The Montreal Gazette also noted this week that the the B.C. Medical Association is planning to bring a resolution banning MMA in Canada to the "Canadian Medical Association’s annual general meeting at Niagara Falls, Ont., from Aug. 23 to 25. If the national group agrees to adopt the resolution, it will lobby the federal government to work with the provinces to bring an end to MMA contests in the country."
At the outset, and as you may have guessed from the title of this blog, I am not a doctor -- I am a lawyer -- so I can't necessarily grasp all of the specific medical concepts surrounding the impact of concussions for athletes later in life.
That said, I am perfectly capable of seeing through an unsubstantiated hack-job "opinion" of a doctor who fails to provide an iota of evidence (or scientific support) in his article -- an article clearly designed to mislead and set-back MMA and provide ammunition for the misinformed, like New York State Senator Liz Krueger. I am also perfectly qualified to see through the superficial "talking points" of directors of "organizations" on a crusade to ban a sport that they know nothing about.
The Actual Medical Research
Let's start with the medical research that Dr. Tim Rindlisbacher fails to mention or address, i.e. the actual research conducted to date by professionals on the health risks of MMA --don't worry, I am not going to pretend that MMA is without risks, it is.
In a Johns Hopkins research article published in July 2006, doctors noted that MMA injuries are comparable to other combat sports that involve striking and concluded that the lower knockout rates in MMA suggest a reduced risk of traumatic brain injury when compared with other striking sports such as boxing. Gregory H. Bledsoe, et al., Incidence of Injury in Professional Mixed Martial Arts Competitions, 5 J. SPORTS SCI. & MED. 136, 140 (2006).
In the Johns Hopkins article, the authors recognize that "[w]ith the growing concern over repetitive head injuries and the risk of dementia pugilistica among career boxers, decreasing the number of head blows a fighter receives during a match has been promoted as an important intervention (Mendez, 1995; Unterharnscheidt, 1995)."
The authors note that a fighter's ability to "tap out" in MMA, "combined with more options of attack when competing, is thought to help explain a knockout proportion in MMA competitions that is almost half of the reported 11.3% of professional boxing matches in Nevada [internal citation omitted]." Specifically, in MMA, "the opportunity to attack the extremities with arm bars and leg locks and the possibility of extended periods of grappling could serve to lessen the risk of traumatic brain injury. When TKOs are compared, proportions between professional boxing (38%) and MMA are similar (Bledsoe et al., 2005)."
Despite this study (or in willful ignorance of it), the Director of the Alberta Centre for Injury Control and Research at the University of Alberta, Don Voaklander, recently told the Montreal Gazette "'[a]bsolutely, our organization would be 100 per cent behind that [a ban on MMA].” "With experience in head injury, Voaklander has concerns about the severity of the blows mixed martial arts participants take to the head. Boxing is less than ideal, but at least in that sport participants are wearing heavy gloves which mitigate blows to the head."
Ignored by Voaklander (and others), however, is the fact that the lighter MMA gloves, with open fingers, permit a fighter to take the fight to the ground. As recognized in "Incidence of Injury in Professional Mixed Martial Arts Competitions," supra, "[t]he mandatory 'grappling' gloves now used in MMA events weigh between 4 to 8 ounces, thinner than the 8 to 10 ounce gloves worn by professional boxers, and are designed with the fingers exposed so a fighter can grasp his opponent." "[T]the possibility of extended periods of grappling could serve to lessen the risk of traumatic brain injury." Further, and intuitively, instead of taking multiple blows to the head, a fighter in trouble can attempt to take the fight to the ground.
Moreover, as set forth in David Plotz's article in Slate, "[t]he purpose of boxing gloves is not to cushion the head but to shield the knuckles. Without gloves, a boxer would break his hands after a couple of punches to the skull. That's why ultimate fighters won't throw multiple skull punches. As a result, they avoid the concussive head wounds that kill boxers--and the long-term neurological damage that cripples them."
The NFL and Concussion Research
Now on to the NFL. At the outset, it is strange that Dr. Rindlisbacher is comparing concussion research initiatives between an organization that has been around since 1920 with MMA "leagues" that only started receiving recognition (and acceptance) in 2000/2001 with the Unified Rules of Mixed Martial Arts.
Also, it is strange that Dr. Rindlisbacher is faulting MMA promoters, as opposed to the respective athletic commissions that are responsible for setting rules and regulations, including medical requirements designed to protect the fighters. I guess it was just more convenient for Dr. Rindlisbacher to attack the promoters in his hatchet job piece because they are the entities making the bulk of the profit and, with boxing as the masses are familiar, promoters often have less than stellar reputations.
Nonetheless, let's look at what the NFL has been doing to protect its players. In 2007, as set forth in this NY Times article, the NFL "enacted measures that required all players to undergo baseline neuropsychological testing and then be retested before being cleared to play; forbade players who were knocked unconscious to return to play the same day; and set up a hot line through which players could report being pressured to play against a doctor’s advice."
The hot line was in response to the Ted Johnson story, detailed in this article, "'I don't want anyone to end up like me'" in which Ted Johnson describes how he was allegedly forced to return to play by New England Patriots coach Bill Belichick too soon after having suffered a concussion. Belichick denies the accusations.
Perhaps more importantly, however, as of early 2009 -- and a set forth in this CNN article, "Dead athletes' brains show damage from concussions," the NFL was still hardly out in front on the issue.
Ted Johnson was one of the first to sign up [consented to have his brain studied after he dies] . He said he believes that concussions he suffered while playing football explain the anger, depression and throbbing headaches that occasionally still plague him.
Johnson said he played through concussions because he, like many other NFL athletes, did not understand the consequences. He has publicly criticized the NFL for not protecting players like him.
