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 It seems that their unpublished research found that concussion rates go down when boxers do not wear protective head gear.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 Charles Butler the chairman of the IBA medical commission and the president of USA Boxing supporting his unpublished research, while others in the medical community believing that the IBA has made an error in removing head gear from the boxers.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: cbc.ca/sports: Andrej Isakovic, Getty Images

 

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gaining weight

Monday, April 14, 2014

Jordan Spieth‘s appearance in Sunday’s final pairing in the Masters was a reminder that age is not always an indicator of skill and the ability to compete. Spieth had already turned pro but there were three amateurs under the age of twenty who might consider forgoing their education to play on the pro golf tour. Sports commentator, Bomani Jones had an interesting observation on twitter about leaving college early: “Anyone think golf needs a rule requiring players to stay in school for three years? Or that only apply to sports you like to watch?”

Presumably the correct answer could be found in physics class and Newton’s second law of motion. Force equals mass times acceleration helps explain why it would be that a teenager never be allowed in an NFL locker room.

College seems to be the place where football players grow larger and their size has become the focus of medical study. Researchers from Oklahoma State University followed football players over the course of their college career and found that linemen’s weight increased by only 3% but at the same time their body fat dropped from 22.5% to 20.6%. Their strength increased by almost 20% but in exchange, they became a little slower. Skill players, like running and defensive backs had a larger weight gain of 9%, they became more just a little more lean, dropping their body fat on average to 8.1% and their strength also increased.

But college players might be considered obese compared to their NFL colleagues. Researchers assessed the height, weight, body fat and BMI (body mass index) of all players who attended the 2003 training camp for the Indianapolis Colts. Skill positions players had body fat measurements as low as 6.3%, while the defensive lineman were 10% leaner than their college counterparts. Only offensive linemen were bulkier, much bulkier at 25% body fat. NFL players represent the players whose talent and body composition have allowed them to rise to the top of their profession. Their performance on the filed mirrors their physical development. As bodies become larger and leaner and as strength increases, the mass and acceleration in F=ma both increase. Unless there is a disparity in skill that can offset the disparity in size, the person with greater F will win the battle in the football trenches.

So how do college players get larger? The Associated Press scoured records from all 120 schools that played in The Football Championship Division, the top tier of college football over an 11 year period. While they weren’t scientists, their data had validity. They found that of 61,000 players reviewed, more than 4,700 had gained more than 20 pounds in a single season. According to the National Center for Drug Free sport, that amount of weight gain should raise suspicion for the use of performance enhancing drugs and yet the number of football players who test positive for steroids and PEDs range between ¼ and a little more than ½ percent. However, the question that could not be answered from the AP review was whether the weight gain was due to fat or lean muscle.

And the trend begins in high school football, more than a decade earlier. Researchers looked at the height and weight of Parade All American football players from 1963 to 1983. Their average height increased by four inches to 6’5” and their average weight went from 213 pounds to 268 pounds. The reason for the rapid growth was not completely clear, though the authors suggested the following: “data do raise questions as to what portion of these gains can be attributed to improved nutrition and training techniques and what portion may be the result of use of performance-enhancing drugs such as anabolic steroids.” (Wang, M. Q., Downey, G. S., Perko, M. A., & Yesalis, C. E. (1993). Changes in Body Size of Elite High School Football Players: 1963 – 1989. Perceptual and Motor Skills, 76, 379-383.)

While those who are blessed with speed and agility are able to progress to the next level in football, for many position players, size matters. Technical skills need to grow alongside physical development but some athletes are in a rush and perhaps use extra help to reach their goal.

Bomani Jones is right when he wonders why we don’t care about golfers or tennis players leaving college early for the pro ranks, but raise the red flag about the integrity of the student athlete. Perhaps it’s because golfers like Jordan Spieth don’t have to evade 300 pound linemen to hit the ball. Few college football players make it to the NFL and those who do have short careers and are unlikely to emerge without significant injury.  And perhaps for that reason alone, football players should be allowed the time to grow in college, though how they grow is a topic for another time.

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