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Cannabis remains banned in-competition under the UFC’s custom tailored USADA anti doping program.  Today USADA revealed that Alen Amedovski was handed a 6 month suspension for testing positive for Carboxy-THC at a urinary concentration exceeding the permitted limits for the in-competition timeframe on April 20, 2019, at Fight Night 149 in Saint Petersburg, Russia.

His penalty was reduced by three months “based on Amedovski’s successful completion of a USADA approved drug awareness and management program”

USADA’s press release went on to note that there are no guarantees that a substance lawfully ingested out of competition will be cleared by competition time with the following warning

Athletes are advised that the use of a substance or medication out-of-competition, that is prohibited only in-competition, may result in an anti-doping rule violation if the prohibited substance is still present in their body when tested at a competition. USADA cannot predict the clearance time for any substance for any particular individual. If an athlete needs to therapeutically use a substance prohibited in-competition and they are nearing a competition, they are strongly encouraged to contact USADA to learn if they need a Therapeutic Use Exemption (TUE).

Despite the above encouragement USADA has not yet granted a UFC athlete a TUE for cannabis as was demonstrated by Elias Theodorou’s efforts.

 

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France is one of the most high profile countries yet to legalize Mixed Martial Arts.  Today it was announced that the longstanding ban will be coming to an end as of January 1, 2020.

Roxana Maracineanu, France’s Minister of Sports, tweeted the following announcement noting the sport will be legalized and governed by a yet to be recognised sports federation.

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The now famous toe kick oilcheck.  If you don’t know what I’m talking about I can do no better job describing the incident than the one and only Robin Black.  View the video then come back.

Now that we’re on the same page here is the question.  Which of MMA’s unified rules, if any, are violated by this violation?

Here are the potential rules in play along with their applicable notations.  The ones that at first glance appear most likely to be triggered apparently are not (fishhooking and orifice attacks) as these are defined to use fingers, not toes.

Assuming none of these rules hit the nail on the head a simple amendment would be to replace the word “finger” with “digit” in the fish Hooking and Orifice sections.

Fish Hooking;
a. Any attempt by a fighter to use their fingers in a manner that attacks their opponent’s mouth, nose or ears, stretching the skin to that area will be considered “Fish hooking”. Fish hooking generally is the placing of fingers into the mouth or your opponent and pulling your hands in opposing directions while holding onto the skin of your opponent.

Strikes to the spine or the back of the head;
a. The back of the head starts at the Crown of the head with a one (1) inch variance to either side, running down the back of the head to the occipital junction.
b. This area stretches out at the occipital junction (nape of the neck) to cover the entire width of the neck. It then travels down the spine with a one (1) inch variance from the spine’s centerline, including the tailbone.

Groin attacks of any kind;
a. Any attack to the groin area including, striking, grabbing, pinching or twisting is illegal. It should be clear that groin attacks are the same for men and women.

Intentionally placing a finger into any orifice, or into any cut or laceration of your
Opponent;
a. A fighter may not place their fingers into an open laceration in an attempt to enlarge the cut. A fighter may not place their fingers into an opponent’s, nose, ears, mouth, or any body cavity.

Unsportsmanlike conduct that causes an injury to opponent;
a. Every athlete competing in the sport of MMA is expected to represent the sport in a positive light emphasizing sportsmanship and humility. Any athlete that disrespects the rules of the sport or attempts to inflict unnecessary harm on a competitor who has been either taken out of the competition by the referee or has tapped out of the competition shall be viewed as being unsportsmanlike.

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When this site started several years back MMA was illegal in certain jurisdictions and regulatory progress was mapped out.  Now Bare Knuckle Boxing “BKB” is walking a similar path and its regulatory story, much like MMA’s, is intriguing as many athletic commission use creative reasoning in allowing the sport.

