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Zuffa LLC via Getty Images

The UFC's big bet to keep fighters fighting

Can high-tech sports science solve MMA's injury problem?

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This article contains images of violence that may upset or offend.

If you're curious about what the world's preeminent mixed martial arts competition is like but did not pay as much as several thousand dollars for Madison Square Garden seats last Saturday, here are some of the sights UFC 217 offered:

Light heavyweight prelim bout. Corey Anderson's head hits the canvas with a resounding whump. The culprit: a crashing left kick to the jaw from a now-strutting Ovince Saint Preux. Each replay of the knockout garners a spontaneous "oh!" -- equal parts exhilaration and wincing -- from the mostly male, disproportionately swole, crowd of 18,000. M.O.P.'s "Ante Up" plays after the bout.

Heavyweight prelim bout. "Elbow him in the face!" a man yells as Walt Harris of Alabama and Mark Godbeer of England face off. There's no decisive elbow, but the 6-foot-5-inch, 250-pound Harris does plant a solid -- and illegal -- knee into Godbeer's groin. As the Brit backs off, Harris sends a kick to his face. The ref stops the fight and Harris is disqualified.

Women's strawweight title bout. Fiery champion Joanna Jedrzejczyk is dethroned in just over three minutes by Rose Namajunas, a lithe, quietly confident 5-foot-5 fighter with a buzz cut. Fighters often jockey for a dominant position over a grounded opponent from which to punch their head repeatedly -- known as "ground and pound" -- which can end a fight. In this case, Namajunas sinks Jedrzejczyk with a left hook, then pounces for a dozen or so punches to her defenseless skull until the champion surrenders.

There were 11 fights in total; we haven't even gotten to the marquee event. Yet somehow, this was one of the less violent nights in the Ultimate Fighting Championship's 24-year existence.

The UFC started with a 1993 fight in Denver. The idea was to pit wildly different fighters -- say, a spindly kickboxer with a 600-pound sumo wrestler -- against each other to compare styles. Once labeled "human cockfighting" by Sen. John McCain, you could count the number of rules in one hand. While regulations varied from event to event, usually only the most barbaric ways of inflicting pain like biting and eye-gouging were banned.

In 2001, Frank and Lorenzo Fertitta bought the UFC for $2 million and the organization started angling for mainstream legitimacy. New rules were added -- no more head-butting or kicking an opponent when he's down -- as well as weight classes and time limits. The company hosted fights in Brazil, Australia and Japan, and launched a reality show, The Ultimate Fighter. UFC events started making a steady pay-per-view profit. Last year, New York, the last state where MMA was still illegal, lifted its ban. Then, the Fertittas announced they'd sold their company for $4 billion to Ari Emanuel- and Patrick Whitesell-led Hollywood talent agency WME-IMG.

Today, mixed martial arts (MMA) rivals boxing as the world's most popular combat sport -- 25 percent of Americans are a fan of the former, while 28 percent follow the latter, according to a recent poll by The Washington Post and UMass Lowell. Each year the UFC, MMA's biggest promoter, puts on about 40 "cards" -- the list of matchups on a fight night -- beaming them to more than 150 countries. Last weekend's card at UFC 217 brought in over a million pay-per-view buys, said the UFC's president and public face, Dana White. Madison Square Garden ticket sales totaled $6.1 million.

MMA's authentic brutality has long been both a key selling point and criticism. The fights are the closest most people get to gawking at skilled, nearly-anything-goes combat.

Fight cards are both soap opera and athletic contest, and injuries disrupt the narratives that build for months ahead of each fight.

The problem with making money off raw aggression is injury. Damage to the body is a byproduct of every sport, but in MMA, harming your opponent is the entire point. Facial lacerations and bruises are just another day at the office; noses and eye sockets breaking are hardly uncommon.

When athletes pull out of one of the UFC's 500 or so annual fights, it's not enough for the promoter to simply find a willing replacement. Fight cards are both soap opera and athletic contest, and injuries disrupt the narratives that build for months ahead of each fight (like the underdog versus the cocky champ). In the UFC, star athletes like Conor McGregor and Ronda Rousey sell tickets through their personalities as much as their technique. A fight that captures the fan's imagination can mean the difference between a million viewers paying for the live action versus 100,000.

