How Instrumented Mouth Guards Tell Us What The Most Dangerous Combat Sport Is w/ Jon Bell (SSOF Ep 151)

Jon Bell1:46

Now they're mandatory in all of rugby league and rugby union. So the England team wear them. I think all six nations teams have to wear them now. You're not allowed on the field of play without one basically. So I've been the first to use them in competitive combat sports.

So they've used him in sparring before in boxing, but they've never used him in a competition. And we used them first actually in the BKFC. So, Conor McGregor's Bare Knuckle Boston. And that's been really interesting. Again, it's just so new that you get the data, don't you? You look at it and you're like, well, what am I going to do with it? I could go a million different ways.

And there's that overriding pressure just not to look like an idiot all the time. So, you've just got some data and you're asking the members of the team to have a bit more experience even though I'm supposed to be leading it and I'm trying just not to sound too stupid.

And I'm finally getting a grips now. I understand that eventually and it's been about a year and a half. And yeah, so basically we're finishing off a few papers with that. It's going to we've got a few conferences coming up that we're going to present some of the data at.

One in two weeks, a few over the summer. And yeah, basically that's the most exciting kind of thing that I'm doing just because it's completely novel at the moment and it's going to have quite high impact where originally I was just happy to get publications from any journal pos any journal would have taken where now now I'm actually doing something that's probably going to be seen all around the world and probably impact real sets.

Yeah. So that's what I'm most excited about and that's probably my by far the most interesting research I've done.

James de Lacey5:04

So what are you looking at metric-wise with these instrumented mouthguards and then what is that what does that influence maybe for you in terms of practice or maybe for these organizations we're putting these events together or medical staff or whatever it is what's the data that comes to you guys then how does that influence or what's the outcome from that data?

Jon Bell5:31

So you take out a lot of it actually but the main I figured out that what we really just need is frequency and magnitude and then overall load. To be fair, a lot of it is what you would expect.

So, if you're in a professional boxing match and they do 12 rounds, the overall loads is generally a lot higher than an amateur boxing or even a bare knuckle boxing match that go maximum five rounds. And that's obviously because they've done more than twice as many rounds.

So, there's some things that I mean, look, no one has ever done them before. So, even the things that are obvious is still going to be worth reporting. And then the magnitude is obviously we're looking at the highest kind of it's all measured in Newtons basically the highest linear angular accelerations but also the speed as well.

So not only the velocity kind of the overall calculation of it together kind of just gives a big number. And they you use them best and again this was nothing to do with me so I kind of take credit but how they're using them in rugby league and union they use them in real time so you get real time data at the moment I'm pretty much just using them the data afterwards and I do nothing real time apart from collect but

you being your predominantly your physio team your medical bay team and you have to have an alert on it so if they go above 50 Newtons. It comes up red with the player's name and you then have to take that player off for head assessment.

It could pass, but so far I don't think anyone's passed. I think the validity of it really high. No one's had who's come up from the late from the head impact has then passed a concussion test as far as I'm aware. I might be talking rubbish there, but last time I heard at least that's what I got told.

So yeah, practically in rugby they used really well in combat sports. It's so new that I mean it is really hard. So for example, I was in a medical course the other day one a fever ran once so for football sorry not fever the effort so the English football association and there were we were going through the medical procedures of when people get hurt and it was just pretty much as soon as you see a head impact or any contact to the head you

then do mills. the way pretty much you you always protect the spine. You treat it like a concussion no matter what. You obviously you get your spinal bars ready. And I was just thinking I work in sports where the whole goal is to hit people in the head.

So there you're getting these 100 odd head impacts in a match and then I'm at a course in football where one head impact and that's it. We're taking them off. spinal boards. And that just reminded me of that how hard it is now how to use the mouth guards because alerts won't matter.

No one cares at bare knuckle boxing if they've got an alert for 50. People are getting three or four alerts per match. So I don't know what to answer your question. I've been very longwinded but I have no idea James. I have no idea how they're going to be how them yet.

The only useful thing that not useful it's useful just to document it but in GB Muay Thai we're going through the different rule sets. So the different categories so Nclass B-class Cclass pram and basically they're just different rule sets.

So, end-class wear shin pads, they can't punch kind of punch the head. Basically, you get the gist of every one going up to pro obviously that gets more brutal. And I'm trying to figure out how much of an impact that actually has.

Does it actually change head impact much because they're wearing shin pads? And that will probably have a direct impact on the rule sets. And I'm also trying to find out if bare knuckle boxing is served in glove boxing. So that's going to be one of my questions.

James de Lacey9:19

Do you have you seen any differences in head impacts?

Jon Bell9:35

So no and yes. So the fear is always I was on I was on the BBC news actually not long ago trying to talk about this. I got absolutely ambushed. They lied to me completely what they wanted to talk about. They put me in a hot room with no air con. I melted and then came out and I just attacked me with lots of these questions about is bare not bare knuckle morally right and is it promoting violence in the streets and I was like I'm in charge of medical research I have no idea these things but the this is the argument would be this the argument is so if you and it's

Purely using biomechanics, which is what I specialize in. So if you hit someone with a small object like a knuckle, for example, all of the energy from that punch is going to be concentrated in a very small area, a bit like a knife.

So a knife will always pierce someone's skin, but it's going to be just completely around that one area where the knife can touch. And it's small, so it's going to cause a lot of soft tissue damage to the area if you get hit by a knuckle, but it's superficial.

So what we're really worried about, or what is the real damage, is CTE, diffuse axonal injury, where obviously you get damage to the nerve fibers in the brain and then they kind of was like scar tissue in the brain, basically. And that comes from repeated load, and it comes from high load as well.

