This article is not intended as a
medical article for doctors.
Your fighter is strong, fast and talented and tonight he/she is in one of the toughest bouts of their lives. The crowd is cheering and the action in the ring is nothing short of "Explosive" by both competitors! When the final bell sounds and the judges scores are read, your fighter wins one of the greatest bouts of his or her life! All is Good!
Sadly what you and your fighter don't know is just how much damage was done in tonights bout. Things may all seem normal after tonights win, but lurking in the darkness is an unforeseen injury that will change the lives of many...
Three weeks later, your fighter is in a much easier bout, and takes a punch to the head that looks like any other head blow, however, the damage that some will believe just happened, actually happened three weeks ago. Your fighter falls to the canvas and lapses in and out of consciousness until finally, they are out cold. Emergency medical staff is immediately by your fighters side and they quickly rush him to a trauma center. Doctors quickly diagnose the problem as... Second-impact syndrome and your fighter is rushed to surgery... Sadly, within hours after the surgery, your fighter is gone, and the questions begin... How and Why?
The initial injury may be a concussion, or it may be another, more severe, type of head trauma, such as cerebral contusion. However, the first concussion need not be severe for the second impact to cause SIS. Also, the second impact may be very minor, even a blow such as an impact to the chest that causes the head to jerk, thereby transmitting forces of acceleration to the brain.
Loss of consciousness during the second injury is not necessary for SIS to occur. Both injuries may take place the same day, maybe even in the same fight. The fighter may continue fighting after the second concussion, and may walk out of the ring without assistance, but symptoms quickly progress and the condition can rapidly worsen.
They usually remain alert on their feet for 15 seconds to 1 minute or so but seem dazed. Usually within seconds to minutes of the second impact, the fighter, conscious but stunned, suddenly collapses, semi-conscious with rapidly dilating (widening) pupils and loss of eye movement, and stops breathing.
Although the condition is often fatal, almost everyone who is not killed is severely disabled. The cause of SIS is uncertain, but it is thought that the brain's arterioles lose their ability to regulate their diameter, and therefore lose control over cerebral blood flow, causing massive cerebral edema. Athletes are most at risk and in order to prevent SIS, guidelines have been established to prohibit athletes from returning to the fight game prematurely. This is why regulatory bodies for the fight game give fighters medical suspensions of a minimum of 30 days. However, in the case above, injuries don't always happen to the losing fighter who just suffered a TKO or Knockout.
After a TKO or KO, ringside doctors are required to suspend a fighter for a determined period of time by recommending the fighter not return to fight (Or even train in a gym) before symptoms of an initial head injury have resolved. Due to the very small number of recorded cases of SIS, there is doubt about whether it is a valid diagnosis. However, the syndrome is recognized by physicians.
Trainers "Should" prohibit a fighter from training in the gym as well as fighting again who has suffered a concussion, regardless of the speed with which the symptoms reportedly resolve. An initial head injury may impair an athlete's judgment and ability to decide to refrain from participating in risky activity, so some health care providers encourage family members (MORE SO, THEIR TRAINERS) and other acquaintances to pressure a fighter not to return to train or fight until they have been cleared by a physician.
If fighter is suspected of having a concussion, a very basic neurological evaluation should be performed. If a medical professional is not immediately available, the examination can be performed by a trainer or another fighter. Assess the injured fighter's level of consciousness, concentration, speech, memory, vision, and coordination. Below is a simple outline of an exam:
The fighter should be awakened every two hours for the first night and stay away from all strenuous activity for 24 hours. If any of the above signs are present, this may indicate increased brain swelling or hemorrhage caused by brain contusions (bruises). This is an indication to seek immediate additional medical care at a local hospital. Furthermore, a fighter will be held from competition and activity for a minimum of one week. Return to competition will be determined by the physician based on the fighter's traumatic brain injury (TBI) history and absence of symptoms.
Several different sets of "Return-to-play" guidelines exist for athletes who have suffered minor head trauma. These exist in part to prevent the player from developing SIS. A variety of concussion grading systems have been devised, in part to aid in this determination. Every return-to-play guideline recommends that an athlete not return to competition until all concussion symptoms are absent during both rest and exercise. The American Academy of Neurology recommends that young athletes be prohibited from returning to play for at least a week in most cases of concussion. The current return-to-play guidelines (Below) may not be strict enough to protect young athletes from SIS. This is why many State Athletic Commissions regulating fight sports established minimum medical suspension requirements for fighters who have been stopped in their bout due to blows or even knocked out in their bout. From these State Athletic Commission requirements, other regulatory and fight sanctioning bodies ( EX: IKF ) have adopted the very same suspensions.
The Colorado Medical Society guidelines were published in 1991 in response to the death of a high school athlete due to what was thought to be second-impact syndrome. According to the guidelines, a grade I concussion consists of confusion only, grade II includes confusion and post-traumatic amnesia, and grade III and IV involve a loss of consciousness. By these guidelines, an athlete who has suffered a concussion may return to sports after having been free of symptoms, both at rest and during exercise, as shown in the following table:
Regulatory bodies, sanctioning bodies and State Athletic Commissions require their ringside physicians to place fighters who have been TKO'ed and Knocked Out on medical suspensions beginning at 30 days ( EX: IKF ). Sometimes the ringside doctor may place a fighter on medical suspension simply due to the fact they were in a hard fought bout, a bout they could have even won. Most trainers and fighters believe their issued medical suspension is the number of days before they are allowed to fight again, however, this is only partly true. As noted above, a fighter who has received too many strong blows or has been knocked unconscious (Even if in the Gym in Sparring!) needs time to recover, which means they should not even be in the gym, hitting a bag, let along sparring, let alone "Fighting" within their suspension time.
Sadly, too often, whether it be the eager fighter seeking another opportunity or an inexperienced trainer with no concept of fighter safety, we hear about a fighter fighting inside their regulated medical suspension. Sure, they can do so and maybe nothing will happen... However, it only takes one time... A fighter is training hard for a much anticipated bout, sparring hard in the gym and while doing so is dropped by their sparring partner, maybe even losing consciousness... They are quickly revived by their trainer and training partners and of course told how tough they are after taking such a shot. "Shake it off, you will be fine!" And as noted above, they can do so and maybe nothing will happen.. But again, "It only takes once..." Days or weeks later in the middle of a bout, the fighter drops from a non knockout blow, drifts in and out of consciousness before blacking out... The damage is done, in fact, the damage was done days, maybe even weeks ago and instead of being safe, keeping his fighter from potential harm, the trainer now is wondering "What happened?"