The first one. This is a really good column in MMA junkie.
Q. I've been watching both Boxing and MMA for years. In the past year I can't help but notice that scar tissue seems to be much more of an issue in MMA. Is there a medical reason for this? It would seem professional boxers take many more punches to the face and orbital-bone area. On a recent broadcast it was even mentioned that Nick Diaz had surgery to remove his scar tissue and "file" down his orbital bones. I found this to be strange as I've not heard of such a thing before. I'm sure scar tissue must be an issue in both sports, but I've really noticed it becoming a very common issue in MMA and even visibly noticeable on the fighters and not so much when I watch boxing.
A. Scar tissue formation is the body's normal response to injury (cuts). Some people heal with more scar tissue than others (scar formers). In MMA vs. boxing, there are two distinct issues that favor a greater likelihood for cuts occurring in MMA contests. For on, MMA gloves have much less padding than boxing gloves. And two, elbows are legal in MMA. Since MMA combatants are much more likely to be cut, they are much more likely to develop scar tissue. The "healed" skin overlying scar tends to be thinner and more fragile than normal skin. Also the mere fact of having a lump of dense/hard scar tissue under that thin, fragile skin allows for the area to be opened up easier with the next violent blow. With each subsequent injury to the area, the problem may grow worse. In certain situations, a plastic surgeon may remove this dense build up of scar tissue and file down protruding bone in hopes of lessening the problem. Remember, cuts are bloody but not particularly dangerous.
Q. I'm sure you are aware of the recent changes made to the unified rules by the ABC. I was curious as to your thoughts on the definition of "back of the head" being "crown of the head down the centerline of the skull into the spine, with a one-inch variance to each side." Prior to this many officials had adopted the "headphone" guideline, meaning if someone were wearing headphones, the area behind the headphones would be considered the back of the head. Is the new definition by the ABC more dangerous to the fighters?
A. Unfortunately, this definition does not cover the area behind the ears known as the mastoid bones. I will not bore you with an advanced anatomy and physiology lecture, but let it suffice to say that damage to these structures can potentially cause significant long-term injury to your sense of balance. And with the area behind the ear being a legal target, a blow misplaced by as little as one inch could easily strike the neck with devastating consequences.
Let me paint a little picture. A tired opponent gets his or her back taken. Both hooks go in. He appropriately guards against the rear naked choke but the elbows start raining down from 12 o'clock (which is now a permitted blow) targeting the legal areas behind the ears. The vulnerable combatant is squirming trying to free himself.. Well we all can imagine where this is going.
The only safe area to the back of the head or the neck is none at all.
The back of the head should be defined as a region extending from the crown of the head down to the top of the shoulders and laterally to, but not including, the ears. No portion of the neck should be a legal target for blows of any kind while grounded.
Q. I have two sons, one in his early teens and the other about to enter his teen years. They are both big fans of the UFC and have expressed their interest in training MMA. They have both taken Taekwondo in the past without incident. My question is about the safety of youth MMA. Is it more dangerous for them to take part in? Should I make them wait until they are older?
A. Youth participation in MMA is currently a raging issue. Proper supervision is the key to safety. Children obviously have growing bones. The ends of the bones around joints (especially the elbow, hip and knee) have very important cartilaginous growth plates. When significant force is applied to the joints, the growth plates are at risk. Damage to a growth plate can affect subsequent growth. A growth plate fracture is potentially a big deal. No one wants his or her children to have very short, disfigured arms for the rest of their lives.
Submission techniques (for example, an arm bar) that apply force to these joints need to be monitored very closely by a properly informed/trained adult. When a submission technique is properly applied, the match should be immediately called. Children shouldn't be forced to tap out.
Also, concussions are a very serious and poorly understood issue in children. With this in mind, there should be NO blows of any kind to the head of a grounded opponent.
With these basic safety measures in place, I believe that competitive MMA is a reasonable activity for children older than 10 years of age. Children younger than 10 years old should only be allowed to train and develop a basic skill set.
Q. There seems to be a growing trend toward athletic commissions not allowing fighters to fight based upon their admitting to taken doctor-prescribed drugs prior to an upcoming fight. Just in the past few months, this has been the case for Joe Riggs, Tim Credeur and Nick Diaz with each using a different substance prescribed by their doctors to treat medical conditions. Each substance apparently appears on a banned-substance list for that state. What are your thoughts on this? Should athletes be penalized for taking his prescribed medication even if they are not considered performance enhancing?
A. I hope that we are not talking about the medicinal use of marijuana here. Usually these penalties/sanctions result from the use of prescription painkillers. The issue arises with the interpretation and application of the rules. Does "banned" mean off-limits under all circumstances? Or does "banned" mean off-limits unless I can find a doctor willing to write me a prescription for it?
In my opinion, banned substances should be strictly enforced with very little interpretation or exception. I don't really care if you have a prescription or not. Please believe me when I tell you that there are a lot of groupie doctors out there more than willing to give a famous, high-caliber athlete a prescription for damn near anything.
Time should be invested in serious, informed medical discussion defining the composition of the list of banned substances. Performance enhancing substances, precursors and narcotic pain relievers should be strictly banned. NSAIDs (ibuprofen, naprosyn, etc.) and glucocorticoids (cortisone) should be legal. Should fighters be allowed to compete injured while taking narcotic pain relievers, or should they be forced to heal sufficiently before they are allowed to compete? Clearly, I vote for the latter. Please remember with respect to narcotic pain relievers, training is one thing, but competing is quite another.
