LAS VEGAS – There has been endless debate for nearly two weeks about whether UFC featherweight champion Jose Aldo actually fractured a rib during training or whether he had a deep bruise, as the UFC has said.
The injury, whatever it was, forced Aldo on Tuesday to withdraw from a planned title defense on July 11 against Conor McGregor in the main event of UFC 189 at the MGM Grand Garden. It also set off wild speculation on social media about Aldo's toughness and the motivations of UFC president Dana White.
Aldo has come under attack for pulling out of a fight for the fifth time in his brief UFC career.
White, who's expressed concern and support to the Aldo camp, has been lambasted on social media for supposedly trying to force an athlete to compete with a serious injury.
Doctors interviewed by Yahoo Sports, including the UFC's Jeff Davidson, and two who declined to speak on the record because they did not personally examine Aldo, all said either injury would have been extraordinarily painful.
At the end of the day, the exact nature of the injury doesn't matter. It was an issue of pain tolerance, as well as Aldo's ability to perform at the level he wanted in his most important fight.
"Every individual has a different threshold for pain tolerance," Davidson told Yahoo Sports. "Anyone who has an injury to the chest wall, they're never quite sure whether they bruised their rib, whether they broke or whether they tore the cartilage. All they know is that it hurts. It doesn't matter what the injury is, it hurts.
"When Aldo, who is a very good athlete, a world-class athlete, tells me it hurts, I believe it hurts. To what degree he would have had recuperation, it's hard to say. We've had fighters fight with very similar injuries as recently as in our last fight in Vegas. Some of them choose to fight and some don't. It's a very individual choice and it is really up to them.
"At the end of the day, I'll ask them, 'On a scale of 1 to 10, how bad is the pain?' " Davidson said. "Some of them call it a 4, others say 8, some say 9 or 10. It's all over. Jose had pain, he felt uncomfortable and the bottom line is, he didn't feel he could perform like he needed."
An NFL or college football player with a similar injury most likely would have played, a doctor who spoke on the condition of anonymity told Yahoo Sports, because he probably would have gotten a shot to numb the pain.
Aldo declined to speak to Yahoo Sports, citing disappointment about withdrawing from the match. His trainer, Andre Pederneiras, released a statement in which he said Aldo made every effort to compete.
Despite the treatments he took, which included plasma rich protein therapy (PRP), Aldo did not feel better, Pederneiras said in his statement.
"The UFC never offered us additional money for Aldo to fight, and they did not pressure us," Pederneiras said. "They let us know that if Aldo could not fight, McGregor would continue on the card, against Chad [Mendes]. And they let us know that because it was the fifth time Aldo withdrew due to injury, they would make it for the interim title. There was no pressure and no offer of any money by the UFC for Aldo to fight. The only disagreement we had was in the diagnosis of the injury, between the doctors we consulted in Brazil, and American doctors. Actually, Dana demonstrated genuine concern for Aldo’s health.
"Despite his broken rib, Aldo tried everything to stay in the fight: He underwent [PRP], had acupuncture treatments, and daily physical therapy. We wanted this fight badly and did everything we could. Unfortunately, after a week of treatment, his pain continued to be very intense, and so we made the difficult decision to withdraw. What matters to us now is that Aldo recover, and return to defend his title 100 percent healthy."
The morning after Aldo's injury, a conference call was held that included Aldo, Pederneiras, White, Davidson, Dr. Marcio Tannure of Brazil and several other UFC senior-level executives.
Davidson had received the report from the radiologist in Brazil who had examined Aldo's MRI and CAT scans.
It read, "There is an irregularity of the left 10th costochondral junction with a radiolucent line on the condral calcification showing minimal edema, suggesting a fracture of the costochondral arch."
The costochondral junction is the area, or junction, where the cartilage that extends from the sternum attaches to the rib. Minimal edema means there was not a great amount of swelling.
"What happens a lot of the time is the cartilage gets calcified from an old injury, from an injury to the ribs," said Davidson, whose full-time job is as an emergency room physician. "When cartilage heals, it heals by calcification. If you get injured in that area again, that calcified cartilage can break and can look like a fracture line.
"But it's still the cartilage that's just become a calcified cartilage."
Davidson said during the meeting that he explained the injury to Aldo and the different treatments that were available.
"The first thing out of Dana's mouth," Davidson said, "was, 'Aldo, we want you to get better and there is no pressure on you to fight. Go do what the doctors tell you and do your therapy and let us know in five or six days how you're feeling.' So at that point, we went through everything and I felt Jose was going to do what he could and then we'd get together again and see how it was coming along."
Aldo saw several other doctors in Brazil, including Jose Luis Runco, who gave him the PRP treatments, and Rickson Moraes.
Despite his efforts, the pain never lessened and Aldo couldn't fight. A Las Vegas-based doctor who has dealt with similar injuries told Yahoo Sports that it was probably excruciatingly painful.
"I've seen a lot of people with this injury, and they always, every time, complain about how much it hurts," the doctor said. "These fighters are different. They have great pain tolerance, and I'm not surprised that you tell me some of them have fought through this.
"No one knows how much it hurts unless they've had it, and each case is different. But if the patient is telling me it hurts badly, the last thing I'd tell him to do is fight someone. There wouldn't have been a risk of a punctured lung, but I sure as heck wouldn't want someone kicking or punching me there."