Incidence of Injury in Professional Mixed Martial Arts Competition

J Sports Sci Med. 2006 Jul; v(CSSI): 136–142.

Published online 2006 Jul 1.

Incidence of Injury in Professional Mixed Martial Arts Competitions

Abstract

Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993. In 2001, Nevada and New Bailiwick of jersey sanctioned MMA events after requiring a serial of dominion changes. The purpose of this written report was to determine the incidence of injury in professional MMA fighters. Data from all professional MMA events that took place between September 2001 and December 2004 in the state of Nevada were obtained from the Nevada Able-bodied Commission. Medical and outcome information from events were analyzed based on a pair-matched example-control pattern. Both conditional and unconditional logistic regression models were used to assess run a risk factors for injury. A total of 171 MMA matches involving 220 different fighters occurred during the study period. There were a total of 96 injuries to 78 fighters. Of the 171 matches fought, 69 (40.3%) concluded with at to the lowest degree one injured fighter. The overall injury rate was 28.6 injuries per 100 fight participations or 12.5 injuries per 100 competitor rounds. Facial laceration was the most common injury bookkeeping for 47.9% of all injuries, followed past hand injury (thirteen.5%), olfactory organ injury (ten.four%), and eye injury (8.three%). With adjustment for weight and lucifer upshot, older age was associated with significantly increased run a risk of injury. The most common conclusion to a MMA fight was a technical knockout (TKO) followed by a tap out. The injury charge per unit in MMA competitions is uniform with other combat sports involving hit. The lower knockout rates in MMA compared to boxing may help forestall brain injury in MMA events.

Key Points

Mixed martial arts (MMA) has changed since the kickoff MMA matches in the United States and now has increased prophylactic regulations and sanctioning.
MMA competitions have an overall high rate of injury.
There have been no MMA deaths in the The states.
The knockout (KO) rate in MMA appears to be lower than the KO rate of boxing matches.
MMA must continue to be supervised by properly trained medical professionals and referees to ensure fighter safety in the future.

Fundamental words: Brain injury, ultimate, boxing, jiu jitsu

Introduction

Mixed Martial Arts (MMA) competitions were introduced in the United states of america with the first Ultimate Fighting Title (UFC) in 1993 (Krauss and Aita, 2002). Styled subsequently the pop Vale Tudo (Portugese for "anything goes") matches in Brazil (Peligro, 2003), these first UFC matches were marketed as barbarous, no-holds-barred tournaments with no time limits, no weight classes, and few rules (Hamilton, 1995).

Politicians such every bit Senator John McCain of Arizona led the charge to ban these competitions from cablevision television, describing the events as "human cock fighting "(Krauss, 2004). When their cablevision contracts were terminated in 1997, MMA events survived underground through cyberspace and word of mouth promotions until their organizers agreed to a change of rules that allowed the Nevada State Able-bodied Commission and the New Jersey Land Athletic Command Board to sanction the competitions in 2001 (Krauss, 2004).

This written report is the get-go report of the incidence of injury in MMA competitions. No study has previously documented injuries in MMA events either before or after the tightening of regulations. Fight results and injury incidence from professional MMA bouts since their sanctioning in 2001 in Nevada are compared to boxing data from the same state. A discussion of MMA events and combat sports injuries is also included.

Methods

Mixed Martial Art (MMA) data from all professional MMA matches in the state of Nevada from September 2001 until December 2004 (n = 171 matches) was obtained from the Nevada Land Athletic Committee. All professional MMA matches occurring in the state during the study catamenia were included. Information obtained included gender, date of the lucifer, appointment of birth, weight, rounds scheduled, rounds fought, whether the fighter won or lost, how the match concluded (knockout, technical knockout, decision, describe, disqualification, no decision, tap out, or choke) and the injuries that occurred in the friction match and the type of injuries sustained. Upwardly to 4 injuries per fighter were recorded per contest. These data are in the public domain and attainable on the website of the Nevada State Athletic Committee (http://battle.nv.gov, last accessed January 2005).

Medical and upshot data for all professional person MMA matches were analyzed based on a pair-matched case-control design. Cases were fighters who sustained an injury during the matches. Fighters who were not injured served every bit controls. Matches in which both competitors were injured or both were uninjured were excluded from the conditional logistic regression. Both provisional and unconditional logistic regression models were used to assess risk factors for injury.

