SPORT-SPECIFIC ILLNESS AND INJURY

Current Review of Injuries Sustained in Mixed

Martial Arts Competition
Bryant Walrod, MD
boxing range from 17% to 25%, and
they approach 24% in MMA. In boxing, competitors typically wear 10- to
16-oz closed-finger gloves, which contrast greatly with the 4- to 6-oz openfinger gloves used in MMA. These
smaller and lighter gloves really may
serve to protect the strikers hands
rather than to decrease the force of the
blow. In fact, Schwartz (4) revealed that
the 4-oz gloves used in MMA do not
mitigate the striking forces when compared with wearing no gloves at all;
however, larger 16-oz gloves do mitigate these forces. Another important aspect of MMA injuries is the mechanism of winning. In MMA, a competitor has
multiple modalities by which he or she can win the bout. Of
course, striking is a common method used against ones
opponent; however, many times, competitions will be decided 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 and
that nearly 60% of matches ended by either decision or
submission, not TKO or KO. In addition, when comparing
MMA to boxing, Bledsoe (1) noted 2 times the incidence of
KOs in boxing compared with MMA. However, he observed
a similar number of TKOs, possibly supporting the idea that
there may be fewer severe head injuries when striking is not
the only modality by which to defeat an opponent. If, for
example, a bout consists predominantly of grappling and
ultimately is decided by an arm bar submission, there is less
chance of head trauma compared with a bout in which there
are multiple head blows. In 2005, Buse (2) reviewed video
footage of 1,284 men competing in 642 matches from 1993
to 2003 and revealed that the proportion of matches ending
by head trauma was higher in MMA (28%) compared with
boxing (9%) and kickboxing (8%). He did not specify
whether the head trauma resulted in a KO or TKO. A significant limitation of Buses review was that it was simply a
video review of televised matches. Speculation was evident
with respect to injury patterns and severity. Finally, in sports
in which striking is allowed, e.g., MMA, kickboxing, and
boxing, there are higher overall injury rates when compared
with sports in which striking is banned, e.g., wrestling (1).
Scoggin (5) compared overall injury rates per exposures in

Abstract
Mixed martial arts (MMA) have enjoyed a tremendous growth in popularity over the past 10 years, yet there remains a paucity of information
with respect to common injuries sustained in MMA competitions. In the
available studies, certain trends pertaining to risk factors for injury, as well
as the most common injuries sustained in MMA competition, were noted.
Common risk factors include being the losing fighter, history of knockout
or technical knockout, and longer fight duration. Common injuries that
were noted include lacerations and abrasions, followed by injuries to the
face and ocular region. Concussions with or without loss of consciousness
also were noted in MMA competition.

Introduction
Mixed martial arts (MMA) have enjoyed a tremendous
growth in popularity over the past 10 years. Pay-per-view
and gate revenues from these events also have noted large
gains. The name mixed martial arts (sometimes called
ultimate fighting) describes a combative event between
two individuals in which they use a myriad of technical
skills against each other. In these competitions, combatants
use skills gleaned from wrestling, boxing, and many martial arts, including jujitsu and tae kwon do. Bouts typically
are 5 min in duration and consist of 3 to 5 rounds. Winners often are declared by judges decision, technical knockout (TKO), referee stoppage, submission, knockout (KO),
physician stoppage, or disqualification. Currently, 43 of 50
individual states legislate specific rules for competition. Despite MMAs rapid growth, there remains a paucity of studies with respect to injuries sustained in these competitions.
This article will review the current literature with respect to
MMA injury patterns.
MMA often has been compared to boxing. Some striking
differences readily are apparent, however. Rates of injury in
Department of Family and Community Medicine, Medical College
of Wisconsin, Milwaukee, WI; and Comprehensive Orthopaedics,
Kenosha, WI
Address for correspondence: Bryant Walrod, MD, Comprehensive
Orthopaedics, 6308 8th Avenue 505, Kenosha, WI 53143
(E-mail: bwalrod@comportho.com).
1537-890X/1005/288Y289
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Volume 10 & Number 5 & September/October 2011

Mixed Martial Arts Injuries

Copyright 2011 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.

