Fistic Medicine: The Zach Kirk Saga Part 1

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Zach Kirk got hooked on mixed martial arts in March 2009. A longtime UFC fan, he picked up a promoter’s flyer at a local gas station, made a call, got briefed on the rules and strapped on the gloves.

“I got in the cage, and they’re saying my name, and I had a huge adrenaline rush!” he says. “It was huge!”

Two months later the sport he loved nearly destroyed his young life.

Supplementing a wrestling base honed in high school with one week of informal MMA training, Kirk won his first fight by second-round corner stoppage. A month later, he TKO’d his opponent in the fight’s first minute, a thrilling performance that earned him a great opportunity -- fighting before a hometown crowd on May 27 at the National Guard Armory in Shenandoah, Iowa. A shot at the title would go to the winner.

“I couldn’t wait for the fight!” Kirk recalls.

Kirk’s fight was that night’s main event. The hall was packed. The bell rang, the fighters touched gloves and Kirk threw a left jab followed by a right. Seven seconds into the fight -- less than 12 minutes into his career as a mixed martial artist -- Kirk lunged into a double-leg takedown. His opponent defended with a routine standing guillotine choke, leaning his weight forward into Kirk. Kirk moved to drop the fight to the ground, arms and legs became entangled and Kirk fell headfirst to the mat. His fifth cervical vertebra shattered, bone fragments ground into his spinal cord and Kirk suddenly went limp.

The last fight of his MMA career was over, and the toughest fight of his life had just begun. The instant the injury occurred, Kirk knew he was badly hurt.

“I knew I couldn’t feel nothing,” Kirk says. “I was just scared -- scared from right there.”

Seconds later, the referee pulled Kirk’s opponent off of him. EMT personnel on the scene rushed him to Creighton University Medical Center, where three hours of emergency neurologic surgery ensued. Kirk’s crushed fifth vertebrae was bolstered with bone harvested from his pelvis. He survived his first 24 hours. The easy part was over. Two days later, doctors took him off sedation and Kirk awoke. He was paralyzed from the neck down.

“The only pain was mental,” he says. “It was hard for me to lay there and think how I’m not going to be able to play ball with my son and teach him the things a father does.”

The nerves that provide movement to the arms originate from the Cervical 5 to Thoracic 1 levels of the spinal cord. Had the injury been a few levels higher -- had Kirk injured C2, as did Christopher Reeve -- Kirk would have lost function in the muscles of respiration, as well as his arms and legs, and probably would have died at the Armory.

Family and friends visited the hospital to bouy his spirits. Houston Alexander paid him several visits. Other fighters and referee “Big” John McCarthy sent shirts and posters to his bedside. From his bed, immobile, Kirk gave interviews defending MMA’s safety to local media. After acute recovery from surgery, Kirk was sent to Madonna Rehabilitation Hospital in Lincoln, Neb.

“Rehab was a great experience,” he says. “I was there for about two months. They told me I wouldn’t have any movement from the neck down, but now I can move both my arms and my left wrist.”

Kirk’s greatest medical asset -- more powerful than any physician or drug -- is his mind. He is the sort of patient with whom therapists love to work: optimistic, committed, endowed with an athlete’s psyche and body.

“My goal is to keep doing therapy -- I call it training -- until I win this fight,” Kirk says.

He does three hours of daily therapy at home and works with a spinal cord injury therapy specialist twice a week.

“I want to be able to play ball with my son, Dominic, and teach him things,” Kirk says. “He -- and my friends and family -- keep me motivated. Without them, I don’t know where I’d be or how much improvement I would’ve made.”

Kirk uses a special tool to send text messages and type on a computer. With concentration, he can move his foot a few millimeters.

“I wake up every morning and just try to move each muscle, seeing if something came back in the night,” he says. “I try to start each day positive.”

