Knocked Out or Just Poor Ref’ing?

Josh Koscheck - dazed and confusedBy Katrina Belcher (

There’s been a lot of discussion about the referee stoppage in the Koscheck vs. Paulo Thiago fight during UFC 95. Seems to be pretty equal as far as I can tell: half believe it was a good call, the other half think it was early and Kos got robbed.

“As for next time, my message to all the ref’s would be to, please let the fight go until I’m put out to sleep.” Josh Koscheck

I like Josh Koscheck. I think he’s actually a pretty nice guy who’s got a huge personality and a lot of self-confidence. The combination can sometimes rub people the wrong way. So I wanted him to win, and my initial reaction was that the ref’s stoppage of this fight was definitely premature. Until I started doing some research.

The thing is, realistically, unless you were in the ring with these fighters at that moment, there’s no way you can judge if the stoppage was right or wrong. Could Kos have recovered? Was he really ever even out? We’ll never know. But what we do know is that according to the Nevada Athletic Commission (NAC) and most AC’s out there who sanction MMA, the first duty of a referee in any MMA bout is the safety of the fighters – regardless what the fans or even the fighters themselves want. Period.

Witness boxing legend Mohammad Ali who today suffers from Parkinson’s Syndrome. Would he have this condition if he’d been a CPA and never fought in the ring? After numerous tests at the Mayo Clinic and other medical centers of note, Ali’s brain stem was shown to be significantly damaged. His attending physicians, in a statement released at Muhammad Ali’s behest, stated that they believed Ali’s brain damage to be boxing-induced. While we will never know for sure, in Muhammad Ali’s case, his Parkinson’s Syndrome was likely caused as the result of repeated blows to the head which irreversibly damaged his brain stem.

We all know that head injuries can occur during a competition. Anything from a mild concussion to a catastrophic cerebral hemorrhage (bleeding inside the brain) is possible. “Competitors, as well as those who care for them, must be aware of the acute symptoms that may present following these injuries in order to avoid further damage. In addition, proper recognition and treatment of head injury can prevent potentially devastating, long-term complications.” (NAC)

The NAC says that “serious head injuries include epidural hematomas, subdural hematomas, subarachnoid hemorrhages, and diffuse axonal (brain cell) injuries. These injuries all require immediate, advanced medical treatment in a hospital setting.” While it’s true these injuries can occur, they usually don’t – pretty much because of the Unified Rules of Conduct for this particular combat sport, and the fact the most fights consist of standup fighting, boxing, kickboxing, judo, BJJ and wrestling combined. That and unlike boxing, where the fighters are constantly hammered to the head for 10-15 rounds with no one but the bell to save them, the fighters can tap out at any time. Subsequently, in many cases, the most damage to the head a fighter will suffer is a concussion. No biggy, right?

Rampage vs. Liddell - with Liddell coming to...We all pretty much know what a concussion is, but in medical terms, according to, a concussion is: “A traumatic injury to tissues of the body such as the brain as a result of a violent blow, shaking, or spinning.” It’s called TBI: traumatic brain injury. TBI can cause a concussion. In fact, according to the American Academy of Neurology, a concussion is a “trauma-induced alteration in mental status that may or may not involve loss of consciousness.” Note the “may or may NOT involve loss of consciousness” part.

To their credit, the NAC has apparently conducted some major research into concussions: “Concussion results in one or more of the following symptoms: light headedness, vertigo (sensation of spinning that causes loss of balance), a brief loss of consciousness, loss of memory, cognitive dysfunction, blurred vision, tinnitus (ringing in the ears), difficulty concentrating, headache, vomiting, nausea, photophobia (sensitivity to light), or dizziness. A fighter may receive a blow to the head, face, neck, or body causing forces to be transmitted to the head without an awareness of a blackout. The event may be quite rapid with a short-lived loss of neurologic function that resolves spontaneously.”

Some of the acute signs and symptoms of concussions include: confusion, disorientation, vacant stare or befuddled facial expression, obvious incoordination (inability to walk in a straight line), emotionality out of proportion to circumstances, irritability, and a whole host of physical conditions such as headache, fatigue, nausea/vomiting, blurry vision and more. Granted, we don’t know if Kos suffered from any of those physical symptoms, but when you look at the video, and the infamous video after the fight in his locker room, it’s obvious that he was suffering from confusion, disorientation, vacant stare or befuddled facial expression, emotionality out of proportion to circumstances, and irritability. Okay – well I guess his emotionality was not exactly out of proportion to the circumstances. I’d probably be irritable if I thought I’d just been on the bad end of an early ref stoppage, but the other symptoms still ring true. Look at his face – he’s confused.

No doubt there’s a risk for long-term complications, and according to the NAC, “the risk is increased by the number of traumatic events that occur within a short time duration. If a fighter experiences only one concussion, the potential for long term effects is minimal. However, multiple concussions can lead to complications such as Postconcussion Syndrome, Second Impact Syndrome, and Post-Traumatic Seizures.”

Here's Karo getting KO'dConceivably, when Koscheck got hit with Paulo Thiago’s uppercut-hook-combo and went to the mat, he could very well have been concussed at that time. Regardless if Kos, the fans, or anyone else could tell if there was a blackout or not, there’s a good chance he was out. And you just don’t take chances with people’s lives – especially if that’s what you’re paid to do: protect the fighters in your ring.

What ring officials know and fans may not: the effects of the Second Impact syndrome. Per the NAC: “If the athlete is still symptomatic, the brain has not fully recovered from the first traumatic event. The brain cells are highly vulnerable to a second traumatic event. Potential diffuse brain swelling can result after a second concussion. The second blow could be very minor, not directly contacting the head such as a blow to the chest; however, the sudden changes in head position with the acceleration/deceleration movements are strong enough to create brain swelling to the already weakened tissue. This complication would require urgent treatment and may even result in death.

MMA Referee SchoolDid the ref stop this fight too early? I don’t think so. He was doing his job. Protecting the fighter. And while the theory of “intelligent defense” exists, it shouldn’t be at the expense of the fighters. There’s no doubt Josh Koscheck is a smart guy. Is he smart enough to leave his life, his livelihood and his brain in the hands of the person officiating future fights — and trust that they are there to keep him safe? Only time will tell.

What Do You Think of This Fight/Event?