Mixed martial arts is considered one of the fastest-growing sports in the world, with the professional UFC league worth more than $4-billion (U.S.) and amateur gyms popping up across the country. Yet in spite of its popularity and full-contact nature, the rate and risk of brain trauma involved in the sport remain unclear.
In a systematic review published online in the journal Trauma on Friday, researchers at St. Michael's Hospital in Toronto found it impossible to determine the incidence of head injuries in mixed martial arts due to a lack of high-quality data and inconsistencies in how injuries are defined and handled in the sport.
"The level of science is so poor right now that I don't think we can really say how dangerous it is," says Dr. Joel Lockwood, the lead author of the study. While in other sports, such as hockey and football, researchers are beginning to understand the accumulative effects of multiple brain injuries over time, "we really don't even have the starting blocks to see how much that's going to affect mixed martial arts athletes," he says.
Within the past 25 years, as mixed martial arts has entered the mainstream, it has also raised questions about its potential dangers. The 2007 death of Sam Vasquez due to complications from head trauma is believed to be the first fatality resulting from a sanctioned mixed martial arts match. In 2010, Michael Kirham died from brain injuries in his first professional fight.
But Lockwood, who is an emergency physician and trauma team leader at St. Michael's Hospital, says little is known about the prevalence of brain injuries in the sport, let alone the efficacy of various interventions to improve athletes' safety, such as different kinds of gloves or headgear.
He and his team reviewed a total of 18 studies. Five of them indicated between 28 per cent and 46 per cent of matches ended as a result of either a knockout, when a contestant is rendered unconscious, or technical knockout, when a referee stops the match or an injury is severe enough to stop the fight.
Lockwood says he became interested in studying the prevalence of head injuries in mixed martial arts after several competitors in a large event were sent to his hospital a few years ago. He noted there's a general lack of infrastructure to protect mixed martial arts athletes. Without adequate concussion protocols, return-to-play guidelines and regulations identifying who's qualified to make ring-side assessments of brain trauma, athletes are often left to manage their own injuries, he says. He adds that some competitors are going back to training before their symptoms have resolved.
"A lot of people aren't really getting the good medical advice that they need," he says.
He and his team noted that in Canada, mixed martial arts is regulated provincially, and in Ontario, a ring-side physician is required for sanctioned events. But Lockwood says there are no rules or legislation regarding the physician's expertise in treating brain injury. In the past, he says, kidney specialists and cardiologists acted as fight doctors, without necessarily having the skills to recognize and treat brain injuries.
Lockwood says there needs to be more medical oversight with regard to head injuries in the sport, as well as more data to make it as safe as possible. Since many young people are engaged in mixed martial arts, he suggests that a better understanding of the risks may lead to guidelines on equipment use or age levels, similar to rules on delaying body checking in hockey until players are a certain age.
In general, many sports organizations track injuries within their own sport, and do not necessarily release their data for public access, says Stephanie Cowle, a spokesperson for the injury-prevention charity Parachute. Parachute does not have statistics on head injuries in mixed martial arts, and Cowle was not able to comment specifically on that sport.
However, having solid data on how injuries occur, how often they occur, and to whom they're happening is critical for the protection of athletes, she says.
"We want to understand the scope of a problem. Is this something that happens very rarely? Or is this something that happens at an alarming rate?" she says, adding it's also important to understand the severity of injuries that are sustained.
"If we don't have that data to begin with, there's no baseline to tell us if what we're doing to prevent injuries is actually working."