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Mixed Martial Arts Medicine

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Other Names

  • Combat Sports Medicine
  • Fight Medicine
  • Ringside Medicine
  • MMA Medicine

Background

  • This page focuses on Mixed Martial Arts Medicine

History

  • Mixed Martial Arts (MMA) was developed from vale tudo, a Brazilian combat sport with minimal rules that was popularized in the 1920s.
  • The first major MMA tournament of North America occurred in 1993 in Denver, Colorado.[1]

Epidemiology

Incidence

  • The incidence pattern of injuries in MMA is similar to that seen in boxing, but dissimilar to that of judo and taekwondo.
  • The injury incidence rate per 1000 athlete-exposures in MMA was 228.7 (95% CI, 110.4-473.5), which was significantly higher than almost all the other combat sports sampled.[2]
  • Additionally, there is a higher incidence of head injuries in MMA than reported concussions in American football and ice hockey.[3]
  • The most common injury locations reported for MMA athletes were the head, face, and neck, followed by upper extremities, trunk, lower extremities, and all other body locations.[4]
  • Based on limited data, this incidence rate may be underestimated.

Introduction

  • Mixed martial arts (MMA) is a combat sport that utilizes varying martial art techniques, such as karate, muay thai, judo, etc.
  • Both striking and grappling are allowed in MMAS, unlike that of BJJ which utilizes only grappling, or karate, boxing, and taekwondo which only utilize striking.
  • MMA matches usually occur between two athletes within an enclosed area, such as a ring or cage.

Level of Evidence

  • Research on MMA is mostly foundational rather than systematic in nature.
  • The internal and external loads and responses to training and competition have not been adequately identified.
  • There is not currently enough evidence to determine which variables are key predictors of success, or how coaches can manipulate these variables.[5]
  • Epidemiological data surrounding injuries in MMA is scarce and severity of injuries has little to no relevant literature.[5]
  • Of the studies published, the two major topics were on the topic of injuries (25%) and weight loss (18.8%).[4]

Terminology

Pathology

  • Tendinopathy - condition of the tendon causing pain and/or swelling
  • Joint injury - injury of tissues within the joint, including ligaments, tendons, cartilage, and synovial fluid
  • Muscle Strain - stretching or tearing of muscle fibers
  • Grade I strain - limited number of fibers affected
  • Grade II strain - nearly half of fibers torn
  • Grade III strain - complete rupture of the muscle
  • Fracture (less common) - partial or complete break in the bone
  • Closed (simple) - skin remains intact
  • Open (compound) - bone protrudes through the skin
  • Non-displaced - bone breaks but remains in alignment
  • Displaced - bone breaks moves out of alignment
  • Dislocation (less common) - separation of two bones at a joint
  • Subluxation - partial dislocation
  • Laceration - tear or cut in the skin

MMA Terms

  • Clinch - standing position where both practitioners have grips on one another
  • Decision - if a match does not end in a TKO or submission, the judges’ scorecards are used to determine the winner
  • Grappling - the fighting technique used on the ground, where practitioners are able to use grips/grabs to control an opponent
  • Guard - grappling position where one practitioner is one his/her back and is controlling the opponent using their legs
  • Mount - a position where one practitioner straddles the other
  • Southpaw - left handed practitioner
  • Submission - when a position causes pain/discomfort causing a practitioner to tap out, signaling defeat
  • Sweep - a move that acts to off-balance an opponent, causing them to land on the ground
  • Takedown - when a practitioner takes the opponent to the ground
  • Technical Knock Out (TKO) - when a referee determines a practitioner to be unfit to continue or unable to defend himself, ending the match.

Equipment

  • 4-6 ounce finger-less, palmless gloves
  • Hand wraps
  • Mouthguard
  • Headgear
  • Shin guards
  • Groin protector
  • Chest protector

Affiliated Bodies

  • Ultimate Fighting Championship (UFC)
  • Bellator MMA
  • ONE Championship

Risk Factors

  • Increasing weight class[6]
    • Note the evidence for this is conflicting
  • Losing the fight3,[7]
  • Fights ending in TKO[6],[7]
  • Male sex[4],[6]
    • Note the evidence for this is conflicting
  • Previous injuries[8]

Pathophysiology

Skin Lacerations

  • Lacerations are frequently seen in MMA
    • They occur as a result of both the cutting forces exerted by knees and elbows, as well as the blunt impact of punches and kicks.
    • The supraorbital ridge is the most common site of laceration, as it has a prominent bone structure and a rich blood supply.[8],[9]

