School of Hard Knocks
UFC great BJ Penn’s erratic behaviour has spotlighted the issue of head trauma in MMA
Battles Combat Sports Journal speaks to experts in head trauma and violent behaviour about UFC Hall of Famer BJ Penn’s issues, top fighters stopping sparring, and the implications of head trauma for all of us who enjoy combat sports. Feed your head.
Oh, the ignominy. ‘Baby’ Jay Dee ‘The Prodigy’ Penn, an inspirational martial artist cited by none other than Anderson Silva as the actual greatest fighter to ever grace The Octagon, lies knocked out on the pavement. Outside a Hawaii nightclub called The Lava Lounge. By an opponent who ‘more resembled a member of the MMA media than an MMA fighter’ (meaning he was fat), to paraphrase some wag.
“It’s not even the straw that broke the camel’s back,” said UFC president Dana White upon releasing Penn from his UFC contract in late September, “I didn't love him continuing to fight anyway. He won't fight again. That's it. That's a wrap.”
It capped a disastrous year for the seminal figure, who’s a former both lightweight and welterweight UFC champ. In April it came to light that Penn’s wife Shealen Uaiwa has obtained a restraining order against him lasting till October 2021. The litany of transgressions makes for sober reading; especially on top of previous scandals. And while Penn’s enthusiasm for his career didn’t seem to be diluting, his illustrious fight record was. At the time of writing he had lost seven of his last eight fights and drawn one. One anecdote that supposedly emerged from his camp is that BJ insisted on sticking with his athletic regimen as it was how he remained calm.
Penn, an exceptional talent from a wealthy background, hardly has a monopoly on unsanctioned altercation. Even telegenic Ultimate Fighter winners, like UFC bantamweight contender Julianna Pena, have been known to kick bar owners in the groin (twice).
While Pena and others though aren’t currently under scrutiny, Penn’s recent rap sheet is so colourful that speculation has turned to whether he is struggling with health issues. Specifically those resulting from TBI, ‘traumatic brain injury’ and possibly CTE, ‘chronic traumatic encephalopathy’. TBI, essentially any blow to the head, can be mild or severe. CTE though is the build up of damaged matter in the crevasses of the brain, caused by repeated TBI. Chris Benoit, the World Wrestling Entertainment star who infamously murdered his family before committing suicide in 2007, was diagnosed with CTE during autopsy – currently the only stage at which it can be medically detected, although progress is being made.
The brain on the right is suffering from stage IV CTE, ‘chronic traumatic encephalopathy’
Wringing our hands over Penn’s fall from grace (or Pena’s indiscretions, or any famous athlete encountering personal issues) is not the purpose of this article. The intention is that any reader competing or training in combat sports can learn the current thinking around head injury and fighting.
How easily are TBI and CTE acquired? How can the two conditions impact on our intelligence, emotions, self-control, relationships and athleticism? Can enthusiastic participation in fight sports actually make us more aggressive after all?
Is it really the case that sparring while wearing a headguard is actually more dangerous than without? Should we give up sparring altogether, like esteemed UFC welterweight Robbie Lawler, stand out boxer Anthony Yarde and any various other fully credentialed hardmen? Is an aggressive mindset a fighter’s staunchest ally… or their enemy within?
To find out, Battles Combat Sports Journal spoke to several experts in the fields of head trauma, transgressive behaviour, and top-flight combat sports training.
Participation in combat sports alone doesn’t necessarily spell trouble outside the gym, says Dr Alex Channon, senior lecturer specialising in martial arts at Brighton University’s School of Sport. “The academic evidence that we do have actually implies the opposite,” is his take. He continues, “Yes, martial arts can give you the tools to live out your existing violent tendencies in a more effective manner. But more often than not they encourage people to reflect on said tendencies, and become better at defusing or not being involved in situations.”
