Medicine, Kinesthesia of Wellness Science, Academy of Pretoria, Pretoria, South Africa
Correspondence
ABSTRACT
Background: Professional mixed martial arts (MMA) has gained international popularity. No African-based studies take reported the prevalence or severity of injuries, risk factors associated with injuries or return-to-play (RTP) time.
OBJECTIVES: To determine the prevalence of injuries and associated risk factors, also as severity of injuries sustained by professional male MMA athletes competing at the Farthermost Fighting Championships Africa (EFC Africa) from 2010 to 2014.
METHODS: Permission to do the study and the medical records of all professional person events (2010 - 2014) were obtained from EFC Africa. Data were obtained from 173 male competitors anile 18 to 44 years, who had participated in 300 professional MMA fights. Results from this prospective cohort study were compared to a like report done in the Us (Us). An injury was defined equally whatsoever damage to an athlete'south body that needed the attending of the ringside dr.. Statistical analyses included descriptive statistics and a stepwise logistic regression. Odds of an injury were predicted with six independent variables: fight upshot, age, weight division, number of fights, injuries in the preceding fight and years of fighter experience.
RESULTS: Caput, face and neck injuries were near common (22%), followed by traumatic brain injuries (knockouts) (6%). Losing a fight was a meaning predictor of injury when using the stepwise logistic regression model (p=0.040). The odds ratio indicated that a preceding fight injury almost doubled the chance of injury in the post-obit fight (OR 1.91; p= 0.163). Traumatic encephalon injuries (TBIs) in this report of African-based competitions (6%) were substantially higher than reported in the American report (i.viii%).
CONCLUSION: Caput, neck and face injuries are common in African fighters. The high rate of TBIs in African contest compared to the U.s.a. study is apropos. This could reflect superior refereeing in the USA group, as fights may exist ended sooner by stoppage. Further investigation of injury trends and preventative measures should be studied to reduce the incidence of injuries during African competitions.
Keywords: mixed martial arts, concussion; return-to-play.
Mixed martial arts (MMA) is a full-contact, unarmed gainsay sport that allows hit and grappling techniques.[ane] This includes karate, Jeet-Kune-Practise, kung-fu, Muay-Thai, boxing, kickboxing, judo, taekwando, ninjitsu, wrestling, jiu-jitsu and Brazilian Jiu Jitsu (BJJ). MMA has evolved into a sport represented by numerous bodies around the world.[2] The Ultimate Fighting Championship (UFC) based in America is regarded as the globe ascendant MMA platform. In 1996, Arizona Senator John McCain described MMA equally "human cockfighting", and sent letters to the governors of all fifty U.s.a. states asking them to ban the effect. Thirty-6 states banned the "no-holds-barred" fighting. In response to all the criticism, the UFC redesigned its rules to remove the unpalatable elements of the fights, while retaining the core elements of striking and grappling. This lead to the creation and implementation of the New Jersey Country Athletic Control Board's Unified Rules[iii] in November 2000, which are obeyed in most professional regulated MMA competitions around the globe. These rules, aimed at increasing the safety of competitors, helped promote the mainstream acceptance of the sport. MMA in Africa is regulated by the International Mixed Martial Arts Federation (IMMAF) [4], and the Unified Rules utilize to EFC Africa.
MMA competitions have male and female divisions, each with their own weight divisions. Competitors wearable compulsory safety gear (4 ounce or 113.4g gloves, mouth guard and groin protector). Fights take place in a three m2 hexagon/ring fenced in surface area. This expanse has a 2.5 cm padded floor and two entrances. All exposed metallic is covered. Competitors have to pass a basic medical exam and screening tests for Human ImmunoDeficiency Virus (HIV) and hepatitis. Normally fights consist of three v-minute rounds with a ane-minute rest menstruum between rounds. Withal, championship bouts consist of five v-minute rounds. A qualified referee oversees the MMA fight and tin use his/her discretion to stop the fight.
During the fight, all rules demand to exist adhered to and if disobeyed, may result in disqualification. The rules ban headbutting, eye-gouging, fish-hooking, groin attacks, fingers into orifices/lacerations, small joint manipulation, 90 caste elbows, blows to the back of the head, blows to the kidney with the heel, throat strikes and grabbing of the trachea/clavicle, boot/kneeing the caput of a grounded opponent, stomping a grounded opponent, and spiking an opponent to the sheet on his head/neck. A fighter can win a match in different ways: submission (exact/tap out); knockout (KO); technical knockout (TKO); or decision via scorecards. The fight can as well be declared a draw, disqualification, forfeit, technical describe/determination or no contest.