Skin Infections

  • MMA poses an increased risk of cutaneous infections (especially MRSA)
    • This is due to several factors outlined by the CDC, including crowded environments, frequent skin-to-skin contact, compromised skin (such as cuts or bruises), exposure to contaminated equipment or surfaces, and inadequate cleanliness.[10]
    • Examples include cellulitis, abscess, impetigo, herpes gladiatorum, Tinea Corporis

Cervical Spine Injuries

  • Cervical spine injuries that resulted from hip throws and suplexes were shown to have a similar mechanism those seen in rear-end motor vehicle collisions.[11]

Rapid Weight Loss

  • Hypohydration: Athletes reduce bodily fluids to make weight
    • This occurs through various practices such as exercising using sweat suits, saunas, laxatives/diuretics, and restricting fluid intake.
    • These methods can lead to electrolyte imbalances including hypocalcemia, which can increase risk for stress fractures and other bone pathology. The use of diuretics is also known to cause hypokalemia, which can lead to death.
    • Hypohydration has also been found to affect mental status and other physiological processes.[4]

Musculoskeletal injuries

  • Impact on sport
    • 17% of match stoppages were due to musculoskeletal stress due to elbow, ankle, shoulder, and knee locks and neck cranks.[9]
  • Location/ Type of injuries
    • Main locations of the injuries sustained during MMA matches were the upper extremities (56%), neck (18%), and head (14%)[9]
    • The hand was the most commonly injured anatomical region of the upper limb with an incidence rate of 6.61 per 100 AE. Contusions/bruises were the most common type of injury of the hand and wrist, followed by fractures in the forearm and muscle/ligament tears in the elbow and shoulder.[3]
    • The majority of upper limb injuries in MMA are self-inflicted through striking, with the hand being the most commonly injured location.
    • The minimal padding in MMA gloves provides little protection to the hand, making it susceptible to injury.[2]
  • Fractures
    • The most common long bone fractures are of the tibia, fibula, femur, radius, and ulna.
    • They are usually due to blocking or striking an opponent, as there are many high-impact bone-on-bone MMA techniques.[9]
  • Dislocations
    • Dislocations usually occur during ground submissions, as many of the techniques are designed to break or dislocate the target joint.[9]

Head Trauma

  • General
    • On average, athletes that sustain a head injury have received 32 significant impacts to their head during their bout.[11]
    • MMA athletes were found to have an increase in stress values (87.2%) and shear stress (111.4%) on the corpus callosum compared to uninjured athletes. These values are used as indicators of concussion.[12],[13]
    • Head trauma was the most common cause of knockouts 88.1% and accounted for 31.6% of match stoppages in general.[14]
  • Concussion
    • Male athletes were found to have a concussion rate of 17 per 100 AE, whereas females were found to have a rate of 11 per 100 AE[12]
    • Concussions in MMA often result from rotational forces, causing shearing stress between the brain and the skull. MMA knockouts have also been found to be a result of similar rotational forces.
  • Chronic Concerns
    • Exposure to repetitive head trauma is associated with white matter density deficits in areas including: bilateral pons, hippocampus, and thalamus.
    • Additionally, higher exposures were associated with impaired performance in processing speed, verbal memory and psychomotor speed.[15]
  • Treatment
    • Studies found that only 13% of the MMA participants sought medical attention post-head injury.
    • Additionally, over half returned to activity in less than two days.[16]

Prevention

Equipment/Environment

  • Using a mouthpiece and headgear during training can minimize injuries to the face and head and decrease rotational acceleration of the head.[6]
  • Increasing padding of MMA gloves would reduce blunt force trauma to an athlete’s hands.[3]
  • Educating referees on presentation of common limb injuries for earlier intervention can help minimize injury severity.[3]
  • Enforcing concussion protocols for athletes that have sustained head injuries and encouraging follow up visits with a provider will help with appropriate management and prevent further injury.[11]
  • Utilizing proper equipment and gym sanitization procedures
    • Also encouraging athletes to maintain a high level of personal hygiene will minimize infection risk for athletes.[17]

Training

  • Functional Movement Scores
    • Implementing a 4-week corrective exercise program improved functional movement screening (FMS) scores.
    • FMS is an assessment that uses screening tools to identify movement patterns that may suggest limitations and dysfunctions of functionality and physical performance.[18]
  • Fatigue monitoring
    • It has been suggested that closely monitoring fatigue and workload can reduce injury risk and even help with performance.[4]
  • Injury Prevention
    • Identifying athletes that are at high risk for a particular injury should be implementing a anatomic specific training regiment to reduce injury risk.[19]

