Injury surveillance in boxing, MMA and bare-knuckle fighting
How often injuries are recorded in competition, where on the body, and what has been tried to reduce them.
Research information, not medical advice. This page does not diagnose, screen or clear anyone to compete.
The sources on this page count injuries. Three are reviews that pool earlier studies in boxing and MMA. Three are surveillance studies: two years of state-sanctioned bare-knuckle bouts in the United States, post-match physician reports from one U.S. state, and eight years of hand and wrist injuries in one national boxing squad. One maps studies of protective equipment and rule changes.
The studies use different denominators: injuries per 1,000 athlete-exposures, per 100 athlete-exposures, per 100 matches or per 1,000 hours. Rates from different studies cannot be set side by side without checking what each one counted.
What the sources report
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
- 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.
- Pooled shares of injury types were about 30% soft tissue contusion, 21% skin laceration, 15% sprain or muscle and ligament injury, 12% concussion and 11% fracture.
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
- 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.
- Losers sustained about three times as many injuries as winners. No included study reported injury severity.
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
- 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.
- 8 concussions with symptoms were recorded. Fighters were transferred to hospital on 5 occasions: 2 for orbital fractures and 3 for traumatic brain injuries.
Ocular injuries in competitive combat sports in Texas
Akanno et al., 2025. BMJ Open.
- Article type
- Retrospective case-control study
- Studied
- 3,070 participants in Texas combat-sport event records.
- Status
- Published in a peer-reviewed journal
- Post-match physician reports for 3,070 fighters in Texas matches from January 2019 to January 2022 were reviewed.
- Ocular injury rates were 9.7 per 100 matches in boxing and 12.2 per 100 matches in MMA. Too few kickboxing and Muay Thai matches were available to calculate rates.
- Ocular injury was associated with losing the match in boxing but not in MMA.
Hand and wrist injuries in elite boxing
Loosemore et al., 2017. Hand.
- Article type
- Prospective injury surveillance
- Studied
- Great Britain Olympic boxing squad, 2005–2012.
- Status
- Published in a peer-reviewed journal
- The team doctor and physiotherapist recorded injuries in the Great Britain amateur boxing squad from 2005 to 2012.
- Finger carpometacarpal instability and extensor hood and capsule sprain of the knuckle joint, known as boxer's knuckle, were more common than other hand and wrist diagnoses.
- The hand and wrist injury rate was 347 per 1,000 hours in competition and under 0.5 per 1,000 hours in training.
Protective measures and rules for reducing injuries in combat sports
Štyriak et al., 2023. Journal of Functional Morphology and Kinesiology.
- Article type
- Scoping review
- Studied
- Seven studies meeting inclusion criteria.
- Status
- Published in a peer-reviewed journal
- Seven studies from boxing, karate and taekwondo, published between 2010 and 2023, met the inclusion criteria.
- In boxing, the included studies reported fewer knockouts and head injuries with mandatory head guards and thicker gloves, and more facial cuts after head guards stopped being mandatory.
- Rule changes such as shorter bouts, the standing count and medical stops were reported to reduce injuries in boxing.
Limits of this evidence
- Injury definitions and recording methods differ between studies, and the reviews say so.
- The MMA meta-analysis found no study that reported injury severity.
- The library holds one surveillance study of bare-knuckle fighting.
- The scoping review of protective measures included seven studies, none of them in MMA or bare-knuckle fighting.
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.