10 competitions are hosted in South Africa every yr by the EFC. More 300 athletes have competed at EFC Africa since its inception in 2009. Despite the popularity of MMA in Africa at that place is no information about the prevalence, severity and chance factors associated with injuries during contest. Therefore the aim of this report was to make up one's mind the prevalence and severity of injuries, every bit well as take a chance factors associated with sustaining injuries in professional MMA competitions in Africa.
Methods
Report design
A prospective accomplice study was designed using medical records as documented by an accredited ringside physician. The Inquiry Ethics Committee of the University of Pretoria canonical the study later permission from the custodian of the data, EFC Africa, was confirmed.
Participants and demographics
All injuries sustained past athletes competing at EFC Africa events from 5 August 2010 to 14 June 2014 were included in the study (n = 300 fights or 600 fight exposures). Competitors consisted of 173 male athletes between the ages of xviii and 44 years. Only male athletes were included in this written report as professional female MMA in Africa was only introduced in 2015.
Medical data collection
Medical records were obtained from the event medical support squad with the permission of the custodian of the data; EFC Africa. An accredited ringside physician recorded these records immediately after the fight, reporting all injuries sustained co-ordinate to anatomic location, type of injury and injury severity. The anonymity of the injured fighter was maintained and the average return-to-play (RTP) fourth dimension after injury was considered an indicator of the severity of the injury.
Data obtained included the appointment of the fight, full number of fights, full injuries (damage to an athlete'due south trunk that needed the attention of the ringside physician), event of the fight, competitor's age at the date of the fight, weight divisions, years of experience, injuries sustained in the previous fights, injuries sustained in the electric current fight past anatomic location and severity, time between fights and fourth dimension off until RTP. Data were compared to a study conducted by Ngai[5], reviewing injury trends in 635 professional USA MMA fights from 20022007.
Statistical analysis
The statistical analysis included descriptive statistics and a stepwise logistic regression model using IBM SPSS Statistics 22. Odds of an injury were predicted with the post-obit contained variables: fight outcome, age, weight partition, number of fights, injuries in the preceding fight and years of fighter feel. These results were also compared to a like report by Ngai as previously mentioned. This study also used the term "fight exposures" as used in the Ngai study, indicating that two athletes are exposed to injury per fight. Similarly, the injury odds ratios were calculated using logistic regression including match outcome, weight, age and fight experience, during a pair-matched case-control study blueprint (n=464). Cases were also defined every bit fighters who sustained an injury/received medical attention during the matches, and controls were defined as fighters who were uninjured.
Results
General
Table 1 summarises fight exposures, the total number of injuries and total number of traumatic encephalon injuries (TBIs). Of the 300 fights (600 exposures), 295 fights ended with a 'win' result for one fighter and a 'loss' result for the other fighter. Two fights were cancelled before taking identify, two fights ended in draws and 1 fight was deemed a 'no contest'. Among the 600 professional person MMA fight exposures included in the report, 222 total injuries were reported. The injury rate is thus 37 per 100 fight exposures.
Percentage of injuries co-ordinate to anatomic location
Tabular array two reflects the total prevalence of injuries in the present study past anatomic location and average RTP post-obit specific injuries. Injuries to the head, face and cervix were the nearly common (22%), followed past TBIs due to knockouts (6%), upper limb injuries (4%), lower limb injuries (iii%) and injuries to the torso/back/ribs (2%). One death due to intra-cerebral haemorrhage resulted from an MMA fight during the report period.
Fifteen fractures were reported (Table 3). The most common fractures sustained were rib fractures (5), followed past metacarpal (4) and metatarsal fractures (2). Only two dislocations occurred during the study period and both involved the shoulder joint. Injuries to the face included 16 episodes of epistaxis, and five auricular hematomas.
Return- to- play (RTP) times
Lower limb injuries were responsible for the longest fourth dimension off play. The boilerplate RTP later injury was 7.7 weeks. Lower limb injuries included anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures, for which the average RTP is ane twelvemonth. 2 of these injuries were recorded during the study period, thus contributing to the increased RTP average.
RTP averages 3.7 weeks following upper limb injury, with metacarpal fractures contributing mostly to the prolonged recovery fourth dimension. A four-week period is the average time needed to recover from TBIs/hypoxia. This follows the thirty day knockout rule.
Injury to the body/dorsum/rib/groin requires three.v weeks until RTP (rib fractures and soft tissue injuries). Following a caput/face/neck injury, RTP averages ii.2 weeks.
The virtually regular time lapse between all fight exposures, whether athletes were injured or uninjured, was 3 months (84%), but may vary between 22 days and four years. The three month time lapse most oft represents the fourth dimension fighters take to rest after preparing for a fight and afterwards competing. Sure athletes compete once more after a shorter time lapse, depending on their workout and motivation for competing (financial gain, title contention, etc.).
