A new research letter published in JAMA Surgery from experts at the University of Pittsburgh School of Medicine is calling attention to the risk of concussion posed by slap fighting.

The letter, titled “Video Analysis of Concussion Among Slap Fighting,” explains that while there is a general consensus regarding the dangers of slap fighting, especially Power Slap, a slap fighting promotion that has recently gained popularity, a quantification of the concussion risk had not been reported.

“Many members of the medical community – including professionals from BIAA – have continually raised questions about the risk of traumatic brain injury that slap fighting poses. Concussions like those witnessed by the Pittsburgh researchers are serious injuries and can be devastating, especially when sustained repeatedly,” said Rick Willis, President and CEO of BIAA. “We applaud the team of researchers at University of Pittsburgh School of Medicine for shining a light on the very real effects of this dangerous activity.”

The team of researchers conducted a cross-sectional study which involved reviewing the rules of Power Slap as presented on the Power Slap website, as well as viewing videos of slap fighting events, which included both legal and illegal slaps. Reviewers watched for visible signs of concussion exhibited by the competitors.

After reviewing a total of 78 fights, which included 333 slaps and 139 sequences among 56 contestants, the reviewers found that concussive signs were observed after 29.1 percent of slaps and 51.8 percent of sequences. Of the 56 contestants, 78.6 percent exhibited at least one concussive sign. The most common signs exhibited included motor incoordination, slow to get up, and a blank or vacant look.

“Not surprisingly, the video analysis of power slap episodes conducted by the Pittsburgh researchers arrived at the logical conclusion: namely, this activity is a paradigm for inflicting blunt force trauma to the head of a defenseless participant and results in the expected constellation of neurological changes seen with impact events,” said Gregory O’Shanick, MD, the Brain Injury Association of America’s Medical Director-Emeritus. “This is, in fact, the established definition of concussion/mild traumatic brain injury as currently recognized by the Centers for Disease Control and Prevention.”

The findings of this study, researchers wrote in their letter, suggest that slap fighting may induce traumatic brain injury in contestants, with a potential for long term consequences. “Therefore, there must be a high surveillance when evaluating such athletes both acutely and on long-term follow-up,” they wrote. “Slap fighting may be a more grievous combat sport than previously assumed, and strategies to prevent neurological demise among its participants should be pursued.”