Determinants and key indicators of concussion in combat sport athletes: a systematic review
DOI:
https://doi.org/10.47197/retos.v64.110631Keywords:
Combat sports, concussion, mixed martial arts, motivational symptoms, physical symptomsAbstract
Introduction: Combat sport athletes are more likely to suffer concussions because one of the goals is to knock out an opponent and apply blows during the fight. Objective: To analyze the mechanisms of concussion specific to combat sports and identify the most prevalent signs and symptoms that affect athletes after concussion. Methods: The PRISMA protocol was applied, searches were performed in electronic databases using the descriptors: Athletes, Fighting, Martial Arts, Combat Sports, Concussion, Brain Concussion, Traumatic Brain Injury, Physical Symptoms and Motivational Symptoms. The identification and peer selection process were performed using the Rayyan software. We then extracted the articles which met the eligibility criteria for qualitative analysis, using the Risk of Bias Used for Surveys tool. Results: A total of 912 articles were identified, 90 duplicates and 81 bibliographic reviews, leaving 65 articles for reading the abstracts. Of these, 46 were excluded according to the eligibility criteria, including 19 articles. Regarding exposure to concussion, 70.2% were related to the number of fights performed and 29.8% fighters. The sports modalities were 45.5% MMA, 18.2% boxing, 9.1% taekwondo, 9.1% karate and 9.1% kickboxing. The injuries found were divided into 27.2% traumatic brain injury and 72.8% concussion. According to the signs and symptoms identified, 55.2% were physical and 44.8% motivational. Conclusion: The frequency of fights is a determining factor for the incidence of concussions in combat sport athletes and the post-concussion symptoms showed significant physical and motivational manifestations, which represent barriers to the technical-tactical development of athletes.
References
Arriaza, R., Cierna, D., Regueiro, P., Inman, D., Roman, F., Abarca, B., Barrientos, M., & Saavedra, M. A. (2017). Low risk of concussions in top-level karate competition. British journal of sports medicine, 51(4), 226–230.
Barley, O. R., Chapman, D. W., & Abbiss, C. R. (2019). The current state of weight-cutting in combat sports. Sports, 7(5), 123.
Bennett, L. L., Stephen, S. J., Bernick, C., Shan, G., & Banks, S. J. (2020). Sex Moderates the Relationship That Number of Professional Fights Has With Cognition and Brain Volumes. Frontiers in Neurology, 11, 574458. https://doi.org/10.3389/fneur.2020.574458
Bernick, C., Banks, S. J., Shin, W., Obuchowski, N., Butler, S., Noback, M., Phillips, M., Lowe, M., Jones, S., & Modic, M. (2015). Repeated head trauma is associated with smaller thalamic volumes and slower processing speed: The Professional Fighters’ Brain Health Study. British Journal of Sports Medicine, 49(15), 1007–1011. https://doi.org/10.1136/bjsports-2014-093877
Bernick, C., Hansen, T., Ng, W., Williams, V., Goodman, M., Nalepa, B., Shan, G., & Seifert, T. (2021). Concussion occurrence and recognition in professional boxing and MMA matches: Toward a concussion protocol in combat sports. The Physician and Sportsmedicine, 49(4), 469–475. https://doi.org/10.1080/00913847.2020.1856631
Bin Zahid, A., Hubbard, M. E., Dammavalam, V. M., Balser, D. Y., Pierre, G., Kim, A., Kolecki, R., Mehmood, T., Wall, S. P., Frangos, S. G., Huang, P. P., Tupper, D. E., Barr, W., & Samadani, U. (2018). Assessment of acute head injury in an emergency department population using sport concussion assessment tool – 3rd edition. Applied Neuropsychology: Adult, 25(2), 110–119. https://doi.org/10.1080/23279095.2016.1248765
Bramer, W., & Bain, P. (2017). Updating search strategies for systematic reviews using EndNote. Journal of the Medical Library Association: JMLA, 105(3), 285.
