Examining Concussions in MMA Part 2: Dr. Sherry Wulkan Talks Medical Protocol

via Sports Illustrated

Following the events of Strikeforce: Fedor vs. Silva I wrote about the oft overlooked issue of post-concussion safety for fighters with a strong focus on Andrei Arlovski. As I mentioned in that piece I will be discussion the concussion issue with a number of experts. After some minor delays in getting in touch with some of the experts I'm very happy to bring the second part in the series. While part one focused on my own feelings about the subject this part focuses of the aspects looked at by the involved medical personnel.

Dr. Sherry Wulkan is the lead ringside physician for the New Jersey Athletic Control Board. I've said in the past and maintain that New Jersey is one of the most well run athletic commissions in the country. Dr. Wulkan is a very educated professional when it comes to the sports of mixed martial arts and boxing. She took the time to answer some of my questions about the process with which fighters are evaluated before and after events. I'm going to skip any editorializing here to allow for Dr. Wulkan to provide her insight.

On the current state of how concussions are handled in the sport:

The Association of Boxing Commissions medical committee, with the support of the American Association of Professional Ringside Physicians, is currently in the process of drafting concussion guidelines for combat sports participants.
 
There will be a presentation at the next ABC Annual Convention. The meeting is scheduled to be held in Washington D.C., July 2011. 

At present, it is left to the discretion of individual Commissions as to what the post-fight follow-up post concussion/ KO should be. One of the ancillary issues to be discussed is how to better educate fight camps regarding the necessity for acknowledging and respecting head injuries that occur in sparring sessions, since the time spent actually competing is miniscule by comparison to the number of ring or cage hours required in preparation for an event.

On the procedure for following up on a knockout in a fight:

While the single punch knock out often seems more dramatic to fans than a three-round, ground -dominated "beat down", the damage incurred by the latter may oft times be more severe.  When examining a fighter in the cage or ring acutely, physicians look for the length of time before orientation to person, place and time returns, the motor and coordination skills of the fighter and the length of time between KO and return to complete coordination and motor tone, the responsiveness, or relative lack of responsiveness to verbal commands, and whether the fighter can open his/her eyes spontaneously or whether he/she needs to be stimulated to do so.
 
In the state of New Jersey, one of the ringside physicians escorts the combatant back to his dressing room (if transport to a hospital is not immediately required) and the fighter then undergoes a more in-depth assessment. Concussion protocols are explained to the camp and significant others, and a laminated Concussion Protocol card is offered to the person staying with the concussed fighter for the first twenty four hours. Oft-times we will ask an inspector to stay with the fighter for 20-30 minutes, so that if any change in mental status occurs, we can be alerted immediately.
 
A minimum of thirty days prior to return to activity is recommended and the participant is placed on national suspension. Depending on the Commissioned physician's findings, recommendations for CT, MRI scans, looking at both grey and white matter damage/MRA, and/or examination by a neurologist may be required prior to clearance. Depending on the findings, the Commissioned physician review group may decide to alter the time interval for follow-up testing for future clearances, rather than follow- the generic, mandated protocols for pre-participation evaluations.

And Dr. Wulkan gives her opinions for additional steps that can be taken to monitor the health of fighters:

Currently, there is no "magic number" of knock-outs that the state of New Jersey uses to deny licensure. However, win- loss records are scrutinized.
 
It is my feeling that periodic reviews of fight footage to assess reaction time, in conjunction with records of speech pattern, may be simple, inexpensive adjuncts to the formal medical testing currently utilized in the long term assessment of fighter safety. Fighters with consistent sequential losses by knock out or "wars" could be earmarked by Commissioners and all relevant information/testing could be sent to individual Commission neurologists and to the ABC Medical Committee for an objective third party position as to level of fitness to compete.
 
Please bear in mind that our recommendations will need to evolve as our understanding of concussions improve, and as our understanding of how better to prevent, and treat existing injuries refines. 

In part three of this series I'll be conducting an interview with concussion expert, author of Head Games: Football's Concussion Crisis and former pro-wrestler Christopher Nowinski.

One last thing: I want to make it clear that the reason I'm pursuing the concussion issue is not because I feel that our sport is barbaric. I simply think it is an issue that needs to be examined and understood by fans and fighters alike. From understanding can come change, not to the sport as conducted from bell to bell but to the way we approach long-term fighter safety.

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