Injuries were recorded based on the clinical report of the physician at ringside. No follow-up written report was done to confirm the accurateness of the reported injury based on radiography or other diagnostic testing. Injuries were divided into seventeen broad classifications: eye injuries, facial lacerations, ear injuries, nose injuries, mouth injuries, jaw injuries, hand injuries, shoulder injuries, elbow injuries, ankle injuries, foot injuries, chest injuries, abdominal injuries, articulatio genus injuries, back injuries, neck injuries, and arm injuries. Lacerations to the eyelid and nose were counted as facial lacerations. Only those injuries documented other than lacerations-such every bit possible orbit fractures or a nose deformity- were listed as center or nose injuries respectively.

The Johns Hopkins Academy School of Medicine's Institutional Review Board approved the study protocol via exemption.

Results

A total of 171 MMA matches involving 220 different fighters occurred during the study menstruum. All participants were male with an average age of 28.5 years (SD = iv.vii, range from 19 to 44 years old). The average weight was 87.6 kg (SD= 16.3 kg, range from 60.four to 166.4 kg). A total of 1,130 rounds were scheduled, of which 624 (55%) were actually fought. These rounds were each 5 minutes for a total of 3120 minutes of fighting. A total of 67 fighters fought in more than than ane fight during the study period. The average number of competitions for these 67 repeat fighters was 2.8 (SD = i) with a range of 2 to 6 fights each.

There were a full of 96 injuries to 78 fighters. Of the 171 matches fought, 69 (40.3%) ended with at to the lowest degree one injured fighter. The overall injury charge per unit was 28.6 injuries per 100 fight participations, 12.five injuries per 100 competitor rounds, or iii.08 injuries per 100 fight minutes. The majority of recorded injuries were injuries to the facial region with facial lacerations beingness the most common. Mitt injuries were the second most common injury, bookkeeping for thirteen.5% of all injuries, followed by injuries to the nose (10.iv%) and heart (8.three%, Table 1).

Tabular array 1.

Frequencies and rates of mixed martial arts injuries to professional competitors, September 2001 through Dec 2004, Nevada.^*

Injury site	Number	(%)	Injury Rate per 100 Competitors
Facial Laceration	46	(47.9)	13.45
Eye	8	(8.three)	2.34
Ear	one	(i.0)	.29
Nose	10	(10.four)	ii.92
Mouth	0	(0.0)	.00
Jaw	ane	(ane.0)	.29
Neck	one	(ane.0)	.29
Shoulder	5	(5.2)	one.46
Arm	1	(1.0)	.29
Elbow	two	(ii.1)	.58
Hand	13	(xiii.5)	three.80
Chest	0	(0.0)	.00
Belly	0	(0.0)	.00
Dorsum	2	(two.one)	.58
Knee	3	(three.ane)	.88
Ankle	2	(2.1)	.58
Foot	i	(1.0)	.29

Older fighters were at greater risk of injury as were those who lost a lucifer by knockout or technical knockout (Tables 2 and iii). Those who lost their match under whatsoever circumstance-whether knockout, technical knockout, conclusion, tap out, choke, or disqualification-were significantly more than likely to suffer an injury during the grade of the contest than those who won (p < 0.001). Also, the incidence of injury increased with the length of the fight with matches lasting 4 or 5 rounds being more likely to include a fighter who suffered an injury (Tables 2 and 3). The near common conclusion to a MMA fight was a technical knockout (TKO) followed by a tap out (Table 4). The proportion of fighters suffering a knockout during the competition was six.four% (n = 11).

Table ii.

Incidence rates of injury in mixed martial arts matches by competition characteristics, September 2001 through December 2004, Nevada.

