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Mixed Martial Arts: Injury Patterns, Trends, and Misconceptions

By Robert S. Dean, MD, Joseph H. Guettler, MD

    • Physicians' Corner

The phrase mixed martial arts (MMA) is a title that was originally coined in 1993 when describing the Ultimate Fighting Championship (UFC)’s first major event (UFC 1). However, the martial arts have been practiced in some capacity for thousands of years. Mixed martial arts is a combination of combat sports that includes both striking and grappling, in a competitive format. While each of these sports were once considered niche, their summation has grown to a global phenomenon attracting a diverse profile of fans from across the world. Once every four years, martial arts athletes come to the forefront of the world stage at the Summer Olympics, as competitors participate in Wrestling, Judo, and Boxing (among others), all components of what we have come to know as the “mixed martial arts.”

As combat sport participants, fans, and caregivers prepare for this summer’s competition in Paris, it gives us an opportunity to acknowledge the massive growth in the sport’s popularity, as well as some current–and sometimes surprising–trends.

Are MMA athletes on a certain road to submission by injury, or should these rumors be knocked out? We will delve into the most common injuries observed in these athletes and ways to prevent them, while providing data that may dispel some common misconceptions.

International Fandom

The origins of the martial arts disciplines have international roots. Among many other ancient art forms, Wrestling is said to date back to the Han Dynasty in China, Boxing to the 1st century BC in ancient Greece, and Brazilian Ju-Jitsu to 1925.

In contemporary times, international audiences have provided many of the largest crowds in MMA history, including events such as UFC 243 in Melbourne Australia and the PRIDE event in Tokyo Japan which had 91,000 people in attendance. Additionally, there are often millions of people paying to view these events on television (Max: 2.4 Million pay-per-view buys for UFC 229; 1.1 Billion social media views for UFC 300). Furthermore, as social media booms at an exponential rate, highlight reel knockouts and/or dramatic submissions have drawn the eyes of a host of new ravenous fans hoping to engage in competitions like these. This growth in popularity has been exemplified by the UFC bringing championship events across the world to Europe, Africa, Australia, the Middle East and by opening training facilities in numerous countries.


Historically, MMA events were dominated by men. In recent years women’s participation in these sports has gained traction, accelerated by several key events, including women’s Judo being awarded medals in the summer Olympics in 1992, the first ever women’s MMA tournament in Japan in 1995, women’s freestyle wrestling entering the Olympics in 2004, and more recently, Rhonda Rousie’s rise in the UFC in 2011 and women’s boxing entering the Olympics in 2012.

According to a study from 2009, only 2% of media attention related to MMA was directed towards women. Within only the past 10 years this number has grown. A 2023 study from Statista reported that 6% of women were avid MMA fans and 18% were casual fans (23% of men reported being avid fans and 30% reported being casual fans).

Women are now headlining televised pay-per-view events and serving as a main attraction in other professional events which is demonstrating to younger girls that MMA participation is a viable option. By making the sport accessible to the once-forgotten 50% of the population, participants and fans alike have reaped both the financial and competitive benefits.

Fighting Styles are Indicative of Specific Injuries

Not surprisingly, fighting style significantly impacts one’s predilection to injury. For example, striking predominant arts such as Boxing, Karate, Muay Thai and Taekwondo injuries are predominantly to the head and face, while submission dominant disciplines such as Judo, Brazilian Jiu-Jitsu and Wrestling have more injuries to larger joints such as the elbow, shoulder and knee.

Head Injuries

Much of the concern related to MMA is centered around perceived repetitive head trauma. A recent systematic review reported that 28-46% of MMA fights end in knock-out or technical knock-out, with 12.7% ending by knock-out.1 Of note, the cited review identified five studies that evaluated long-tern neurological outcomes of MMA participants following trauma, all of which identified microstructural brain damage.1 In fact, in a recent survey study conducted by The Athletic, 61.2% of UFC fighters reported that their career gives them worry about potential long-term brain damage, with an additional 9% answering “maybe”.2 In this same survey, 21% of participants reported noticing discernible differences in their brain function after their fighting career.

