Guideline for Concussion in Mixed Martial Arts and the recommended return to fighting pathway
Concussion must be taken extremely seriously to safeguard the short- and long-term health and welfare of combat sports athletes, and especially our junior participants.
Most concussions resolve in a short period of time, normally 7-10 days. This may be longer in athletes under 18 years old, and a more conservative approach should be taken with them. During this recovery time however, the brain is more vulnerable to further injury if an athlete returns before
they have fully recovered this may result in:
- Prolonged symptoms of concussion,
- Possible long-term health concerns, e.g. psychological brain degenerative disorders; and
- further concussive events being lethal, due to severe brain swelling – known as second impact syndrome.
What should athletes do to return to training and competition?
The recommended pathway is shown in the diagram below:
An athlete’s age is deemed to be their age as at the time of the concussive incident.
- Rest. Athletes should avoid activities such as reading, watching TV, playing computer games and driving whilst symptomatic and then gradually re-introduce these activities as tolerated.
- It is reasonable for a student to miss a day or two of academic studies due to a concussive incident.
- An athlete may start the graduated return to training program once all symptoms have resolved and it is recommended to be cleared by a Health Care Professional (HCP) or Doctor (for juniors).
NOTE: It must be emphasized that these are minimum return to training and competition time frames. In athletes who display symptoms of concussion during the stages, they will require a longer rehabilitation period. Each stage requires the athlete to be symptom free from concussion to progress.
Graduated return to training (GRTT)
The GRTT should be undertaken on a case by case basis and with the full cooperation of the athlete and parents/guardians in the case of
A summary of the GRTT is shown in the following diagram:
Before an athlete can commence the exercise elements of the GRTT they must be symptom free for a period of 24 hours (adult) or 48 hours
The athlete can progress through each stage if no signs or symptoms of concussion return. The athlete would normally proceed through each stage on
successive days, or every 2 days for juniors.
If symptoms occur while progressing through the GRTT protocol, the athlete must consult with their medical practitioner before returning to the previous stage. Attempting to progress again after a minimum 24 hours (adult) or 48 hours (junior) period of rest, without the presence of symptoms.
On completion of level 5 without the presence of symptoms and a minimum of 21 days (adult) or 28 days (junior) the athlete may return to full training with no restrictions and can be cleared by a doctor for competition. Where an athlete has been issued a suspension from a ringside physician, suspension from competition will be based on the longest duration from either the ringside physician or governing commission. I.e. If the ringside physician issues a 30-day suspension the minimum time will be 30 days, if the ringside physician issues a 14-day suspension the minimum time will be 21 days (adult) or 28 days (junior). (Based on a commission having a minimum of 21 days for Adults and 28 days for juniors, this will vary depending on location)
It is the athlete’s responsibility to obtain a medical clearance before returning to competition
The author of this article is a registered paramedic within Australia, these guidelines are current for combat sports within Queensland Australia and should be reviewed by an athletes medical team for suitability. This article is intended to assist coaches and athletes to better manage their return to play post a concussive incident and is not to be used as an alternative to seeking individual professional opinions.