Does MMA Make You Stupid? Impact, Concussions and Brain Damage in Mixed Martial Arts

MMA has been my guilty pleasure for a long time.

On the one hand, I’m a huge fan. I’ve been watching the UFC since its inauguration in 1993, and have enjoyed fights in Pride FC, Shooto, WEC, Strikeforce, Bellator, and many other organisations. I have good friends who are professional fighters, and have helped them prepare for their fights. And I have nothing but respect for the skill, athleticism and mental toughness of the modern MMA fighter.

But on the other hand I’ve always had misgivings about the sport too.

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Initially it was the seedy underbelly of the sport that worried me. The established press of the time pilloried the UFC as an underground bloodsport, and they weren’t that far off base. There was copious blood, a general lack of rules, extreme mis-matches between fighters, and brutal fights that went on much longer than would be acceptable today.

Furthermore, the only places in my town televising the early events were strip clubs, which only amplified the sense of it being an illicit activity. Watching the fights alongside strippers, drug dealers and Hell’s Angels wannabes didn’t add much legitimacy to the sport. I enjoy my sex, I enjoy my violence, but I’ve never particularly enjoyed mixing the two!

But despite my misgivings I was fascinated by this sport. Events weren’t nearly as frequent in those days, so every couple of months my friends and I would make our way to the Marble Arch stripclub in downtown Vancouver to watch Royce Gracie, Mark Coleman, Don Frye, Oleg Taktarov and the other early icons of the sport do battle in the octagon and tear apart my notions of what worked in a real fight.

I’d get so excited during these events that I’d always get hit with serious insomnia afterwards. I’d lie awake for hours obsessing about matches, replaying the finishes in my mind, and wondering what each fighter should have done at certain points in the match. Eventually I resorted to popping a couple of over-the-counter sleeping pills on the way home; those usually allowed me to get to sleep despite all the adrenaline still coursing in my veins.

My appreciation of the sport shocked and appalled some of my more politically correct friends. They had, of course, never actually seen any of the events, but were pretty sure that the existence of the UFC was a sign of the end times. A modern day equivalent of the brutal gladiatorial games of Imperial Rome…

Arguing with these friends I tried to give them the party line, that MMA was actually LESS brutal than boxing.

Sure, there was blood. Sure, there were broken bones, twisted limbs, and dislocated joints. The chance of orthopaedic injury in early MMA were fairly high, but I told myself (and anyone who would listen) that sport was a lot safer than boxing, at least when it came to the issue of brain trauma.

After all, in boxing there were no submissions and no tapping out. Boxers wore gloves which allowed them to hit harder. There were rounds and standing eight counts which essentially allowed someone on the brink of getting knocked out just enough time to recover to go back out and then absorb even more punishment.

MMA has matured greatly over the last two decades. The rules have evolved. Referees now have the power to stop matches, and the presence of judges means that open-ended fights are a thing of the past. The events are overseen by doctors and athletic commissions. Fighters have become respectable professional athletes. MMA has gone mainstream.

But something is preventing me from fully enjoying the new, improved, sanitised spectacle. Despite the improvements it’s still a guilty pleasure, and my mixed feelings remain. And that’s because of the mounting tidal wave of evidence connecting the sport with serious, permanent brain damage.

We can no longer live in denial. Modern MMA is going to result in an epidemic of shattered fighters.

The Road from Grappling to Striking

First we need to do a bit of backpedaling and take a look at how the sport changed as it gained worldwide television exposure. Back before kids starting opting for posters of their favorite MMA fighter on their walls instead of basketball and baseball players.

If you’ve seen footage of the early UFC fights, you might notice the fights typically took a very different trajectory from the matches on TV today.

The biggest difference? Fighters then just didn’t strike as much as they do now. Back then a winning strategy almost always involved lots of grappling, and the beer-swilling trailer park crowd didn’t always get the action-oriented slugfest it wanted.

The fights were sometimes bloody when someone got cut, yes, but in the early days there was less chance of severe brain trauma. The primary reason for this was that the lack of gloves meant hits to the head didn’t connect as hard as in gloved sports such as boxing.

If anyone still thinks that the fighters wear gloves to protect their opponent’s heads, think again!

