With Goodridge's admission, is CTE coming to MMA?
UFC president Dana White believes MMA is safer than boxing and kickboxing. He'll go even further than that when it comes to the safety of fighters under contract with the UFC.
"It's the safest sport in the world when you know you've got two healthy athletes stepping into the octagon to compete against one another," White told MMAjunkie.com (
www.mmajunkie.com).
But at the same time, he knows MMA is not exactly safe. And nowhere could its potential danger be clearer than with UFC veteran Gary Goodridge's belief that he suffers from "early onset" chronic traumatic encephalopathy, or CTE, according to a recent diagnosis.
"We have a 20-year history now in the UFC and mixed martial arts where you don't see as much head damage as you do in these other sports," White said. "But this isn't kickball."
Chronic traumatic encephalopathy is a degenerative disease of the brain caused by repetitive head trauma. It's most commonly found in athletes who participate in contact sports such as football, hockey and boxing. Until now, MMA has avoided the high-profile cases of CTE seen in its big-league counterparts.
Goodridge retired from fighting in late 2010 after seven consecutive losses in various MMA promotions domestic and abroad. His career spanned 14 years and included 46 MMA fights. He also fought 38 kickboxing matches and hadn't won a kickboxing fight in four years when he hung up his gloves.
As a striking specialist, Goodridge, who made his octagon debut at 27 when he fought at UFC 8, lost 23 fights by way of KO or TKO and took countless shots to the head. Now 46 and living in Barrie, Ontario, Canada, he takes a variety of medications to treat his condition.
"My mother says she sees the difference," Goodridge said of his treatment. "I can't tell the difference, but people close to me can tell if I'm taking my pills or I've missed some. I think I slur my words when I don't take them."
Goodridge entirely blames his condition on the time he spent in kickboxing, where shots to the head were far more frequent.
"I never got anything from MMA, other than a lot of money," he said. "It was definitely the kickboxing because that's where all the knockouts came. The whole thing about K-1 when I was in Japan was knockouts. I guarantee you people that were there that fought more than six times, we all got brain injury. Every one of them has got what I got. The reason why the company liked me is because every time I fought, there was a knockout."
CTE hard to detect
Dr. Robert Cantu, the co-director of the Center for the Study of Traumatic Encephalopathy at Boston University's School of Medicine, serves on the medical advisory board for the Massachusetts State Athletic Commission and frequently serves as a ringside physician for boxing and MMA fights in his home state. He is skeptical of Goodridge's diagnosis.
"We have a very high index of suspicion of individuals who may ultimately, when they die, be proven to have CTE," Cantu said. "But right now, it's not possible to be certain in somebody who is alive. Because the clinical patterns for CTE very closely overlap two other widely known dementias – Alzheimer's (disease) and frontotemporal dementia – and you really can't, just based on the cognitive difficulties, the emotional difficulties, be certain what you're dealing with. No way to know when he's alive."
Cantu said the Center has examined football players who thought they had CTE but turned out to have frontotemporal dementia, which primarily involves the degeneration of the part of the brain responsible for short-term memory and attention.
The nature of brain trauma continues to invite scientific attention. The UFC has encouraged fighters to participate in a long-term study on brain health currently underway at Las Vegas' Cleveland Clinic Lou Ruvo Center for Brain Health. Researchers are seeking 600 fighters to study changes in the brain over a four-year span and hope to reduce the incidence of diseases such as CTE and dementia pugilistica, according to the "Las Vegas Review-Journal." In exchange for their participation, fighters get free MRIs that enable them to be licensed to compete in Nevada. So far, 170 have signed up.
But for veterans whose careers have already ended, the damage may be harder to track.
Price of competition
As part of his role as UFC president, White said it's his job to make sure fighters quit before they endanger their health. In 2010, he very publicly retired former champ and UFC Hall of Famer Chuck Liddell, one of the sports biggest stars and heaviest hitters before a string of bad knockout losses. He bristles at promoters who employ past-their-prime fighters and fail to care for medical needs arising from fights.
"A lot of other companies in the past – actually, I'm going to say every company in the past, all of them – don't do the medical things that we do," White said. "We go above and beyond. We know exactly what's going on with our fighters before, during and after a fight.
"These guys get CAT scans, MRIs, all the stuff. Think that [expletive] is cheap? It's very expensive. But we do it. All these other companies in the past didn't do any of this [expletive] because it's very expensive. We do. We know exactly where our guys are."
While the UFC provides fight-night insurance that covers potential injuries suffered during a fight, as well as accident insurance for injuries sustained outside the cage, fighters are responsible for the cost of medical tests needed to be licensed. Although the UFC frequently pays for additional treatment and diagnostic care, the majority of the UFC's rank and file go out of pocket for such things as MRIs and bloodwork.
White often touts the UFC's safety record during its 19 years in business, and that means saying no to some who don't want to quit. Despite the fact that Liddell was still a prime draw at the time of his slide, White put his foot down.
"When we get to the point where I think a guy has been knocked out too much, unfortunately, I'm the guy that's going to tell you to retire," he said. "Because sometimes people are too tough for their own good, or unfortunately, there's a lot of people who haven't done the right things with their money, and they need to stay in the sport. But that's not my problem. I'm not going to watch you get hurt in the UFC, or later on after you're done. I'm not going to make a dollar of that money."
Unfortunately, though, by the time a fighter has suffered several knockouts, it may be too late. While it's believed there are several contributing factors to the cause of CTE, there aren't yet reliable measures of predicting who will and won't suffer from the disease. Scientists agree, however, that losing consciousness isn't a prerequisite.
