Position Statement

Position Statement on Slap Fighting

June 25, 2025
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Background

Slap fighting is a new-age combat activity that is rapidly gaining national and international popularity. The activity features two fighters (striker and “defender”), wherein the striker inflicts an aimed, full-powered, flat-handed strike to the face area of the defender, who is standing stationary with the target area exposed. After the impact, the defender must demonstrate the ability to continue the match. The roles switch, and then the cycle repeats until the match is over.

The critics of this activity highlight the inherent risk of traumatic brain injury to its participants as a notable cause for concern. One slap fighter died in 2021 due to a brain bleed. The index study investigating the burden of traumatic brain injury among slap fighters noted that 78.6% of the contestants demonstrated at least one visible sign of concussion as identified through video analysis of 78 slap fight matches. While this activity is nascent compared to its more conventional combat sport equivalents, slap fighting carries its own injury risk. It also carries a heightened concern for reproducibility among children, due to the minimal equipment required for engagement.

Position Statement

Amidst the growing interest in slap fighting, there is an under-representation of its associated health risks. Health care professionals have a duty to protect the public from activities that pose foreseeable harm. Even if consenting participants contend they are aware of the risks, they may not fully grasp the potential for short and long-term brain injury.

The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) unequivocally denounce adult and pediatric participation in slap fighting. Governing authorities should reconsider their recommendation to promote slap fighting – given the risk for permanent and devastating brain injury. Health care professionals in child-facing roles should encourage children not to participate in slap fighting. For those individuals already participating in slap fighting, health care professionals should counsel them of the inherent potential for brain injury.

Rationale

Although combat sports are amassing a growing fan base, necessary safety regulations need to be observed prior to play. Slap fighting is an offense-emphasized activity that penalizes reflexive, defensive maneuvers such as flinching. The construct of the sport raises several questions regarding the safety of the participants. Furthermore, the fast tempo of the match means that defenders are exposed to repetitive impacts, which can exacerbate the effects of the concussive blows sustained earlier in the match. Prior longitudinal studies have also noted rates of concussion in boxing and kickboxing, which are lower when compared to the data on slap fighting. Without adequate regulations, the business of combat sports may disproportionately prioritize entertainment value over athlete health and safety.

References

  1. Bahari S. Pro slap fighting wins approval in Texas despite safety worries. The Dallas Morning News. https://www.dallasnews.com/news/texas/2024/08/08/pro-slap-fighting-wins-approval-in- texas-despite-safety-worries/
  • Roberts M. Health warning over face-slap fighting. BBC News. Published September 18, 2024. Accessed May 28, 2025. https://www.bbc.com/news/articles/cn9dxg0w7vzo
  • Brain Injury Association of America. BIAA calls on Nevada Athletic Commission to end slap fighting. Published February 23, 2023. Accessed May 28, 2025. https://biausa.org/public- affairs/public-awareness/news/biaa-calls-on-nevada-athletic-commission-to-end-slap-fighting
  • Lavadi RS, Kumar RP, Kann MR, et al. Video Analysis of Concussion Among Slap Fighting Athletes. JAMA Surg. Dec 1 2024;159(12):1435-1436. doi:10.1001/jamasurg.2024.2605
  • Michael L, Joseph L, Deborah P-G, Ian G, James B, Chris B. Boxing injury epidemiology in the Great Britain team: a 5-year surveillance study of medically diagnosed injury incidence and outcome. British Journal of Sports Medicine. 2015;49(17):1100. doi:10.1136/bjsports-2015- 094755
  • Zazryn TR, Finch CF, McCrory P. A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia. Br J Sports Med. 2003;37(5):448-51. doi:10.1136/bjsm.37.5.448
  • Zazryn TR, McCrory PR, Cameron PA. Injury rates and risk factors in competitive professional boxing. Clin J Sport Med. Jan 2009;19(1):20-5. doi:10.1097/JSM.0b013e31818f1582

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