Distal rupture of the biceps brachii tendon in a female mixed martial arts athlete: a case report.

The distal rupture of the biceps brachii muscle tendon (DBT) accounts for 3% of biceps ruptures. Diagnosis typically relies on high clinical suspicion and complementary imaging studies, with >90% of cases documented in males between the fourth and sixth decades of life. Reports of DBT ruptures in females are scarce, mostly involving partial and degenerative injuries. Here, we present an unprecedented case of a 28-year-old female professional mixed martial arts athlete with a total traumatic DBT rupture. The athlete underwent surgical repair using anchor reattachment technique. No complications were observed, and the athlete showed satisfactory outcomes, being cleared for physiotherapy after 2 weeks and returning to sports after a 3-month postoperative period.

Acute Effects of the Dry Needling Session on Gastrocnemius Muscle Biomechanical Properties, and Perfusion with Latent Trigger Points - A Single-Blind Randomized Controlled Trial in Mixed Martial Arts Athletes.

The study aimed to evaluate the immediate effects of a dry needling (DN) therapy session on biomechanical properties, muscle power, perfusion, and pressure pain threshold of the gastrocnemius muscle with latent trigger points. Twenty mixed martial arts athletes (MMA) were randomly divided into two groups: experimental (eDN, n = 10) and sham (qDN, n = 10) to undergo one session of DN either with a real or a qazi needle. The measurements were taken at rest, 1-5 minutes after the DN (Post1-5min) and 24h after the DN (Post24h). DN significantly increased the muscle perfusion (Post1-5min and Post24h, p < 0.001), reduced its tone (Post1-5min and Post24h, p < 0.001) and stiffness (Post1-5min, p < 0.05; Post24 h, p < 0.001), and improved its elasticity (Post1-5min and Post24h, p < 0.001). DN also caused a significant increase in pressure pain threshold (Post1-5min, p < 0.001; Post24h, p < 0.05) and in muscle power (Post24h, p < 0.01). The DN session increased the blood perfusion and improved the biomechanical properties of the gastrocnemius muscle, which led to improved muscle power. The DN also had an analgesic effect. These effects were maintained at 24 h, which suggests that DN could facilitate muscle recovery in a post-exercise period of MMA athletes.

Acute Anterior Thigh Compartment Syndrome in a Young Mixed Martial Arts Fighter.

Acute compartment syndrome (ACS) of the thigh is an uncommon injury, and diagnosis of such cases can be easily delayed or even missed due to the rare nature of this condition.  We present a case of ACS of the thigh in a young, healthy mixed martial arts (MMA) semi-professional athlete with no history of previous medical illnesses and normal coagulation.  This MMA fighter sustained a direct blow to the anterolateral aspect of his left thigh with a strong kick during a sparring match with his opponent.  After early surgical fasciotomy, this athlete returned to his pre-injury state and athletic performance within six to eight months postoperatively. Our literature review asserts that young athletic males with high muscle mass, engaging in contact sports, are at a higher risk of developing ACS of the thigh.

Transgender competition in combat sports: Position statement of the Association of ringside physicians.

The Association of Ringside Physicians (ARP) is committed to the concept of fair competition. It advocates for two equally skilled and matched athletes to keep bouts fair, competitive, entertaining, and, most importantly, safe for all combatants. Numerous studies have proven that transgender women may have a competitive athletic advantage against otherwise matched cis-gender women. Likewise, transgender men may suffer a competitive disadvantage against cis-gender men. These differences - both anatomic and physiologic - persist despite normalization of sex hormone levels and create disparities in competitive abilities that are not compatible with the spirit of fair competition. More importantly, allowing transgender athletes to compete against cisgender athletes in combat sports, which already involve significant risk of serious injury, unnecessarily raises the risk of injury due to these differences. Hence the ARP does not support transgender athlete competition against cisgender athletes in combat sports.

Knockout rates across the states as a way of predicting injury and knockout based on fighter sex, weight, or experience.

