Archive for the ‘Safety Studies’ Category

Although the mandatory use of gloves in Mixed Martial Arts was one step which helped bring the sport from its ‘human-cockfighting‘ stigma into greater mainstream acceptance, this requirement likely increased the incidence of brain trauma for the sport’s participants.

Gloves protect fighters’ fists from injuries and reduce superficial cuts to opponents but do little to protect an opponent from brain injury.  Given the greater understanding of the long term harm that accompanies head trauma, I decided to look at objective evidence of the greater rate of knockouts from punches in MMA with the addition of gloves.  In short, the knockout rate from punches increased from 1% to 10% after gloves became mandatory for the sport.  While I appreciate that correlation does not always prove causation this is, at the very least, a compelling statistic.

Methodology -

I reviewed the results from the numbered UFC events from UFC 1 to UFC 50.  Where only a KO was noted with no accompanying information as to the cause of the KO, I reviewed the bouts to determine if the KO was from punches or other strikes.  In the early tournament format UFC’s I excluded any alternate bouts as video footage was not readily accessible to review any ambiguously reported knockouts.  TKO stoppages were not included in this study.

Results -

Gloves became a required part of the sport at UFC 14.  For this reason the study broke these events down into two categories, the events from 1-13, and 14-50.  In the first 13 events a total of 101 bouts occurred.  Of these only 4 knockouts by punches were noted.  However, 3 of these occurred with the winner wearing gloves.  The only bout with a knockout stoppage noted from punches with the winner not wearing gloves occurred at UFC 3 with Harold Howard defeating Roland Payne with a KO at the 0:46 mark.

This leaves a margin of one glove-less knockout via punches out of 98 bouts, a frequency of about 1%.

Moving on to UFC 14 – UFC 50 the data reveals a total of 279 bouts.  Of these 27 ended via knockout noted by punches.  This is a total of approximately 10%, a tenfold increase in the rate of KO by punches.

Removing gloves from MMA will increase the rate of fractured hands and superficial lacerations to competitors.  “Bare knuckle” fighting is also likely to be met with resistance by government regulators so the likelihood of the removal of gloves from the sport is slim.  That said, the above shows that the removal of gloves from the sport can reduce head trauma.  If government and MMA stakeholders review the rules of the sport with brain injury in mind the data is fairly clear that gloves protect the hands, not the brain.

Adding to this site’s archived medical literature addressing safety issues in combat sports, an important study was published this week in the Journal of the American Medical Association addressing objective brain changes in college football players.

The study compared three groups:

1. College football players with no concussion history

2. College football players with a concussion history

3.  A control group of non football players

The study found that the football players with no concussion history had smaller hippocampal volumes than the control group and the players with a concussion history had an even more reduced volume.

Perhaps more importantly the study showed that “there was a statistically significant inverse relationship between left hippocampal volume and number of years of football played“.  In other words, the more years playing football, the greater changes in the brain.

This study adds to the literature strongly suggesting that repeated sub concussive hits (ie – checking in hockey, contact in football and striking in combat sports) do take their toll over time.

As previously discussed, the relevant lesson from studies such as these is that there is a shelf life for combat sports participation and further that hard sparring takes its toll.  The brain can only take a finite number of jostles before negative repercussions take place.  Combat athletes would do well to not only be aware of this but to spar smart and not expose themselves to unneeded damage while training.

Below is the full abstract of the recent study.


Importance  Concussion and subconcussive impacts have been associated with short-term disrupted cognitive performance in collegiate athletes, but there are limited data on their long-term neuroanatomic and cognitive consequences.

Objective  To assess the relationships of concussion history and years of football experience with hippocampal volume and cognitive performance in collegiate football athletes.

Design, Setting, and Participants  Cross-sectional study conducted between June 2011 and August 2013 at a US psychiatric research institute specializing in neuroimaging among collegiate football players with a history of clinician-diagnosed concussion (n = 25), collegiate football players without a history of concussion (n = 25), and non–football-playing, age-, sex-, and education-matched healthy controls (n = 25).

Exposures  History of clinician-diagnosed concussion and years of football experience.

Main Outcomes and Measures  High-resolution anatomical magnetic resonance imaging was used to quantify brain volumes. Baseline scores on a computerized concussion-related cognitive battery were used for cognitive assessment in athletes.

