A Little about Boxing, Boxers and Fans

It’s easy to see, that boxing draws huge crowds and generates millions of dollars for promoters, television networks, advertisers and athletes, among other stakeholders. What is not easy to see, is the impact and damage which occurs each and every time an athlete is punched in the head, face or neck. The consequences of long term exposure to these types of hits are dangerous and can create long-term devastating effects, such as brain injuries to the athlete. This is a dilemma that isn’t easily solved. The sport of boxing is dangerous and there should be greater safeguards to protect athletes from devastating injuries, such as chronic traumatic encephalopathy (brain injury). Is there a way to make boxing safer, does it simply need to be banned, or is it the free will of the athlete to take the risk?

There are many sports that are plagued with serious long term effects to the athlete; both football and hockey players experience injuries similar to boxers, but they wear protective gear designed to decrease the risk. In boxing, athletes are taking and delivering deliberate blows with the intent to knock their opponent out or at the least, take them off their feet.

Spectators watch a replay in slow motion as the hook punch comes around, the sweat goes flying on impact, and the collective crowd cringes verbally and physically, knowing how awful that hit was. They watch the athlete; the physical specimen who takes this abuse and remains standing to the spectator’s amazement, until he’s not. Round after round, spectators watch, as athletes become increasingly bruised and bloodied. Nobody turns away; after all they paid good money to see exactly this.

How many spectators or athletes for the matter, know what happens when that punch makes contact? How does the punch impact the inside of the athlete’s brain and body. Here is a breakdown of exactly what happens when a boxer takes a head jab; trauma, CTE. Chronic Traumatic Encephalopathy, which can easily be described as the greatest health risk in the sport of boxing, is the result of head trauma. Upon impact of a head punch, the motion of the head halts abruptly and inertia forces the brain forward. The brain smashes against the skull, forward and backward, similar to whiplash in a car accident.

The hook punch is the boxer’s greatest danger. A hook landing on the side of the opponent’s head, will snap spin the head at the neck, which can impact not only the brain, but the neck and the spine. Additionally, a punch from the side is more devastating because the head isn’t braced and usually the opponent doesn’t see it coming, further rattling the head. A punch landed straight on is usually less damaging because the chin and entire head is braced from behind the neck, especially if the chin is tucked.

Chronic Traumatic Encephalopathy is the result of multiple blows to the head. While diagnosed concussions are a factor, they do not alone indicate a CTE diagnosis. Every time an athlete sustains a blow to the head, whether it results in a diagnosed concussion or not, there is a risk for the development of proteins associated with CTE. According to a CTE research team at Boston University, The beginning stage of CTE can be symptomless. Stage two can be characterized by rage, impulsivity, depression, and later, confusion and memory loss. Ultimately in the final stages of CTE, advanced dementia can occur. Some of the specific symptoms looked for include speech and gait disturbance, memory impairment, behavior or personality changes, and psychiatric issues. Some or all symptoms can be present and are not uncommon in professional and ametuer boxing.

CTE is not a new concept. In the 1970’s, although the term CTE was not used, the symptoms were present in boxing athletes. Boxers suffering from brain damage during and following their career, most likely had CTE, but were referred to as “punch drunk.” There was little discussion of brain damage among athletes in sports until the past 10 years when athletes across sports increasingly became identified as having brain damage due to suffering multiple blows to the head. However, there is evidence and studies dating back to 1928 of boxers suffering from it’s effects.

There does not appear to be solid information as to why this series of minor brain traumas can become CTE. This is primarily due to the fact that concrete diagnosis cannot be determined until after death, upon examination of the brain. Therefore, diagnosis on the living depends on clinical judgement and a careful review of patient histories. As aforementioned, early stages of CTE is distinguishable from other types dementia, but in the later stages symptoms may look like typical elderly dementia or alzheimer's.

It has become increasingly obvious that boxing and other combat sports are linked to brain damage. It is largely unknown as to whom is at risk and on the road to developing CTE. About ninety percent of boxers suffer concussions throughout their career, and there a good probability that a large number of them also deal with CTE, although the exact amount is unclear.

Around 2012, Dr. Charles Bernick, a CTE researcher at the Cleveland Clinic, conducted a CTE study in which researchers looked at 78 boxers and mixed martial arts (MMA) fighters, with an average age of 29, who were enrolled in the ongoing 'Professional Fighters Brain Health Study.' They had MRI brain scans and took computer tests to measure their memory and thinking abilities. They were split into groups based on years of fighting experience; more or less than nine years.

