Narrative review: Incidence of health problems in Australian mixed martial arts and Muay Thai competitors

Why this study matters

Mixed martial arts (MMA) and Muay Thai are widely practised. The authors say research on the full range of health problems after competition is limited, above all for Muay Thai, where they count only five earlier injury studies. Most earlier studies were retrospective, looking back at past events, and focused on severe injuries. According to the authors, they used differing definitions of injury, often had few female participants, and did not follow athletes to see how long a problem lasted. Illness had seldom been studied in these sports.

What the researchers did

The study covered 26 sanctioned MMA and Muay Thai events in Western Australia between August 2022 and November 2023. Competitors aged 18 or older could take part. Five to seven days after each event they were sent an online questionnaire. It asked about any health problem: any condition the athlete saw as a reduction in their normal state of full health, with or without medical attention. This could be injury, illness, pain or a mental health problem. Athletes with more than one problem named their worst. Anyone with a problem was then followed weekly until the worst problem resolved or they stopped replying.

The questionnaire included the Oslo Sports Trauma Research Centre Questionnaire on Health Problems 2 (OSTRC-H2). Its four questions cover training participation, changes to training, performance and symptoms, and give a severity score from 0 to 100. The Western Australia Combat Sports Commission supplied each athlete’s time in the bout. The researchers used this to calculate rates per 100 athlete exposures (one athlete in one bout) and per 100 minutes of exposure.

What they found

Of 459 potential participants, 175 (38%) took part: 119 in Muay Thai and 56 in MMA. They gave 238 responses, because some answered after more than one event. Men gave 181 of the responses (76%). In 146 responses (61%) the athlete reported no health problem. In the other 92 (39%), athletes reported 411 health problems: 315 injuries and 96 illnesses. Six responses contributed 85 health problems. The rate was 20.1 health problems per 100 minutes of exposure in MMA (95% confidence interval 16.5 to 24.4) and 25.0 in Muay Thai (22.3 to 28.0). A confidence interval is the range likely to contain the true rate.

Most injuries were to the lower limb, which made up 61.3% of the 181 injured body regions (70.4% in Muay Thai and 34.8% in MMA). The head and neck made up 16%. By type, 42.2% of the 315 injuries were to superficial tissues, mainly bruises, and 30.5% were pain with no tissue type given. The most frequent illnesses were non-specific illness (27.1%), upper respiratory illness (24%) and neurological complaints such as fatigue and headache (22.9%).

At seven days, 24 responses (10.1%) said the athlete could not train because of a health problem. Of the 92 worst problems, 91% were injuries, most often to the lower leg (26%), foot (13%) or head (11%). Follow-up data were obtained for 78 of them. The median time affected, meaning the middle value, was 20 days in MMA, 16 days in Muay Thai and 17 days overall.

Strengths and limits

The authors state that this is the first study to describe all health problems from MMA and Muay Thai events using methods recommended by the International Olympic Committee.

Only 38% of potential participants took part, and the authors say those who did not respond may differ from those who did. Every health problem was reported by the athlete and was not checked against medical records. Twenty-seven respondents dropped out before their worst problem resolved. For them the date of the last reply was used, which the authors say may understate the impact. There were no data on competitive level or protective equipment. Some problems were reported as both injury and illness, and the authors could not confirm that each was classed correctly. The findings apply to competition, not training. The Western Australia Combat Sports Commission regulates the events, part-funded the study and supplied the exposure data. The authors state that the funders had no role in the study.

What it adds to research on fighter health

This study adds athlete-reported data on injury and illness after MMA and Muay Thai contests, with rates based on minutes of exposure. Its injury rates are higher than those in earlier studies based on reports by ringside physicians. The authors suggest this is because they counted every problem athletes reported, including minor ones. Illness made up almost a quarter of the health problems reported. The authors call for a consensus statement on how injuries and illnesses in combat sports are recorded and reported. The study covers MMA and Muay Thai only, not boxing or bare-knuckle fighting.