Incidence of Injury in Professional Mixed Martial Arts Competitions
Full Text:
Mixed martial arts (MMA) is a full-contact, unarmed combat sport that allows striking and grappling techniques. [ane] This includes karate, Jeet-Kune-Do, 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. [two] The Ultimate Fighting Championship (UFC) based in America is regarded as the globe ascendant MMA platform. In 1996, Arizona Senator John McCain described MMA as "human cockfighting", and sent messages to the governors of all 50 The states states asking them to ban the event. Xxx-six 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 cadre elements of hit and grappling. This lead to the creation and implementation of the New Jersey State Athletic Control Board'south Unified Rules [3] in Nov 2000, which are obeyed in nearly professional regulated MMA competitions around the world. These rules, aimed at increasing the prophylactic of competitors, helped promote the mainstream credence of the sport. MMA in Africa is regulated by the International Mixed Martial Arts Federation (IMMAF) [4], and the Unified Rules apply to EFC Africa.
MMA competitions have male and female divisions, each with their own weight divisions. Competitors wear compulsory safety gear (four ounce or 113.4g gloves, rima oris guard and groin protector). Fights take identify in a three [m.sup.two] hexagon/band fenced in area. This area has a 2.5 cm padded floor and two entrances. All exposed metal is covered. Competitors have to pass a bones medical examination and screening tests for Man ImmunoDeficiency Virus (HIV) and hepatitis. Normally fights consist of three 5-minute rounds with a ane-infinitesimal residual menstruation between rounds. However, title bouts consist of five 5-minute rounds. A qualified referee oversees the MMA fight and can apply his/her discretion to finish the fight.
During the fight, all rules need to be adhered to and if disobeyed, may issue in disqualification. The rules ban headbutting, eye-gouging, fish-hooking, groin attacks, fingers into orifices/lacerations, small articulation manipulation, 90 degree elbows, blows to the back of the caput, blows to the kidney with the heel, throat strikes and grabbing of the trachea/clavicle, kick/kneeing the caput of a grounded opponent, stomping a grounded opponent, and spiking an opponent to the sail on his head/neck. A fighter tin win a match in different ways: submission (exact/tap out); knockout (KO); technical knockout (TKO); or decision via scorecards. The fight can also exist declared a draw, disqualification, forfeit, technical draw/decision or no competition.
Ten competitions are hosted in South Africa every year by the EFC. More than 300 athletes have competed at EFC Africa since its inception in 2009. Despite the popularity of MMA in Africa there is no information most the prevalence, severity and risk factors associated with injuries during competition. Therefore the aim of this study was to determine the prevalence and severity of injuries, too as take chances factors associated with sustaining injuries in professional MMA competitions in Africa.
Methods
Study design
A prospective cohort study was designed using medical records as documented by an accredited ringside doc. The Research Ethics Committee of the University of Pretoria approved the study after permission from the custodian of the data, EFC Africa, was confirmed.
Participants and demographics
All injuries sustained by 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 18 and 44 years. Only male person athletes were included in this study as professional female MMA in Africa was only introduced in 2015.
Medical information collection
Medical records were obtained from the effect medical support squad with the permission of the custodian of the data; EFC Africa. An accredited ringside physician recorded these records immediately later on the fight, reporting all injuries sustained according to anatomic location, type of injury and injury severity. The anonymity of the injured fighter was maintained and the average render-to-play (RTP) fourth dimension subsequently injury was considered an indicator of the severity of the injury.
Information obtained included the appointment of the fight, full number of fights, full injuries (damage to an athlete's body that needed the attending of the ringside dr.), consequence of the fight, competitor's age at the date of the fight, weight divisions, years of feel, injuries sustained in the previous fights, injuries sustained in the current fight by anatomic location and severity, time betwixt fights and time 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 assay
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 independent variables: fight outcome, historic period, weight division, number of fights, injuries in the preceding fight and years of fighter experience. These results were too compared to a similar written report by Ngai as previously mentioned. This written report 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, historic period and fight feel, during a pair-matched case-control written report design (n=464). Cases were also defined as fighters who sustained an injury/received medical attention during the matches, and controls were divers as fighters who were uninjured.
