An athlete with a spinal cord injury performs combat sport training
Exercising using combat sport skills
An athlete with an excellent stroke recovery is warming up
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 .
Paralympic judo men’s and women’s weight classes
<60 kg (extra-lightweight)
60–66 kg (half-lightweight)
66–73 kg (lightweight)
73–81 kg (half-middleweight)
81–90 kg (middleweight)
90–100 kg (half-heavyweight)
>100 kg (heavyweight)
<48 kg (extra-lightweight)
48–52 kg (half-lightweight)
52–57 kg (lightweight)
57–63 kg (half-middleweight)
63–70 kg (middleweight)
70–78 kg (half-heavyweight)
>78 kg (heavyweight)
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 .
ABC unified rules of boxing 
1. Each round shall consist of a three (3) minute duration, with a one (1) minute rest period between rounds
2. The referee is the sole arbiter of a bout and is the only individual authorized to stop a contest
3. All bouts will be evaluated and scored by three (3) judges
4. The 10-point must system will be the standard system of scoring a bout
5. The mandatory eight (8) count after knockdowns will be the standard procedure in all bouts
6. All professional boxers are required to wear a mouthpiece during competition. The round cannot begin without the mouthpiece. If the mouthpiece is dislodged during competition, the referee will call time and have the mouthpiece replaced at the first opportune moment, without interfering with the immediate action. Points may be deducted by the referee if he feels the mouthpiece is being purposely spit out
7. There is no standing eight (8) count
8. There is no three (3) knockdown rule
9. A boxer shall receive a twenty (20) second count if the boxer is knocked out of the ring and onto the floor. The boxer is to be unassisted by spectators or his/her seconds. If assisted by anyone, the boxer may lose points or be disqualified with such a decision being within the sole discretion of the referee
10. A boxer who has been knocked down cannot be saved by the bell in any round.
11. If a boxer sustains an injury from a fair blow and the injury is severe enough to terminate the bout, the injured boxer shall lose by TKO
12. Injuries sustained by fouls (referenced in Table 27.3)
A. Intentional fouls.
1. If an intentional foul causes an injury and the injury is severe enough to terminate the bout immediately, the boxer causing the injury shall lose by disqualification
2. If an intentional foul causes an injury and the bout is allowed to continue, the referee shall notify the authorities and deduct two (2) points from the boxer who caused the foul. Point deductions for intentional fouls will be mandatory
3. If an intentional foul causes an injury and the injury results in the bout being stopped in a later round, the injured boxer will win by technical decision if he is ahead on the score cards; and the bout will result in a technical draw if the injured boxer is behind or even on the score cards
4. If the boxer injures himself while attempting to intentionally foul his opponent, the referee will not take any action in his favor, and this injury shall be the same as one produced by a fair blow
5. If the referee feels that a boxer has conducted himself in an unsportsmanlike manner, he may stop the bout and disqualify the boxer
B. Accidental fouls
1. If an accidental foul causes an injury severe enough for the referee to stop the bout immediately, the bout will result in a no decision if stopped before four (4) completed rounds. Four (4) rounds are complete when the bell rings signifying the end of the fourth round
2. If an accidental foul causes an injury severe enough for the referee to stop the bout after four (4) rounds have occurred, the bout will result in a technical decision awarded to the boxer who is ahead on the score cards at the time the bout is stopped
a. Partial or incomplete rounds will be scored. If no action has occurred, the round should be scored as an even round. This is at the discretion of the judges
13. A fighter who is hit with an accidental low blow must continue after a reasonable amount of time but no more than five (5) minutes, or he/she will lose the fight
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) .
MMA unified rules 
1. Head butting or striking with the head in any manner
2. Eye gouging of any kind
4. Hair pulling
5. Fish hooking
6. Groin attacks of any kind
7. Placing a finger into any orifice or into any laceration of your opponent
8. Small joint manipulation
9. Deliberate strikes of the spine or back of the head
10. Throat strikes of any kind, including, without limitation, grabbing the trachea
11. Clawing, pinching, or twisting the flesh
12. Kicking the head of a grounded opponent (grounded: more than just the soles of the feet on the ground)
14. Pile-driving your opponent into the mat
15. Purposely throwing your opponent out of the ring or caged area
16. Holding the shorts or gloves of an opponent
17. Engaging in any unsportsmanlike conduct
18. Holding the ropes or the fence
19. Attacking an opponent on or during the break
20. Attacking an opponent who is under the care of the referee
21. Attacking an opponent after the bell has sounded the end of the period of unarmed combat
22. Disregarding the instructions of the referee
23. Timidity, including, without limitation, avoiding contact with the opponent
24. Interference by the corner
25. Smothering (hand cupped over opponent’s mouth)
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) .
1. Mouthpiece (often must be approved by ringside physician)
2. Gloves (fingered or fingerless depending on the discipline)
3. Groin protection for males
4. Chest protection for females
5. Head and ear protection (headgear should cover the eyebrows when properly fit)
6. Pads over elbows, knees, or shins
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 .
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 .
Role of the Physician
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.