A team of researchers at the University of Pittsburgh School of Medicine is the first in the United States to detail the physical risks of slap fighting. Slap fighting is an activity that involves full-force, open-handed blows to the face.
What Is Slap Fighting?
Slap fighting was once an underground activity centered in Europe. Now, it’s growing more popular in the United States.
Ultimate Fighting Championship President Dana White recently launched the Power Slap League. He’s trying to sell slap fighting as the latest and greatest combat sport. It’s the first regulated slap fighting league in America.
Participants stand upright and take powerful slaps to the face. Opponents may not flinch or otherwise protect themselves from the slap. Participants wear no protective headgear.
Fighters often fall backward or stand in a stupor with a blank, vacant stare. Some get knocked unconscious after repeated slaps to the face.
In 2021, a Polish slap fighter suffered a brain bleed following a match that doctors say led to his death.
Visible Signs of Concussion
A team at the University of Pittsburgh School of Medicine analyzed visible signs of concussion in individuals participating in professional slap fighting competitions. They reported the results in a paper published in JAMA Surgery in September 2024.
It’s the first academic study to offer evidence of the possible dangers of competitive slap fighting.
The medical community has expressed serious concerns about the potential dangers of slap fighting related to head injury and brain trauma. However, no peer-reviewed study has attempted to record the risks until now.
For the study, trained reviewers watched videos of slap fighting competitions and analyzed 333 slaps. They recorded visible signs of concussions — from a diminished awareness of the environment to a complete loss of responsiveness.
“We were watching for visible signs of concussion, such as blank and vacant stare, impact seizure, motor incoordination loss, loss of responsiveness or consciousness, slow to get up, clutching at the head and/or face, visible facial injury, as well as amnesia and vomiting,” says lead author Raj Swaroop Lavadi, MD, a postdoctoral research fellow in Pitt’s Department of Neurosurgery. “These were similar signs to what sideline physicians look for in other contact sports such as football, soccer, rugby, or hockey.”
More than half of the slap sequences resulted in participants exhibiting visible signs of concussion, according to the analysis.
By the end of the matches:
- About one-third of the sequences resulted in participants having a blank and vacant look.
- Nearly 40% of sequences resulted in signs of poor motor coordination.
- Nearly 80% of fighters demonstrated visible signs of concussion at least once in the series of matches.
- A quarter of the sequences featured participants who were slow to get up after a blow knocked them down.
The findings suggest that slap fighting may induce traumatic brain injury in contestants. This may lead to long-term neurological consequences.
Raising Public Awareness
The study points to a need for further conversations and safety regulations that help protect participants’ long-term health. It also highlights a need to prevent schoolyard slap fighting inspired by social media.
“We need to heighten public awareness about this,” says senior author Nitin Agarwal, MD, an associate professor of neurosurgery at Pitt. “I don’t want our youth engaged in backyard or school playground slap fighting.
“The fact that it’s been popularized on social media and on the internet — I think the most important thing is not to just bring awareness to the public but to the participants themselves,” he continues. “I don’t think they are aware of the dangers of this. It’s not a sport, it’s a dangerous activity.”
Keeping Participants Safer
Banning any sport or activity like slap fighting is difficult. But making them safer for participants and raising awareness about their harms remain possible.
“I want people to be aware that when they promote this or get involved in this that the safety considerations and mechanisms of safety are not there,” says Dr. Agarwal. “As a physician who has a background in martial arts and is passionate about combat sports, I remain concerned regarding the frequency of overt signs of concussion among slap fighters.”
The study’s findings will help inform participants, officials, and ringside physicians. It’ll also provide a starting point for improved safety regulations going forward.
The team is now working to measure and analyze the physical impact of an average slap. They’re doing this using mouthpieces similar to those that professional football players wear.
“Since this paper has been published, many interested scientists have reached out to us for research collaborations,” says Dr. Lavadi. “We are actively engaged in multiple projects to further raise the awareness regarding concussion in slap fighting.”