Stephan Kesting: Does MMA make you stupid?

Friday, September 20, 2013

BJJ Black Belt and instructor in Combat Submission Wrestling Stephan Kesting wrote a vital blog about head trauma in MMA, briefly excerpted below.

Boxing, Soccer, Football and MMA

There aren’t a lot of big studies looking at brain damage in MMA.  Not yet anyway, because it hasn’t been around for long enough.  But there’s a plethora of scary anecdotes, studies and hard evidence from other sports.

To start with, it’s not surprising that a lot of research has been done on boxers.  Even the general public is aware of the neurological toll that the sweet science inflicts on it’s practitioners.  Retired boxers slurring their words and unable to remember what they had for breakfast are much more common than we would like to admit.

Other contact sports have been studied too, including football, hockey, and even soccer.   Impact is impact, after all, regardless of whether the blow came from a fist encased in a glove, a soccer ball, or the helmet of a 300 lb defensive tackle in the NFL.  We’ll be reviewing some of that research later on in this article.

While science can tell you what sort of things cause CTE to develop, it is still no closer to knowing at what point it begins to develop. Charles Bernick, a CTE researcher at Cleveland Clinic spoke about the issue saying: “While we already know that boxing and other combat sports are linked to brain damage, little is known about how this process develops and who may be on the path to developing CTE.”

However, Dr. Bernick just released the results of a study encompassing 78 boxers and MMA fighters. They fighters are split into groups according to how long they had been fighting for and then had their memory and thinking abilities tested extensively.

Using MRI tests Bernick found that the brains of fighters who have been fighting for 6 or more years actually get smaller.

And it’s not all just about brain size; it’s also about what those brains can do.  Among fighters who have been fighting more than nine years Dr. Bernick found a direct relation between the number of annual fights and declining performance on thinking and memory tests.

So is that to say that nine years is the cutoff period for an MMA fighter? Not quite. Dr. Bernick pointed out: “Our study shows there appears to be a threshold at which continued repetitive blows to the brain begin to cause measurable changes in memory and thinking, despite brain volume changes that can be found earlier.”

The most interesting, and scary, part is that Dr. Bernick says this change in brain volume can start to occur after only six years of fighting, long before symptoms appear. Basically, most fighters won’t know they have a problem until it’s too late.

So while Dr. Bernick’s findings might still be slightly inconclusive, he can say with certainty that the memory centers in the brains of some fighters have shrunk as a direct result of fighting.

Maybe you’re thinking that these fighters just got unlucky.  That most of this damage might have come from one particularly bad beating, or a few super-powerful shots.

But even light shots to the head may have a cumulative effect if there are enough of them.

Recent studies of have found that heading a soccer ball can cause your memory and mental processing speed to get worse.  Of course the impact from a soccer ball is a lot less than a left hook from George Foreman, but it seems that a sufficient number of light impacts can also add up to cause concussion-like damage over time.

So What’s the Solution?

I feel under pressure to wrap things up with some kind of ‘feel good’ message.  I’d like to be able to absolve fans of the MMA who, like me, have mixed feelings about supporting the sport with our pay-per-view dollars.  And I’d like to be able to give some advice to fighters who are duking it out for our enjoyment.  But I don’t think I can do that…

There’s no indication that the sport of MMA is going to go backwards and start becoming “less violent,” or start focusing more on grappling to ensure the mental health of the fighters. What sells right now is heavy impact.  And it sells for a reason, even if it comes at the expense of the fighters’ brain capacities.

Fighters, coaches, and training partners need to become hyper-aware of the danger of severe and/or repeated concussions.  The macho nature of the sport means that many fighters will shrug off a good hit and keep going.  Or, even worse, get knocked out in sparring  and then fight in a match shortly thereafter. Unfortunately it’s not always easy to tell when a fighter has a concussion, even for a doctor, so it can be really to hard to know when something is wrong.

As a coach, knowing your fighter is key.  Hopefully you’re sensitive enough to their moods and bodily signals that you can tell when they’re sick or overtrained, so keep an eye out for changes that might indicate a concussion.  The trouble is, of course, that the studies tell us brain damage occurs years BEFORE the outward symptoms manifest themselves.

If you’re a fighter then some things that may help include paying attention to your defensive skills, doing less sparring and more drilling, not going full-force with your sparring, taking time off after a head injury, strengthening your neck and trapezius muscles so your head doesn’t bounce around so much, and calling it quits before it’s too late.

Here are some links to procedures and protocols that you should probably print out and have around the gym. These links were sent to me by an Emergency Medicine and Internal Medicine resident physician who also practices BJJ; they are the current clinical guidelines used by doctors to manage concussions.

The Sport Concussion Assessment Tool, used to determine how severe a given concussion actually is.
The 2013 American Academy of Neurology Guidelines for concussion patients and their families
•The updated 2013 American Academy of Neurology Guidelines for clinicians
A Return to Play protocol; guidelines for getting back into contact sport following a concussion (starts on page 188).

Of course hardcore MMA fighters will probably disregard my advice and the advice of the medical community the same way they ignore the dangers of concussion.  But if they won’t listen to me then maybe they’ll listen to the articulate words of UFC fighter Mac Danzig from when he appeared on Joe Rogan’s podcast.

While talking about punch drunk boxers, Mac said, “The crazy thing is that it (brain damage) might not be apparent during their career lots of times. You see it 15 years after they retire in lots of cases… And I think a lot of the prevention can happen in the gym… Now I’m realising that the less shots I take in practice, the less likely it is that my chin is going to become glass as I get older, and the better I’ll be able to have a functioning brain.” (Click here to go to the section where Mac talks about modifying his training, or here for the whole 2 1/2 hour interview).

For the recreational MMA practitioner the danger probably isn’t that great.  You’re not getting hit as often or as hard as the professionals.  But PLEASE remember that you DON’T need to be in an all-out slugfest every time you train.  There are ways to develop all the technical skills using drills and controlled, light-contact sparring.  And if you crave the feeling of complete exhaustion and having been put through the wringer I’d suggest that you do it with grappling rather than kickboxing.

But all those brain-friendly options are only going to work if you’ve got a level-headed, sane instructor and training partners who can check their egos at the door.  If you’re in a club full of steroid-injecting meatheads then getting a concussion is only a matter of time.

The brain consists of 100 billion neurons with 1,000 trillion (1,000,000,000,000,000) connections between those neurons.  Christof Koch, chief scientific officer of the Allen Institute for Brain Science, calls the brain “the most complex object in the known universe.”

Complex objects tend to be fragile.  You wouldn’t drop your computer onto a concrete floor, or use a Rolex watch to drive a nail into a board.  So if the 3 lb squishy object between your ears really is the most complex object in the known universe then shouldn’t you be at least a little bit concerned about someone punching you in the head as hard as they can?

Read entire blog…