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Professional boxing, kickboxing, and mixed martial arts (MMA) are popular sports with substantial risk for both acute and chronic traumatic brain injury (TBI). Although rare, combat sports athletes have died in the ring or soon after the completion of a bout. Deaths in these instances are usually the result of an acute catastrophic neurological event such as an acute subdural hematoma (SDH). Other causes may include acute epidural hematoma (EDH), subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), or a controversial, rare, and still disputed clinical entity called second-impact syndrome (SIS). Neuroimaging or brain imaging is currently included in the process of registering for a license to compete in combat sports in some jurisdictions of the United States of America and around the world. However, the required imaging specifics and frequency vary with no consensus guidelines. The Association of Ringside Physicians (an international, nonprofit organization dedicated to the health and safety of the combat sports athlete) sets forth this consensus statement to establish neuroimaging guidelines in combat sports. Commissions, ringside physicians, combat sports athletes, trainers, promoters, sanctioning bodies, and other healthcare professionals can use this statement for risk stratification of a professional combat sports athlete prior to licensure, identifying high-risk athletes and for prognostication of the brain health of these athletes over the course of their career. Guidelines are also put forth regarding neuroimaging requirements in the immediate aftermath of a bout.

The Association of Ringside Physicians (ARP) is committed to the concept of fair competition. It advocates for two equally skilled and matched athletes to keep bouts fair, competitive, entertaining, and, most importantly, safe for all combatants. Numerous studies have proven that transgender women may have a competitive athletic advantage against otherwise matched cis-gender women. Likewise, transgender men may suffer a competitive disadvantage against cis-gender men. These differences – both anatomic and physiologic – persist despite normalization of sex hormone levels and create disparities in competitive abilities that are not compatible with the spirit of fair competition. More importantly, allowing transgender athletes to compete against cisgender athletes in combat sports, which already involve significant risk of serious injury, unnecessarily raises the risk of injury due to these differences. Hence the ARP does not support transgender athlete competition against cisgender athletes in combat sports. [ABSTRACT FROM AUTHOR]