FACT KIT-STATE BENEFITS - MMA Facts KIT - COMBINED.pdf · Mixed Martial Arts has its roots in a wide variety of ancient martial arts, including judo. Photo by ... Korean style martial

FACT KIT

STATE BENEFITS The surging popularity of Mixed Martial Arts (MMA) has meant sell out events at arenas across America, welcome news not just to arena owners and their employees but to the cities and states that are reaping the rewards in jobs, tourist spending and sales tax revenues. At a time when the country is facing difficult economic times, the additional revenue is a great benefit for cash‐strapped states and cities. In Upstate New York, especially, MMA events could bring much‐needed tourist dollars and tax revenue. MMA events regularly break arena records for concession sales, merchandise sales and ticket prices.

• The City of Columbus gained significant economic benefits from March 2007’s UFC® 68. It was the largest gate in Nationwide Arena history and it set the re‐cord for the highest North American attendance figure for a mixed martial arts event ever. Approximately 40 percent of attendees (8,000) visited from outside of Ohio, a boon for hotels and restaurants in Columbus. According to the Ohio

JULIE WOOD 895 BROADWAY, FIFTH FLOOR NEW YORK, NEW YORK 10003

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FOR MORE INFORMATION: Nearly all MMA events sell out, and they currently are consistently breaking arena records for concession sales, merchandise sales and ticket prices. Photo by Gabriel Bouys. All rights reserved.

Athletic Commission, the single MMA event produced $11 million in external economic activity for the city. • At UFC® 67 in Las Vegas, 72 percent of attendees came to Las Vegas from out‐side of Nevada, indicating that the primary purpose of their trip was for the event and underscoring the tourism boost MMA offers. • MMA events have among the highest average ticket prices of any sporting event. UFC® ’s August 2007 event in Las Vegas sold out the Mandalay Bay and had an average ticket price of over $340. Assuming even ticket prices 50 per‐cent lower, an event in Buffalo would translate into hundreds of thousands of dollars for city and state coffers. • Unlike other arena events, MMA attendees arrive early and stay late, meaning record concession and merchandising sales and corresponding sales tax reve‐nue. At most boxing events, arenas are lucky to be a quarter‐filled during the under card fights. For UFC® bouts, they are often close to full hours before the main event. Arena owners throughout New York attest to the potential economic impact of MMA events held in their cities. • The Times Union Center in Albany anticipates a single MMA event generat‐

ing close to $1 million in economic impact for Albany businesses and an ad‐ditional $100,000 in tax revenues for Albany County. “The UFC® is one of the highest attended and one of the most profitable sports events being pre‐sented in the US. We would love to bring the UFC® to the Times Union Cen‐ter.”

• According to Madison Square Garden in New York City, if an MMA audi‐

ence is similar to a typical boxing event audience, approximately one in five attendees would be traveling from beyond the metropolitan area, spending money on hotels, restaurants, shopping and entertainment on a multi‐day stay.



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FACT KIT

THE SPORT Mixed Martial Arts (MMA) was originally launched in the United States by the “first family of Jiu‐Jitsu.” They brought together the very best martial artists from the various disciplines to compete against each other on a level playing field. The goal was to determine which of the disciplines was best. Could a boxer beat a wrestler? Could a kung fu champion beat a karate master? The first Ultimate Fighting Championship® event was held at McNichols Arena in Denver, Colorado in 1993. The undersized Royce Gracie beat bigger, stronger, and faster opponents with his Gracie Jiu‐Jitsu to win the tournament. The fledg‐ling sport became an overnight sensation.

The shows became must see TV for fans, but in the early years, the lack of state regulation and significant set of rules led to the show being taken off cable tele‐vision. After a series of relatively dark years, the Las Vegas based Zuffa LLC took over the company in 2001. They implemented a set of unified mixed martial arts rules, and suddenly MMA was no longer a spectacle, but a legitimate sport. As the sport has evolved, so have the athletes, and they well know that one par‐




Mixed Martial Arts has its roots in a wide variety of ancient martial arts, including judo. Photo by Philip Lee Harvey.. All rights reserved.

ticular style will not work in competition on a consistent basis. This means Mixed Martial Artists must learn a variety of martial arts including boxing, wres‐tling, kickboxing, and jiu‐jitsu to effectively spar with their opponents. Under the Unified Rules of Mixed Martial Arts, athletes compete for three five‐minute rounds, with championship matches waged over five five‐minute rounds. Scoring, like boxing, is done on a ten‐point system, with the winner of the round receiving ten points and the loser nine points or less. Unlike boxing, MMA matches are scored not only for effective striking attacks, but for ground fighting effectiveness, submission and takedown attempts and defense, as well as ring generalship. Bouts end via knockout, referee, corner or doctor stoppage, or submission. When a bout ends by submission, the fighter either verbally or physically “taps out,” signaling that he has had enough. Mixed martial arts athletes are experts in virtually every discipline – from Tae Kwon Do, Judo and Kung Fu to Bruce Lee’s Jeet Kune Do and Sambo – employed in the sport. For an athlete to truly be successful he needs to have a base in the following:




Boxing An Olympic sport since 1920, boxing is the sport of fighting with the fists.

Brazilian Jiu‐Jitsu Brazilian Jiu‐Jitsu has its roots in Judo and was created in the 1920’s in Brazil by MMA pioneer Carlos Gracie. Gracie modified the practice of judo with moves that require less strength and are more effective against larger opponents.

