The vast majority of us have likely been concussed at one point in our lives. Only recently have we seen an emphasis placed on discussions around concussions in both the media and scientific communities. This research has mainly been concerned with American Football and the role repeated concussions can have in the neurodegenerative condition known as Chronic Traumatic Encephalopathy (CTE), a very real concern in the world of MMA too.
CTE has been on doctors’ radars from as early as 1928, referred to then as Dementia Pugilistica or Punch Drunk Syndrome, a condition often associated with boxers. Despite being recognised as an issue for the better part of a century, concussions, traumatic brain injuries (TBI), and CTE are still not well understood…and what we previously thought was correct may not necessarily be the case.
We spoke to Australia’s leading expert on sports concussions Dr. Alan Pearce, an Associate Professor at the Swinburne University of Technology and an Adjunct Senior Research Fellow at the University of Melbourne, to see where the most current research is pointing and what the future holds.
What Is A Concussion?
According to Dr. Pearce the definition of ‘concussion’ is still in contention and was a point of discussion at the 5th International Consensus Conference on Concussion in Sport, in Berlin earlier in 2016. To put it simply, a concussion is a functional injury to the brain.
Concussions often get grouped with TBIs and though a concussion could be a TBI in some cases, the main “difference between a TBI and a concussion is that with TBI…there’s actually damage to the brain…whereas concussion is what we call a ‘functional injury’. It doesn’t show up in a scan because you only see signs and symptoms of a concussion.”
These signs and symptoms are well known to anyone who has watched contact sports -loss of balance, disorientation, nausea, headaches, incoherent speech, and the inability to concentrate. The cause of these symptoms, in layman’s terms, occur when the skull stops and the brain keeps moving, resulting in a collision. Contrary to popular belief, “you don’t actually need to be knocked out cold to get a concussion.”
It is important to note that there doesn’t need to be a direct blow to the head to induce concussion symptoms either, any impact to the body that may jerk or twist the head can cause a concussion. Examples of this could be a car crash, or a strong kick to the chest.
“You’ll see players getting concussed – they get up and they’re dizzy and losing their balance, or they’re slurring their words and don’t know which way they’re running…there could be some amnesia. That’s a classic concussion.”
Concussions And Chronic Traumatic Encephalopathy
The short term symptoms of a concussion might be unpleasant but the long-term impacts are an even stronger deterrence.
“Probably the most publicised consequence of long term, repeated head injury – is coming out from the US – is CTE.” Dr Pearce explained that, “CTE is a neurodegenerative condition. It presents a bit like Alzheimer’s, but the difference is that CTE is really only seen in those who participate in contact sports, collisions sports, fighting sports…”
Symptoms of CTE are varied and can include poor judgment, increased risk taking, slurring of words, depression, slower movement, memory loss, suicidality, and Parkinsonism. As it turns out it isn’t even just concussions that we need to be worried about when it comes to CTE. Even repeated, smaller blows – sub-concussive impacts – might be a factor in the development of CTE.
“Everyone is suggesting – and there’s still evidence emerging – that it’s not necessarily concussions that are causing the long term issues, it’s the repetitive head trauma, like multiple jabs to the head. It’s collisions dozens of times a week. That leads to hundreds of times a year, leading to thousands of times over their career.”
For MMA (and all sports), it’s wise to minimise the amount of full-contact training when possible. There are other, more technical drills that can even be more beneficial. Sparring will likely always have a place in combat sports but the popularity of hard sparring on a regular seems to be in decline. Which is good news…
It has been hypothesised by researchers at the University of Rochester, and others, that impacts to the brain might disrupt its ability to remove waste, shaking proteins like tau from their axons, allowing them to tangle and reach toxic levels. It is thought that is linked to CTE.
At the moment there is no ‘cure’ for CTE. This is due, in part, to the fact that with current methods CTE cannot be diagnosed while the patient is alive; it requires post-mortem examination. The brain needs to be studied, doctors need to “Look at the microscopic architecture of the brain and…see if it’s CTE or another form of dementia. They all start to look a little bit different under the microscope.”
There are also no scientifically proven pre-emptive measures a person can take to reduce the severity of a concussion or delay the onset of CTE. Dr. Pearce’s best advice was, “don’t get hit, basically”…Even more reason for mixed martial artists to work on head movement and defence. This advice did come with a caveat though…
“What we are saying, and this is backed by evidence, is if you don’t participate in physical activity the long-term physical and mental outcomes are actually going to be worse through obesity and other lifestyle related conditions. What we’re saying is do not not participate; you just need to manage it properly if you do get concussed.
We’re not against physical sports. In fact we know that – and this is sort of happening with people getting panicky about the issue – participation rates…are starting to go down.”
As with all things in life, this subject is all about balance – finding a happy middle ground. As the great Oscar Wilde once said, “everything in moderation, including moderation“.
Another factor to consider with concussions and CTE is dehydration. After dieting, Mixed Martial Artists often dehydrate themselves in order to lose additional kilograms to make weight for a certain division. It has been suggested that dehydration could worsen concussions and increase the chances of CTE due to a reduction the amount of cerebrospinal fluid in the brain.
While the science is still out on that specific mechanism, Dr Pearce noted that there are some very real dangers to the practice of weight cutting via dehydration.
“What it will do [being dehydrated] is increase the risk of being injured…when you’re competing in a dehydrated state your brain is not working optimally. You’re slowing your reaction times, your decision making. If your brain is not optimally hydrated then the chances of knockouts are much greater.”
The Conventional Wisdom
Knocks to the head affect people in different ways and an identical impact delivered to two people could see vastly different results.
