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Concussion management in combat sports: consensus statement from the Association of Ringside Physicians
  1. John Neidecker1,2,
  2. Nitin K Sethi3,
  3. Randolph Taylor4,5,
  4. Raymond Monsell6,7,
  5. Don Muzzi8,9,
  6. Bruce Spizler10,
  7. Larry Lovelace11,
  8. Edmund Ayoub12,
  9. Rick Weinstein13,
  10. Joseph Estwanik14,
  11. Patricio Reyes15,
  12. Robert C Cantu16,17,
  13. Barry Jordan18,
  14. Margaret Goodman19,
  15. John W Stiller20,21,
  16. Jonathan Gelber22,23,
  17. Robert Boltuch24,
  18. Domenic Coletta25,
  19. Angela Gagliardi26,
  20. Stephen Gelfman27,
  21. Patrick Golden28,
  22. Nicholas Rizzo29,
  23. Paul Wallace30,
  24. Allan Fields31,
  25. Calvin Inalsingh32
  1. 1 Department of Sports Medicine, Orthopaedic Specialists of North Carolina, Raleigh, North Carolina, USA
  2. 2 Campbell University School of Osteopathic Medicine, Buies Creek, North Carolina, USA
  3. 3 Department of Neurology, New York-Presbyterian Hospital, New York City, New York, USA
  4. 4 Memorial Hermann Healthcare System, Houston, Texas, USA
  5. 5 Baylor College of Medicine Department of Family and Community Medicine, Houston, Texas, USA
  6. 6 Aneurin Bevan University Health Board, Newport, UK
  7. 7 Royal College of Surgeons in Ireland Faculty of Sports and Exercise Medicine, Dublin, Ireland
  8. 8 Essentia Health, Duluth, Minnesota, USA
  9. 9 University of Minnesota Medical School – Duluth Campus, Duluth, Minnesota, USA
  10. 10 Association of Ringside Physicians – Legal Counsel, Baltimore, Maryland, USA
  11. 11 INTEGRIS Southwest Medical Center, Oklahoma City, Oklahoma, USA
  12. 12 Desert Regional Medical Center, Palm Springs, California, USA
  13. 13 White Plains Hospital Center, White Plains, New York, USA
  14. 14 Metrolina Orthopedic and Sports Medicine Clinic, Charlotte, North Carolina, USA
  15. 15 Phoenix VA Health Care System, Phoenix, Arizona, USA
  16. 16 Centre for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts, USA
  17. 17 Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA
  18. 18 The Burke Rehabilitation Hospital, New York City, New York, USA
  19. 19 Voluntary Anti-Doping Association, Las Vegas, Nevada, USA
  20. 20 Mood and Anxiety, Psychiatry, University of Maryland Baltimore Medical School, Baltimore, Maryland, USA
  21. 21 George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
  22. 22 Connecticut Children’s Medical Center, Hartford, Connecticut, USA
  23. 23 Elite Sports Medicine, Farmington, Connecticut, USA
  24. 24 Jupiter, Florida, USA
  25. 25 Cape Regional Health System, Cape May Court House, New Jersey, USA
  26. 26 New York, USA
  27. 27 Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
  28. 28 Saint Agnes Medical Center, Fresno, California, USA
  29. 29 Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
  30. 30 Cedars-Sinai Medical Center, Los Angeles, California, USA
  31. 31 Fort Lauderdale, USA
  32. 32 St. Augustine, Trinidad and Tobago
  1. Correspondence to Dr John Neidecker, Department of Sports Medicine, Orthopaedic Specialists of North Carolina, Raleigh, NC 26614, USA; neidy13{at}


Various organisations and experts have published numerous statements and recommendations regarding different aspects of sports-related concussion including definition, presentation, treatment, management and return to play guidelines.1–7

To date, there have been no written consensus statements specific for combat sports regarding management of combatants who have suffered a concussion or for return to competition after a concussion. In combat sports, head contact is an objective of the sport itself. Accordingly, management and treatment of concussion in combat sports should, and must, be more stringent than for non-combat sports counterparts.

The Association of Ringside Physicians (an international, non-profit organisation dedicated to the health and safety of the combat sports athlete) sets forth this consensus statement to establish management guidelines that ringside physicians, fighters, referees, trainers, promoters, sanctioning bodies and other healthcare professionals can use in the ringside setting. We also provide guidelines for the return of a combat sports athlete to competition after sustaining a concussion. This consensus statement does not address the management of moderate to severe forms of traumatic brain injury, such as intracranial bleeds, nor does it address the return to competition for combat sports athletes who have suffered such an injury. These more severe forms of brain injuries are beyond the scope of this statement. This consensus statement does not address neuroimaging guidelines in combat sports.

  • concussion
  • boxing
  • kick boxing
  • martial arts

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  • Contributors Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data: JN, NKS, RT, RM and DM. Drafting the work or revising it critically for important intellectual content: JN, NKS, RT, RM, DM, LL, EA, RW, JE, PR, RCC, BJ, MG, JWS and JG. Grammar editing: BS. Final approval of the version published: all authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PR serves as the CMO for the Retired NFLPA and as CTO of Premier Biomedical. RCC serves as a consultant to the NFL, Concussion Legacy Foundation and to NOCSAE. A version of this statement is posted on the ARP website:

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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