The knuckles of a bare fist are actually quite fragile, and early MMA fighters often broke their hands punching their opponents in the relatively tough bones of the head. The gloves and handwraps of the modern MMA fighter allow them to hit much harder. If you don’t believe me try punching a wall with a bare hand and see how the bones in your hand feel afterwards (if they aren’t broken).

The lack of gloves meant that hunting for big knockout punches was a dangerous and painful strategy, making grappling the safer, more effective, strategy to engage an opponent.

In addition, it’s a lot easier to control your opponent and hunt for submissions when you’re not wearing gloves. So the addition of gloves also favours strikers by making grappling less effective.

Finally, a lot of rule and scoring changes have been introduced to favour strikers. These include standups when the action slows down on the ground, standups at the end of rounds, and judges giving relatively more weight to strikes than to takedowns and ground control.

These changes have no doubt increased the mass appeal of the sport. From a fan’s perspective, what is more entertaining to watch? Two men in a technical positional battle on the ground, or two guys hammering on each other until one passes out? Some fighters in fact, have even begun apologising for winning their matches by submission and not by knockout! But at the end of the day the changes have resulted fighters getting hit more often and a lot harder in the head.

For better or for worse, increased striking in MMA seems like it is here to to stay.

And not all damage comes from the bouts themselves. Every serious MMA fighter now has a striking coach, and spends countless rounds in the gym training his boxing and kickboxing skills. Most fighters try to use some restraint in sparring, but tempers often flare, and stories of friendly training sessions turning into all-out wars are very common.

In the final analysis, all contact, whether light or heavy, whether sustained in training or in a match, still contributes to the overall damage sustained.

How Much Impact is Too Much for the Brain?

We love it when modern day MMA gladiators go all out and put on a fight of the night performance for those of us enjoying the action from our living rooms. It’s always exciting to have two guys swinging for the fences. But I’m going to argue that those exciting fights come at a very real cost – brain injuries that are serious, permanent, and largely irreversible.

If you get hit hard enough in the head your brain bounces off the inside of your skull. This can injure your brain; this injury is called a concussion (and no, you don’t need to get knocked out to have a concussion).

Concussions often result in headaches, but there are lots of other possible symptoms, including feeling like you’re in a fog, mood swings, loss of consciousness, amnesia, irritability, slowed reaction times, and/or sleep disturbances. Sometimes people make light of concussions by calling it “getting your bell rung,” but the truth is that a concussion – any concussion – is a brain injury. That’s why the wikipedia page on concussions refers to them as MTBI’s, or Mild Traumatic Brain Injuries.

Getting concussed is never fun, but the symptoms from a single concussion are seldom permanent. However if you get hit hard enough, or if you’ve suffered previous concussions, or if you’ve drawn the short straw genetically, then you might end up with something called Post Concussion Syndrome. Here you get to experience all the symptoms of your concussion – headaches, dizziness, sleep problems, mood swings, etc. – for weeks, months, or even years.

I personally know a former professional fighter who had a very promising career cut short by a brutal KO, which happened at the end of knock-down, drag-out fight. It was never formally diagnosed as Post Concussion Syndrome, but right after this knockout, my friend started experiencing severe vertigo after any kind of spinning or rolling motion. Even years after quitting fighting this person couldn’t do a somersault or a rolling breakfall without the whole world starting to swim before their eyes for several minutes.

Maybe this cumulative brain trauma is also the reason for some fighters developing a ‘glass jaw’ late in their careers. Fighters like Mirko ‘Cro Cop’ Filipović, Gary Goodridge, Mark Hominick, Mark Kerr, Cheick Kongo, Chuck Liddell, Duane Ludwig, Seth Petruzelli, and Wanderlei Silva. These were all guys who could take a pounding in their glory days and could still come back to win the fight but then, all of a sudden, start getting knocked out easier and easier.

But if you get hit in the head enough times you might develop something much worse than a glass jaw. You might become a victim of a degenerative brain disease known as CTE (chronic traumatic encephalopathy). CTE is the newer fancier name for what we used to call being being punch drunk. Full blown CTE has many of the same symptoms as Alzheimer’s disease, and is currently only detectable during an autopsy.

