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Head games - MMA
Posted on Tue, Oct 5, 2010 at 5:26 am
by IDMA Editor

At last. Canadian doctors have voted on the issue of preventable brain damage. The verdict? They’re against it. Back on Aug. 25, the Canadian Medical Association (CMA) officially declared its support for a ban on professional mixed martial arts (MMA). This type of fighting “leads to serious issues, including damage to people’s brains,” said Dr. Anne Doig, outgoing CMA president. “We must speak out against that.” But some fight fans and promoters sneered. What do a bunch of doctors know about the safety of mixed martial arts?

Photo by Bruce Edwards/Postmedia News - The nature of mixed martial arts fighting means traumatic brain injuries are unavoidable, writes Dr. Tim Rindlisbacher, given that hits to the head are basically part of the object of the game.

The fight fans have a point. Research on MMA has been poor. The largest and purportedly best study so far (by researchers at Johns Hopkins, reported in the British Journal of Sports Medicine in 2008), shows that MMA may be no more dangerous than other combat sports, or even high school football. MMA supporters quote these results often. Very often. But the study relied on assessments provided by ringside doctors being paid by mixed martial arts leagues to declare whether or not a fighter sustained an “injury.” These doctors used MMA’s own metrics, meaning that a technical knock out (TKO) was not necessarily considered an injury, despite the fact that a TKO can mean a fighter has taken several blows to the head without being able to defend himself. So while 33.7% of the bouts examined in the study ended in a TKO, the ringside doctors reported that only 23.6% of the fighters overall sustained an “injury.” I’ve got news for these people: When the toughest athletes in the world stop defending themselves, they’ve probably sustained a brain injury.

Traumatic brain injury (TBI) is grossly underreported in all sports. Athletes have multiple incentives to keep quiet, especially in an ultra-macho sport like MMA, where you win by forcing a man to “submit,” fail to defend himself or knocking him unconscious. What fighter will go running to a doctor complaining about “these little headaches I’ve been getting?” It’s like saying: “I’m weak. I can’t take it. I’m not so tough after all.”

Who else has come out against MMA fighting? The American Medical Association. Bravo. But Canadians have some extra skin in the game. We pay for healthcare out of the public purse. So these cases of intentional head trauma end up on our taxpaying bills, which makes MMA a public health issue. (American MMA fighters, on the other hand, need to make big money and invest it wisely. They’ll have to have deep pockets to pay for chronic care in their twilight years.)

Mixed martial arts prizefights will generate tax revenues for the big city jurisdictions where they’re likely to be held, but will those bumps be enough to offset the long-term cost of caring for a generation of ex-fighters suffering from traumatic brain injuries? Maybe the system will break even with the Top 100 money earners. But what about their beaten opponents? And the layers of amateur fighters who never make the big time? The ripple effect could be outrageous. Because TBI can’t count. Sometimes, after only one or two good knocks, patients are standing in my sports medicine office, asking for relief from daily headaches. Even winners lose in combat sports. Just take a look at Muhammad Ali. He dished out more than he took over the course of his career. But he sits in a wheelchair now, a broken man, unable to summon his old eloquence.

TBI is a slow, silent disabler. We’re only coming to realize the long-term effects of repetitive brain injury in established sports like football. Yet the fledgling mixed martial arts industry turns two very blind eyes to the danger.

Supporters will say: “It’s better to live hard and die young than never to have truly lived at all,” but that’s nonsense. Especially the part about dying young. TBI doesn’t finish you off all at once. It maims you gradually. To be fair to the current rules of MMA, it isn’t a free-for-all where combatants “pummel, kick, punch, scratch” (in the words of CMA’s Dr. Doig). Fighters train and battle in ancient warrior traditions. It’s just unfortunate they’re also working with an ancient understanding of brain trauma.

We should be skeptical about the data collected so far about MMA-incurred head injuries. TBI can be subtle and injury data relies on self-reporting from athletes who pride themselves on being able to “take it.” The German Nobel laureate Thomas Mann once wrote: “People’s behaviour makes sense if you think about it in terms of their goals, needs and motives.” MMA promoters have obvious financial incentives. So do politicians who see prizefights as a source of tax revenues.

But what about the goals, needs and motives of the Canadian Medical Association? Canadian doctors seem to be driven by some kind of concern -- perhaps it’s a sense of humanity and public responsibility -- for a class of skilled, vigorous and determined young athletes who aren’t thinking about their long-term brain health when they step into the ring, but who will surely be thinking about it later in life. That is, if they can think at all.

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