This post will be updated from time to time as new US and Canadian jurisdictions allow the sport.  To date these are the athletic commissions which have legalized BKB and their methods of doing so

  1. The Wyoming State Board of Mixed Martial Arts was the first state athletic commission to allow BKB in the modern era.  Thedy did so under the logic that BKB was not a subset of boxing but rather was a sub-set of Mixed Martial Arts.  Technically BKB in Wyoming is a seperate ruleset for MMA.
  2. Mississippi was the second jurisdiction to allow the sport.  As a default BKB should not be allowed in the State as the rules require boxing bouts to utilize the ABC’s unified rules of boxing which mandate gloves.  However, the Commission enjoys the power to waive any of its own rules and such waiver takes precedence.  Using this power the Mississippi Athletic Commission allowed BKB.
  3. Florida came next.  Florida’s laws specifically require gloves to be used in boxing and MMA bouts.  Unlike Mississippi, the Florida State Boxing Commission does not enjoy the power to waive this requirement.  That was no deterrent, however, with the Commission being persuaded that nothing in their legislation required gloves to cover a boxer’s knuckles.  They approved ‘gloves’ which were nothing more than padding placed under the fighter’s handwraps and did not cover the fist from the knuckles down.
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Just as regulatory standards differ across jurisdictions when it comes to combative sports, so do concussion/brain injury screening protocols before and after a bout.  Hoping to change this scattered landscape Dr. Nitin K Sethi, the Chief Medical Officer, New York State Athletic Commission and Associate Professor of Neurology, New York-Presbyterian Hospital published the following suggested standards at BrainDiseaseBlog –

For more on this topic I suggest reviewing the Consensus Statement from the Association of Ringside Physicians published in the British Journal of Sports Medicine.

In the ring and cage during a fight:

1. If concern for concussion or traumatic brain injury arises during the course of the bout, the ringside physician shall assess the combatant preferably between the rounds. The evaluation will be carried out by the ringside physician during the 1-minute break between rounds or after the 1-minute break but before commencement of the next round by requesting the referee to call a time out. The ringside physician shall assess the combatant with the use of Maddocks questions. Maddocks questions include but are not restricted to:

a) What venue are we at today?
b) Who are you fighting today?
c). What round is it now?
d). Who did you fight last?

2. The ringside physician shall conduct a focused neurological evaluation of the combatant in the ring/cage. This evaluation shall include:

–asking the combatant if he/she has any subjective complaints such as headache, dizziness, visual disturbances, nausea, feeling off-balance.
–giving the combatant a two-step command (touch your right ear with your left glove).
–assessment of pupil size symmetry and reactivity (integrity of cranial nerves II and III)
–assessment of extraocular movements (integrity of midbrain and pons by assessment of cranial nerves III, IV and VI)
–assessment of cerebellar function and infratentorial compartment integrity by checking gait and stance (stand still with feet together and/or tandem gait).

The ringside physician should be aware of the NO-GO criteria. If any one of the NO-GO criteria is present, consult with Chief Medical Officer (CMO)/Assistant Chief Medical Officer (ACMO) and consider advising the referee to stop the fight on medical grounds.

The NO GO criteria are the following:

1. If the combatant exhibits any period of LOC or unresponsiveness after a KO.

2. if the combatant exhibits confusion (any disorientation or inability to respond appropriately to questions) at time of assessment by ringside physician.

3. If the combatant exhibits amnesia (retrograde / anterograde) when assessed by the ringside physician. The ringside physician shall assess for retrograde and anterograde amnesia in the ring/cage using Maddocks questions including but not limited to:

a) What venue are we at today?
b) Who are you fighting today?
c). What round is it now?
d). Who did you fight last?

4. If the combatant voices to the ringside physician or his corner any new and/or persistent subjective symptoms such as headache, nausea, dizziness.

5. If the combatant vomits during the course of the fight (this criterion should not be used in isolation to stop a fight on medical grounds).

6. If the combatant has an abnormal neurological examination (ataxia, impaired balance, pupil size asymmetry and/or reactivity) when assessed by the ringside physician.

7. If the combatant has a concussive seizure also at times referred to as an impact seizure (seizure occurring at the time the fighter’s head makes impact with the ring/cage canvas).

