Mixed Martial Arts Summer Project Final – Head Injuries & Safety Concerns

Concussion Litigation Reporter — November 2014

(Editor’s note: What follows is an excerpt of an article written by Leslie McDonald, Mark Robinson, Nailah Ellis Timberlakem and Rashaan Williams – all of whom were enrolled in in attorney Carla Varriale’s “The MMA Project” sports law class at Columbia University’s School of Continuing Education in New York City. For the full article, subscribe to Concussion Litigation Reporter.)

Introduction/History of Mixed Martial Arts

The origins of Mixed Martial Arts (MMA) are traced back to the full contact, Brazilian fight sport of “Vale Tudo.” Vale Tudo, which literally means “anything goes,” were full-contact martial arts contests with limited rules.  These contests were popularized by the Grace family in Brazil during the early 20th century.   As such, the first MMA event hosted by the Ultimate Fighting Championships banner, sponsored in part by the Gracie family, was held on November 12, 1993 in Denver, Colorado.

The event included practitioners of several martial arts, including Brazilian Jiu-Jitsu, Wresting, Boxing, Muay Thai and Kempo Karate, and was intended to showcase the Gracie’s version of Brazilian Jiu-Jitsu superiority of the over other forms of mixed martial arts.  The rules of the first UFC event were as follows:  1) five 5-minute rounds with one minute in between each round; 2) the contests were to be held in a circular pit, 20’ in diameter; 3) fighters wore clothing according to their style; 4) the contest could be stopped for knock out, submission, corner throw in a towel, choke-out, doctors intervention; 5) punches, kicks, elbow strikes, joint locks and/or chokes were permitted; 6) target areas for all strikes included head and body with the exception of eyes and groin; 7) six ounce boxing gloves or Kempo gloves were required if the fighter’s used closed fist and strikes to the face and head, otherwise bare-knuckles were permitted; 8) no point system was utilized – fight continued into overtime rounds until one fighter scored a knock-out, submitted, or choked-out; and 9) the fight could not be interrupted in the event of a clinch and/or fall to the mat.

Safety Concerns

Although commercially successful, concerns about safety and violence were expressed by regulators and politicians throughout the United States. The culmination of the concern occurred in 1996 when Arizona Senator John McCain labeled MMAs as sport “human cockfighting” and sent letters to governors in every state, including Governor George Pataki in New York, urging MMA’s prohibition.  In response, the UFC began to implement more extensive rules, which included prohibiting hair-pulling, small-joint manipulation, headbutts, groin strikes, kicks to a downed opponent and strikes to the back of the head and neck.

By April 1997, however, New Jersey State Athletic Control Board (NJSACB) had been in close contact with the California State Athletic Commission, which had been working closely with Jeff Blatnick, Nelson Hamilton, and Paul Smith in establishing rules for the UFC. While the California commission approved the sport through a rule set principally authored by Blatnick, the commission could not obtain legislative approvals and funding required to become legalized in the state. As of 2000, the NJSACB began to formally oversee and approve MMA promotions upon submission and review of their established rules and regulations.

On April 3, 2001, NJSACB held a meeting in Trenton to discuss the regulation of MMA events. The purpose of the meeting was to unify the myriad of rules and regulations, which were used by different mixed martial arts organizations in various jurisdictions. At this meeting, the rules discussed, modified and then agreed upon by several other regulatory bodies, numerous promoters of mixed martial arts events and other interested parties in attendance. At the conclusion of the meeting, all parties in attendance were able to agree upon a uniform set of rules to govern the sport of mixed martial arts.   Consequently, May 4, 2001 at the Trump Taj Mahal in Atlantic City, New Jersey, UFC 31 was the first event under the agreed upon unified rules.

Statistics show that elite MMA athletes are less likely to obtain serious injuries compared to athletes who participate in other contact sports such as ice hockey, boxing, and American football. This is based on the amount of weekly training sessions (12-14) compared to the amount of bouts they have per year (1-3), resulting in long periods of rest in between major competitions. MMA techniques are a combination of already established sports such as boxing, wrestling and taekwondo, all of which are Olympic sports, and there are more than 30 rules that apply to MMA to ensure the safety of all participants.