And you would think through a glove, a gloved hand, because everything is strapped and compact, they can hit more and they can hit hard without any worry about hurting your hand. I know if anyone's actually ever punched anything, be a person or a wall, anything out of anger, they'll know that really hurts if you punch something without a glove on.

Plus you should get more momentum transfer as well if you're wearing a glove, for the larger surface area. And that's always been the argument and no one's been able to prove it. And obviously till I publish stuff, there is the whole ethical issue that I can't give too much information, but I can say that it's confusing. It's about the same, roughly, and basically the reason why it's about the same is because the bare knuckle boxers are incredibly tough and mental.

James de Lacey12:04

So they're just hitting as hard as you would do with—they have their hands wrapped super tight as well, right? It's literally braced, their hands?

Jon Bell12:04

So it's different per promotion. Some strap up to the knuckle, but obviously the whole rules is you have to have the knuckles out. And some literally just strap the wrist. BKFC, they go around the thumb, so they go around the front and back, I believe.

So the big thing is what's the difference between professional boxing and BKFC is they always limit it to five rounds in bare knuckle boxing. So they're two-minute rounds, sorry. And there's five of them where professional boxing obviously can be more than twice as much. So professional boxing will always be worse, but it's mainly to do with the fact that there's more time.

There's more time to hit each other, which I know isn't—it's not groundbreaking. And I need to collect more. I'm probably collecting for another year or two. But generally speaking, if you give people more time to hit each other, then they will have more head impacts and more overall load, which probably wouldn't have cost a £15,000 grant and all the money on mouth guards. But yeah, that's basically it.

James de Lacey13:23

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I remember I interviewed Gary—I don't know if you listen to Gary Turner at all on his neck stuff?

Jon Bell14:24

I have, but not regularly.

James de Lacey14:24

So I interviewed him way back when I started this podcast, episode three I think it was, and he was talking about similar to what you were saying about that short surface area for a punch versus a larger one with the glove, and that potentially obviously having the larger surface area means more force around the head, et cetera.

Same thing he was talking about with headgear. I don't know if that's something you've looked at as well. Headgear obviously they use to mitigate cuts and things, but they often also use it as almost a safety net for, I guess, brain injury. Have you seen anything different with the mouth guards with head gear?

Jon Bell14:56

There was no head gear. So we've not used them in head gear, but some of the original studies with the technology—not as dated now compared to these mouth guards—but they used to put them in headgear, didn't they, just because they hadn't figured out how to make them small enough to put them in a mouth guard, but they could put them in the head gear. So I've seen some of the old, I guess you would call them historical studies now.

And yeah, pretty much it doesn't stop the head going back and it doesn't stop the head turning in an angular fashion, and that's what causes the injury. It's whiplash to the brain. So it doesn't—like you said, it doesn't really matter that it's padded on the front because it would stop lacerations, basically. But from what I can tell—and we are going to put them in kids—I should give more context that we're just going to find some kids and give them some mouth guards.

We're going to put it in at the point in amateur boxing where you can take away the head guards, and we're going to measure just before that head gear, heads to just after. But from what I can see from the more historical studies, it doesn't really matter at all in terms of what we call CTE, which is literally just the whiplash effect.

And I can't show you yet, they're certainly not recorded, but we've got some really good models like computer-based models of what's happening to the brain. So there's a computing engineer on the team who's—he's so smart, he's intimidatingly smart—and he can make some amazing models with the data. You can see where the head's twisting. It comes up with all the angular linear velocity, but then we can also now see how it affects the brain inside the head.

And it is really cool and it's such a good visual way to be able to show someone who, if you just tell people numbers, they're generally just like, I don't know what that means unless one number's higher than the other. So yeah, again, I've not given a yes or no, but from what we do have, yeah, headgear only protects from lacerations.

James de Lacey17:08

Interesting. Interesting. People tend to get bloody noses more when we do the most high-level sparring because the whole area is unprotected, the nose, for some reason. And the amount of bloody noses that we get almost nearly triples.

Jon Bell17:34

Everyone aims there. Yeah, I guess so. It's a big thing in the middle, is it like a target? And then, so your argument would be, yeah, it just would not really work.

James de Lacey17:53

We had someone in the chat. He was saying that you look like Raphael Fiziev, but you're more muscular. So I guess that's a good compliment.

Jon Bell17:53

I don't know who that is, but I'm glad for the compliment about my muscles. I'm pumped up after wrestling, though.

James de Lacey18:06

Oh yeah, that's true. A post-wrestling pump is another level.

Jon Bell18:06

Yeah, it really is. And yeah, I think I've got heat stroke as well. We've only had one hot day in the UK all year and it was today, and I don't deal well with the heat.

James de Lacey18:25

Fair enough. I wanted to ask you as well around the mouth guards. Have you correlated anything with neck strength? Because neck strength is obviously a very controversial, I guess, topic when we're talking about CTE or just concussion or traumatic brain injury.

Just with this—maybe I'll say some quick background, again purely from my conversation with Gary many years ago—where his view is having a stronger neck is worse for traumatic brain injury because when the head moves, it dissipates force better around the head, whereas the head is still, the force goes straight through to the brain. Obviously I don't know what maybe your views are on that, but it'd be interesting to know if you've correlated anything with neck strength, if you have any views on neck strength and traumatic brain injury.

Jon Bell19:15

Yeah, so I have actually just made a big push because I've managed to worm my way into high positions in a lot of the MMA and a lot of the national teams. I've been collecting normative data on neck strength for a while.

So I've probably—a guy called Aiden Doyle, the head physio for GB Boxing, helped me with it a lot. And basically just got a big Excel sheet just full of what we wanted, a big spreadsheet of normative data. And we pretty much got there now, but the idea is now to do something with it.

