Note: This article was published before Pornsanae retired. He is currently retired and has landed his dream job over at Evolve MMA training students. So everything worked out for Pornsanae and his career, see the very end of this article — April 2015).

The year of 2014 was not a good one for Pornsanae Sitmonchai. Throughout 2014, Pornsanae had lost 8 out of 10 fights and had been KOed (TKO) 7 times. A fighter who was known for his vicious battles in the ring and endless heart could no longer keep up the same fighting style.

In 2014 the super-charged Pornsanae had more KO losses than in all his previous 8 years combined.

The fighter known for his fantastic highlight reel knockouts was starting to be on the receiving end of those fight-ending knockouts.

Young Pornsanae in Rajadamnern stadium. Photo Credit: Sitmonchai Gym

Young Porsanae. Photo Credit: Sitmonchai Gym

Since stepping into the ring at the age of 11, Pornsanae has accumulated hundreds of fights over his 22 year career. While most fighters in Thailand retire by their mid-twenties, Porsanae is still fighting, making Porsanae one of the few high-level fighters left still fighting in their 30’s.

Unlike evasive fighters like Saenchai who rarely take any damage in a fight, Pornsanae is a fighter that uses his aggression and power to overwhelm opponents by knockout. If you’ve ever watched a Pornsanae fight, you know he will either win by KO or probably lose by points.

Unlike the traditional Thai style of pacing yourself for the first 2 rounds, Pornsanae never wasted a moment for the action to begin. Because of his aggressive hard hitting style, Pornsanae was arguably the most exciting Muay Thai fighter. Every single punch and every single kick was always thrown with bad intentions written all over them.

This is typical Pornsanae here, aggressive and dominant. Video Credit: MuayTies

The side effect of this style is you leave yourself exposed to counters from skilled opponents who wait for openings in your attacks. This leads to a large accumulation of damage that occurs over the years. While a young healthy fighter may be able to handle this amount of wear and tear, as a fighter gets older they begin to get more sensitive to damage.

Let’s look at what getting knocked out repeatedly can do to your brain…and performance as a fighter. This may be an uncomfortable read, but it’s something EVERYONE who participates in Muay Thai should know. If you know what can happen, you can take (some) steps to prevent it.

The Effects of Knockouts on the Brain

One thing that is often overlooked in Muay Thai is the effects of knockouts on the brain. When you see someone get knocked out in a fight, you probably don’t realize how much it can impact a fighter’s career.

Porsanae’s KO loss to Pokkeaw. Video Credit: Muay Ties

While you might have a brief moment of sympathy for the person getting KOed in the ring, that moment will quickly pass. The truth is knockouts are great to watch, but they can be devastating to the long-term health of the fighter. In many regulated fight organizations back in North America, you are in fact not medically allowed to fight for anywhere between 30 to 90 days after suffering from a TKO or KO.

While Thailand’s Muay Thai regulators do have an official amount of time you have to wait before you can fight again, you often see guys fighting a few days or weeks after a brutal KO in the local stadiums that are not properly regulated.

And there are some good reasons why you don’t want to suffer more trauma to a head shortly AFTER a knockout. Because you can suffer brain damage (even die).

I think it is fair to say that most fighters who have been fighting for a while will have experienced concussion symptoms at some point in their career. That is expected. However, if you continually start to get knocked unconscious, it will have a big impact on your health as a fighter.

Before we continue our look at Pornsanae’s future as a fighter, let’s look at how a concussions and head trauma effects fighters. Do read this, as EVERY person who spars or fights SHOULD know this stuff for safety.

Every Time a Fighter Get’s KO’ed They Suffer a Concussion

Let’s make this crystal clear so there are no misunderstandings:

if you suffer a KO, you suffer from a concussion (of varying degrees). But you don’t have to get KO’ed to get a concussion.

The problem with concussions is that a lot of people don’t truly understand what concussions are. The lack of education means that people aren’t able to identify symptoms of a concussion and often train through them, even though they should be resting.

You Can Get a Concussion without Getting KO’ed

What does this mean?

A lot of people falsely believe that you have to be knocked unconscious to suffer a concussion. The reality is you can win a fight and still suffer a concussion after the fight if you take a lot of shots to the head.

I recommend you look closely at this list of concussion symptoms so you can tell right away if you end up with a concussion — either during a fight or from sparring.

There are (3) Types of Concussions

  1. Grade 1 (Mild): No loss of consciousness; symptoms last less than 15 minutes
  2. Grade 2 (Moderate): No loss of consciousness; symptoms last more than 15 minutes
  3. Grade 3 (Severe): loss of consciousness

Grade 1 or 2 concussions can take a minutes, days, or even a couple weeks to heal fully. Grade 3 and you should see a doctor. Grade 3 can take weeks or even a couple months to fully heal. 