	Competitors #(%)	Injured Competitors #(%)	Injury Rate per 100 Competitors	Rounds fought #(%)	Injury Rate per 100 Fought Rounds
Age Groups (years)^*
<25	76 (22.three)	13 (xvi.9)	17.1	132 (21.ii)	9.viii
25-29	144 (41.v)	29 (37.7)	xx.six	260 (41.eight)	11.ii
thirty+	124 (36.4)	35 (45.five)	28.2	230 (37.0)	15.2
			χ²=3.nine, p=0.14		χ^two=2.two, p=0.33
Weight Class
Fly, bantam, plumage, or light	32 (9.4)	5 (half dozen.4)	15.23	53 (eight.5)	ix.4
Welter or Middle	150 (43.8)	35 (44.nine)	23.33	300 (48.one)	11.seven
Light heavy, heavy, or super heavy	160 (46.eight)	38 (48.7)	23.75	271 (43.iv)	fourteen.0
			χ²=1.04, p=0.59		χ²=0.95, p=0.62
Match Outcome
Win	169 (49.4)	27 (34.6)	xvi.0	306 (49.0)	8.8
Loss	169 (49.4)	51 (65.4)	30.2	306 (49.0)	16.seven
Draw	four (1.two)	0 (0)	0.0	12 (1.ix)	0.0
			χ²=9.half-dozen, p<0.001		χ²=8.2, p=0.02 ^†
Type of Outcome
TKO or KO	158 (46.2)	42 (54.0)	26.6	240 (38.5)	17.5
Other	184 (53.8)	36 (46.2)	nineteen.six	384 (61.5)	9.4
			χ²=2.38, p=0.12		χ²=6.viii, p=0.009
Rounds fought
i	176 (51.5)	32 (41.0)	18.2	176 (28.2)	xviii.2
ii	76 (22.ii)	xix (24.4)	25.0	152 (24.iv)	12.5
3 - 5	ninety (26.iii)	27 (34.7)	30.0	296 (47.4)	9.12
			χ²=five, p=0.08		χ²=6.3, p=0.04

Table 3.

Odds Ratios (OR) and 95% Confidence Intervals (CIs) of injury in mixed martial arts matches from multivariate logistic regression models, September 2001 through December 2004, Nevada.

Model	Variables	OR	95%CI
Unconditional logistic regression
	Age ^* ^†	1.29	0.73-two.26
	Weight ^* ^†	ane.03	0.95-i.eleven
	Lost match	2.32	1.36-3.98
	KO or TKO	ane.71	0.97-3.01
	Rounds fought ^†	one.44	one.11-i.87
one:1 matched provisional logistic regression
	Historic period ^* ^†	3.eleven	i.11-eight.59
	Weight departure ^* ^†	1.10	0.ninety-i.34
	Lost match	2.69	1.44-five.0

Table 4.

Results of Mixed Martial Arts Competitions in Nevada, September 2001 through December 2004.

Issue	Number (%)
Technical Knockout	68 (39.8)
Tap Out	52 (30.iv)
Conclusion	31 (18.i)
Knockout	11 (6.iv)
Choke	iv (2.three)
Disqualification	3 (1.8)
Draw	ii (1.ii)
Full	171

Discussion

Though initially promoted as barbarous, no-holds-barred contests, Mixed Martial Arts competitions in the United states have changed dramatically and at present have improved regulations to minimize injury. A total of 13 states now sanction MMA events, the first two being Nevada and New Jersey in 2001. Since the sanctioning, MMA competitions take followed much stricter regulations. Fighters are now forbidden to headbutt, stomp or knee joint an opponent on the ground, strike the pharynx, spine or dorsum of the head, must fight within a predetermined weight class, and are allowed only one fight per dark-all important changes that were implemented with sanctioning.

The mandatory "grappling "gloves now used in MMA events weigh betwixt iv to 8 ounces, thinner than the viii to 10 ounce gloves worn by professional boxers, and are designed with the fingers exposed so a fighter can grasp his opponent. Fighters must pass the same physical exam used to screen professional person boxers including a cognitive MRI, earlier being licensed. Referees and ringside physicians are required to exist nowadays and have the say-so to cease the match at any time.

Fighters railroad train in both the hit and grappling arts (Amtmann, 2004) and get proficient in a number of means of "submitting "or defeating their opponents (Figures ane and 2). Fights can be ended not only by the traditional knock out, technical knock out, and decision of boxing, but also past "tap out"-where an opponent either taps the mat or his opponent to betoken his want to stop the match or verbally indicates to the referee his want to cease-and "choke"-where an opponent refuses to tap even though defenseless in a choke concur and passes out.

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Fighter A (in blue) applies a traditional jiu jitsu choke to Fighter B (in white).