So it’s often not possible to test for this specific type of damage until it’s much too late.

Unfortunately there isn’t a magic formula that says “Get hit in the head x number of times at a force of y, and brain damage will occur.” Sometimes all it takes is one hard hit to the head for brain damage to occur. In most cases, it occurs slowly over time, but you can never underestimate the power of what one, strong, well-placed blow to the head can do.

Brain Damage in Boxing, Soccer, Football and MMA

One recent study that suggests that MMA injuries tend to be more trivial than boxing injuries (i.e. more bruises and contusions, less eye and brain injuries).  This research is going to be cited by a lot of people as ‘proof’ that MMA is safer.  But the results from this study were gathered immediately after the matches in mandatory post-fight medical examinations.  But it is short term data.  They didn’t look at the long term effects of competition and training, and as we already know it can take years and decades for CTE to become apparent.

There just aren’t a lot of big studies looking at long term brain damage in MMA. Not yet anyway, because it hasn’t been around for long enough. But there’s a plethora of scary anecdotes, studies and hard evidence from other sports.

To start with, it’s not surprising that a lot of research has been done on boxers. Even the general public is aware of the neurological toll that the sweet science inflicts on it’s practitioners. Retired boxers slurring their words and unable to remember what they had for breakfast are much more common than we would like to admit.

Other contact sports have been studied too, including football, hockey, and even soccer. Impact is impact, after all, regardless of whether the blow came from a fist encased in a glove, a soccer ball, or the helmet of a 300 lb defensive tackle in the NFL. We’ll be reviewing some of that research later on in this article.

While science can tell you what sort of things cause CTE to develop, it is still no closer to knowing at what point it begins to develop. Charles Bernick, a CTE researcher at Cleveland Clinic spoke about the issue saying: “While we already know that boxing and other combat sports are linked to brain damage, little is known about how this process develops and who may be on the path to developing CTE.”

However there are other ways to get a sense of the brain damage that may have occurred.  There is a study encompassing 78 boxers and MMA fighters. The researchers, led by Dr Bernick, split fighters into groups according to how long they had been fighting for and then had their memory and thinking abilities tested extensively.

Using MRI tests Bernick found that the brains of fighters who have been fighting for 6 or more years actually get smaller.

And it’s not all just about brain size; it’s also about what those brains can do. Among fighters who have been fighting more than nine years Dr. Bernick found a direct relation between the number of annual fights and declining performance on thinking and memory tests.

So is that to say that nine years is the cutoff period for an MMA fighter? Not quite. Dr. Bernick pointed out: “Our study shows there appears to be a threshold at which continued repetitive blows to the brain begin to cause measurable changes in memory and thinking, despite brain volume changes that can be found earlier.”

The most interesting, and scary, part is that Dr. Bernick says this change in brain volume can start to occur after only six years of fighting, long before symptoms appear. Basically, most fighters won’t know they have a problem until it’s too late.

So while Dr. Bernick’s findings might still be slightly inconclusive, he can say with certainty that the memory centers in the brains of some fighters have shrunk as a direct result of fighting.

Maybe you’re thinking that these fighters just got unlucky. That most of this damage might have come from one particularly bad beating, or a few super-powerful shots.

But even light shots to the head may have a cumulative effect if there are enough of them.

Recent studies of have found that heading a soccer ball can cause your memory and mental processing speed to get worse. Of course the impact from a soccer ball is a lot less than a left hook from George Foreman, but it seems that a sufficient number of light impacts can also add up to cause concussion-like damage over time.

And then there’s a study on boxers which found that copious and intense sparring caused more impairment of brain function than the actual amount of knockouts suffered in competition. The researchers mostly blame the “mechanical trauma incurred by repetitive, mostly sub-concussive, head impact” for the reduced brain function. So even if you don’t get knocked out, ‘repetitive, mostly sub-concussive head impact’ (which happens every time you do boxing or kickboxing sparring) takes its toll too. Obviously it’s better to have sparring partners who hold back on their punches, but even that might not be enough.

And for other sports with heavy head impacts the data is even more dramatic.