Get a Second Concussion before Your First Concussion is Healed, You Can Get Second Impact Syndrome

Basically, you don’t want SIS, not at all. Second Impact Syndrome radically increases the chance of brain swelling, which just might kill you, not to mention have lasting horrible effects on your brain functions. If you survive, the overall long-term effects are basically the same as suffering Severe Traumatic Brain Injury, which by the way is all bad news. This means you can suffer a lot of long term effects and it can take you a hell of a lot longer to fully recover than from a ‘normal’ concussion, which is classified as mild to moderate Traumatic Brain Injury.

The scary thing about this is that MANY athletes are at risk — you can easily get a concussion during a match and not realize you have a concussion and continue fighting — but you are fighting WITH a concussion, risking a second concussion (and SIS)

Just look at this terrifying interview (less than 6 minutes) with Gerald McClellan, former boxing champion of the world, six years after his brutal fight with Nigel Benn; McClellan was brutally TKO’ed and suffered massive brain damage from the blows he took during that fight, ending his career. He basically ended up with a concussion during the course of the match and the final TKO knockdown likely added a second concussion to the first.

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Once You’ve had a Concussion, the Odds of it Happening Again Increase Dramatically

Being concussed makes you more susceptible to future concussions because it lowers the threshold for the amount of force needed to injury your brain. Studies have shown that you are three to six times more likely to suffer a second concussion if you’ve previously been concussed.” (Source)

This is nature’s way of protecting your body from taking any more permanent damage to your brain. So the resulting effects of accumulating brain trauma over time is your brain will start to shut down with less trauma than someone who has taken less damage.

“Anytime you take damage to the head delicate neural pathways in the brain can become damaged, causing neurological disturbances.” (Source)

This is why Boxers, Muay Thai, or MMA fighters usually have a weaker ‘chin’ later in their careers.

A particularly brutal concussion can damage your brain for good

While it’s very rare that a single, one-off KO can permanently debilitate you, it can happen (though having your career ended by a single KO is more likely the final straw in a large haystack of accumulated damage over time, it can happen that one particularly horrible KO or concussion can end it all).

Boxers, with vicious, accurate power shots (with guys who are the best in the world at punching) to the head during matches are the most at risk here, though other sports athletes as well, such as American Football, Hockey, and of course Muay Thai. There are plenty of videos you can find showing a brutal KO killing or ending someone’s fight career.

Lower Impact Strikes Over Time = Just as Dangerous as KO’s

There’s a misconception out there that it’s only a series of dramatic, highlight reel worthy knockouts that can end a fighter’s career or cause permanent brain damage which can negatively impact a fighter’s performance both in the ring out outside of the ring.

Getting KO’ed can have a host of negative, long-term impacts. In terms of your ring performance, acquiring a ‘weaker chin’ is directly caused by KO’s. But it’s not just suffering from hard knockouts that causes issues for fighters. In fact, the more deadly, subversive kind of brain damage can occur slowly over time without you ever really knowing about it until it’s too late.

You see, repetitive, below-the-knockout-threshold blows over time can cause dementia after a few years, which is a different sort of brain damage, and the effects are devastating — not just career ending, but life changing outside of the ring too.

The scary thing is that this brain damage is not (mostly) caused from a serious one-off beatdowns during competition fights but from a steady supply of lower impact hits you might get during regular sparring over time. 

The poster boy for these sort of injuries are Western Boxers who are notorious for ending up with serious brain trauma issues after years in the sport. And it’s not necessary from their fights, but their TRAINING for their fights that causes most of the long-term brain damage. In fact, there are so many (western) boxers with brain injuries (15-20 percent of professional boxers so experts think), there’s even a name for the condition: “Boxers Dementia“.

Take a look at the effects of Boxer’s Dementia:

The condition, which occurs in athletes having suffered repetitive blows to the head, manifests as dementia, or declining mental ability, problems with memory, and Parkinsonism, or tremors and lack of coordination.[2] It can also cause speech problems[2] and an unsteady gait. Patients with DP may be prone to inappropriate or explosive behavior and may display pathological jealousy or paranoia.[2] Individuals displaying these symptoms also can be characterized as “punchy”, another term for a person suffering from DP (source: Wikipedia)

Boxer’s Dementia is nasty — you don’t want to end up with this. Just look at Muhammad Ali or Joe Fraizer or Freddy Roach any number of the 15-20 percent of pro boxers who have it to see what it can do to your quality of life.