MMA has strict safety rules that are called The Unified Rules of MMA  and include: Weight classes, timed rounds, no strikes to the back of the head, no small-joint manipulations, no groin strikes, no hair pulling, head butting or kicks to the head of a downed opponent. On the international level, there are another set of rules set forth by The International Mixed Martial Arts Federation (IMMAF) that are not enforced, but are widely used and considered the basis for various MMA governing entities to adopt in their respective countries.

The IMMAF established a Safely Ladder to illustrate the progression of MMA from recreational exercise to elite sport with six levels. Once a practitioner exhibits sufficient experience and maturity in regards to health and safety, they move up a level.

  1. Martial arts without full-contact impacts
    This is the first level of athletic development where practitioners will learn the movements and tactics of different kinds of martial arts without receiving any full-contact impacts. Examples of such martial arts are wrestling, judo, jiu-jitsu, semi-contact boxing and muaythai.
  2. Full-contact martial arts
    On this level practitioners exercise and compete in full-contact martial arts such as amateur boxing and amateur muaythai.
  3. Full-contact sports closely related to amateur MMA
    This level is very similar to amateur MMA but with a more restricted set of rules. For instance the rule set can allow for striking and kicking while standing but once on the ground only grappling is allowed. This is an appropriate level to start competing in before entering amateur MMA.
  4. Amateur MMA
    Amateur MMA is similar to professional MMA with the exception for some differences in the rule set and the length of the bouts which are limited to two rounds. Also the athletes do not receive payment for their athletic performances.
  5. National Professional MMA
    This is the highest professional level on a national scale. In different countries there might be differences in rules regarding the use of certain techniques.
  6. International professional MMA
    This is the most physically and mentally challenging level of MMA and follows the recognized rule set called the Unified Rules of MMA. Very few athletes around the world have the ability to compete at this level, and these rules are used for leading promotions such as the UFC.
  7. Health Concerns:
    The Bylaws of the USA Mixed Martial Arts Federation states that sports organizations must take the appropriate measures to ensure that the competition is conducted by qualified officials and that proper medical supervision is provided to athletes. Each state athletic commission establishes its own set of medical requirements for fighters, including pre- and post-fight testing for both performance-enhancing and recreational drugs and reserves the right to ban certain types of strikes. Athletes in professional MMA are examined by doctors before, during and after competitions and if injured at any point, they are pulled from competition and are medically suspended from training and competition until they are cleared by a physician.

Today, almost all states that regulate MMA are governed by the Unified Rules of Mixed Martial Arts. These regulations include, but are not limited to pre-fight medical testing, medical insurance and ringside physician requirements, and a medical data base which track fighter’s medical history and injury status throughout participating states.

The New York State Athletic Commission (SAC) is authorized to regulate professional boxing and wrestling matches throughout the state. They administer licenses, provide training for officials, enforce rules and ensure that medical and safety standards are met. This gives New York State the ability to influence and control the safety aspect of MMA via medical oversight. The regulation by New York State Athletic Commission will ensure that this sport is done as safely as possible.

Mixed Martial Arts and Head Injuries

Although the rules and regulation of MMA have greatly evolved for the better over the past several years, the concern over the long term effects of head injuries have recently become been under increased scrutiny.  The MMA community, however, has taken a proactive approach to understanding the risks of contact sports, and to mitigate those risks.  The two studies which epitomizes this approach yet appear to reach vastly different conclusions were conducted at 1) University of Toronto’s Concussion Program at the MacIntosh Sports Medicine Clinic study which examined 844 fights from 2006-2012; 7 and 2) Cleveland Clinic’s Lou Ruvo Center for Brain which used Magnetic Resonance Imagining (MRI’s) of professional fighters to determine changes in brain health that correlate with decreased cognitive ability.  The Cleveland Clinic’s study currently has over 400 fighter enrolled, and is expected to examine 225 more. 8   In the Toronto Study, researchers studied videos of UFC fights and found that head strikes drastically increased within the last 30 seconds of a match, and the percentage of knock-outs and TKO’s in those fights and how they directly correlate to repetitive head blows.  The Toronto Study was the first of its kind, but it contained a serious flaw and data gaps because it did not take into consideration a fighter’s pre and post-fight health nor did the clinicians conduct medical screenings of actual fighters.   The Cleveland Clinic is working to decrease such assumptions, fill the data gaps, and identify tangible risks and recommend measures to make MMA safer.

(For the analysis of the Cleveland and Toronto studies, as we as the group’s conclusions and recommendations, subscribe to Concussion Litigation Reporter.)

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