MEDICAL COMMITTEE REPORT: November 2016 re Heel Strikes To The Kidneys & Changes To The Downed Opponent Rule

At the request of the ACSC’s participating jurisdictions, the Medical Committee was
asked to do a medical review of two proposed rule changes:

1. heel strikes to the kidneys

2. changes to the downed opponent rule

and to write consensus statements summarizing the committee’s findings.

Drs. Michael Kelly ( sports medicine), Dr. Marc Greenstein ( urology),  Dr. James
Pritsiolas ( nephrology), and myself (Internal Medicine/ER) all submitted written
documentation ( Dr. Kelly included references) regarding short term and long term
medical consequences of blunt trauma to the kidney. Dr. Stiller submitted an email
stating his strong opposition to allowing heel strikes to the kidneys.

Dr. Kelly,  John Stiller (neurology), and I wrote detailed accounts of our concerns
regarding changes to the downed opponent rule; Dr. Kelly and Dr. Wulkan’s documents
were distributed to ABC member jurisdictions by Commissioner Larry Hazzard of the
NJSACB. Dr. Charles Prestigiacomo ( Chief, Neurosurgery/Rutgers University) voiced
his opinions in a phone conversation with Dr. Wulkan.

The ACSC Medical Committee held its first teleconference September 6, 2016.

Present on the call :

(Alphabetical order)

Marc Greenstein, M.D.

Don Muzzi, M.D.

Joan Pierce, R.N.

Nicholas Rizzo, M.D.

Sheryl Wulkan, M.D.

It was decided by those members participating in the teleconference that Dr. Wulkan
write the initial draft of the consensus statement. The initial draft was then sent
to the entire medical committee for comment. Addenda were accepted through 9/12/16. 
Drs. Muzzi, Stiller and Kelly submitted commentary.  Their suggestions were added to
the original draft.  Dr. Rizzo wrote his opinion in a separate statement which will
be sent to member jurisdictions as an attachment.

Majority Consensus statement #1

The ACSC medical committee recommends that ALL DIRECT strikes to the kidneys
(elbows, knees, punches, kicks and heel strikes) be considered ILLEGAL due to the
short term and potential long term health effects of repeated blunt trauma to these
organs. Round house kicks would still be permissible, as the majority of the impact
is most often absorbed  on the competitor’s front or side.

Consequences of blunt trauma include:

1. blood in the urine

2. capsular tears

3. kidney bruises

4. tears of blood vessels supplying the kidneys

5. kidney rupture

6. acute or chronic kidney dysfunction

7. kidney induced hypertension (high blood pressure)

8. kidney failure

Combat sports participants have also been documented to suffer from undiagnosed
kidney problems including renal dysfunction, contusions, kidney masses, and kidney
stones,  (all of which make the fighter more vulnerable to blunt kidney trauma.

Even one episode of acute kidney injury can increase the future risk of chronic
kidney disease, and may exacerbate underlying, perhaps previously unknown, clinical
conditions. In addition, combat sports athletes with congenital abnormalities such

1.  a single kidney/ one functioning kidney

2.  a kidney that grows into the abdomen or pelvis

3.  a horseshoe kidney

are at increased risk for possible life threatening conditions such as kidney
rupture and life altering conditions such as chronic kidney disease.

In addition, many combat  sports participants participate in weight cutting rituals,
which may be deleterious to kidney function, and which may predispose the kidney to
greater injury due to blunt trauma.

Majority Consensus statement #2:

The ACSC Medical Committee DOES NOT endorse the suggested rule change regarding a
downed opponent.

When the head is down and the neck flexed, as may occur while placing both palms on
the ground in order to comply with the suggested change in definition of  a downed
fighter, the back of the head and the neck may potentially be predisposed to a
greater number of unintentional strikes from knees, elbows and kicks. Strikes to
this area, whether intentional or not, can be lethal.

Full weight bearing on both hands places the neck in a hyper-extended position when
attempting to stand,  placing it at greater risk from strikes when the grounded
opponent attempts to stand.  Furthermore, if both palms must be weight bearing for a
competitor to be grounded, it makes it virtually impossible to bring one or both
hands to defensive position to prevent head strikes. It is also rare to see
combative sports competitors post from the weight bearing palm position. Most post
to fingertips. Because this position is no longer considered a downed opponent, the
opponent has another second or so to attack an unprotected head with strikes. The
risks of skull and orbital fractures, brain contusions and brain bleeds potentially
increases with this rule change, as it would with knees to the head of a grounded
opponent. This type of trauma has been extensively studied in football players and
was found to directly increase the risk of catastrophic neck and brain injury
prompting rule changes and to improve safety.