The prevalence, risk factors predicting injury and the severity of injuries sustained during competition in professional mixed martial arts in Africa

Corresponding author: S Venter ([email protected]) Mixed martial arts (MMA) is a full-contact, unarmed combat sport that allows striking and grappling techniques.[1] This includes karate, Jeet-Kune-Do, kung-fu, Muay-Thai, boxing, kickboxing, judo, taekwando, ninjitsu, wrestling, jiu-jitsu and Brazilian Jiu Jitsu (BJJ). MMA has evolved into a sport represented by numerous bodies around the world.[2] The Ultimate Fighting Championship (UFC) based in America is regarded as the world dominant MMA platform. In 1996, Arizona Senator John McCain described MMA as “human cockfighting”, and sent letters to the governors of all fifty USA states asking them to ban the event. Thirty-six states banned the “no-holds-barred” fighting. In response to all the criticism, the UFC redesigned its rules to remove the unpalatable elements of the fights, while retaining the core elements of striking and grappling. This lead to the creation and implementation of the New Jersey State Athletic Control Board’s Unified Rules[3] in November 2000, which are obeyed in most professional regulated MMA competitions around the world. These rules, aimed at increasing the safety of competitors, helped promote the mainstream acceptance of the sport. MMA in Africa is regulated by the International Mixed Martial Arts Federation (IMMAF) [4], and the Unified Rules apply to EFC Africa. MMA competitions have male and female divisions, each with their own weight divisions. Competitors wear compulsory safety gear (4 ounce or 113.4g gloves, mouth guard and groin protector). Fights take place in a three m2 hexagon/ring fenced in area. This area has a 2.5 cm padded floor and two entrances. All exposed metal is covered. Competitors have to pass a basic medical examination and screening tests for Human ImmunoDeficiency Virus (HIV) and hepatitis. Normally fights consist of three 5-minute rounds with a one-minute rest period between rounds. However, championship bouts consist of five 5-minute rounds. A qualified referee oversees the MMA fight and can use his/her discretion to stop the fight. During the fight, all rules need to be adhered to and if disobeyed, may result in disqualification. The rules ban headbutting, eye-gouging, fish-hooking, groin attacks, fingers into orifices/lacerations, small joint manipulation, 90 degree elbows, blows to the back of the head, blows to the kidney with the heel, throat strikes and grabbing of the trachea/clavicle, kicking/kneeing the head of a grounded opponent, stomping a grounded opponent, and spiking an opponent to the canvas on his head/neck. A fighter can win a match in different ways: submission (verbal/tap out); knockout (KO); technical knockout (TKO); or decision via scorecards. The fight can also be declared a draw, disqualification, forfeit, technical draw/decision or no contest. Ten competitions are hosted in South Africa every year by the EFC. More than 300 athletes have competed at EFC Africa since its inception in 2009. Despite the popularity of MMA in Africa there is no information about the prevalence, severity and risk Background: Professional mixed martial arts (MMA) has gained international popularity. No African-based studies have reported the prevalence or severity of injuries, risk factors associated with injuries or return-to-play (RTP) time. Objectives: To determine the prevalence of injuries and associated risk factors, as well as severity of injuries sustained by professional male MMA athletes competing at the Extreme Fighting Championships Africa (EFC Africa) from 2010 to 2014. Methods: Permission to do the study and the medical records of all professional events (2010 – 2014) were obtained from EFC Africa. Data were obtained from 173 male competitors aged 18 to 44 years, who had participated in 300 professional MMA fights. Results from this prospective cohort study were compared to a similar study done in the United States of America (USA). An injury was defined as any damage to an athlete’s body that needed the attention of the ringside physician. Statistical analyses included descriptive statistics and a stepwise logistic regression. Odds of an injury were predicted with six independent variables: fight outcome, age, weight division, number of fights, injuries in the preceding fight and years of fighter experience. Results: Head, face and neck injuries were most common (22%), followed by traumatic brain injuries (knockouts) (6%). Losing a fight was a significant predictor of injury when using the stepwise logistic regression model (p=0.040). The odds ratio indicated that a preceding fight injury almost doubled the risk of injury in the following fight (OR 1.91; p= 0.163). Traumatic brain injuries (TBIs) in this study of African-based competitions (6%) were substantially higher than reported in the American study (1.8%). Conclusion: Head, neck and face injuries are common in African fighters. The high rate of TBIs in African competition compared to the USA study is concerning. This could reflect superior refereeing in the USA group, as fights may be ended sooner by stoppage. Further investigation of injury trends and preventative measures should be studied to reduce the incidence of injuries during African competitions.