Freestyle Wrestling An Olympic sport since 1904, contestants strug‐gle hand to hand in an attempt to throw or take down their opponent without striking blows.

Greco‐Roman Wrestling An Olympic sport since 1896, Greco‐Roman wrestling is similar to Freestyle wrestling, the only difference being that Greco‐Roman wres‐tling rules forbid attacks below the waist.

Jiu Jitsu An ancient Japanese martial art that encom‐passes throwing, joint locks, striking, and weap‐ons training.

Judo An Olympic Sport since 1964, Judo is a Japanese martial art founded in 1882 by Jigoro Kano. Derived from Jujutsu, Judo emphasizes throws and forbids striking in competition.

Karate Karate is the name used to identify many Japa‐nese and Okinawan martial arts known for pow‐erful, linear techniques. Practitioners are trained in striking, grappling, locks, restraints and throws.

Kickboxing Kickboxing is a martial art combining boxing punches and martial arts kicks.

Tae Kwon Do An Olympic sport since 2000, Tae Kwon Do is a Korean style martial art known for its flashy kicking techniques. It is one of the most prac‐ticed martial arts in the world.

FACT KIT

THE HISTORY Mixed Martial Arts (MMA) has a rich history and tradition dating back to the Olympic Games in Athens. About 80 years ago, a Brazilian form of MMA known as Vale Tudo sparked local interest in the sport. In 1993, the UFC® organization brought MMA to the United States. The goal was to find “the Ultimate Fighting Champion” through a tournament of the best athletes skilled in the various disciplines of martial arts, including karate, jiu‐jitsu, boxing, kickboxing, grappling, wrestling, sumo and other sports. The win‐ner of the tournament would be crowned the champion. The sport became an instant hit, but it drew controversy because it was unregu‐lated and, although its owners enforced their rules, it also used the slogan 'There Are No Rules!' creating concerns for fighter safety.

In 1998 after widespread criticism UFC® lost all cable pay per view distribution and was spiraling toward ruin. In 2001 three fans of the sport saw past their unfortunate record and saw the potential of a real sports league where no one discipline dominated, rather ath‐



FOR MORE INFORMATION: From its earliest days, the sport of MMA has been popular with its fans, but it took the marketing prowess of Ultimate Fighting Championship to bring the famed “Octagon” and the sport into the mainstream. Photo by Daniel Berehulak. All rights reserved.

letes would have to cross train in all disciplines to win. Brothers Lorenzo and Frank Fertitta joined with their friend, a boxing manager, Dana White to form Zuffa LLC and buy the Ultimate Fighting Championship® franchise. They were determined to turn MMA into a sanctioned and regulated sport that would pro‐tect the safety of the fighters while preserving the integrity of the athleticism that the sport required. Zuffa's number one goal was cooperation with and operation under the guide‐lines of the State Athletic Commission to establish UFC® as a legitimate and sanctioned sport that could find its way into the mainstream sports scene. In May 2001, the New Jersey State Athletic Control Board drafted and adopted rules known as the Unified Rules of Mixed Martial Arts under which the sport is now governed. The rules include: licensing, medical examinations, approved gloves, weight classes, time limits, rounds and mandatory drug testing. Zuffa secured sanctioning in Nevada in 2001 and shortly thereafter, in Septem‐ber of the same year, UFC® returned nationwide to cable television’s pay‐per‐view. As a result, the UFC® organization now offers twelve to fourteen live pay‐per‐view events annually through cable and satellite providers. MMA programming is also distributed internationally, including broadcast on Viewer's Choice in Canada, MAIN EVENT in Australia, Globosat in Brazil and Setanta and Bravo in the United Kingdom. The biggest of the MMA organizations, UFC® is regulated and recognized by the world's most prestigious sports regulatory bodies including the California, Flor‐ida, Nevada, New Jersey, Ohio and Pennsylvania State Athletic Commissions. The UFC® organization strives for the highest levels of safety and quality in all aspects of the sport.




The sport of Mixed Martial Arts (MMA) has exploded in popularity in recent

years. From TV viewership to press coverage to record crowds at events, the

numbers tell it all.

The following are some of the more interesting statistics about the sport:

Television Coverage

• The annual percentage growth of PPV buys has increased from 47% in 2004

(over 2003) to 189% in 2005 to 352% in 2006.

• Gross revenues of PPV events has had annual increases of 47% in 2004, 232%

in 2005, and 424% in 2006.

• Over 55 hours per month of television programming on US channels including

Fox, FSN, Spike TV, National Geographic Channel, Discovery Channel, and in syn-

dication.

• An average growth rate over the past four years of almost 390% in terms of

hours of monthly television programming featuring MMA.

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Television Ratings

The number one rated fighting event among men 18-34 (including boxing) of

2006 on television was a Spike TV featuring UFC® fighters Ortiz and Shamrock.

Three of the top ten fights were MMA fights, with the rest featuring boxing.

The Ortiz vs. Shamrock fight was the fourth highest rated among all cable net-

work sporting events in 2006 (the first two were football, the third was college

football and the rest of the top ten included the NBA playoffs, the NFL draft,

and World Cup Soccer).

