INTRODUCTION: In the past decade, sports-related concussions have drawn considerable attention from the public, the media, and sports medicine professionals. Epidemiological reports provide convincing evidence that numerous concussions occur at all levels of sport activity, but little is known about the differences in the level of protection that rules offer to the athletes in different sports, especially in those where risks are higher, as combat sports. METHODS: A revision of the rules of the different Olympic combat sports (boxing, taekwondo, judo, wrestling, fencing and karate)was done, in order to compare the level of protection (in trms of protective equipement, level of impact allowed, umpires decisions in case of a concussion, and protective time to return to sports after a concussion) both in adults and in adolescent athletes. RESULTS: Only two sports (boxing and taekwondo) allow concussion as a way to victory in a match, both in adults and in athletes over 16 years of age. Competition rules in karate restrain impact force in younger athletes to that which would no represent a significant energy transfer to the head of the athlete (i.e.: no displacement when receiving the hit). Protection period after a concussion ranges from 7 days in Judo to 30 days in boxing and Taekwondo, although only karate rules impose a longer period after a second concussion (3 months) and even longer after a third one (one year). Helmets are used in boxing for females and for under 18 year old boxers; they are used in taekwondo through all ages, as they are instrumented with contact sensors, as they are in fencing. Protection gloves are quite different in boxing, karate and taekwondo, both in size and weight. Rules in taekwondo and karate give extra points to hits in the head area compared to the body CONCLUSION: In light of the obvious differences among the different combat sports, it is not possible to unify criteria regarding protective equipement, but probably a more uniform joint effort to establish protection criteria regarding time to return to sport should be set. Also, the fact that the head offers a higher score in karate and taekwondo, and that the goal of redeeming an oponent out of combat is clearly easier in boxing through head impacts than through body punches, clearly encourages using the head as target and increases the risk of concussions.
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