Archive for May, 2017

In my ongoing efforts to highlight relevant safety studies addressing combat sports,  a recent study was published in the Journal of Neurology documenting decreased brain volume with associated cognitive dysfunction in professional fighters.

The recent study, titled Longitudinal MRI and Cognitive Change in Professional Fighters, is part of the Professional Fighter Brain Health study which is perhaps the biggest ongoing study to date of fighter brain health.   It is funded in part by a host of combat sports stakeholders including the UFC, Haymon Boxing, the UCLA Dream Fund, Bellator and Top Rank.

The authors reviewed MRI brain imaging of 76 professional fighters with a mean number of professional fights of 14.46.  These fighters were followed, on average, between 2-5 years.  The fighters also underwent cognitive testing.

The data revealed decreased brain volume coupled with cognitive dysfunction related to these findings.  The full abstract reads as follows:

Objective: To assess the relationship between change in MRI measured regional brain volumes and cognitive performance in professional fighters.

Background: Previous cross sectional research has demonstrated a relationship between lower brain volumes in specific regions and poorer performance on certain tests of cognitive function in a cohort of professional fighters. Little is known as to whether longitudinal decline in brain volumes are associated with cognitive performance.

Design/Methods: 76 subjects participating in the Professional Fighters Brain Health Study and who have been followed over at least 2 years were included in this study. Subjects underwent MRI brain imaging, along with computerized cognitive testing (CNS Vital Signs), at baseline and on an annual basis for a minimum of 2 subsequent visits.

Rate of decline in volumes was assessed both as a continuous and categorical variable. Analyses were performed to assess the relationship between decline in regional volume and decline in each of the cognitive spheres tested (processing speed, reaction time, psychomotor speed and memory), adjusting for age, race and years of education.

Results: The mean age of the cohort was 29.54 years, with mean number of professional fights 14.46, and years of education 13.06. Duration of follow up ranged from 2–5 years. Decline in the anterior corpus collusum, left cerebellum, left hippocampus, and right thalamus were significantly associated with decline in processing speed; whereas decline in right and left thalamus and left and right cerebellum was associated with decline in memory. Comparing the decliner v. non-decliner groups, subjects in the decliner group for left hippocampus and posterior corpus collusum showed a significant association with decline in performance in processing speed.

Conclusions: MRI brain volumetric measures may warrant further study as a tool to follow accumulating brain injury over time.

 

Earlier this week the Daily Mail reported that UFC middleweight champion Michael Bisping is in the midst of trial being sued by his former manager Anthony McGann.

The Daily Mail reports that “McGann…is suing him for £270,000 in unpaid fees and expenses dating back ten years.”.   The lawsuit is based on a disputed contract which purportedly has “a clause for the McGann and Wolfslair to receive a 20 per cent commission” of Bisping’s earnings.

Bisping says he has met his contractual obligations.  He further suggests the contract presented in court had been altered and that his signature “appears on a contract that I didn’t sign” contending the document produced in court was several pages longer than the one he signed in 2005.

The trial will likely turn on the credibility of the parties and the authenticity of the document produced.  If, however, it is proven that a valid contract exists giving McGann a 20% interest in Bisping’s fight purses, a further question arises as to whether this is enforceable.

The contractual period of time stems from 2005-2012.  During these years Bisping fought many bouts around the globe including several in North America.  Unlike many of his overseas bouts the North American bouts are subject to Government run Athletic Commission regulation.  Among the regulations are requirements which must be met for managers to be entitled to slice of a fighter’s purse.

For example, in 2012 Bisping fought in Toronto.  This bout was governed by Ontario’s Athletic Control Act which requires that “No person shall manage a participant in a professional contest or exhibition except under the authority of a licence or permit issued by the Commissioner.”

Bisping had 3 bouts in Nevada where the Nevada Athletic Commission requires management contracts to be “filed with the Commission at least 72 hours before a scheduled contest or exhibition“.

He also fought in California during this timeframe where s. 221 of California’s regulations stipulate “The original contract entered into between managers and boxers…shall be placed on file with the commission at the time it is approved pursuant to Rule 222. Except as provided below, a contract becomes null and void if at any time during its term the manager or promoter, after notice from the commission, is not licensed by the commission. .”  As Ronda Rousey’s manager learned, this provision is binding and failing to comply with it disentitles the manager to their cut of the fighter’s purse.

Even if the contract presented in Court is proven to be genuine and if Bisping did not meet all of his financial obligations under it, he may have a defense when it comes to paying McGann a percentage of his earnings from North American bouts unless McGann was a licenced manager in all these jurisdictions and had his contract comply with the various commission requirements.

It is unclear from the Daily Mail’s report if Bisping is advancing such arguments but, if not, his legal team should certainly consider doing so.