"The underlying causal concept of CTE is repetitive seemingly innocuous impacts to the head, meaning impacts that wouldn't cause immediate incapacitation," said Dr. Bennet Omalu, who first discovered the disease and named it thereafter. "These are impacts you wouldn't pay attention to. Over time, it's cumulative in a multiplicative fashion."
Ten years ago, Omalu, a forensic pathologist and neuropathlogist, examined the brains of several former football players who had prematurely died, and he discovered brain trauma that caused the type of decay frequently seen in people with Alzheimer's disease. Prior to their deaths, the players had displayed violent personality changes that left them unable to live a normal life. Several had committed suicide.
Omalu believes dementia pugilistica, a degenerative brain disease named after the boxers in which it was found, is merely a general term for CTE that came from a time when less was known about the brain. Since co-founding an institute dedicated to the study of brain injury, Omalu has examined the brains of two MMA fighters, one of whom died after a fight outside of competition and the other who committed suicide. (He declined to name the fighters citing an agreement with their families.) Although he did not find the telltale signs of the disease, he said their brains exhibited "early changes of brain damage – white-matter damage – which is what repetitive trauma to your head essentially causes."
The damage, he noted, was not extensive enough that it had caused irreversible trauma. But had the fighters continued to compete, he believes they would have been candidates for CTE.
"What I'm saying is that mixed martial arts belongs to the high-risk group of CTE," Omalu said. "I would consider mixed martial arts just like I would boxing."
Risk to MMA fighters
That opinion is not shared by all experts familiar with the disease. Cantu believes that a fighter's style is the most reliable determinant of whether he or she develops CTE later in life. In the case of boxers, he sees a clear correlation between brawlers and technicians who avoid punishment.
"Those people who wound up with CTE were those who mostly had the highest number of fights and mostly were the individuals who were the sluggers that took a punch or two to try to deliver their own punch," he said. "Over the course of the fight, they would take quite a bit of trauma compared to ... a Floyd Mayweather-type fighter.
"I think you're going to find the same thing in mixed martial arts. The person coming up with the highest risk for CTE is going to be somebody who is primarily known as a striker, somebody who took quite a bit of trauma, somebody who stayed in the sport probably well past their prime, and I think you'll see some of those people probably show the mental decline, the recent memory failures, the lack of impulse control and depression that are the hallmarks of CTE."
But Cantu also believes that overall incidences of CTE in MMA will be lower in the long term than those of other combat sports, primarily because of the grappling that's so deeply ingrained in it. There's frequently less time for damage to occur, as well.
"[MMA competitors] fight a much shorter fight, and many of them are not primarily strikers," he said. "So the amount of head blows is much reduced in mixed martial arts as compared to, say, boxing."
Outside-the-cage dangers
The great unknown, of course, is what happens outside the cage. While most reputable trainers keep tabs on fighters who take serious hits in the gym, few are trained in the type of diagnostic exams that have become prevalent in football and hockey since the emergence of CTE as a public health issue. In 1995, the California State Athletic Commission instituted a rule that required licensed gyms to report fighters who had been knocked out or injured during training sessions. But it has never been enforced, and a proposal last year to send inspectors to gyms, in part, to encourage owners to submit monthly reports about injuries such as concussions wasn't put into place because it would have required an increase in the fee for a gym license. Even if it had been, the accuracy of the reports would be questionable.
"Frankly, most gyms would submit a piece a paper that said no one was injured," said Kathi Burns, CSAC's assistant executive officer. "We don't have the funding to enforce it."
That leaves the burden on the fighter to report injuries when he or she fills out a medical-history questionnaire that's used by doctors who conduct by ore-bout physicals. But for professionals with a vested interest in competing, they can't be relied upon to disclose whether or an injury has occurred prior to a fight.
"I estimate that 99 percent of the time, the answer's always no," Burns said.
And while treating the lacerations and broken bones that often result from fight night is a routine process using the best medical technology available, the possible long-term consequences of head trauma can't be fully evaluated. A fighter who loses consciousness or takes repeated head shots in a sanctioned bout is medically suspended by the attending athletic commission, in theory, to allow time for recovery. Many fighters, however, ignore the suspensions and return to the gym immediately after they fight.
How long it takes to recover, and what the cutoff in trauma is for permanent damage? It's not yet known. But answers are on the way, Omalu said.
"It's going to become a major medical/legal issue," he said. "I think it will gradually emerge once we begin to pay attention to it because like in football ... the players leave the sport. They wander into oblivion. Nobody knows about them. Nobody cares about them. So once you encourage [fighters] to step up, they will begin to step up, just like in football.
"Ten years ago, no retired football player would come out and admit that he's having memory problems because of the machismo culture. But if you notice now, people are beginning to admit they have problems. I think the same thing applies to mixed martial arts."
Goodridge is the first to say he has CTE. His days as a UFC fighter are long over, and his time in the ring and cage exists only in his memory. One day, those will fade. He said he has no regrets about fighting as long as he did. He's now dedicated to passing on his knowledge to the next generation of fighters, living as happy a life as possible.
Although sometimes just by opening his mouth, he passes on knowledge of the price you may pay for taking years of punishment.
"I wouldn't say MMA is the safest sport in the world," he said. "But I wouldn't say it's a bad one. MMA, sure, you're going to get a brain concussion. But (when) you get knocked down, you're done. You don't get an eight-count and get back up. MMA had nothing to do with my problem."