Muay Thai and Brain Damage

There’s has NOT been many studies on Boxers Dementia or brain damage in Muay Thai fighters (though it’s a well established, well-studied condition for boxers), but given the number of Nak Muay and the level of training they do, day in and day out, it’s likely a problem that no one talks about, yet exists. With most of the fighters in Thailand, from poor villages and complete lack of medical coverage, there’s not a lot of data just yet.

The common phrase I hear about Muay Thai is that it’s safer than say Boxing because the damage you take is distributed throughout the entire body, not just the head like in Boxing. Yes, this is true, but you can get shin-kicked to the head, elbowed to the head, knee-‘ed to the head, or straight out punched to the head. Plenty of people fighting Muay Thai get KO’ed — and those KO’s are brutal.

There are a few studies on brain trauma and Muay Thai, and the results do not look good.

Muay Thai fighters are at higher risk of Parkinson’s Disease. More fights = more risk.

Stephen Strotmeyer on our facebook page was nice enough to share a medical study done on Muay Thai fighters in Thailand looking to see if Parkinson’s Disease is correlated to the number of Muay Thai fights (i.e. Head Trauma). And surprise surprise, the study found Nak Muay are more likely to suffer from Parkinson’s Disease than non-fighters. And the more fights you have, the more at risk you are. You can read the study here.

Studies found child Muay Thai boxers in Thailand suffered from brain damage and lower memory ability

A study done in Thailand comparing 13 child Muay Thai boxers brains to the brains of 200 non-boxer children found permanent brain damage in the child fighters (thanks to Edward Sutherland for posting this in the comments):

.”..compared 13 of these young fighters to 200 children of similar ages in the brain mapping study and confirmed not just that their brains showed abnormalities but that their memory response was far lower. ‘They look like ordinary children but all of them revealed abnormalities in their scans. Some have damage that looks similar to the diffuse axonal injury that occurs when the head is rapidly accelerated or decelerated, as may occur in auto accidents, falls, and assaults,’ Jiraporn says.” (source)

How Can You Protect Your Brain from Damage

This is an entire article in itself that we will write in the future, but I’ll just touch briefly on some strategies. Obviously, you love Muay Thai / Boxing / MMA, and stopping is not an option. Fair enough. But there are a few things you can do to reduce chances of acquiring brain damage.

  • If you suffer a brain trauma, give yourself PLENTY of rest before risking head trauma again: This means if you end up even with a mild concussion, you should not risk any head trauma for at least a month. That means avoid sparring and don’t be stupid and take an actual fight. If you have a concussion and end up getting another concussion shortly after, you can suffer permanent brain damage or even die (it’s happened to fighters in Thailand).
  • When appropriate use headgear: While it’s not always practical to use headgear, if you are doing a lot of boxing sparring or there is some good risk of getting shin kicked to the head, consider putting on some well-padded headgear. No one likes wearing it, but it CAN protect your brain.
  • Don’t spar every single day: It’s not a good idea to spar day in, day out, every day. When you get punched in the head, brain cells die and bad things happen. You do need time to recover. It’s best to have a day of rest between sparring. One option might be Muay Thai sparing rotated with boxing sparring. But certainly do not boxing spar 5-6 days a week!
  • If you have headaches after sparring or during your sparring, STOP and take a few days off: Common sense folks. I am not telling you to stop in the middle of a sparring session, but don’t be a hero. And if you think taken a really good knock and you feel it hours after and have difficulty sleeping, DO SEE A DOCTOR. There are stories you can find about guys who take a good knock to the head, feel pain, go home and come back a day or two later and take another knock on the head only to die. It’s a small risk maybe, but you don’t want to be one of those statistics.
  • Don’t be a (Western) Boxer 😉 Boxing is REALLY bad for the brain. 

The Longevity of Aggressive Fighters

Understanding the effects of concussions on the brain makes it easier to see why Pornsanae has been on the decline in the past year. Even though he has one of the biggest hearts in the sport, his brain could no longer withstand the same punishment it once could.

Porsanae had suffered 12+  knockout losses in his career. Meaning he has suffered at least 12 serious concussions. This number does not take into account the amount of times he has been knocked down in a fight or suffered concussions symptoms after a fight.

Superlek high kicking the aggressive Pornsanae. Video Credit: Muayties

Brain damage is often irreversible. Legends like Mohammed Ali suffered from numerous ailments when he retired from boxing due to all the brain trauma incurred over the course of his career.

Is a fighter the same after a brutal knockout? It all comes down to how well they can recover after the fight. Consecutive knockouts make it unlikely they will be the same fighter they were before.