Players in American Football are getting bigger, stronger, and faster. Every game involves huge amounts of brain-rattling impacts. Helmets probably only make the problem worse, because essentially it allows the head to be used as an offensive weapon.

It now seems certain that a large percentage of football players retire with some degree of CTE. One autopsy-based study study found brain disease in 34 out of 35 former NFL and CFL players.

I’ve talked about my own ambivalence towards MMA: I love the action, but I fear for the health of the fighters. People are beginning to feel the same way about football; nowhere is this better expressed than in Malcom Gladwell’s excellent article Offensive Play, How Different are Dogfighting and Football?

And there are beginning to be serious legal implications for all this sport-induced brain disease. More than 4,500 former players filed lawsuit against the National Football League contending that the League was concealing what it knew about the dangers of multiple concussions suffered while playing football. This lawsuit was recently settled for $765 million dollars. That’s almost a billion dollars!

Are we going to see a similar lawsuit filed against Dana White, the Fertitta brothers and the UFC at some point in the future? I wouldn’t be the slightest bit surprised.

Some Fighters You Might Have Heard Of…

The list of boxers with CTE is very long. Famous punchdrunk boxers include such greats as Floyd Patterson, Sugar Ray Robinson, and Joe Frazier. And many people place at least some of the blame for Muhammad Ali’s Parkinson’s Disease on his long and brutal boxing career.

It’s scary to compare interview footage of boxers early in their career – when they are often articulate, intelligent, and funny – with the slurred, mumbling trainwrecks they become after years of sparring and competing have taken their toll. Check out this footage of Riddick Bowe from 2013 for a sad, brutal example a punch drunk boxer who should have hung up his gloves long ago.

It’s easy to vilify boxing, but what about brain damaged MMA fighters? Do we have any examples of CTE and permanent brain damage in this sport too?

The first case of brain-damage in an MMA fighter that I personally became aware of was Gary ‘Big Daddy’ Goodridge.

He first burst onto the scene at UFC 8, brutally knocking out Paul Herrera at UFC 8 with a series of elbows from the crucifix position. A few years later he became the de facto gatekeeper for the Pride MMA organisation in Japan – fighters new to the organisation had to fight their way past him first to prove themselves to the organisers and the fans. By the end of his career, with no other ways to pay the bills, he was fighting in no-name events in Bulgaria and Lithuania, devaluing his record with eight straight losses.

Goodridge had 85 MMA and 38 kickboxing fights in his career. He lost his last 8 MMA matches, lost or drew his last 13 kickboxing matches and was knocked out a combined total of 36 times. That’s a TON of damage.  CTE resulted from those countless shots to the head in training and in the ring. He is now only in his forties, but has to take multiple medications suited for Alzheimer’s patients just to get through the day.

In the interview below you can hear a slight slur to Gary’s speech.  What’s scary is that many veteran boxers have fought and trained with significantly more slurring (James Toney for example), inevitably compounding and accelerating the damage which already existed.

Recently, Dr. Johnny Benjamin, who specializes in spinal surgery and has extensive experience working with athletes, participated in a controversial interview regarding the MMA community. In this interview, Dr. Benjamin named several MMA fighters, whom he feels would be better off by quitting MMA before they completely damage their brains.

Among that list of fighters, are top names like Stefan Struve and Wanderlei Silva. One interesting point that Dr. Benjamin makes is that while lots of these MMA fighters might appear healthy now, they could be just one punch away from permanent brain damage.

Dr Benjamin even used fan favorite Chuck Liddell as an example, saying, “You could beat that man with a baseball bat, and he wasn’t going anywhere. Then, all of the sudden, something changed, and he couldn’t take it anymore.” At some point Chuck’s brain turned the corner and became vulnerable to getting knocked out.

At UFC 115 Rich Franklin even managed to knock him out with a punch from broken arm! If one of the greats like Chuck Liddell isn’t immune to the effects of all those blows to the head, nobody is.

But the damage that took Chuck Liddell out of the UFC goes way, way beyond simply acquiring a glass jaw late in your career. Getting knocked out more easily is just the tip of the iceberg of what is going on deep in the brain. We will have to wait for the smoking gun, which will be autopsies of the brains of former MMA fighters, but I’m sure that’s going to be coming at some point.

