Boxing: Medical Considerations
Kevin deWeber
INTRODUCTION
Acute traumatic brain injuries (TBI) and permanent and irreversible neurologic dysfunction are the primary medical concerns of boxing and the ringside physician.
Amateur and professional boxing have unique differences in their approach to providing for the safety of the boxers.
This chapter discusses the medical considerations required of the ringside physician.
AMATEUR VERSUS PROFESSIONAL BOXING
Amateur and professional boxing have many similarities but also many differences (Table 84.1). An objective assessment of amateur boxing leads to the conclusion that it probably does not involve the same degree of neurologic risk as seen in the professional sport. Shorter competitions, termination of a bout for head blows, headgear, and shorter careers make this understandable.
Rules for professional boxing vary by state; check http://www.aaprp.org for summary (American Association of Professional Ringside Physicians). Rules for amateur boxing are governed by USA Boxing; check http://www.usaboxing.org for latest Rulebook (7).
MEDICAL RESPONSIBILITIES OF THE RINGSIDE PHYSICIAN
Prevention and treatment of acute injuries is the primary role of the physician at ringside. This is accomplished through a sound medical plan to cover all aspects of the event — the precompetition phase, the ringside observation, and the postbout examination.
PRECOMPETITION PHASE (3,5,6)
Having two to three ringside physicians is recommended. This assures that the contest can continue on schedule when a more thorough postbout examination is necessary.
Evaluation of the competition site by the ringside physician is mandatory. An area for prebout and postbout assessments should be secure, easily accessible, and quiet with enough room and light to perform a neurologic examination, treat an injured boxer, and place a cot or stretcher for observation or transportation.
Identify the nearest emergency room with neurosurgical, ophthalmologic, and dental capabilities. The on-duty emergency physician and neurosurgeon (if available) should be notified of the event. Have all emergency numbers available and map out evacuation routes.
Request and require emergency medical technician (EMT) services to be available on site. EMTs are a valuable asset in their support of injury care and medical assessments. They should remain on site until they are dismissed by the head physician.
There should be a table large enough to seat the physicians at ringside. It should be situated near a neutral corner with an unobstructed view of the competition.
A set of steps next to that corner will allow the physician quick and easy access to the ring apron (the narrow area just outside the ropes).
Recommended items (as a minimum) for the ringside physician are the following:
Stretcher, cervical spine stabilization pads, and oxygen apparatus under the ring
A physician’s emergency bag to handle cardiopulmonary resuscitation (i.e., Ambu bag, oral and nasal airways) and to manage an unconscious patient
Sterile gauze pads for cuts and epistaxis
Disposable examination gloves
Otoscope and ophthalmoscope
Penlight
Blood pressure cuff and stethoscope
Other supplies should be on hand, such as would be carried in a typical team physician medical bag.
Precompetition Physical Examination
Each boxer must undergo a comprehensive history and physical examination by a licensed physician when joining a boxing club, looking for disqualifying conditions (Table 84.2) and those that need treatment prior to
participating in boxing. The evaluation should be updated annually. Optimally, this should be available for review by the event physician.
Table 84.1 Differences in Amateur and Professional Boxing
Amateur
Professional
1.
Governing body
USA Boxing; AIBA
Multiple, by state
2.
Scoring
All blows equal; computerized at Nationals and above
Weighted toward knockdowns; more subjective
3.
Age limit
34 years old (open division USA)
None
4.
Competition
3 rounds of 1-2 minutes, based on age
4-12 rounds of 3 minutes
5.
Referee
Stops contest early
Stops contest late
6.
Headgear
Required
Sparring only
7.
Standing 8 count
Up to 3 in 1 round, 4 in bout
Varied rules
8.
Lacerations
Uncommon due to headgear; more likely to stop contest
Less likely to stop contest
9.
Retinal tear
No further competition
Individual decisions
10.
Medical restriction
Uniform periods
Varied rules
11.
Risk of cTBI/CTE
No strong evidence of link
Low-quality evidence of link
AIBA, Association Internationale de Boxe Amateur (International Amateur Boxing Association); cTBI, chronic traumatic brain injury; CTE, chronic traumatic encephalopathy.
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