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FactCheck: Is MMA really safer than boxing?

TheJournal.ie’s FactCheck deals with one of the most emotive controversies of the week.

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THE SPORT OF mixed martial arts has once again been thrown into the spotlight of the Irish news media and the public at large, this week, following the tragic death of Joao Carvalho.

The Portugese MMA fighter died on Monday after falling ill very soon after his fight with Irishman Charlie Ward at the National Stadium on Saturday night.

A torrent of debate has ensued this week, with many strongly criticising the sport and calling for it to be banned, while others defended its safety measures and strict rules, but called for it to be properly regulated and codified as a sport in Ireland.

One line of argument has been a comparison between the dangers of boxing and MMA, with many fans of the former appearing to “draw the line” at the latter.

Junior Minister for Sport Michael Ring told Seán O’Rourke on RTE Radio One’s Today programme:

I like the boxing, but this other sport, it doesn’t fit for me.

The Irish Times boxing correspondent Johnny Watterson called the fateful bout “legal killing” and said MMA “crossed the line”.

Peter McCabe, CEO of the UK brain injury non-profit Headway (who has previously also called for boxing to be banned) wrote in the Guardian:

When the objective is to render opponents senseless by kicking and punching them in the head, it is no surprise when someone is seriously hurt and sustains fatal neurological damage.

One caller to Liveline on Tuesday called boxing “unequivocally more dangerous”, while another labelled it ”clean and wholesome” and “vigorously controlled”, in comparison to the “legalised bloodsport” of MMA, which he likened to badger-baiting and dogfighting.

With emotive language entering the debate, and passions running high in the aftermath of a shocking and tragic death, it’s time to introduce some facts.

Before we start, it’s important to say that until we have the results of the post-mortem, we simply do not know what precisely caused or potentially contributed to the death of Joao Carvalho.

However, let’s dive into the wider, ongoing dispute between boxing and MMA.

If you hear a claim that sounds dodgy, email factcheck@thejournal.ie.

Claim: Mixed martial arts is safer than boxing
Verdict: Half-TRUE. The scientific evidence (of which there is relatively little) is mixed.

The Facts

UFC 196 Mixed Martial Arts Source: Eric Jamison/PA

Death

The prevalence of deaths across the two sports is difficult to precisely measure.

The most comprehensive data on fatalities in the ring come from the Manuel Velazquez Boxing Fatality Collection, which began tracking deaths in the 1940s.

However, it includes fatalities surrounding unlicensed boxing matches, sparring sessions, and “Toughman” contests (often ad hoc events involving untrained amateurs).

A 2010 academic study, largely using information from the Velazquez collection, found 339 deaths from head injuries in boxing matches, from 1950 to 2007.

Because mixed martial arts is a relatively very new sport, it’s difficult to find definitive figures on fatalities.

The Velazquez collection counted four MMA-associated deaths from 1981-2007, but only one of those – the death of Sam Vasquez – involved a regulated contest.

One, for example, involved a heart attack at an unregulated bout in a sports bar in South Korea.

The Mixed Martial Arts website lists eight deaths surrounding an MMA contest, from 1998-2013 – three of them in regulated contests – and there was a further fatality at a regulated fight in South Africa in 2014.

This leaves us with four verified deaths directly linked to an MMA fight, up until last Saturday.

From 1998-2011 (the most recent year available), the Velazquez collection listed 60 deaths associated with professional boxing matches. (We excluded amateur contests and outliers such as incidents during training, heart attacks, and so on.)

However, comparing those absolute numbers to try and find the prevalence of deaths across the two sports is even trickier.

A year-by-year analysis isn’t reliable, because it doesn’t take into account how many events in each sport actually take place on an annual basis.

(If there is one death per year at the running of the bulls in Pamplona, and two deaths per year in cycling, for example, that doesn’t make the running of the bulls a safer activity than cycling – it only happens once a year.)

Unfortunately, definitive figures are just not available for the total number of boxing and MMA matches worldwide every year, so we will have to wait in order to make a proper comparison of death rates between the two sports.

Injury

Facebook 2015s Top Topics Source: Associated Press

We do have some scientific research here.

The first major “meta-analysis” (collecting and evaluating several separate studies in one go), came in 2014.

That research concluded that the risk of some kind of injury was higher in MMA than several other combat sports, including judo, taekwando, amateur and professional boxing.

However, the injury rate (technically speaking the rate of injury per 1,000 “athlete-exposures”) for non-MMA sports was taken from previous existing studies, and analysed in less detail.

The gap between professional boxing and mixed martial arts was the smallest.

  • The probability of an injury taking place in a given MMA contest was just short of 23%, on average
  • For professional boxing, the average risk ranged from 12% to 25%.

The study also found that the pattern of injuries was “very similar” between the two sports – i.e. there was a high proportion of facial cuts, fractures and concussions in both.

Notably, this meta-analysis did not evaluate the severity of injuries

Last year, the same researcher – Reidar Lystad from Central Queensland University – conducted an even broader and more comprehensive meta-analysis.

mmalystadchart

The 2015 research once again concluded that the highest risk of injury was in MMA, and second-highest in boxing (as shown in the chart above), but found some important additional information.

