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Many combat sports have as their overt goal the incapacitation of the opponent which is often achieved by blows to the head. While head impact in contact sports like football, rugby and hockey is accidental and susceptible to sanctioning, strikes directly to the head are intentional and determinants of success in combat sports like Muay Thai, kickboxing, boxing and mixed martial arts (MMA).1 2 Yet, combat modalities are often not mentioned among the sports identified with the highest concussion rates. Boxing is found ‘far behind’ equestrian events, rugby union, cricket, soccer and other organised college sports (eg, football and hockey).3 Data remain limited or unavailable for fighting arts.4
Fighting has been a sport since at least 648 BC in ancient Greece with pankration, a discipline that combined wrestling and boxing. Almost a century ago, ‘dementia pugilistica’ and ‘punch drunk’ described neurological impairments manifested in long-time boxers. Neuropathological reports on the long-term effects of boxing predate those in football.5
The popularity and financial power of combat sports have grown exponentially in recent years. Karate joined boxing, wrestling and taekwondo as an Olympic modality, while kickboxing …
Twitter @FollmerBruno, @E_PaulZehr
Contributors BF and EPZ designed and prepared this manuscript.
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 None declared.
Provenance and peer review Not commissioned; externally peer reviewed.