The Ultimate Guide to Preventing and Treating MMA Injuries: Featuring advice from UFC Hall of Famers Randy Couture, Ken Shamrock, Bas Rutten, Pat Miletich, Dan Severn and more! (2016)

WEIGHT-CUTTING

One of the most significant health issues currently facing the sport of MMA is weight-cutting. Fighters have been known to cut up to 20 pounds for a weigh-in merely a day or two before their fight. Of course, weigh-ins have been a standard for combat sports for generations, but there is a significant difference between a steady and controlled weight-cut and losing weight at the last minute only to then put it all back on to have an advantage over your opponent.

Some fighters seem to have no problem making weight, while others struggle. Weigh-ins can be daunting, and not making weight could make the difference between a chance in the UFC and not making rent. It is not unheard of for fighters to dehydrate themselves to the point of needing intravenous fluids right after the weigh-in. The crazy thing is, many bouts are between two fighters who weighed in at the same weight class but then fight the next night, both at the same weight — one weight class above the one they weighed in at! As many fighters can tell you, a drastic or “hard” weight-cut can sometimes lead to a suboptimal performance when the actual bout begins.

Some weight-loss methods can prove detrimental to a fighter’s health. The most simple but dangerous weight-cutting practice is starvation or fasting. Significant starvation can cause your body to enter a state of emergency as it struggles to break down its own fat, and if necessary, muscle storages, leading to high levels of dangerous substances in the blood such as lactate and ketones.

Another unhealthy method of weight loss is the use of diet pills or laxatives. Many diet pills contain substances that supposedly increase your body’s metabolism, but in reality your body will experience an increased heart rate and/or high blood pressure, possibly even to dangerous levels. In addition, laxatives can lead to dehydration from excessive water loss and not allow the body to absorb the nutrients it needs before the food is pushed through the body. Furthermore, some of the diet pills and laxatives contain ingredients that are banned by national and international sports organizations and could lead to a suspension and fine if detected.

Dehydration is a result of more fluid being expelled than consumed. When fighters sweat but don’t drink any liquids, they will lose weight quickly, but this is a very dangerous practice. Dehydration may lead to electrolyte imbalances that can have serious health consequences. In addition, practices such as working out in garbage bags or saunas can cause your body to overheat and your blood pressure and heart rate to skyrocket, preventing your body from naturally keeping itself under control.

When your organs don’t see enough fluid or when electrolyte imbalances occur, the organs can begin to fail. The two-time Olympic wrestler Daniel Cormier had a scary experience during the 2008 Beijing Games. As is customary with almost all elite-level wrestlers, Cormier was cutting water weight. However, due to his fluid loss, his kidneys began to fail, forcing him to withdraw from the competition. Another UFC veteran, Marcus Davis, has told the story of when he left the UFC and fought for Canada’s MFC at 155 pounds. Davis said the cut “nearly killed him,” leaving him unable to speak at the weigh-ins because his throat was so coarse from dehydration, and also unable to use the bathroom for several days. And yet a third story circulating the internet is that Rory Markham cut weight so much that his body cramped severely enough to collapse a lung. It’s clear there is a problem out there with dangerous weight-cutting techniques and regulation.

What is needed in the sport of MMA is an overall governing body. Unfortunately, the way the system runs now is that each state has its own commission that oversees contests. And even then, fighters can fight on Native American soil and not become subject to state regulations. Many of us in the medical community are trying to find a solution to these issues. In addition, commissions are looking at ways to limit weight-cutting and gain by re-weighing fighters before bouts or limiting the weight classes they can cut down to based on their hydration levels. However, we cannot do it alone. We need the help of the MMA community to identify and solve problems as the sport grows. We also need to discourage the unsafe practices that are out there through education and proper training. There are some good resources available at the NCAA and USA Wrestling websites, as well as some of the state athletic comissions. In addition, you should plan how much you can cut by seeing a certified athletic trainer who can measure your hydration status and body composition and use that information to plan out a safe and healthy weight-cut plan.

As a general guideline, the NCAA promotes the 1.5% rule among its collegiate wrestlers. The 1.5% per week rule states that you should lose no more than 1.5% of your body weight a week. So, a 165-pound athlete should not lose more than two and a half pounds (1.5%) per week. Make sure to recalculate the 1.5% each week. By following this, a 177-pound athlete would safely be at middleweight (170 pounds) after 3 weeks. This rule is in place to minimize the degree of dehydration that results from losing too much body water. Dehydration of even 1% of your body weight decreases your body’s endurance and physical performance. Losing weight is best done by creating a calorie deficit of 500 to 1,000 calories per day both by increasing physical activity and decreasing food intake. This approach results in slower weight loss but a greater likelihood that the weight lost will be primarily from fat, not water or muscle. Some basic strategies to help you reach your weight goal are: set a reasonable goal and avoid trying to make a weight class that is not realistic or safe for your body; plan ahead to know where your weight needs to be and consider the time you need to get there safely; adequately fuel your body all day — by skipping meals during the day and eating a lot at night you may encourage storage of body fat and use of lean tissue for energy.