In a welcome development by arguably the most pro-active jurisdiction in North America tackling the perils of rapid extreme weight cuts in MMA, the California State Athletic Commission has unanimously passed major reforms in regulating this practice.

As first reported by Marc Raimondi, the CSAC unanimously passed a 10-point plan which seeks to alter the landscape of dangerous weight cuts in MMA.

Raimondi reports that “the UFC, Bellator and Invicta all wrote letters to the commission supporting this plan“.

The changes include new weight divisions, steeper penalties for missing weight and recommendations compelling changes of weight classes for fighters who undertake extreme cuts.

The full reforms read as follows:

CSAC 1 to 4

CSAC 5 to 10.PNG

After being struck by illegal knees to the head at UFC 211 Dustin Poirier was unable to continue and his bout with Eddie Alvarez was ruled a no-contest by referee Herb Dean.

Dean declared that the knees, while illegal, where not intentional fouls, leading to the no-contest decision.

Poirer has now stated his intention to appeal hoping to overturn the result to a victory by way of disqualification.

Here are some legal points worth noting in this appeal.

While people often think of the so-called unified rules of MMA after controversy arises, when legal scrutiny of a bout occurs these are of zero value.  Instead, the parties must turn to the actual laws and regulations on the books of the jurisdiction where the bout took place.  For UFC 211, this brings us to the Lone Star State.

Texas’ laws provide appellate rights including allowing the final decision of the commission to be scrutinized by judicial review.

Section 61.111 of Texas’ Administrative Rules of the Texas Department of Licensing and Regulation set out the actual rules of the contest.

Kneeing to the head of a grounded opponent” is prohibited but the question then is what remedies are available when this foul occurs?

Section 61.41(e) states “If a contestant is accidentally fouled, including a head butt but can continue, the referee may stop the bout for a reasonable time, and inform the judges and the contestant’s second of the accidental injury.

Section 61.41(n), which presumably was drafted with boxing in mind but applies to MMA bouts, imposes the following duty on a referee where an accidental foul is deemed –

If during the first four rounds a contestant is accidentally injured, and is unable to continue, or is pushed, knocked or falls out of the ring, and is injured by the fall and unable to return, the referee shall declare the bout a no decision. If such injury occurs during later rounds, all completed rounds and the partial round in which the bout is terminated shall be scored and the contestant ahead on points shall be declared the winner by technical decision.

Section 61.111(s) gives a referee discretion to disqualify an opponent or deduct points following a foul.

Appeals based on referee discretion are hard pressed to succeed.  Dean chose not to disqualify Alvarez and that is his right.

Section 61.111(t) only allows the following results for MMA contests –

(t) The determination of the winner shall be as follows:

(1) by submission, either verbally or by tapping two or more times on the mat, ropes, ring corner or the opponents body;

(2) by knockout;

(3) by being down on the map for a ten count;

(4) by the referee disqualifying a contestant through a technical knockout;

(5) by the referee stopping a match based upon a ring physician’s advice;

(6) by a contestant’s corner stopping the bout;

(7) by the referee disqualifying a contestant for a violation of these rules; or

(8) by the judges decision based upon technique and aggressiveness minus the number of penalties.

Yes, that’s a 10 count you see there!  Leaving this relic aside, the framework exists to justify the end of this contest.

Since Dean did not disqualify Alvarez under subsection (7) the only justification for the end of the bout will be subsection (5) ie – a doctor’s stoppage.  From here we default back to  section 61.41(n) which requires a “no-decision” result.

Unless Dean is prepared to fall on his sword and say he was wrong in calling the knees unintentional, or unless the commission is prepared to say that such a use of discretion is clearly wrong, Poirer will be hard pressed to succeed on this appeal.

After wining gold in the 2016 International Brazilian Jiu Jistsu Federation (IBJJF) world championships, which took place in California,  Paulo Miyao was tested by USADA.  His sample tested positive for Clomiphene, a prohibited substance.

Miyao argued that he should not be subject to any discipline as he speaks little English and USADA should not have jurisdiction in these circumstances.  In short the argument was that USADA only had jurisdiction by agreement and since Miyao did not understand the documents he signed consenting to USADA testing there was no agreement. An independent arbitrator dismissed this defence and in doing so provided the following reasons:

Miyao 1.PNG

Miyao 2

USADA handed Miyao a 2 year suspension.

On October 17, 2015 boxer Prichard Colon was left in a coma following a traumatic brain injury sustained in a bout with Terrel Williams.  According to a lawsuit filed by Colon’s legal guardians the fighter to this date “lies in a vegetative state at his mother’s home with no prospect of every regaining his faculties“.

The bout was regulated by Virginia’s Department of Professional and Occupational Regulation (DPOR).  DPOR investigated following the bout and in 2016 announced that, according to their internal review, “No regulatory violations appear to warrant disciplinary action” against any of the licencees involved in the bout.  DPOR’s full report can be found here.