Logistic regression: Injury prediction
Logistic regression models were used to compare injured athletes to non-injured athletes. (Tabular array iv). The odds ratio of an injury were modelled using 4 independent variables: the outcome of the fight, the age of the athlete, the weight division and the number of fights. The results of this logistic regression were compared to a report conducted by Ngai[5] in the U.s., using the same predictors. 3 models were synthetic: Model 1 included the higher up-mentioned iv predictors; in Model ii, two more predictors were added, i.e. injuries sustained in the preceding fight and the total years of feel of each fighter. For Model 3 a stepwise logistic regression was performed to identify possible predictors of injury (with a stepwise procedure, but significant predictors are included in the model).
In SA Model 1 no single predictor was constitute to exist significant for predicting an injury, although there is moderate to strong quality evidence that losing a fight is a predictor (p=0.052), controlling for age, weight and number of previous fights. The additional two predictors in SA Model ii (years of feel and injury in the previous fight) were too non significant. However, losing a fight was a meaning predictor of injury when controlling for the other five explanatory variables. Using stepwise logistic regression (SA Model 3), losing a fight was again a meaning predictor of injury in that fight (p=0.041). The odds ratio (OR) indicated that losing the previous fight doubles the take a chance of injury (OR 2.02). A preceding fight injury likewise more doubles the risk of injury in the following fight (OR two.19; p= 0.060).
Discussion
Overall injury prevalence appears to be as loftier as 37% in the present study compared to only 24% in the USA study past Ngai.[5] The total percentage of TBIs in the African-based competitions (half dozen%) is also essentially college than in the Usa-based competitions (two%). Losing a fight was a meaning predictor of injury when employing a stepwise logistic regression model (p=0.041), doubling the take a chance of sustaining an injury in the following fight (OR ii.02). Fighters who sustained an injury in the preceding fight likewise more than than doubled the risk of sustaining an injury in the post-obit fight (OR 2.185, p=0.06) (Table 4).
The total percent of injuries averaged 37% between 2010 and 2014 (Table 1). A substantial increase in the amount of TBIs was recorded in 2011. Possible causes could include competitor-dependent variables such every bit inexperience, poor weight-cutting techniques and injuries sustained during preparation; unrealistic RTP periods; poor refereeing or application of rules and safety measures; and poor pre-fight medical screening. At that place was also a dramatic increase in the per centum of injuries sustained during 2014 (Table one). This may exist an indication of superior post-fight medical assessment of fighters by experienced sports physicians.
Professional MMA fighters accept a three times higher injury rate than amateur MMA fighters.[6] It is the author's opinion that this could be ascribed to a college level of contest, or it could also be due to the lack of protective gear and the legality of knee and elbow strikes to standing/grounded opponents in the professional fights. Further studies are brash in this regard.
MMA and concussion
The Ngai studyt[5] reports that 36% of all injuries in MMA occur to the head/neck/face region which is higher than the 22% rate reported in the SA study. Approximately 7% of fights end in a KO in the The states study equally compared to 6% in the SA written report. Scoggin et al.[vi] found that 20% of injuries sustained during MMA bouts were concussions resulting in cursory (<15seconds) loss of consciousness and/or retrograde amnesia.
Caput-impact (also implying concussion) in MMA training and competition is common. Head injuries occur in other contact sports, and in a multitude of non-contact sports.[7] Boxing carries a high charge per unit of head injuries with the highest rate of sport-related mortality due to TBIsJviii] A recent article, however, claims that cyclists have the highest rate of sports-related TBIs.[9] Other contact sports in which TBIs frequently occur include ice-hockey, Muay-Thai, kick-boxing and rugby. Non-contact sports in which athletes sustain regular concussions include soccer, basketball, skiing, lacrosse, baseball, basketball, snowboarding, skateboarding and motocross. Many head injuries in athletes are the effect of improper playing techniques and this can be reduced in African athletes through the didactics of proper skills and enforcing safety promoting rules.[10]
Condom gear and TBIs
The use of protective headgear has remained a controversial topic of discussion. The main viewpoints regarding the apply of headgear are, firstly, the ability to decrease the impact of strikes to the caput, and thereby limiting the incidence of TBIs. The International Boxing Association (AIBA) banned amateur boxers from wearing headgear in a bid to reduce the incidence of concussion. This conclusion supports the second point of view, following an internal study by Wang[xi], showing that a lack of headgear actually reduces the take chances of concussion. Researchers agree that while headgear can assist to avert other serious caput and facial injuries, there was no scientific evidence proving that information technology contributes to the prevention of concussion, and, paradoxically, it may even encourage fighters to take greater risks. Repeated, sub-concussive hits to the head damage the claret-brain-bulwark and are besides linked to chronic traumatic encephalopathy later in life.[12] Headgear tin obscure peripheral vision, making it harder to see when a blow is aimed at the side of the head.
