All the outcomes are predetermined. The storylines are designed to entertain as are the gimmicks. And we all know that if you really got piledrived (just ask Stone Cold) or hit with a flying elbow it could and probably would cause some serious damage. However a lot of the hits that happen in the ring are real, especially in the indies. There have been to many injuries and to much blood spilt to deny the fact that on occasions wrestling action is real.