Brown, D. A., Grant, G., Evans, K., Leung, F. T., & Hides, J. A. (2021). The association of concussion history and symptom presentation in combat sport athletes. Physical Therapy in Sport, 48, 101–108. https://doi.org/10.1016/j.ptsp.2020.12.019
Bryant, B. R., Narapareddy, B. R., Bray, M. J. C., Richey, L. N., Krieg, A., Shan, G., Peters, M. E., & Bernick, C. B. (2020). The effect of age of first exposure to competitive fighting on cognitive and other neuropsychiatric symptoms and brain volume. International Review of Psychiatry, 32(1), 89–95. https://doi.org/10.1080/09540261.2019.1665501
Cattaneo, C. (2021). Are athletes active in high-contact sports at risk of impaired executive functioning? A quasi-experimental study on competitive mixed martial arts (MMA) athletes. https://www.diva-portal.org/smash/record.jsf?pid=diva2:1561322
Claro, R. F. T., Junior, A. T., Cassola, A. R., Dutra, A. A., Fernandes, G. T., Campos, J. P. S., Salles, M. M. M., Nunes, N. L. A., Peruzzo, P. H. C., & Gomes, V. L. (2024). Analysis of cerebral concussion in combat sports. Seven Editora. http://sevenpublicacoes.com.br/index.php/editora/article/view/4410
Correia, W. R., & Franchini, E. (2010). Academic papers about fight, martial arts and combat sports. Motriz Revista de Educação Física, 01-09. https://doi.org/10.5016/1980-6574.2010v16n1p01
Curran-Sills, G., & Abedin, T. (2018). Risk factors associated with injury and concussion in sanctioned amateur and professional mixed martial arts bouts in Calgary, Alberta. BMJ Open Sport & Exercise Medicine, 4(1), e000348.
de Carvalho, G. N., da Silva Rego, R., Chagas, A., de Oliveira Schreiner, D., Teixeira, F. G., Antonietto, N. R., ... & Miarka, B. (2022). Women Brazilian Jiu-jitsu practitioners showed a higher incidence of concussion: an epidemiological analysis. Motricidade, 18(2), 151-155. https://doi.org/10.6063/motricidade.25225
Donnelly, R. R., Ugbolue, U. C., Gao, Y., Gu, Y., Dutheil, F., & Baker, J. S. (2023a). A Systematic Review and Meta-Analysis Investigating Head Trauma in Boxing. Clinical Journal of Sport Medicine, 33(6), 658–674. https://doi.org/10.1097/JSM.0000000000001195
Dretsch, M. N., Fauth, J., Moya, M. M., Connaboy, C., & Kontos, A. (2019). Modest utility of brief oculomotor test for concussion screening in military mixed-martial arts training. Brain Injury, 33(13–14), 1646–1651. https://doi.org/10.1080/02699052.2019.1658226
Fares, M. Y., Salhab, H. A., Fares, J., Khachfe, H. H., Fares, Y., Baydoun, H., Abboud, J. A., & Alaaeddine, N. (2021). Craniofacial and traumatic brain injuries in mixed martial arts. The Physician and Sportsmedicine, 49(4), 420–428. https://doi.org/10.1080/00913847.2020.1847623
Fernandes, J. R., Andrade de Brito, M., Brito, C. J., Aedo-Munoz, E., & Miarka, B. (2022). Technical-tactical actions of fighters specialized in striking, grappling, and mixed combat in the ultimate fighting championship®. Ido Movement for Culture. Journal of Martial Arts Anthropology, 22(2), 23–31.
Fernandes, J. R., de Brito, M. A., Ferreira, A., Pérez, D. V., Muñoz, E. A., Miarka, B., & Brito, C. J. (2024). Acute impact of mixed martial art bouts on cognitive function: A comparative study of regular and occasional sparring practitioners. Revista iberoamericana de psicología del ejercicio y el deporte, 19(4), 454-457.
