Archive for May, 2016

Adding to this site’s archived summaries of studies addressing safety issues in combat sports, a recent study was published in the Journal of Neuroradiology canvassing the extent of objective white matter disturbance in the brains of amateur boxers compared to a control group.

The study, titled Reduced White Matter Integrity in Amateur Boxers, posed the question of whether amateur boxers would have white matter disturbance detectable on imaging given the greater safety protocols in place at the amateur level.  The study conducted  diffusion tensor imaging of the brains of 31 amateur boxers an compared these to a non boxing peer group.

The study found that “revealed widespread white matter disturbance partially related to the individual fighting history in amateur boxers. These findings closely resemble those in patients with accidental TBI and indicate similar histological changes in amateur boxers.

The full abstract is reproduced below –

Introduction

Professional boxing can lead to chronic traumatic encephalopathy, a variant of traumatic brain injury (TBI). Its occurrence in amateur boxers is a matter of debate since amateur boxing is considered to be less harmful due to more strict regulations. However, several studies using different methodological approaches have revealed subtle signs of TBI even in amateurs. Diffusion tensor imaging (DTI) is sensitive to microscopic white matter changes and has been proven useful in TBI when routine MR imaging often is unrevealing.

Methods

DTI, with tract-based spatial statistics (TBSS) together with neuropsychological examination of executive functions and memory, was used to investigate a collective of 31 male amateur boxers and 31 age-matched controls as well as a subgroup of 19 individuals, respectively, who were additionally matched for intellectual performance (IQ).

Results

All participants had normal findings in neurological examination and conventional MR. Amateur boxers did not show deficits in neuropsychological tests when their IQ was taken into account. Fractional anisotropy was significantly reduced, while diffusivity measures were increased along central white matter tracts in the boxers group. These changes were in part associated with the number of fights.

Conclusions

TBSS revealed widespread white matter disturbance partially related to the individual fighting history in amateur boxers. These findings closely resemble those in patients with accidental TBI and indicate similar histological changes in amateur boxers.

UPDATE June 2, 2016the text of the Bill has now been published and can be found here. 

______________________

MMA Ali Act Introduced in Congress

The long rumored attempt to expand the protections of the “Ali Act” to MMA have now taken the first formal steps with Bill 5365 being introduced in the US House of Representatives by Republican MarkWayne Mullin.

The Bill, titled, “To amend the Professional Boxing Safety Act of 1996 to include fighters of combat sports in the safety provisions of such Act” appears to have some level of bipartisan support being co-sponsored by Democrat Joseph P. Kennedy.

The text of the bill is not yet available but I will further report on this development once it is publicly released.

For an understanding of what expanding the protections of the Ali Act to MMA and other combat sports means you can click here to read a previous section by section breakdown. 

The Bill’s progress can be tracked here.

In the parallel world of anti-doping efforts of combat sports there is potential for friction between regulatory bodies and privately contracted anti doping agencies.   Diego Brandao, for example, was disciplined by both USADA and the NSAC for a singular anti doping violation. Brandao received similar penalties by both authorities but this result will not always be the case.

The State of Nevada is looking to clarify these parallel schemes with an overhaul to the Nevada State Athletic Commission’s regulations with confirmation of their entitlement to receive, and presumably rely on, evidence collected by the private contractors.

The proposed regulations, which not only will open the books between the UFC and USADA and also the WBC and VADA, also specifically require privately contracted anti-doping agencies to be approved by the NSAC, to share results with the NSAC, and to make the results public records.  The overhauled regulation will read as follows –

NAC 467.465 Contracts to perform drug testing must be approved by the Commission (NRS 467.030)

1. The Commission must approve, in advance, any contract between a promoter and third party to perform drug testing. The Commission is authorized to reject any or all third party contracts. The Commission is authorized to reject any third party contract for drug testing that is or may be performed by the Commission pursuant to NAC 467.462.