Case Reports

  • 1 case of a common carotid artery pseudoaneurysm after receiving a kick to the neck during an MMA bout.[20]
  • 1 case of constrictive pericarditis associated with repetitive blunt chest trauma from MMA.[21]
  • 1 case of acute peroneal nerve palsy (unilateral foot drop) due to blunt trauma that occurred furing a professional MMA bout.[22]
  • 5 cases of carotid artery dissection, 3 cases of vertebral artery dissection, 2 cases of ischemic stroke without dissection associated with sportive choking in submission grappling disciplines (MMA, BJJ, etc.)[23]
  • 1 case of Ustilago echinata infection following an open distal tibia fracture[24]
  • 1 case of extreme weight cutting lead to hypernatremia and acute kidney injury (AKI).[25]
  • The first documented case of CTE in an MMA athlete was diagnosed in a 25 year old named Jordan Parsons.[26]

See Also


References

  1. Fliotsos, M. J., Reed, D. S., Giles, G. B., Altman, A. H., Santamaria, J. A., Zafar, S., Carlton, D. K., Johnson, A. J., Davies, B. W., Legault, G. L., Woreta, F. A., & Justin, G. A. (2021). Prevalence, patterns, and characteristics of eye injuries in professional mixed martial arts. Clinical Ophthalmology, Volume 15, 2759–2766. https://doi.org/10.2147/OPTH.S319025
  2. 2.0 2.1 Lystad, R. P., Gregory, K., & Wilson, J. (2014). The epidemiology of injuries in mixed martial arts: A systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine, 2(1), 232596711351849. https://doi.org/10.1177/2325967113518492
  3. 3.0 3.1 3.2 3.3 Fares, M. Y., Baydoun, H., Elhassan, B., & Abboud, J. A. (2022). Upper limb injuries in mixed martial arts. The Physician and Sportsmedicine, 1–8. https://doi.org/10.1080/00913847.2022.2123257
  4. 4.0 4.1 4.2 4.3 4.4 Bueno, J. C. A., Faro, H., Lenetsky, S., Gonçalves, A. F., Dias, S. B. C. D., Ribeiro, A. L. B., da Silva, B. V. C., Filho, C. A. C., de Vasconcelos, B. M., Serrão, J. C., Andrade, A., Souza-Junior, T. P., & Claudino, J. G. (2022). Exploratory systematic review of mixed martial arts: An overview of performance of importance factors with over 20,000 athletes. Sports, 10(6), 80. https://doi.org/10.3390/sports10060080
  5. 5.0 5.1 Kirk, C., Clark, D. R., Langan-Evans, C., & Morton, J. P. (2020).
  6. 6.0 6.1 6.2 6.3 Fares, M. Y., Fares, J., Fares, Y., & Abboud, J. A. (2019). Musculoskeletal and head injuries in the ultimate fighting championship(Ufc). The Physician and Sportsmedicine, 47(2), 205–211. https://doi.org/10.1080/00913847.2018.1546108
  7. 7.0 7.1 Ross, A. J., Ross, B. J., Zeoli, T. C., Brown, S. M., & Mulcahey, M. K. (2021). Injury profile of mixed martial arts competitions in the united states. Orthopaedic Journal of Sports Medicine, 9(3), 232596712199156. https://doi.org/10.1177/2325967121991560
  8. 8.0 8.1 Bastidas, N., Levine, J. P., & Stile, F. L. (2012). The “sweet science” of reducing periorbital lacerations in mixed martial arts. Annals of Plastic Surgery, 68(1), 43. https://doi.org/10.1097/SAP.0b013e31820eb325
  9. 9.0 9.1 9.2 9.3 9.4 Zimmerman, D., Kovalski, N., Hain, B., & Lipsitz, J. (2015, October 1). Mixed martial arts injuries. Journal of Urgent Care Medicine. https://www.jucm.com/mixed-martial-arts-injuries/
  10. Mrsa and the workplace | niosh | cdc. (2023, February 22). https://www.cdc.gov/niosh/topics/mrsa/default.html
  11. 11.0 11.1 11.2 Thomas, R. E., & Thomas, B. C. (2018). Systematic review of injuries in mixed martial arts. The Physician and Sportsmedicine, 46(2), 155–167. https://doi.org/10.1080/00913847.2018.1430451
  12. 12.0 12.1 Greenwald, B. D., Ambrose, A. F., & Armstrong, G. P. (2012). Mild brain injury. Rehabilitation Research and Practice, 2012, 469475. https://doi.org/10.1155/2012/469475
