Current Review of Injuries Sustained in MixedMartial Arts CompetitionBryant Walrod, MD

AbstractMixed martial arts (MMA) have enjoyed a tremendous growth in popu-larity over the past 10 years, yet there remains a paucity of informationwith respect to common injuries sustained in MMA competitions. In theavailable studies, certain trends pertaining to risk factors for injury, as wellas the most common injuries sustained in MMA competition, were noted.Common risk factors include being the losing fighter, history of knockoutor technical knockout, and longer fight duration. Common injuries thatwere noted include lacerations and abrasions, followed by injuries to theface and ocular region. Concussionswith orwithout loss of consciousnessalso were noted in MMA competition.

IntroductionMixed martial arts (MMA) have enjoyed a tremendous

growth in popularity over the past 10 years. Pay-per-viewand gate revenues from these events also have noted largegains. The name mixed martial arts (sometimes calledultimate fighting) describes a combative event betweentwo individuals in which they use a myriad of technicalskills against each other. In these competitions, combatantsuse skills gleaned from wrestling, boxing, and many mar-tial arts, including jujitsu and tae kwon do. Bouts typicallyare 5 min in duration and consist of 3 to 5 rounds. Win-ners often are declared by judges decision, technical knock-out (TKO), referee stoppage, submission, knockout (KO),physician stoppage, or disqualification. Currently, 43 of 50individual states legislate specific rules for competition. De-spite MMAs rapid growth, there remains a paucity of stud-ies with respect to injuries sustained in these competitions.This article will review the current literature with respect toMMA injury patterns.

MMA often has been compared to boxing. Some strikingdifferences readily are apparent, however. Rates of injury in

boxing range from 17% to 25%, andthey approach 24% in MMA. In box-ing, competitors typically wear 10- to16-oz closed-finger gloves, which con-trast greatly with the 4- to 6-oz open-finger gloves used in MMA. Thesesmaller and lighter gloves really mayserve to protect the strikers handsrather than to decrease the force of theblow. In fact, Schwartz (4) revealed thatthe 4-oz gloves used in MMA do notmitigate the striking forces when com-pared with wearing no gloves at all;however, larger 16-oz gloves do miti-

gate these forces. Another important aspect of MMA inju-ries is the mechanism of winning. In MMA, a competitor hasmultiple modalities by which he or she can win the bout. Ofcourse, striking is a common method used against onesopponent; however, many times, competitions will be deci-ded by a submission with little striking to the head or body.In reviewing 635 sanctioned MMA matches, Ngai (3)revealed that 35% of matches ended with submission andthat nearly 60% of matches ended by either decision orsubmission, not TKO or KO. In addition, when comparingMMA to boxing, Bledsoe (1) noted 2 times the incidence ofKOs in boxing compared with MMA. However, he observeda similar number of TKOs, possibly supporting the idea thatthere may be fewer severe head injuries when striking is notthe only modality by which to defeat an opponent. If, forexample, a bout consists predominantly of grappling andultimately is decided by an arm bar submission, there is lesschance of head trauma compared with a bout in which thereare multiple head blows. In 2005, Buse (2) reviewed videofootage of 1,284 men competing in 642 matches from 1993to 2003 and revealed that the proportion of matches endingby head trauma was higher in MMA (28%) compared withboxing (9%) and kickboxing (8%). He did not specifywhether the head trauma resulted in a KO or TKO. A sig-nificant limitation of Buses review was that it was simply avideo review of televised matches. Speculation was evidentwith respect to injury patterns and severity. Finally, in sportsin which striking is allowed, e.g., MMA, kickboxing, andboxing, there are higher overall injury rates when comparedwith sports in which striking is banned, e.g., wrestling (1).Scoggin (5) compared overall injury rates per exposures in

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288 Volume 10 & Number 5 & September/October 2011 Mixed Martial Arts Injuries

Department of Family and Community Medicine, Medical Collegeof Wisconsin, Milwaukee, WI; and Comprehensive Orthopaedics,Kenosha, WI

Address for correspondence: Bryant Walrod, MD, ComprehensiveOrthopaedics, 6308 8th Avenue 505, Kenosha, WI 53143(E-mail: bwalrod@comportho.com).

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certain combative sports and revealed an injury rate of 23%to 28% in MMA versus 29% to 31% for karate, 25% forboxing, and 6.3% for tae kwon do.