An external file that holds a picture, illustration, etc. Object name is jssm-05-CSSI1-136-g002.jpg

Fighter A (in blue) applies a traditional jiu jitsu armbar to Fighter B (in white).

MMA events should be differentiated from the infamous "Toughman "competitions held effectually the country. Toughman competitions feature amateur fighters who often take piddling or no training experience, vesture "one-size-fits-all "protective gear, do not need a thorough physical exam to compete, and often characteristic inexperienced referees and ringside physicians (Branch, 2003). While there have been no deaths in the United states in MMA competitions, at least 12 participants have died during Toughman events-two of whom were being supervised by ringside physicians who were chiropractors (Co-operative, 2003). Incidentally, both Nevada and New Jersey-the commencement two states to sanction MMA competitions-are "among 10 states that have banned or attempted to ban [Toughman] events. "(Branch, 2003).

The relatively loftier incidence of injuries in combat sports has been well documented. The giving and receiving of high velocity blows seems to be the best correlation of whether a sport will have an increased adventure of injury.Styles that include striking-such as boxing (Bledsoe et al., 2005; Zazryn et al., 2003a), kickboxing (Gartland et al., 2001; Zazryn et al., 2003b), karate (Zetaruk et al., 2005), and taekwondo (Kazemi and Pieter, 2004)-have been shown to have a higher incidence of injury than styles that involve grappling alone, such as collegiate wrestling (Jarret et al., 1998). Strikes from elite athletes, particularly professional boxers, tin can generate a significant amount of strength (Walilko et al., 2005)-equivalent to "a padded wooden mallet with a mass of six kg (13 lbs) if swung at 20 mph "(Atha et al., 1985) co-ordinate to i report. This seems to explicate why many injuries in the striking arts are prevalent non only in the target areas of the face up and torso, merely also the extremities used for striking such as the hands for boxing and the upper and lower extremities in kickboxing and karate.

While no prior manufactures certificate the incidence of injury in MMA, injury rates from boxing take been reported. In 2003, Zazryn and colleagues (2003a) reported an overall injury rate to professional boxers in Victoria, Commonwealth of australia of 25 injuries per 100 fight participations. A recent expect at the injury rates of professional boxers in Nevada showed 17.1 injuries per 100 fight participations (Bledsoe et al., 2005). With an overall injury rate of 28.6 injuries per 100 fight participations, MMA competitions demonstrate a high rate of overall injury, simply a rate in keeping with other combat sports involving striking. By contrast, sports involving grappling accept demonstrated much lower rates of injury. For instance, collegiate wrestling has been documented to have rates every bit low as ane injury per 100 participations when analyzed for participants in both practice and contest (Jarret et al., 1998).

As opposed to professional boxing, MMA competitions have a machinery that enables the participant to stop the competition at any time. The "tap out "is the second well-nigh common means of ending a MMA competition (Table 4) This unique characteristic, combined with more than options of set on when competing, is idea to help explicate a knockout proportion in MMA competitions that is nearly one-half of the reported eleven.3% of professional boxing matches in Nevada (Bledsoe et al., 2005). With the growing business organisation over repetitive head injuries and the take chances of dementia pugilistica amidst career boxers, decreasing the number of head blows a fighter receives during a match has been promoted as an of import intervention (Mendez, 1995; Unterharnscheidt, 1995). With MMA competitions, the opportunity to attack the extremities with arm bars and leg locks and the possibility of extended periods of grappling could serve to lessen the risk of traumatic brain injury. When TKOs are compared, proportions between professional boxing (38%)and MMA are similar (Bledsoe et al., 2005).

At that place are several limitations to this study. Kickoff, the injuries reported were based on the concrete exams performed at ringside by the ringside physician. No labs or radiologic studies were ordered and no diagnoses were confirmed. The incidence of injury in these fighters may accept been higher than reported. 2d, although the study included all MMA fights throughout a 40 month menses, the total number of matches was relatively small. Third, the fights included in this report were all held in Nevada, the premiere site for MMA events. How injury rates would change for events held under different weather with less supervision is a affair of concern. Finally, for the purpose of discussion, knockouts and technical knockouts were not defined equally injuries although many would argue that these represent the well-nigh serious of all boxing injuries. Due to the sometimes subtle nature of traumatic brain injury-and since there was no radiographic imaging available to verify whether an injury had occurred-KOs and TKOs were discussed every bit dissever entities and not included in the overall injury data. Further research is needed to decide the truthful nature of these injuries and their cumulative furnishings upon the individual fighters.

