Slap fighting may seem like an extreme spectacle — two people standing across from each other, delivering punishing blows to the face using only their open hands. But behind the viral videos and millions of online views lies a troubling question: What toll is this sport taking on its participants?

For the first time, researchers have scientifically documented the risks that slap fighting poses. A study conducted by neurosurgeons at the University of Pittsburgh School of Medicine analyzed the potential neurological damage in participants — and the findings are alarming.

Slap Fighting Under the Microscope

The research team reviewed 333 slaps across 78 slap-fighting matches, looking for visible signs of concussion. Their analysis showed that more than half of the slaps resulted in signs of concussion, such as impaired motor skills, a blank and vacant stare, or slow recovery after a knockdown.

“Slap fighting may be entertaining to watch as a lay viewer, but as medical professionals, we found some aspects of the competitions to be quite concerning,” said Dr. Raj Swaroop Lavadi, the study’s lead author.

The study paints a grim picture, with nearly 80% of participants showing visible signs of concussion at least once during their matches.

A Brutal “Sport” with No Defense

Unlike sports like boxing or football, where athletes wear protective gear, slap fighters have no such safeguards. There are no helmets, no ducking or dodging — just full-force slaps to the face, delivered in front of cheering crowds. According to the official rules, participants cannot even flinch as they stand still to receive the blow. This creates an environment with heightened risks of brain trauma.

Dr. Nitin Agarwal, a senior author on the study and an associate professor of neurosurgery, expressed serious concerns. “In professional football, there’s talk about improving helmets,” he noted. “For this, there is no defense. Your defense is to stand still and get hit.”

The stark reality is that repeated concussions, even mild ones, can accumulate over time and lead to chronic traumatic encephalopathy (CTE), a progressive and degenerative brain disease seen in athletes of contact sports. In slap fighting, the immediate visible signs of injury — poor coordination, vacant stares, and delayed recovery — are red flags for long-term damage.

What’s Next for Slap Fighting?

As slap fighting continues to gain popularity, events are being held in places like the U.S. and the U.K., drawing massive online audiences. Recently, even celebrities like Arnold Schwarzenegger have been spotted watching slap-fighting events ringside. But these growing crowds have done little to stem the rising concerns in the medical community.

This isn’t the first time slap fighting has faced scrutiny. In 2021, Polish slap fighter Artur Walczak suffered a fatal brain injury after being knocked out during a match. In 2023, retired female slap fighter Kortney Olson publicly shared her story of memory loss and confusion following a severe hit during a slap fight.

The research from the University of Pittsburgh aims to spur much-needed conversations about regulating this sport, which is still largely underground. Dr. Agarwal’s team plans to continue their work by measuring the physical impact of an average slap using mouthpieces similar to those used in professional football. Their hope is to provide data that can inform safety regulations — if the sport is to continue.

Yet, some researchers question whether slap fighting should be classified as a sport at all. “I don’t think this should be publicized as a sport,” said Agarwal. “It’s quite devastating to me to see that people are willingly participating in this, and I’m hoping there is a recognition of the danger here.”

A Growing Awareness of Head Trauma

Concussions have become a major topic of concern in sports, especially in the context of contact-heavy activities like football, hockey, and rugby. Organizations like FIFA and the World Health Organization have recently launched awareness campaigns to promote better recognition of concussion symptoms and safer protocols for athletes. However, slap fighting operates in a much less regulated space, with few — if any — concussion protocols in place.

“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,” said Agarwal.

Whether slap fighting will adopt safety measures, or even face bans, remains to be seen. For now, it continues to attract thrill-seekers and fans alike — despite the known risks. But the question remains: Is the entertainment worth the long-term cost?

The findings appeared in the journal JAMA Surgery.