So now regular testing. We can actually now see the differences between different sports. GB Boxing hasn't been testing neck strength for—I don't know, I don't know the view of their S&C coach, but basically he had a negative view.

He basically said there was no normative data. So how do we know if someone if the tests of... Was this Gary hat or... I don't know. I'd have to ask Aiden. But yeah, basically there's no normative data. So, how do you know if it's good or not?

It's not like we can say that looks strong, but is it strong if you've only got a sample of 10 people? Maybe they all have strong necks. So, maybe this guy who's got a slightly less strong neck has still got a strong neck, which is a good point, but I'm trying to build that database now.

We probably would probably try and publish it. Maybe it's all about publications nowadays. We probably try and put it out there. Yeah, I'm a big believer that neck strength will help. I know there's limited studies and everyone quotes that one study.

I can't even remember the percentage now. 5%. It was a 5%... well, every one pound of neck strength increase is 5% reduction in concussions, I think. And it came from one study, didn't it? And it's been heavily like over-referenced, but it needs exploring more.

I can, again with attenuation and how the body attenuates force and this is me thinking on the spot, I can't see how the head being still would aid in actually helping... sorry, not the head being still, quite the opposite, having the head move. Because we do know and it's been proven many times that whiplash and angular acceleration causes more brain injuries and more damage to the brain than anything else.

So, we know that that's pretty much been out there for a while. So yeah, the idea is to prevent that. I mean, have you ever really seen, have you seen many people get knocked out when the head hasn't been shot back or twisted?

And probably the answer I imagine probably would be no. I certainly watch a lot of people get knocked out in my role as a medical kind of staff in a lot of these events. And when you watch it back, the heads are all, they've always bounced back.

They've always twisted. Someone can take a shot and move the head, it's very likely going to be knocked out. I know that's like a very anecdotal, subjective thing to say, but people like imagery, don't they? So yeah, I would disagree with that.

It would be an interesting discussion though to have because I'm literally thinking on the spot. But the mouth guards, I haven't done it yet and I didn't actually have a... I've got, it's so like novel at the moment, I've got so much that I can pump out with it that I probably not going to look at neck strength for a long long time.

But a researcher called Molly who's helping me as well, she's took all the rugby league data and now what she's doing is she's measuring neck strength and she's trying to find a link. So Molly, one of our researchers, is trying to do that.

Last time I spoke to her, I don't know if she's found a... actually have scored anything yet. I'll let you know when she does because I'm really really interested in it. But again, it's something you constantly hear, isn't it?

We have a fixed plate dynamometer called Kangatech. I think it's by an Australian company actually and cost us loads of money and basically that's pretty much how they sold it to us. Not that we needed a selling page, we needed a fixed plate dynamometer.

I think we're going to buy it no matter what. But that was kind of it, that this guy had been using it going around. He was working in hockey in Scandinavia and he was using it to measure neck strength after concussion and kind of used baseline to then post-concussion testing as a measure of returning people to sport again. Heavily anecdotal but he swore by it. But I guess what we're figuring out from me blabbing on is that there's not enough research, is there?

And it's predominantly anecdotal at the moment, so realistically it's going to probably, I'm not going to get to it for a long time because there's so much more that I need to kind of get down and publish first. But hopefully they'll fill in, in rugby.

James de Lacey24:30

Yeah. Are you training your own neck based on just general I guess theory, anecdote?

Jon Bell24:30

Well I need to train more in general. I don't do a lot of supplementary stuff anymore because life is busy. There was a time where I did and I certainly put a lot of effort into kind of neck strength based stuff.

Now not so much. I mean I'm still, I still compete in the catch wrestling championships next Saturday which I'm competing in. But with my time, I'm literally just, I'm pretty much sprinting the VITS and wrestle are the only things because the only thing I can fit in.

But I definitely recommend it to whenever I kind of... in with athletes. And again, you kind of know the dynamics in bigger teams. You kind of have like, it's always kind of a... in your multi-discipline teams sometimes kind of like the more sports med staff will have players for a certain amount of time and then it'll go to S&C. Or I've even been in S&C teams where you're just based in the S&C team.

You're just a member of the S&C team and you just take on the aspects that best fit you and it kind of gets that like filtered out that way. And certainly it's always been a massive thing in the professional rugby that I've worked in. Combat sports, so much. But they don't really, they don't really train as a national team. Within the GB wrestling they have like... GB Muay Thai have like one... sorry, England Muay Thai... they get together

like once every two months or something, have a big session where they all just kick the hell out of each other, take a big picture, and then... So like there's no, there's no training. It's probably something that I would definitely recommend because I can't see a negative in it and if you can't see a negative in it and a possible link to lowering concussion, I would probably do it personally.

James de Lacey26:46

Yeah, yeah, yeah. Just sign up GB Muay Thai and stuff for the Sweet Science of Fighting training app. What's funny enough is the neck stuff was interesting me. I've done some video, must have been geez almost seven years ago I think, and I've redone some videos on neck stuff.

What really interested me was the idea of like reactive neck training. Because a lot of times you don't see whatever's coming. And I had a... So, what I had is I had like a neck harness and I hooked it up to a 1080 Quantum.

I don't know if you've used a 1080 Quantum at all.

Jon Bell27:18

No.

James de Lacey27:18

It's basically like, it's like a big cable column and you can set the tether to like isotonic, isokinetic, etc. And so I had it on isokinetic eccentric overload. So my idea was if I do eccentric overload on my neck, I can get adaptations, right?

Longer muscle fascicle length, faster shortening velocity, faster rate of force development. So if something does whatever happen, I can pull right in the neck. And I was like, "Yeah, sweet." And I thought it was going to be so sore, but luckily I guess I was doing enough neck in jiu-jitsu where I didn't have the DOMS. But 40 kilos, this like thing on front and then boom, and then have it pull my head forward and just resist.

