The reality of combat sports risk
While combat sports provide a particularly rich soil for personal development due to the high, but structured, and gradual physical and emotional challenges, they also come with inherent risks. This includes both visible injuries and latent, cumulative damage that builds up throughout years of training. The repetition of impacts for years and decades makes even training in combat sports a dangerous venture. The risk of acute injuries, that are immediately transparent and can break or end one’s competitive journey, usually decreases with experience, though.
The below illustration shows the specially high risk of the combative journey compared to other activities. Despite a decrease in risk over time, as one gets more familiar with the game, improves their defences, and pays attention, it remains higher than any other field.
Competition adds to the risk posed by training itself due to their higher intensity and lower inhibition brought on by the stake. Competing in combat sports is a particularly dangerous activity. But just how dangerous? In this article, we will explore and analyse the grim side of combat sports: deaths and severe injuries. The goal is not to invoke fear, but to make you understand the commitment required and the defence needs to be built up to minimize the risks. Combat sports carry a heavy price. It’s vital we know that price. When we are aware that our health and life are on the line, we have the option to put effort into self-preservation. With this new awareness, hopefully you will train with more focus, intent, and severity.
#1 Boxing
It’s not surprising that any sport that involves hitting your opponent as hard and fast as possible will result in a great deal of trauma. Due to the high level of ‘head hunting’ in Boxing, it is more harmful to the brain than other striking sports that involve kicks or grappling. The best available data suggests (though this is certainly not 100% accurate) that there has been roughly 2,000 deaths due to boxing since 1884. In 1884, the Queensbury Rules (code of generally accepted rules) were put into practice, before this time, boxing was especially brutal.
Bare-knuckle fights would have an unlimited number of rounds. A round ends only when an opponent is knocked down, so there is no set time limit. Countless deaths that we are not aware of and have no means to estimate were caused by the combination of minimal rules and lack of regulations. Also, many deaths have occurred not from knockouts or punches, but from fighters hitting their heads on the canvas when falling down, which is still a risk. However, the introduction of regulations has led to a decrease in death rates over time. For instance, there were 233 boxing-related deaths in the 1920s, while there were 103 in the 2000s. Thus, the annual death rate went down by about 50%. A CNN article states that on average, 13 boxers die in the ring each year nowadays. Regarding injuries, the American Medical Association has shown that up to 40% of ex-boxers have been found to have symptoms of chronic brain injury.
Other studies have shown that nearly all professional boxers, even those lacking symptoms, have some form of brain damage, so there doesn’t seem to be a way around it. This is due to the nature of the sport: the biomechanical power produced by punches is tremendous, and the head is one of the main targets. One interesting scientific study conducted by the Mild Traumatic Brain Injury Committee and National Football League showed that the impact of boxing punches causes translational and rotational head acceleration. In their tests, Olympic boxers threw four different punches at a dummy (which were measured and recorded), and were compared to laboratory-reconstructed NFL concussions.
The results were astonishing: a single circular, wide punch thrown by the boxers matches any blunt force trauma caused by a full-body NFL impact. In other words, a single hook is equivalent to a 300-pound linebacker barrelling into you. In comparison, that means the force of a professional boxer’s fist is equivalent to being hit with a 13-pound bowling ball travelling 20 miles per hour. Because there are only two targets (body and head), as opposed to other striking arts, boxers tend to take most of these shots to the head, which makes training Boxing particularly adverse.
It’s important to note that many brain injuries occur from sub-concussive blows. Meaning that shots that don’t knock you out or hurt badly will eventually add up. If it comes to brain health, practically it would be better to be knocked out in the first round than taking over 200 punches to the head during a 12-round fight.
Other very important thing to take into account is the second impact syndrome, which refers to the event when someone sustains a concussion but receives another head injury before they can recover, leaving the brain prone to intense swelling. While it happens to other striking arts as well, it definitely more common in Boxing.
