No More Monkeys Jumping on the Bed: TBI and Martial Arts

“Five little monkeys jumping on the bed.
One fell off and bumped his head.
Called the doctor and the doctor said,
“No more monkeys jumping on the bed.”

I like to watch boxing and the occasional MMA match (which are more and more disappointing to watch- sometimes the striking and awareness looks about as developed as something I’d see in a grade school fight) but I have to confess that I feel a certain guilt each time I tune in. Combat sports, by nature, involve heavy physical contact. In the case of boxing and MMA, the majority of that contact is directed at the head. And every time one of those guys gets hit in the head, that grey-pink stuff inside of it gets sloshed around. When watching sports, boxing/MMA bouts, and action movies, we tend to become desensitized to the fact that this sort of repeated head trauma is extremely dangerous, and is itself the cause of a serious, but often invisible injury.

As martial artists, whether traditional or non-traditional, hobbyist or competitive athlete, we are also exposed to a higher risk of concussion and brain injury. Even non-contact schools involve feet and fists moving at speed towards the head and face, and accidents are easy to come by in large classes of mixed skill levels. In a setting where moderate contact, take downs and chokes are included in free sparring contexts, the risk multiplies. Full contact striking and take downs within free sparring contexts multiplies the risk even further. However, this risk often goes unacknowledged by teachers and participants. I’ve had several conversations with high school and college aged male athletes and martial arts students who take a disturbingly cavalier attitude towards concussions and the contact that causes them- “It’s part of the sport/training”, “it wasn’t that serious because coach/the ref put me back in after I got up”, “I get knocked out all the time, it’s no big deal, I can take it” etc. Obviously, there should be no place in amateur sports participation or martial arts training for this attitude, yet it still persists in many places.

In the case of professional athletes, the stakes are admittedly different. Boxing matches and UFC fights are between individuals who have trained for this level of competition, and who presumably understand and agree to the risks inherent in competitive full contact fighting. Watching two people who are being paid to kick the living shit out of each other is a different matter entirely than watching someone get hit in the head in a martial arts class, tournament or other amateur sporting event. But a very large grey area has emerged when it comes to the long-term effects of repeatedly being elbowed, kneed and kicked in the head in a UFC style match (to be fair, full contact Kyokushin style karate matches, real Muay Thai and bare knuckle fights also produce repeated concussions, but none of these have spawned the appeal that the UFC has in the U.S.). And when one considers that droves of people are attracted to amateur practice of MMA because it is touted as being “superior” to all other martial arts, one must also wonder how much of the accepting attitude of professionals towards the contact that causes brain injury goes along with it.

The simple fact is that every hard jolt sent through that blob of tissue that we call the brain damages it. And causing damage to the brain can (or more realistically, will) negatively affect your quality of life. This animation (courtesy of the U of Penn and A.D.A.M.) is the best tool that I’ve seen for giving viewers a visual representation of what a knock to the head does to the organ inside of it. As a society, we often forget that this organ is who we are. Everything about us, from breathing and sleeping to personality and memories, happens in the brain. Everything. Damage the brain, and you run the risk of damaging some aspect of your life. And it doesn’t take much to make this damage very serious or permanent. In the case of mild concussions, this might manifest as a few days or irritability, forgetfulness or other mental disruptions. But in the case of more serious concussions, or repeated mild to moderate ones, the damage begins to add up quickly, and the after effects become more severe and permanent. A neuropsychologist once cautioned me that “with brain injuries, one and one do not equal two- the effects are synergistic and unpredictable, so two concussions might produce damage far worse than either single injury.” Better awareness of the seriousness of Traumatic Brain Injury (a term which includes concussions, but far better communicates the reality of brain injury) is slowly emerging in America, thanks to efforts by the CDC and the fact that the Iraq war has produced a terribly high rate of soldiers with serious brain injuries. Despite this increasing awareness, amateur fans of MMA-style competitive fights seem to be oblivious to the serious risk of sustaining a brain injury in such activities. Consider this remark on the topic made on a popular karate forum:

“Any sport has its dangers, some more then othrs eg boxing, kick boxing, full contact martial arts. Its (ed: brain injury) a risk the dedicated student has to take..“

This statement may be applicable to a dedicated professional competitor, but the person making it is an amateur who trains for fun. Dedication to training is admirable, but willingness to sustain serious injury in the pursuit of a fuzzy ideal of dedication is both naive and dangerous. Again, for a pro competitor in the ring, brain injury is a risk that he or she is taking in exchange for payment; but this is not the same thing as an amateur student or weekend warrior who trains without monetary compensation or medical care. As the debate over MMA vs. “traditional” martial arts rages on, we must consider the risks involved in full contact competition in this light. For that matter, those of us who engage in karate, kung fu, Judo, etc… must also consider the risks that we are willing to expose ourselves and others to in the course of our training. Occasional bumps on the head, black eyes and fat lips are one thing, and are to be expected if one engages in vigorous training that aims to be realistic. But if we keep in mind that this sort of training is a different thing altogether from what goes on in UFC (or other NHB/full contact style) matches, the line between vigorous and unacceptably dangerous is very clear.

I’m unfortunately very familiar with the aftermath of concussions and head trauma. I’ve sustained a number of them over the years from violent assaults and one in particular from a very, very nasty car accident. The car accident nearly killed me, and not a day goes by that I am not amazed to be alive and well instead of paralyzed, a comatose vegetable, or dead- just a few centimeters difference in any direction would have placed me into one of those categories. So I have to temper my love of mixing it up in hard sparring and training with the reality that I am already living with serious side effects from previous TBIs, and another one must be avoided at all costs. Fortunately, I train with people who respect this boundary. We do train very hard, and have often earned the disapproval of other karate groups because of how “rough” some of it might appear to be. But I cannot envision anyone within TKRI intentionally putting them self or another at risk for a TBI or other serious injury. While accidents can and do happen, our group’s first priority in training is to take care of each other. If training negatively affects our health and ability to enjoy the rest of our lives, what’s the point?