And I did the same thing sideways, 40 kilos just pulling and then resisting this way.

Jon Bell27:42

What were the DOMS like on your neck? That must have been like...

James de Lacey27:42

I was good. I was good the next day. Yeah, I was good. I thought I was going to be effed. I was like this is going to be the dumbest experiment. But I think just because I was training so often jiu-jitsu at the time, like four or five days a week and then I was also training my neck. So I was obviously conditioned enough to be able to handle it.

But I was like if I wasn't doing anything... Yeah, it wouldn't have been good.

Jon Bell28:12

Yeah, I get it. I sometimes we have like validity studies just of all the time that you can at the uni that I'd sometimes jump into to make that, put the sample up one person basically. And I was doing it on a fixed plate dynamometer. And I had neck DOMS for about four days.

It was horrible and all I did was like five minutes of like max, max effort, 5 seconds like isometric contractions each way and my neck just, it took days. I was like that's brutal. Like max ISO is like that's tough man because you don't, you don't often maximally exert your neck.

You're kind of just resisting the entire time when you're doing different sport. Well, there was a lot of young students like around 20, 21 that I already knew their scores and I was determined not to get beat by them. So, I really really pushed it.

But one guy did beat me which is an American footballer. I take that, like he was big, about twice... he was big. Yeah, he wasn't that big. I just every time I tell the story, he gets bigger and bigger and bigger.

James de Lacey29:32

Have you, do you have any data or insights into MMA gloves versus boxing gloves?

Jon Bell29:32

No, that's the... So that's what the next grant is for. So basically yearly I have to bid for a grant. I also, I have to write what I've done with the money in the previous year.

And then I have to then bid for more money for this year. And hopefully, well actually it's only, it's normally mid-June out, I'll know if I've got enough money then to put it into MMA. There is one researcher called Nazer at the University of Colchester, but he's using, he pretty much just doing... well he is, he's doing pure sparring data too, which it'll be interesting to see what he finds.

But what I like about comp data is we know what everyone's going to be doing, hitting as hard as they can. When we're sparring, again, completely subjective, but I imagine it's going to differ from gym to gym depending on how they spar, what the philosophy is to the gym and so forth, or even the level of what and how experienced they are.

So I am really interested. Oh no, I tell a lie. I've used MMA gloves once. Me personally. So Hitman is a promotion in the UK by Liam Harrison, a legendary, actually—that's why two wrestling that bad company—but Liam Harrison's now got his own promotion, Hitman, and they use it as kind of like a feeder to the ONE Championship. Pretty much to have like, it's almost like a league, and if you get to the top you get a contract with ONE Championship, because ONE Championship fight in MMA sometimes when they do Muay Thai.

One of the fighters, Fus Smith, it was amongst others, had to fight in MMA. So I actually got some data from that, to which I don't think I'm going to use because it doesn't really fit into anything at the moment. But not all the data I take I'm actually going to use for studies. I just kind of, it's just good to learn. The more I know about it, probably the better I know how I'm going to, like now, theme and put further topics on.

And yeah, it did to be fair, it did look pretty high. The thing is though, it again, not groundbreaking, but the heavier the fighter is, the harder the impacts are. So every time you go a weight category, all like the hits get harder.

So when to then compare, have an accurate, probably not even accurate, but a better comparison, you need everyone—you need to be comparing data in weight categories. And again, I don't have enough people in every weight category for me to make many conclusions. So it's going to just be kind of like an overall load of people adding up with overall weight than me being able to do individual comparisons.

But yeah, it's pretty high in MMA gloves, meaning they've got the whole thing, the hands wrapped and they've got connection on the hand, so they're very unlikely to break the hand, so they can still punch as much as they want. But obviously it's still much more smaller surface area, so there's more lacerations, but they're also punching to the frequency and the magnitude of what you could do in a 10 oz glove.

But again, I think the saving grace is the round system and the amount of time that they're actually in being able to throw punches. And I think it's pretty much going to come, always going to come down to that. And it sounds like such a terrible conclusion to a student because it is very obvious. Let someone hit you for 20 minutes or let someone hit you for 8 minutes, and it's always going to be a higher load in the 20.

So yeah, I'm interested. I'm really interested to see. I think with MMA it's going to be different because obviously that was Muay Thai wearing MMA gloves, but there's no ground. Well, there's no ground and pound. I'm really interested to see what ground and pound is going to be like. But the overall load might go down because it depends how grappling heavy a match is.

So yeah, I am really interested, wanted to move ahead like a steam train basically, but I've realized that the data is so novel that like it has to go step by step. So like basically it just has to be descriptive data. And in fact the first step is to do a validity rating on the mouth guards in boxing. So we've got a validity rating from a crash test dummy, we've got a validity rating in rugby league, but we now need to test all the false positives to the positives and give it a validity rating and then do all the descriptive analysis.

So it's such a long way from me being able to kind of yeah, do what I planned on doing when I bid the grant. But I'm not, I'm still just as excited. And it means that there's more publications, and more publications just looks good, doesn't it, on research gates? That's what it's all about.

James de Lacey35:05

Yeah, there's a—I have—but a lot of it is what's the impact factor in the journal and how many do you have? Yeah, pretty much. What's interesting about the MMA versus boxing as well is obviously the anecdotal, I guess, reference of like boxing, you're always punching to the head. Well, most times the head in training, you're always striking, whereas in MMA you kind of mix it up.

Some days you might have grappling. The sport also involves grappling, so you might not have head strikes. Obviously you mentioned the time thing, but I'm assuming then that MMA would be slightly quote unquote safer for the brain and head than boxing. Would you tend to agree with it?