#2 Lethwei
Although less well-known, Lethwei is often regarded as the most brutal martial art. Its fighters wear no gloves, similar to bare knuckle boxing, but worse than that, they also can kick, elbow, knee, and headbutt. Yes. Headbutt. If Muay Thai is the art of 8 limbs, Lethwei is the art of 9 limbs, adding in the head as an extra weapon. What makes Lethwei truly unique (and dangerous) is that it has all the weapons of Muay Thai, but because one can only win by knockout, it has the headhunting aspect of boxing. The presence of headbutts makes it nearly impossible to stall an action by clinching. Thus, opponents are constantly under threat, regardless of their position. This is truly a lethal combination, especially when done with little oversight or regulations, as it happens in some of the more traditional provinces.
Lethwei is actually quite old, originated in Myanmar and was used by its warriors to protect their homeland. It gradually spread from the battlefield to the sand pits, where fighters engaged in fighting for entertainment, ritual, and status. In ancient times, fights were only ended if someone was knocked out or physically wasn’t able to continue; there were no draws or rounds. No weight classes existed either. This was almost unchanged until the mid or late 20th century, when more modern rules started being implemented. The two-minute recovery rule was particularly unique, as it required each fighter to regain consciousness and composure within two minutes after being knocked out. In essence, a fighter was required to score two knockouts to win. The removal of this was the most significant change brought about by the new rules. But inviting new rules to Lethwei is a very controversial topic. Traditionalists argue that new rules lead to ruin and water down the sport. Which is why some provinces choose to stick to their traditional rules.
There is very little information available regarding the number of deaths and injuries. It’s safe to say that there were a lot of fatalities and injuries, particularly during the early days. Even today, because so many fights happen in rural areas with little oversight, it’s hard to obtain official statistics on the death rate. Even though the new rules included set times, rounds, and weight classes, fighters are still limited to winning by KO. If both fighters still stand at the end of the allotted rounds, it is considered a draw.
#3 MMA
Since the first bout of MMA, circa 1993, there have been 29 deaths (9 from unregulated bouts) recorded officially. This translates to approximately one death per year. Of course, we need to take these numbers with some caution; they are unlikely to reflect the full picture. Neither unofficial matches nor later deaths are included in the statistics, and it’s not easy to link sport to indirect deaths from cumulative injuries. Despite that, the death rate is still considerably lower than in Boxing. The reason for this is that there is a much lower rate of head trauma in MMA. With kicks to the body and leg, the use of clinching, grappling, and submissions, there are so many more avenues to take to dominate the opponent than simply hitting them in the head.
The other considerable differences between MMA and Boxing are the glove size and the 10 count rule. Boxing gloves are much bigger, offering more padding and protection than MMA gloves. Boxers are encouraged to hit harder and possibly with less caution because there’s a lower chance of injuring their own hands. Due to the minimal padding on their gloves, MMA fighters are more likely to injure their hands, so they need to be more careful and precise. Also, in boxing, the 10 count rule allows fighters to continue fighting even if they are concussed. But in most MMA organizations, if a fighter does not recover immediately, the referee will stop the fight.
In MMA due to the grappling aspects instead of brain injuries, it’s quite common to see severe knee and leg injuries. Also, the thinner gloves and the use of elbows and knees make fighters more susceptible to cuts and bleeds. From Anderson Silva’s leg snapping due to Weidman’s check block, to Cyborg’s skull being fractured from a flying knee to the head, the injuries can be very traumatic.
Another factor that puts MMA fighters at high risk is the occasional extreme weight cut. A notable case is the ONE Championship fighter Yang Jian Bing, who died after a gruelling cut. This led to new hydration protocols in the organization, which limit the amount of water weight a fighter can lose before weigh-ins as it makes the brain more vulnerable to damage and can prevent the organs from functioning properly.
While MMA may have a lower official death rate, there are still high risks that its fighters need to be aware of. The sport of MMA is more dynamic and explosive than that of Boxing. Because of this, injuries are common and can end careers and lives either immediately or at a later point. The grappling, throws, and kicks leave a lot of room for joint and other injury. Adding in the high-paced and explosive nature of the sport, it’s evident how severe injuries can add up and deter the fighter’s health.