Conclusions

Mixed Martial Arts competitions have changed dramatically since the first Ultimate Fighting Championship in 1993. The overall injury rate in MMA competitions is now similar to other gainsay sports, including battle. Knockout rates are lower in MMA competitions than in battle. This suggests a reduced risk of TBI in MMA competitions when compared to other events involving striking.

Professor and Managing director of Research, Department of Emergency Medicine, The Johns Hopkins Academy School of Medicine.

Research interests:

Injury epidemiology and prevention

E-postal service: ude.imhj@ilhg

References

Amtmann J.A. (2004) Self-reported training methods of mixed martial artists at a regional reality fighting event. Journal of Strength Conditioning Research 18, 194-196 [PubMed] [Google Scholar]
Atha J., Yeadon K.R., Sandover J., Parsons K.C. (1985) The damaging punch. British Medical Journal (Clinical Enquiry Edition) 291, 1756-1757 [PMC free article] [PubMed] [Google Scholar]
Bledsoe 1000.H., Li G., Levy F. (2005) Injury risk in professional person boxing. Southern Medical Periodical 98, 994-998 [PubMed] [Google Scholar]
Co-operative Chiliad. (2003). Toughman competition faces its own battle. USA Today: 3C. May xx [Google Scholar]
Gartland S., Malik Yard.H., Lovell 1000.Eastward. (2001) Injury and injury rates in Muay Thai kicking boxing. British Periodical of Sports Medicine 35, 308-313 [PMC free article] [PubMed] [Google Scholar]
Hamilton M. (1995) Brawling over brawling: Politicians attempt to finish off "man cockfighting"? Newsweek 126 (22), 80 [Google Scholar]
Jarret Thousand.J., Orwin J.F., Dick R.W. (1998) Injuries in collegiate wrestling. American Journal of Sports Medicine 26, 674-680 [PubMed] [Google Scholar]
Kazemi Yard., Pieter W. (2004) Injuries at the Canadian National Tae Kwon Do Championships: a prospective study. BMC Musculoskeletal Disorders 5, 22. [PMC gratis commodity] [PubMed] [Google Scholar]
Krauss E. (2004) Warriors of the ultimate fighting championship. Citadel Press, New York [Google Scholar]
Krauss E., Aita B. (2002) Brawl: A behind-the-scenes lLook at mixed martial arts competition. ECW Press, Toronto, Canada [Google Scholar]
Mendez One thousand.F. (1995) The neuropsychiatric aspects of battle. International Journal of Psychiatry in Medicine 25, 249-262 [PubMed] [Google Scholar]
Peligro K. (2003) The gracie mode: An illustrated history of the World's Greatest Martial Arts Family unit. Invisible Cities Press, Montpelier, Vermont [Google Scholar]
Unterharnscheidt F. (1995) A neurologist'south reflections on boxing. Two. Acute and chronic clinical findings secondary to primal nervous organization impairment. Revista de Neurologia 23, 833-846 [PubMed] [Google Scholar]
Walilko T.J., Viano D.C., Bir C.A. (2005) Biomechanics of the head for Olympic boxer punches to the face. British Journal of Sports Medicine 39, 710-719 [PMC free article] [PubMed] [Google Scholar]
Zazryn T.R., Finch C.F., McCrory P. (2003a) A 16 twelvemonth report of injuries to professional boxers in the state of Victoria, Australia. British Journal of Sports Medicine 37, 321-324 [PMC costless article] [PubMed] [Google Scholar]
Zazryn T.R., Finch C.F., McCrory P. (2003b) A sixteen year study of injuries to professional kickboxers in the country of Victoria, Australia. British Periodical of Sports Medicine 37, 448-451 [PMC free article] [PubMed] [Google Scholar]
Zetaruk Thousand.N., Violan M.A., Zurakowski D., Micheli L.J. (2005) Injuries in martial arts: a comparing of five styles. British Journal of Sports Medicine 39, 29-33 [PMC free article] [PubMed] [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863915/

Incidence of Injury in Professional Mixed Martial Arts Competition