Ask the Doc: Dr. Benjamin discusses the medical mystery of concussions (2024)

Believe it or not, I actually read the comments. I enjoy your opinions and learn a great deal from them.

As you can tell, I am a fan of MMA. And the fan in me, much like you, loves to see a good scrap. But the fan in me who wants to imagine the cage as similar to the Roman Coliseum and today’s elite combatant somehow akin to an ancient gladiator is unfortunately detrimental to the sport.

I must constantly attempt to control my “inner fan” and allow the physician in me an opportunity to see things a bit more clearly. My “doctor” brain gently reminds my inner fan that gladiators fought to the death, which in most civilizations is now considered just a bit barbaric. To the contrary, world-class athletes utilize their mind, speed, agility and technique to defeat rather than maim their foe.

Dr. Michael Clancy, past Chairman of the Department of Orthopedic Surgery at Temple University Hospital in Philadelphia, Penn. (my beloved mentor – so he’s off-limits in the comment section), used to commonly and not so gently remind us during training, “What a poor surgeon lacks in judgment and technique he makes up in brute force.”

Maybe – just maybe – this bit of time-honored wisdom has some application in the arena of MMA.

As always, if you have a question you’d like answered in a future column, my contact information is below.

Now, onto the questions…

Q. Exactly what is a knockout or concussion? (Part I)

A. We have all seen and love the knockout, but no one, including doctors and scientists (infinitely smarter than me), knows exactly what it is. We can tell you what it looks like, but we cannot test for it or describe it physiologically. That is part of what makes it potentially so dangerous. We know it’s a brain injury but to date have no test for it (forget MRI and CT) and don’t medically treat it very well.

A concussion is the body’s attempt to shut down non-vital functions (standing, thinking, bowel and bladder control, etc.) and redirect resources to the brain, heart and lungs after a minor closed-head injury most commonly caused by a blow.

By definition a knockout is a concussion, but a concussion doesn’t require a loss of consciousness (knockout). That’s the reason fighters get clipped and go down or get dazed briefly and then come back fighting. They probably suffered a concussion. They did not fall because they got knocked off balance, but rather, the blow caused their forebrain to take a break (concussion) and briefly shut down control of their muscles and equilibrium (kinda frightening if you look at it like that, huh?).

So, late on a Saturday night after I paid my $44.95, when that “ignorant $%#@ of a ref” prematurely tackles “my guy” off that sorry-ass fighter (who I can’t stand… have never met… has never disrespected me… and is brave enough to actually compete and not just talk or type about it) who’s about to catch the beating of his life — maybe I should pump my brakes and remember concussions are serious business.

Q. Why is a fighter suspended after a knockout? (Part II)

A. The fighter is suspended because we don’t understand well what actually happened to his or her brain. We do know that each concussion makes it easier to get the next. A person can slip from concussion into coma. Also, multiple concussions in rapid succession have caused death.

The question is: when is it safe for a concussed fighter to return to contact?

Who knows for certain? As a physician or governing body, you’ve got to base it on something. Usually we wait until all symptoms have cleared (headache, confusion, dizziness, light and noise intolerance, nausea/vomiting, ringing in ears, mood disturbance, etc.). Unfortunately, this method is very subjective and dependent on an athlete, who wants to quickly return to competition (and in many instances their livelihood), being honest and forthright about the true state of his condition. Obviously, it’s not the ideal method.

The state-of-the-art solution is what’s called “neurocognitive” or” psycho-motor” testing (as now required in the NFL).

Simply put, at the beginning of the season, each athlete takes a computerized test that assesses and scores his ability to solve simple word problems, short-term memory, spatial relationships, fine motor movements and other things. Each healthy athlete’s score is archived just in case he suffers a concussion during that year. After being concussed or a concussion is suspected, the athlete cannot return to contact (including training and sparring) until he retakes the test and matches his specific “healthy score.” Each person is compared to himself when healthy — not some standardized “normal” value that may or may not have any significance for his specific situation.

In closing, I want to give a free bit on information. For an excellent mouth guard that seems to significantly reduce the incidence of concussions in contact/combat athletes, check out www.mahercorlabs.com. (And no, The Junkie and I don’t get a penny from them. Damn!)