Results  Players with and without a history of concussion had smaller hippocampal volumes relative to healthy control participants (with concussion: t48 = 7.58; P < .001; mean difference, 1788 μL; 95% CI, 1317-2258 μL; without concussion: t48 = 4.35; P < .001, mean difference, 1027 μL; 95% CI, 556-1498 μL). Players with a history of concussion had smaller hippocampal volumes than players without concussion (t48 = 3.15; P < .001; mean difference, 761 μL; 95% CI, 280-1242 μL). In both athlete groups, there was a statistically significant inverse relationship between left hippocampal volume and number of years of football played (t46 = −3.62; P < .001; coefficient = −43.54; 95% CI, −67.66 to −19.41). Behavioral testing demonstrated no differences between athletes with and without a concussion history on 5 cognitive measures but did show an inverse correlation between years of playing football and reaction time (ρ42 = −0.43; 95% CI, −0.46 to −0.40; P = .005).

Conclusions and Relevance  Among a group of collegiate football athletes, there was a significant inverse relationship of concussion and years of football played with hippocampal volume. Years of football experience also correlated with slower reaction time. Further research is needed to determine the temporal relationships of these findings.

Findings were published in this month’s American Journal of Sports Medicine studying “incidence, risk factors, and characteristics of knockouts (KOs) and technical knockouts (TKOs) from repetitive strikes in professional MMA“.  The study focused specifically on UFC’s pay per view cards.

The study concludes that “Rates of KOs and TKOs in MMA are higher than previously reported rates in other combative and contact sports.”.   The study also notes the statistical risk factors making brain injuries more likely as “weight class, earlier time in a round, earlier round in a match, and older age“.

The National Post, who also reported on this study, printed the following graph analyzing MMA KO/TKO rates compared with other contact sports: (Note: some of the methods and conclusions have been subject to criticism)

NationalPost Info Graphic

Here is the full abstract of the study:

Background: Mixed martial arts (MMA) is a full combative sport with a recent global increase in popularity despite significant scrutiny from medical associations. To date, the empirical research of the risk of head injuries associated with this sport is limited. Youth and amateur participation is growing, warranting investigation into the burden and mechanism of injuries associated with this sport.

Purpose: (1) To determine the incidence, risk factors, and characteristics of knockouts (KOs) and technical knockouts (TKOs) from repetitive strikes in professional MMA; and (2) to identify the mechanisms of head trauma and the situational factors that lead to KOs and TKOs secondary to repetitive strikes through video analysis.

Study Design: Descriptive epidemiology study.

Methods: Competition data and video records for all KOs and TKOs from numbered Ultimate Fighting Championship MMA events (n = 844) between 2006 to 2012. Analyses included (1) multivariate logistic regression to investigate factors associated with an increased risk of sustaining a KO or TKO secondary to repetitive strikes and (2) video analysis of all KOs and TKOs secondary to repetitive strikes with descriptive statistics.

Results: During the study period, the KO rate was 6.4 per 100 athlete-exposures (AEs) (12.7% of matches), and the rate of TKOs secondary to repetitive strikes was 9.5 per 100 AEs (19.1% of matches), for a combined incidence of match-ending head trauma of 15.9 per 100 AEs (31.9% of matches). Logistic regression identified that weight class, earlier time in a round, earlier round in a match, and older age were risk factors for both KOs and TKOs secondary to repetitive strikes. Match significance and previously sustained KOs or TKOs were also risk factors for KOs. Video analysis identified that all KOs were the result of direct impact to the head, most frequently a strike to the mandibular region (53.9%). The average time between the KO-strike and match stoppage was 3.5 seconds (range, 0-20 seconds), with losers sustaining an average of 2.6 additional strikes (range, 0-20 strikes) to the head. For TKOs secondary to strikes, in the 30-second interval immediately preceding match stoppage, losers sustained, on average, 18.5 strikes (range, 5-46 strikes), with 92.3% of these being strikes to the head.

Conclusion: Rates of KOs and TKOs in MMA are higher than previously reported rates in other combative and contact sports. Public health authorities and physicians should be cognizant of the rates and mechanisms of head trauma. Preventive measures to lessen the risks of head trauma for those who elect to participate in MMA are described.


Update – Dr. Benjamin offered the following thoughtful comments with respect to this study:

Although I have a tremendous amount of respect for my University of Toronto colleagues, I respectfully disagree with some of their conclusions and suggestions.

