Amateur Boxers Risk Brain Injury

Jan. 27, 2000 (Atlanta) -- A new study suggests that, from a medical perspective, the recent hit movie Fight Club might accurately have been called "Concussion Club" instead. That's because researchers have found evidence of traumatic brain injury in a group of amateur boxers in the Netherlands, despite the use of protective headgear.

The study, which is published in the latest issue of The Physician and Sportsmedicine, compared the mental function of 38 amateur boxers, before and after a bout, with that of 28 amateur boxers who did nothing but hit a punching bag.

Overall, the group that boxed scored lower on tests of planning, attention, and memory -- but similar to the non-boxing group on tests examining how fast they could process information and pay attention. But the researchers found that the intensity of individual boxing matches did affect results. For example, "impact" -- a factor of weight and number of punches -- reduced scores on a visual short-term memory test, while knockouts (KOs) and technical knockouts (TKOs) were associated with a decline on a verbal memory test.

While only 13% of the fights ended in a KO or TKO, the researchers say that blows to the head were common -- with 35% of competitors getting punched in the head more than 10 times during a match. They conclude that amateur boxing is thus a potentially dangerous sport, because of the risk of acute traumatic brain injury (ATBI).

But the news isn't all bad for boxers, according to one of the study's authors. "The take-home message is that you can have some subtle cognitive impairment with amateur boxing," co-author Barry D. Jordan, MD, director of the Traumatic Brain Injury Program at Burke Hospital in White Plains, N.Y., tells WebMD. "However, I think, as with most types of concussions you see in sports, these are self-limiting." Jordan does say, however, that amateur boxers who get a concussion shouldn't fight again without proper medical evaluation.

He also tells WebMD that the study confirms the long-held notion that "protective" headgear -- when it comes to boxing -- is a misnomer. According to Jordan, the gear does nothing to stop "rotational acceleration," the injury that occurs when the head rotates to the side after a blow.

"Overall, I would say the study fits nicely into the growing body of literature that says amateur sports can be dangerous," says David Burke, MD, director of the Inpatient Brain Injury Rehabilitation Program at Spaulding Rehabilitation Hospital in Boston. "You would expect that of boxing, where the intent is to hurt the brain." Burke reviewed the study for WebMD.

What's surprising, Burke says, is the finding that such a small number of head blows (the median number in the study was 8) affected mental function. He says it leaves amateur boxers with a question: "Is this sport worth some brain damage to you? If you say yes, then how much is too much? When it interferes with your ability to function at a high-level job ... or to meet your basic needs? I think, if posed with that question, very few people would move beyond that first tier," he tells WebMD.

"I grew up as a great Muhammad Ali fan and love the sport myself," says Burke. "But when asked as a physician, I can't support it. It's too dangerous."

Gary L. Brown has been teaching boxing outside Atlanta for more than 30 years. He tells WebMD that the biggest problem with amateur boxing is that some coaches pay more attention to winning at all costs than to safety. "In my studio, I've never had a problem with any of my students -- headache, brain damage, slow in school, or mental problems -- because we work so much on pairing up shots," he says. Pairing up shots refers to having fighters keep their fists up to defend against blows that might otherwise go to the head.

And Brown adds that there is no shame in stopping a match gone awry -- that it's a simple matter of caring more about the fighter than the fight. "Somebody's got to get the word out: It's not the win all the time," he says. When his fighters get upset about having to abort a match, Brown gives them this advice: "Oh, chill. I'm here for you, son. We'll be here to fight another day for this."

Vital Information:

  • A new study shows that amateur boxers experience traumatic brain injury, despite the use of protective headgear.
  • About 35% of boxers experienced more than 10 blows to the head during a match, according to the study.
  • One coach advises that boxers pay attention to safety, even if it interferes with winning a match.