Fighter’s who have taken a lot of knockouts in their career are more likely to suffer from concussion symptoms like memory loss, intense anger or aggression, personality problems, inattention or lack of focus, problems organizing and  the inability to problem solve. (Source: Center for Brain Health).

If you want to look at the harsh affects of brain trauma AFTER fighters (boxers in this documentary) retire, I highly suggest you watch this fascinating yet disturbing documentary “After The Round Ends”:

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When is Enough Enough?

Anyone who had been following Pornsanae’s career knew that 2014 was a bad year. One of the most difficult questions fighters face is knowing when to hang up the gloves and retire? For fighters like Pornsanae who are known for their heart, giving up is not in their vocabulary.

This has been a trademark of his fighting style his whole career. You can never question his heart when he steps into the ring, which, unfortunately, can also mean you won’t know when to quit fighting.

This is the end of Pornsanae’s last fight. Up until this point, he was winning the fight.

While there is a governing body of Muay Thai that in Thailand that oversee Muay Thai fighters, fighter safety is not prioritized like it is in Western countries. In most countries, sanctioning bodies would look at Pornsanae’s fight history and would never sanction him to fight in the ring.

The difference between Thailand and Western countries is the fighter safety takes a backseat to the opportunity to make money. For example, after most of Pornsanae’s KO losses, he was fighting in the ring the next month. Why? Money!

In Thailand, there is often a conflict of interest between a fighter’s health and their ability to produce money for their gym. Since Muay Thai fighters are owned by the camps they train at (foreigners are the exception because they usually pay money to train), they are considered a money-producing asset for the gym. Each time that fighter fights, the gym will take a percentage of the fight purse (30-50%). The moment that fighter stops fighting in Thailand, he’s no longer producing money for the business and in a business sense, he’s no longer valuable to the gym.

This relationship between the camp and the fighter makes it easy to understand why there is often a conflict of interest between the fighter’s long-term health and their ability to produce income for the camp.

In addition to camps making money off fighters, the fighters themselves often live paycheck to paycheck. Meaning that if they don’t fight for a month, they don’t have any money to pay their bills. Unless the fighter becomes a trainer (which most of them do) they will have to find other means to make money — like man a street cart or drive a taxi all day.

Pornsanae has a young family he has to take care of. If he decided to quit fighting, how would he pay for the bills at the end of the month? Most fighters fight out of necessity, not choice.

When Does a Fighter Call It Quits?

The story of Pornsanae ended up on a good note. When we first wrote this article in 2014, Pornsanae got knocked out again only a few weeks later. However, he fought one more time after this and won his fight in a spectacular fashion; after winning, Pornsanae suddenly retired taking up a dream job at Evolve gym in Singapore — a gym that only hires Lumpinee champions. Paying over 10x the salary of a trainer in Thailand, Evolve is THE gym that all the fighters/trainers in Thailand dream of landing. For Pornsane, that dream is a reality and he can now live a high quality of life.  

Watch Steve working on technique with Pornsane in this Evolve Training video

Pornsanae is one of the most entertaining fighters in Muay Thai.

Pornsanae has been one of the most exciting fighters to watch over the years.

Nobody will ever argue Pornsanae’s heart and toughness. He is the type of guy that can lose a fight by KO and get in the ring 3 weeks later and fight again.

While Pornsanae was certainly not the same fighter at the end of his career that he was in the beginning, he was still a top level fighter. That being said, given the trajectory of his career in the past year, I think retiring from the ring was definitely the right decision.

As a fight fan you can appreciate Pornsane for all of his entertaining battles that he put on. He has provided so many entertaining fights over the years that it is difficult to find another fighter as exciting as him.

Live by the sword, die by the sword

Fighters should consider their health as a deciding factor in whether or not they should continue fighting. Given Pornsanae’s fighting style and knockout losses, he was bound to get KO’ed again — it’s was only a matter of time. While he might not feel the immediate effects of his knockout losses now, the long terms effects of concussions, as we looked at above, are not at all trivial.

Pornsanae Sitmonchai had nothing left to prove. He had the heart of a lion and will always be one of my favorite fighters to watch. Ultimately the decision to continue to fight or not was a financial one that he made. He was only fighting because he needed to support his family, simple as that.

The said reality is that many fighters in Thailand simply can’t afford to stop fighting, even when they should for health reasons.They don’t teach Thai fighters financial planning, so when they make a big purse they spend all the money without putting anything into savings. That is why most ex champions retire broke and have to work as trainers in the gyms.

Such is the the life as a Muay Thai fighter in Thailand.