Combat sports, such as boxing and mixed martial arts [MMA], have the unique objective to finish a bout by way of knockout [KO] or technical knockout [TKO]. There are potentially both short- and long-term neurological injuries that can happen as a result of the repeated head trauma sustained in bouts, and thus it is imperative to identify the athletes that are at increased risk. Using an online database of professional boxing bouts [boxrec.com] over a 6-month period, KO/TKO rates were calculated across different states, weight classes, sex, and Fight Exposure Score [FES] categories. There was found to be a significant association between KO/TKO rates and weight class, sex, and FES category with heavyweights, males and FES 0 boxers having higher KO/TKO rates. KO/TKO rates were increased in winless boxers. KO/TKO rates across the states are documented in the study.

Weight cutting in female UFC fighters.

BACKGROUND: It is common practice for fight sport athletes to use a variety of weight manipulation strategies to compete in desired weight classes. Although numerous studies have highlighted rapid weight loss (RWL) strategies and the magnitude of weight loss, few have focused specifically on weight loss in female fighters. The purpose of this study was to provide descriptive information on professional UFC female fighters engaging in RWL in all women's UFC weight divisions: strawweight (52.2 kg): flyweight (56.7 kg); bantamweight (61.2 kg); featherweight (65.8 kg). METHODS: All fighter's weights were obtained at five separate time points: 72 hrs. pre-weigh-in, 48 hrs. pre-weigh-in, 24hrs. pre-weigh-in, official weigh-in, and 24 hrs. post-weigh-in (competition weight). Mixed effects models and random effects analysis were used to assess changes in weight and differences between weight divisions. All statistics were analyzed, and significance was set at p ≤0.05. Significant changes in weight between all time points were reported. RESULTS: No statistical differences between weight divisions were observed. Female fighters lost 4.5-6.6% of their weight prior to the official weigh-in. CONCLUSION: Females engaged in RWL practices lose weight in a similar fashion irrespective of weight class.

Headguard use in combat sports: position statement of the Association of Ringside Physicians.

Headguard use is appropriate during some combat sports activities where the risks of injury to the face and ears are elevated. Headguards are highly effective in reducing the incidence of facial lacerations in studies of amateur boxers and are just as effective in other striking sports. They should be used in scenarios - especially sparring prior to competitions - where avoidance of laceration and subsequent exposure to potential blood-borne pathogens is important. Headguards are appropriate where avoidance of auricular injury is deemed important; limited data show a marked reduction in incidence of auricular injury in wrestlers wearing headguards.Headguards should not be relied upon to reduce the risk of concussion or other traumatic brain injury. They have not been shown to prevent these types of injuries in combat sports or other sports, and human studies on the effect of headguards on concussive injury are lacking. While biomechanical studies suggest they reduce linear and rotational acceleration of the cranium, changes in athlete behavior to more risk-taking when wearing headguards may offset any risk reduction. In the absence of high-quality studies on headguard use, the Association of Ringside Physicians recommends that further research be conducted to clarify the role of headguards in all combat sports, at all ages of participation. Furthermore, in the absence of data on gender differences, policies should be standardized for men and women.

Boxing as an Intervention in Mental Health: A Scoping Review.

Introduction: Physical activity has been shown to have a multitude of mental health benefits. However, there is limited evidence on the specific mental health benefits of boxing. We conducted a scoping review of academic and grey literature to map research of boxing exercises as an intervention in mental health and to identify gaps in knowledge. Methods: The authors utilized the PRISMA-ScR methodological approach and guidelines from the Joanna Briggs Institute and a structured search was completed from inception until August 08, 2022. Results: We identified 16 documents that used non-contact boxing as an exercise intervention that improved various mental health difficulties. Non-contact boxing exercises, usually in a high-intensity-interval training group setting, provided significant reduction in symptoms of anxiety, depression, PTSD and negative symptoms of schizophrenia. Non-contact boxing provided a cathartic release of anger and stress, with evidence of improved mood, self-esteem, confidence, concentration, metabolic burden, strength and coordination. Conclusions: Preliminary evidence indicates that non-contact boxing exercises are a promising intervention to improve mental health burden. Further well designed randomized controlled trials using group, non-contact boxing exercises as an intervention for common mental disorders are warranted to confirm its benefits for mental health.

A burst of fenoterol excretion during the recovery of a weight loss protocol.