Results
General
Table ane summarises fight exposures, the full number of injuries and total number of traumatic brain 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 concluded in draws and ane fight was deemed a 'no contest'. Amongst the 600 professional MMA fight exposures included in the study, 222 total injuries were reported. The injury rate is thus 37 per 100 fight exposures.
Percentage of injuries according to anatomic location Table two reflects the full prevalence of injuries in the present study by anatomic location and average RTP following specific injuries. Injuries to the head, face and neck were the about common (22%), followed by TBIs due to knockouts (6%), upper limb injuries (four%), lower limb injuries (three%) and injuries to the body/back/ribs (2%). Ane expiry due to intra-cerebral bleeding resulted from an MMA fight during the study period.
Fifteen fractures were reported (Table iii). The well-nigh common fractures sustained were rib fractures (5), followed past metacarpal (iv) 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 5 auricular hematomas.
Return- to- play (RTP) times
Lower limb injuries were responsible for the longest time off play. The average RTP after injury was 7.7 weeks. Lower limb injuries included inductive cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures, for which the average RTP is i year. Two of these injuries were recorded during the report period, thus contributing to the increased RTP average.
RTP averages iii.7 weeks post-obit upper limb injury, with metacarpal fractures contributing mostly to the prolonged recovery time. A four-week flow is the average time needed to recover from TBIs/hypoxia. This follows the 30 24-hour interval knockout dominion.
Injury to the trunk/back/rib/groin requires 3.5 weeks until RTP (rib fractures and soft tissue injuries). Following a head/face/cervix injury, RTP averages ii.2 weeks.
The most regular time lapse between all fight exposures, whether athletes were injured or uninjured, was three months (84%), but may vary betwixt 22 days and four years. The three month time lapse most frequently represents the time fighters take to rest after preparing for a fight and afterward competing. Certain athletes compete again after a shorter time lapse, depending on their conditioning and motivation for competing (financial proceeds, 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 four independent variables: the outcome of the fight, the historic period of the athlete, the weight division and the number of fights. The results of this logistic regression were compared to a study conducted past Ngai [5] in the United states, using the aforementioned predictors. Iii models were constructed: Model ane included the above-mentioned four predictors; in Model 2, two more predictors were added, i.east. 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, simply significant predictors are included in the model).
In SA Model 1 no single predictor was found to be significant for predicting an injury, although there is moderate to stiff quality testify that losing a fight is a predictor (p=0.052), controlling for age, weight and number of previous fights. The additional ii predictors in SA Model 2 (years of experience and injury in the previous fight) were also not significant. However, losing a fight was a significant 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 risk of injury (OR 2.02). A preceding fight injury likewise more doubles the risk of injury in the post-obit fight (OR 2.nineteen; p= 0.060).
Discussion
Overall injury prevalence appears to exist as high as 37% in the present written report compared to only 24% in the USA study by Ngai. [5] The total percentage of TBIs in the African-based competitions (6%) is besides substantially higher than in the USA-based competitions (2%). Losing a fight was a significant predictor of injury when employing a stepwise logistic regression model (p=0.041), doubling the adventure of sustaining an injury in the following fight (OR 2.02). Fighters who sustained an injury in the preceding fight also more than doubled the risk of sustaining an injury in the following fight (OR two.185, p=0.06) (Table 4).
The total percentage of injuries averaged 37% between 2010 and 2014 (Table ane). A substantial increment 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 prophylactic measures; and poor prefight medical screening. In that location was as well a dramatic increase in the pct of injuries sustained during 2014 (Table 1). This may be an indication of superior post-fight medical assessment of fighters past experienced sports physicians.
Professional MMA fighters have a three times higher injury rate than amateur MMA fighters. [vi] Information technology is the author's stance that this could be ascribed to a higher level of contest, or it could also be due to the lack of protective gear and the legality of knee joint and elbow strikes to continuing/grounded opponents in the professional person fights. Further studies are brash in this regard.
MMA and concussion
The Ngai study [5] reports that 36% of all injuries in MMA occur to the head/neck/confront region which is college than the 22% rate reported in the SA study. Approximately 7% of fights end in a KO in the USA report equally compared to 6% in the SA study. Scoggin et al. [6] found that twenty% of injuries sustained during MMA bouts were concussions resulting in brief (<15seconds) loss of consciousness and/or retrograde amnesia.