The tension has plagued MMA for years. It's a sport that's institutionally organized around two people brawling until one is unconscious or unwilling to continue. Can its biggest promoter keep athletes fit enough to maintain bankable stars with lengthy careers and regular fights? To find an answer, the UFC is turning to technology.

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A few miles from the Las Vegas strip is the UFC Performance Institute, a gleaming, 30,000-square-foot, $14 million bet that the latest performance technology can maintain their athletes' bodies.

At the end of 2014, the UFC was going through an internal audit. "It was a bit of a bad year so we tried to identify the cause of that," said James Kimball, the Performance Institute's VP of operations. Athletes were falling off fight cards through injury, not recovering fast enough, or failing to get their bodies to the right weight for competition. Spurred by Lorenzo Fertitta, the UFC examined the facilities of NFL and NBA teams, eventually modelling their center largely on Manchester City Football Club's. Part of the organization's new corporate campus, the UFC wants to make the institute a mothership for some 500 fighters around the world to check into occasionally and fine-tune their training.

UFC flyweight Joseph Benavidez.

Recently, Conor McGregor prepared here for his boxing bout against Floyd Mayweather. Cirque du Soleil performers, the NBA's Brooklyn Nets and NHL team Vegas Golden Knights have also passed through. But a regular face here is Joseph Benavidez, the second best fighter in the UFC's under-125-pound flyweight category, who lives a 15-minute drive away.

Benavidez has been an MMA fighter for 11 years, but his first serious injury came earlier this year in a freak accident during routine sparring. "I just pushed off for a punch and my foot kind of just got stuck in the mat," said Benavidez, who at 33 has the face of a veteran fighter: cauliflower ears, slight crook in his nose, scar from a split brow. "There was no blunt force or anything foul going on." Benavidez's body went one way, his foot stayed planted, and he fell to the ground.

Weeks out from a major fight in New Zealand, Benavidez had torn his anterior cruciate ligament (ACL) as well as two other ligaments holding his knee together. In short, he would need a full knee reconstruction and 10 months on the sidelines.

An ACL tear is a traumatic injury for any athlete. Recovery essentially requires reprogramming the brain on how to control the leg as if the sportsman were a baby again. Only then can Benavidez build muscle and practice fighting moves, all while trying to avoid injury in the same, vulnerable spot again -- especially in a sport where opponents may target a perceived weakness.

With strength and conditioning coaches, nutritionists and physical therapists under one roof, the UFC wants to aggregate everything a fighter needs to train in one place.

Since his surgery, Benavidez has been in rehab at the Performance Institute five days a week. Recently off crutches, he does cardio on an anti-gravity treadmill -- which seals the atmosphere below the waist so athletes can run on as little as 20 percent of their body weight -- to reduce the impact on his knee. Meanwhile, he uses the DEXA machine, which is a type of X-ray that can precisely measure how much muscle he has rebuilt in his right leg compared to the uninjured left one. The hard data both serves his trainers and gives him quantified feedback on how quickly he's improving.

The institute also houses something that looks like a tanning bed but uses infrared light to reduce inflammation and speed up muscle repair. A PowerKube pad quantifies the power of an athlete's punch while pressure plates in the weight room can measure movement patterns on every rep of a squat. A sealed altitude chamber can mimic elevation of up to 22,000 feet, so athletes can push their cardio exercises in a short amount of time.

Essentially, the institute's equipment molds the environment around an athlete to maximize the efficiency of their training and recovery. With strength and conditioning coaches, nutritionists and physical therapists under one roof, the UFC wants to aggregate everything a fighter needs to train in one place. And, while they're at it, to measure as much of that activity as possible and turn it into data.

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Around the facility, iPads are placed on the walls and next to weight racks with the headshots of every athlete who's visiting that day. They tap into their profiles and can access a bespoke training plan while inputting everything from how well they slept to their mood. The hope is that when they return to their home gyms, they'll continue inputting this information manually.

"The UFC in all honesty probably wasn't doing a really great job in tracking performance-related issues in terms of data, in terms of understanding what is the cause of certain physical ailments," Kimball said. "Really this facility is meant not just to be a training center for the athletes but a research, innovation and development and data capture facility."