Follmer, B., Dellagrana, R. A., & Zehr, E. P. (2019). Head Trauma Exposure in Mixed Martial Arts Varies According to Sex and Weight Class. Sports Health: A Multidisciplinary Approach, 11(3), 280–285. https://doi.org/10.1177/1941738119827966
Follmer, B., Varga, A. A., & Zehr, E. P. (2020). Understanding concussion knowledge and behavior among mixed martial arts, boxing, kickboxing, and Muay Thai athletes and coaches. The Physician and Sportsmedicine, 48(4), 417–423. https://doi.org/10.1080/00913847.2020.1729668
Förstl, H., Haass, C., Hemmer, B., Meyer, B., & Halle, M. (2010). Boxing—Acute Complications and Late Sequelae: From Concussion to Dementia. Deutsches Ärzteblatt International, 107(47), 835.
Giza, C. C., & Hovda, D. A. (2014). The New Neurometabolic Cascade of Concussion. Neurosurgery, 75(Supplement 4), S24–S33. https://doi.org/10.1227/NEU.0000000000000505
Hammami, N., Hattabi, S., Salhi, A., Rezgui, T., Oueslati, M., & Bouassida, A. (2018). Combat sport injuries profile: A review. Science & Sports, 33(2), 73–79. https://doi.org/10.1016/j.scispo.2017.04.014
Heath, C. J., & Callahan, J. L. (2013). Self-Reported Concussion Symptoms and Training Routines in Mixed Martial Arts Athletes. Research in Sports Medicine, 21(3), 195–203. https://doi.org/10.1080/15438627.2013.792082
Hutchison, M. G., Lawrence, D. W., Cusimano, M. D., & Schweizer, T. A. (2014). Head Trauma in Mixed Martial Arts. The American Journal of Sports Medicine, 42(6), 1352–1358. https://doi.org/10.1177/0363546514526151
Jackson, W. T., & Starling, A. J. (2019). Concussion evaluation and management. Medical Clinics, 103(2), 251–261.
James, L. P., Haff, G. G., Kelly, V. G., & Beckman, E. M. (2016). Towards a Determination of the Physiological Characteristics Distinguishing Successful Mixed Martial Arts Athletes: A Systematic Review of Combat Sport Literature. Sports Medicine, 46(10), 1525–1551. https://doi.org/10.1007/s40279-016-0493-1
Ji, M. (2016). Analysis of injury types for mixed martial arts athletes. Journal of physical therapy science, 28(5), 1544–1546.
Karpman, S., Reid, P., Phillips, L., Qin, Z., & Gross, D. P. (2016). Combative Sports Injuries: An Edmonton Retrospective. Clinical Journal of Sport Medicine, 26(4), 332. https://doi.org/10.1097/JSM.0000000000000235
Karton, C., & Hoshizaki, T. B. (2018). Concussive and subconcussive brain trauma: The complexity of impact biomechanics and injury risk in contact sport. Handbook of clinical neurology, 158, 39–49.
Khatib, A., Post, A., Hoshizaki, T., & Gilchrist, M. D. (2021). Brain trauma characteristics for lightweight and heavyweight fighters in professional mixed martial arts. Sports Biomechanics, 1–23. https://doi.org/10.1080/14763141.2021.1922740
Kirk, C., & Childs, C. (2023). Combat Sports as a Model for Measuring the Effects of Repeated Head Impacts on Autonomic Brain Function: A Brief Report of Pilot Data. Vision, 7(2), 39. https://doi.org/10.3390/vision7020039
Komatsu, T., Umeshita, S., Izumi, S., Ishibashi, T., Sato, Y., Aramaki, Y., Nakayama, H., & Koyama, Y. (2023). Traumatic brain injuries caused by knockout in Japanese amateur boxers: A questionnaire-based survey. Medicine, 102(44), e35810. https://doi.org/10.1097/MD.0000000000035810
Lota, K. S., Malliaropoulos, N., Blach, W., Kamitani, T., Ikumi, A., Korakakis, V., & Maffulli, N. (2022). Rotational head acceleration and traumatic brain injury in combat sports: A systematic review. British medical bulletin, 141(1), 33–46.
Lystad, R. P. (2014). Concussion injury in Olympic-style Taekwondo: A systematic review. J Int Assoc Taekwondo Res, 1(2), 1–11.