Caput-affect (besides 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 rate of head injuries with the highest rate of sport-related bloodshed due to TBIs. [viii] A contempo article, nonetheless, claims that cyclists have the highest charge per unit of sportsrelated TBIs. [nine] Other contact sports in which TBIs frequently occur include water ice-hockey, Muay-Thai, kicking-boxing and rugby. Non-contact sports in which athletes sustain regular concussions include soccer, basketball, skiing, lacrosse, baseball, basketball, snowboarding, skateboarding and motocross. Many caput injuries in athletes are the result of improper playing techniques and this tin be reduced in African athletes through the education of proper skills and enforcing prophylactic promoting rules. [ten]
Prophylactic gear and TBIs
The use of protective headgear has remained a controversial topic of word. The primary viewpoints regarding the use of headgear are, firstly, the power to decrease the touch on of strikes to the head, and thereby limiting the incidence of TBIs. The International Boxing Clan (AIBA) banned amateur boxers from wearing headgear in a bid to reduce the incidence of concussion. This decision supports the second indicate of view, post-obit an internal report by Wang [11], showing that a lack of headgear actually reduces the risk of concussion. Researchers concord that while headgear can help to avoid other serious head and facial injuries, there was no scientific evidence proving that it 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 blood-brain-barrier and are too linked to chronic traumatic encephalopathy later in life. [12] Headgear tin obscure peripheral vision, making it harder to come across when a blow is aimed at the side of the head.
The employ and size of gloves regarding MMA and boxingrelated head injuries are also controversial. Strikes to the head were less common in the bare-knuckle era because of the take chances of manus injuries. Gloves reduce the incidence of lacerations to the face up, only inquiry has stated that gloves do not reduce TBIs and may even increment the incidence. [13] This is explained by because head dispatch-deceleration as the mechanism of injury leading to a concussion. Large gloves force fighters to deliver an increased number of more forceful strikes to the head (higher hitting rate and acceleration) in gild to attain a KO.
RTP
A much disputed expanse of gainsay sport is the return of fighters to competition after injury. [fourteen] The most debated issue is the fourth dimension lapse during this convalescent menses and how it differs for specific injuries (caput injuries, fractures, dislocations, etc.). Concussions are oft missed, while their detection and management are imperative, equally mismanagement of this syndrome tin can 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) encephalon scan. No fighters are immune to return to competition later suffering a KO loss in a fight within 30 days (the 30-mean solar day knockout rule). The average RTP after injury varies from 2.2 weeks to 1 year, depending on the blazon, anatomic location, and severity of injury. The 30-day knockout rule is a mandatory medical suspension that applies to all athletes who suffered TBIs during competition. Unfortunately, it is hard to assess athletes for TBIs sustained during grooming and the onus of RTP following such injuries is largely placed on the athletes themselves and their coaches.
Choke submissions every bit a method of victory occurred in 10% of MMA fights included in this study. These manoeuvres are reported separately, equally the mechanism involved in causing loss of consciousness while beingness choked differs from that of a KO. Choke submissions induce temporary encephalon hypoxia, whereas KOs are related to acceleration-deceleration TBIs. Thus choke submissions cannot be regarded as concussions. Articulation submissions contributed to a win result in three% of cases, and injuries sustained due to these manoeuvres are later 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, head, limb, torso and groin injuries.
The submission-grappling component has increased the incidence of strains and dislocations to the shoulder, elbow, wrist, knee and talocrural joint 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 U.s.a.. One professional MMA event is held in SA every month, while several events take place in the USA on a weekly ground. This study is the first comprehensive analysis of injuries sustained in professional MMA competition in Africa to date.
Further studies are advised to record injury trends, including the chance factors associated with injuries and the severity of injuries in professional MMA. The concussion rate during training and the subsequent RTP should be studied to minimise incidents of exposing concussed athletes to contest too early. Pre-fight Magnetic Resonance Imaging (MRI) studies, although expensive, could aid in the detection of preparation-related concussions.
This written report provides the most comprehensive analysis of ringside physician-nerveless data on professional male MMA fighters in Africa. No study has included the possible predictors of injury or the RTP time, making this written report a valuable aid to fighter safety for fighters, physicians, promoters and referees. Only 1 study has reviewed the epidemiology of injuries in MMA, and this included apprentice and professional athletes of both genders. [half-dozen]
Although much has been washed to ameliorate fighter safety by the introduction of the Unified Rules of Carry [three], MMA still remains a contact sport with limited command over the incidence of injuries.