Television Shows featuring MMA include:

Magazine Features about the sport and its athletes have appeared in:

Gate Revenues

In terms of gate revenues, the UFC® is the premier organization, and their

events have grown from five live events in 2001, with an average ticket price of

$81.45 to 10 events in 2006, with an average ticket price of $273.68. Particu-

larly noteworthy was the ticket price jump of almost $100 between 2005 and

2006 (going from $178.01 in 2005 to the aforementioned $273.68 in 2006). JULIE WOOD


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60 Minutes

The Tonight Show with Jay Leno

NBC Sports

Jimmy Kimmel Live

The O’Reilly Factor

Extra

Late Night with Conan O’Brien

Fox & Friends

Entourage

Best Dams Sports Show Period

Access Hollywood

The Sopranos

ESPN Cold Pizza

Scarborough Country

Outside the Lines

Dr. Phil

MAD TV

Entertainment Tonight

The Craig Kilborn Show

Inside Edition

Business Nation

Time

Maxim

Advertising Age

Forbes

Business Week

Entertainment Weekly

FHM

Variety

US Weekly

ESPN Magazine

GQ

Men’s Journal

People

Shock! Magazine

STAR

Muscle and Fitness

Men’s Fitness

Flex Magazine

Stuff Magazine

Sports Illustrated

FACT KIT

MYTHS vs. REALITY There are many myths associated with Mixed Martial Arts. Some of the most common of them are addressed here: Mixed Martial Arts (MMA) is unregulated and uncontrolled. Mixed Martial Arts is one of the most regulated and controlled sports in the world. With imposed time limits, set numbers of rounds, mandatory judges, five weight classes and over 31 other rules governing how the bouts are fought, or‐ganizations strive for the highest safety standards. The UFC®, the biggest of the organizations, only holds bouts in states where the sport is regulated . MMA is recognized by the world’s most prestigious sports regulatory bodies including the California, Florida, Nevada, New Jersey, Ohio and Pennsylvania State Ath‐letic Commissions. MMA is dangerous and its fighters are put at a serious risk of injury each time they enter the Octagon. MMA fighters are given more care and precaution than athletes in any other sports organization in the world. With supervised fights, pre and post‐fight MRIs, four ringside doctors and two ambulances in case of emergency at each event and mandatory steroid testing – these organizations reach the highest levels of safety and quality in all aspects of the sport. Safer than boxing, no or‐ganization fighter has ever suffered a serious injury or death. MMA is a steel cage death match. MMA is an intense, strategic sport that demands world class athleticism from its fighters. The athletes use interdisciplinary forms of fighting that include jiu‐jitsu, judo, karate, boxing, kickboxing, wrestling and others to their strategic and tac‐tical advantage in supervised matches. Mixed martial artists are nothing more than street fighters. Mixed martial artists are some of the best athletes in the world. Before taking up MMA many of the athletes were college All‐American’s and Olympic champi‐ons. To stay competitive, all of the athletes are trained in a variety of martial arts disciplines including judo, wrestling, boxing, karate and jujitsu. UFC®, the biggest MMA organization, boasts that a significant majority of their fighters have college degrees.




MMA has only one rule, prohibiting eye gouging. MMA is governed under the Unified Rules of Mixed Martial Arts which were created by the most prestigious state sports regulating bodies in the United States. In addition to the five weight classes, the imposed time limits, and set number of rounds, there are 31 other rules that govern how the sport is played. In fact, most of the rules are derived from the rules governing Olympic wres‐tling, boxing and martial arts. MMA is much more harmful than other fighting sports like boxing. MMA is much safer than boxing. Since its inception in the United States there have been no serious injuries or deaths in any of the major, sanctioned MMA organizations. Unlike boxing, in which fighters sustain repeated blows to the head for up to 15 rounds, MMA bouts last only 3‐5 rounds and much of the fighting takes place on the mat as wrestling or grappling. In addition, unlike box‐ing gloves, MMA gloves are not weighted. MMA is a fringe sport that appeals only to young men. In the past five years, MMA has seen a meteoric rise in interest from nearly every age and demographic, adding to its cache as a mainstream sport. UFC® nearly always sells out arenas where their events are held, and regularly breaks gate records across the country. Additionally, UFC®’s reality show, the Ultimate Fighter™ often beats the ratings of NBA and baseball playoffs. Mainstream sponsors and partners are eager to form relationships with MMA, including Via‐com, Showtime, Harley‐Davidson, Bud Light, the U.S. Army and all the major cable companies.




FACT KIT

THE FANS Mixed Martial Arts (MMA) is breaking all stereotypes when it comes to its fan base. Long‐regarded as a fringe sport with a fan base of young men, MMA is quickly being embraced by a much larger and more diverse fan base. More women In 2007, at UFC® 67 in Las Vegas and UFC® 69 in Houston, a third of the atten‐dees were women, according to research leader Harris Interactive. In Houston, roughly half of all groups in attendance included a mix of men and women. More middle‐class Attendees reported mean incomes above $70,000 in Houston and above $85,000 in Las Vegas. A majority of attendees (60% in Las Vegas and 84% in Houston) reported that they were attending their first event, signaling the rapid influx of new fans.

