Head injury, concussion and post-bout assessment
Guidance written for the people who examine fighters, reviews of how often head injury is recorded in competition, and one unvalidated proposal for a structured examination after a bout.
Research information, not medical advice. This page does not diagnose, screen or clear anyone to compete.
The sources on this page are of three kinds. Two are consensus statements from the Association of Ringside Physicians. Several are reviews and surveillance studies that count concussions among other injuries. One is a preprint that proposes a structured examination to be carried out after a bout.
Read each source for what it is. A consensus statement records what a professional society agreed. A count of recorded concussions depends on who was examining the fighters and how concussion was defined.
What the sources report
Concussion management in combat sports: ARP consensus statement
Neidecker et al., 2019. British Journal of Sports Medicine.
- Article type
- Professional-society consensus statement
- Studied
- Combat-sport concussion management; no new participant cohort.
- Status
- Published in a peer-reviewed journal
- The statement gives guidance for ringside physicians and others on managing a fighter with a concussion and on return to competition after a concussion.
- It states that concussion management in combat sports should be more stringent than in non-combat sports.
- It does not cover moderate or severe brain injury, such as intracranial bleeds, or neuroimaging.
Neuroimaging in professional combat sports: ARP consensus statement
Sethi et al., 2023. The Physician and Sportsmedicine.
- Article type
- Professional-society consensus statement
- Studied
- Professional combat-sport neuroimaging; no new participant cohort.
- Status
- Published in a peer-reviewed journal
- The statement sets out neuroimaging guidance for professional boxing, kickboxing and MMA.
- It addresses imaging before licensure, to identify higher-risk fighters, and imaging immediately after a bout.
- It notes that imaging requirements vary between jurisdictions and that no consensus guideline existed before it.
Head trauma in boxing: systematic review and meta-analysis
Donnelly et al., 2023. Clinical Journal of Sport Medicine.
- Article type
- Systematic review and meta-analysis
- Studied
- 35 included boxing studies.
- Status
- Published in a peer-reviewed journal
- 35 studies were included.
- The review reports a higher concussion risk in boxing than in other combat sports.
- Among boxers in the included studies, 147 of 631 had cavum septum pellucidum and 125 of 411 had some form of brain atrophy.
Boxing injury incidence and pathology types in the 21st century
Mao et al., 2023. Orthopaedic Journal of Sports Medicine.
- Article type
- Systematic review and meta-analysis
- Studied
- 14 boxing epidemiology studies published in the 21st century.
- Status
- Published in a peer-reviewed journal
In this review, concussion made up about 12% of recorded boxing injuries across the pooled studies.
- 14 studies published from 2000 to 2021 were included. 11 were rated moderate in quality.
- Injury rates were higher in professional boxing than in the amateur and female groups.
The epidemiology of injuries in mixed martial arts
Lystad et al., 2014. Orthopaedic Journal of Sports Medicine.
- Article type
- Systematic review and meta-analysis
- Studied
- Six MMA injury epidemiology studies.
- Status
- Published in a peer-reviewed journal
In the six MMA studies in this review, concussion made up 3.8% to 20.4% of recorded injuries.
- Six studies were included. The pooled injury incidence was 228.7 per 1,000 athlete-exposures (95% CI 110.4 to 473.5).
- The head was the most commonly injured region (66.8% to 78.0% of injuries), followed by the wrist and hand (6.0% to 12.0%). Lacerations, fractures and concussions were the most frequent injury types.
MMA injuries after adoption of the Unified Rules
Zachovajevas et al., 2025. Orthopaedic Journal of Sports Medicine.
- Article type
- Systematic review
- Studied
- 43 reports on injuries after Unified Rules adoption.
- Status
- Published in a peer-reviewed journal
- 43 reports were included. They varied widely in design, injury definitions and data collection.
- After adoption of the Unified Rules, competition injury rates ranged from 23.6 to 54.5 per 100 athlete-exposures. Soft tissue injuries were the most common type and the head and neck the most common location.
- Reported concussion rates ranged from 14.7 to 16.1 per 100 athlete-exposures. The authors report that injury rates and types appear similar to those before the Unified Rules.
Epidemiology of professional bare-knuckle fighting injuries
Muzzi et al., 2022. The Physician and Sportsmedicine.
- Article type
- Observational injury surveillance
- Studied
- 141 sanctioned bare-knuckle bouts; 282 fighter exposures.
- Status
- Published in a peer-reviewed journal
This study recorded 8 concussions with symptoms among 282 fighter exposures in bare-knuckle bouts.
- 141 state-sanctioned professional bare-knuckle bouts held from June 2018 to November 2020 were observed. Of 282 fighters, 105 (36.6%) sustained at least one injury.
- Lacerations were the most common injury: 98 were recorded, 80 of them facial. 17 fractures were recorded, including 8 hand fractures.
Standardized post-bout ringside concussion screening in combat sports
Sears, 2026. Combat Sports Regulation and Science, Report No. CSX-003.
- Article type
- Systematic evidence review with instrument development
- Studied
- Combat sports under any rule set. The source states its evidence comes mainly from amateur boxing.
- Status
- Preprint, not peer reviewed
Related-party work. The author founded Fight Medicine Research Institute. The full disclosure is on the record.
- The work reviews published evidence on ringside and sideline concussion screening and uses it to develop RACE1, a structured examination carried out after a bout.
- The source states that a multidomain post-bout screen can standardize what is recorded at ringside, and that a normal screen cannot rule out a concussion.
- The source states that RACE1 is used only after the bout and never clears a fighter or permits a same-day return.
Limits of this evidence
- Consensus statements record expert agreement. They are not trials of whether the recommended steps change what happens to fighters.
- Recorded concussion rates vary widely between studies. They depend on who examines the fighter, when, and how concussion is defined.
- The structured post-bout examination listed here is described in a preprint by a related party. The source states that it has not been validated.
- Nothing on this page is a tool for deciding whether a fighter has a concussion or may compete.
Fight Medicine Research Institute checked each source’s details against PubMed, Crossref, Europe PMC or the publisher. It has not carried out a formal critical appraisal of each paper.