As much as we’d like to think it’s just a couple of fighters getting weak, or an over-protective doctor just “doing his job”, fighters who should have quit before they got hurt are all too common in the world of MMA. Basically, MMA fighters are walking around with brain injuries with no way of knowing it, besides their sometimes erratic behavior.

There’s nothing sadder than a fighter who had his day in the sun but is now past his prime and just can’t leave the sport. I’ve known quite a few fighters who have lost the burning desire to train, but still end up fighting in smaller and smaller shows, for smaller and smaller paycheques.

To some extent it’s because nobody wants to retire on a loss. Fighters fantasise about getting a couple of big wins and then retiring on their own terms. But honestly, the main thing that keeps once-great fighters competing long after they should have quit is financial need: they’ve spent 20 years in the gym developing their striking and grappling skills, during which time everyone else was developing their business and career skills.

These fighters often don’t have other ways to make money. They have no exit strategy. The bills keep piling up, and getting paid a few thousand dollars to climb back into the ring seems like a much better option than working as a Walmart greeter for minimum wage.

Typically it takes a string of losses, combined with health issues and insurmountable orthopaedic injuries, to get these fighters to hang up their gloves for good. You usually take a lot more damage when you lose a fight, and so those late-career losses may be doing the lion’s share of the damage.

The Hidden Danger of Brain Damage

It’s almost silly to say, as most people believe the dangers behind brain damage are pretty apparent already. However, there are a few, less talked about, side effects of brain damage and MMA fighting that need to be addressed.

While we all understand brain damage to mean an impairment of your brain’s natural functions, it can do a whole lot more than just making you stupid or slow. One only needs to look at examples like NFL linebacker Junior Seau, who committed suicide, which his family believes was brought on by his brain injuries he received while playing in the NFL. His autopsy revealed he was suffering from CTE.

MMA is no different. Many factors including brain damage can lead to depression in MMA fighters. As we all know, depression, when left untreated often leads to other mental disorders and even suicide.

It doesn’t fit with the tough guy image, but we’re finally beginning to hear about how depression is a growing problem in MMA. Tough as it might be to picture the biggest, baddest guys in the ring, feeling depressed or contemplating suicide, it is all too real for those that struggle with it. The feelings of disappointment when losing a match can be bad enough for a normal brain, but devastating to a brain that has suffered several concussions and other injuries.

As if all that wasn’t enough to convince you this is a very real problem, how does a bit of lowered testosterone and decreased sex drive sound? There are several lines of evidence connecting brain trauma with a decrease in your body’s ability to produce testosterone.

While the final verdict on studies like these are still out, much like the other studies surrounding MMA fighting, what’s for sure is that if you incur enough brain trauma, your testosterone, and as a result, your sex drive will take a good deal of the blows.

Many fighters turn to TRT (Testosterone Replacement Therapy), anabolic steroids, growth hormone, and a witch’s brew of other synthetic chemicals, all in hopes of getting bigger, stronger, faster and winning their next fight.

But these high levels of artificial hormones undoubtedly have psychological and neurological side-effects. They are, in effect, psychoactive substances. And the combination of those synthetic chemicals with a brain already damaged through repeated concussions is a potentially volatile mix: it’s not difficult to see why these fighter’s physical injuries can quickly deteriorate into serious mental conditions.

So What’s the Solution?

I feel under pressure to wrap things up with some kind of ‘feel good’ message. I’d like to be able to absolve fans of the MMA who, like me, have mixed feelings about supporting the sport with our pay-per-view dollars. And I’d like to be able to give some advice to fighters who are duking it out for our enjoyment. But I don’t think I can do that…

There’s no indication that the sport of MMA is going to go backwards and start becoming “less violent,” or start focusing more on grappling to ensure the mental health of the fighters. What sells right now is heavy impact. And it sells for a reason, even if it comes at the expense of the fighters’ brain capacities.

Fighters, coaches, and training partners need to become hyper-aware of the danger of severe and/or repeated concussions. The macho nature of the sport means that many fighters will shrug off a good hit and keep going. Or, even worse, get knocked out in sparring and then fight in a match shortly thereafter. Unfortunately it’s not always easy to tell when a fighter has a concussion, even for a doctor, so it can be really to hard to know when something is wrong.