'They don't want you to know,' said Johnson. 'It's not like when you get into the NFL there's a handout that says 'These are the effects of multiple concussions so beware.'
In a statement, the NFL indicated that their staffs take a cautious, conservative approach to managing concussions.
While they support research into the impact of concussions, they maintain that, 'Hundreds of thousands of people have played football and other sports without experiencing any problem of this type and there continues to be considerable debate within the medical community on the precise long-term effects of concussions and how they relate to other risk factors.'
The NFL is planning its own independent medical study of retired NFL players on the long-term effects of concussion.So, as of January 27, 2009, the NFL, which has been around since 1920, was only "planning" its own independent medical study. Impressive indeed Dr. Rindlisbacher.
In fact, it wasn't until congressional hearings in late-2009 where the NFL was compared to the tobacco industry that the NFL took additional, more serious, steps to deal with these issues.
Specifically, "[o]n Oct. 28 [2009] in Washington, lawmakers questioned NFL Commissioner Roger Goodell about the league's approach to concussions and grilled him on whether head injuries in football can be linked to brain disease. Since then, Goodell has announced stricter return-to-play guidelines that make it tougher for players to get back on the field after head injuries and has made every team enlist an independent neurologist who can be consulted when players have concussions."
In fact, as of January 2010, at a follow-up Congressional hearing, "Dr. Ira Casson, a symbol of the N.F.L.’s reluctance to recognize mounting evidence linking professional football and dementia before his resignation as co-chairman of a league committee on brain injuries, continued to deny the existence of any such relationship while testifying before a House Judiciary Committee hearing Monday."
According to the New York Times article, Dr. Casson stated in his written statement before his testimony (in January 2010) that “'[m]y position is that there is not enough valid, reliable or objective scientific evidence at present to determine whether or not repeat head impacts in professional football result in long-term brain damage.'”
While Casson and and the co-chairman of the league’s committee on concussions, Dr. David Viano, both resigned in November 2009, it is a bit perplexing that Dr. Rindlisbacher holds the NFL's efforts with respect to concussions in such high regards when the individuals charged with dealing with the issue up until late-2009 were in denial.
While we are talking about concussions, sports, and Canada, what about Hockey?
I thought it was interesting that a Canadian doctor focused his piece on football instead of hockey, which has a high concussion rate itself.
As set forth in an article at Newobserver.com, "NHL may be poised to curb concussions," there was a meeting in November 2009 of the NHL general managers to discuss, inter alia, the long term affects of concussions on players. According to the article, Dr. Kevin Guskiewicz, "who heads the sport concussion program at UNC-Chapel Hill and is research director for the Center for the Study of Retired Athletes" stated as follows:
"'Hockey has so many unanticipated impacts, where you don't see the hit coming,' he said. "The body is ill-prepared to steady itself and give good support to the head. ... In hockey, you often have two players moving in opposite directions at top speed - the perfect storm.'
* * *
Guskiewicz said hockey has been slow to change, saying the sport introduced 'testicular cups' in 1873 for protection but didn't begin making helmets mandatory until 1979.
'I guess it took them more than a hundred years to realize the brain is just as important,' he said.
Guskiewicz said helmets are not designed to fully prevent concussions. Guskiewicz said a three-year study involving the Junior Hurricanes, a youth hockey program sponsored by the Carolina Hurricanes, has been revealing. The junior players' helmets have accelerometers that gauge impacts. 'The average magnitude of the hits, 19 to 20 Gs, are nearly identical to [hits of] football players,' he said.A December 2009 article in the New York Times, Brain Damage Found in Hockey Player, describes how "Reggie Fleming, a defenseman and left wing known for fighting as much as scoring in a long career from 1959 to 1974, was found by Boston University researchers to have chronic traumatic encephalopathy, a neurodegenerative disease known to cause cognitive decline, behavioral abnormalities and ultimately dementia."
With respect to general precautions after a head injury, the article notes as follows:
The N.H.L. and the N.H.L. Players Association jointly administer the league’s protocol for players returning from concussions, which has been in place since 1997-98. The program was the first in pro sports to mandate independent baseline and postconcussion neuropsychological testing, as well as clearance from independent doctors before a player can return to game action. A similar protocol was adopted by the N.F.L. only last month.
In recent years the N.H.L. has experienced several incidents of head injuries to its players. But unlike in Fleming’s day, most of today’s concussions are caused by checks to the head delivered at high speed with players’ shoulder pads. The league’s general managers have consistently declined to take steps curbing such hits, which are legal under N.H.L. rules.While checks to the head are barred in the Ontario Hockey League, there are still other causes of concussions in hockey.
Whether Dr. Rindlisbacher used hockey as the comparative sport (or football), the result would have been the same -- a superficial attack on MMA designed to undermine a growing sport.
Dr. Rindlisbacher should stick to science and not baseless comparisons that lack scientific (or factual) support.
Update (8-23-2010): I checked out Dr. Rindlisbacher's biography -- I was going to email him this post -- and it turns out he is extensively involved with hockey and, in fact, he is a consultant to the NHL. This brings me back to my point above, i.e. what about hockey Dr. Rindlisbacher?
Why did you choose the NFL and not the sport that you are so extensively involved with and "enjoy playing" to launch a comparative attack against MMA?
For ease of reference, below is directly from his biography:
- "enjoys playing hockey"
- "has acted as team physician for the Toronto Raptors, Buffalo Bills, Toronto Argonauts and Toronto Roadrunners Hockey Club"
- "He has provided team medical coverage to junior hockey teams for over 12 years including the Mississauga Ice Dogs, Mississauga St. Michael's Majors and Team Canada ‘Under 18’ Men's and World Junior National Teams"
- He "is a consultant to the National Hockey League Players Association"
Fight Lawyer