2. The Commission shall be provided complete results of all tests performed by any approved third party.

3. All contracts and test results may become public records pursuant to NRS Chapter 239.

BEllator Lawsuit Screenshot

Yesterday a lawsuit was filed with the Superior Court of California, County of Los Angeles, leveling serious allegations against MMA promoter Bellator.

The lawsuit alleges that Bellator wrongfully dismissed the Plaintiff Zachery Light, Bellator’s former “talent development director” who was terminated from his position on March 17, 2016.

The lawsuit alleges that Bellator engaged in a host of illegal or unethical practices which were met with indifference when the Plaintiff pointed these out to his employer.  He alleges that this environment in turn led to anxiety and stress and eventually led to his termination.

The alleged practices include

  • arranging various “collusive matches” where fighters represented  by management allegedly disliked by the promotion were set up against opponents where they would likely “be badly beaten
  • asking the Plaintiff to negotiate with a fighter directly despite knowing the fighter was represented by a manger and further asking the plaintiff to “interfere with the manager/client relationship
  • allowing fighters to compete using forged/falsified medical reports
  • hiring an an individual acting in an executive capacity for the promotion who simultaneously managed fighters
  • Allowing an employee to drive a Bellator branded transport van to and from events on a suspended licence

The Plaintiff seeks damages for economic, general and punitive loss along with costs from Bellator and parent company Viacom Inc.  A jury trial has been requested.

Bellator has not yet formally responded to the lawsuit and it is prudent to note that none of the allegations have yet to be proven in court.

Update June 1, 2016 – I am advised that this Bill, due to critical public feedback, has been slowed down and sent back to Committee and will not resurface until at least December when, hopefully, it revised to ensure objective safety standards are put into place.

_____________________________________

Update May 28, 2016 – This Bill has not yet made it out of the Senate with it now being revised prior to vote.  The amended bill can be found here.

In short, the amended bill has made it clear that it will allow not-for-profit organizations host amateur “full contact” martial arts contests which include amateur MMA as there was some ambiguity with the original Bill.  The amended Bill also will require that a “sanctioning body”oversee such an event.

A shortcoming of the bill, however, is that it has an “Incumbent Sanctioning Body” loophole which will allow any “organization that notifies the Department in writing that it is a recognized sanctioning body in more than 10 American States” to automatically be a sanctioning body with no further oversight required.  This is problematic on two fronts, the first is there appears to be no due diligence in the organization proving they are recognized in more than 10 States, they simply need to tell the Department that they are.

Secondly, and perhaps more problematically, once an organization is recognized as an Incumbent Sanctioning Body they are free to call the shots as they see fit when overseeing an amateur full contact event.  Many corners can be cut when it comes to safety standards under this law. If such an organization removes any of the below basic safety measures they would be free to do so and the State could not intervene under this legislation

  • HIV testing
  • Hepatitis testing
  • Eye exams
  • Pre and post-bout physical exams by a physician
  • Having an ambulance on site
  • Having paramedics on site
  • Reporting of injuries to the national record-keeping organization
  • Requiring standard time off after bouts or injuries
  • State inspection of hand wraps for foreign bodies like metal or plaster
  • Requirements for physical ring and cage safety
  • Certified or licensed referees
  • Expert matchmaking to ensure safety, including the checking of win/loss records
  • Application and identity verification of fighters
  • Standardized weight classes (they could create their own weight classes at will)

If the State wants to pass the buck to private organizations that’s fine, but not at the expense of allowing safety to be compromised. This bill needs to be tightened up or it should not pass. Locals in Illinois should speak up to their government representatives promptly.

__________________

Update  May 25, 2016 – I am advised this bill made it out of committee today and is expected for Senate vote this Friday leaving little time for those who oppose this legislation to voice their concerns.

In what appears to be a huge step backwards in the world of combat sports regulation, the Illinois General Assembly has introduced a Bill which, if passed, will deregulate a host of amateur combative sports, including amateur MMA in essence stripping the sport of all consistent central safety oversights.