Jon Bell35:48

Yeah, for the simple fact that when people get knocked out, or even in a position where they look like they're going to get knocked out because they're getting ground and pounded, it stops. Where in boxing it doesn't. They get stood up and it can get stood up multiple, multiple times. And you've probably heard that before. I don't think that's anything kind of novel. People have been saying it for a while.

But from my knowledge and from the mouth guards, it's incredibly—well, not even from the mouth guards—we know it's incredibly dangerous to possibly get a concussion and then go back in and get another. It's like, it's the second concussion is that's always the dangerous, the most dangerous one. And that generally what can kill people when people have died in sport from head impact, it's normally multiple concussions in one that people haven't spotted.

And that's obviously why on the head protocols have come in, and as soon as people fail these concussion tests that they put forward, they're off. And now that we have like really kind of detailed guidelines to return to play, and I guess that's why I want in combat sports—I guess that's the big kind of goal—to actually have some sort of baseline testing.

So in football we use SCAT 6. So SCAT 6, you basically go up in numbers to have a meeting. I think it's in Berlin every couple of years, all the experts, and they update this kind of baseline testing protocol. So then in a couple of years we'll have SCAT 7, SCAT 8. We're on SCAT six at the moment. And basically if you do a baseline test when you think you've had a concussion, you can take the test again. It's basically like a cognitive test.

Do you remember when Donald Trump was saying he did the test and he said that he remembered all the all the things, whatever it was, kitchen? It's literally like that. You get told, it's like, here's five words, repeat them back to me. And you get a score if you can do them in order. And then you do a few kind of, can you walk in a straight line, like in tandem, and so forth.

And yeah, you can do that after you suspect someone has a concussion. And obviously if the score's dropped, it even shows you which possible things it's dropped on. So like, at what part of the cognitive testing they're worse at, like more like the somatic sensory kind of stuff, or the more the cognitive stuff. And that's then how you would then return them.

So all the way through you go through these like so many days before returning to contact, and then you can keep doing the SCAT six again. And it's really good. And it's like, I—it should happen in combat sports, really. I know a lot of promotions will literally just say like, that's you out for 30 days, that's you done for three months, depending if it looked bad. Where there's actually tools that really well-funded sports have to do it properly.

Or there's an app called Impact GB. Boxing, we're using it for a bit. That again is like an app where you just do all through the app. Again, you figure out the return to play through guidelines. And that is what is really needed, and it can easily be fit in, like before Muay Thai has tournaments like world championships and so forth. Other fighters, professional fighters obviously don't really have tournaments, so they have one or two, possibly three fights a year.

But doing it before the fight or doing it put in with the S&C kind of periodization plan—you're going to do all these baseline assessments that we're going to use to help kind of measure progress—let's put some kind of concussion baseline testing in there too. And I think that's what will really change the game.

And it's so simple to do. It's much more simple than buying an expensive mouth guard and following something around with an iPad and then getting all this data and being like, let's do what? Let's publish some statistics. So there's loads of stuff that's already out there. And that's kind of what I'm hoping to do with like the GB Muay Thai Association and the English MMA association. It's all about—everyone's very enthusiastic, people are involved. Everyone wants it.

But then it's finding logistically how to do it when everyone's scattered all over the country and only comes together like once a month. And so yeah, that is probably my goal more so than research, is actually putting something in place that I know will actually be positive. Because like research is a dime a dozen. Sometimes you put out an epidemiology study, you're going to get maybe some citations in someone's dissertation, but realistically what it doesn't—of my experience, it doesn't do anything. I was—I've got a mug with my first publication on.

I was so happy. It's got the abstract on. I thought that's it, I've changed freestyle wrestling in Britain forever now. Everyone, safety protocols are going to come in. Obviously nothing happens. And you're just like, well, that was incredibly anticlimactic.

And it's just like, well yeah, that's right, because not many people read research papers. It's only kind of a certain level of a coach or a clinician that will. What I found is best is actually getting people, is working with associations.

It's working with people in a gym. If you've got access to a gym and you're the physio, the sports therapist, even the S&C coach, because the S&C coach will still know tons more about concussion because of the physiology that they know. And again, probably just working in a sport for a long time, just being like, right, why don't we do this at the gym? But even at gym level, association level, it would really help. Even just a poster on the wall like, do you think you're concussed? Here are some signs. Because you don't really see it around.

And when it comes to severity, it's much more severe than someone pulling a hamstring or even fracturing their ankle. It will heal, where obviously we don't really know the extent of how much impact's needed for CTE yet. So that's just the best way to do it. It's not to stop your sport. No one wants to stop their sport. People do their sport because they're good at it. They've trained for, some people, all their life, for mental health, for social aspects.

So you're not going to get people to stop it, and that's not what people are trying to do, or at least I hope it's not. It's trying to bring in procedures that have worked in other sports that have a lot of funding and just being like, right, let's use this. Fifteen minutes it takes a SCAT, six then fifteen minutes to do it when you think you're concussed.

But again, I've rambled a bit there, but that's in my opinion. If I can manage to get that to become a regular thing, then I'd be a very happy man, because I know that it would actually do good when I'm sat here writing what's the fanciest word to use in a sentence. It's not going to do anything, is it?

Yeah, that's my goal. It's what I want. And if I achieve that, I'll be very proud of myself.

James de Lacey43:17

How sensitive is, say, something like that SCAT test? And I mean, I mean there's – I'm not sure how to frame it properly, but will it pick up even minor concussion symptoms? I'm assuming there's probably some people that can operate pretty well even if they've been knocked in the head.

Jon Bell43:35

Yeah. And I think it's very – I was going to say holistic. I'm not sure if that's the right word, but it's got different sections. So it would be very hard for someone to – I don't know if you're trying to beat it, because it's not a lie detector test – but be very hard for someone to get through the whole test without lowering the score. And that's what we're looking for.

