Contact and Concussions

Fightland Blog

By Jimmy Jolliff

Junior Seau was 43 years old when he committed suicide.

Before that, he’d been a charismatic and beloved NFL linebacker. He was a defensive leader who was instrumental in the San Diego Chargers’ sole trip to the Super Bowl, and he was as compelling an athlete to watch as they come. His grim ending came too early and wasn’t befitting the sort of champion he was. Seau suffered from severe bouts of depression that he suspected were the result of repeated head trauma. He suspected this to the extent that when the depression finally got to be too much, he inflicted gunshot wounds to his chest, presumably to preserve his brain for study.

It turns out he was right. Results have now been released that Seau suffered from CTE, or Cephalic Traumatic Encephalopathy, a degenerative disease that is thought to be the result of multiple concussions. To make matters even more complicated, new research is emerging linking many types of head trauma — including hits far less serious than concussions — with the disease. It appears that, from a neuropathological standpoint, most forms of contact to the head can lead to the development of serious brain disorders. On this point common sense and science converge: Getting hit in the head is bad for you.

CTE is basically medically identical with another condition, dementia pugilistica, or the state of being “punch drunk,” a condition well known to the world of boxing and not-unknown to the world of MMA (cage veteran Gary Goodridge was diagnosed with CTE last February). The isolation of head trauma as the root cause of the disease would perhaps seem to excuse MMA, at least by comparison. The argument that MMA is ultimately safer than many combat sports usually cites the potential variation of the target of strikes, and the validity of the option to end fights via submission. Also significant is the size of the glove used by the fighters. We spoke to Dr. Michael Kelly, a sports medicine specialist and MMA ringside physician practicing in New Jersey, about the differences in the 4oz. MMA glove and the much larger boxing glove:

“When you have that big, pillowy glove on you can keep hitting the skull over and over without injuring your hand,” Kelly said. “With an MMA glove the risk of hand injury is a little bit higher. We suspect that [smaller gloves] will decrease the incidence of Chronic Traumatic Brian Injury. Going back in the history of boxing, in the bare-knuckle fights, there was less incidence of Chronic Traumatic Encephalopathy. Without gloves, you could only punch the skull a couple of times before your hand was killing you.”

This same logic also applies to a football helmet. In both football and boxing, gear that appears protective also allows for more repeated contact at higher intensities and much more damage accumulating over time, increasing the risk of CTE. 

Still, it’s important to remember that “safer” is not safe. MMA fighters take shots to the head, and shots to the head contribute to CTE.

“With concussive brain injury, it’s the shaking — the movement of the brain cells,” Dr. Kelly says. “[As a result of head trauma] you have very fast transient morphological changes in the cell that lead to a whole dysfunction of metabolic cascading … In fighters who’ve had this, there’s a lot of damage on the under surface of the brain; scar tissue, seen on the autopsy studies. We think that has to a lot do with repetitive blows [which] cause a lot of movement of the brain across the base of the skull … from the head moving faster than the mass of the brain can move.”

So when a hit is sustained and the head snaps back, the brain and the bottom of the skull rub across each other, causing microscopic scars that can be seen in autopsy. (It’s worth noting that CTE was previously thought to be only detectable post mortem, but in a recent study doctors argue they have been able to discover evidence of the condition in living patients).

In the hopes of confronting this problem, some seemingly insane questions are being raised. In the NFL, rule changes have been speculated on, but you have to wonder: What does football look like without hitting? In a similar vein, What does fighting look like without hitting? Ior, to put it another way: What does fighting look like without fighting?

It should come as no surprise that MMA is dangerous, that fighters are not merely technicians but men and women engaging in highly risky situations. And this is also what’s great about the sport. Fighting — when masterfully articulated, sanctioned, and sporting — is still fighting, and the genuine human violence it contains is a great deal of what draws us to it. It’s the danger that excites us. But that danger is inseparable from the risk of head trauma. I love submission grappling decidedly more than the next guy, but it is an entirely different phenomenon from MMA.

What calls out to spectators from fight-spectacles is something extra-moral. And it seems pointless to try and sanitize that impulse with the convoluted sort of apologia that “intellectual” fight fans feel obliged to slather all over their otherwise normal and understandable interest in mixed martial arts. This sport is dangerous. There are considerable risks. The onus of learning about these risks and taking them into account  is on everyone in the MMA community. That MMA fighters are suspended for three months if they suffer concussions is proof both of the seriousness of the issue and the seriousness with which the sport is approaching it -- something that can't be said for football. The shinbones of Muay Thai fighters are made denser over time by micro fractures sustained from kicking trees and poles. Brain tissue doesn’t work that way, and shouldn't be treated as such.

At least one fighter has opted out because of the risk of head trauma. Rising bantamweight prospect Nick Denis was a biochemistry Ph.D. candidate who left school to fight in the UFC. After losing a bruising fight last May, he announced his retirement in November, citing recent research about concussions and their long-term effects. He blogged extensively about this decision, which he says was not easy to make. And no doubt he will be the exception not the rule.

Athletes in many sports cite the code of a kind of warrior culture, where injury and danger are both posited as potential consequences of action, are even imbued with a kind of honor. This idea is certainly at the heart of MMA, where fighters dance on a knife’s edge as far as very serious injury is concerned. Many would argue that CTE is just another in a long list of risks that fighters know they’re taking, and most of them have already committed to sacrificing “later” for the sake of “now.” But it’s hard not to feel a twinge when you hear a story like Junior Seau’s. The life of athletes is permeated with sacrifice. This sacrifice is rightfully celebrated; it’s a crucial part of the culture. But it’s hard not to wonder  if the stakes of this sacrifice can at times be too great.