In the post-fight examination area/locker room after the fight is over

The ringside physician shall assess for the presence or absence of concussion/ traumatic brain injury with the aid of a multimodal concussion screening and assessment battery including but not limited to:

a) Glasgow Coma Scale Score (best motor response, best verbal response and eye-opening). CGS score less than 13 is mandatory transfer to the emergency department (ED) of the designated Level I Trauma Center via on-site ambulance for urgent CT scan head to rule out acute traumatic brain injury.
b) Detailed neurological examination including higher mental function testing, cranial nerve II to XII testing, pronator drift testing, assessment of motor function, finger to nose testing, tandem gait assessment and Rhomberg’s test.
c) Standardized Assessment of Concussion (SAC) test-check orientation, immediate memory, concentration, delayed recall (see attached SAC form).
d) Balance Error Scoring System (BESS) test-double leg stance, single leg stance and tandem leg stance (see attached BESS testing procedure).

Management of a concussed combatant is on a case by case basis with majority of combatants discharged from the venue with a medical suspension. Duration of the suspension may vary from 30 to 90 days with mandatory 90-day suspension and follow up with a neurologist if the concussion occurred by a KO. All combatants discharged home from the venue are instructed to remain in close observation of a family member/coaching staff for the next 24 hours with instructions to report to the nearest emergency department (ED) if any neurological symptom (headache, dizziness, blurred vision, vomiting, impaired balance) or sensorium (lethargy, unresponsiveness) is reported. All discharged combatants are educated about post-concussion symptoms with instructions to seek medical care if these are reported. A combatant may be referred to the ED of the nearest Level I trauma center for an urgent CT scan of the head and further evaluation if deemed appropriate by the ringside physician. Transport in these cases shall take place via on site ambulance.

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While some doctors are debating whether routine chokes in combat sports have negative impact on brain function similar to concussion (a topic where more research is needed) it is worth pointing out that there are known risks to the dangers of chokes.

After reading some posts from this site Dr. Smock, a Police Surgeon with the Louisville Metro Police Department who specializes in reviewing injuries from carotid vascular restraints (think rear naked chokes), was kind enough to reach out to me and share some of his insights and data.  Dr. Smock welcomed me to share his information here which I am pleased to do.

According to Dr. Smock the majority of law enforcement agencies in the US have banned or reserved vascular restraints for deadly force encounters.  This was due to the well known harm that these holds can pose with 15 people dying after LAPD chokeholds from 1976-1982 alone.

Carotid Restraints have been documented to lead to the following harms:

  • Dissection of carotid or vertebral arteries resulting in stroke or death
  • Embolic stroke from plaque rupture
  • Asphyxia death
  • Anoxic brain damage
  • Fractures of laryngeal cartilage and trachea
  • Carotid artery thrombosis
  • Vocal cord paralysis
  • Permanent swallowing problems

In addition to several training based injuries Dr. Smock documented over the years he shared the following studies highlighting some risks of choking in martial arts that are worth reviewing for those interested in the topic:

Dr. Smock provided the following flow chart with recommendations on considerations an emergency department should have when reviewing a patient with choke related injuries.  If you train in combative sports with chokeholds it is wise to err on the side of caution when it comes to early tapping given some of these well documented risks.

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Three of the ongoing lists I’ve kept on this site are documenting doping in MMA, documenting weight cut injuries/deaths in MMA and MMA’s modern fatality list.

With Tim Hague being the second known MMA athlete (and first UFC alumnus) to be diagnosed with the disease I will now also document this.  As with the other lists I will update this as new cases become known.  CTE can only be definitively diagnosed by direct tissue examination after death.  The below list will therefore be broken down to confirmed cases of CTE and suspected.  The latter will be comprised of athletes who publicly admitted to be suffering from the disease but without a definitive diagnosis.

  1.  Jordan Parsons (Confirmed)– Parson, a Bellator fighter, was diagnosed in 2016, via autopsy, as having CTE following being killed as a pedestrian in a vehicle collision.
  2. Tim Hague (Confirmed)– In 2017 Hague died from brain trauma in a boxing bout.  He was subsequently diagnosed, via autopsy, as having CTE.
  3. Renato Sobral (Suspected) – In 2019 the longtime MMA veteran Sobral admitted to living with the disease.
  4. Gary Goodridge (Suspected)- In 2012 Gary Goodridge admitted to living with CTE.
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Earlier this year I highlighted debate among physicians addressing whether chokes in combat sports play any role in CTE.

A more recent study was published in the journal of Brain Injury suggesting that MMA bouts (or training sessions) ending in a choking submission result in cognitive consequences similar to concussion.  Like last year’s article this recent suggestion has received some pointed criticism.