Risk factors for injury in MMA competition also werereviewed in multiple studies. Ngai (3) reviewed MMAcompetitions from 2002 to 2007 in Nevada. He noted thatthe losing fighter was 2.53 times more likely to be injuredthan the winning fighter. However, he noted that age,weight, and fight experience had no significant effect onincidence of injury. In contrast, Bledsoe (1) noted that olderparticipants and those who lost by a KO or TKO were at ahigher risk of injury. His findings did support Ngai in thatlosing under any circumstance resulted in a higher incidenceof injury (65% vs 35% for those who won). Both Ngai andBledsoe observed that increased duration of fighting resul-ted in increased incidence of injury.

The types of injury in MMA competition have beenanalyzed in three different studies. Bledsoe (1) revieweddata from the Nevada State Athletic Commission from 171MMA matches involving 220 different fighters from 2001through 2004. Ngai (3), in 2007, looked at 635 bouts with1,270 athletes competing from 2002 to 2007 in the state ofNevada. Finally, in May 2010, Scoggin (5) published datafrom 179 participants and 116 MMA bouts that took placein the state of Hawaii from 1999 through 2006. The overallincidence of injury in MMA competitions was reported tobe in a similar range in the studies, i.e., 23 to 28 per 100fight participants. The most common injuries were noted tobe lacerations and abrasions. This was observed con-sistently in the major study reviews. Ngai noted lacerationsoccurring about 17% of the time, whereas Scoggin noted28 facial lacerations and abrasions occurring per 232 par-ticipants or about 12%, and finally, Bledsoe noted 13.5lacerations per 100 participants. It is difficult from theavailable reviews to ascertain the severity of the lacerationsand abrasions. The second most common area for injurywas the face. Ngai noted about 15% of matches beingstopped because of injuries to the face or ocular area.Scoggin looked at the incidence of injuries during MMAcompetition and discovered that approximately 10% oftotal injuries sustained were injuries to the face.

Two important injuries to consider are head trauma andconcussion. Because our understanding of concussion stillis evolving, it is difficult to reach firm conclusions withrespect to head trauma and concussion. Some of the availablestudies reviewed video evidence to evaluate head trauma.

It is difficult to determine the incidence of concussion onthe basis of video evidence of head trauma alone. Never-theless, there are some data with respect to head trauma.Ngai revealed that 15.5% of matches had either ocularinjury or injuries to the face. He also observed severe con-cussion as an injury in 3.3% of matches. He classified se-vere concussion as loss of consciousness resulting from aKO, however. He reported this incidence to be similar towhat has been demonstrated in tae kwon do competitions.Scoggins evaluation of 116 bouts in Hawaii reported 11of the 55 injuries to be concussions. Seven of the fighterswho had concussions had loss of consciousness, and fourhad retrograde amnesia. In addition, 5 of the 55 reportedinjuries were facial injuries. Thus, concussions occurred in4.7% of exposures, and facial injuries occurred in 2.2%of exposures.

ConclusionsMMA has continued to evolve and grow during the past

10 years. As it grows, several studies have helped us tounderstand some of the more common injuries that occurduring competitions. We cannot comment accurately onwhat occurs during practice or what occurs in unsanctionedbouts. There also remains a lack of data with respect toconcussion incidence and possible adverse sequelae duringMMA competitions and trainings. Hopefully, further pro-spective studies will improve our understanding of theseissues with respect to MMA competition.

AcknowledgmentThe author has no disclosures.

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2. Buse GJ. No holds barred sport fighting: a 10 year review of mixedmartial arts competition. Br. J. Sports Med. 2006; 40:169Y72.

3. Ngai KM, Levy F, Hsu EB. Injury trends in sanctioned mixed martial artscompetition: a 5-year review from 2002 to 2007. Br. J. Sports Med.2007; 42:686Y9.

4. Schwartz ML, Hudson AR, Fernie GR, et al. Biomechanical study of full-contact karate contrasted with boxing. J. Neurosurg. 1986; 64:248Y52.

5. Scoggin JF 3rd, Brusovanik G, Pi M, et al. Assessment of injuries sus-tained in mixed mixed martial arts competition. Am. J. Orthop. (BelleMead NJ). 2010; 39:247Y51.

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