Cageside: what the medical team is watching for during a round
While the crowd watches the shots land, the medical team is watching what happens next: how a fighter gets up, how they defend and how they answer.
In short
- Most of what matters cageside is what happens after a shot lands.
- Observable signs such as unsteadiness, a blank look or slow responses can tell us a fighter is hurt before they know it themselves.
- If we are worried, we tell the referee straight away. The UK guidance is clear: if in doubt, sit them out.
This film comes from a bout at Manchester Mayhem. If you watch a fight from the medical seats you see it differently. The crowd follows the strikes; we follow the fighter. A clean shot matters less to us than what the fighter does in the second or two after it.
The signs we look for
Concussion is diagnosed by clinicians, but many of its early signs can be seen from the cage side by anyone who knows what to look for. These are the ones that make us pay closer attention:
- No protective response: a fighter who stops defending or does not put their hands up after being hit.
- Unsteadiness: stumbling, wobbly legs, or needing the cage to stay upright.
- A blank or vacant look, or eyes that do not seem to focus.
- Slow to get up after a knockdown, or lying still.
- Confusion: not responding properly to the referee, or seeming unsure where they are.
- Clutching the head, or a seizure or stiffening after a blow.
Working with the referee
The referee is closest to the action, but they are also managing the fight itself. The medical team gives them a second set of eyes trained on one thing: the fighter’s health. If we see signs that worry us, we tell the referee, and if needed we ask to examine the fighter. International consensus on concussion in combat sports supports exactly this: a low threshold for assessment, and no return to the same bout for a fighter with a suspected concussion.
After the bout
Any fighter we are concerned about is examined again after the bout, and anyone with a suspected concussion leaves with written advice, a suspension and a staged return to training. The UK’s grassroots concussion guidance is a good rule of thumb for everyone else: remove the person from activity immediately, no training or competition within 24 hours, and call NHS 111 within 24 hours of a suspected concussion. Red flags such as a worsening headache, repeated vomiting, a seizure or increasing confusion mean an urgent hospital assessment.
Questions we get asked
Can you have a concussion without being knocked out?
Yes. Most concussions happen without any loss of consciousness, which is why the medical team watches for other signs such as unsteadiness, confusion and a blank look.
What are the red flags after a head injury?
A severe or worsening headache, repeated vomiting, a seizure, increasing confusion or drowsiness, weakness or tingling in the arms or legs, or double vision. Any of these means an urgent hospital assessment: call 999 or go to A&E.
Why can’t a concussed fighter just carry on if they feel OK?
Because a second blow to a brain that has not recovered can cause a far more serious injury. The rule is simple: no return to the same bout with a suspected concussion.
What tool do doctors use to assess concussion?
Clinicians use structured assessments such as SCAT6, from the international Concussion in Sport Group, along with their own examination. Cageside, the first step is recognising the signs and removing the fighter from danger.
Further reading
- Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam 2022 British Journal of Sports Medicine (2023)
The international expert consensus behind SCAT6 and the graduated return to sport. - Concussion management in combat sports: consensus statement from the Association of Ringside Physicians British Journal of Sports Medicine (Neidecker et al.)
The first consensus written specifically for ringside doctors on concussion and return to competition. - UK Concussion Guidelines for Non-Elite (Grassroots) Sport (November 2024 update) Sport and Recreation Alliance / UK Government
The UK-wide “If in doubt, sit them out” guidance: remove immediately, no training or competition within 24 hours, NHS 111 within 24 hours. - Those with suspected concussion urged to ‘sit it out’ for at least 24 hours under new guidance England Boxing
How a combat sports governing body explained the guidance to its clubs.
General information, not medical advice for an individual. If you are worried about a head injury, call NHS 111; for a severe or worsening headache, repeated vomiting, a seizure or increasing confusion, call 999. Suspension minimums are those of the EMMAA minimum suspension protocol our doctors apply.