In the recent study, titled The King-Devick test in mixed martial arts: the immediate consequences of knock-outs, technical knock-outs, and chokes on brain functions, the authors looked at King-Devick times (an accepted concussion evaluation tool) in MMA trainees and competitors.  They looked at training/bouts that ended via head trauma events and those that ended via submission events.  The authors noted that both KO and non KO ‘events’ led to a slowing of King-Devick testing.  From this they concluded that “athletes who sustained non-head trauma “events” also demonstrated slowing on their K-D tests, suggesting these “events” may also cause some impairment in
brain function indicative of a concussion“.

The full abstract and conclusion read as follows:

ABSTRACT
The aim of this prospective cohort study was to determine the effect of an ‘event,’ defined as a knockout
(KO), technical knock-out (TKO), choke, or submission, on King-Devick (K-D) test times in mixed
martial arts (MMA) athletes. MMA athletes (28.3 ± 6.6 years, n = 92) underwent K-D testing prior to and
following a workout or match. Comparison of baseline and post-workout/match K-D times to assess any
significant change. K-D tests worsened (longer) in a majority of athletes following an ‘event’ (N = 21)
(49.6 ± 7.8 s vs 46.6 ± 7.8 s, p = 0.0156, Wilcoxon signed-rank test). K-D tests improved (shorter)
following a standard workout or match in which no ‘event’ occurred in a majority of cases (n = 69) (44.2
± 7.2 s vs 49.2 ± 10.9 s, p = <0.0001, Wilcoxon signed-rank test). Longer duration (worsening) of postmatch
K-D tests occurred in most athletes sustaining an ‘event’; K-D tests shortened (improved) in a
majority of athletes not sustaining an ‘event’. Our study suggests MMA athletes suffering an ‘event’ may
have sustained a brain injury similar to a concussion.

Conclusion
The vast majority of MMA athletes sustaining an “event” with
witnessed head trauma (KO or TKO) had significant slowing
of their K-D test. It is probable that slowing of the post-match
or post-training K-D test in this population indicates that the
athlete has sustained a concussive type brain injury.
Furthermore, athletes who sustained non-head trauma
“events” also demonstrated slowing on their K-D tests, suggesting
these “events” may also cause some impairment in
brain function indicative of a concussion. Our findings suggest
that any MMA athlete with a slowed post-match or posttraining
K-D test requires further evaluation by a medical
professional trained in concussion management.

This conclusion drew strong criticism from Samuel J. Stellpflug and Robert C. LeFevere of the Department of Emergency Medicine, Regions Hospital, Saint Paul, MN, USA.  In reply to the the above study the doctors summarized their criticism of the conclusions as follows:

In summary, this study doesn’t establish a link between
transient choking and significant worsening in K-D times, nor
between transient chokes and anoxic brain injury with cerebral
changes comparable to concussion. The listed supporting references
don’t support either of these claims. Additionally, the brief
hypoxia associated with transient chokes is analogous to brief
vasovagal syncope, which does not cause lasting brain injury.
Concussions involve a traumatic force causing injury that can
have long-lasting effects. There is no established reason to
believe, based on the different mechanisms, that brief hypoxia
causes the lasting damage that a concussion can cause. Lastly,
there is a limitation in terming these MMA chokes as nontraumatic
scenarios when the totality of the physical transgressions
that lead to the choke is taken into account. Overall, this
study does not provide any convincing data that chokes in
combat sports cause injuries to the brain similar to concussion.

It would be of value to the combat sports community to have a study conducted involving grapplers who tap out due to chokes (who do not sustain any head impacts in the process as they would in an MMA competition) to see if the K-D scores are negatively impacted.  Such a study can help further this debate and add clarity to the competing points of view.

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Last month Ontario Introduced a combat sports bill which sought to overhaul how professional and amateur combative sports are regulated in the Province.  The bill has now passed into law.

On May 29, 2019 Bill 100 (Schedule 9 of which is the new Combat Sports Act) passed Third Reading and Received Royal Assent.  This means the Bill has now formally been passed into law and it officially comes into force “on a day to be named by proclamation of the Lieutenant Governor“.  Presumably that will the the day the Regulations under the Act are ready.