Of Penn’s insistence on competing despite an apparent loss of form, and possibly needing to be in training camp to ‘stay calm’, Dr Channon says “it sounds like exercise addiction. When it becomes a compulsion, exercise stops curing anxiety and becomes a source of it. The norms we have constructed around exercise, especially in combat sports, do not help. It’s not just a case of ‘I need to train.’ It’s ‘what if I don’t train? What will others think of me? Am I still part of the culture? This is actually common in many high performance sport cultures at the moment. But in fight sports especially – think of amateur wrestling culture in America – there is no ‘too much.’ And that is reflected in the head trauma conversation as well.”
Gary Turner is a therapist who’s studying a multi-disciplinary Phd on ‘the behavioural effects of head impacts on fight sports athletes’ at Winchester University. And he also boasts a record of over 1000 combined boxing, kickboxing and MMA fights. This includes finishing Tank Abbot in his 2007 Cage Rage debut, a victory via tap-to-strikes over seasoned boxer Julius Francis, and a loss to talismanic Dutch kickboxer Tyrone Spong.
Martial arts veteran Gary Turner (seen here facing off with Tank Abbott before a Cage Rage UK MMA bout) is now studying a Phd in the behavioural effects of head impacts on fight sports athletes
While Turner is vocal about the dangers of head trauma, as you shall read, he’s keen to point out that it’s unlikely to be brain damage caused by blows alone that’s causing Penn’s erratic behaviour. “From what I do know of BJ Penn situation, my conclusion would be that he has a ‘poly pathology’ and there are biological, psychological, and social reasons why he is acting this way,” Turner says, “but the evidence is quite clear that it’s very likely a contributor to this will be the number of head impacts he’s had. It won’t be the only reason, but it will be part of it.”
Mike Fisher is the UK’s go-to expert on anger management and regularly appears on TV, including as the temper guru on reality show Big Brother. He says of Penn’s stubborn refusal to retire, “It raises questions around self esteem, credibility, and self value, the places we get our reassurance from. Why would I give up the sport if I’m getting validation from it? It is also possible that he is addicted to the adrenaline, the pain, the competition and the positive strokes he receives. Moreover, it seems like he has no impulse control and the only outlet for his rage and fury is cage fighting, which keeps it in check.”
Dr Stephen Blumenthal of the esteemed Tavistock clinic is the writer of books including Assessing Risk: a Relational Approach. Like all of the experts we spoke to, he is wary of diagnosing Penn both in public, and without first hand knowledge. But he does draw attention to his age, 40 at the time of writing.
“This is a critical moment in the male life cycle,” Dr Blumenthal says, “physical strength is diminishing, testosterone is lowering, certain goals may not have been met, character armour is diminishing and hints of vulnerability are coming through. Think of the moment when the silverback gorilla is challenged by the younger generation. Some men who have been very successful have a crisis at this particular point. Impulsive violence, from the point of view of the perpetrator, can be an attempt to prevent a worse outcome. The person is struggling with something and they don’t know how to express that.”
So head trauma alone is unlikely to be the only cause of Penn’s public unwinding. But it’s the element which the rest of us in the fight sports community share.
“Combat sports is what I’ve spent my life doing,” says fighter turned therapist Gary Turner, “so this is a portent of what’s to come for me, especially with my style of taking five hits to give six over 1000 fights. However, each case is ‘heterogenic’ meaning it’s unique to the individual. So, one thing I am very interested in is why some are more affected than others.”
There is relatively clear scientific thinking around how head trauma initially occurs though.
“The overall trajectory of what the research states is accelerating,” Turner explains, “every strike, including hitting your head on the ground, is ‘concussive’ by nature. Hypocrites, the Greek philosopher, identified it 2000 years ago as ‘an earthquake-like shaking’ of the head. By the way, grapplers should be aware that ‘hypoxia’, lack of oxygen brought on by strangulation, has a similar effect.”
Turner says that put simply, “the brain’s wiring, its axons, are comparable to spaghetti. When the brain receives force they become broken, sheared, stretched and perforated. Materials inside start to flow out. Communication between neurons [information receptors in the brain] is broken. Information flowing around the brain now has to take a longer journey, diverting around the broken axons. There may not be a subjective effect on the outside, but inside it’s taking longer to think, act and react. And there’s only so many before function is lost.”