Fenoterol is a sympathomimetic ß2 receptor agonist primarily used as a bronchodilator. Due to its sympathomimetic actions, the World Anti-Doping Agency (WADA) has banned it. Multiple acute weight loss protocols (WLP) are used by Olympic athletes for sports that segregate athletes by weight; these generally involve caloric and water deprivation combined with heat exposure. Athletes use WLP before weigh-in, then transition to different body acute weight regain protocols (WRP) before competitions. Here, we studied the pharmacokinetics of fenoterol under WLP conditions: energetic dietary restriction, decreased water intake, and exposure to a dry sauna (80 ± 2 °C), followed by a WRP. Five elite-level female judo athletes participated in the study. Four received fenoterol (200 µg; n = 2 or 400 µg; n = 2), while one was a control receiving placebo under identical conditions. We measured excretion of the fenoterol parent molecule and presented qualitative data of its sulfated metabolite using QqQ tandem quadrupole mass spectrometry for 118 h. The fenoterol parent appeared earlier in urine than did its conjugated metabolite; excretion profiles were similar among all subjects. The centers of mass for fenoterol parent curves were (time, fenoterol): athlete A (10.9, 7.3); athlete B (9.2, 27.3); athlete C (8.5, 6.9); athlete D (9.7, 5.0). After initiating WRP, we observed a burst in urinary fenoterol excretion once in complete decay. This trend was observed for all four athletes who received fenoterol. Our results suggest that during hypohydration, some of the unmetabolized fenoterol accumulates in tissues, then is released during rehydration. These findings can be important for detecting fenoterol use in athletes.

Force and velocity of impact during upper limb strikes in combat sports: a systematic review and meta-analysis.

Upper limb strikes are frequent movements in combat sports and self-defence systems, in which numerous types of strikes can be applied. Therefore, the aim of this systematic review and meta-analysis was to summarise and compare the mechanical consequences of different types of upper limb strikes among various sports disciplines. A literature search was conducted in Scopus and Web of Science, with the following search formula: (impact force) AND (strike) AND (taekwondo) OR (karate) OR (self-defence) OR (combat sport) OR (boxing). The search resulted in 28 studies describing 9 kinds of strikes, where straight punches and reverse punches have larger mean impact forces than the kung fu punch (p < 0.001) and that a palm strike had a lower strike velocity (p < 0.001) than a reverse punch, straight punch, or junzuki punch. The highest recorded mean force was found for a straight punch (3427 N). Athletes in mixed martial arts, trainers of self-defence or tactical coaches can expect that straight punches and reverse punches should be performed at high speeds (over 10 m/s) and provide similar or larger impacts than other upper limb strikes; therefore, those punches should favour a combat athlete to win a competition or succeed in self-defence.

Neuroimaging in professional combat sports: consensus statement from the association of ringside physicians.

Professional boxing, kickboxing, and mixed martial arts (MMA) are popular sports with substantial risk for both acute and chronic traumatic brain injury (TBI). Although rare, combat sports athletes have died in the ring or soon after the completion of a bout. Deaths in these instances are usually the result of an acute catastrophic neurological event such as an acute subdural hematoma (SDH). Other causes may include acute epidural hematoma (EDH), subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), or a controversial, rare, and still disputed clinical entity called second-impact syndrome (SIS). Neuroimaging or brain imaging is currently included in the process of registering for a license to compete in combat sports in some jurisdictions of the United States of America and around the world. However, the required imaging specifics and frequency vary with no consensus guidelines. The Association of Ringside Physicians (an international, nonprofit organization dedicated to the health and safety of the combat sports athlete) sets forth this consensus statement to establish neuroimaging guidelines in combat sports. Commissions, ringside physicians, combat sports athletes, trainers, promoters, sanctioning bodies, and other healthcare professionals can use this statement for risk stratification of a professional combat sports athlete prior to licensure, identifying high-risk athletes and for prognostication of the brain health of these athletes over the course of their career. Guidelines are also put forth regarding neuroimaging requirements in the immediate aftermath of a bout.

Examining the occurrence and outcomes of concussion and mTBI in mixed martial arts athletes: a systematic review.

