Matt Pitt Explores Dementia Pugilistica and Its Relationship to Mixed Martial Arts


Dr. Matt Pitt is back on with his inimitable column "Fistic Medicine". This time he takes a look at Dementia Pugilistica or Punch Drunk Syndrome. He makes several points about what is now known as Chronic Traumatic Encephalopathy (CTE) - the injury applies to rugby and football players as much as boxers, and that this syndrome is not an accelerated form of Alzheimer's as some suggest - before turning his attention to MMA:

It is true that there is compelling evidence that MMA is safer than boxing. But "safer" is not safe. MMA fighters are starting younger, are enticed by the money involved to fight longer and eventually MMA will have a cohort of neurologically impaired veterans of its own. With the overwhelming medical, scientific and epidemiologic evidence that a career worth of head blows leads to CTE in one out of five fighters, the moral imperative for some meaningful change is inarguable. The sport is too good not to be better.

Unfortunately, even if the need for greater safety is clear, what actually can be done to lessen the danger of CTE in combat sports is less certain. Football or rugby can adapt new equipment or rules to lessen the danger; fight sport has less clear options. In general, most of a fighter's head blows -- if not the most severe -- will occur during training, out of reach of promoters and athletic commissions. Heavily padded gloves may paradoxically worsen the danger. Headgear appears to be of limited use, may even be harmful and, in any event, is unpopular with fighters and fans alike.

Further, it is difficult to stop what cannot be demonstrated to exist in real-time. Pre-autopsy testing for MTBI is effectively unavailable. The commonly used CAT scan -- which does show bleeding -- does not show MTBI. Blood tests for evidence of brain injury are unreliable, and lumbar puncture testing is impractical. The long delay between traumatic insult in a fight and onset of symptoms means that a fighter who shows no quantifiable evidence of injury during his career can still develop CTE at a relatively young age.

* * *

Almost certainly the greatest barrier to preventing CTE in fight sport will be the tolerance of promoters and fans. Violence sells. A Google search for "Top 10 MMA Knockouts" produces 60,000 hits. A search for "Top 10 MMA well-fought three-round decisions" is strangely silent. The violence is promoted and well compensated, the harm it causes de-emphasized and well hidden.

But there is reason for hope: The Nevada State Athletic Commission vice chairman mentioned in this article who was so disturbed by Terry Norris' fight-related brain damage is a familiar figure to fight fans: Mr. Lorenzo Fertitta. I understand he has some pull in the world of MMA. We shall see how he uses it.

We shall see indeed. While present changes to protocol to improve safety at this juncture seem unclear, being vigilant about medical developments or proposed rules adjustments could pay dividends in protecting the fighters who make this business move. The quest to improve safety should be a defining principle of this sport's regulation, one which never expires. It should be part and parcel of the culture of MMA, particularly as the methods of delivering punishment and damage by increasingly capable athletes continues to expand.

And for those who may have missed it, I interviewed Dr. Pitt about the nature and extent of the injuries that sidelined Brock Lesnar for MMA Nation on 106.7 The Fan. It's not to be missed. Quite literally, there is no one within the MMA community who is currently writing that has command of these medical issues like Dr. Pitt. He is an invaluable resource and we are better and more capable of making informed choices or opinions by having his contributions.

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