The company that centralizes all that data is Kitman Labs. Founded five years ago in Dublin, Kitman aims to use machine-learning to find the root causes of sports injuries, correlating a host of metrics like athletes' training plans, hydration levels and medical records. Having worked with Everton Football Club in the UK, the LA Dodgers and Miami Dolphins, Kitman claims to reduce injury between 30 and 40 percent across different sports by combing through data that already exists.

"Whether it's the NFL, the NBA, Major League Baseball, Major League Soccer, they all store medical records on their athletes, and they all store private performance data that the teams are collecting," said Stephen Smith, CEO at Kitman Labs. "They're collecting that data and they're storing it in the equivalent of a bucket. They're basically putting the lid on it every day, and it's useless."

For Duncan French, the UFC Performance Institute's VP of performance who previously worked with the British Olympic taekwondo team, University of Notre Dame and Newcastle United FC, identifying the cause of the UFC's injuries is the "golden bullet." "We're never going to stop injury. What we're trying to do is minimize injury rates," he said.

"I've been researching for the last 20 years, 15, years, what's the best way to train for MMA. Nobody really knows."

About 35 percent of the UFC's fighters have used the facility in its first five months, said Kimball, and the more athletes use the facility, the more data feeds into the UFC's system. As red flags for injury are discovered over the next 12 months, the UFC can educate its athletes on how to train most effectively. As a relatively young sport with individual gyms dotted around the world, there are few standardized training techniques.

"I've been researching for the last 20 years, 15, years, what's the best way to train for MMA. Nobody really knows," said Forrest Griffin, a former UFC athlete in the hall of fame who has been involved in the Performance Institute's development since conception and is its VP of athlete development. "Every football, every soccer, every baseball, basketball -- you know what traits you're trying to magnify. But MMA is the most open sport there is. We have guys that are horrible athletes and they're amazing fighters -- why? Guys that are amazing athletes but they're horrible fighters -- why?"

The Performance Institute is essentially the next step in the UFC's evolution as a serious sport. Three of the institute's official targets are to reduce injury, maintain cards on pay per view and accumulate athlete data, although a UFC spokesman declined to make the numbers they are targeting public. Right now, says French, the UFC is "working toward" an analysis of how much revenue injury is costing them every year.

"MMA is behind other more mainstream sports when it comes to surrounding the athletes with a good team and resources, so the Performance Institute is a big step in the right direction," said Jonathan Gelber, a sports medicine specialist and board member of the Association of Ringside Physicians. "Tracking injuries and performance is what all the other major sports do on a regular basis."

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Over the years, UFC audiences have seen an arm get broken in four places, an ear half ripped off and teeth sent flying from the cage. Yet the ailments hanging over UFC, and all contact sports right now, are brain injuries.

A recent study of deceased NFL players' brains showed that 110 of 111 of them had chronic traumatic encephalopathy (CTE), a degenerative brain disease associated with repeated trauma to the head. Meanwhile last year, Jordan Parsons was the first MMA fighter to be publicly diagnosed with CTE after he died at 25 in a traffic accident.

While many brain diseases don't become apparent until later life, CTE can only be identified posthumously. It's only now that a generation of MMA fighters are retired and discovering the long-term effect the sport has had on their brains.

"It's a relatively young sport," said Robert Cantu, the co-founder and medical director of the Concussion Legacy Foundation and a clinical professor of neurosurgery at Boston University School of Medicine. "The amount of research that's been done is trivial."

There are also many questions around CTE, such as whether there's a threshold of hits to the head one can take before the disease risk shoots up and what makes some people more susceptible to it than others.

"The body doesn't adapt to being punched in the head at all ... You don't get used to it."

The most comprehensive ongoing research is the Professional Fighters Brain Health Study at the Cleveland Clinic, partially funded by the UFC, which has been giving MRI scans and cognitive tests to current and former fighters once a year since 2011. Meanwhile, a University of Toronto study found that 32 percent of UFC fights between 2006 and 2012 resulted in head trauma -- a higher rate than ice hockey and football. Yet most injuries happen in training.

