MD: ‘Sense of urgency’ over brain trauma in MMA

Thursday, May 09, 2013

A knockout is the most exciting moment in sports. It is also bad for you.

Scott Harris from Bleacher Report has put together the most comprehensive article to date on head trauma in combat sports.

While the issue of head trauma as only recently come up in the NFL and NHL, boxing and mixed martial arts are regulated by the government, and as such are a generation ahead of other sports regarding head trauma, with suspensions administed as a routine part of the game, and in the leading ACs mandatory brain magnetic resonance imaging to establish a baseline to check for degradation.

However, everyone who cares about this sport should further their understanding of brain trauma, and the B/R story is a fine place to start. The article is far from perfect, but it is important. If you are the most casual fan, skip the next couple of hightlight or WSHipHop videos, and read the article. If you are a fighter or trainer, read it like it is your job.

Some excerpts appear below, but reading the entire article should be, well, required reading.

The MMA community finds itself in a race against time to bring medical evidence up to speed with what are essentially common-sense assumptions about the inherent dangers of the sport.

“I would say there is a sense of urgency,” said neurologist Dr. Charles Bernick, associate medical director at the Lou Ruvo Center for Brain Health in Las Vegas and one of the nation’s leading experts on brain injury and disease. “We’re making progress in our research, but we don’t know enough to make firm recommendations. There are a lot of questions we just don’t know the answers to.”

In the meantime, there are few commonly accepted methods of evaluating the extent or risk of brain injury in an MMA fighter. Bernick is hoping his research will help to change that.

“There really is no objective way to decide when a person should stop fighting or not be licensed to fight,” Bernick said. “When do you decide not to fight or grant a license? It all depends. We have no objective way to make these decisions.”

Earlier this spring, Bernick and his team revealed findings that showed substantial degradation in certain areas of the brains of long-tenured MMA fighters. The affected areas are critical to learning, memory and emotion. Evidently, these maladies are consistent with the symptoms of chronic traumatic encephalopathy (CTE), a condition caused by multiple head injuries and characterized by dementia, memory loss, aggression, confusion and depression. CTE generally appears years, or even decades, after the trauma occurs.

Sports attorneys say the legal ramifications and human consequences revaled by the recent NFLlarger class-action suit could hold lessons for MMA.

“MMA could learn from the litigation of the NFL,” said Matthew Mitten, director of the National Sports Law Institute at Marquette University Law School. “Don’t wait until former athletes suffer strong adverse effects. Be proactive rather than reactive. You can’t totally eliminate the risk, but at some point you could see potentially changing down the road.”

Part of the problem is that the science is still emerging, especially in an MMA context. Part of that is because the sport and brain science are still relatively new, but Keith Kizer, executive director of the influential Nevada State Athletic Commission, said medical research on MMA has long been lacking, in part because doctors have typically spurned the sport.

“Questions are finally being asked,” Kizer said. “When I came on seven years ago, where was the medical community? You had great ringside doctors and so on, but a lot of the doctors were against these sports. It was almost a discriminatory feel from the medical community.”

Fortunately, this perception is changing. Bernick’s recent findings were part of the Professional Fighters Brain Health Study, which is aimed at understanding the cumulative effects of head trauma on the brains of combat athletes.

The study, slated to take place over several years, just completed its first year. To date, 135 MMA fighters as well as 104 boxers are participating, though Bernick hopes to recruit up 400 pro fighters for the research.

Kizer said the Nevada commission is working with the Ruvo Center by sharing more information. Bernick noted that UFC leaders are making more appearances (and donations) at brain injury fundraising events.

But the journey is still in its early stages. New findings like those on subconcussive trauma indicate that brain injuries can occur and accumulate away from the bright lights and the highlight reels.

MMA training is not directly regulated or monitored by athletic commissions or any other entity. Kizer said individual fighters and camps should take more responsibility for their own brain health and those of their charges.