The use and size of gloves regarding MMA and boxing-related head injuries are also controversial. Strikes to the caput were less common in the bare-knuckle era because of the chance of hand injuries. Gloves reduce the incidence of lacerations to the face, but research has stated that gloves do not reduce TBIs and may even increase the incidence.[13] This is explained by considering caput acceleration-deceleration equally the mechanism of injury leading to a concussion. Large gloves force fighters to deliver an increased number of more forceful strikes to the head (college striking rate and acceleration) in order to achieve a KO.
RTP
A much disputed expanse of combat sport is the render of fighters to competition after injury.[fourteen] The most debated issue is the time lapse during this convalescent menses and how information technology differs for specific injuries (head injuries, fractures, dislocations, etc.). Concussions are often missed, while their detection and management are imperative, equally mismanagement of this syndrome tin lead to persistent/chronic post-concussion syndrome or diffuse cerebral swelling.[15] In keeping with international standards, EFC Africa requires fighters to undergo a pre-fight uncontrasted Computerised tomography (CT) brain browse. No fighters are allowed to return to competition after suffering a KO loss in a fight within 30 days (the xxx-day knockout rule). The boilerplate RTP after injury varies from 2.two weeks to one year, depending on the type, anatomic location, and severity of injury. The xxx-day knockout rule is a mandatory medical intermission that applies to all athletes who suffered TBIs during contest. Unfortunately, it is difficult to appraise athletes for TBIs sustained during training and the onus of RTP following such injuries is largely placed on the athletes themselves and their coaches.
Choke submissions as a method of victory occurred in 10% of MMA fights included in this study. These manoeuvres are reported separately, as the mechanism involved in causing loss of consciousness while existence choked differs from that of a KO. Choke submissions induce temporary brain hypoxia, whereas KOs are related to dispatch-deceleration TBIs. Thus choke submissions cannot be regarded every bit concussions. Joint submissions contributed to a win effect in 3% of cases, and injuries sustained due to these manoeuvres are after reported as upper or lower limb injuries.
Injuries
Although TBIs are the most feared injuries in MMA, other less serious injuries occur regularly. These include auricular haematomas, orofacial, caput, limb, body and groin injuries.
The submission-grappling component has increased the incidence of strains and dislocations to the shoulder, elbow, wrist, knee and ankle joints respectively. The striking component is largely responsible for injuries to the face, head, ribs, long bones and soft tissue of the extremities.
Conclusion
The pool of professional MMA athletes in Africa is small (161 signed athletes) compared to the thousands of athletes competing in the USA. I professional person MMA event is held in SA every calendar month, while several events take place in the USA on a weekly footing. This study is the offset comprehensive assay of injuries sustained in professional MMA competition in Africa to date. Further studies are advised to tape injury trends, including the hazard factors associated with injuries and the severity of injuries in professional MMA. The concussion rate during training and the subsequent RTP should exist studied to minimise incidents of exposing concussed athletes to competition also early. Pre-fight Magnetic Resonance Imaging (MRI) studies, although expensive, could assist in the detection of training-related concussions.
This study provides the most comprehensive analysis of ringside physician-nerveless data on professional person male MMA fighters in Africa. No report has included the possible predictors of injury or the RTP time, making this report a valuable help to fighter safety for fighters, physicians, promoters and referees. Merely one study has reviewed the epidemiology of injuries in MMA, and this included amateur and professional athletes of both genders. [six]
Although much has been done to improve fighter safety by the introduction of the Unified Rules of Conduct[3], MMA still remains a contact sport with express command over the incidence of injuries.
This written report recorded the prevalence of injuries, the risk factors associated with sustaining an injury and the severity of injuries during contest in Africa.
The value of this study
This written report has highlighted the following:
• The overall prevalence of injuries during MMA competition in Africa from 2010-2014 was as high equally 37%;
• The incidence of life-and/or limb-threatening injuries appears higher when compared to the USA study;
• Run a risk factors for sustaining an injury in competitive professional African athletes include an injury in die previous fight and losing the current fight;
• TBIs in the African based competition report (6%) was substantially higher than the USA study by Ngai[5] (i.8%).
Thus this study contributes to enhancing overall fighter safety past creating awareness amongst sanctioning bodies, trainers, referees, sports physicians and fighters:
• Losing a fight vs. injury correlation: A focus on mental toughness and additional care should be given to losing fighters;
• RTP should not be considered before full recovery;
• Fights may exist ended sooner due to referee stoppage.
Farther studies are needed to aid in maximising the safety of MMA fighters by educating the sanctioning bodies, trainers, referees, sports physicians and fighters.
References
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S Venter
drventer@yahoo.com
Source: http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1015-51632017000100004