For most fans, the KO reigns as the definitive way to validate a fight's conclusion. However, there remain many unanswered questions regarding the physical and mental toll that suffering a knockout places upon fighters.

 In an effort to separate fact from fiction, we discussed the issue with Dr. Gregory H. Bledsoe, a board certified emergency medicine physician who is also a student of Brazilian jiu-jitsu. Dr. Bledsoe is co-author of "Incidence of injury In Professional Mixed Martial Arts Competition." This 2006 "Journal of Sports and Medicine" article documented a study that was conducted to determine the incidence of injury in professional MMA fighters. The study was conducted on behalf of the Johns Hopkins University School of Medicine, where Dr. Bledsoe served as a faculty member for five years.


What determines if a blow will result in a KO?
It's tough to provide an exact formula for that because some people are more susceptible to knockouts than others. From what we can tell, though, a very fast, high-velocity blow to the chin - usually in a rotational direction and executed via a cross or hook - seems to be the type of blow which most frequently results in a knockout.

Therefore, as has often been stated, one could indeed say that the chin is the sweet spot for a knockout. Regarding the individual fighter, we know that there are genetic tendencies which lead to brain injuries or to some people having glass jaws, while other people aren't affected that way. However, there are no objective parameters, providing an exact formula to determine that if you take a blow of a particular speed, utilizing a glove of a specific weight, executed by a fighter of certain dimensions, that the result will be a knockout. It's not that simple.

What occurs both mentally and physiologically from the onset of a knockout blow to the head?
We're not exactly sure, but the medical community is generally in agreement that when one receives a very high velocity blow to the head, resulting in a knockout, the electrical activity to the brain is disrupted. In such circumstances, the severity of the brain injury depends upon the type of blow that was received. If it's a simple concussion or simple knockout, the recipient will hopefully bounce back sans any lingering physical injury, detectable on a CT scan. There can be other psychological and emotional injuries incurred, too but as far as, say, the initial minute after onset of the blow is concerned, it's basically just a disruption of the brain's electrical activity.

What determines whether or not a KO results in permanent damage?
There are two types of injuries to worry about after a knockout: one is a "seen" injury while the other is an "unseen" injury.
Seen injuries are things such as bleeds. Some examples would be subdural hematomas, epidural hematomas or bruising to the brain in which you'll see an accumulation of blood where it shouldn't be. All of these can be viewed on an MRI or a CT scan; however, unseen symptoms like memory loss, inability to focus, obstruction of sleep patterns, depression and anxiety are all things which can't be measured on CT scans or MRIs.

It's been said that while in competition a boxer is more susceptible to brain damage than a mixed martial artist because boxers are permitted to repeatedly get up after a knockdown in order to beat the standing eight-count. Additionally, stoppages in MMA matches are called as soon as a combatant is unable to intelligently defend himself. How true do you find this to be and why?
Unfortunately, there's never been a study done to definitively answer that question. What we have found is that in a typical 12-round boxing match a combatant is likely to be punched in the head more than 400 times. Contrarily, you'll find that an MMA fighter competing in a three- to five-round match is far less likely to receive as many head blows.

Additionally, I find boxing's standing eight-count incredibly dangerous because you're taking someone who is essentially concussed and continuing to allow him to receive more head blows. It's comparable to a scenario in which an individual is knocked out on a football field, yet given the okay to get right back out there, in turn, being knocked out again.

In such cases, you're taking an injured brain and re-injuring it. That, to me is far more risky than the notion of a grounded MMA fighter receiving one or two more incidental shots after the round has ended.  

Contrary to the crux of the previous question, there are those who claim MMA is too brutal. They often comment upon having witnessed the hardcore ground and poundings guys incur via those ultra-light gloves, as well as fighters' heads bouncing off the cage floor during such blows. How on target is their thinking?
Anytime the head is bounced around it's inherently an unsafe thing so I agree with them to a point. Consider those high-intensity slams from which fighters' heads bounce off the mat or where grounded fighters receive multiple head strikes via punches or elbow strikes. These are circumstances that need to be monitored very carefully.

Unfortunately, at this point in time, there's no definitive data out there and no studies have been done to determine the extent of the injuries that can be sustained by such blows. However, the amount of torque potentially generated by a punch thrown from a standing position can be absolutely unbelievable when executed by someone with training.

Contrarily, when on the ground, one is incapable of generating a comparable amount of force because the impact emanates from the shoulders and arms. When standing, however, the torque and velocity are derived from one's hips and torso, resulting in far more weight behind that blow. It's a completely different arena as far as the degree of power is concerned.

From a pre-match preparation standpoint, are there any things a fighter can do to lessen the likelihood of incurring a KO?
While no studies have been done on this, two things do come to mind from a theoretical point.

The first is to ensure that you have strong neck and shoulder muscles. This aids in preventing the head from sloshing back and forth while receiving blows.

The other thing that seems to make a difference is to get a well-fitting mouth guard that has been customized by a dentist.  

To read the full story, see page 74 of the December issue of Ultimate Grappling.