Why Doctor: Dr Brauge, first of all, can you explain to us what a concussion is and what are the biological mechanisms that come into play during a head impact in an MMA fight?
Dr David Brauge : Concussion belongs to the category of so-called mild head trauma, meaning that there is no severe permanent disturbance of consciousness after the impact. It is therefore a brain trauma which will cause a transient dysfunction responsible for variable symptoms visible at the time of impact: loss of consciousness (KO), balance disorder, dissolution of muscle tone, confusion, etc. . Sometimes these symptoms are very fleeting but, even in this situation, they indicate that the brain has been affected by the shock wave. All of the biochemical and metabolic abnormalities induced by this trauma will then take several days to correct, which explains the symptoms still present several days after the onset of the concussion. This phase during which the fighter’s brain recovers is a phase of vulnerability where he must absolutely not re-expose himself to contact.
When a fighter receives a blow that knocks him out or knocks him to the ground, what are the first reactions in his brain? Is he experiencing immediate trauma?
Just after the impact there is a massive depolarization of a large population of neurons. This then leads to a drastic drop in energy molecules in the brain (ATP) which will take time to be replenished. This also explains why the fighter is exhausted after a concussion. We also note the initiation of inflammation and possibly a disorganization of neural networks.
The more concussions an athlete has had in their career, the more likely they are to suffer them.
Why do some people get knocked out after a hit while others don’t, even after a similar impact? Are there individual factors that influence the severity of the concussion?
Indeed, several individual factors come into play. Before entering the octagon there are factors specific to the athlete: the more concussions an athlete has had in his career, the more he is at risk of having them. The number at which a vulnerability sets in is, however, not clearly defined and it seems that this can vary from one athlete to another. However, it is certain that the occurrence of a concussion in the preceding weeks is a major risk factor. Then there are rather anatomical elements, in particular linked to the musculature of the neck and shoulders. A history of dyslexia and attention deficit hyperactive disorder also appears to be a risk factor. Finally, once in the octagon it is clear that an offensive style is more risky for the fighter than one who evolves in a very defensive register. The mouthguard is a protective factor. It is also mandatory in fights organized by the UFC.
When a fighter falls to the ground after a blow, what happens to the brain during the fall and after impact with the ground?
As noted previously, the impact causes massive depolarization with release of glutamate. All of the biochemical anomalies induced by this impact will then be corrected within a period varying from a few minutes to a few days (sometimes even much longer). If during this recovery period a second impact is received by the fighter, the recovery period will lengthen considerably. This explains, among other things, why the referee will immediately stop the fight if the fighter collapses KO on impact.
You mentioned the importance of equipment, including mouth guards. Can you explain why even a blow to the jaw can have a direct impact on the brain?
Dr David Brauge : The explanation is not very clear. Two main mechanisms are mentioned: on the one hand the mouthguard would have an attenuating effect during the transmission of the shock wave secondary to an impact on the jaw or face. On the other hand, work carried out at the University of Bordeaux suggests that contraction on a mouthguard is accompanied by contracture of the neck muscles, which would limit the movement of the head in the event of impact.
Repetitive head impacts significantly increase the risk of developing chronic brain damage.
Is the concussion recovery process in MMA well defined? How long does it typically take for a fighter to be “ready” to return to fighting after suffering a knockout?
From a medical point of view, things are simple for a fighter who has been the victim of a knockout: as long as the fighter feels symptoms (headaches, difficulty concentrating, dizziness, sleep problems, etc.) he cannot resume contact. His brain is in fact still in the recovery phase. It is therefore often requested that the fighter be seen by a specialist to attest to complete recovery from the disorders. Even if he is doing very well, there are minimum downtime periods which can vary depending on the organization (from 30 to 90 days most often)
Can repeated knockouts in a fighter’s career lead to long-term consequences, such as chronic brain damage?
Yes, repeated head impacts significantly increase the risk of developing chronic brain injuries, such as Chronic Traumatic Encephalopathy (CTE). Studies of professional athletes, including American football, rugby, European football and boxing, have shown that accumulated shocks over a career likely increase the risk of long-term neurodegenerative disorders. Even without loss of consciousness with each blow, repeated impacts can cause cumulative damage to the brain, causing cognitive, mood, and memory problems.
MMA: “Cognitive and neurological tests before and after each fight are essential”
What safety measures can be taken to reduce the risk of concussion among fighters?
The first measure is prevention. Training fighters to absorb blows well and improve their self-defense technique is essential. Then, it is crucial to put in place strict medical protocols to assess the severity of each shock, and above all to prohibit the resumption of fights before the fighters are fully recovered. Cognitive and neurological tests before and after each fight are essential. It would also be necessary to limit the frequency of fights and impose sufficient recovery periods to avoid the too rapid repetition of shocks. Obviously it is crucial that doctors and other health professionals who work with these athletes are trained in the recognition and management of these health problems.
Are there any medical tests or protocols that can detect a concussion after a knockout?
In the event of knockout (loss of consciousness), the diagnosis of concussion is easy. However, the majority of concussions do not necessarily result in knockouts. In this situation, if the healthcare professional has any doubt, there is a battery of validated tests to help with the diagnosis. This is the SCAT (Sport Concussion Assessment Tool) test. The brain scan will be carried out urgently if a more serious lesion with intracranial bleeding is suspected.
Is there enough research on concussions and their effects in the field of MMA? What could be improved?
Research is progressing, but much remains to be done, particularly regarding the cumulative impact of concussions. Further epidemiological studies of MMA fighters are essential to better understand long-term risks. Furthermore, the development of new protective equipment and the improvement of medical protocols would be important advances. Research also focuses on treatment and rehabilitation of fighters who have suffered brain injuries.