As a coach, knowing your fighter is key. Hopefully you’re sensitive enough to their moods and bodily signals that you can tell when they’re sick or overtrained, so keep an eye out for changes that might indicate a concussion. The trouble is, of course, that the studies tell us brain damage occurs years BEFORE the outward symptoms manifest themselves.

If you’re a fighter then some things that may help include paying attention to your defensive skills, doing less sparring and more drilling, not going full-force with your sparring, taking time off after a head injury, strengthening your neck and trapezius muscles so your head doesn’t bounce around so much, and calling it quits before it’s too late.

Here are some links to procedures and protocols that you should probably print out and have around the gym. These links were sent to me by an Emergency Medicine and Internal Medicine resident physician who also practices BJJ; they are the current clinical guidelines used by doctors to manage concussions.

• The Sport Concussion Assessment Tool, used to determine how severe a given concussion actually is.
• The 2013 American Academy of Neurology Guidelines for concussion patients and their families
• The updated 2013 American Academy of Neurology Guidelines for clinicians
• A Return to Play protocol; guidelines for getting back into contact sport following a concussion (starts on page 188)

If you enjoy the limb-to-limb struggle of MMA and the ability to field test your techniques against a resisting opponent then maybe you can get those same benefits from training mostly in BJJ or submission grappling.  It’s still a great workout, it’s very competitive, and the odds of traumatic brain injury are much reduced.

That being said, I believe that anyone interested in martial arts and/or self defense should know what it feels like to get punched in the face.  That way if it actually happens in the street it won’t be a total surprise should you actually ever get struck (check out this famous video of a make-believe martial arts master who pretty much folds the second he gets hit in the head for real – don’t be that guy)!

It wouldn’t be enough for a professional boxer or MMA fighter, but if you’re a recreational hobbyist martial artist then you probably don’t need to spar with contact more than a couple times a year to skim off most of the benefits of sparring with relatively little risk.

Of course hardcore MMA fighters will probably disregard my advice and the advice of the medical community the same way they ignore the dangers of concussion. But if they won’t listen to me then maybe they’ll listen to the articulate words of UFC fighter Mac Danzig from when he appeared on Joe Rogan’s podcast.

While talking about punch drunk boxers, Mac said, “The crazy thing is that it (brain damage) might not be apparent during their career lots of times. You see it 15 years after they retire in lots of cases… And I think a lot of the prevention can happen in the gym… Now I’m realising that the less shots I take in practice, the less likely it is that my chin is going to become glass as I get older, and the better I’ll be able to have a functioning brain.” (Click here to go to the section where Mac talks about modifying his training, or here for the whole 2 1/2 hour interview).

For the recreational MMA practitioner the danger probably isn’t that great. You’re not getting hit as often or as hard as the professionals. But PLEASE remember that you DON’T need to be in an all-out slugfest every time you train. There are ways to develop all the technical skills using drills and controlled, light-contact sparring. And if you crave the feeling of complete exhaustion and having been put through the wringer I’d suggest that you do it with grappling rather than kickboxing.

But all those brain-friendly options are only going to work if you’ve got a level-headed, sane instructor and training partners who can check their egos at the door. If you’re in a club full of steroid-injecting meatheads then getting a concussion is only a matter of time.

And don’t even get me started about kid’s MMA. I’m in the minority, but I think it’s insane to mix all this potential brain trauma with the highly malleable brains of children. I will do everything I can to prevent my children from boxing, playing football, and fighting in MMA.

The brain consists of 100 billion neurons with 1,000 trillion (1,000,000,000,000,000) connections between those neurons. Christof Koch, chief scientific officer of the Allen Institute for Brain Science, calls the brain “the most complex object in the known universe.”

Complex objects tend to be fragile. You wouldn’t drop your computer onto a concrete floor, or use a Rolex watch to drive a nail into a board. So if the 3 lb squishy object between your ears really is the most complex object in the known universe then shouldn’t you be at least a little bit concerned about someone punching you in the head as hard as they can?

Stephan’s Note: I first published this article in September 2013.  In September 2015 it was updated for accuracy and additional content.

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