“At the end of the day, a lot of this takes place beyond our scope, in the gym and the sauna,” Kizer said. “Once you know enough about the right way to do things, you do it in your entire career arc as well as just on fight night, when there are doctors present and you can get testing. Education is the important thing. You’re a real athlete, so act like it. Take it seriously.”

Kizer said commissions “often share past medical records on a case-by-case basis.” He acknowledged that “it would be better if there was a national medical registry,” but noted that concerns over cost and privacy make that a “difficult” proposition.

“It’s always subjective as far as what you require of a fighter after a fight,” Kizer said. “With a severe knockout, it’s easy to make the call. You go to the hospital, get a CAT scan and set the suspension. But what if they’re not knocked out? It’s a tough thing.”

That’s where the current research race comes in. Bernick and his team—the nation’s only research team regularly studying brain injuries in combat athletes—are hoping their work ultimately leads to a more structured, science-driven approach to assessing brain health and protecting fighters.

Ideally, Bernick said, research would lead to “some kind of risk factor index that can be useful to fighters and regulatory agencies.”

For example, the MMA community could one day develop an algorithm that accounts for risk factors like genetics and number of fights and knockouts, then assigns a risk factor “score” to each fighter.

With medical science playing catch up, what are the short- and long-term risks to MMA? Could a similar legal cloud to the one shadowing the NFL be hanging over the head of the UFC?

“There are inherent risks in MMA,” Marquette’s Mitten said. “The real question will be whether anything the UFC or any other group did or did not do enhanced those risks.”

One of the principal allegations in the NFL players’ lawsuit is that the league knowingly obscured brain injury science and misled players and the public, all in the name of financial gain.

In the context of MMA violence, however, the sport may have a key legal ally: violence itself.

“The sport is so incredibly violent that it would be hard to argue [fighters] were not aware they were assuming risks. How could anybody make the case that they were misled?” said Michael Gilleran, a sports attorney and the executive director of the Santa Clara University Institute for Sports Law and Ethics. “There’s no attempt to minimize or conceal that violence.”

Kizer said comparing MMA to the NFL was an apples-to-oranges proposition.

“In the NFL, you’re taken out for a few plays and then you go back in,” Kizer said. “In MMA, that would never happen. The referee stops the fight and there’s a medical suspension.”

“It does seem like boxers have greater reductions [in brain capacity],” Bernick said. “But MMA is not immune to these injuries. The more exposure you have to fighting, the more disruption you see in the brain…I don’t know if we have enough knowledge to say one is safer than others. An MMA fighter who fights frequently might just be at greater risk than a careful boxer.”

Though it seems fighters knowingly assume the risk of brain injury in selecting their line of work, and that legal risk to promotions like the UFC is fairly low as a result, groups like athletic commissions are accountable for fighter health and well-being, particularly in terms of licensing and referee protocol.

“It’s a question of whether somebody is competent to make a decision,” said Ronald Katz, chairman of the board of Santa Clara’s sports law institute and an attorney who won a $26 million jury verdict in a 2008 class-action lawsuit of 2,062 retired NFL players against their union. “The referee makes that determination, so the sport has some responsibilities there. It’s the responsibility of the boxing commissions to say whether to grant permits. Each commission has its own legal framework.”

Kizer defended MMA referees, calling it a complex job and pointing to fighter health outside the cage as the most promising area for improvement.

“It’s not just punches that referees look at,” Kizer said. “It’s eyes and breathing. Sometimes you can hear the air come out of them. Those refs have a better angle than anyone. They compare later rounds to earlier rounds. It’s really more pre-fight and post-fight issues that can be tweaked, rather than during a fight.”

According to Katz, a medical calamity, not a legal one, might be more likely to spur changes in MMA’s brain injury culture. Though no UFC fighter has died or suffered a major head injury in the promotion’s history, the lesson from the new research and the NFL suit is that the danger stretches well beyond the cage.

“It’s predictable that something bad will happen,” Katz said. “There may very well be some sort of tragedy that occurs that causes people to reexamine this. I hope it doesn’t happen, but it’s hard to think it wouldn’t.”

Read entire article…