The proposed legislation, AMENDMENT TO HOUSE BILL 1646, carves out the following numerous exceptions to events which will not need any government oversight

  1. Amateur boxing or full-contact martial arts contests conducted by accredited secondary schools, colleges, or universities, although a fee may be charged
  2. Amateur boxing contests that are sanctioned by USA Boxing or any other sanctioning organization approved by the Association of Boxing Commissions
  3. Amateur boxing or full-contact martial arts contests sponsored by a State, county, or municipal entity.
  4. Amateur martial arts contests that are not defined as full-contact martial arts contests under this Act, including, but not limited to Karate, Kung Fu, Judo, Jujutsu, Tae Kwon Do and Kyuki-Do
  5. Full-contact martial arts contests, as defined by this Act, that are recognized by the International Olympic Committee or are contested in the Olympic Games are are not conducted in an enclosed fighting area or ring
  6. Amateur boxing or martial arts contests that are conducted by a not-for-profit organisation

“Amateur” contests include contests where promoters can charge a fee to the public and participants can receive a non-monetary prize worth no more than $50 in value or “a stipend for an athletic club or sponsor of the contestant to cover the cost of training and participation expenses not to exceed $1,500

Also noteworthy are that ‘full contact martial arts’ are defined to expressly include MMA.

In short this legislation will allow a host of ways for promoters to host for profit combat sports events without the need to comply with any state sanctioned medical requirements such as blood testing, physicals, results reporting, suspensions and other practices which have developed to ensure the integrity of these sports.

It is difficult to understand why a legislature believes this broad stripping of oversight is a good idea and if any stakeholders in the Illinois combat sports community agree now is the time to speak up to ensure this legislation is properly scrutinized before having a chance to pass.

BJ Penn has had another set back in coming out of retirement to fight once again in the UFC.

The celebrated fighter with a history of an anti IV stance, has curiously admitted to USADA to using an IV in an out of competition setting.  Penn apparently admitted to having an IV administered during a USADA out of competition test administered in March.  The UFC released the following statement confirming that Penn has been provisionally suspended as a result of this admission:

“The UFC organization was notified today that the U.S. Anti-Doping Agency (USADA) informed BJ Penn of a potential Anti-Doping Policy violation. Penn disclosed the usage of a prohibited method – the use of an IV in excess of 50 ML in a six-hour period – during a March 25, 2016, out-of-competition sample collection. In accordance with the UFC Anti-Doping Policy, Penn has received a provisional suspension, and has been removed from his scheduled bout against Cole Miller on June 4 in Los Angeles.

“UFC will announce a replacement opponent for Miller shortly, and additional information will be provided by USADA and UFC at the appropriate time as the process involving Penn moves forward.”

It is unclear why Penn required or chose to use an IV.  Assuming it was for a legitamite and documented medical incident there is some hope he can have the use retroactively approved by USADA.

Of note, USADA has at least one precedent of handing out a retroactive TUE for IV use granting Floyd Mayweather this courtesy when he fought Manny Pacquiao.

Despite some ambiguity in the UFC/USADA Anti Doping Program, USADA has confirmed that athletes can indeed apply for retroactive TUE’s using WADA standards who have previously advised as follows on this issue:

Regarding your inquiry, the review process for the UFC program is identical to that of the Olympic program with respect to determining the medical need/appropriateness for the TUE. In both cases, the WADA international standards govern the criteria considered by the independent TUE Committee when taking in to account such requests.

The WADA TUE test is as follows –

a. The Athlete would experience a significant impairment to health if the Prohibited Substance or Prohibited Method were to be withheld in the course of treating an acute or chronic medical condition.

b. The Therapeutic Use of the Prohibited Substance or Prohibited Method would produce no additional enhancement of performance other than that which might be anticipated by a return to a state of normal health following the treatment of a legitimate medical condition. The Use of any Prohibited Substance or Prohibited Method to increase “lownormal” levels of any endogenous hormone is not considered an acceptable Therapeutic intervention.

c. There is no reasonable Therapeutic alternative to the Use of the otherwise Prohibited Substance or Prohibited Method.

d. The necessity for the Use of the otherwise Prohibited Substance or Prohibited Method cannot be a consequence, wholly or in part, of the prior Use, without a TUE, of a substance or method which was prohibited at the time of Use.