The prospects for Kirk’s further recovery are not good. Medical science offers very little for spinal cord injury patients; damaged neurons in the central nervous system, the brain and spinal cord, simply do not regenerate. At some point, stem cell therapy may offer some hope, but that day lies on a distant horizon. Statistically, Kirk’s life expectancy is 40 years of age.

Zach Kirk’s injury is the sort of tragedy opponents of MMA use as the foundation for their arguments against the sport’s legalization. They fear that, as MMA grows in popularity, the incidence of catastrophic injuries such as Kirk’s will rise. They are right. It most certainly will, but their arguments about MMA’s unusual dangers run afoul of the facts.

Of the immediate reactions to Kirk’s injury -- horror, outrage, grief -- there was very little surprise. Iowa has a proud wrestling heritage, and Iowans know cervical spine injuries are not unexpected in grappling sports. As a wrestler, Kirk knew the risks: “I knew injuries could happen in MMA just as easy as in any other sport. I know accidents happen all the time in all sports.”

If Kirk’s injury had occurred two years earlier, when he was a high school wrestler using identical double-leg takedowns in scholastic competition, his tragedy would be just one more of the almost 60 severe high school wrestling injuries recorded by the National Center for Catastrophic Sports Injury Research in the past 26 years.

The incidence of high school wrestling related catastrophic spinal cord injury and death is approximately one per 100,000 participants. Because the takedowns in MMA are essentially wrestling moves, we assume the MMA risk is similar. Approximately 250,000 boys and an increasing number of girls participate in high school wrestling annually. It is unknown how many young people participate in MMA, but beyond doubt, that number is growing rapidly.

A Boden and Jarvis 2008 article in Neurlogic Clinics identified the factors that are highest risk for grappling-related cervical spine injury: their article reads like a play-by-play of Kirk’s doomed fight.

Most serious neck injuries occur exactly as Kirk’s did, during takedowns of a standing opponent in a defensive posture. Being thrown to the mat while arms are pinned and striking the top of the head are particularly high risk. As in Kirk’s case, a wrestler falling to the mat with the weight of his opponent on him is at compounded danger. Injuries are more common when the neck’s natural protective backward curve is removed by flexion, as Kirk’s was, pinned beneath his opponent’s armpit. Lastly, injuries are more common in lower weight classes: Kirk fought at 145 pounds.

Is 1:100,000 a “safe” threshold for catastrophic injury? How seriously must society consider paralysis in a 14-year-old freshman or a 20-year-old father? What degree of risk is acceptable for a state-sanctioned sport? What degree of human suffering are citizens and fight fans willing to endorse?

Cheerleading has a catastrophic injury risk of 0.6 per 100,000. High school football’s risk of death or paralysis is the same as wrestling’s. Though exact statistics are hard to come by, pole vaulting has a catastrophic injury risk of approximately five per 100,000 athletes, and competitive diving has a risk of approximately 20 per 100,000. Professional wrestling, if one adds suicides to in-ring catastrophes, has a risk on the order of 2,500 per 100,000 participants. These are sports of unquestioned legality everywhere in America.

MMA athletes have a right to ask -- regardless of the bloodthirsty image cultivated in the sport’s early years -- for legislatures to treat their sport rationally.

By that same token, if we who wish the sport of mixed martial arts to prosper ask legislatures to be analytical in their evaluation of the sport’s relative safety, we must, in turn, be realistic in acknowledging its dangers. The current young generation of fighters -- boys and girls now in their teens -- is certain to produce new Chuck Liddells, Georges St.Pierres, Jon Joneses and Anderson Silvas.

It will also produce new Zach Kirks. Those young fighters, and we who support the sport with our money and enthusiasm, must face that fact with eyes wide open.

Check beck tomorrow to finish reading The Zach Kirk Saga.

Matt Pitt is a physician with degrees in biophysics and medicine. He is board-certified in emergency medicine and has post-graduate training in head injuries and multi-system trauma. To ask a question that could be answered in a future article, e-mail him at [email protected].