For the UFC, that means a change in mind-set: While blows to the head are inevitable in the ring, they can be minimized in sparring. "You shouldn't compete every day. You shouldn't put yourself in a win-or-lose situation where you're going to go 100 percent with another human being every day," said the UFC's Griffin. When he was competing, Griffin would spar two or three times a week for as many as 10 rounds, which he now calls "unnecessary." It's part of a mentality in some fighters that the more you spar and get hit, the more prepared you are for the fight. "The body doesn't adapt to being punched in the head at all," he said. "You don't get used to it. You don't build up calcium deposits."

An Octagon at the performance center equipped with 12 VICON cameras next to an 82-inch touch screen for video analysis is supposed to encourage athletes to fight less and analyze their spars more, something Griffin says he did at most five times in his career.

However, to some experts, brain injury is going to be inevitable for UFC athletes, and it's unclear how much tech-assisted training methods can stop that.

"That's part of the culture. If you can knock a guy out in MMA with a shot to the head you're going to do it," said Shelby Karpman, chief medical officer for the Edmonton Combative Sports Commission in Canada. Karpman has worked as a ringside physician in boxing and MMA fights since 1992, handling about a half dozen annually; this September he saw UFC fighter Gavin Tucker get four bones broken in his face in one fight.

"The fans love to see people get hit in the head," Cantu said. "So those fighters tend to learn to strike because they make more money and they are more popular. Long-term, later-life ramifications of all that head trauma is going to be a reality."

The knockouts, after all, are what everyone is here to see.

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By the time UFC 217's fight of the night comes on, the blood of past combatants on the Octagon floor has settled into burgundy smears around the Harley Davidson logo.

The hero and villain of this fight has been telegraphed loud and clear. Michael Bisping, the defending middleweight champion is a weathered and cocky Brit who, at the pre-fight press conference, made fun of his opponent's suit and called him a "little bitch" to jeers from the fans in attendance.

Georges St-Pierre, a mild-mannered Canadian and former champion known both as a cultured grappler and lover of dinosaurs, is making his comeback after four years away from the sport. He's been drinking in Bisping's derision for months with a bemused grin. Amid the smack-talking culture of MMA, "GSP" is the kind of guy who says things in interviews like "martial arts is not about who's got the biggest balls," then apologizes immediately for saying "balls."

Their fight -- like many others -- has already been delayed twice, with St-Pierre recovering from an eye injury and Bisping nursing his knee. Finally, it starts.

In the third round, St-Pierre takes Bisping to the ground and wraps his arms around him, pushing his head into Bisping's chest. Bisping, trapped beneath the stocky Canadian, launches elbow after elbow to his face.

They get back up. St-Pierre's face is a mess of crimson, his head and nose cut open, blood streaking down his chest and covering Bisping's torso too. He looks fatigued, unable to keep Bisping on the floor, where he is most effective. But a left hook from St-Pierre soon drops the Brit, and he follows up with a flurry of punches and elbows to his downed opponent.

Then, St-Pierre maneuvers himself for a Hollywood finish: the rear naked choke. He wraps his legs around Bisping from behind, fastens one arm around his neck and applies pressure with the other. It's a move of complete domination; once Bisping is locked in, everyone knows it's over, including Bisping. The 6-foot-3-inch middleweight champion has a look of helpless panic on his face before he slips out of consciousness and slumps over.

This is the moment everyone has waited for. The prospect of a knockout, of extreme, cringe-but-can't-look-away, blink-and-you-miss-it violence animates every moment of a fight. Its occurrence is like a home run: a flawless show of superiority. The money shot replays on giant screens in slow motion, repeatedly. The stadium roars.

After the fight, White declares UFC 217 "one of the best ever -- if not the best ever" nights they've had. "This is the best year by a long shot in the company's history," he adds.

Bisping's face is splotchy with purple bruises, but nothing serious -- "scuffs," he says.

St-Pierre is whisked to hospital for stitches in his nose right after the victory. He is ordered by doctors not to fight for 45 days, wins congratulations from Prime Minister Justin Trudeau and gets a $50,000 "performance of the night" bonus for his troubles.

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