INTRODUCTION: Mixed martial arts (MMA) is a sport growing in popularity around the world. However, many individuals participate in the sport with little understanding of the potential short- and long-term consequences of injuries sustained while participating. Specifically, individuals are placed at a high risk of minor traumatic brain injury (mTBI) and concussive episodes as a result of head injuries incurred during training and competition. AIMS: The current review aimed to examine the literature surrounding the occurrence and outcomes of mTBI in MMA athletes to gain a better understanding of these consequences. METHODS: Twenty-five studies were identified within the current review, of which 14 examined occurrence of mTBI within the sport setting, and elevenidentified outcomes of injury. RESULTS: Overall, studies found that MMA athletes experienced mTBI and concussion to a greater extent than athletes in other sports. Deficits in memory, reaction time and processing speed were identified following occurrence of mTBI; however, several gaps in outcome measurement were identified within the current literature, including a lack of focus on speech and language outcomes. CONCLUSION: Future research should examine a wider variety of outcomes to provide a clearer understanding of the consequences of participating in the sport.

Rapid Weight Gain and Weight Differential Predict Competitive Success in 2100 Professional Combat-Sport Athletes.

PURPOSE: Combat-sport athletes commonly undergo rapid weight loss prior to prebout weigh-in and subsequently rapid weight gain (RWG) prior to competition. This investigation aimed to evaluate the effect of RWG and weight differential (WD) between opponents on competitive success. METHODS: A retrospective cohort study was performed using data from professional mixed martial arts (MMA) and boxing events held between 2015 and 2019. The primary outcome was RWG (relative and absolute) between weigh-in and competition stratified by bout winners and losers. Binary logistic regression was used to explore the relationships among bout outcome, RWG, and WD between competitors on the day of their bout. RESULTS: Among 708 MMA athletes included, winners regained more relative body mass (8.7% [3.7%] vs 7.9% [3.8%], P < .01) than losers. In 1392 included male boxers, winners regained significantly more relative body mass (8.0% [3.0%] vs 6.9% [3.2%], P < .01) than losers. Each percentage body mass increase resulted in a 7% increased likelihood of victory in MMA and a 13% increase in boxing. The relationship between RWG and competitive success remained significant in regional and male international MMA athletes, as well as boxers. WD predicted victory in international mixed martial artists and boxers. WD predicted victory by knockout or technical knockout in international MMA athletes and regional boxers. CONCLUSION: This analysis of combat-sport athletes indicates that RWG and WD influence competitive success. These findings raise fair-play and safety concerns in these popular sports and may help guide risk-mitigating regulation strategies.

Criteria for assessing the adaptive changes in mixed martial arts (MMA) athletes of strike fighting style in different training load regimes.

Background: To study the peculiarities of changes in functional indicators and body composition parameters of mixed martial arts (MMA) athletes of strike fighting style and a number of biochemical blood indicators during two months of using different intensity training load regimes, and to determine the most informative criteria for assessing adaptive body changes in these training conditions. Methods: We examined 40 MMA athletes (men) aged 20-22, who used mainly strike fighting style in their competitive activity, and divided them into 2 research groups (A and B), 20 athletes in each group. Group A athletes used medium intensity (R a  = 0.64), and group B-high intensity (R a  = 0.72) training load regime. To assess the adaptive body changes we applied methods of control testing of maximum muscle strength growth (1 RM), special training (the number of accurate kicks on the mannequin for 30 s), and bioimpedansometry. By monitoring biochemical parameters (testosterone, cortisol, creatinine, phosphorus, calcium, cholesterol, LDH) in the blood serum of athletes, we determined the peculiarities of adaptive-compensatory body reactions in response to training loads. Results: The obtained results of special training increased during the study period by an average of 10.5% in group B athletes, but group A participants' results had no significant changes compared to basal data. The largest increase in the development of maximum muscle strength growth by an average of 44.4% was recorded after 2 months of research in group B. Group B athletes also had positive changes in body fat and fat-free mass indicators during the study which were two times higher than the results of group A. The laboratory studies and correlation analysis showed informative biochemical markers (cortisol, testosterone and creatinine) for assessing the condition of athletes in both groups before using high and medium training load regimes. The biochemical markers for assessing the adaptive-compensatory reactions of athletes in response to high-intensity physical stimuli at the beginning of the study were indicators of LDH and cholesterol, and in conditions of medium intensity it was LDH, testosterone and cortisol. After 2 months of study the set of biochemical markers assessing the adaptation processes before the load completely changed only in group B athletes and consisted of LDH, phosphorus, cholesterol, and calcium. At the same time, the set of biochemical criteria for assessing adaptive-compensatory reactions after training in group B athletes was completely changed compared with the data recorded at the beginning of the study. Conclusion: Defining the optimal set of criteria for assessing the adaptive-compensatory changes in MMA athletes of strike fighting style will allow in the shortest possible time to correct the parameters of the training load regime for accelerating the body functionality in the process of special power training.

