How Doctors Should React to Cage Fighting

Mixed martial arts (MMA), also known as cage fighting, is a rapidly growing, albeit relatively young, sport. Popularized in the U.S. in 1993 with the formation of the Ultimate Fighting Championship (UFC), the sport existed previously in an underground and unregulated form.

Naturally, we would expect to see an increase in the number of MMA-related injuries in our clinics, some through accident and emergency department referrals.

Otolaryngologists on the Front Line

The first medical officer to attend to such a patient is often an ENT practitioner. In fact, over the past two months, there has been an increase in the number of MMA-induced injuries seen here in the ENT department at Luton and Dunstable Hospital in London. More specifically, we have seen three septal hematomas, four pinna hematomas and several fractured nasal bones, all caused by MMA fighting. In two of the cases of pinna hematomas, the patients returned several times—four times in a month in one case—requiring repeated draining due to persistent fighting. This occurred even though they had been advised that if they continued to fight without adequate protection, they were likely to suffer similar injuries.

A study done at Johns Hopkins University School of Medicine showed that the overall injury rate from competitive MMA fighting was 28.6 percent, of which 47.9 percent were facial lacerations, 10.6 percent nasal injuries and 1 percent ear injuries (J Sports Sci Med. 2006:136-142). Another study showed that combatants with more years of experience were more likely to sustain injuries than those who were inexperienced (Br J Sports Med. 2005;39(1):29-33).

Contrary to popular belief, the sport does have a number of rules that fighters must adhere to in the octagon (the fighting arena). The rules allow for both stance and floor fighting, due to the number of different fighting styles used in MMA, including karate, muay Thai, boxing, jiu-jitsu and judo. To name just a few of the 31 fouls, contestants are not allowed to strike to the back of the head or spine, strike or grab the throat, or gouge lacerations or orifices. For protection, fighters must wear a mouth guard and gloves that must weigh between four and six pounds. A groin protector is optional.

MMA has often been criticized for its brutality. In fact, in a 2008 position paper posted on its website, the British Medical Association (BMA) called for a “complete ban” on MMA fights because the fighters are “open to a myriad of injuries.” However, strong voices against the BMA’s position argue that banning MMA would deny freedom of choice (BMJ. 2011;343:d6937). It has also been argued that MMA, like many other martial arts, encourages meaningful exercise and can be used as a treatment modality for youths who are at risk for violence (WMJ. 2009;108(1):40-43).

In fact, a September 2011 article in The Guardian reported on a social club in England that hosts cage fights involving children. The article quoted a professional cage fighter and gym owner who said that although children as young as five take MMA training at his gym, they are not allowed to strike until the age of 14.

In the U.S., where the sport has been around longer and is therefore at a more mature stage, there have been several calls for the presence of ringside physicians at sanctioned events. Additionally, it has been argued that sports medicine providers should have an appropriately equipped medical bag and should coordinate with emergency medical personnel in order to deliver care more efficiently if urgent situations arise (Curr Sports Med Rep. 2011;10(3):147-150).

Push for Protection

Indeed, the freedom of choice associated with MMA fighting comes at a cost that can result in multiple hospital attendances. With MMA on the rise throughout the U.K. and the U.S., it is clear that we will be seeing more MMA-associated injuries. As a medical profession, we should consider striking a middle ground between those calling for a complete ban on the sport and those advocating freedom of choice. One additional option could be to push for the introduction of protective headgear.

Whatever the case, when presented with patients with MMA-induced injuries in our clinics, we must be sure to take a detailed history of how the injuries have happened in order to give targeted advice to the patient with regard to follow-up treatment.

Dr. Hadjisymeou is a core surgical trainee, year two, and currently works in the ENT Department at Luton and Dunstable NHS TRUST. Dr. Shah is a core surgical trainee, year one, currently working in the General Surgery Department at Luton and Dunstable NHS TRUST. Dr. Panesar is an ENT consultant, specializing in Head and Neck, at Luton and Dunstable NHS TRUST.

Disclaimer: The opinions and views expressed in this op-ed are strictly those of the writers and do not represent any positions held by ENT Today, the Triological Society, sponsors or advertisers.