When most people picture bare-knuckle boxing, they imagine a bloodsport of broken bones and brain damage. The reality, according to groundbreaking medical research, tells a very different story that challenges everything we thought we knew about combat sports safety.

The Modern Revival of an Ancient Sport

Bare-knuckle fighting made its legal comeback in 2018 with Wyoming hosting the first sanctioned professional event in over a century. Since then, the sport has rapidly expanded across the United States, gaining official recognition in Florida, Missouri, Mississippi, Kansas, and Alabama. But with this revival came an urgent question: just how dangerous is fighting without gloves?

Dr. Don Muzzi, Chief Medical Officer for Bare Knuckle Fighting Championship, led a comprehensive two-year study to answer exactly that question. The results, published in The Physician and Sportsmedicine, analyzed every state-sanctioned bare-knuckle bout from June 2018 through November 2020.

The Numbers Tell a Counterintuitive Story

The study tracked 141 professional bouts involving 282 individual fighters. Here’s what the data revealed:

Injury Overview:

• 36.6% of fighters sustained at least one injury during competition
• 123 total injuries were documented across all bouts
• Only 1.8% of fighters required hospital transfer

The Injury Breakdown:

Lacerations dominated the injury profile. With 98 lacerations recorded (34.8% of all combatants), cuts were by far the most common injury. The majority were facial lacerations requiring an average of 6.2 sutures. This makes sense when you consider the physics involved: bare knuckles create concentrated force on skin and tissue, while boxing gloves distribute impact across a broader surface area.

Hand fractures were surprisingly common. Eight fighters suffered hand fractures during the study period. The human hand evolved for many things, but repeatedly striking skulls wasn’t one of them. Without padding, the boxer’s own fist becomes vulnerable, which may actually serve as a natural brake on throwing full-power head shots.

Concussions were notably rare. Perhaps the most striking finding: only 8 fighters (2.8%) experienced concussions with symptoms. This is significantly lower than traditional boxing rates.

Other documented injuries included:

• 6 nasal fractures
• 2 orbital fractures
• 2 dental fractures
• 8 periorbital hematomas (black eyes)

Only 5 fighters required hospital transfer during the entire two-year study period: two for orbital fractures and three for traumatic brain injuries.

Why Fewer Concussions Without Gloves?

This counterintuitive finding has a logical explanation rooted in physics and fighter behavior. Boxing gloves add significant mass to the fist, increasing the momentum delivered with each punch. More importantly, gloves protect the puncher’s hands, which encourages fighters to throw harder, more frequent punches to the head.

In bare-knuckle boxing, fighters instinctively moderate their power, especially on head strikes, because the risk of breaking their own hands is very real. The skull is harder than the metacarpal bones. A broken hand means a lost paycheck and months of recovery – a powerful incentive to fight more strategically.

Additionally, bare-knuckle bouts tend to end more quickly when significant facial lacerations occur, reducing the cumulative brain trauma that accumulates over longer fights. In gloved boxing, fights can continue for many rounds, allowing fighters to absorb hundreds of sub-concussive blows that don’t cause immediate injury but contribute to long-term neurological damage.

What This Means for Combat Sports

This research challenges the conventional wisdom that padded gloves automatically make boxing safer. While gloves clearly reduce acute facial injuries, they may paradoxically increase the risk of chronic traumatic brain injury by enabling fighters to sustain and deliver more powerful head shots over longer periods.

The data suggests bare-knuckle boxing presents a different risk profile than traditional boxing:

• Higher risk: Facial lacerations, visible cosmetic damage, hand injuries
• Lower risk: Concussions, cumulative head trauma, fights continuing after significant injury

Neither format is “safe” – these are combat sports, after all. But the injury patterns are fundamentally different in ways that matter for fighter health, especially long-term neurological wellbeing.

The Limitations and Future Research

It’s important to note the study’s limitations. The two-year observation period captured the sport’s early days when the fighter pool and number of events were relatively small. As bare-knuckle boxing continues to grow, longer-term studies tracking fighter careers and post-retirement health will be essential.

Questions that remain include:

• What are the long-term neurological outcomes for bare-knuckle fighters compared to traditional boxers?
• Do the reduced concussion rates translate to lower rates of chronic traumatic encephalopathy (CTE)?
• How do training practices and sparring contribute to injury patterns?
• What’s the optimal medical protocols for managing lacerations and preventing infection?

The Bottom Line

Bare-knuckle boxing’s injury profile defies expectations. The sport produces more visible damage – cuts and facial injuries that look dramatic – but appears to result in fewer brain injuries than its gloved counterpart. The spectacle of blood may be harder to watch, but the invisible accumulation of brain trauma in traditional boxing may pose a more serious long-term health risk.

As the sport continues its modern evolution, ongoing medical research will be crucial. The early data suggests that our assumptions about combat sports safety may need serious reconsideration. Sometimes, the old ways weren’t as barbaric as we thought – and sometimes, the modern “improvements” come with hidden costs we’re only beginning to understand.

For fighters, promoters, regulators, and fans, this research provides valuable evidence for informed decision-making about the risks and trade-offs in different combat sports formats. The conversation about fighter safety has always been important, but now we have actual data to guide it.

This article is based on the peer-reviewed study “Epidemiology of professional bare-knuckle fighting injuries” by Muzzi D, Blaeser AM, Niedecker J, and Gonzalez-Lomas G, published in The Physician and Sportsmedicine, 2021.