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Fighting Fitness - A Sports Surgeon's Ringside View

Posted on 1 Feb 2018

The following took place at Thrive Championship, August 5th 2017, in association with Fight Pro-Motion.

Blood streamed across Steven Le’s face in the closing seconds of the round. The screams of the crowd merged into a collective gasp as the young Vietnamese fighter spun in the air and landed a spectacular cartwheel kick on his opponent Idris Hassan. Moments earlier, Idris, an executive at Thye Hua Kwan, had landed a vicious spear elbow to Steven’s forehead.

As a Fight Doctor sitting at ringside, I was mesmerised by the skill and heart shown by these two fighters, but I also carefully noted every blow, and considered what treatment the fighters might need at the end of the bout.

With my background as an Orthopaedic Surgeon specialising in Sports Injury, I have fixed plenty of broken limbs, usually from road traffic accidents. However, the main concern I had for the fighters was concussion – a traumatic brain injury which can be caused by a violent force to the head or body. Concussion can cause a range of symptoms including confusion, visual disturbance and balance problems.

doctorxdentist

A second traumatic brain injury after a concussion can cause brain swelling and death.

After the fight, Steven and Idris were carefully assessed by my excellent team of doctors and nurses for any disturbances to their brain function. As symptoms can appear over time, their trainers were advised that they should not be left alone overnight, and that any sparring sessions should only be gradually resumed under the supervision of a specialist trained in the management of concussion.

Return to sport whilst suffering from the effects of concussion can result in the rare but catastrophic "second impact syndrome", where a second traumatic brain injury can cause brain swelling and death. Repeated concussion and blows to the head over a lifetime can lead to conditions such as dementia pugilistica in boxers, and chronic traumatic encephalopathy, which is a major concern in impact sports like American Football.

These risks are not enough to hold back fighters like Jeremy Jude. “Jer-em-y, Jer-em-y” chanted the supporters of the Bia Muay Thai fighter. The chants intertwined with the rousing shouts of the BXG fans for their very own star, Ian Gerard. Strains of Sarama music and the Pi Kaek clarinet rose above the cacophony, as the two fighters performed the traditional pre-fight Wai Kru Ram Muay dance - a sign of respect to their teacher, gym and family. Ritual over, Jeremy and Ian clashed together in a storm of fists, elbows, knees and shins –  a hypnotic display of the “Art of the Eight Limbs” of Muay Thai.

Dr Alan Cheung ringside

From my ringside view, I carefully note down every blow, and consider what treatment the fighters might need.


Shin bone 2

Repeated pivoting movements of the rear leg can cause enough torsional force to damage knee menisci.

Although the impact of shin bone on shin bone rarely causes the kind of tibial fracture that can be seen on Youtube, repeated pivoting movements of the rear leg, and rotation of the striking leg can cause enough torsional and shearing force on the knee to damage the menisci – two crescent shaped rings of fibrocartilage that protect the knee joint surface. Meniscal tears can result in pain and locking of the knee, which I treat routinely through keyhole surgery.

Landing awkwardly after a kick or knee can tear the ligaments in the knee, most commonly the anterior cruciate ligament, which controls stability. This usually results in pain, immediate swelling and inability to weight-bear. After several weeks when the swelling has subsided, athletes may find that the knee is now unstable and prone to giving way during certain movements like side-stepping and pivoting. Again, I treat this condition routinely through keyhole surgery.

Shin bone

Landing awkwardly after a kick or knee can tear the anterior cruciate ligament, which controls stability.

Dr Alan Cheung Sports Surgeon

Muay Thai is referred to as the "Art of Eight Limbs" because it uses 8 points of contact in the form of punches, kicks, elbows and knee strikes.

On to the main event - the young Thai fighter, Boy, had the Singaporean Hao Xun in a clinch. Boy's knee smashed down on Hao Xun's ribs and liver, which I mentally noted I would have to check post-fight. With a heave and a twist, Boy attempted to throw Hao Xun to the ring floor with an impact that could have dislocated a shoulder. Seconds later, there was a stunning reversal as a right hook sent Boy tumbling to the canvas. KNOCKOUT! My Paramedic colleague Siva and I were ready to leap into the ring, but fortunately Boy recovered quickly from his concussion and groggily got back on his feet.

Right hook muay thai

A right hook sends Boy tumbling to the canvas.


Muay Thai is the national sport of Thailand, and is said to date back more than 2000 years ago. King Naresuan the Great (1590-1605), one of Thailand’s most famous heroes, is believed to have been an excellent boxer. It was he who made Muay Thai a compulsory part of military training.

Gradually, this lethal art developed into a sport. Ron Ng, MMA instructor, explains that there are several different styles of Muay Thai fighter – the brawler, knee specialist, kicking specialist and technical fighter. Each has their own strengths and weaknesses versus the other styles.

Muay Thai Dr Alan Cheung

Muay Thai fighting styles include the brawler, knee specialist, kicking specialist and technical fighter.


Dr Alan Cheung Muay Thai

Jeremy: “Muay Thai has increased my confidence and shown me that nothing is impossible”.

What struck me most when watching the fighters and trainers was their respect for the sport, and for their opponent. There was no Mayweather/McGregor hype and braggadocio.

Steven explained his motivation for fighting after the event:

I fight for my parents, coaches and teammates, and want to be a good example for my juniors in Vietnam.

Clearly this art requires a lot of stamina and heart, and the humility demonstrated by the fighters is palpable. As a fight doctor, it is a privilege to look after such motivated and conditioned athletes. If you are looking for a stand-up sport that allows to use your "eight limbs", and trains your mind as well as your body, then Muay Thai is the discipline for you.


Dr Alan Cheung is a Consultant Orthopaedic Surgeon at Singapore Medical Specialists Centre. He specialises in Sports Injury, Adult Reconstruction and Trauma, and trains in BJJ at Evolve MMA.

Thanks to Mr Wilip Ho (MD at Thrive and Fight Pro-motion), Siva Paramedic at Abella Agency, Kelvin Ngui Photography and Dr’s Rajesh Vasant Asurlekar, Milindu Chanaka Makandura, Michael Chee and Staff Nurses Christine Mabanta, Natalie Tan, Kmalata Subarmaniam and Shania Eballe.

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