Setting attendance records At arena after arena, MMA events are setting attendance and gate records. • UFC® 75: CHAMPION vs. CHAMPION, which took place Saturday, Sept. 8, 2007



FOR MORE INFORMATION: The fans of Mixed Martial Arts include women, families, celebrities and members of both the middle and upper class. Photo by Al Bello. All rights reserved.

at 02 Arena in London, England was attended by 16,000 people (sellout crowd) and grossed a gate of over £1,356,859.50 (Approx. $2.6 million). The fight was the most watched UFC® event ever, garnering 4.7 million viewers on Spike TV. The fight card drew more Men 18‐49 than anything else on television, broadcast or cable, including heavy sports competition from college football on ABC and ESPN, NASCAR on ABC, and the U.S. Open Women’s Final on CBS. • UFC® 68: THE UPRISING, which took place March 3, 2007 at Nationwide Arena in Columbus, was attended by over 19,000 people and grossed a gate of more than $3 million. It was the largest gate in Nationwide Arena history and it also set the record for the highest North American attendance figure for a mixed martial arts event ever. • UFC® 83, which took place in Canada, was the fastest sell out and largest live audience for a North American mixed martial arts event. Celeb Fans Mixed martial arts has become a must‐see event for Hollywood stars. The fol‐lowing are some of the famous faces who have appeared at recent MMA events.

Red Belt And now comes the first feature‐length film about mixed martial arts. Ac‐claimed writer/director David Mamet’s Red Belt is due in theaters this spring. Mamet (best known for indy hits like Glengarry Glen Ross and The Spanish Pris‐oner) has been a fan of MMA for years. “I've become fascinated by the art and science of jiu jitsu,” says Mamet.




Andre Agassi & Stefi Graf Charles Barkely Jason Biggs Jay ZNicolas Cage Cindy Crawford Carson Daly Michael Clark Duncan Kevin James

Nick Lachey Shaquille O’Neal The Rock Adam Sandler Rob Schneider Paul Walker Barry Bonds

Mixed Martial Arts (MMA) is among the fastest growing sports in America. Ulti-

mate Fighting Championship (UFC) is the most heavily regulated and widely

known of the MMA leagues. Known for its intense competition and remarkable

athleticism, the sport is winning an increasingly large following and garnering

significant positive press.

In 2001, UFC® was bought by Zuffa LLC with the express goal of doing what

previous owners had not – fully embracing regulation in every state and

allowing state athletic commissions to develop the full set of rules neces-

sary to make the sport legal and fighter safety the foremost concern.

The UFC is regulated and recognized by the world’s most prestigious sports

regulatory bodies including the California, Florida, Nevada, New Jersey,

Ohio and Pennsylvania State Athletic Commissions. In total it is regulated in

44 states.

UFC imposes strict rules, above and beyond those required in boxing, to

JULIE WOOD


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Ultimate Fighting Championship (UFC) is the most successful and the most heavily regulated and widely known of the MMA leagues.

ensure fighter safety:

− Mandatory steroid and recreational drug testing

− Baseline MRI/MRA with mandatory follow ups

− Baseline ophthalmological exams

− Mandatory blood screening

− 4 ringside doctors and two ambulances at each venue

− Referees empowered to stop fights at any time

− Judges

− 5 weight classes

− Rounds

− Imposed time limits

− 31 specific ways to foul

UFC Athletes are the best in the world, having trained in nearly every mar-

tial arts discipline. Many UFC athletes were All American college wrestlers

or competed in the Olympics.

Over 80% of UFC athletes hold college degrees.

Five Olympic sports are represented in mixed martial arts. Of the 10 mar-

tial arts (Judo, Jujitsu Boxing, Freestyle Wrestling, Greco Roman Wrestling,

Tae Kwan Do, Karate, Kickboxing, Brazilian Jujitsu, and Kung Fu) that make

up mixed martial arts, five are Olympic sports (Boxing, Freestyle Wrestling,

Greco Roman Wrestling, Tae Kwan Do and Judo).

Mixed Martial Arts is widely considered to be safer than boxing, in fact no

UFC fighter has ever sustained a serious injury or died.

UFC is an opportunity to bring tourist dollars, tax revenues and jobs to

host cities, especially Upstate.

− According to the Ohio Athletic Commission, the single MMA event

held in Columbus, Ohio produced $11 million in external economic

activity for the city.

− According to the Las Vegas Sun newspaper, “The Nevada State Ath-

letic Commission had estimated it would collect $2 million in fees

from mixed martial arts matches annually in the next two fiscal

years. But a state advisory committee raised the projected revenue

- generated by a 10 percent entertainment tax on ticket prices - to

$2.5 million per year because of the increasing fan interest in mixed

martial arts...”

UFC sells out nearly every venue where it hold events and breaks gate re-

JULIE WOOD


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cords time and time again.

− Over 14,000 people attended a November event at the Prudential

Center in Newark, NJ. UFC set a new gate record of $2.1 million.

− Over 16,000 people attended an event at U.S. Bank Arena in Cincin-

nati in October, setting a new gate record of $2.5 million.

− Over 15,000 people attended an event at the Toyota Center in

Houston, which grossed a gate of more than $2.8 million. This set a

record for the Toyota Center, beating the prior record gate from a

Rolling Stones concert in 2005.

UFC has a Spike TV reality show, THE ULTIMATE FIGHTER, that regularly

outdraws NBA and baseball games among the 18- to 34-year-old male

demographic.

− UFC® Fight Night™ (Oct. 10, 2006) achieved record ratings for Spike

TV and the Ultimate Fighting Championship®. The two-hour live UFC

fight card on Tuesday, October 10 (8:00-10:00pm ET/PT) drew 4.2

million viewers, topping out at 5.7 million from 9:30pm-9:45pm.

