In karate, kickboxing and/or mixed martial arts the two contenders bow to one another, acknowledging to the other that contusions, knockouts, and lacerations are inherent consequences of their competition/match. One should also be acutely aware of the signs and symptoms of a concussion within the context of combat sports, and understand the potential for a brain bleed from a concussion.

DISCLAIMER: My expertise as a professional trainer in kickboxing and karate does not provide oversight to your safety and development in a combat sport, and is to be assessed by a trained coach.  

[Dr. Brancato has 48 years of martial arts experience and was one of the main sparring partners for two-time middle-weight kickboxing champion Dan Magnus]

What is A Concussion?

A concussion, according to the Centers of Disease Control (CDC), is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth against one’s skull. “The sudden movement causes the brain to bounce around or twist at the skull, creating chemical changes in the brain that causes stretching and damage to the brain cells”.

Classifications of Concussion [WebMD]

  • Mild concussion: with symptoms lasting less than 15 minutes and yet no loss of consciousness. In boxing or kickboxing this is known as a flash-knockdown where there is no loss of consciousness and the competitor immediately gets upright.
  • Moderate concussion: with symptoms lasting longer than 15 minutes and involving no loss of consciousness. The competitor remains disoriented unable to complete the match, as determined by the referee.
  • Severe concussion: where the person loses consciousness, requiring medical assistance to be awakened.

What Happens to the Brain During a Concussion

Within the skull, the brain floats in a protective suspension of cerebrospinal fluid. The concussion caused by direct impact, or by whiplash, causes the brain to move inside the head hitting the skull, causing the brain’s neurons to be damaged or bruised. Medical care is advised to manage symptoms, which occur immediately, or can be delayed up to 7 to 10 days after the concussion. Symptoms may take up to three months to dissipate, but some can last up to a year.

Symptoms can include:

  • Headache or ‘pressure’ in the head.
  • Nausea or vomiting.
  • Balance problems or dizziness, or double or blurry vision.
  • Bothered by light or noise.
  • Feeling sluggish, hazy, foggy, or groggy.
  • Confusion, concentration or memory problems.
  • Just not feeling “right” or feeling down.

[Guyton Medical Physiology; WebMD and PubMed]

Medical Evaluation

Brain Bleed

Brain bleeds may occur when the hitting/twisting of the brain against the skull causes the brain’s delicate blood vessels to rupture, causing blood to fill the intracranial space, adding pressure swelling on the brain. The brain bleed may not be evident until many hours after the bleed occurs, causing significant blood loss; and, possibly a hematoma large enough to compress the brain that causes loss of brain function.

What are the symptoms of a brain bleed?

  • Sudden tingling, weakness, numbness, or paralysis of the face, arm or leg, occurring on one side of the body.
  • A sudden severe ‘thundercap’ headache indicating a subarachnoid hemorrhage may have occurred.

Blood tests to assess concussions were recently approved by the FDA. The blood test will measure certain proteins that are released in the bloodstream within 12 hours of the concussion/ or head injury. The blood test allows the medical professional to determine if a CT scan is needed. A cranial CT scan is comprised of a series of X-Rays as the machine rotates around the patient’s head. The CT scan assesses intracranial bleeding. Magnetic Resonance Imaging (MRI) may be preferred which uses powerful magnets and radio waves to create images of the brain, which does not use radiation. The MRI uncovers subarachnoid hemorrhages, bleeding in the brain. 

A medical professional will monitor the brain bleed closely and will decide best how to stop the bleed. Medical professionals report that if the patient survives the initial hemorrhage, then the brain bleed will heal itself. This is not to say that the patient is free from complications. There is a chance the individual that survives a brain-bleed will experience neurological problems.

[NOTE: It is imperative the individual that sustained a concussion be continuously observed/evaluated, which may be needed by a medical professional. Falling asleep after a concussion, or blow to the head can be detrimental, as was the case with Bob Saget’s death caused by a brain bleed after hitting his head.]

Concussion Testing

If the competitor that sustained a concussion wishes to continue in the combat sport, then concussion testing is recommended. Testing includes a questionnaire that measures one’s attention, memory, and speed of answers, followed by a physical exam. The physical exam checks vision, hearing, balance coordination, reflexes, memory, and concentration. Test results will be interpreted by the medical professional to determine if the competitor can or cannot continue in combat sports. [MedLinePlus and Cleveland Clinic] 


When the body is hit the subconscious brain signals the body to regain biological homeostasis. Contusions from a kick and/or punch can result in ‘black and blue’ marks caused by broken blood vessels under the skin, e.g., a black-eye.

Concussions, on the other hand, caused by and punch/kick to the head forces the brain to bounce back and forth and/or twist against the skull, damaging the brain cells which may cause a loss of consciousness, either instantaneous or prolonged. A competitor that is ‘knocked-out’, meaning defeated, will require immediate evaluation by the ring-side physician, determining if ER medical evaluation is needed.

A concussion can lead to a brain bleed, causing blurred vision, thundercap headache, and possible paralysis. The ER physician may order a blood test, and if positive for certain proteins, will order a cranial CT scan or an MRI to determine if a brain bleed occurred.  If the results confirm a brain bleed, then the ER physician will determine treatment options.

Not all concussions result in brain bleeds. Absent a brain bleed from a concussion the brain may enter into a state of plasticity where it heals itself. Recovery needs to be assessed with concussion testing in order to determine if the competitor can continue in combat sports.


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David Brancato

Dr. Brancato’s cumulative experience in nutrition, alternative medicine, chemistry, toxicology, physiology directed him to holistic approaches in human physiology to correct system imbalances. He maintains his professional certifications as a Naturopath from the American Naturopathic Medical Certification and Accreditation Board; the National Federation of Professional Trainers; Black belts in Kick Boxing and Kenpo.