Maximum Isometric and Dynamic Strength of Mixed Martial Arts Athletes According to Weight Class and Competitive Level.

Mixed martial arts (MMA) athletes must achieve high strength levels to face the physical demands of an MMA fight. This study compared MMA athletes' maximal isometric and dynamic strength according to the competitive level and weight class. Twenty-one male MMA athletes were divided into lightweight professional (LWP; n = 9), lightweight elite (LWE; n = 4), heavyweight professional (HWP; n = 4), and heavyweight elite (HWE; n = 4). The handgrip and isometric lumbar strength tests assessed the isometric strength, and the one-repetition maximum (1RM) bench press and 4RM leg press the dynamic strength. Univariate ANOVA showed differences between groups in absolute and relative 1RM bench press and absolute isometric lumbar strength. Post hoc tests showed differences in 1RM bench press between HWE and LWE (117.0 ± 17.8 kg vs. 81.0 ± 10.0 kg) and HWE and LWP athletes (117.0 ± 17.8 kg vs. 76.7 ± 13.7 kg; 1.5 ± 0.2 kg·BW-1 vs. 1.1 ± 0.2 kg·BW-1). In addition, there was a correlation between 1RM bench press and isometric lumbar strength for absolute (r = 0.67) and relative values (r = 0.50). This study showed that the 1RM bench press and isometric lumbar strength were associated and could differentiate MMA athletes according to their competitive level and weight class. Therefore, optimizing the force production in the upper body and lower back seems important in elite and professional MMA athletes.

Assessment of the Relevance and Reliability of Reaction Time Tests Performed in Immersive Virtual Reality by Mixed Martial Arts Fighters.

Immersive virtual reality (VR) is increasingly applied in various areas of life. The potential of this technology has also been noticed in recreational physical activity and sports. It appears that a virtual environment can also be used in diagnosing certain psychomotor abilities. The main aim of this study consisted of assessing the relevance and reliability of VR-implemented tests of simple and complex reaction time (RT) performed by mixed martial arts (MMA) fighters. Thirty-two professional MMA fighters were tested. The original test developed in the virtual environment was applied for RT assessment. The fighters' task consisted of reacting to the lighting up of a virtual disc situated in front of them by pushing a controller button. The relevance of the test task was estimated by juxtaposing the obtained results with the classic computer test used for measuring simple and complex reactions, while its reliability was assessed with the intraclass correlation procedure. Significant relationships found between the results of VR-implemented tests and computer-based tests confirmed the relevance of the new tool for the assessment of simple and complex RT. In the context of their reliability, RT tests in VR do not differ from tests conducted with the use of standard computer-based tools. VR technology enables the creation of tools that are useful in diagnosing psychomotor abilities. Reaction time tests performed by MMA fighters with the use of VR can be considered relevant, and their reliability is similar to the reliability obtained in computer-based tests.

A brief descriptive outline of the rules of mixed martial arts and concussion in mixed martial arts.

Mixed martial arts (MMA), a combat sport consisting of wrestling, boxing, and martial arts, is a popular activity associated with danger and violence. Of concern are the repetitive head impacts, both subconcussive and concussive, sustained by MMA athletes. The rules of MMA encourage head strikes, but there was no formal concussion protocol in the Ultimate Fighting Championship (UFC) until 2021. Because the UFC was established less than 30 years, the long-term consequences of these repetitive concussive head blows are lacking. In this review, we focus on current literature sought to summarize the current knowledge of repetitive head impacts and concussions in MMA. The objectives were to outline (a) the rules of MMA; (b) the postconcussion protocol for UFC athletes; (c) current behavioral and biochemical diagnostic measures; (d) epidemiology and prevalence of concussion in MMA; (e) long-term effects of subconcussive repetitive head impacts; (f) biomechanics of head impacts; and (g) considerations and research topics that warrant future research.

Facial width-to-height ratio predicts fighting success: A direct replication and extension of Zilioli et al. (2014).