 

It is becoming ever clearer that mileage matters when it comes to exposure of head trauma and poor long term cognitive outcomes.

A recent study, titled  “Cognitive, Psychiatric, And Neuropathological Manifestations Of Repetitive Mild Traumatic Brain Injury” published as a dissertationn paper in Wayne State University’s Psychiatry and Behavioral Neurosciences sought answers to the important question of how much traumatic ‘mileage’ is too much when it comes to brain functioning.

In the study, which can be found here, the authors administered  30 head impacts over an extended period of time to lightly anesthetized, completely unrestrained mice in order to mimic sports related concussive and sub concussive impacts.  The authors then “assessed the sensorimotor, psychiatric, and cognitive outcomes of rmTBI at two different time points using different impact conditions“.

The study concluded that “Animals receiving repeated head impacts exhibited outcomes consistent with those observed in athletes with a history of rmTBI including depression-like behavior and cognitive impairment…Notably, these outcomes occurred in mice receiving head impacts that did not delay recovery of the righting reflex indicating that subconcussive impacts present just as serious risk of injury to the CNS as concussive blows. Aside from this outcome, these data indicate that there is a cumulative and dose-dependent effect of repetitive head impacts that exacerbate the neurobehavioral and neuropathological outcomes as seen in humans with a history of rmTBI.

The full abstract reads as follows –

Abstract

Millions of athletes participate in contact sports that involve repeated head impacts (e.g., football, ice hockey, boxing), often from a very young age, and it is feared that subsequent impacts can synergize with previous ones so that their effects on the brain become magnified. Repetitive mild traumatic brain injury (rmTBI) has been linked to the development of chronic traumatic encephalopathy (CTE). The neurodegeneration accompanying CTE occurs over many years following repeated head impacts and is characterized by progressive brain atrophy, accumulation of hyper-phosphorylated tau and aggregates of TDP-43, myelinated axonopathy, neuroinflammation and degeneration of white matter tracts. The relationship between head impact parameters (force, number, frequency) and the manifestations of rmTBI is not well understood nor is the severity or frequency of head injury required to trigger CTE. An animal model of rmTBI (i.e., sports-related TBI) is urgently needed to minimize risk of TBI in athletes and the studies described herein confirm that our method bears the attributes necessary to fulfill this need. The studies included in this project validate a method of rmTBI that unequivocally simulates human sports-related head impact in both form and outcome. To our knowledge, this is the first study to administer 30 head impacts over an extended period of time to a lightly anesthetized, completely unrestrained mouse. We have assessed the sensorimotor, psychiatric, and cognitive outcomes of rmTBI at two different time points using different impact conditions. Animals receiving repeated head impacts exhibited outcomes consistent with those observed in athletes with a history of rmTBI including depression-like behavior and cognitive impairment. The neuropathological outcomes of rmTBI included reactive gliosis, axonal degeneration, elevated levels of Aβ (1-42), β-amyloid, p-tau, TDP-43, and significant thinning of several white matter tracts. Notably, these outcomes occurred in mice receiving head impacts that did not delay recovery of the righting reflex indicating that subconcussive impacts present just as serious risk of injury to the CNS as concussive blows. Aside from this outcome, these data indicate that there is a cumulative and dose-dependent effect of repetitive head impacts that exacerbate the neurobehavioral and neuropathological outcomes as seen in humans with a history of rmTBI. This model will enable future study of the most pressing issues associated with sports-related head impact including the relationship between the number and frequency of head impacts to the development of behavioral and CTE-like outcomes. Future studies elucidating the cellular manifestations of rmTBI and its behavioral correlates will aid in the development of potential therapeutics. Finally, these results demonstrate the ability of our method to expand our understanding of the neuropathological, psychiatric, and cognitive sequelae underlying this insidious injury.