The two-hour event drew more Men 18-34 (1.6 million), than any-

thing on television (broadcast or cable) on Tuesday, October 10,

and drew an impressive 500,000 more Men 18-34 head-to-head

against the MLB playoffs on FOX (1.6 million – 1.1 million).

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©Journal of Sports Science and Medicine (2006) CSSI, 136-142 http://www.jssm.org

Combat Sports Special Issue

Research article

INCIDENCE OF INJURY IN PROFESSIONAL MIXED MARTIAL

ARTS COMPETITIONS

Gregory H. Bledsoe , Edbert B. Hsu, Jurek George Grabowski, Justin D. Brill and

Guohua Li Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland, USA Published (online): 01 July 2006

ABSTRACT Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993. In 2001, Nevada and New Jersey sanctioned MMA events after requiring a series of rule changes. The purpose of this study was to determine the incidence of injury in professional MMA fighters. Data from all professional MMA events that took place between September 2001 and December 2004 in the state of Nevada were obtained from the Nevada Athletic Commission. Medical and outcome data from events were analyzed based on a pair-matched case-control design. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. A total of 171 MMA matches involving 220 different fighters occurred during the study period. There were a total of 96 injuries to 78 fighters. Of the 171 matches fought, 69 (40.3%) ended with at least one injured fighter. The overall injury rate was 28.6 injuries per 100 fight participations or 12.5 injuries per 100 competitor rounds. Facial laceration was the most common injury accounting for 47.9% of all injuries, followed by hand injury (13.5%), nose injury (10.4%), and eye injury (8.3%). With adjustment for weight and match outcome, older age was associated with significantly increased risk of injury. The most common conclusion to a MMA fight was a technical knockout (TKO) followed by a tap out. The injury rate in MMA competitions is compatible with other combat sports involving striking. The lower knockout rates in MMA compared to boxing may help prevent brain injury in MMA events. KEY WORDS: Brain injury, ultimate, boxing, jiu jitsu.

INTRODUCTION Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993 (Krauss and Aita, 2002). Styled after the popular Vale Tudo (Portugese for “anything goes”) matches in Brazil (Peligro, 2003), these first UFC matches were marketed as brutal, no-holds-barred tournaments with no time limits, no weight classes, and few rules (Hamilton, 1995).

Politicians such as Senator John McCain of

Arizona led the charge to ban these competitions from cable television, describing the events as “human cock fighting” (Krauss, 2004). When their cable contracts were terminated in 1997, MMA events survived underground through internet and word of mouth promotions until their organizers agreed to a change of rules that allowed the Nevada State Athletic Commission and the New Jersey State Athletic Control Board to sanction the competitions

Injury in mixed martial arts competitions

137

Table1. Frequencies and rates of mixed martial arts injuries to professional competitors, September 2001 through December 2004, Nevada.*

Injury site Number (%) Injury Rate per 100 Competitors

Facial Laceration 46 (47.9) 13.45 Eye 8 (8.3) 2.34 Ear 1 (1.0) .29 Nose 10 (10.4) 2.92 Mouth 0 (0.0) .00 Jaw 1 (1.0) .29 Neck 1 (1.0) .29 Shoulder 5 (5.2) 1.46 Arm 1 (1.0) .29 Elbow 2 (2.1) .58 Hand 13 (13.5) 3.80 Chest 0 (0.0) .00 Abdomen 0 (0.0) .00 Back 2 (2.1) .58 Knee 3 (3.1) .88 Ankle 2 (2.1) .58 Foot 1 (1.0) .29

*Up to four injuries recorded per competitor per match. in 2001 (Krauss, 2004).

This study is the first report of the incidence of injury in MMA competitions. No study has previously documented injuries in MMA events either before or after the tightening of regulations. Fight results and injury incidence from professional MMA bouts since their sanctioning in 2001 in Nevada are compared to boxing data from the same state. A discussion of MMA events and combat sports injuries is also included. METHODS Mixed Martial Art (MMA) data from all professional MMA matches in the state of Nevada from September 2001 until December 2004 (n = 171 matches) was obtained from the Nevada State Athletic Commission. All professional MMA matches occurring in the state during the study period were included. Data obtained included gender, date of the match, date of birth, weight, rounds scheduled, rounds fought, whether the fighter won or lost, how the match ended (knockout, technical knockout, decision, draw, disqualification, no decision, tap out, or choke) and the injuries that occurred in the match and the type of injuries sustained. Up to four injuries per fighter were recorded per competition. These data are in the public domain and accessible on the website of the Nevada State Athletic Commission (http://boxing.nv.gov, last accessed January 2005).

Medical and outcome data for all professional MMA matches were analyzed based on a pair-matched case-control design. Cases were fighters who sustained an injury during the matches. Fighters who were not injured served as controls. Matches in which both competitors were injured or both were uninjured were excluded from the conditional logistic regression. Both conditional and unconditional logistic regression models were used to assess risk factors for injury.

Injuries were recorded based on the clinical report of the physician at ringside. No follow-up study was done to confirm the accuracy of the reported injury based on radiography or other diagnostic testing. Injuries were divided into seventeen broad classifications: eye injuries, facial lacerations, ear injuries, nose injuries, mouth injuries, jaw injuries, hand injuries, shoulder injuries, elbow injuries, ankle injuries, foot injuries, chest injuries, abdominal injuries, knee injuries, back injuries, neck injuries, and arm injuries. Lacerations to the eyelid and nose were counted as facial lacerations. Only those injuries documented other than lacerations—such as possible orbit fractures or a nose deformity—were listed as eye or nose injuries respectively.

