Combat sports tend to be one-on-one with each opponent having supportive team members in their corner. Athletes are matched by weight. There is a separation between amateur and professional competitions. The competitors are required to weigh-in to confirm their appropriate weight on the day of or day prior to the fight.

The unified rules and regulations of boxing and MMA are well defined by the Association of Boxing Commissions (ABC) and the Ultimate Fighting Championship (UFC), respectively. In these organizations, athletes are classified based on the competitors’ weights, similar to the judo athletes in the Paralympics. Paralympic judo weight classes have been developed to establish competition against similarly sized athletes. Paralympic judo has established seven weight classes each in a Men’s and Women’s division and are listed in Table 27.1 [8].

Professional boxing rules in the United States are well defined by the ABC. The Association of Ringside Physicians observes the following unified list of rules in Table 27.2 [9].

The UFC organization uses 5 minute rounds. Matches may reach three rounds, unless a championship match is taking place. Then, five total rounds would be the maximum. Note that the rules below are forbidden acts in the UFC (Table 27.4) [10].

Combat sports are often hand to hand, but some sports, such as fencing, are considered combat sports as well as a pugilistic sport. Depending on the sport, the competitors may or may not wear specific protective equipment (Table 27.5) [11].

Apparel utilized in competition varies depending on the discipline utilized in the combative sport. Mostly, the athletes will wear some sort of shorts, briefs, singlet, gui, or judoka, with the addition of a protective bra for women. Boxing and wrestling permit shoes, where MMA does not permit footwear, due to allowing participants to utilize their foot as an offensive weapon [11].

An athlete’s supporting team members usually have a bucket, water bottle, towel, stool, and any other permitted items that are kept adjacent to the arena of competition and are brought into the ring or cage in between rounds [11].

The physician should be clearly identifiable and introduce themselves to inspectors/referees as well as any emergency medical staff. It is important for the physician to know the location of the local emergency department and trauma center. Prior to the event, the team physician and event coordinator should review an emergency action plan that would establish the best exit route from the ring or cage to the ambulance for transporting an athlete to the hospital efficiently. Furthermore, ringside physicians may require a stethoscope, sphygmomanometer, nasal speculum, ophthalmoscope, penlight, gauze, petroleum jelly, and gloves. Additionally, some venues or competitions will require an automated external defibrillator (AED) or cardiac life support kit, including a bag mask and oxygen, onsite. It may be required to have emergency medical services (EMS) on site and/or in the area with equipment for cervical spine stabilization. There should be equipment in preparation to provide airway management and possible ventilator support, should the fighter take a striking blow to the throat or neck.