Zilioli et al. (2014) were the first to show an association between male facial width-to-height ratio (fWHR) and physical aggression and fighting ability in professional mixed-martial-arts fighters. Here, we re-examined this relationship by replicating (using all original measures) and extending (using 23 new variables related to fighting performance) Zilioli et al. (2014) in a statistically well-powered sample of 520 fighters using automatic and manual measures of the fWHR involving both eyelid and eyebrow landmarks, used interchangeably in previous reports (Studies 1-2). Most importantly, we successfully replicated Zilioli et al.'s (2014) central finding that fighters' fWHR, when manually calculated using the eyebrow landmark, predicted their fighting success (p = .004, controlling for body mass index and total fights). Consistent with past criticisms of using fight rather than fighter data to examine fighting success, which have argued that individual fights can be suddenly and unexpectedly determined and do not capture an individual's overall ability to succeed, Study 3 (N = 1367 fights) found no association between fWHR and singular victories. Studies 1-3 showed continual evidence that larger fWHRs were associated with grappling abilities, even after controlling for demographic and allometric factors. Strikingly, Study 3 discovered associations between all fWHR measures and grappling skill that remained robust before and after controlling for 17 different control variables. We discuss that grappling, or the act of taking down an opponent, involves a more aggressive, close-combat approach than does striking. Combined, these results offer additional support for the argument that fWHR may have been shaped by sexual selection.

Biochemical profile in mixed martial arts athletes.

The study aimed to evaluate changes in selected biochemical indicators among mixed martial arts competitors in subsequent periods of the training cycle. The research involved 12 mixed martial arts athletes aged 25.8 ± 4.2 years competing in the intermediate category. Selected somatic indicators were measured twice. Biochemical indicators were assessed five times during the 14-week study period. Serum concentrations of testosterone, cortisol, uric acid, myoglobin, total protein, interleukin 6, and tumor necrosis factor, as well as creatine kinase activity were determined. One hour after sparring completion, there were significant increases in cortisol (by 54.9%), uric acid (22.0%), myoglobin (565.0%), and interleukin 6 (280.3%) as compared with the values before the simulated fight. The highest creatine kinase activity (893.83 ± 139.31 U/l), as well as tumor necrosis factor (3.93 ± 0.71 pg/ml) and testosterone (5.83 ± 0.81 ng/ml) concentrations (p = 0.00) were recorded 24 hours after the simulation. Systematic observation of selected blood biochemical indicators in the training process periodization in mixed martial arts helps understand adaptive, compensatory, and regenerative mechanisms occurring in training athletes.

Evaluation of the early weigh-in policy for mixed martial arts events adopted by North American athletic commissions.

OBJECTIVE: To characterize the epidemiology of overweight athletes before and after the introduction of the Early Weigh-In Policy (EWIP). METHODS: A retrospective cohort study examined the weigh-in results for professional mixed martial arts (MMA) events over a 2-year period around the introduction of the new EWIP between 2014 and 2018. Descriptive statistics were used to characterize the study populations. Risk ratios were used to identify differences in the study populations before and after the introduction of the EWIP. RESULTS: After the introduction of the EWIP, the number of overweight athletes increased from 5.7% to 8.4% and the average overweight mass increased from 1.3 kg (2.9 lbs) to 1.8 kg (3.9 lbs) [difference, 0.5 kg (1.0 lb), p = 4.35 × 10^(-5)]. The proportion of athletes is not distributed similarly across the different overweight mass categories when comparing the pre- and post-EWIP time frames (p = 0.006). More athletes in the pre-EWIP period were overweight by smaller amount, while in the post-EWIP period athletes were overweight by larger amount. Of the athletes who were overweight before the regulation change, 28.7% were over the weight limit by greater than 1.8 kg (4 lbs), compared to 39.5% after the new EWIP introduction. On average, the ratio of overweight athletes per events by commission was 1.2 before the introduction of the EWIP and 2.1 after. CONCLUSION: These results appear to indicate that the EWIP has not altered weight-cutting culture in MMA in a positive manner. This study casts doubt on the benefits of an EWIP and raised the possibility of utilizing the longitudinal weight monitoring approach to mitigate rapid weight-cycling behavior. However, before additional changes are made by any athletic commission, further research is needed to examine the efficacy of the abovementioned longitudinal weight monitoring approach or any other strategy.