Malcolm, D., Papathomas, A., & Warden, C. (2023). Concussion in professional wrestling: Agency, structure and cultural change. Qualitative Research in Sport, Exercise and Health, 15(5), 585–600. https://doi.org/10.1080/2159676X.2023.2175898
McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., Cantu, R. C., Cassidy, D., Echemendia, R. J., & Castellani, R. J. (2017). Consensus statement on concussion in sport—The 5th international conference on concussion in sport held in Berlin, October 2016. British journal of sports medicine, 51(11), 838–847.
Neidecker, J., Sethi, N. K., Taylor, R., Monsell, R., Muzzi, D., Spizler, B., Lovelace, L., Ayoub, E., Weinstein, R., & Estwanik, J. (2019). Concussion management in combat sports: Consensus statement from the Association of Ringside Physicians. British journal of sports medicine, 53(6), 328–333.
Nudelman, G., & Otto, K. (2020). The development of a new generic risk-of-bias measure for systematic reviews of surveys. Methodology, 16(4), 278–298.
Ohhashi, G., Tani, S., Murakami, S., Kamio, M., Abe, T., & Ohtuki, J. (2002). Problems in health management of professional boxers in Japan. British journal of sports medicine, 36(5), 346–352.
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan—A web and mobile app for systematic reviews. Systematic Reviews, 5(1), 210. https://doi.org/10.1186/s13643-016-0384-4
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., & Moher, D. (2021). Updating guidance for reporting systematic reviews: Development of the PRISMA 2020 statement. Journal of clinical epidemiology, 134, 103–112.
Paizante, R. O., Carrenho Queiroz, A. C., Fernandes, J. R., Brito, M. D. A., Dos Santos, M. H., Aedo-Muñoz, E., Valenzuela Pérez, D. I., Nóbrega, O. D. T., Miarka, B., & Brito, C. J. (2024). Headgear increases protection against acute concussion symptoms in amateur Olympic boxers. Retos, 60, 405–412. https://doi.org/10.47197/retos.v60.106894
Pieter, W., & Zemper, E. D. (1998). Incidence of reported cerebral concussion in adult taekwondo athletes. Journal of the Royal Society for the Promotion of Health, 118(5), 272–279. https://doi.org/10.1177/146642409811800512
Scalia, P. (2015). Factors Associated With Head Trauma Among Professional Mixed Martial Arts Athletes. [PhD Thesis, Université d’Ottawa/University of Ottawa]. https://ruor.uottawa.ca/handle/10393/32979
Schlegel, P., Novotny, M., Valis, M., & Klimova, B. (2021). Head injury in mixed martial arts: A review of epidemiology, affected brain structures and risks of cognitive decline. The Physician and Sportsmedicine, 49(4), 371–380. https://doi.org/10.1080/00913847.2021.1885966
Stephen, S. J., Shan, G., Banks, S. J., Bernick, C., & Bennett, L. L. (2020). The relationship between fighting style, cognition, and regional brain volume in professional combatants: A preliminary examination using brief neurocognitive measures. The Journal of head trauma rehabilitation, 35(3), E280–E287.
Tapajčíková, T. (2022). Injuries in Sports Karate. Slovak Journal of Sport Science, 8(1). https://doi.org/10.24040/sjss.2022.8.1.16-23
Tiernan, S., Meagher, A., O’Sullivan, D., O’Keeffe, E., Kelly, E., Wallace, E., Doherty, C. P., Campbell, M., Liu, Y., & Domel, A. G. (2020). Concussion and the severity of head impacts in mixed martial arts. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 234(12), 1472–1483. https://doi.org/10.1177/0954411920947850
Warden, D. L., Bleiberg, J., Cameron, K. L., Ecklund, J., Walter, J., Sparling, M. B., Reeves, D., Reynolds, K. Y., & Arciero, R. (2001). Persistent prolongation of simple reaction time in sports concussion. Neurology, 57(3), 524–526. https://doi.org/10.1212/WNL.57.3.524
Zazryn, T. R., Finch, C. F., & McCrory, P. (2003). A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia. British journal of sports medicine, 37(5), 448–451.
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