PEDs AND TRT

Another controversial issue in MMA, and in all sports, is the use of performance enhancing drugs (PEDs). PEDs have no place in professional sports, and fighters who abuse them should be punished. A recent topic of controversy has been the use of synthetic testosterone for therapeutic use. The chemical signaling pathway of the body is called the endocrine system and it is a very complex system, interweaving several different parts of the body secreting several different types of hormones, or chemical signals. When the testosterone level in the blood is low, sometimes referred to as low “T,” the hypothalamus in the brain releases gonadotropin-releasing hormone (GnRH), which triggers cells in the front of the pituitary gland, located at the base of the brain. The pituitary gland then releases luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These two hormones then act on the testes. The LH triggers the testes to produce testosterone. Then, when the amount of testosterone in the body reaches an acceptable level, the hypothalamus senses this and stops releasing GnRH. This intricate balance of production and inhibition can be disrupted anywhere along the way, either by decreasing the production of a specific hormone or preventing the necessary feedback sensors from knowing how much hormone is circulating in the blood.

While testosterone replacement therapy is not approved for athletic competition, some athletes are given therapeutic exemptions, because they have documented low levels of testosterone. There is a long laundry list of causes of low testosterone, and many are applicable to MMA fighters and other athletes. Some include anabolic steroid abuse, painkiller abuse, head trauma, and weight-cutting. Of these, head trauma, and weight-cutting are the most controversial, because, ostensibly the fighter hasn’t done anything wrong other than prepare for his match and absorb physical punishment.

The most plausible and researched cause for hypogonadism (when the body can’t produce normal amounts of testosterone), according to studies published in fairly reputable journals, seems to be pituitary dysfunction after head trauma. Whether MMA athletes receive head trauma severe enough to cause this remains a question. Low testosterone from weight-cutting or weight loss is less researched, and even those studies that have looked at it don’t show a direct causation between weight loss and low testosterone levels. For example, one study of wrestlers competing in several bouts during a single-day tournament showed that while testosterone levels do decline below normal from the beginning of the tournament to the end, shortly after the matches, the testosterone levels actually spike above normal. (3) In addition, there is a lot more going on during a tournament than simply weight loss. Thus, it’s hard to connect weight loss to low levels of testosterone.

In the general population, the rate of hypogonadism tends to be a low 2%, and the vast majority of these people aren’t elite athletes. However, it seems that the percentage of MMA fighters asking for or using TRT is much higher than the expected 2% of the population. Some people point to steroid abuse or head trauma as specific causes, which may be more prevalent in the MMA population and, therefore, it’s not surprising to see high levels of athletes requiring TRT. Others see the use of TRT simply as an attempt to cheat the system. Certainly, if a fighter has low testosterone due to steroid abuse, giving him TRT after that may seem to be compounding the athlete’s abuse of PEDs. As a result, California and Nevada currently no longer allow for therapeutic use exemptions (TUEs) for TRT, and it is likely many states who wish to discourage using TRT as a PED will follow suit.

When it comes to supplements, science often takes a back seat to opinion or personal experience. The vast majority of supplements fighters and other athletes use have never been shown to speed up recovery or improve performance by validated scientific studies. That is not to say they don’t help; there is just no sound scientific data to justify using them. That being said, if a fighter stays smart and researches what he or she is putting into his or her body, they can try to find an advantage and lower the risk of hurting themselves. Discussing all of your supplements with your doctor is very important, as some of them may interact with each other or affect the way medications work. In addition, the supplement industry is not tightly regulated, and you may not know what substances are actually in what you’re taking. There are some services available to the athlete that will actually test your supplements to make sure there are no harmful or banned substances in them.

3 “Physiological and performance adaptations of elite Greco-Roman wrestlers during a one-day tournament.” Eur J Appl Physiol. 2011 Jul; 111(7): 1421-36. doi: 10.1007/s00421-010-1761-7. Epub 2010 Dec 16. Barbas I, Fatouros IG, Douroudos II, Chatzinikolaou A, Michailidis Y, Draganidis D, Jamurtas AZ, Nikolaidis MG, Parotsidis C, Theodorou AA, Katrabasas I, Margonis K, Papassotiriou I, Taxildaris K.