Care of the Mixed Martial Arts Athlete Rance McClain, DO Associate Dean, Clinical Sciences William Carey University College of Osteopathic Medicine Learning Objectives

• Apply the PPE to MMA athletes • Understand PPE situaons unique to MMA athletes • Idenfy condions which increase athlete risk in compeon • Idenfy condions which preclude compeon • Be able to address athlete health between events

Mixed Martial Arts (MMA) History

• Ancient Greek sport of Pankraon • Contested in the early Olympic games • Combined striking and wrestling • 19th century boxing matches oen looked more like modern MMA unl rules emerged • Bartsu(England): judo, jujitsu, boxing, kickboxing and sck fighng • Merikan (Japan): “american fighng” KO/TKO, submission victories, rounds

Mixed Martial Arts (MMA) History

• Vale Tudo (anything goes) • Brazilian fighng compeon • “no holds barred” style of combat • Gracie challenge • Gracie family would challenge anyone to compeon, oen held in garages or gyms • Became famous for being able to beat much larger or stronger opponents via submission due to talent in Brazilian Jujitsu Mixed Martial Arts (MMA) History

• Ulmate Fighng Championship • Started in 1993 with first event in Denver, CO • Touted as an event to answer the queson of what fighng style was superior to all others • Competors came from boxing, wrestling, sumo wrestling, kickboxing, boxing and Jujitsu backgrounds • Won by Royce Gracie What is an MMA athlete

• Modern MMA athletes are skilled in all areas of combat sports parcipaon • Boxing • Kickboxing • Wrestling/Grappling • Jiu Jitsu • Grappling • Karate/Taekwondo • Muay Thai

Where does a Doctor fit in?

*Cauon: Some images and videos contained in the PowerPoint show injuries sustained by combat sports athletes and can be considered graphic in nature

My Experience in MMA Coverage

• Covered my first MMA event in • Lead Ringside Physician for 2006 • Ulmate Fighng Championship • Over 400 events (UFC) • Bellator MMA • Over 6,000 athletes • Invicta Fighng Championship • Strikeforce • M-1 Global • Titan Fighng Championships • Resurrecon Fighng Alliance • Victory Fighng Championships • ISCF World MMA Tournament MMA Research

• Injury Profile of Mixed Maral Arts Competors • McClain, Rance; Wassermen, Jason; Mayfield, Carlene; More • Clinical Journal of Sport Medicine . 24(6):497-501, November 2014. • 711 Bouts/1422 parcipant database over 3 ½ years • This data was discussed with the Ulmate Fighng Championship during their efforts to get MMA legalized in the state of New York Prior to the Event

• Prebout physical examinaon • Conducted just prior or just aer contestant weigh-ins • Usually done the day prior to the event itself for professional bouts • Comprehensive physical examinaon • Vital signs and general appearance • Physical examinaon Prior to the Event

• Vital signs • Varies by state or organizaon • Resng systolic blood pressure greater than 150, diastolic blood pressure greater than 100 • General appearance • Looking for deformies, general well-being (parcularly signs of excessive dehydraon), signs of Marfan’s syndrome Prior to the Event

• Eyes • Fundoscopic exam and test of acuity such as the Snellen eye chart • Worse than 20/200 uncorrected (20/60 corrected) in either eye or 20/60 vision bilaterally • So contact lens are ok • Risk aer eye surgery (RK), newer procedures are not a contraindicaon, but athletes are advised of risk involved • Scar ssue or laceraons around the eyes • Ears, Nose and Throat • Otoscopic exam • Evidence of acute nasal bone fracture Prior to the Event

• Cardiovascular Exam • Aenon should be paid to any cardiac abnormalies, especially tachycardia, dysrhythmia, systolic and diastolic murmurs or cardiac enlargement • Resng heart rate must be below 100 BPM to qualify • Respiratory system • Looking for signs of acute or chronic infecon or dyspnea • Back and Chest • Looking for deformies or areas of tenderness • Must include examinaon of the ribcage with compressive pressure to assess for recent injuries to the ribs Prior to the Event

• Abdomen • Examine for hernias, masses, organ enlargement • Hepatosplenomegaly examinaon • Genital-urinary system • A formal exam is generally not required • In a doctor’s office further evaluaon is appropriate if a large hernia is suspected. Although a unilateral tess is not disqualifying in itself, it could prompt discussion; the same is true for one kidney or for breast implants Prior to the Event

• Musculoskeletal system • Congenital or acquired deformies, range of moon, joint sffness or laxity, signs of inflammaon or injury • Boxer’s fracture, muscle strength tesng • Neurological Examinaon • Exam of the cranial nerves, as well as evaluaon for tremors, locomotor impairment, dysarthria, reflexes. • Gait /balance/posture disorders • Evaluaon of mental status by observaon or tesng; likewise, for mental deficiencies and psychiatric disorders Day/Evening of the Event

• Arrive early and make sure to follow up on anything from the weigh ins or other pre-event acvies • Understand how the event will take place in the facility and what is available to you • Make sure to note any changes to the event • Note the safety aspects to the event setup • Go over your event plan with anyone helping on medical coverage so everyone knows their role • Meet with EMT/Paramedic crew EMT/Paramedic Plan

• Verify that the ambulance is dedicated to the event and the venue • Idenfy the locaon where the Paramedics will be staoned at the event and how you will nofy them if you need them • Make sure they have the necessary equipment • Stretcher, spine board, cervical collar, oxygen and airway management equipment • Clear path to the ring/cage and out of the venue • No stairs, elevator, obstrucons, proper crowd control • Verify what hospital injured competors would be taken to if injured • Must have neurosurgery capabilies if head trauma injury Examination/Treatment Room

• Verify you have adequate facilies to deal with injuries that do not need transported to the hospital • Quiet • Adequate lighng • Adequate space • Organize equipment Final Meeting with Referee/Commission

• Make sure you have a good working relaonship with your referee • They should trust your opinion and seek your advice if a contestant appears injured • Discuss event concerns with the commissioner • Inspect the ring/cage for safety concerns Meet with “cutman/woman” Enjoy the View of Great Athletes Competing