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 as: 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.
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