Slap Fighting Study Finds Disturbingly High Concussion Risk in Power Slap

Several years have passed since the arrival of slap fighting, a new combat sport, and fears about traumatic brain injuries are increasing.

Neurologists have reviewed video of the first televised professional slap fighting event in the US, concluding that the likelihood of concussions appears disturbingly high.

"Slap fighting may be a more grievous combat sport than previously assumed, and strategies to prevent neurological demise among its participants should be pursued," the doctors argue.

How Power Slap and slap fighting work

Slap fighting is precisely what its name suggests. Two competitors face one another and alternately strike the other person's face as forcefully as possible with an open hand. The recipient is unable to protect themselves: headgear is prohibited, and they are not even permitted to flinch.

Power Slap, a slap fighting promotion owned by Ultimate Fighting Championship (UFC) chief executive Dana White, launched its first television programme in 2023. The competition is now in its third season.

Concussion signs seen in televised slap fighting

While examining first-season footage, neurologists at the University of Pittsburgh and the VA Pittsburgh Healthcare System identified several observable concussion indicators among competitors. These included blank or vacant stares, delayed attempts to stand, poor coordination, vomiting, amnesia and impact seizures.

The medical team determined that a contestant had sustained a concussion when even one of these signs was seen and confirmed.

The same approach has been applied to detecting concussions in American football players, although it does not provide perfect estimates. For example, almost a quarter of football players who suffered concussions on the field displayed no visible concussion signs.

Among the 333 slaps assessed, signs consistent with concussion appeared after 97 slaps, nearly 30 percent. Of the 56 competitors observed, 44 displayed at least one concussion sign, representing more than three-quarters of the group.

Visible evidence of a second concussion during competition was also seen in 20 contestants.

Competitors who showed concussion signs lost the sequence 75 percent of the time.

The signs observed most frequently were impaired motor coordination, taking longer to rise, and a blank or vacant expression.

These early results are drawn from a small sample and rely only on visible concussion indicators rather than formal diagnoses.

Nevertheless, the researchers state that "slap fighting may induce traumatic brain injury in contestants, with potential for long-term consequences".

Medical concerns and safer standards for Power Slap

The study's authors are not alone among medical specialists in becoming worried about the increasingly popular sport.

Soon after Power Slap's 2023 season was broadcast, neuroscientist and former professional wrestler Christopher Nowinski spotted a competitor exhibiting immediate indications of brain injury.

Following a slap, the contestant's body assumed a 'fencing posture', in which the arms move into an unnatural position. Doctors use this reflex, alongside brain scans, to establish the severity of a traumatic brain injury.

"This is so sad," Nowinski wrote on Twitter. "Note the fencing posture with the first brain injury. He may never be the same… Pure exploitation. What's next, "Who can survive a stabbing"?"

Nikolas Evangelou, another neurologist at Nottingham University Hospital, described the sport as a "recipe for disaster".

"It's all a matter of time before we see more serious brain injury from a dissection," he told Sky News in 2023.

"Slap fighting may be entertaining to watch as a lay viewer, but as medical professionals, we found some aspects of the competitions to be quite concerning," says Raj Swaroop Lavadi, the University of Pittsburgh neurologist who led the latest research.

"Our end goal is to make all professional sports safer for the neurologic health of the athletes. It is really difficult to ban any sport, but it is possible to raise awareness about the associated harms."

The researchers are now conducting a study using mouthpieces to measure the force with which the head is struck. The Pittsburgh neurologists hope the findings will lead to improved safety standards for participants in this emerging sport.

The study was published in JAMA Surgery.