The Johns Hopkins University School of Medicine’s Institutional Review Board approved the study protocol via exemption. RESULTS

Bledsoe et al.

138

A total of 171 MMA matches involving 220 different fighters occurred during the study period. All participants were male with an average age of 28.5 years (SD = 4.7, range from 19 to 44 years old). The average weight was 87.6 kg (SD= 16.3 kg, range from 60.4 to 166.4 kg). A total of 1,130 rounds were scheduled, of which 624 (55%) were actually fought. These rounds were each 5 minutes for a total of 3120 minutes of fighting. A total of 67 fighters fought in more than one fight during the study period. The average number of competitions for these 67 repeat fighters was 2.8 (SD = 1) with a range of 2 to 6 fights each.

There were a total of 96 injuries to 78 fighters. Of the 171 matches fought, 69 (40.3%) ended with at least one injured fighter. The overall injury rate was 28.6 injuries per 100 fight participations, 12.5 injuries per 100 competitor rounds, or 3.08 injuries per 100 fight minutes. The majority of recorded injuries were injuries to the facial region with facial

lacerations being the most common. Hand injuries were the second most common injury, accounting for 13.5% of all injuries, followed by injuries to the nose (10.4%) and eye (8.3%, Table 1).

Older fighters were at greater risk of injury as were those who lost a match by knockout or technical knockout (Tables 2 and 3). Those who lost their match under any circumstance—whether knockout, technical knockout, decision, tap out, choke, or disqualification—were significantly more likely to suffer an injury during the course of the competition than those who won (p < 0.001). Also, the incidence of injury increased with the length of the fight with matches lasting 4 or 5 rounds being more likely to include a fighter who suffered an injury (Tables 2 and 3). The most common conclusion to a MMA fight was a technical knockout (TKO) followed by a tap out (Table 4). The proportion of fighters suffering a knockout during the competition was 6.4% (n = 11).

Table 2. Incidence rates of injury in mixed martial arts matches by competition characteristics, September 2001 through December 2004, Nevada. Competitors

#(%) Injured

Competitors#(%)

Injury Rate per 100

Competitors

Rounds fought #(%)

Injury Rate per 100 Fought Rounds

Age Groups (years)* <25 76 (22.3) 13 (16.9) 17.1 132 (21.2) 9.8 25-29 144 (41.5) 29 (37.7) 20.6 260 (41.8) 11.2 30+ 124 (36.4) 35 (45.5) 28.2 230 (37.0) 15.2

χ2=3.9, p=0.14

χ2=2.2, p=0.33

Weight Class Fly, bantam, feather, or light 32 (9.4) 5 (6.4) 15.23 53 (8.5) 9.4 Welter or Middle 150 (43.8) 35 (44.9) 23.33 300 (48.1) 11.7 Light heavy, heavy, or super heavy 160 (46.8) 38 (48.7) 23.75 271 (43.4) 14.0

χ2=1.04, p=0.59

χ2=0.95, p=0.62

Match Outcome Win 169 (49.4) 27 (34.6) 16.0 306 (49.0) 8.8 Loss 169 (49.4) 51 (65.4) 30.2 306 (49.0) 16.7 Draw 4 (1.2) 0 (0) 0.0 12 (1.9) 0.0

χ2=9.6, p<0.001

χ2=8.2, p=0.02 †

Type of Outcome TKO or KO 158 (46.2) 42 (54.0) 26.6 240 (38.5) 17.5 Other 184 (53.8) 36 (46.2) 19.6 384 (61.5) 9.4

χ2=2.38, p=0.12

χ2=6.8, p=0.009

Rounds fought 1 176 (51.5) 32 (41.0) 18.2 176 (28.2) 18.2 2 76 (22.2) 19 (24.4) 25.0 152 (24.4) 12.5 3 - 5 90 (26.3) 27 (34.7) 30.0 296 (47.4) 9.12

χ2=5,

p=0.08 χ2=6.3, p=0.04


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Table 3. Odds Ratios (OR) and 95% Confidence Intervals (CIs) of injury in mixed martial arts matches from multivariate logistic regression models, September 2001 through December 2004, Nevada.

Model Variables OR 95%CI Unconditional logistic regression

Age *† 1.29 0.73-2.26 Weight *† 1.03 0.95-1.11 Lost match 2.32 1.36-3.98 KO or TKO 1.71 0.97-3.01 Rounds fought † 1.44 1.11-1.87

1:1 matched conditional logistic regression Age *† 3.11 1.11-8.59

Weight difference *† 1.10 0.90-1.34 Lost match 2.69 1.44-5.0

*Odds Ratio for a ten-unit change in age and weight. † A continuous variable. DISCUSSION Though initially promoted as brutal, no-holds-barred contests, Mixed Martial Arts competitions in the United States have changed dramatically and now have improved regulations to minimize injury. A total of 13 states now sanction MMA events, the first two being Nevada and New Jersey in 2001. Since the sanctioning, MMA competitions have followed much stricter regulations. Fighters are now forbidden to headbutt, stomp or knee an opponent on the ground, strike the throat, spine or back of the head, must fight within a predetermined weight class, and are allowed only one fight per night—all important changes that were implemented with sanctioning. Table 4. Results of Mixed Martial Arts Competitions in Nevada, September 2001 through December 2004.