With the growing interest in women’s combat sports, it’s important to acknowledge some of the key differences: women’s fights are on average 90 seconds longer than male fights, with a significantly higher portion ending after knockout from a head injury when compared with men’s fights (32.2% vs 23.1%). Similarly, the average female fighter receives more head strikes per minute (2.95 vs 2.37) and more total head strikes (7.73 vs 6.2) per fight than the average male.3

Despite these dangers, the sport of MMA is thought to be significantly safer than other specific disciplines that are encompassed by the MMA umbrella. Sports such as Boxing and Kickboxing are surprisingly associated with significantly more head trauma. In a study from the University of Alberta, 7.1% of boxers were knocked-out or lost consciousness, which is significantly higher than 4.2% of MMA fighters.4 Additionally, head and neck injuries were found to be highest in Boxing (84%), Karate (74%) and MMA (64%).5 More drastically, in the history of Boxing its been estimated that there have been over 1000 deaths from injuries sustained within the fight, while only 7 deaths have been reported in sanctioned MMA bouts. While the current authors understand that boxing has a significantly longer history, it must be acknowledged that there were 4 Boxing-related deaths within the last year alone.

To address these head injuries, boxing organizations have implemented a 3 knockdown rule which means that the fight is typically stopped if one competitor is knocked down 3 times. Similarly, many competitors utilize head gear during training to minimize the impact of multiple practice sessions.

Joint/Long Bone Injuries

Submission focused martial arts such as Judo, Brazilian Jiu-Jitsu and Wresting have more joint and long bone injuries. These sports focus on complex movements that force limbs into unique positions of stress that can result in injury to either the soft tissue structures about the joints or fracture of the long bones.

For example, a study from Bickley et al. reported on a large database study of patients presenting to the U.S. emergency department found that 8400 injuries from MMA were identified between 2009-2019. They found that strains/sprains (32%) and fractures (19%) were the most common injuries. The study also reported that lower extremity injuries were more frequent than upper body injuries (42.5% vs 36%) and that men were more likely to sustain fractures (20% vs 17%) and dislocations (3.5% vs 2.4%) compared to women, while women were more likely to have ankle injuries (10% vs 6%).6

Another recent study on Brazilian Jiu-Jitsu athletes found that 30% of fighters reported at least one knee injury in the last year, with MCL (38%) and LCL (19%) injuries being the most commonly reported injuries.7 This same study reported that shoulder injuries were the next most common at 18% of athletes.

An epidemiological study on injuries in combat sports found that 27% of injuries in MMA were fractures, while only 7% of injuries in both boxing and Kickboxing were fractures. While this study does not discuss the specific fracture patterns or the anatomic region of these fractures, it is worth noting that both Kickboxing and Boxing are striking sports while MMA includes the submission-based grappling, in addition to striking, which likely explains the difference in fracture incidence identified in the study.

Athletes that compete in submission sports or have a submission-based strategy during MMA use a combination of force and leverage to place unnatural strain on both their competitor and their own limbs, making both competitors susceptible to long bone fracture and soft tissue injury.

Training Injuries

As is the case with many sports, a substantial percentage of injuries occur during training. Furthermore, when one considers that many competitors train or practice multiple times per day, without taking days off, only to compete a handful of times per year, it stands to reason that the martial arts would have a higher percentage of injuries that occur while training. In fact, 70% of Boxing, 82% of Taekwondo, 63% of Wrestling, 71% of Karate and Judo, and 78% of MMA injuries occur during training.8-12


With the growing popularity of MMA across the world, and the spotlight on the specific martial arts disciples as the Summer Olympics approach, it becomes our job as clinicians to be cognizant of the injury patterns associated with these athletes. Recent epidemiological studies have identified these patterns and pointed to the separation of submission based and striking based sports as a key differentiator in injury patterns; they have also identified training to be the most frequent setting for injuries to occur. The literature has also shown that mixed martial arts might not be quite as dangerous as expected, especially when it relates to brain trauma.

Moreover, the best treatment is prevention, and contemporary studies have led to the implementation of additional protective measures that can help limit the risks to our athletes including a mandate that all professional combat sports contests in the U.S. require a health professional to be present at ringside.

Although more long-term prospective studies are needed to determine how best to treat these athletes and to ultimately determine the natural sequela of these injuries, proper care starts now with the recognition of injury patterns and a swift diagnosis in this rapidly growing and evolving discipline.

Enjoy the Summer Games! This senior author (and four-year collegiate wrestler who could have been a UFC pro if it existed back then) certainly will.


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12. Rainey CE. Determining the prevalence and assessing the severity of injuries in mixed martial arts athletes. N Am J Sports Phys Ther. 2009;4:190-199.

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