“It really needs an individualised management program. For example you might get concussed and recover within a day. I might get a similar hit to the head but I might take seven days. There’s no correlation between the severity of the injury and the recover timeline.”
Previously if someone were to suffer from a concussion the conventional wisdom was to let them rest in a darkened room with no stimulation whatsoever. As it turns out this course of action “ended up causing a lot of athletes to have depression, because they were restricted in their activities.”
The latest thinking is that if someone has a concussion then yes, they should rest. However, “one of the things that’s coming through now is to look at a little bit of stimulation…if there are no symptoms you can watch TV, you can do a bit of work if you go back to work, and do very light exercises as well.” It’s important to keep the brain active, as long as it’s not put under too much stress as it recovers.
Athletic commissions in Australia and the United States often impose periods of no contact for athletes who have lost via KO/TKO, or if they took a lot of damage. These periods range from a month and increase with the severity of the injury.
Dr Pearce did concede that “there are ways to get around it…but at least there are now policies in place to protect athletes.” If you have suffered from a concussion the best course of action is to speak to a medical professional, ease back into taxing tasks slowly, and lay off alcohol and other drugs.
The More You Get Knocked Out, The Easier You Are To Knock Out
When it comes to concussions there is a lot we don’t know. There’s plenty of anecdotal evidence out there but if you’re looking for hard scientific facts you could have a bit of a wait on your hands.
In combat sports we’ve seen heroes from yesteryear go from being able to absorb the most unimaginable punishment to the head, to collapsing from a strike that they would have scoffed at earlier in their career. Names like Chuck Liddell, Wanderlei Silva and Antonio Silva come to mind. Losing one’s chin has nothing to do with mental strength or toughness.
“What we do know is that the more times you get concussed the easier it is to induce concussion symptoms and the longer it actually takes for recovery…We’re still trying to understand that from a physiological perspective, but we’re not really too sure – other than maybe there’s a change in the threshold of when the neurons in the brain just short circuit, so to speak.”
While the mechanism behind this phenomenon are not fully understood, it’s clear that eating two or three punches to deliver one of your own is not the best strategy for a mixed martial artist seeking a long career.
Can We Use Technology To Help Us?
Dr. Pearce has also been involved in the creation of new technology that can assist with the clinical assessment of concussion. The brainBAND is a part of a Samsung’s Launching People program and was created in conjunction with Braden Wilson. Together, Dr. Pearce and Wilson have created a device capable of measuring the force of impacts to the head as well as rotational forces.
The brainBAND isn’t just for collision sports and could be worn by mixed martial artists during training, to monitor impacts during sparring. As well as indicating the severity of an impact through a colour coded lighting system, the device can log the data of impacts. Over time this will give the user a history of head trauma, making the choice of when to whether to engage in full contact or not a bit easier. This data will also prove to be a valuable resource for researchers in the future.
“It’s still in development at the moment…We had eight weeks for Braden and I to come together, introduce ourselves, and try and develop something…I gave the intellectual input on what we need and he’s the genius that sort of makes the tech pack and the brainBAND.”
Unfortunately the Samsung brainBAND is not available to the public yet but we’ll have our ear to the ground to report on any developments.
Changing Attitudes Towards Concussions
While concussions and CTE have been the focus of discussion in the MMA media, trauma to the head is still heralded as the epitome of entertainment in the sport. The same can be said for other sports like American Football, Rugby league and union, or even AFL. To better protect professional athletes down to the weekend warrior, attitudes need to change.
As fans we need to consider the health of the athletes who are entertaining us, not just our desire to see devastating victories. If a referee stops a fight ‘early’, he or she shouldn’t be booed by the crowd. The fight was stopped because the referee felt an athlete wasn’t defending him or herself adequately. Sure, they may have been able to work out of a horrible position, but at what cost?
“We’ve got a bit of work to do but I do have to admit that in the last 3-5 years the major sports have come round 180 degrees, so they definitely need some credit for changing their policies. At the elite level the athletes are much more aware of the issue and are taking it more seriously.”
At the highest levels of MMA we’ve seen changes in policy and behaviour to mitigate the impact of concussions and brain injuries. Organisations like the UFC have moved weigh ins further from competition and banned rehydration via IV help solve the dehydration issue. However, these policies aren’t always implemented at the lower levels of the sport.
In all types of sports “we see a disconnect between full time pro athletes and weekend warriors, or even semi-professional athletes. There’s still very much a difference of opinion, and awareness, and attitude towards the injury”.
If an athlete (or you) suffers a concussion it shouldn’t be viewed as badge of honour, it should be viewed as any other injury that takes time to heal. There should be no shame in sitting out if you’re suffering from the symptoms of a concussion, your body will appreciate it.
“…it’s ok to say, ‘I’m not alright, I need a bit of rest’.”
There are still many unanswered questions around concussions and the long term impacts of trauma to the brain. As concussions are non-discriminatory – everyone hits their head from time to time – these questions should be a priority for all of us, not just athletes.
“What it comes down to is funding. Despite the huge amount of discussion in the community, and the media, and all the questions I get from athletes, we can’t answer them because we can’t get enough research funding to answer the questions. It’s actually really poorly funded area of research here in Australia.”
Should you have the same concerns and want to help with the lack of funding for concussion research, check out the Smart Head Play’s (SHP) website. SHP is an Australian, non-profit organisation focused on researching the short and long-term effects of concussion.
We shouldn’t allow the fear of concussion and CTE lead us to a sedentary, bubble wrapped life. Just be careful, that’s all.