Photo courtesy of Dr. Benjamin
Leading spinal and orthopedic surgeon, Dr. Johnny Benjamin, discusses fighter head trauma and TRT use in MMA.
The constant fear of losing your job is a heavy cross to bear. The MMA landscape is precarious at best, and a bad performance leading to a loss can mean a pink slip. The result of such pressure can be seen in balls out performances like the one we saw with Matt Grice vs Dennis Bermudez, or in the ever increasing instances of testosterone use, whether it be under an exemption, or without, the latter being contraindicated in the rule set.
With both of these examples, a question of safety comes into play. TRT can give an athlete an unfair edge, and is considered as cheating by most. Performances like the Grice / Bermudez bout, or more recently, the Silva / Stann bout, bring to mind issues of continuous head trauma sustained during fights which can lead to CTE.
I recently conducted a long interview with Dr. Johnny Benjamin, a leading board certified orthopedic surgeon who also carries a specialty in spine surgery. He has worked with athletes for many years and is a Medical Advisory Panel member of the ABC. In addition to his professional credentials, Dr. Benjamin also actively campaigns for VADA in an effort to level the playing field for athletes.
The first part of this interview was posted Saturday, where he opined about the safety of female athletes that might face transgender female fighter, Fallon Fox. That story can be found here. This final post is dedicated to his opinions on TRT and head injuries in MMA. Here's what he had to say:
SD: What are your thoughts on the series of punches Stefan Struve ate that not only dislodged a tooth, but fractured his jaw?
JB: When I saw it, I wasn't really surprised, because when I see a fighter get tired and start mouth breathing, trying to get as much air as possible into their lungs, I always think it's just a matter of time before they get their jaw broken. If you're not clenched down on that mouthpiece, you're very susceptible to what happened. We all know that Mark Hunt punches like a mule kicks, so it wasn't surprising at all, the outcome of that fight.
SD: How long would you personally recommend that Struve stay away from combat activity, considering the severity of his injuries?
JB: Many people think, and Stefan will probably think, 'The doctor said I'm good to go, so I'll get right back in the gym and go at it', but, even though we're great at healing bones, it's not so easy to heal the brain. How many times has he been knocked out? I know he's a young man, but he's been knocked out more than a few times.
At some point, someone really needs to ask the question, should he still be fighting? That many concussions, so quickly, and at this young age ... a person has two types of age, chronological and physiologic age. Stefan's license may say he's 25, but in physiologic years, he's much, much older than that, with all the concussive force that he's sustained.
I'm sure nobody will like to hear this, but Stefan Struve really needs to think about retiring. If it's not him that will make that decision, then Dana White needs to start talking to him about retiring. The question out there is how many sustained concussions is too many, and according to the latest literature that's coming out, the answer is starting to look like it's somewhere between two and three. That's where you start having permanent changes.
Knowing that data, Stefan is definitely beyond that number (Stefan has been TKO / KO 5 times), and someone really needs to initiate serious discussion with either him or his promoter that he probably needs to do something else for a living.
JB: Anybody who loves fighting, loves Wanderlei Silva. You just can't not like Wanderlei. It's impossible. Once again, if you like human beings, if you like people who can still remember where they put their car keys or the names of their kids, Then you should have hope that there's a life after fighting for Wandy, because he won't fight forever, and he won't live a long life if he continues doing what he's doing.
The types of concussive force that he's sustained can also lead to depression, which can make it a pretty difficult life in the future. I've been saying it for a few years now, Wandy, I love you, but please stop. Please retire.
SD: What about Brian Stann? He was knocked down, blasted hard several times, and eventually knocked out. Would that type punishment, for him or Wandy in that one fight, be enough to constitute multiple concussions?
JB: You can absolutely receive multiple concussions in a single fight. That is one of the most dangerous instances. There's something called second impact syndrome, where after a concussion, you receive another one in a short time, and you can die from it.
The thing about Brian Stann is that you have to wonder if he's received any concussions while he was in the military. Has he been involved in any blast situations with IEDs or things like that? Lots of data we're receiving now, regarding concussive force, is coming from soldiers.
SD: What's your opinion of guys with very solid chins that can take enormous punches, seemingly without being phased?
JB: The funny thing about that is, you have a solid chin until one day, you just don't. Chuck Liddell is a prime example. You could beat that man with a baseball bat, and he wasn't going anywhere. Then, all of the sudden, something changed, and he couldn't take it anymore.