You get a score at the end. So it's just doing a pub quiz. You'll get a score, fifty out of, you get fifty first time, and then if they then redo it and they get forty-nine – well, not forty-nine again, it's not enough to drop – but say thirty-nine or whatever, then again that's just saying they've got a concussion. You treat it the same. So it doesn't matter if they've dropped by ten points or twenty points. It doesn't matter if they've dropped from their original baseline. All that matters is what they got in baseline.

That's not normative data. It's just what they drop from their baseline. We still treat it as a concussion, and therefore then they stick to the guidelines. So you return to play, your fourteen days, your twenty-one days, your twenty-eight days.

So there is validity studies and things like that. I know they're all very high, and obviously that's the reason why FIFA and the English Football Association and many other football associations use them, because it's one of the most – I think it's the most reliable tool that we currently have. And there's another app called ImPACT, but you have to pay for that, and then again it becomes expensive. You then need it for your whole team and so forth. SCAT six, again, they're free. You can just print them off, or you can do them online, I believe.

So yeah, it's a free tool. It costs no one any money, and it is really simple to do. It literally tells you what you need to ask. It needs to tell you what you need to ask them to do. You know, walk in tandem for two meters. That's how it is. So it's idiot-proof.

So yeah, it's hard to do. When we teach our students it, they pick up pretty fast, even if they don't fully understand why they're doing it. And hopefully they do understand, or else they will do it by the end of the degree. But it's just something that you can go through the process of actually recording and then knowing if the score's dropped, without maybe even fully understanding why it's dropped. But at least they can say, right, you have a concussion. And obviously, even when they were a student, they would come to a supervisor who would look at it in more detail.

So even if people are doing it in the gym and they don't fully understand why it's dropped and they don't really fully understand the test, they can at least say, I'm pretty sure you've got a concussion because your score's dropped. Go and see your doctor or go.

So yeah, I think in the long term, that's currently with what we have, and when it comes to actually having resources or not wanting people to pay for stuff, this is so easy to implement. Anyone listening to this can just start implementing it and just doing it regularly, and they can have the data and look at it. Yeah, it's just – for the time it takes to do versus how it's going to help you, it's like...

People ask me all the time, when they're in fights, they're like, I think I've got a concussion. How long should I take off? I'm like, did you do any baseline testing? Considering you are a fighter and you know you're going to fight and you know you're going to get hit in the head, and – no. Well, now it's just guesswork. It's just guesswork now, because I have nothing to go by. So you just do basic generic guidelines, where it's...

I'm just passionate about it. I've seen it for many years now, just like, come on, you're going to – you want a long career in fighting and I want you to have a long career, but I also want you to be healthy when you're forty, you're fifty, you're sixty. And I'm not telling you to stop. I'm just saying, why don't we put the effort in that you put into running every morning or...

Yeah, that's my roundabout on SCAT six, but I'm quite passionate about it.

James de Lacey47:34

What's interesting as well – have you, so regarding hidden impacts and traumatic brain injury, the first person that comes to mind is someone like Rod Tang, right? He takes a ton of head impact, and he seems, I guess, okay, or at least doesn't – he doesn't get dropped or anything like that. Have you found that some guys are just more robust to high impact? You mentioned that fifty-unit threshold in rugby and guys have to go off the field. Have you just seen guys that maybe just can handle high impacts or high impact loads throughout a fight?

Jon Bell48:08

I mean, it's hard to tell, because there's people that can handle concussions better, that's for sure. But again, if you were to take – if you were to do a SCAT six after, basically there are people that come in to – so we run an injury clinic on campus and it just – we have an athlete development center. We're really lucky. We've got a very state-of-the-art building that's only a couple of years old and cost a lot of money.

So we get a lot of local teams, like the Rhinos is obviously the closest rugby league team, but we've had Josh Warrington, the boxer, and other – some Olympic athletes that use it. And basically all the teams come into our injury clinic. It's free, and we use our students – students use it to practice.

And yeah, people coming in all the time for the SCAT six. Well, yeah, they said they think they've got concussion, and they did a baseline. You can have a full conversation with them, when they're waiting for the appointment for twenty minutes. They can be incredibly articulate. They walked in fine. They said that they even cycled to university that day, and they feel completely fine. And then they'll fill the SCAT six.

So it is really interesting. I've had loads of concussions and I can – I've already got a prominent lisp. I'm deaf in my right ear from when I was in Afghanistan. I'm already relatively hard to understand, but I am just – I almost can't lecture because my brain is gone. I can't – there's so much. It's terrible. You won't want to sit in the front row.

But I can't deal with concussions very well at all. But, as you said, there's some people that are just – but they still fail the SCAT six. And that's, I guess, what the important thing is. And yeah, it's – and I don't know why it is. I have no idea what the physiology is behind it and how some people just don't appear concussed when they are. It would be interesting to do. I honestly don't know how you would go about that study. That's probably way above my intelligence level.

Just put the mouth guard in Rodtang and just see. Yeah, just, but that's it. He will still get the impacts because I mean you don't need a mouth guard to know that he's taking impacts. And then like you said, he just eats them up.

So yeah, I guess some people are more resilient to an extent, but it doesn't necessarily mean he's getting less brain damage. And it'll be interesting to see what he's like in like 20 to 30 years. I mean, it's not a given by any means, but I mean, it's like smoking, isn't it? The more you smoked, the more chance you've got of getting lung cancer, but it doesn't mean you will get lung cancer.

So like, yeah, it's one of those things that, you know, it's 2025 and we're still just finding out things. Like I didn't think it would take till 2025 to be able to measure head impact in a competitive bout with mouthguards. I presumed it was already done. Like before I got into academia, like if you had said to me when I was in the military, "Oh, I can do this," like yeah, of course I can, sure I can, we can do everything nowadays. It's only when you start researching you like, we're actually, there's not as much out there as you think there is.

