Medical perspective on Mixed Martial Arts (MMA)

I am a big fan of mixed martial arts, also known as MMA, most commonly associated with the world's largest MMA organization, the UFC (Ultimate Fighting Championship).

Max Kellerman, the great sports commentator and noted boxing fan, frequently notes that fighting is the most intrinsically interesting of all sports. A thought experiment he likes to make is to imagine that you are in the middle of an intersection of two streets with a crowd of people. Imagine that on three of the street corners there is a different sporting event going on- one street corner has a baseball game, another a basketball game, and on the third a football game. The crowd at the intersection would likely have their attention split amongst the basketball, football, and baseball games- none would dominate interest.

Now imagine that on the 4th street corner a fight breaks out. Nearly everybody would stop watching whatever they were watching and turn to watch the fight. It's simply more interesting- fighting is, at it's essence, the most purely interesting of all sports.

Max Kellerman made this argument in defense of boxing, but I think it applies even more to MMA. In recent years, MMA has become the dominant combat sport in America. The stars of the UFC- Brock Lesnar, GSP, Fedor, Forrest Griffen- are now bigger stars than the boxers. UFC fights dominate on pay per view, and the UFC fight cards draw bigger crowds in Las Vegas than do boxing cards.

Senator John McCain famously referred to the early sanctioned MMA fights as "human cockfighting." I have tremendous respect for Senator McCain, and there is some truth in his assessment of early MMA- the rules were not clearly established, and the early cards often seemed to promote the brutality of the exhibitions rather than the elgance and athleticism. It was being marketed as show rather than a sport.

I also think that, at least in part, McCain was speaking as a boxing fan. He loves boxing, and was bothered by a newer sport supplanting boxing. I love boxing too- like most people of my generation, some of my favorite sporting moments as a fan are the great Sugar Ray Leanord/Marvin Hagler/Thomas Hearns/Roberto Duran middleweight bouts, or the Evander Holyfield/Mike Tyson era.

But, I am a much bigger fan of MMA now than boxing, for 3 major reasons:
1. As a sports fan, I think the matches are far more entertaining.
2. As a biomechanists, I think MMA is more elegant. Watching a great multidisciplinary fighter, like Georges St Pierre, is like watching a text book on human movement. It is similar on some level to watching a great dance troupe like Alvin Ailey or great gymnasts like Cirque de Soleil, only with a greater sense of urgency because it is taking place in the context of a fight.
3. As a physician, I think MMA is safer than boxing.

The last point is the major one that inspired me to write this posting.

I don't think it has always been true that MMA is safer than boxing. The early sanctions to clean up the sport, though, have been very successful. There are a few things that make the sport safer now:

1. Most importantly, encouraging a referee to step in quickly when an opponent cannot defend themselves.
2. Rules changes to minimize things like small joint manipulation and kicking an opponent in the head when they are on the ground, that remove some of the most dangerous elements.
3. Creating weight classes, which minimizes the risks of greatly mismatched opponents
4. Moving away from tournaments, which increase the risk of cumultive trauma
5. Increasing popularity, which places an impetus on keeping stars healthy, and creating enough stars that they can alternate on who the headliner is for the card. A top fighter may only have 4 fights in a year

There have been several studies in the past few years that have tried to assess the risk of MMA, both overall, and in comparison to boxing. I don't think the data is conclusive, but my impression is that MMA is safer.

The big difference, in my opinion, is concussion rate. Concussion, or mild TBI (traumatic brain injury), is in my opinion the most serious risk of combat sports. I think the risk of concussion is significantly higher in boxing for several reasons:

1. In MMA, there are many other ways to win, including submissions. In boxing, the main goal of the sport is to give your opponent a concussion and knock them unconscious.
2. The gloves: The thick padded gloves in boxing probably increase the rate of concussion by several mechanisms. I think the most important one is that they protect the hands, so there really isn't much disincentive from punching your opponent in the head. In MMA, the thinner padding of the gloves results in punches hurting the fighter's hands more. This often results in fighters trying alternative approaches, including takedowns and submissions, rather than just punching. Of course, in boxing those options don't even exist. Furthermore, the padding of boxing gloves widely distributes the force, which may minimize the knockout potential of any one punch. This can lead to greater cumultive trauma over the course of a fight.
3. Quick stops. Right now, refs in UFC and most of the other sanctioning organizations are quick to stop fights when fighters cannot defend themselves. Sometimes this is frustrating to viewers, but I think it is one of the most important safety factors for the sport, and it is the one variable that could dramatically change the sport. If UFC wants to continue as a mainstream sport, they MUST continue to protect their fighters.

Enough with medical talk ....

I am very excited about the sport of MMA right now. There are some huge, huge fights on the horizon. UFC has done a tremendous job of promoting their fighters, and I don't know an MMA fan who isn't simply giddy in anticipation of the December 27 card coming up, with 3 fights fully worthy of main event status.

The one major logistical issue that I see right now is that 2 of those most appealing fighters on the planet, Fedor Emelianko and Gina Carano, are not under UFC contracts. I hope that changes. Fedor is, in my opinion, the best fighter who has ever lived, and I want to see him fight all of the best competition available. Gina Carano is a phenomenon in her own right- a legitimately terrific fighter whose marketability is off the charts. A series of fights between her and Cris Cyborg and Tara Larosa would easily be the most heavily anticipated fights in female fighting history. I hope they happen.