Head Games

“I just don’t want to see anyone hurt. That’s all I care about. When you get to a point—in my opinion, I’m no doctor—that you start getting knocked out on a regular [basis], that’s it. I don’t want to see that any more.”

—UFC president Dana White

Dana White made that statement after MMA legend Wanderlei Silva defeated Cung Le in San Jose, California, at UFC 139 in November. With an aggressive knockout-or-be-knocked-out fighting style and a 47-fight, 15-year MMA career, speculation ran wild before “The Axe Murderer” entered the Octagon that White may have to “Chuck Liddell” him into retirement if he suffered another brutal loss. Fortunately for Silva, his Fight of the Night victory will allow him to fight another day…but should he?

“I’m going to fight as long as I can,” says Silva from his Las Vegas training center a week after the Le fight.

No matter the sport, it’s difficult for fans to witness the inevitable deterioration of an athlete’s skill set as they grow older. Whether it’s a running back in football who loses that burst of speed that once separated him from would-be tacklers or the relief pitcher in baseball who can no longer throw the fastball, it’s not easy to watch an athlete attempt to continue to play at the level they once did without success.

When it comes to combative sports, the risk of fighting for too long is dangerous and can lead to long-term complications. Many professional fighters develop serious neurological conditions, including dementia and Parkinson’s disease. The most prominent example is former champion boxer Muhammad Ali, who was diagnosed with Parkinson’s in 1984 at the age of 42. Several studies suggest that up to 50 percent of fighters could develop these conditions.

Hard-Knock Study

A landmark study at the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas is recruiting boxers and mixed martial artists to participate in a research study with the ultimate goal of improving brain health awareness and detecting and warning fighters about permanent damage before it’s too late.

“We know that repetitive blows to the head can lead to chronic brain conditions, dementia, slurred speech, and depression, and this has been shown for many, many years with boxers,” says Charles Bernick, MD, and principal investigator of the study. “We know that head trauma can cause these problems, but they don’t cause it to everybody, so we have several questions we want to address in this study. The first is, can we identify changes in the brain due to head trauma very early by using sophisticated techniques with images of the brain and computerized testing? The other goal would be to predict which fighter will be more at risk to develop chronic problems. And finally, the hope is to be able to prevent it, so if we see somebody who is starting to decline, there may be ways to intervene very early to prevent long-term damage to the brain.”

Wanderlei Silva has no plans on retiring anytime soon, and although he is not participating in the study, he understands the importance of this research. “We need to take care of fighters, because sometimes fighters don’t take care of themselves,” says Silva. “That’s why these tests are important… because any problem with the brain is a big problem.”

As of December, approximately 110 fighters have volunteered for the study, and it’s an equal split between boxers and mixed martial artists. The participants undergo a comprehensive evaluation that includes an MRI, MRA angiogram, a neurological examination, and computer and verbal tests.

The participants are asked to repeat the study once a year for the four-year duration that the study is funded. Dr. Bernick’s goal is to average approximately 150 participants each year, totaling 600 fighters who will undergo the evaluation. Any changes in brain volume, scarring, and blood flow seen in the MRI results will be monitored and then linked with performance on the neurologic and neuropsychological tests.

“Every fighter gets a complete evaluation, including blood work, an MRI scan of the brain, and an MRA, which is required in Nevada for licensure,” says Dr. Bernick. “All of these studies are free of charge. Of course, if there were any abnormalities, we would inform the fighter. All of the information that is obtained in this project is confidential, so nothing is released to any athletic commission or anybody else unless the fighter chooses to have that.”

A free MRI? The price is right for a young fighter struggling to make a living in MMA, especially when many don’t have health insurance and an MRI can cost thousands of dollars.


Taking advantage of the opportunity is Wandi Fight Team member and UFC fighter Jorge Lopez. Training since he was 13 years old, Lopez was a Utah State Wrestling Champion and has compiled an 11-2 record in MMA. There’s no secret as to why he’s participating.

“Well, it’s free,” says Lopez. “I needed to get an MRI for my last fight and Tea Silva [Wanderlei’s wife, who is a physician] told me this study was providing free MRIs, so I decided to come in and get the tests done. Maybe it will help me and help the sport.”

Currently, a fighter must supply the Nevada commission with only one MRI result over the course of their career, unless they suffer a knockout or serious head injury in the ring or the cage. Having the future generation of fighters participate is significant, but so is having regulatory agencies and promotions involved. Although not directly involved with the study, the Nevada State Athletic Commission, the UFC, and Top Rank Boxing are assisting and supporting the project.

“This is a world-class study—very detailed— and I give a lot of credit to the Ruvo Center for stepping up to the plate,” says Keith Kizer, executive director of the Nevada State Athletic Commission. “A lot of the top fighters, they have the money to get an MRI every year on their own, although it’s not required for licensing. The younger fighters or less successful fighters don’t have that option—well, now they do.”

The groundbreaking study is so revolutionary that even the doctors aren’t sure what the changes in the brain may mean,however, Dr. Bernick is hopeful that athletes in combat sports will embrace the research and commit to the study.

“Our main goal, initially, is to enroll as many participants as we can, as many fighters as we can, because the more we have, the more we’ll learn,” he says. “The improved safety of the fighters and safety of the sport is our goal. If the metrics show that a fighter is losing his skills and at risk for long-term complications, this type of information may be important for regulatory agencies such as the Nevada State Athletic Commission to make future decisions on whether fighters are fit to fight. We can also give fighters feedback if they are starting to develop changes in the brain. If we have the techniques to indicate that a fighter may be losing his skills and it correlates with changes in their brain, then they need to know that.”

Keith Kizer believes that the results of the study could have a sweeping effect and may benefit anyone with a head trauma injury— regardless of the cause.

“This is something that isn’t going to just help fighters be healthier, it’s going to help all of us potentially be healthier, by leading to better treatment for people who get into any type of accident or injury that involves head trauma.”

With the UFC busier than ever, another advantage of this study could be the fact that it may alleviate at least one of Dana White’s endless responsibilities—the burden of trying to convince a fighter it’s time to hang up the gloves. In the future, a medical authority may do that for him.

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