So again, I can't answer that definitely. I can only say that some people, they just look completely symptom-free until you get them to do all these cognitive tests and then you realize that they have dropped. And it's what their original baseline is. Some people just have high baseline, so their baseline can drop and they can still function better than some people can when they're not concussed.

James de Lacey51:58

So being dumb.

Jon Bell51:58

Yeah, you could have a really poor baseline just because you're very clumsy. But you just still drop, so you just become more clumsy and more stupid.

James de Lacey51:58

I think I've got another question that you might not be able to answer as well, which is the opposite of that. So you obviously hear about fighters who get chinny, quote unquote, as they progress through their career and they get dropped. I don't know, have you seen any data or trends around that?

Jon Bell52:35

Are they taking less impact force and still getting dropped? I don't know. I don't know if there's something. I might be able to answer this better because I feel like I've not even answered one of your questions for you.

James de Lacey52:47

That's good. It's part of it, right? Like you kind of have different answers that you gave me a week before. I wonder, it's good. I love discussion on the spot.

Jon Bell52:47

So yeah, there is data on, it's easier to get a concussion when you fall. So basically every concussion you get, is easier then to get your next concussion, which is something that I didn't learn through studying this. It's something that I've had. I've had 13 diagnosed concussions, which is really high, isn't it? I know some were just stupid, some were just accidents, and some was from wrestling or doing MMA.

And it was then that I asked the doctor, this was years ago, I asked the doctor, I'm like, "That's more than average." And he was like, "Yeah, obviously," obviously talking to me like I'm an idiot because I've had [expletive] concussions. He's probably within his right to do it.

It was from that that I looked into it, and obviously I've looked back into it now and kind of looking at it. And yeah, basically you do. So again, you would say that to knock somebody out, I don't know if that directly correlates with you're more likely to get concussion. So you can say you're more likely to get a concussion from being knocked down afterwards, but I don't know if that, and again, I don't know, I'd have to look into it.

I don't know if there's an answer that or not. It doesn't necessarily explain why their chin can't take it. It can explain why cognitively their brain can't take it, and something that wouldn't have necessarily been a concussion is now a concussion. But I don't know if then that correlates with the force and what they're hit with to knock them out.

And again, you could investigate that with the mouth guards, but you would have to take a lot of data over a long period of time to do that. It would take a long period of time and it would need to monitor several fighters that have had several knockouts to do it, and still you'd only, you wouldn't even have enough data to confidently say. You would only be able to say it suggests.

So if that is also really interesting though, that would be a really good thing to look into. And I think it's going to be one of those longevity studies, isn't it, where if we keep the mouth guard in for a long time, we can actually start to look back at historical, but we can start back to look at the data and just see what trends we can find.

The problem is, is unless you're in professional fighters, people's careers are quite short, especially if you're looking at an amateur sport. And in bare knuckle boxing, I've only got a certain amount of money to work with, James. And I am, somebody will say they'll be on a card to fight. So they'll be on BKFC to fight. They'll come to the press day where we do a bit of athlete testing and we get everyone fitted for, get dental scanned because they're all custom dental scans.

And we get the, pay for the mouth guard, get the mouth guard ordered, and then the fight won't be on the card anymore and disappeared.

You try and contact them. "Are you going to fight again? Just to let you know, you've got your mouth guard. It's fitted to your mouth, so I can't do anything with it." And they'll just, they just won't get back to you. And you'll be like, "Well, that's, to me, it's just like that's one down in my sample." Then it's also then in the grand, I'm going to have to now explain it at the end of the year to why certain, some money's just gone.

And it's happened to me three times now. Dude, every time is really quite, good going because I'm just like, and you think about who you could have given it to as well. You're like, so-and-so wanted one and I said, "Oh no, we want this data from this event. I might want bare knuckle boxers rather than an MMA guy or Muay Thai." And then the fighter that wanted it, you didn't, go on to have an amazing five-round bout that had loads, you're looking at it every time the head shoots back and you're just like, "Oh, disappointment."

So yeah, it's a frustrating thing. So it's even, finding the best way to do it. I found going for BKFC has been amazing because I've worked for them for a long time. I know a lot of the fighters, but because it's a promotion, you go through the promotion and they say, "Right, these are on our cards. We can get in touch with them for you and we'll say, we'll explain why the study's good," and they get behind you and that's great.

And then you can just turn up on the card and so many, like set amount of people are wearing your mouth guards and you take so much data from that card. When you work with say an association or you go into gyms, you end up going to an event for one person with a mouth guard. You end up driving two hours away, waiting all night, and then that one person comes out and you get some data and then all sorts goes wrong.

So you need video to clarify with a video. So I watch it back on, I use that Spot. So like that's just something I can stop the decimal by decimal, and I have to verify that every hit was actually a hit. And it hits where it says it is because the mouth guards tell you where on the head it's hit. So I have to check that it's all right.

And then you message the promotion after and they were like, "Oh no, we can't give you the footage." You're like, "Well, that's my, gone. I drove two hours, got this, and then I can't do anything with the data." It's a bit like where I can sometimes say people's fights and stuff that, and it doesn't, it's not, it doesn't go against my ethics because I can't use that data.

So I can actually, and I end up being able to tell people a lot because it's not in the study anymore just because something went wrong. And then I'm just trying to refine that now, James, so I don't end up wasting my time and I don't end up wasting my money. And like I said, wasting a day I could be spending with my little girl. Instead, I'm driving to Wolverhampton to watch an amateur boxing thing in a working men's club and then I don't get any data from it and then I drive back and then crying in my car on the drive back.

