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14 July 2016updated 04 Oct 2023 10:37am

The knockout blow – the risk of brain injury in mixed martial arts

The passion driving fighters to be in the cage in the first place is one that will inevitably put them at risk of a brain injury.

By Hasan Chowdhury

On Saturday 9 July, an audience of almost 20,000 crowded into an arena in Las Vegas to watch the events of Ultimate Fighting Championship 200 unfold. The night marked the 200th major event for the UFC, a mixed martial arts organisation that has capitalised on the desire of fighters and fans alike to have a professional, regulated space in which their fervour for the most extreme displays of physicality can be fulfilled.

The penultimate fight of the night saw the 6ft 3, 265-pound behemoth Brock Lesnar return to the Octagon – an eight-sided steel cage in which fights take place – to face Mark Hunt, a heavyweight whose heavy hands and proven knockout power were a cause of concern for the returning Lesnar. However, after shaking off some ring rust in the opening minutes of the first round, Lesnar went on to destroy his opponent for 15 minutes. He floored Hunt and pummelled his face and head with a succession of hammer fist strikes.

It’s a scene that UFC acolytes will be accustomed to, in a sport that prizes extreme aggression. But things could have gone very differently for Lesnar. Hunt devastatingly knocked out heavyweight Stefan Struve in March 2013 – a knockout that raised serious concerns around Struve’s health. Knockouts are classified as moderate concussions, in which a total loss of consciousness occurs. In his career, Struve has been knocked out six times in a similar fashion – a startlingly high number given the impact just one concussion can have.

SB Nation conducted a lengthy interview with spinal and orthopaedic surgeon Dr Johnny Benjamin, in which he said of Struve:

“At some point, someone really needs to ask the question, should he still be fighting? That many concussions, so quickly, at this young age . . . a person has two types of age, chronological and physiological age, Stefan’s license may say he’s 25, but in physiological years, he’s much, much older than that, with all the concussive force that he’s sustained.”

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Continuing his warning, Dr Benjamin went on to tell SB Nation that in fact, multiple concussions can be received by a fighter in a single bout. In this particularly perilous situation, a fighter could die from second impact syndrome – a condition that surfaces when a second concussion occurs before symptoms from the first have been cleared.

And it’s not just the medical establishment chiming in with their concerns; fighters are worried too. UFC flyweight champion Demetrious Johnson, previously criticised for his conservative fighting style, said that “there’s not enough money in the world” for him to risk brain damage by employing a reckless brawling style of fighting.

As the sport of mixed martial arts continues to gain popularity in the UK, particularly with the rise in prominence of the Irish fighter Conor McGregor propelling its growth, it’s important to ask: from the knockout power of Hunt and Lesnar, to the lighter blows endured in gyms across the country during casual training, how real is the risk of brain injury?

Brain injury can occur in various forms, with a surprisingly wide range of causes involved. Traumatic brain injury can be sustained by trauma to the head; an unfortunate collision while driving or an accidental fall, for example, can pose real threats to the brain. Traumatic brain injury falls into a larger category of acquired brain injury – one that encompasses any situation in which an injury has occurred to the brain since birth.

Luke Griggs, a spokesperson for Headway, the brain injury association that works to improve life after brain injury, tells me: “Our advice is that everyone should be aware of the signs of concussion. Too many people falsely believe that a concussion can only happen if a person loses consciousness. In reality, only around 10 per cent of reported concussions involve a loss of consciousness.”

The symptoms of concussion cross over with many other things, which make it difficult for people to know that what they’re experiencing is attributable to a concussion. Dizziness, nausea, blurred vision and imbalance are just some of the markers to look out for. For most, the risk of long-term damage is minimal if the appropriate medical advice is taken.

But in the case of mixed martial arts, a sport in which victory is very often claimed through knockout, the passion which drives fighters to be in the cage in the first place is one which will inevitably drive them to endure as many blows to the head as possible in order to stand tall at the end.

The UFC and mixed martial arts’ growing popularity in the UK means more needs to be done to make people aware of the risks of getting involved in such sports. Griggs adds: “Our brains control everything we think, feel and do. Therefore a brain injury – whether as a result of one blow to the head or many – can affect our ability to speak and comprehend language and instruction; it can change personalities and the ability to control and manage our emotions, and it can affect our physical capabilities.”

In an effort to educate the public about concussions in both sporting arenas and in everyday life, Headway launched a campaign in May called Concussion Aware. The campaign takes an “if in doubt, sit it out!” approach to head injuries, a mantra specifically aimed at sports clubs which may be bustling with amateurs keen to imitate the athletes who compete on an international stage.

“We are urging all sports clubs, as well as academic institutions, to sign a pledge at to signal their commitment to taking a sensible, safety-first approach,” Griggs says. “In doing so, they can access a host of materials to help spread the Concussion Aware message.”

Medically, continued research and the use of PET scans is helping researchers draw up new guidelines that could potentially protect fighters, through honest and accurate assessments of their brain health.

The UFC itself has taken full responsibility for ensuring that its fighters can remain healthy. In 2014, the UFC, along with a number of other fight organisations sponsored a study which looked into the impact repeated blows to the head can have on the brain, and examine whether MRIs can play a crucial role in analysis.

For a growing sport that shows no signs of slowing down, it’s the promotion of this type of awareness and demand for greater protection that will give it a greater legitimacy.

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