I find their observations regarding older fighters and knockout/TKO history being significant risk factors extremely interesting. Also, 17 blows to the head, on average, before a TKO being called seems like a lot of punishment when you put it on paper!

Unfortunately, like me (in my earlier days) they took the bait and stepped into the pointless “Which is more dangerous?” debate. It reminds me of the thin vs. thick crust or Pat’s vs. Geno’s cheesesteaks debates.

The far more important and medically relevant question that unfortunately went unaddressed is, are combat sports following current concussion management guidelines and protocols, and the latest research regarding enhanced player safety? The clear answer is, not even close!

Their basic conclusion that MMA is more dangerous than these other contact sports does not consider the importance of the accumulation of damage over time due to sub-concussive blows. Research clearly suggests that far more important than the highlight-reel stoppages, it’s the hundreds or thousands of routine head strikes that do the real damage over time. Therefore, drawing your conclusion from accumulation of head strikes over time is far more likely to be predictive and useful than mere stoppages.

I believe that 10-second counts potentially subject an injured athlete to additional unnecessary head trauma. If a fighter is so injured that he needs 10 seconds to shake it off or gain his composure, the fight should be stopped.

The NFL experience shows that it takes a sideline concussion expert roughly seven to nine minutes to properly evaluate a potentially concussed athlete. Therefore, a 10-second count/assessment/evaluation is meaningless and probably dangerous.

Greater referee training regarding concussions is a must!

The more I learn about mTBI, the more I believe that sustaining repeated blows to the developing brain (specifically kids younger than 14) regardless of the activity or sport (tackle football, soccer headers, girls lacrosse without helmets, amateur boxing, full-contact martial arts, etc.) is not a good idea.

This paper is a good step to further the conversation and encourage stakeholders in combat sports to aggressively address the mTBI elephant in the room.


Dangerous weight cutting practices have been attracting an ever increasing spotlight in the combat sports community.  The Association of Ringside Physicians have now weighed in on the issue providing the following press release (ARP Weight Cut Reform Press Release) calling for reform:

Unhealthy and sometimes dangerous weight loss practices continue to be a
significant problem in amateur and professional combat sports. The ARP
recommends that regulatory bodies adopt standardized weigh-in policies in
conjunction with year-round weight management and educational programs.

There is a growing body of information in the medical literature that presents
unequivocal evidence of the danger of excessive weight loss, rapid weight loss, and
repeated cycling of weight gain and loss. Rapid weight loss and dehydration have
been proven to negatively affect a number of health-related parameters including:
physical performance, cardiovascular function, temperature regulation, hormonal
balance, nutritional status, neurologic function, mental performance, and energy
utilization. These may cause life-threatening muscle breakdown, shock, heat illness,
kidney failure, and electrolyte imbalances, in addition to placing the athlete at
increased injury risk. Additionally, the possible relationship between dehydration
and predisposition to concussion requires more investigation. Significant
dehydration also puts the athlete at risk of improper rehydration techniques — when,
in reality, proper re-hydration requires hours to days.

The prevalence of these problems is significant. One recent study found that 39% of
MMA fighters were entering competition in a dehydrated state. Many cases of
dehydrated athletes using intravenous fluids to re-hydrate after weigh-ins have been
reported – considered a doping violation with several international organizations.
Heat illness and death in athletes have been previously documented in the sports of
wrestling and MMA. Weight management regulations for boxing/MMA competitors
are warranted to mitigate improper weight loss techniques contributing to severe
dehydration and starvation and their complications.

A number of organizations including the National Collegiate Athletic Association
(NCAA) have adopted rules to minimize unhealthy weight loss in weight–classified
sports. The rules emphasize hydration and body composition assessment to identify
an individual’s proper weight class, and provide a safe, gradual, weekly weight
control plan (gain or loss) to achieve same if desired. The new regulations were
subsequently investigated for their effectiveness and were reported to be successful
by minimizing unhealthy weight loss, excessive weight fluctuations, and competition
at weight classes inappropriate for a given athlete. It is noted that the effectiveness
and success of protocols such as same day weigh-ins are directly tied to proper
weight management programs.


