Altered Vestibular Balance Function in Combat Sport Athletes

J Neurotrauma. 2021 Aug 15;38(16):2291-2300. doi: 10.1089/neu.2020.7432. Epub 2021 May 21.


Combat sports pose a risk for accumulative injuries to the nervous system, yet fighters have remained an understudied population. Here, our purpose was to determine whether repetitive blows to the head have an effect on vestibular balance reflexes in combat sports athletes. We compared lower-limb muscle responses evoked with electrical vestibular stimuluation (EVS) between fighters (boxing/muay thai) and non-fighter controls. Each participant received stochastic vestibular stimulation (0-25 Hz, ±3 mA) over their mastoid processes while they stood relaxed with their head to the left or right. Surface electromyography was recorded from the medial gastrocnemius and soleus muscles bilaterally. Short and medium latency response (SLR/MLR) peaks were significantly delayed in the fighter group compared to controls. SLR and MLR peak amplitudes were also significantly lower in fighters. Fighter-estimated cumulative repetitive head impact (RHI) events demonstrated strong positive correlations with the timing of SLR and MLR peaks. Cumulative RHI events also negatively correlated with peak MLR amplitude and response gain at frequencies above 5 Hz. Our results provide evidence of a progressive vestibular impairment in combat sports athletes, potentially resulting from blows to the head accumulated in sparring practice and competitive bouts throughout their careers. Taken together, EVS-based vestibular assessments may provide a valuable clinical diagnostic tool and help better inform "return-to-play" and career-length decisions for not only combat sports athletes, but potentially other populations at risk of RHIs.

Keywords: balance; combat sports; electrical vestibular stimulation; electromyography; reflex; vestibular system.

MeSH terms

  • Adult
  • Boxing / injuries*
  • Case-Control Studies
  • Craniocerebral Trauma / physiopathology*
  • Electric Stimulation
  • Female
  • Humans
  • Lower Extremity
  • Male
  • Martial Arts / injuries*
  • Middle Aged
  • Muscle, Skeletal / physiopathology
  • Postural Balance / physiology*
  • Reaction Time
  • Vestibular Evoked Myogenic Potentials / physiology*
  • Vestibule, Labyrinth / physiopathology*
  • Young Adult