Concussion management in combat sports: consensus statement from the Association of Ringside Physicians

Abstract

Various organisations and experts have published numerous statements and recommendations regarding different aspects of sports-related concussion including definition, presentation, treatment, management and return to play guidelines.To date, there have been no written consensus statements specific for combat sports regarding management of combatants who have suffered a concussion or for return to competition after a concussion. In combat sports, head contact is an objective of the sport itself. Accordingly, management and treatment of concussion in combat sports should, and must, be more stringent than for non-combat sports counterparts.The Association of Ringside Physicians (an international, non-profit organisation dedicated to the health and safety of the combat sports athlete) sets forth this consensus statement to establish management guidelines that ringside physicians, fighters, referees, trainers, promoters, sanctioning bodies and other healthcare professionals can use in the ringside setting. We also provide guidelines for the return of a combat sports athlete to competition after sustaining a concussion. This consensus statement does not address the management of moderate to severe forms of traumatic brain injury, such as intracranial bleeds, nor does it address the return to competition for combat sports athletes who have suffered such an injury. These more severe forms of brain injuries are beyond the scope of this statement. This consensus statement does not address neuroimaging guidelines in combat sports.

Prevalence of sports-related injuries in paralympic judo: An exploratory study

“…Such injuries may lead to devastating consequences, including paralysis and neuropathological changes. 23 Severe head and spine injuries are a problem also in able-bodied judo, and it has been recommended to conduct neuromusculoskeletal examinations, neck muscle training along with injury surveillance and video analysis for preventing these injuries 24 . Such strategies as well as guidelines for the acute handling, rehabilitation and return to sport is recommended to also be implemented in Paralympic judo.…”

Low Prefrontal GABA Levels Are Associated With Poor Cognitive Functions in Professional Boxers

“…In contrast, all healthy individuals had not experienced any sort of TBI. The mTBI was defined as a brain trauma that may produce transient mental status changes which resolve spontaneously and completely in a few minutes (Carroll et al, 2004; Group, 2006; Pérez-Arredondo et al, 2016; Neidecker et al, 2019). We excluded boxers who had ever suffered from moderate to severe brain injury which is defined as resulting in a loss of consciousness for more than 20 min.…”

Head Trauma Exposure in Mixed Martial Arts Varies According to Sex and Weight Class

“…15 It should also consider the potential differences in concussion rates and recovery between males and females 16 and the imminent influence of the weight category on the head trauma risk and severity, as shown in the present study. Finally, the King-Devick test, 5 the Fight Exposure Score, 3 and computerized neuropsychological testing 21 are practical alternatives to diagnose and follow-up after concussive events in MMA, even though brain injury can be present without measurable cognitive impairment. 23 The MMA continues to experience public growth and attracts the attention of medical associations concerned about the safety of the sport.…”

“…23 The MMA continues to experience public growth and attracts the attention of medical associations concerned about the safety of the sport. 7,11,12,21 However, the majority of the conclusions concerning brain injury and concussion are still made based on studies with American-style football male players, 13,14 in which the rates of impacts to the head are already known for differing according to the position on the field. 25 Similarly, sex and weight category must be taken into account for future investigations and recommendations with regard to head trauma analysis in MMA.…”

“…4,7,11 Both outcomes could easily entail concussive events, as sports-related concussion is, among various aspects, a subset of mild traumatic brain injury induced by biomechanical forces that may or may not involve loss of consciousness. 15,21 Recently, inappropriate representation of the long-term risks of repeated head trauma and concussions in popular culture has gained attention. 27 The previous studies reporting traumatic brain injury risk in MMA did not consider that there are significant differences between weight categories in several aspects of the fight, including strikes landed in the distance, clinch, and on the ground.…”