The study found that those fighters with more years of experience and more fights performed worse on thinking and memory tests than less experienced fighters. On those with less than nine years experience there was no correlation between thought and memory abilities and head injury. Bernick indicated “Our study shows there appears to be a threshold at which continued repetitive blows to the brain begins to cause measurable changes in memory and thinking, despite brain volume changes that can be found earlier.' He also indicated that the study found changes in brain volume may occur after six years of fighting, years before symptoms emerge. This was reported on the CBS news by Lee Cowan, in which he says that “The only thing Bernick can say with certainty is that the memory centers in the brains of some boxers have shrunk,” and the key to helping those afflicted would be to find out why and how this occurs.

There are many notable boxers on the list of confirmed cases of CTE; Joe Lewis, Sugar Ray Robinson, Paul Pender and Floyd Patterson. There are also some very well known athletes who will not be found on this list; including Muhammad Ali and Mike Tyson. These two former athletes have been suggested to have or have had the condition, but do not make this list for various reasons.One of the most famous names in boxing history is Mohammed Ali. A song, a movie, documentaires, biographies and countless commentary on this colorful boxing legend. You won’t find him on a list with a concrete CTE diagnosis, however. His family, personal physicians and those closest to him deny that he had brain injury from boxing, rather that his Parkinson’s disease, with which he officially diagnosed, was genetic. This does not stop the suspicion that his brain issues were related to his boxing career and CTE. We also can’t forget about Iron Mike Tyson; many have commented on the possibility that his bizarre behavior is related to brain injuries from boxing. He bit off an opponent's ear, has had many domestic issues and has spent time in prison related to his behavior. He is alive and until that is no longer the case, one can only speculate as to the cause of his antics. 28 year old boxer, Davey Brown died as a result of a subdural hematoma suffered during a boxing match. He was not alone. By 2015, there had been about 2036 known boxing matches in which a competitor had died, by all accounts, these deaths were all related to head trauma of sorts.

One study of 30 professional boxers found that 11 had normal brain function, 12 had mild deficits, four were moderately impaired and three had signs of severe impairment. It also found that boxers who had 12 or more professional bouts had significantly higher levels of brain injury.

Although people are aware that boxing causes significant brain damage, there are still people that believe the sport should not change. According to the article “How To Reduce Brain Damage In Boxing: Is It Even Possible?” In order for boxing to maintain the integrity of the sport, it’s violent nature and knock outs must continue. The article also mentioned that “having heavier equipment to sedate the fighting would simply kill the sport.” There is no question that any sport involving regular blows to the head leaves its participants at risk of injury, it has also been argued that as long as fighters know the risks, it is their decision. Nevertheless, there have been calls for the sport to consider safety a priority. Somehow there needs to be controls and measures to prevent brain injuries in these athletes, but they need to do it without losing the core elements of the sport.

There a couple of possible options that may assist in the prevention of brain injuries, or at least decrease the number. Lowering the number of rounds to 10, is one idea, which would be very unpopular with almost everyone in the boxing circles. Another way that could be helpful in prevention of injuries would be for the referee to call off a fight if, in his opinion, a boxer no longer has a realistic chance of winning, or calling the fight if one fighter is ahead by six or more rounds. It would also be helpful to have brain scans periodically and before and after fights. Protective headgear is also an option. This is worn in ametuer contests, but not in professional contests.

One of the most important factors in prevention and treatment would be early detection. At the first sign of injury, making it mandatory that a fighter is medically treated. This alone could make an impact as it is likely many of the less significant injuries go untreated. Learning how to identify and manage the injury for maximum recovery is critical. This can help minimize the long-term effects of brain injury, and increase the chance of the injured person returning to normal activities.

Recently, sports leagues are recognizing the effects and dealing with the aftermath of the recognition of long term CTE effects on athletes. Fines and suspensions are directed at minimizing risk and dealing with actions causing significant injuries to athletes. Unfortunately the very nature of boxing makes the fine or suspension possibility nearly impossible.

Although banning seems unrealistic, it also sound like making it safer would be met with resistance from proponents, who indicate that the integrity of the sport would be ruined if anything were altered for safety. Fans do pay to see the violence of what happens in the ring. What does this say about our society?

At the very least, head protection for professional boxing athletes should be considered. Also, regular brain scans should be conducted, as well as some type of published threshold indicating information as to a fighter’s risk should he continue after after a certain amount of brain changes have already occured based on current scans. While it appears that other protective factors may be unrealistic due to the strength of the boxing community, these preventative measures should be implemented as soon as possible.   

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