boxing and concussion

Monday, July 28, 2014

For most of the amateur boxers at the Glasgow Commonwealth Games this week, something was missing. As they eyed their opponent across the ring, the only protective gear seen was on their fists. The helmets presumably worn to protect their brain were gone, a decision made by the sport’s ruling body, the International Boxing Association. It seems that their unpublished research found that concussion rates go down when boxers do not wear protective head gear. Presumably, wearing head gear allowed fighters to lean into their opponent and take more blows to the head. There is controversy in this decision, with Dr. Charles Butler the chairman of the IBA medical commission and the president of USA Boxing supporting his unpublished research, while others in the medical community believing that the IBA has made an error in removing head gear from the boxers.

boxing image

The purpose of helmets in sport has been blurred somewhat and understanding anatomy may help explain some of the controversy that boxing has invited upon itself. The brain sits within the skull, but it is not a tight fit. When the head is hit, there is a slight delay between skull and brain acceleration, allowing the brain to move within the skull and bounce back and forth against the inner bony walls of the skull. A direct blow to the head is not necessary to cause damage; the head being shaken is enough to rattle the brain. The helmet is meant to prevent skull fractures, facial fractures and lacerations. These injuries can be associated with intracranial bleeding (bleeding within the skull) like subdural and epidural hematomas. The helmet however, does not prevent the concussion type injuries where the brain is shaken and there is no obvious outward damage. Even CT scanning of a concussed brain may be structurally normal. It may take imaging with special MRI or PET scan to show brain damage on a function level. For that reason concussion is a clinical diagnosis.

Loss of consciousness is not required to make the diagnosis of a concussion and the initial symptoms may be very short lived. The longer term consequences may take hours or longer to show themselves and headache, concentration and balance problems may take weeks or more to resolve. On the football field, there are teammates and coaches who can assess the mental status of a potentially concussed player, but in the boxing ring, there may be a delay in recognizing the injury. In football, soccer, basketball and other team sports, a concussion assessment takes many minutes on the sideline before the decision is made to return to play. When a boxer is knocked down, there may be only a few seconds taken by the referee.

In boxing, the head is the target for most blows. As in football and baseball, the helmet is meant to prevent broken bones (fractures), but present technology does not prevent the brain from being shaken within the skull. The removal of headgear may make boxers more wary and change the style of the sport, but the goal for winning remains the same, to inflict a concussion upon your opponent. It seems difficult to understand the position of the IBA medical commission that boxing’s goal will be altered by removing protective gear. The sport has given us the term dementia pugilistica, being punch drunk, likely the equivalent brain injury of chronic traumatic encephalopathy in football due to repeated blows to the head.

Perhaps after these Commonwealth Games and the Rio Olympics, the IBA will have more data to show that arbitrarily removing a piece of safety equipment was the way to go. While head gear may not prevent concussions, they will decrease the risk of facial fractures and lacerations, especially around the eye. It might have been wiser to have the IBA and Dr. Butler’s research and data published and allow the scientific community the opportunity to make its own recommendations, but it seems unreasonable that amateur boxers be used as guinea pigs while the answer is yet unknown.


Image attribution: Andrej Isakovic, Getty Images


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