  • The proportion of injuries to the head and neck was highest in boxing (84%)
  • Followed by karate (74%) and MMA (64%)

injuryarealystad Source: Reidar Lystad via Australian Epidemiologist

  • Boxing had a significantly higher rate of concussion (14% of all injuries) than MMA (4%)
  • Kickboxing had the highest concussion rate
  • MMA had a much higher rate of bone fractures than boxing (27% and 7% of all injuries, respectively)

injurytypelystad Source: Reidar Lystad via Australian Epidemiologist

Head injury

Probably the biggest concern about MMA (and boxing) is the prevalence and long-term effects of blows to the head, concussion, and traumatic brain injury.

So how do the two sports compare on this score?

Only one peer-reviewed scientific study has included a comparative analysis of injuries across MMA and boxing in the same study – a 2015 paper by Dr Shelby Karpman from the University of Alberta in Canada.

The research, which attracted widespread media attention last autumn, found:

  • Professional boxers were more likely to sustain no injuries in a given contest
  • MMA fighters were more likely to sustain injuries in general, but those injuries were more likely to be relatively minor (bruising, and so on).
  • Professional boxers, on the other hand were significantly more likely to suffer severe injuries, including loss of consciousness and serious eye injuries such as retinal detachment.
  • Boxers were almost twice as likely to sustain a concussion that involved a loss of consciousness
  • Average medical suspensions for boxers were 26 days, compared to 20 days for MMA fighters, which also suggests a higher prevalence of serious injuries

We contacted Karpman, who explained why he excluded amateur boxing from the study (which involved analysing 11 years’ worth of medical tests performed after fights in the city of Edmonton).

One, they [amateur boxers] wear head gear, which protects their head to some extent. And two, in amateur boxing you can score points based on body blows, and it’s the points total that makes the difference.
Whereas in professional boxing there’s no such thing. It’s all by judges, and if you’re not scoring significant head shots, then you’re not scoring, in the eyes of the judges.

Britain Boxing IBF Heavyweight Source: Matt Dunham/PA

A 2014 study by Dr Michael Hutchison at the University of Toronto, came to somewhat different conclusions.

That research involved analysing video records and competition data for 844 Ultimate Fighting Championship (UFC) fights from 2006 to 2012, in order to measure the prevalence of head trauma in MMA.

It used knockouts (KOs) and technical knockouts (TKOs) after a sequence of repeated blows to the head, as something of a proxy for diagnosed head trauma and concussion – what it called “match-ending head trauma.”

Here’s what it found:

  • The KO rate was 6.4 per 100 athlete-exposures (12.7% of all matches)
  • The rate of TKOs with repeated head blows was 9.5 per 100 athlete-exposures (19.1% of all matches)
  • The combined “match-ending head trauma” rate of 15.9 per 100 athlete-exposures in MMA was higher than previous studies found for boxing (4.9) and kickboxing (1.9).

Hutchison acknowledged that there was some weakness in his methodology, because (unlike Shelby Karpman’s study) it doesn’t involve an actual diagnosis of head trauma.

Instead, it is based on the principle that a knockout “meets the criteria for a concussion” and a TKO preceded by a flurry of punches to the head (to the point that a referee considers a fighter unable to defend himself and ends the match) is “highly suggestive of a brain injury.”

On the other hand, Hutchison also claims the rate of match-ending head trauma that he found probably understates the overall prevalence of head trauma, because he only did detailed video analysis on the moments leading up to a KO or TKO, and some concussions do not have visible effects.

Finally, the point of comparison for boxing in this research was a 2002 study which used an entirely different methodology – post-fight medical exams as opposed to video and match analysis.

By contrast, a 2006 study found that 6.4% of MMA matches ended in knockout, while that number was 11.6% for professional boxing.

Its author, Dr Gregory Bledsoe from Johns Hopkins University, argued that MMA was a safer sport because, along with the KO, TKO and judges’ decision present in boxing, an MMA fight could also end via choke-out and tap-out.

As a combination of several martial arts, MMA also involves grappling, wrestling, leg sweeps, and so on – all of which places less of a premium on blows to the head.

(Although it could also be argued that at the higher levels of MMA, fighters are rewarded, including financially, for knockouts).

Conclusion

UFC 189 Mixed Martial Arts Source: Associated Press

This is a tricky one, mostly because the youth of mixed martial arts as a sport means there is a relative dearth of proper scientific research comparing its effects to boxing and other combat sports.

Based on the evidence available at the moment, there appears to be something of a consensus that MMA does carry a higher risk of injury in general.

However, the evidence is mixed on which sport has the highest risk of serious injury – in particular traumatic brain injuries.

And since these are the injuries that carry the highest risk of serious long-term damage, as well as death, more weight should be given to this aspect of the debate.

The relative youth of the sport again means a lack of data on the long-term comparative effects of repeated concussions among retired MMA fighters, including the insidious and very serious disease chronic traumatic encephalopathy (CTE).

There is evidence to support the proposition that professional boxing is more dangerous than mixed martial arts, and evidence to the contrary.

So, for now, we rate the claim Half-TRUE.

Send your FactCheck requests to factcheck@thejournal.ie

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About the author:

Dan MacGuill

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