certain combative sports and revealed an injury rate of 23%

to 28% in MMA versus 29% to 31% for karate, 25% for
boxing, and 6.3% for tae kwon do.
Risk factors for injury in MMA competition also were
reviewed in multiple studies. Ngai (3) reviewed MMA
competitions from 2002 to 2007 in Nevada. He noted that
the losing fighter was 2.53 times more likely to be injured
than the winning fighter. However, he noted that age,
weight, and fight experience had no significant effect on
incidence of injury. In contrast, Bledsoe (1) noted that older
participants and those who lost by a KO or TKO were at a
higher risk of injury. His findings did support Ngai in that
losing under any circumstance resulted in a higher incidence
of injury (65% vs 35% for those who won). Both Ngai and
Bledsoe observed that increased duration of fighting resulted in increased incidence of injury.
The types of injury in MMA competition have been
analyzed in three different studies. Bledsoe (1) reviewed
data from the Nevada State Athletic Commission from 171
MMA matches involving 220 different fighters from 2001
through 2004. Ngai (3), in 2007, looked at 635 bouts with
1,270 athletes competing from 2002 to 2007 in the state of
Nevada. Finally, in May 2010, Scoggin (5) published data
from 179 participants and 116 MMA bouts that took place
in the state of Hawaii from 1999 through 2006. The overall
incidence of injury in MMA competitions was reported to
be in a similar range in the studies, i.e., 23 to 28 per 100
fight participants. The most common injuries were noted to
be lacerations and abrasions. This was observed consistently in the major study reviews. Ngai noted lacerations
occurring about 17% of the time, whereas Scoggin noted
28 facial lacerations and abrasions occurring per 232 participants or about 12%, and finally, Bledsoe noted 13.5
lacerations per 100 participants. It is difficult from the
available reviews to ascertain the severity of the lacerations
and abrasions. The second most common area for injury
was the face. Ngai noted about 15% of matches being
stopped because of injuries to the face or ocular area.
Scoggin looked at the incidence of injuries during MMA
competition and discovered that approximately 10% of
total injuries sustained were injuries to the face.
Two important injuries to consider are head trauma and
concussion. Because our understanding of concussion still
is evolving, it is difficult to reach firm conclusions with
respect to head trauma and concussion. Some of the available
studies reviewed video evidence to evaluate head trauma.

www.acsm-csmr.org

It is difficult to determine the incidence of concussion on

the basis of video evidence of head trauma alone. Nevertheless, there are some data with respect to head trauma.
Ngai revealed that 15.5% of matches had either ocular
injury or injuries to the face. He also observed severe concussion as an injury in 3.3% of matches. He classified severe concussion as loss of consciousness resulting from a
KO, however. He reported this incidence to be similar to
what has been demonstrated in tae kwon do competitions.
Scoggins evaluation of 116 bouts in Hawaii reported 11
of the 55 injuries to be concussions. Seven of the fighters
who had concussions had loss of consciousness, and four
had retrograde amnesia. In addition, 5 of the 55 reported
injuries were facial injuries. Thus, concussions occurred in
4.7% of exposures, and facial injuries occurred in 2.2%
of exposures.
Conclusions
MMA has continued to evolve and grow during the past
10 years. As it grows, several studies have helped us to
understand some of the more common injuries that occur
during competitions. We cannot comment accurately on
what occurs during practice or what occurs in unsanctioned
bouts. There also remains a lack of data with respect to
concussion incidence and possible adverse sequelae during
MMA competitions and trainings. Hopefully, further prospective studies will improve our understanding of these
issues with respect to MMA competition.
Acknowledgment
The author has no disclosures.

References
1. Bledsoe GH, Hsu EB, Grabowski JG, et al. Incidence of injury in professional mixed martial arts competitions. J. Sports Sci. Med. 2006;
136Y42.
2. Buse GJ. No holds barred sport fighting: a 10 year review of mixed
martial arts competition. Br. J. Sports Med. 2006; 40:169Y72.
3. Ngai KM, Levy F, Hsu EB. Injury trends in sanctioned mixed martial arts
competition: 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 fullcontact karate contrasted with boxing. J. Neurosurg. 1986; 64:248Y52.
5. Scoggin JF 3rd, Brusovanik G, Pi M, et al. Assessment of injuries sustained in mixed mixed martial arts competition. Am. J. Orthop. (Belle
Mead NJ). 2010; 39:247Y51.

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