This brain damage itself isn’t the only result of a concussive blow, which causes a series of effects known as a ‘metabolic cascade’.
“Other areas of the brain shut down to help repair the damage,” says Turner, “glucose is reduced and the recipient of the blow becomes lethargic, as if they have entered a hibernatory state. There is some ‘neurogenesis’ – brain repair – that takes place amongst the cells, which has only recently been discovered. But it also turns out that you never completely recover from a concussion, and the effects of a single impact last a lifetime.”
The impeded thinking which results can manifest in unhealthy and dangerous behaviour.
“The areas of the brain that are most likely to be damaged are the more evolved ones, such as the pre-frontal cortex, amygdala, hippocampus and memory,” says Turner, “so the sufferer will be more likely to display a lack of inhibition, plus impulsivity, aggression and depression.”
There’s a lot of variables involved, too. For example, some of us are genetically inclined to suffer more from dementia as we get older. And women are more sensitive to concussions during the luteal phase of their biological cycle (14 days after menstruation). “The threshold is hard to mark out. There are currently 76 different risk factors identified and as the research goes on, these increase in number,” says Turner, “but certainly the earlier you start having head impacts, plus the higher the severity and the number, the worse it’s going to be.”
Furthermore, in something of a counter-intuitive revelation, wearing protective padding like large boxing gloves and headguards actually increases the likelihood of concussions.
This has been the perceived wisdom for several years now, and was validated by the Amateur International Boxing Association’s (AIBA) decision to forgo head guards in men’s boxing bouts at the 2016 Olympics. AIBA’s announcement at the time focussed on reasons such as ‘risk compensation theory’, which is when “those wearing protection are more likely to take risks, and those interacting with them are more likely to do so too” as Turner explains. The announcement also cited statistics that showed referees stopped more bouts where participants were wearing headgear than otherwise.
But it’s actually complex biomechanics that play the largest part in protective padding actually enhancing the likelihood of brain injury.
“The research comes from road safety and crash test dummies,” says Turner. “To create a concussion you need to get as high a number of molecules as possible, moving as fast as possible – mass and velocity,” he continues, “but for the force to injure the brain it requires what we call ‘low compliance’, which is its rate of transfer. A slower rate means the force is diffused throughout the head. But force applied with high compliance is more likely to deform or break the skull.”
An example of ‘high compliance’ is fighting with, for example, bare fists or the four ounce gloves used by professional MMA promotions. ‘High compliance’ blows are more likely to lead to superficial injuries like black eyes, and bone breaks like orbital fractures. “From bare knuckle through to 20oz gloves, you’re going to get brain damage – but the bigger the gloves, the more transfer of force to the brain,” says Turner.
So far, the only thing shown to be protective “is to possess a ‘cognitive buffer’, essentially a higher starting point,” says Turner, If you’re using your brain and keeping the connections you have alive, you have further to fall from once the degeneration starts.”
Mixed martial arts fans will point to how erudite their retired legends remain in comparison to notoriously ‘punch drunk’ boxers. “The question though is always ‘compared to what, and to whom?’” says Turner, “some chronic effects take as long as fifty years to kick in.” While there’s no proven link between Alzheimer’s disease and CTE, the symptoms are very similar (in CTE waste material accumulates at the bottom of the brain’s crevices, but in Alzheimer’s on the upper surfaces). Boxers are more likely to suffer from Parkinsonism – like the late, great Muhammad Ali.
Damage to the brain stem puts boxers at risk of Parkisonism, the disease that afflicted Muhammad Ali
It’s a sobering conversation to say the least. But are omens of doom, even scientifically proven ones, enough to adjust our own attitudes to the sports we love?
Speaking personally, as someone who optimistically identifies as a ‘pressure fighter’ himself, I’ll need guidance and encouragement to “train smart and fight easier” as Turner puts it.
Paul Hines, head trainer at The MMA Clinic gyms and coach over time to fighters including the UFC’s Darren Stewart and Joe Duffy, echoes Gary’s concerns.