This study 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 report has highlighted the post-obit:
* The overall prevalence of injuries during MMA contest in Africa from 2010-2014 was every bit high as 37%;
* The incidence of life-and/or limb-threatening injuries appears college when compared to the United states of america study;
* Risk factors for sustaining an injury in competitive professional person African athletes include an injury in the previous fight and losing the electric current fight;
* TBIs in the African based competition report (6%) was substantially higher than the United states of america study by Ngai [5] (one.8%).
Thus this written report contributes to enhancing overall fighter safe by creating awareness among sanctioning bodies, trainers, referees, sports physicians and fighters:
* Losing a fight vs. injury correlation: A focus on mental toughness and additional care should exist 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 assistance in maximising the rubber of MMA fighters by educating the sanctioning bodies, trainers, referees, sports physicians and fighters.
DOI: 10.17159/2078-516X/2017/v29i0a1471
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S Venter, (one) MSc; D C Janse Van Rensburg, (1) Dr.; 50 Fletcher, (3) PhD; C C Grant, (1) PhD
(1) Section Sports Medicine, Kinesthesia of Health Science, Academy of Pretoria, Pretoria, South Africa
(two) Institute for Sports Research, Academy of Pretoria, Pretoria, Southward Africa
(3) Department of Statistics, Kinesthesia of Natural & Agronomical Sciences, University of Pretoria, Pretoria, Due south Africa
Respective author: S Venter (drventer@yahoo.com)
Table 1. Fight exposures, full injuries and total traumatic brain injuries (TBIs) Year Number of fight Injuries TBIs exposures# n (%) n (%) Overall 600 222 (37) 50 (eight) 2010 * 70 21 (27) 7 (10) 2011 120 47 (34) 13 (11) 2012 154 57 (34) 11 (seven) 2013 180 60 (31) 13 (seven) 2014 ** 76 37 (49) six (8) n, number of participants; TBIs, Traumatic Brain Injuries. #2 athletes are exposed to injury per fight. * As from v August 2010. ** As at 14 June 2014. Table ii. Prevalence of injuries and return-to-play (RTP) Body region Injuries northward (%) Average RTP (95% CI) Upper limb 25 (four) 3.7 weeks (two.8;4.iv) Lower limb 21 (3) 7.7 weeks (0.2;15.2) Caput/confront/neck 130 (22) 2.2 weeks (2.0;2.3) TBIs (KO) 34 (6) * 4 weeks Trunk/back/rib/groin 12 (2) 3.5 weeks (2.ii;4.8) Total number of 222 (37) injuries north, number of participants; TBIs, Traumatic Encephalon Injuries; KO, Knock Out * Hypoxic brain injuries due to chokes (n=87; 14.5%) were not included in the statistical analyses of the data, as this isn't considered an injury per se, simply rather a method of victory. Fighters usually 'tap out' and thus submit to their opponents before any physical damage occurs. Table 3. Injury prevalence past anatomic location (excluding brain injuries) Soft tissue Ligament Body region injury Fracture Dislocation rupture Paw 8 four Elbow 5 i 1 Shoulder three 1 2 Foot eight ii Ankle 4 Knee v ii Head/ 128 2 face/cervix Trunk/ 5 5 back/rib Groin two Total 168 15 two 3 188 Table four. Logistic regression results Comparison of injured vs. non-injured athletes Odds ratio (OR) (p-value) SA Model 1 SA Model 2 SA Model 3 Losing fighter 2.04 (0.052) ** 2.xvi (0.040) * 2.02 (0.041) * Historic period one.05 (0.313) 1.03 (0.515) -- Weighty (0.206) (0.212) -- Number of ane.09 (0.218) 1.05 (0.545) -- Fights Years of -- 1.01 (0.788) -- Experience Injured in -- 1.92 (0.163) 2.19 (0.060) ** previous fight SA, Southward Africa * Meaning at the five% level of significance. ** Significant at the ten% level of significance. f Weight was entered in the model as a categorical variable with six different weight divisions.
Source: https://link.gale.com/apps/doc/A560413383/AONE?u=googlescholar&sid=AONE&xid=34d7b2b9