So yeah, I even just from that level, I need to sort, I need to find the best possible methodology to get the most data and not waste my time. And so yeah, like there's all these amazing questions I want to answer, and I'm still at the point of how do I stop fighters saying they're going to fight and then just running off with a free dental-fitted mouth guard.

I feel like I'm so far, basically I'm so far away from certain things that I want to be at. But at the same time, just the basic level knowledge that I'm gaining, just the fact that I can code now. I have to code to be able to do the data and I couldn't before. And just the fact

That I actually it went from me just having a pure headache just looking at someone else coding to being able to do it just means that I know I have progressed but yeah all these questions. I wish I could answer them better for you, James, but I just at the moment, it's I'm just asking questions that keep coming in my head and they're amazing and they're things I want to know myself and it's almost frustrating.

If I had more money and a bigger team, not my money, I'm not I had more grant money and I had people that could collect the data for me and I could send people to multiple events, it would be so much quicker. It is frustrating to me is that I can't cuz it's been going for over a year and a half and we still haven't got our first publication.

We're not far but again it's a lot of time spent asking for more money. Again, you feel a bit like a beggar sometimes creating these models or asking someone who knows how to create models to do stuff for you so you can bid for more money and then you end up not actually then doing the study. You end up bidding for more money to do the study. And anyway, I'm just running into about my problems in life. I'm just moaning about my life podcast.

James de Lacey1:01:16

Yeah. It is becoming a therapy problem. It's all good. It's good to get an insight into kind of it was probably good for listeners as well to get insight on what goes on into how some of this research was done and some of the problems that arise from doing it. But where can people find and follow you John and keep up with what you're doing?

Jon Bell1:01:38

I'm not on a lot cuz I hate social media for mental health. I'll try to stay off it. But I do have a charity page that was set up. So, a while ago, I set up some events, some BJJ, some wrestling events that made was to raise money for the British Limitless Veteran Association.

Because it was something that was close to my heart and it's moved on to this disabled charity, youth disabled charity from my hometown that I used to do volunteers for and it's called Northern Grappling Co. So, it's a bit confusing at first cuz it's just what is this? Cuz that's what it started out as. That it's just a charity page for me setting up these events that all money went to these charities and now it's kind of progressed.

So obviously that's where we contacted each other and then now it's kind of progressed to there's some research on there, some podcasts on there, there's some pictures from the BKFC and some cuts. It's a bit of everything. I should really maybe I'm terrible at marketing and I don't really have anything to sell so I don't need to market but it's kind of I should maybe refine it a bit more and just stick to a theme.

So it is all over the place but yeah now I've been grappling codes where they can find me more importantly if you wanted to get in touch because you want to say if you want something more niche more specific than that but if you want to collaborate in research then by all means I'm massively into people helping out and obviously being part of the research purpose or if you're an athlete and you're interested in obviously at the moment it's very UK based I was talking to Dom Miya the head of medical for BKFC in America trying to maybe get the mouth guard over there.

So yeah, if you're an athlete, if you're a researcher, if you've just got a question, a question about concussion, if I can't answer it, I know some amazing doctors that work with these events that can. Yeah, that's the best place. I'm not really on anything else. If you Google, not that giving it away, James Google my own name, haven't I? If you Google my name and put wrestling or grappling on stuff, you know, it comes up with all my research purpose and things like that.

So, you can get to me that way. Not that I do that on a weekly basis, but yeah, that you can find me that way as well. That's my work email as well, but I don't give that out that much because that's obviously I need to keep that mainly for the university. But you can if you were to Google my name and the and Legg University, you would find my work email. Honestly, it's relevant to research or something. I wouldn't mind if I got if people contacted me that way as well.

James de Lacey1:04:10

Perfect. I'll actually I'll link your Instagram down in the description as well for anyone who's who's keen to follow and get in touch. But I appreciate you coming on and sharing everything. All right. To get you back on as well when you start getting through more of this research.

Jon Bell1:04:27

Yeah, I appreciate I've followed you for a while now, James, and I get really frustrated with some of the absolute awful stuff on social media and you have been a you've been a shining light in in the stuff that I see you doing.

James de Lacey1:04:44

Well, I appreciate this. I appreciate that cuz I just got sent a a little cease and desist in my email.

Jon Bell1:04:44

Well, I I like your stuff, James. I think I think in a world of disinformation or just just stuff that doesn't need to be said. You you've got some really good stuff. I think I've reposted you a few times, so I've know I send you directly to people that ask questions about it. So, I'm really glad that you've that you wanted me on, to be fair.

James de Lacey1:05:01

Of course, man. Of course. I'm always keen to bring guys like yourself on who are doing research in the space and stuff. A very soft spot for people doing research and and stuff cuz yeah, I love it. I love all the all the stuff going on and obviously within combat sports it's there's only so much going on as well within within research.

So it's even better and it brings a unique perspective as well than just you know just somebody working out of a gym or whatever and doing things. You get kind of fresh perspectives and real expertise into a certain topic.

Jon Bell1:05:42

Everyone. There's not a single person that doesn't have something important or useful to say find because everyone works in different environments. Everyone's seen different things and everyone can bring a complete different perspective to everything. And that's mainly before you start any research. You talk to a lot of people you talk to.

There might be a coach who's coached for 20 years but has never read an academic paper in his life, but he's still worth absolutely picking his brains because he will tell you everything about the sport. And yes, I love I love discussion. And I I I really like your stuff as well, James. So, I thought I'd tell you that as well before I went.

James de Lacey1:06:12

No, I appreciate it. I appreciate it. Well, cheers for coming on and we we'll stay in touch anyway.

Jon Bell1:06:28

Thanks, James. We're just going to keep thanking each other.