Neil Magny remembers a time when head trauma was not even a consideration in an MMA gym. Truthfully, it wasn't even that long ago.
It's only natural for a fighter to try his or her best to ignore injuries, to push through. It was that way after blows to the head in training, too.
"They didn't really understand how severe a concussion could be and how devastating the long-lasting effects can be," Magny told MMA Fighting. "For them, it was just out of ignorance, like ‘Oh, you're fine, you'll be OK. Everyone gets rocked once in a while.' Some people still train that way."
Knowledge about head trauma is still at a developing level in sports. The NFL only instituted a concussion protocol in 2013. The Cleveland Clinic has been studying brain injuries in combat sports athletes since 2011.
All of it is still new to many people, fighters included. The conversation, though, has at least started. Elevation Fight Team, where Magny trains in Colorado, is hoping to take it to another level.
In September, Elevation began working with a company called NeuroSlam in a pilot program attempting to track potential concussions and head injuries and their potential effects. According to coach Leister Bowling, all of the team's fighters, including former UFC bantamweight champion T.J. Dillashaw and Matt Brown, have been on board with it. Brown, in particular, has been very open recently about his history of concussions.
There is a medical theory that a protein in the body increases in the brain after a hard blow to the head. NeuroSlam tests fighters for that protein, called S100 and what doctors call a biomarker, through their saliva. Workers from the company have established baselines for all the athletes and will test them after regular training sessions, sparring, and strikes to the head.
The goal is to see how much, at all, the biomarker increases after shots to the head compared to just a hard workout. And if the protein has any links to concussions and traumatic brain injury.
"We're all interested in health, we're all interested in fighters, and we're all interested in performance," said Dr. Chad Prusmack, a neurosurgeon who also works for the Denver Broncos. "This was to get some ideas of what role does MMA practice and MMA sparring have on this biomarker. Good, bad, other, that's not the role here. A more formal protocol, we have to work on. So we're working on research protocols to evaluate brain trauma."
Prusmack was the one who put Elevation and NeuroSlam together. He trains at Elevation's MusclePharm gym under striking coach Christian Allen and has a relationship with doctors at NeuroSlam.
"Because of the unified interest, we all want to be healthier, and we all want to be safe, this was a meeting of three different minds," Prusmack said.
Bowling said when the NeuroSlam staffers pick up on an increase in the biomarker, he makes that fighter sit out until the level of the protein goes down. NeuroSlam also administers games to the athletes to test the biomarker levels before and after a sparring session, and how that could possibly relate to head trauma. Magny said many of the games are memory based.
"It's obviously all a work in progress," Bowling said. "We'll see. Only time will tell if it works, but we're very proud to be one of the first ones out there that's actually implementing this into our training."
Collecting the saliva sample is simple, according to NeuroSlam's Lauren Ruhl. Athletes spit into a device that's shaped like a lollipop. Ruhl or a colleague then put the device into a machine, which will present the level of S100 protein by color. If it's green, the fighter has a normal level. If it's orange or red, it's likely high.
"Truthfully, an athlete is always going to say they're fine," said Ruhl, who played college basketball. "With this elevation in the biomarker, they can't lie about that."
What all of it means, no one is really 100-percent sure. That's why collecting the data is so important. Prusmack said showing correlations between high biomarker levels and concussions or even reduced performance can lead to even more research, which could mean a breakthrough in what is still a growing field of study.
Most importantly, though, Prusmack said just having an open dialogue with fighters is the key. Keeping the conversation about concussions and brain trauma open is vital.
"It allows guys like myself to open up a discussion, a topic which they never hear," he said. "When you're around 15 fighters and you have some doctors and you start talking biomarkers and brain, it just opens up the conversation so that then they're armed with more questions, with the ultimate idea that we're all responsible for our own health."
Magny said having data in front of him makes it easier to accept that maybe he should take a few days off from sparring. If his biomarker is high and he wants to wait for it to go down before training again, that seems like a much more official process than just going by gut or feel.
"Before, if I were to get hit in training or took a pretty hard shot, it would be up to my coach to tell me, ‘You took a couple hard shots. Take a couple weeks off and then get back to training after that,'" Magny said. "But to have something to actually base that off of instead of just winging it — ‘oh, I think two weeks is good enough, let's see how you feel' — they can say it based on a number."
Even if fighters are not feeling that great, Magny said, they almost always still want to train or spar. Fighters push through injuries on the regular. The mindset for some is to train hard and ask questions about health later, even if it comes to a hard shot to the head.
"Your first instinct as a fighter when that happens is, ‘Let me at him, let me in there coach,'" Magny said. "You need someone on the outside to say, ‘Nah, you took a pretty hard shot, dude. You're done for the day. Let's pick it up next week and see how you feel.' That's the biggest tool to have in training."
Magny credits his coaches like Bowling for how active he has been in the UFC. Without them telling him to take it easy once in a while, Magny figures he'd be injured and inactive a lot more.
Prusmack said the culture definitely has to change among athletes. Not just in MMA, either. But in all sports, football and boxing included.
"At the end of the day, it's like, ‘Hey look, this is something we need to be aware about,'" the doctor said. "Just know that the person right next to you might know less than you know about it. So, in that, make sure you always raise the question. No question is ever too stupid. And, in that, we build a positive culture of protecting each other's brains."
Prusmack believes that boxing and football can actually lead to more traumatic brain injury than MMA, just due to sheer volume of blows to the head. But no one is sure of anything, he said.
Jordan Parsons, the late Bellator fighter, was the first MMA fighter to be diagnosed with chronic traumatic encephalothopy (CTE) earlier this month by Dr. Bennet Omalu, the man portrayed by Will Smith in the Hollywood movie "Concussion" about the NFL. CTE can only be diagnosed post mortem with a brain autopsy.
No one knows what causes CTE, Prusmack said, but "head injury is obviously a risk factor for it." The first symptoms of CTE are things like disorientation, dizziness, and headaches. It can move on from there to memory loss, erratic behavior, and poor judgment. It only gets worse, to things like dementia and suicidal thoughts.
Fighters are at risk for concussions more than most people. Strikes to the head are just part of the game, Magny said. It's nothing athletes didn't know before stepping in the gym.
"When I decided to be a fighter, it's almost like a risk that came with it," said Magny, who estimates he's had three concussions in his career. "If I go my entire career without getting a concussion, that would be great. But at the end of the day, it's something that's associated with the sport. It's almost like a work-related hazard. It comes with the territory. The biggest thing is knowing when to pull back."
That's why NeuroSlam and Elevation are working together on this research program. If the studies come back to show a real correlation between high S100 protein levels and brain injuries, fighters and coaches all over the world would have real guidelines on how best to prevent and reduce concussions and the like.
Right now, though, everyone — doctors included — are still throwing things at the wall and hoping they'll stick. But at least many athletes now know what they're battling against aside from just their opponents in the cage.
"Most of us at the end of the day, we don't know what we're doing when it comes to concussions," Magny said. "We just know how we feel day in and day out and we just base our training off of that."