  13. Hamdan, J. L., Rath, M., Sayoc, J., & Park, J.-Y. (2022). A brief descriptive outline of the rules of mixed martial arts and concussion in mixed martial arts. Journal of Exercise Rehabilitation, 18(3), 142–154. https://doi.org/10.12965/jer.2244146.073
  14. Mańka-Malara, K., & Mierzwińska-Nastalska, E. (2022). Head trauma exposure in mixed martial arts. International Journal of Environmental Research and Public Health, 19(20), 13050. https://doi.org/10.3390/ijerph192013050
  15. Schlegel, P., Novotny, M., Valis, M., & Klimova, B. (2021). Head injury in mixed martial arts: A review of epidemiology, affected brain structures and risks of cognitive decline. The Physician and Sportsmedicine, 49(4), 371–380. https://doi.org/10.1080/00913847.2021.1885966
  16. Lockwood, J., Frape, L., Lin, S., & Ackery, A. (2018). Traumatic brain injuries in mixed martial arts: A systematic review. Trauma, 20(4), 245–254. https://doi.org/10.1177/1460408617740902
  17. Nguyen, J. (2021, July 30). Staph vs mma: The invisible battle - nozin. Nozin® Nasal Sanitizer® Antiseptic. https://www.nozin.com/staph-infection-mma/
  18. Bodden, J. G., Needham, R. A., & Chockalingam, N. (2015). The effect of an intervention program on functional movement screen test scores in mixed martial arts athletes. The Journal of Strength & Conditioning Research, 29(1), 219. https://doi.org/10.1519/JSC.0b013e3182a480bf
  19. James, L. P. (2014). Injury prevention strategies for mixed martial arts. Strength & Conditioning Journal, 36(5), 88–95. https://doi.org/10.1519/SSC.0000000000000086
  20. Crilly, S. M., McElroy, E., Ryan, J., O’Donohue, M., & Lawler, L. P. (2018). “Mixed” trauma to the carotid artery in a mixed martial arts injury—A case report and review of the literature. Journal of Radiology Case Reports, 12(5), 1–11. https://doi.org/10.3941/jrcr.v12i5.3234
  21. Ferrel, M. N., Iriana, S., Raymond Thomason, I., Ma, C. L., Tsarova, K., Wilson, B. D., McKellar, S. H., & Ryan, J. J. (2021). Constrictive pericarditis in the setting of repeated chest trauma in a mixed martial arts fighter. BMC Cardiovascular Disorders, 21(1), 561. https://doi.org/10.1186/s12872-021-02378-8
  22. Sethi, N. (2017). Acute unilateral foot drop as a result of direct blunt trauma to the peroneal nerve in a professional mixed marital arts bout: A case report. 1. https://doi.org/10.17159/2078-516X/2017/v29i1a4260
  23. Stellpflug, S. J., Dummer, M. F., Martin, C. D., Vera, J. A., & LeFevere, R. C. (2022). Cervical artery dissections and ischemic strokes associated with vascular neck compression techniques(Sportive chokes). The Journal of Emergency Medicine, 63(1), 49–57. https://doi.org/10.1016/j.jemermed.2022.04.015
  24. Stewart, E., Waldman, S., Sutton, D. A., Sanders, C., Lindner, J., Fan, H., Wiederhold, N. P., & Thompson, G. R. (2016). Ustilago echinata: Infection in a mixed martial artist following an open fracture. Mycopathologia, 181(3), 311–314. https://doi.org/10.1007/s11046-015-9967-1
  25. Kasper, A. M., Crighton, B., Langan-Evans, C., Riley, P., Sharma, A., Close, G. L., & Morton, J. P. (2019). Case study: Extreme weight making causes relative energy deficiency, dehydration, and acute kidney injury in a male mixed martial arts athlete. International Journal of Sport Nutrition and Exercise Metabolism, 29(3), 331–338. https://doi.org/10.1123/ijsnem.2018-0029
  26. Campbell, B. (2016, October 21). Parsons first MMA fighter diagnosed with CTE. ESPN.com. https://www.espn.com/mma/story/_/id/17852351/jordan-parsons-diagnosed-cte-first-mma-fighter-known-disease
Created by:
John Kiel on 29 August 2023 11:52:41
Authors:
Last edited:
10 October 2023 16:08:01
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