#4 Muay Thai
Muay Thai is undoubtedly among the most brutal combat sports. The use of elbows and knees during Muay Thai fights can quickly turn into blood baths, so any professional fighter is likely to sustain some nasty cuts and stitches. John Wayne Parr, for instance, said to endured as many as 346 stitches during his career. However, the main tool of destruction is the roundhouse. If it’s not blocked properly, it can easily break your arm, as it has happened to many fighters. Similar to this, if not set up effectively, you can break your own leg when hitting someone’s shin.
Although injuries are abundant and visible, the rate and amount of deaths in Muay Thai are more difficult to quantify, as statistics for Muay Thai deaths are largely lacking. The rate is certainly lower than in Boxing based on official numbers. It’s no surprise since headhunting in this sport is much less than in Boxing. In fact, some fighters can, and indeed have, won fights without even landing a significant strike to the head. We might refer to Hardy Stockmann’s book, Kickboxing: Muay Thai and the Art of Siamese Un-armed Combat, in which it was mentioned that from February to April 1971, three fighters died as a result of knockdowns. And also, in a particularly dark and tragic period, from 1966 to 1967, six fighters died in a one-year period.
It’s important to note that this was prior to the 1990s, when numerous new safety regulations were introduced. Some researchers put the death rate at 1 to 2 per year. Finding a true number can be difficult, because in rural areas of Thailand there are still many unannounced, unregulated, and unrecorded fights. Most of the deaths in Muay Thai are linked to lax or even non-existent safety rules and regulations. A big pressure relating to fighters’ health is that it is not uncommon for a fighter to have multiple fights in a single month, or even a week.
The fighting of younger children is a major topic of debate, as children as young as 8 may fight multiple times within a short period of time. This is mainly due to economic factors; often, struggling families rely solely on Muay Thai fights as their only source of income. Fighting and sustaining hits to the head while the brain is still developing is clearly a major concern. The negative effects have been demonstrated by studies, but even without them, how detrimental it is to the well-being of young fighters. The impact of gambling on sports, particularly when it comes to kid fights, is another major concern that warrants attention. When there is a lot of money involved, rules can be bent or ignored, putting the health of fighters at risk.
#5 Bare Knuckle Boxing
Bare knuckle boxing has existed for hundreds of years, taking place predominantly pre-1889, and this sport is known for its bloody and gruesome fights. It has made a resurgence in modern times with the rise of a new organization, BKFC (Bare Knuckle Fighting Championship), having its first event in 2018. As with all things, there are pros and cons. Early studies indicated that there is a higher rate of hand fractures and lacerations, but less severe concussions. This is in line with our previous argument about comparing boxing and MMA gloves. In BKFC, a fighter’s risk of injuring their hand is high due to having only a minor hand wrap, so they cannot afford to throw a sloppy or wild punch. Therefore, they must have a precise, controlled, and deliberate shot placement.
Due to the young age of the sport in its new form, there is limited data on its potential danger. The ABC medical committee was quick to make a point after the first death in the sport, the death of Justin Thornton’s. The tragic death occurred as a result of Thornton falling on the canvas. The way he hit his head when falling caused neck compression and spinal hematoma. Which again underlines the danger we talked about in the Boxing section; it’s not just the punch that one must worry about, but also the fall. Muay Thai referees from Thailand often literally dive and leap to catch the head/neck of a knocked out athlete to prevent such tragedies.
It is said that the lack of proper medical screening, combined with the BKFC’s habit of using older fighters who often have had long periods of inactivity, and possibly some skill deterioration, is very concerning for the ABC medical committee. They advise that commissions considering licensing these events, proceed with caution.
Conclusion
While every sport carries some risk, accidents are the leading cause of harm in most of them. In combat sports, the nature of the game is to cause harm. When it happens, it’s not an accident, but a successful punch, kick, choke, etc. You need to have a clear picture of what you signed up for before the flashing banners and blinding lights suck you into the game to deep. Enrolment needs to be an informed decision followed by appropriate competition preparation to minimize the risk. A stronger defence, quicker wins, less injuries, and higher rewards are all brought about with your understanding of risks.
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