Result Number (%) Technical Knockout 68 (39.8) Tap Out 52 (30.4) Decision 31 (18.1) Knockout 11 (6.4) Choke 4 (2.3) Disqualification 3 (1.8) Draw 2 (1.2) Total 171

The mandatory “grappling” gloves now used

in MMA events weigh between 4 to 8 ounces, thinner than the 8 to 10 ounce gloves worn by professional boxers, and are designed with the fingers exposed so a fighter can grasp his opponent. Fighters must pass the same physical exam used to screen professional boxers including a cerebral MRI, before being licensed. Referees and ringside

physicians are required to be present and have the authority to stop the match at any time.

Fighters train in both the striking and grappling arts (Amtmann, 2004) and become proficient in a number of means of “submitting” or defeating their opponents (Figures 1 and 2). Fights can be ended not only by the traditional knock out, technical knock out, and decision of boxing, but also by “tap out”—where an opponent either taps the mat or his opponent to signal his desire to stop the match or verbally indicates to the referee his desire to stop—and “choke”—where an opponent refuses to tap even though caught in a choke hold and passes out.

Figure 1. Fighter A (in blue) applies a traditional jiu jitsu choke to Fighter B (in white).

MMA events should be differentiated from

the infamous “Toughman” competitions held around the country. Toughman competitions feature amateur fighters who often have little or no training

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experience, wear “one-size-fits-all” protective gear, do not need a thorough physical exam to compete, and often feature inexperienced referees and ringside physicians (Branch, 2003). While there have been no deaths in the United States in MMA competitions, at least 12 participants have died during Toughman events—two of whom were being supervised by ringside physicians who were chiropractors (Branch, 2003). Incidentally, both Nevada and New Jersey—the first two states to sanction MMA competitions—are “among 10 states that have banned or attempted to ban [Toughman] events.” (Branch, 2003).

Figure 2. Fighter A (in blue) applies a traditional jiu jitsu armbar to Fighter B (in white). The relatively high incidence of injuries in combat sports has been well documented. The giving and receiving of high velocity blows seems to be the best correlation of whether a sport will have an increased risk of injury.Styles that include striking—such as boxing (Bledsoe et al., 2005; Zazryn et al., 2003a), kickboxing (Gartland et al., 2001; Zazryn et al., 2003b), karate (Zetaruk et al., 2005), and taekwondo (Kazemi and Pieter, 2004)—have been shown to have a higher incidence of injury than styles that involve grappling alone, such as collegiate wrestling (Jarret et al., 1998). Strikes from elite athletes, particularly professional boxers, can generate a significant amount of force (Walilko et al., 2005)—equivalent to “a padded wooden mallet with a mass of 6 kg (13 lbs) if swung at 20 mph” (Atha et al., 1985) according to one study. This seems to explain why many injuries in the striking arts are prevalent not only in the target areas of the face and torso, but also the extremities used for striking such as the hands for boxing and the upper and lower extremities in kickboxing and karate.

While no prior articles document the incidence of injury in MMA, injury rates from boxing have been reported. In 2003, Zazryn and colleagues (2003a) reported an overall injury rate to professional boxers in Victoria, Australia of 25

injuries per 100 fight participations. A recent look at the injury rates of professional boxers in Nevada showed 17.1 injuries per 100 fight participations (Bledsoe et al., 2005). With an overall injury rate of 28.6 injuries per 100 fight participations, MMA competitions demonstrate a high rate of overall injury, but a rate in keeping with other combat sports involving striking. By contrast, sports involving grappling have demonstrated much lower rates of injury. For example, collegiate wrestling has been documented to have rates as low as 1 injury per 100 participations when analyzed for participants in both practice and competition (Jarret et al., 1998).

As opposed to professional boxing, MMA competitions have a mechanism that enables the participant to stop the competition at any time. The “tap out” is the second most common means of ending a MMA competition (Table 4) This unique characteristic, combined with more options of attack when competing, is thought to help explain a knockout proportion in MMA competitions that is almost half of the reported 11.3% of professional boxing matches in Nevada (Bledsoe et al., 2005). With the growing concern over repetitive head injuries and the risk of dementia pugilistica among career boxers, decreasing the number of head blows a fighter receives during a match has been promoted as an important intervention (Mendez, 1995; Unterharnscheidt, 1995). With MMA competitions, the opportunity to attack the extremities with arm bars and leg locks and the possibility of extended periods of grappling could serve to lessen the risk of traumatic brain injury. When TKOs are compared, proportions between professional boxing (38%)and MMA are similar (Bledsoe et al., 2005).

There are several limitations to this study. First, the injuries reported were based on the physical exams performed at ringside by the ringside physician. No labs or radiologic studies were ordered and no diagnoses were confirmed. The incidence of injury in these fighters may have been higher than reported. Second, although the study included all MMA fights throughout a 40 month period, the total number of matches was relatively small. Third, the fights included in this study were all held in Nevada, the premiere site for MMA events. How injury rates would change for events held under different conditions with less supervision is a matter of concern. Finally, for the purpose of discussion, knockouts and technical knockouts were not defined as injuries although many would argue that these represent the most serious of all boxing injuries. Due to the sometimes subtle nature of traumatic brain injury—and since there was no radiographic imaging available to verify whether an injury had occurred—KOs and TKOs were discussed as separate entities and not included in the


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overall injury data. Further research is needed to determine the true nature of these injuries and their cumulative effects upon the individual fighters. CONCLUSION Mixed Martial Arts competitions have changed dramatically since the first Ultimate Fighting Championship in 1993. The overall injury rate in MMA competitions is now similar to other combat sports, including boxing. Knockout rates are lower in MMA competitions than in boxing. This suggests a reduced risk of TBI in MMA competitions when compared to other events involving striking.

