Knees no more dangerous than fists?

Sitting ringside at the first UFC event ever in Atlantic City, Domenic Coletta was horrified. Tito Ortiz had just picked Evan Tanner up and slammed him down on the back of his head in what Coletta, the doctor on duty that night, described as “a piledriver.”

After the fight, Coletta, a longtime boxing doctor, walked over to then-New Jersey state athletic commissioner Larry Hazzard with a stark look on his face.

“This is a neck fracture waiting to happen,” Coletta said of that night in February 2001. “I don’t want to work this sport if it’s that brutal.”

Hazzard assured him things were changing. Sure enough, a few months later Hazzard, Coletta and a handful of others, including representatives from the UFC, huddled in a room in Trenton and drew up the unified rules of mixed martial arts, which are still used today.

The key that day was to make MMA and the UFC more appealing to the masses – and to get political enemies like Sen. John McCain to pipe down. One of the compromises made was to ban knees and kicks to the head of a grounded opponent. But not necessarily for medical reasons; it was for reasons of perspective.

(‘Shogun’ Rua attempts one of his signature stomps)

“A knee to the head is not going to create significantly more brain injury than a punch to the head,” Coletta said. “It probably won’t create any more.”

Head trauma comes from the brain bouncing against the skull, Coletta said, and a knee, a kick or a punch to the face all possess a similar result. Knees, kicks and elbows to the head are more likely to cause cuts than a gloved fist. But that’s not why the rules were put in place.

“For the people who want to see it banned, at the very least it seemed to civilize it a little bit,” Coletta said. “Taking away the knee to the head [of a grounded opponent], I think you made some progress.”

Illegal knees have become a hot topic. On Saturday night at UFC Fight Night: Machida vs. Munoz, a lightweight bout between Melvin Guillard and Ross Pearson was ruled a no contest when Guillard caught Pearson with a knee while his hand was on the ground.

The ringside doctor ruled that Pearson could not continue due to a cut opened up by the knee and referee Marc Goddard waved the fight off.

Goddard had to quickly determine whether or not Pearson was putting his hand on the ground simply to avoid taking a knee to the skull – what UFC president Dana White and referees have dubbed “playing the game” – or whether he was actually attempting to protect himself by getting into a downed position.

"I saw Ross’ hand, and when I say hand, I mean his palm – his entire hand,” Goddard told Ariel Helwani on’s “The MMA Hour.” “It wasn’t what we’re used to before with the fingertips and playing the game, as me and a couple of other refs will allude to. This was a deliberate action, in terms of Ross making himself safe, putting his full hand down on the mat.”

(Wanderlei Silva unleashes a soccer kick on Kazuyuki Fujita)

According to the Association of Boxing Commissions (ABC) rule book, a fighter is technically grounded “when he has more than just the soles of [his] feet on the ground (i.e., could have one shin or one finger down to be considered a downed fighter).”

“It’s about a matter of balance,” Coletta said. “He might be caught off balance and caught off guard and a strike in that situation could cause more damage.”

Fighters have tried to abuse that rule, so it was decided at this year’s ABC conference that it was up to the referee to determine whether there was intent to become grounded just to avoid a knee or kick to the head. If the ref thinks the fighter was “playing the game,” he can rule the knee or kick legal.

Referee Rob Hinds says he and his peers need to do a better job communicating that distinction to fighters before they step into the cage at pre-event rules meetings.

(Igor Vovchanchyn goes in for the kill against Dan Bobish)

“Some [referees] do a very good job at a rules meeting,” said Hinds, a certified referee and judge trainer. “Some, more than others, do not. An effective rules meeting can make or break what’s going to happen in the cage. That’s not my opinion. That’s fact. That’s what we’ve found out through research.”

So why do things have to be this complicated? Why leave the quick judgment up to the referee?

“It’s a lot of pressure,” Hinds said. “Fans can watch in slow motion all day, but [referees] don’t have instant replay yet.”

And with a split second to react, how can a fighter possibly determine the nuanced legality before throwing a knee? It’s nearly impossible.

“If it was me in that position, I probably would have done the same thing,” Pearson said at the post-fight press conference.

Pearson and Guillard will meet again March 8 in London at another UFC Fight Night. The rules will likely be the same, but should they? Or should the UFC return to the days of PRIDE and bring back soccer kicks and knees to the head on the ground? At the very least, it would cut out some of the confusion.

“I’m a fan of the old PRIDE rules,” Hinds said. “As a fan I love those things, but I also understand the standard to move the sport forward.”

Which is exactly what Coletta and others were trying to do 12 years ago in New Jersey.