The ARP recommends standardized weigh-in policies in conjunction with year round

weight management programs. These would include scheduling weigh-ins
twenty four hours or less before the start of competition. Therefore, establishing a
lowest allowed fighting weight (weight class) for competitors through body
composition and hydration assessment is essential. Combatants should be assessed
and certified at biased examiners, in conjunction with licensure, and stored in an
international data bank accessible to athletic regulatory bodies. In this light, the
ARP will be estabtheir appropriate weight annually. This assessment should be
completed by non-lishing a medical database to provide this and other resources.

Regulatory bodies should also consider adding additional weight classes in certain
sports where needed

Additionally, in order for an athlete to maintain proper weight control and optimal
body composition, a continual commitment to proper diet and training is required.
Educational programs should be established to inform coaches, athletes,
administrators, promoters and sponsors about the adverse consequences of prolonged
fasting and dehydration on performance and health. These programs should
discourage the use of extreme methods for making weight; i.e., excessive heat
methods (such as rubberized suits, steam rooms, hot boxes, saunas), excessive
exercise, induced vomiting, laxatives and diuretics. Nutritional programs should
also be instituted to emphasize and meet an athlete’s individual needs for adequate
daily caloric intake from a balanced diet high in healthy carbohydrates, the minimum
requirement of fat, and appropriate amounts of protein.

The ARP wishes to thank Alan C. Utter, Ph.D., M.P.H., FACSM, Appalachian State
University, Boone, NC for his dedicated assistance in the development of this
consensus statement.


There is no escaping the reality of the threat of head trauma for combat sport combatants.  Both acute injuries and prolonged sub-concussive exposure can lead to harsh consequences.  This week there are two stark reminders of this reality from the combat sports world.

In tragic news South African middleweight Booto Guylain passed away after sustaining serious injuries in a third round TKO defeat at EFC 27 last week.  The EFC reports that Guylain suffered a serious head injury during his Mixed Martial Arts (MMA) bout at EFC AFRICA 27 last Thursday. Immediately after the bout he was stabilised by the on-site medical team and transported to hospital where he was treated for swelling and bleeding on the brain. “

While deaths following MMA bouts have been rare, the reality of profound head trauma always remains a risk for participants. reports this is the ninth known death in MMA since 1993 and puts these numbers into context.

In a more common illustration of the toll of head trauma on professional combatants, long time MMA veteran Mac Danzig authored a thoughtful post announcing his retirement after many years in the sport.  While no regrets are expressed in the well written post it is clear that a driving factor behind Danzig’s retirement are the consequences of a career’s worth of head trauma.  He provides the following sensible comments and advice:

Really, the only physical cue for me to step back from competition came last year, when I began to suffer repeated concussions in training, leading up to what would end up being my first ever actual knockout loss, in July.  After that, my ability to take hard strikes in training without losing consciousness began to deteriorate rapidly.   After 14 years of training and taking shots like a champ, my brain was finally telling me to chill out.  I was never the type of fighter to “train stupid”, but sparring was always something I partook in at full throttle. I truly feel that the damage was done in the gym over the past decade, and hundreds of hard sparring sessions have accumulated, leading me to the situation I find myself in now. Certainly, some of my performances throughout the years in which I had fallen short can be directly attributed to the idea that I “left it all in the gym.”   

 I would like to serve as an example for the up and coming fighters of the world and hopefully encourage smarter training practices that include less sustained trauma in training camp, leading to a longer, healthier career and better performances in the ring.

 As a parent, I must take into consideration how important my sustained brain function is and how tragic it would be to have Parkinsons, Alzheimer’s, dementia, etc. Nobody ever forced me, I chose to be a fighter and I have no regrets about what has already transpired thus far, but I must make the right decision for the future. This was never a concern for me until I became a father. And fighting, to me, had never seemed even the slightest bit dangerous until the past year. That is a good sign for me to bow out. As a hardcore fan, I have seen far too many people in the sports of MMA and boxing let themselves stay in far too long.   Legacies get tarnished and the body pays for it as well. Part of me wants to fight forever, but I feel I am making the right decision.

New research reveals that concussive injuries come with objectively measurable changes in the brain.  The findings are remarkable because while post concussive symptoms are well known this study gives insight into the structural damage that may cause these symptoms.  The findings were published this week in the Journal of Neurosurgeory showing that the brain indeed is physically altered following a concussive injury and these subtle changes are detectable on dMRI imaging.  The article dealt with hockey players however are equally applicable to concussions sustained in MMA and other combat sports.