MMA events must continue to be properly supervised by trained referees and ringside physicians, and the rules implemented by state sanctioning—including weight classes, limited rounds per match, proper safety gear, and banning of the most devastating attacks– must be strictly enforced. Further research is necessary to continue to improve safety in this developing new sport. ACKNOWLEDGEMENTS The authors would like to express their appreciation to Michael Johnson and Steve Lord for permission to use their photographs to demonstrate the jiu jitsu techniques.

REFERENCES

Amtmann, J.A. (2004) Self-reported training methods of mixed martial artists at a regional reality fighting event. Journal of Strength Conditioning Research 18, 194-196.

Atha, J., Yeadon, M.R., Sandover, J. and Parsons K.C. (1985) The damaging punch. British Medical Journal (Clinical Research Edition) 291, 1756-1757.

Bledsoe, G.H., Li, G. and Levy, F. (2005) Injury risk in professional boxing. Southern Medical Journal 98, 994-998.

Branch, G. (2003) Toughman competition faces its own battle. USA Today: 3C. May 20.

Gartland, S., Malik, M.H. and Lovell, M.E. (2001) Injury and injury rates in Muay Thai kick boxing. British Journal of Sports Medicine 35, 308-313.

Hamilton, K. (1995) Brawling over brawling: Politicians try to finish off "human cockfighting". Newsweek 126(22), 80.

Jarret, G.J., Orwin, J.F. and Dick, R.W. (1998) Injuries in collegiate wrestling. American Journal of Sports Medicine 26, 674-680.

Kazemi, M. and Pieter, W. (2004) Injuries at the Canadian National Tae Kwon Do Championships: a prospective study. BMC Musculoskeletal Disorders 5, 22.

Krauss, E. (2004) Warriors of the ultimate fighting championship. Citadel Press, New York.

Krauss, E. and Aita, B. (2002) Brawl: A behind-the-scenes lLook at mixed martial arts competition. ECW Press, Toronto, Canada.

Mendez, M.F. (1995) The neuropsychiatric aspects of boxing. International Journal of Psychiatry in Medicine 25, 249-262.

Peligro, K. (2003) The gracie way: An illustrated history of the World's Greatest Martial Arts Family. Invisible Cities Press, Montpelier, Vermont.

Unterharnscheidt, F. (1995) A neurologist's reflections on boxing. II. Acute and chronic clinical findings secondary to central nervous system damage. Revista de Neurologia 23, 833-846.

Walilko, T.J., Viano, D.C. and Bir, C.A. (2005) Biomechanics of the head for Olympic boxer punches to the face. British Journal of Sports Medicine 39, 710-719.

Zazryn, T.R., Finch, C.F. and McCrory, P. (2003a) A 16 year study of injuries to professional boxers in the state of Victoria, Australia. British Journal of Sports Medicine 37, 321-324.

Zazryn, T.R., Finch, C.F. and McCrory, P. (2003b) A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia. British Journal of Sports Medicine 37, 448-451.

Zetaruk, M.N., Violan, M.A., Zurakowski, D. and Micheli, L.J. (2005) Injuries in martial arts: a comparison of five styles. British Journal of Sports Medicine 39, 29-33.

AUTHORS BIOGRAPHY

Gregory H. BLEDSOE Employment Assistant Professor, Department of Emergency Medicine, The Johns Hopkins University School of Medicine. Degrees MD, MPH Research interests Injury prevention, combat sports injuries, expedition medicine. E-mail: [email protected] Edbert B. HSU Employment Assistant Professor, Department of Emergency Medicine and Office of Critical Event Preparedness and Response (CEPAR), The Johns Hopkins University School of Medicine. Degrees MD, MPH Research interests Disaster preparedness and response. E-mail: [email protected]

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Jurek George GRABOWSKI Employment Researcher, Department of Emergency Medicine, The Johns Hopkins University School of Medicine. Degree MPH Research interests Occupational and recreational injury prevention, spatial data analysis, and Geographic Information Systems (GIS). E-mail: [email protected]

Justin D. BRILL Employment Research Coordinator, Department of Emergency Medicine. The Johns Hopkins University School of Medicine. Degree BA Research interests Disaster response and emergency department operations. E-mail: [email protected]

Guohua LI Employment Professor and Director of Research, Department of Emergency Medicine, The Johns Hopkins University School of Medicine. Degrees MD, DrPH Research interests Injury epidemiology and prevention. E-mail: [email protected]

KEY POINTS • Mixed martial arts (MMA) has changed since

the first MMA matches in the United States and now has increased safety regulations and sanctioning.

• MMA competitions have an overall high rate of injury.

• There have been no MMA deaths in the United States.

• The knockout (KO) rate in MMA appears to be lower than the KO rate of boxing matches.

• MMA must continue to be supervised by properly trained medical professionals and referees to ensure fighter safety in the future.

Gregory H. Bledsoe, MD, MPH 600 N. Wolfe Street, Marburg B-186, Baltimore, MD 21287-2080, USA.

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