Mixed Martial Arts: Ringside Safety

Mixed Martial Arts: Ringside Safety

Anthony G. Alessi

Michael B. Schwartz


  • Mixed martial arts (MMA) is the fastest-growing segment of combat sports. Participants vary in age, weight, gender, and fighting styles. Combat sports are the only contests that are won solely on the basis of causing direct injury to the opponent. This diversity presents a challenge for the ringside physician.

  • Common styles of MMA combat include wrestling, boxing, kickboxing, Brazilian jiu-jitsu, karate, and Muay Thai.

  • There are both amateur and professional classifications but no unified governing body for the sport. Medical requirements for participation are based on individual jurisdictions without any uniformity.

  • The safety of the contest is heavily dependent on the competence of the ringside physician.


  • MMA contests consist of between two and five rounds, lasting 3-5 minutes.

  • The contest may be held in a cage or standard boxing ring.

  • A contest may end by knockout, submission (a fighter taps either his opponent or the mat three times), or technical knockout.

  • It is imperative that ringside physicians have the authority to end a contest at any time if they believe a fighter is too severely injured to continue. This is not a standard rule and should be explored by the physician before agreeing to participate in an event.


  • The responsibilities of the ringside physician are best divided into three phases: prefight, ringside, and postfight.

Prefight Responsibilities

  • The preparticipation examination (PPE) is a vital aspect in determining fitness, preventing deaths, and minimizing injuries.

  • The PPE consists of multiple evaluations including:

    • Review of previous fight results when available.

    • Collection and analysis of prefight medical requirements (Table 85.1). The medical requirements listed were developed by the American Association of Professional Ringside Physicians and the Association of Boxing Commissions.

    • Medical history.

    • Physical examination.

  • The medical history should begin with completion of a simple but comprehensive medical history form including:

    • Family history: sudden premature death, hypertension, diabetes, lipid disorders

    • Cardiac history: chest pain, syncope, dizziness

    • Pulmonary history: wheezing, shortness of breath, coughing

    • Medications: daily medications, anti-inflammatory medications, supplements

    • Surgical history: laser-assisted in situ keratomileusis (LASIK), orthopedic, neurologic

  • Physical examination: The prefight examination allows the ringside physician an opportunity to identify potential physical limitations.

  • The examination must be brief and directed. Variation from these criteria may lead to disqualification. Essential elements include:

    • Vital signs: blood pressure < 140/100 mm Hg, pulse < 100, afebrile.

    • Skin: look for surgical or traumatic scars, rashes

    • Visual acuity: < 20/40 bilaterally near or < 20/100 distant

    • Eyes: signs of radial keratotomy or LASIK procedures, cataracts

    • Ears: ruptured tympanic membranes

    • Nose: rhinitis, deviation

    • Throat/glands: exudate, lymphadenopathy

    • Respiratory: prolonged expiration, wheezing

    • Cardiac: arrhythmias, murmurs

    • Abdominal: distension, tenderness

    • Genitourinary: hernias, testicular exam

    • Musculoskeletal: range of motion, joint deformities

    • Neurologic: pupils, fundi, cognitive, motor, cerebellar, sensory

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May 22, 2016 | Posted by in SPORT MEDICINE | Comments Off on Mixed Martial Arts: Ringside Safety
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