In my ongoing efforts to document scientific studies addressing safety issues in combat sports, a recent article was published examining the facial injury rate among boxing, wrestling and martial arts competitors.

The article, titled “Adding Insult to Injury – A National Analysis of Combat Sports-Related Facial Injury” was published this month in the Annals of Otology, Rhinology and Laryngology.  

The authors reviewed the National Electronic Injury Surveillance System (NEISS) for facial injuries from wrestling, boxing, and martial arts leading to emergency room visits from 2008 to 2013.  Perhaps somewhat counter-intuitively, the study found that wrestling, a combative sport without striking, led to the highest rate of facial injury requiring ER visits with an injury rate of 120 injuries per 100 000 participants with boxing and martial arts competitors suffering facial injuries at a rate of less than half of wrestlers.

The full abstract reads as follows:

Abstract

Objectives/Hypothesis: To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics.

Methods: The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics.

Results: There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting.

Conclusions: The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination.

In the earlier stages of the Anti Trust Lawsuit against UFC parent company Zuffa the parties requested and the Court approved a blanket protective order over documents exchanged during the discovery process which largely prevents the public from accessing the documents when filed as part of the judicial proceedings.

Earlier this month, however, Magistrate Judge Peggy Leen provided reasons for judgement critical of this this broad protective order and requiring the parties wishing to keep documents from the public eye to meet their burden of proof on a document by document basis.  In other words, the Court says it will not act as a rubber stamp.

In the recent reasons (Le v. Zuffa) Judge Leen provided the following direction to the parties –

This Order is intended to remind counsel and the parties that there is a presumption of public access to judicial files and records…

Although the Court approved the blanket protective order, the parties have not shown, and this Court has not found, that any specific documents are secret or confidential…Parties seeking to maintain the secrecy of documents attached to dispositive motions must show compelling reasons sufficient to overcome the presumption of public access…The sealing of entire documents is improper when any confidential information can be redacted while leaving meaningful information available to the public…

Here, if an opposing party files a motion to seal certain documents based on the parties’ Stipulated Protective Order (Dkt. #217), the designating party is required to file within 14 days an appropriate memorandum of points and authorities making a particularized showing why the documents should remain under seal or why the designating party should be allowed to file a redacted version. If the designating party fails to timely comply with this Order, the motion to seal will be denied and the Clerk of the Court will be directed to unseal the documents to make them available on the public docket.

When lawsuits unfold the usual way the public obtains access to gritty underlying details are by obtaining copies of all court filings, affidavits and exhibits.  These reasons make it more likely that further inner workings of Zuffa will make their way into the public realm.

Shortly after testing positive for marijuana metabolites by an in competition test conducted by USADA at UFC 195 along with other legal woes Diego Brandao was released from the  promotion.

This week USADA announced that they have sanctioned Brandao with a 9 month suspension  for the anti-doping policy violation.  This is the first example of USADA’s retained jurisdiction in action.

Although Brandao is no longer under UFC contract, his contract adopted the USADA Anti Doping Policy which expressly gives them jurisdiction to sanction Brandao even after he is cut from the promotion.  Specifically this is allowed under Article 7.9 of the Policy which reads as follows

“If an Athlete retires or ceases to be under contract with UFC while USADA is conducting the results management process, including the investigation of any Atypical Finding or Atypical Passport Finding, USADA retains jurisdiction to complete its results management process. If an Athlete retires or ceases to be under contract with UFC before any results management process has begun, and USADA had results management authority over the Athlete at the time the Athlete committed an Anti-Doping Policy Violation, USADA has authority to conduct results management in respect of that Anti-Doping Policy Violation…”

Although State, Provincial and other Athletic Commissions have no obligation to honor this suspension, should Brandao resume fighting before the suspension is completed the UFC have a heavy club to wield should the suspension not be honoured with section 10.10 providing the following powers –

UFC may impose a fine on an Athlete or other Person who commits an Anti-Doping Policy Violation up to the sum of $500,000 depending on the seriousness of the violation and the relative compensation of the Athlete or other Person