Below are the conclusions of the study:


Concussion is a common injury in ice hockey and a health problem for the general population. Traumatic axonal injury has been associated with concussions (also referred to as mild traumatic brain injuries), yet the pathological course that leads from injury to recovery or to long-term sequelae is still not known. This study investigated the longitudinal course of concussion by comparing diffusion MRI (dMRI) scans of the brains of ice hockey players before and after a concussion.


The 2011–2012 Hockey Concussion Education Project followed 45 university-level ice hockey players (both male and female) during a single Canadian Interuniversity Sports season. Of these, 38 players had usable dMRI scans obtained in the preseason. During the season, 11 players suffered a concussion, and 7 of these 11 players had usable dMRI scans that were taken within 72 hours of injury. To analyze the data, the authors performed free-water imaging, which reflects an increase in specificity over other dMRI analysis methods by identifying alterations that occur in the extracellular space compared with those that occur in proximity to cellular tissue in the white matter. They used an individualized approach to identify alterations that are spatially heterogeneous, as is expected in concussions.


Paired comparison of the concussed players before and after injury revealed a statistically significant (p < 0.05) common pattern of reduced free-water volume and reduced axial and radial diffusivities following elimination of free-water. These free-water–corrected measures are less affected by partial volumes containing extracellular water and are therefore more specific to processes that occur within the brain tissue. Fractional anisotropy was significantly increased, but this change was no longer significant following the free-water elimination.


Concussion during ice hockey games results in microstructural alterations that are detectable using dMRI. The alterations that the authors found suggest decreased extracellular space and decreased diffusivities in white matter tissue. This finding might be explained by swelling and/or by increased cellularity of glia cells. Even though these findings in and of themselves cannot determine whether the observed microstructural alterations are related to long-term pathology or persistent symptoms, they are important nonetheless because they establish a clearer picture of how the brain responds to concussion.


association of ringside physicians logo






If doctors are to blame for bringing Testosterone Replacement Therapy into combat sports perhaps they will also be the ones to take TRT TUE’s out.  The American Association of Professional Ringside Physicians has issued a press release calling for a ban of  TRT TUE’s in combat sports.  Given the integral role ringside physicians play in combat sport regulation this public statement is bound to have influence with policy makers.

The press release can be found here (Association of Ringside Physician Press Release TRT TUE) and reads as follows:

For Immediate Release January 27, 2014

Association of Ringside Physicians Releases Consensus Statement on
Therapeutic Use Exemptions for Testosterone Replacement Therapy

The Association of Ringside Physicians (ARP), an international, non-profit
organization dedicated to the health and safety of the boxer and mixed
martial arts athlete, has released a consensus statement on therapeutic use
exemptions for testosterone replace therapy in professional combat sport
athletes, as follows:

The incidence of hypogonadism requiring the use of testosterone
replacement therapy (TRT) in professional athletes is
extraordinarily rare. Accordingly, the use of an anabolic steroid
such as testosterone in a professional boxer or mixed martial artist
is rarely justified. Steroid use of any type, including unmerited
testosterone, significantly increases the safety and health risk to
combat sports athletes and their opponents. TRT in a combat sports
athlete may also create an unfair advantage contradictory to the
integrity of sport. Consequently, the Association of Ringside
Physicians supports the general elimination of therapeutic use
exemptions (TUE) for testosterone replacement therapy.

For more about the ARP, visit its website at

hourglass image

Caught doping in an Olympic Sport?  WADA will hit you with a 4 year ban for the first offence.   If you get caught doping a second time you face a lifetime ban.  Major professional sports, on the other hand, start with the equivalent of a slap on the wrist before moving to escalating suspensions.

What about MMA?  The sport, which arguably has the greatest need for protecting participants from those who seek advantage by using illicit PED’s, has no uniform policy.  MMA penalties for PED abuse will vary at the discretion of State and Provincial Athletic Commissions and in some circumstances at the discretion of fight promotions.  If a uniform model is adopted the question is which way should it lean; the no nonsense way of WADA or the more lenient ways established in professional sports?  If science is used as a guide the former is likely the answer.

The issue of PED’s in combat sports has taken the spotlight again with one of MMA’s pioneers, Ken Shamrock, admitting the not so well kept secret that PED abuse is prevalent in the sport.  Shamrock told AXSTV

I never entered into the ring while using steroids…just to get that clear…but I have used steroids in the past….it is a problem because what is happening is the people who are making the most money are the people who can obviously spend money to cheat, to get around the testing.  That’s the issue you run into.”