This law creates major changes to the Ontario combat sports scene.  The Act allows for a far broader range of combative sports to be legalized in Ontario.   The following are some of the highlights

  • The Act regulates both amateur and professional combative sports which are defined as follows

     a sport in which contestants meet by previous arrangement for the purpose of an encounter or fight and,

      (a)  strike their opponents using their hands, fists, feet or any other body part or any combination of them;

      (b)  use throwing, grappling or submission techniques; or

      (c)  engage in any other prescribed technique.

  • It repeals the current Athletics Control Act
  • The Act requires the Minister in charge to appoint a Combat Sports Commissioner for the Province
  • Additionally a combative sports advisory council is created
  • The details of which combative sports will be legalized will be set out in regulations so many important details have yet to emerge.  The above definition is broad enough to allow any known striking sports such as boxing, kickboxing, muay thai, MMA and others.  It also allows professional grappling contests, amatuer grappling contests and most importantly discretion is built in for the Province to allow other combative sports by ‘designation‘.
  • The Act appears to break the monopoly Ontario handed Provincial Sports Organizations over amateur combative sports.  Presently Ontario recognizes various PSO’s and hands them monopoly power over their respective combative sport.  This legislation allows anyone to apply to the Commissioner for a permit to hold an amateur combative sport event in the future even if it is outside of the PSO monopoly model.  Section 43 of the Act notes that anyone who receives an “event permit” is deemed to have permission under the Criminal Code to host the event allowed under the permit.
  • When determining what Professional and Amateur combat sports are allowed the Minister is given broad power to pass regulations.  Specifically Regulations a)  setting out sports as combative sports for the purposes of subsection 1 (3); (b)  governing the conduct of an amateur combative sport contest or exhibition and the conduct of a professional combative sport contest or exhibition, including prescribing rules relating to such contests and exhibitions;
  • The Regulations even allow combative sports contests to be permitted with deviations to the published rules for those sports with Section 49(4) of the Act noting “A regulation made under clause (1) (b) may permit the Minister to exempt an amateur combative sport contest or exhibition or professional combative sport contest or exhibition from the rules set out in the regulation that apply to the combative sport, provided that the Minister is satisfied that the contest or exhibition satisfies such requirements as set out in the regulation.“
  • Even if a sport has no rules published for it this Act allows events with unique rules to be permitted with Section 49(5) noting “If no regulation is made under clause (1) (b) prescribing rules in respect of a particular combative sport, the Minister may make regulations requiring a person wishing to promote, conduct or hold an amateur combative sport contest or exhibition or professional combative sport contest or exhibition involving the combative sport to obtain the Minister’s approval of rules that will apply to the contest or exhibition.”

The key details of what will be allowed in Ontario will be set out in yet to be published regulations.  What is clear is that this new law gives Ontario the ability to host the broadest range of professional and amateur combat sports in all of Canada.

The full Combat Sports Act can be found here.

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Several former UFC fighters have come forward in recent years admitting they are living with the consequences of CTE.  The disease, however, can only be formally diagnosed at this time after death via autopsy.

It appears the first formal diagnosis of CTE has now been made in a former UFC fighter.

Tim Hague, known as “the thrashing machine” died following a profoundly lopsided boxing bout in Edmonton in 2017.  The death has sparked litigation against several defendants.

A key detail revealed in the lawsuit is that Hague apparently was diagnosed with CTE at the time of his death.  This means he would have already had the progressive brain disease when he was licenced for his last bout.  Specifically the Hague family notes as follows in their Statement of Claim:

“Following an autopsy of Tim Hague, it was determined that Tim Hague had developed chronic traumatic encephalopathy (mild, early stage) (“CTE”) and the Plaintiffs plead that this is the cumulative result of head trauma sustained by Tim Hague throughout the various fights noted above and others not mentioned”.  The lawsuit goes on to note that regulators failing to note the realities of this disease fail fighters in their regulatory duties.

Although Hague appears to be the first UFC fighter to be formally diagnosed with the disease he is not the first MMA fighter.  In 2016 former Bellator fighter, Jordan Parsons was diagnosed with CTE post-mortem after being killed in a vehicle collision. 

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