Over time, the punishment accumulates. It's not only in the fights. Think about all the training these fighters do. All those blows count also. If you want to look at a different sport, look at Roy Jones, Jr. Roy got clipped many times in his career, and he wasn't going anywhere, but after Antonio Tarver got him, Roy got knocked out several times since. Something changed. People like to say, 'Oh, he has a granite chin.' You have a granite chin until you don't anymore.
SD: What do you think of the new PET (positive emission tomography) scan research regarding CTE and do you think use of it can be applied practically for combat sports?
JB: Well, it's not widely available, and it's very expensive, so I don't see it being used for screening purposes, but what is exciting about it and where it can be useful, is that in the ongoing research, we can start to determine guidelines that say, 'After this many concussions, in this period of time, a certain amount of time needs to pass and tests need to be administered before a person can return to contact.'
All this research that's coming out will hopefully allow us to set better guidelines on how much damage is too much, and what are the things we need to look for in a person that may be showing the effects of too many wars.
What I would like to see with the bigger promotions like the UFC and Bellator, is the use of neurocognitive testing. All the major sports outside of MMA use it. It's basically a computerized test that you take every year before concussions are sustained. You go online, and take this test, and a baseline is archived away. If they receive a concussion, they take the test again, and until they can reproduce that score, they're not allowed to get back to contact training or competition.
SD: What are your thoughts on Vitor's secrecy about using TRT leading up to his last fight?
JB: I think Vitor is a great fighter, but should TRT be allowed in a combat sport? Absolutely not. Any way you look at it, cheating is cheating, whether it's with a doctor's note or not. Testosterone is the original anabolic steroid. Bearing that in mind, if we say anabolic steroids are banned substances under our rules, how is it all the sudden legal with a doctor's note?
It's legalized cheating. They've created a loophole for various reasons, most of them monetary, to allow people to legally cheat. Some states even let you cheat more than other states, Nevada especially.
People say that there may be reasons their levels can be low. Let's talk about those reasons. One is that they were born that way. That's possible, but highly unlikely, because it's very hard for me to believe that a person could go through puberty with low testosterone, never have it treated, and subsequently ascended to the lofty heights of a world class athlete in MMA with such a deficiency that you can't produce muscle mass. How did you ever become such an elite athlete with low testosterone?
The next theory is that the reason they have low test is because of all the head trauma they sustained. Now they are brain damaged, and their pituitary glad is injured, so therefore they don't produce enough test. That's never really been shown in combat athletes, but it has been shown in soldiers returning from war. The thing is, if your argument is that you have brain damage, should brain damaged fighters be allowed to compete in MMA?
SD: The rules seem to be a little unclear about who gets an exemption. Overeem was not allowed an exemption because he had been busted in the past for testing positive for a banned substance, yet they gave other fighters exemptions that had also tested positive in the past. What do you make of that?
JB: If they have low testosterone from prior steroid use, that prohibits you from getting a TUE. The thing is, people don't want to treat the use of testosterone as a steroid in the traditional sense. Guess what, if you used test in the past without a TUE, you should not be given one now. A rule that is not exercised uniformly and fairly is no rule at all. Let's make it simple and close the loophole altogether. You can't use testosterone under any circumstances. Problem solved.
SD: What do you think about Dana White's about face regarding TRT use? Is he being more approachable to you regarding VADA testing?
JB: [laughs] No, he's not more approachable at all, but I personally like the evolution and enlightenment of Dana White. I thought he was on the wrong side of the argument at one time, but now, over time, and with some better education, I think he's coming down firmly against TRT. I respect that enlightenment. Just because you were once on the wrong side of an argument doesn't mean that you can't learn and come over to the right side of it. I've got no problem with that at all.
The real question is, now that he talks it, what's he going to do about it? He says there's going to be more stringent testing on these guys with the TUEs, but what about the guys that don't have them, and are just cheating outright? Are you testing the Hell out of them, too?
People say it's the commission's job, but they really don't have the resources to police these guys that well. If Dana is going to 'test the shit out of these guys', then why not test the shit out of all of them or just not allow TRT in his house anymore. He should just say, 'It's a privilege to fight in the Octagon, not a right. If you want to fight there, you're not going to fight on TRT. I don't care what buddy of yours happens to be a doctor, writing your prescriptions, you're not going to use it in the UFC.'
You can follow Dr. Benjamin via his Twitter account, @DrJCBenjamin