Shamrock goes on to call out for reform arguing change needs to take place at the entry level to weed out PED cheats before they get a foot hold in the sport.

While Shamrock’s calls for reform are welcome his distinction of using but never “entering the ring” while on steroids is artificial at best.  Recent scientific study demonstrates that there are long term gains to PED use which can continue well after the drugs are discontinued.

The Science:

In a 2006 study involving power lifters it was found that the athletes continued to enjoy advantage over their clean peers years after they stopped using the drugs.  Specifically the research concluded that “Based on the characteristics between doped and non-doped power lifters, we conclude that a period of anabolic steroid usage is an advantage for a power lifter in competition, even several years after they stop taking a doping drug.”

In a study published last year in the Journal of Physiology researchers looked into long term benefits of anabolic steroids after discontinuance and concluded that “brief exposure to anabolic steroids might have long lasting performance-enhancing effects.”.  The study involved mice who were treated with testosterone.  The researchers hypothesize that PED use can result in a 10 year advantage in human beings even after discontinuance and are currently working with the help of WADA funding to further explore this topic.

These studies suggest combatants who use illicit PED’s can gain long term benefit well after cycling off the drugs.  In other words, there may be no such thing as a fair fight after doping.  Appreciating that PED bans exist to protect clean competitors, the real question is how long of a ban is appropriate?  If studies such as these form the foundation of a regulatory norm then long term WADA style bans would be well justified.

Journal of Neurotrauma Image

TJ Grant’s slow recovery made headlines again this week with reports that he still is not cleared to fight since last year’s concussive injury.  Is there really anything unusual about this timeline given that he just had a “mild” concussion? Unfortunately the answer is no.  The reality of post concussive symptoms is they can take time to clear, sometimes they never do.  This month’s Journal of Neurotrauma sheds more light on this topic.

In the recent study (Symptomology and Functional Outcome in Mild Traumatic Brain Injury: Results from the Prospective TRACK-TBI Study) findings were published revealing what people who study head injuries already know; there is nothing necessarily mild about a mild traumatic brain injury.

In the study a group of patients who suffered MTBI (with a Glasgow Coma Score of 13-15) were followed at 3, 6 and 12 months post injury.  None of the patients required admission to hospital and none had objective findings on imaging (in other words all of them had what is often referred to as a mild concussion). The study revealed that despite the “mild” nature of the brain injuries, 33% were functionally impaired 3 months post injury, 22% were below functional status at the one year mark and further that 82% still had at least one lingering post concussive symptom 12 months post trauma.

The bottom line is there is nothing unusual about TJ Grant’s ‘slow’ recovery; in fact it is quite typical.  If anything is unusual, given current medical knowledge, it’s that more combat athletes don’t take longer to return to the fight game following diagnosed concussive injuries.

C.T.E. (chronic traumatic encephalopathy) is a progressive degenerative disease which is linked to combat and other contact sports such as hockey and football.  When an athlete experiences too many concussive or sub concussive shots over the course of a career they are at risk of developing CTE which can have profound consequences later in life.

So how much contact is too much?  This is the vital yet presently unanswerable question.  The troubling aspect is that symptoms of CTE often don’t set in for decades making it difficult for an athlete to gauge whether they are exposing their brain to too much trauma.  There is no known cure for CTE so it is problematic to only learn of the damage after the point of no return.  Presently the only known way of diagnosing the condition is by studying brain tissue after death.

There appears to be some medical progress, however, giving hope that earlier diagnosis may be possible.  Earlier this year The American Journal of Geriatric Psychiatry published findings indicating that through PET Scans it may be possible to diagnose CTE prior to death.  The New York Times recently published a thorough article addressing this study which is worth reading for better understanding of this topic.

If you want the Cliff’s Notes version the bottom line is further research is needed but there is some promise of earlier diagnosis of CTE.   It will take years before there is any certainty to the possibility of earlier diagnosis and there is no indication whether the condition will be able to be diagnosed before the point of no return.  All combat athletes should know that there is no good guage on when you have exposed yourself to one hit too many.  If you choose to compete in combat sports it is vital to take precautions minimizing how much head trauma you expose yourself to over a career.

For more on participant safety you can click here to access this site’s archived posts discussing other safety studies related to MMA and other combat sports.