The silly new sport with potentially lethal consequences
Key Takeaways
Slap fighting is a relatively new combat sport in which two competitors deliver powerful open-handed slaps until one is incapacitated.
This sport carries significant risks, including severe injuries such as brain bleeds, concussions, facial fractures, and even death.
Research on similar impacts in other sports suggests the repetitive nature of these blows may lead to serious long-term health consequences, including progressive neurodegenerative disorders.
A new sport is capturing the public’s attention, involving contenders who compete by slapping each other silly.
Power Slap, America’s first slap-fighting league, provides the “ultimate stage” for fighters to “showcase their power, technique and resolve,” according to organizer Dana White, the president of the Ultimate Fighting Championship (UFC).[]
The novel sport is gaining new fans at a rapid clip, and the medical community is taking note. It can be incredibly risky—competitors are vulnerable to serious injuries, including broken bones in the face, brain bleeds, multiple organ failure, and even death, proving that professional slap fighting is far from harmless fun.
The dangers of slap fighting
The combat sport has more rules and regulations than you might expect, but the basic premise is as follows: Two competitors (often physically imposing men) open-handed slap each other as hard as they can until one concusses or can’t continue.[]
It has caused at least one death—in 2021, a Polish slap fighter experienced a brain hemorrhage during a match and ultimately died of multiple organ failure.[]
Raj Swaroop Lavadi, MBBS, a postdoctoral research fellow in neurological surgery at the University of Pittsburgh School of Medicine, tells MDLinx that the risk of slap fighting include (but are not limited to) concussion, craniofacial fractures, brain bleeds, and soft-tissue injuries.
“These risks are largely theoretical, as this sport has not been studied before, but concussion may be the only understood consequence of this sport,” he says. “Its recent popularity makes it difficult to assess its long-term impacts, although this is something that certainly cannot be ignored.”
What the research says
Much investment has been poured into the examination of concussion as it relates to sport—such as the CARE Consortium, a multi-institutional study spanning 10 years and including more than 53,000 college athletes and military cadets.[]
In a press release, Thomas McAllister, MD, principal investigator for the CARE Consortium and professor of psychiatry at Indiana University School of Medicine, said, “Mild brain injury was known as the signature wound of the war on terrorism. [...] At the same time, there was a lot of publicity around the NFL and the discovery that people with multiple concussions could develop a progressive neurodegenerative disorder which became known [as] CTE.”[]
According to Dr. McAllister, due to the high number of athletes who participate in contact sports, the risk of sport-related brain injury could be defined as a public health issue. He also noted that similar blows to the head impact individual participants differently, and the topic of long-term repercussions is complex.[]
CTE is a public health issue
The concept of chronic traumatic encephalopathy (CTE) has tied together traumatic brain injury (TBI) and dementia, which are among the most pressing health challenges in medicine today.
Recent research has highlighted the presentation of a dementia syndrome in people who are exposed to repetitive mild TBI (mTBI), Dr. Lavadi tells MDLinx. “Assuming that each strike results in a concussion, slap fighters can be compared to ‘human TBI models,’ wherein a single impact is inflicted at a time when the subject is motionless,” he says.
The mainstream media has fueled public concern regarding CTE by describing an inchoate operationalized cluster of symptoms and outcomes suggested to be related to cerebral tauopathy identified in brains of former professional athletes, according to authors of an article published in Journal of Neuropsychiatry and Clinical Neurosciences.[]
“This sense of alarm has led many individuals with repetitive mTBI from a variety of exposure settings to suspect that they have CTE because of symptoms similar to those of people who were later found to have the condition at autopsy. Some people may even suspect that they have CTE after a single mTBI,” the authors wrote.[] “Such individuals may be markedly distressed by their self-diagnosis, or by having had this diagnosis suggested by a medical professional."
"They frequently turn to clinicians, seeking validation for their suffering while at the same time expressing concerns that they have an incurable disease."
— Authors, Journal of Neuropsychiatry and Clinical Neurosciences
Diagnosing CTE
Diagnosis of CTE requires autopsy. To date, there are no validated biomarkers for CTE. Understanding of the clinical presentation is based on retrospective telephone interviews with family. Patients’ loved ones have described the following:[]
Poor regulation or control of emotions or behavior (eg, impulsivity, explosiveness, rage, emotional lability)
Progressively worsening and non-specific cognitive impairments (especially in executive functions and episodic memory)
Parkinsonism and motor neuron disease
With the rising popularity of televised slap fighting competitions, like Power Slap, physicians may see more patients with serious injuries related to a slap to the face. “Slap fighting promotions have largely succeeded in de-escalating the concussive nature of this sport by stating that 'it's just a slap' or that a slap cannot be worse than a punch,” Dr. Lavadi explains. “The same rationale may be adapted by curious individuals, leading to greater engagement and underground participation. This may inevitably lead to a greater incidence of traumatic brain injury resulting in hospitalization.”
What this means for you
Slap fighting is an incredibly dangerous sport where each fighter takes turns bracing for blunt force trauma, raising their risk of TBI, CTE, and other serious injuries. Patients may be inspired to take up slap fighting given its rising popularity. It may be prudent for physicians to be aware of the risks of slap fighting, and explain the risk of brain damage to patients who may be inclined to participate in this combat sport.