“I stopped sparring with my one-on-one clients a few years ago now,” he reports, “and for my fighters I want quality sparring, not quantity. The damage is done in training – there’s eight weeks of sparring before a fifteen minute fight where they take a lot more punches. This is why fighters like Robbie Lawler and Donald Cerrone say they don’t spar any more. Once my fighters are in the UFC they certainly don’t need to prove themselves in sparring. I just need to get their skill level up and improve their diet.”
Gary Turner has gone even further in his own kickboxing class. “I have no head strikes whatsoever,” he says, “and I believe that it’s illegal for children under 18 to receive any kind of head impact, in combat sports or otherwise. One drill we use is ‘super slow motion sparring’ to train reactions and defence. It looks ridiculous but it works a treat.”
Our attitudes to head trauma are what require changing most, says Turner: “the ‘suck it up, buttercup’ and ‘train hard, fight easy’ mindsets must end. Ultra marathon runners work on technique and ability, then let the sense of competition take care of the distance.”
Mental ill health caused by head trauma is a trope sneaking into popular culture. The Netflix DC superhero series Titans features a former college football star turned vigilante (he’s called ‘Hawk’) who’s storyline revolves around his mental deterioration. But while contact sports like American Football and rugby – plus even cricket after Australian captain Steve Smith was sent back on the pitch by his team doctor after being felled by a 94mph bouncer in August – are under intense scrutiny, statistically they are not in the same league as, for example, boxing when it comes to concussive injuries. A 2018 study into rugby quoted by the BBC puts concussions suffered in professional rugby at 20.9 ‘per 1000 athlete exposures’ (meaning each time an individual plays a game). Studies for boxing have come in as high as 250.6, with MMA at up to around half that figure – although it must be stressed that results between papers vary widely, and statistics for amateurs training are much lower than the rates for professionals competing.
And while the combat sports space seems to be at a stage when the dangers of head trauma are taken seriously, many of us are reluctant to take decisive action. Hotly tipped British boxer Anthony Yarde attracted opprobrium for his own decision not to spar during his camp for a WBO title fight against Sergey Kovalev in August this year. His contemporary Carl Frampton openly criticised this course of action in the aftermath. “Yarde actually gave a good account of himself in a difficult situation, demonstrating that he was prepared,” comments Gary. Yarde himself has come out swinging, with both he and his trainer Tunde Ajayi determined to stick to the no-sparring strategy.
Boxer Anthony Yarde is among the top names reducing the importance of hard sparring in fight preparation
Prevention is currently the only cure, and damage is notoriously difficult to detect via even sophisticated scanning procedures. “The definition of CTE set by Boston University’s leading ‘Brain Bank’ research centre can only be diagnosed posthumously at autopsy,” points out Gary Turner, “so they interview close friends and family members of known sufferers to find patterns of behaviour.” The ‘collective diagnostic criteria’ includes aggression, impulsivity, suicidal tendencies, depression, mood disorders and anxiety. Which are exactly the emotions that some of us feel are kept in check by combat sports participation.
“In a martial arts class there will be people who have recognised that they need a structure to contain their instincts,” says transgressive behaviour guru Dr Stephen Blumenthal, “it’s important to find a way of preserving that.” Anger management expert Mike Fisher adds, “I’ve worked with people with a history of combat sports, which they love, enjoy and openly admit is a way to disperse aggression, plus it features bonding and fun. They get married and start a family, don’t have access to that outlet any more, and act out their aggression in relationships.”
So how about yourself? Can you see yourself abandoning the rough ’n’ tumble games we all derive so much excitement, identity and catharsis from? What precautions will you take before you start kicking nightclub bouncers in the balls? Or struggle with your work?
The question is, to use gym vernacular, enough to do one’s head in.
This article is not intended to be exhaustive. To find out more about the subject of concussion and combat sports, listen to Gary Turner discussing this subject further on The British Boxing Podcast.
This sculpture used to illustrate some versions of this article is ‘Boxing Brain’ by Ron English