Prevalence and severity of whiplash associated disorders in mixed martial arts athletes
Mixed martial arts (MMA) is a full-contact combat sport that has become increasingly popular, even though having been described as violent. There is a growing concern about the risk of head trauma and acceleration injuries in this contact sport. Second to general neck and head injuries, concussion has been noted to be a prevalent injury in martial arts. The symptoms of concussion and whiplash can often not be distinguished from each other. The biomechanics of whiplash and concussion injuries are similar and both incidents occur concomitantly. The prevalence of whiplash associated disorders (WAD) has not been established in MMA and finding of WAD in other forms of sport is scant. However, due to the nature of MMA, athletes’ head and neck are susceptible to translational forces during training and competition. Therefore, it can be postulated that MMA athletes are at risk of recurrent whiplash. WAD describe a collection of cognitive and cervical symptoms often persisting for longer than three months after a whiplash incident. Predicting the course of recovery from WAD is challenging and improvement of symptoms may be seen during the acute phase but prove more resistant to treatment as symptoms become chronic. The prevalence and severity of WAD in MMA athletes is unknown. A quantitative, observational descriptive design was used in this study, with the aim of determining the prevalence and severity of WAD in amateur MMA athletes in Cape Town and Bloemfontein, South Africa. Athletes were conveniently sampled and data were recorded by means of one self-developed questionnaire, three standardised questionnaires, and a clinical assessment. The presence of cervical and cognitive symptoms, related to whiplash and concussion, were reported according to the Rivermead Post Concussion Questionnaire (RPQ). The Neck Disability Index (NDI) was used to establish disability due to cervical symptoms. The nature of pain experienced by athletes was assessed and classified according to Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS). A clinical assessment established the presence and grade severity of WAD according to the Quebec Task Force Classification (QTFC). The clinical assessment evaluated the intensity of neck pain, presence of muscle spasms and point tenderness, impaired cervical range of motion, and neurological findings (decreased sensation, decreased muscle strength, and decreased reflexes). Seventeen (n=17) amateur MMA participants were included in this study, most of which were male (n=15; 88.2%) and young adults with a median age of 25 years. All of the athletes had been participating in MMA training for at least two years. Participants in this study reported suffering knock-out’s (KO’s) during both training (n= 5; 29.4%) and competition (n=7; 41.2%). Moderate to severe post-concussion and post-whiplash symptoms, were reported in less than a third (<33%) of participants. Headaches, fatigue, feelings of frustration, and sleep disturbances were, however, frequently reported. According to the NDI, disability due to cervical symptoms was mild in over half of participants (n=11; 64.7%). The presence of neuropathic pain was rated as low and only reported in four participants (n=4; 23.5%). This study found that 58.8% of athletes presented with neck pain mostly rated as mild. Muscle spasm and point tenderness was prevalent in the majority (n=16; 94.1%) of athletes. All of the participants (n=17; 100%) showed some decrease in their cervical range of motion, however, in most cases, cervical ROM was in the average to good range in all planes of movement. Decreased sensation in dermatomes was reported in three participants (n=3; 17.7%) and decreased muscle strength in myotomes was recorded in four participants (n=4; 23.4%). In accordance with the classification criteria of the QTFC, WAD was found to be present in ten participants (n=10; 58.8%). Four participants (n=4; 23.5%) presented with WAD II and six participants (n=6; 35.3%) with WAD III. This study was limited by a small sample size and the findings can likely not be generalised to the MMA athletes in South Africa or the larger population of MMA athletes The findings of this study do support the need for further studies in larger populations of MMA athletes to explore the risk and consequences of the repetitive head trauma in MMA. Amateur MMA athletes in South Africa are at risk of repetitive head trauma causing concussion and whiplash, and thereby WAD The findings suggest that recurrent head trauma, including concussive and whiplash injuries, may occur during bouts and possibly go unreported or un-noticed. More than half of the participants in this study were classified as having WAD and this should be a point of concern for clinicians.