Perhaps the most damning finding in the report is that Colon was allowed to continue fighting despite complaining of headache and dizziness following an illegal blow to the back of the head with the DPOR report noting

Colón was hunched over in the corner grabbing the back of his head. According to Kenny Rice, an announcer, Colón told (ringside physician) Ashby that he felt dizzy and was hurting in the back of his head but felt he could go on and Ashby concurred and was waiting for Colón to shake it off and resume action.`

 

Prichard’s family disagrees that no wrongdoing occurred and filed a lawsuit in the Superior Court of the District of Columbia alleging negligence against the bout’s promoters and ringside physician.

In short the lawsuit alleges that the ringside physician failed to adequately respond to signs of brain trauma and quicker intervention could have led to a better outcome for Prichard.  The complaint sets out as follows –

42. Dr. Ashby formed a doctor-patient relationship when he agreed to serve as the ringside physician for the fight.

43. Acting as Prichard’s physician, Dr. Ashby owed Prichard a duty to comply with the applicable standard of care.

44. Dr. Ashby deviated from the applicable standard of care. His deviations included, but were not limited to, accepting the position as ringside physician without an adequate brain injury protocol; agreeing to serve as a ringside physician and assuming the duty of care for Prichard while not having the proper training or medical knowledge to ensure the boxer’s health and wellbeing; failing to disclose his conflict of interest and to honor his obligation to Prichard over advancing his career as a promoter; failing to adequately screen Prichard for a brain bleed during the contest; ignoring Prichard’s complaints of pain and dizziness; failing to stop the fight and to send Prichard to the hospital and to otherwise render timely medical aid.

45. As a proximate cause of Dr. Ashby’s negligence, Prichard endured and continues to endure severe pain and suffering, lost the ability to engage in gainful employment, and suffered life-altering injuries that will require around-the-clock care for the rest of his life

In addressing whether the ringside physician met the applicable standard of the care the Court will likely look to, among other things, the requirements for ringside physicians under Virginia’s regulations which instruct physicians as follows

Virginia Duties of Ringside Physicians

This matter has yet to be adjudicated.  The full complaint can be found here – Prichard Colon Lawsuit

Update May 11, 2017today USADA announced that Gastelum accepted a 6 month period of ineligibility and this sanction was then reduced by three months “based on Gastelum’s successful completion of a USADA approved drug awareness and management program” making the USADA suspension match that handed out by the STJDMMA.

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Following his TKO victory over Vitor Belfort at UFC Fight Night 106 Kelvin Gastelum tested positive for Carboxy-Tetrahydrocannabonol above the in competition threshold allowed by WADA standards.  USADA provisionally suspended Gastelum pending results management.

The Brazilian MMA Sports Court (STJDMMA), who also enjoy jurisdiction over the matter, sought to punish Gastelum and reached a plea with the fighter.  As first reported by Raphael Marinho of Brazil’s Combate, a plea was reached resulting in a 90 day suspension retroactive to March 11, a 20% fine of his purse and the victory is overturned to a no contest.

USADA’s result management process remains underway.

Although not combat sports related, an important study was published last month in journal Neuroimage: Clinical revealing the rapid toll on brain structure that a short span of repeated subconcussive hits can bring.

In the recent study titled “The Effect of Repetitive Subconcussive Collisions on Brain Integrity in Collegiate Football Players over a Single Football Season” the 20 NCAA football players had their brains imaged via multiple MRI sequences both before and after a single college football season.  All of the participants were asymptomatic for signs of concussion at the start of the season with the authors noting “none of the athletes were recovering from, or were diagnosed with, a concussion during the period of study, or in the nine months prior to the pre-season evaluation.

The study revealed statistically “significant” changes on imaging at the conclusion of the season.  Of note, none of the players were diagnosed with a concussion during the season making the volume of subconcussive hits the most likely cause for the noted changes.

The authors concluded as follows:

In a study of clinically asymptomatic collegiate football athletes, statistically-significant MRI changes were observed that are likely a consequence of participation for one season at the NCAA Football Bowl Subdivision level. Specifically, these changes (at Post, relative to Pre) were found in measures derived from multiple MRI modalities: CBF, rs-fMRI, and SWI. Critically, these changes were greater in athletes who were more likely to have an impact history including larger average numbers of high-G impacts (≥ 80G). A linkage between high intensity impacts and neuroimaging-observed changes adds to the growing literature in support of the hypothesis that collision-sport athletes may be at increased risk of long-lasting changes to brain functional and structural integrity. Future work in larger cohorts and involving a broader array of integrated biomarkers will enable more precise identification of athletes who are at risk, and will facilitate development of intervention strategies to permit collision-sport participation with reduced risk.

While it goes without saying that combative sports have inherent dangers, this is yet another study stressing the need for combat sports participants to take measures to reduce exposure to sub concussive blows in training.