Punches and kicks come in many forms.

But are they any more dangerous to an unconscious opponent as they are to a fully awake competitor?

Reader "Dan" recently watched UFC 113 and Mauricio "Shogun" Rua vs. Lyoto Machida, and in our latest "Ask the Fight Doc" installment, he asks MMAjunkie.com medical columnist Dr. Johnny Benjamin whether there's a significant difference between the two.

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Hi Doc: Firstly, I love your articles on MMAjunkie.com. They give an awesome insight into issues that us fans would not usually be aware of and help us to one day become keyboard physicians as well as keyboard warriors. My question relates to strikes to an unconscious opponent. During UFC 113, we saw "Shogun" Rua admirably stop striking (before the ref stepped in) as soon as he realized Lyoto Machida was unconscious. But in recent years, we've seen strikes to a clearly unconscious opponent. From a medical perspective, are these strikes more dangerous than being hit while fully conscious? Does the body react any differently? - Dan

I'm glad that you enjoy the articles, and I thank you for the kind words. And I also appreciate the great question!

As anyone who has read many of my articles is surely aware, I am a zealot when it comes to concussion prevention, management, recognition and safety. Broken bones heal quite readily, but brain injuries and trauma are not nearly so forgiving.

My friend, your observation and concern for unconscious and conscious-but-concussed combatants are very well-founded. Not allowing a defenseless and concussed fighter to continue to absorb blows to the head is one of the most vital functions of a MMA referee.

An unconscious fighter lying on the mat is in a particularly vulnerable position with regard to potential serious brain injury for several reasons.

If the fighter were standing when struck, the fall commonly provides a second blow to the back of the head as it bounces off the mat. And remember: the brain is sloshing around within the skull and contacting the bony vault with significant force. This rattling around of the brain causes an accumulation of injury.

The downed fighter is unable to defend and deflect the additional blows of an often-standing opponent. Commonly, as the fighter falls, the conscious fighter will pounce with all of his body weight directly on the injured fighter, usually with one or more head strikes.

The unconscious fighter will often go limp and lose muscle tone, which severely limits the neck's ability to absorb the strike and dampen the force transmitted to the brain. Strong neck musculature acts as a shock absorber for the head.

As if this all were not enough, the downed unconscious fighter may very well have his head pinned to the ground with the finishing strike. The inability of the head to move back to dissipate the blow causes an incredible amount of force to be transmitted to the skull and its contents.

I know it is a lot of information, so let's try to put it all together.

Two fighters are in the stand-up, and one gets clipped and is out on his feet. His body goes limp, and the fighter falls as his head bounces off the mat. The standing fighter quickly realizes that the haymaker connected, and in the heat of battle, he dives on top of the defenseless fighter to deliver a blow with full body weight. The bottom fighter cannot avoid, defend, deflect or dissipate the force of the strike(s) that pin his head to the floor.

Get the picture?

As I've stated many times, the most talented person in the cage or ring needs to be the referee.

The safety of the world's greatest fighters needs the world's best MMA referees. The UFC needs the skill set of veteran referees such as "Big" John McCarthy. (And that's all that I have to say on that subject.)

Dr. Johnny Benjamin is MMAjunkie.com's medical columnist and consultant and a noted combat-sports specialist. He is also a member of the Association of Boxing Commissions' MMA Medical Subcommittee. Dr. Benjamin writes an "Ask the Doc" column every two weeks for MMAjunkie.com. To submit a question for a future column, email him at askthedoc [AT] mmajunkie.com, or share your questions and thoughts in the comments section below. You can find Dr. Benjamin online at www.drjohnnybenjamin.com, and you can read his other sports-related articles at blog.drjohnnybenjamin.com.