• Boxing is one of the most ancient sports.

  • Marquis of Queensbury modified the rules in the early 1800s.

  • The 1904 Olympic Games in St. Louis saw men’s boxing introduced as a competition sport and women’s boxing as an exhibition sport.

Amateur Boxing

  • Divided by age class ( Box 87.1 )

    Box 87.1

    Amateur Boxing Age Classes *

    * Age group class determined by year of birth; i.e., age of boxer on December 31 determines age group.

    • 8–14 years-Prep

      • 8–10 years-Peewee

      • 11–12 years-Bantam

      • 13–14 years-Intermediate

    • 15–16 years-Junior

    • 17–18 years-Youth

    • 19–40 years-Elite and Senior

    • 40–45 years-Senior/Elite or Masters

  • Weight classes ( Table 87.1 )

    TABLE 87.1


    Males: 10 weight categories in each Elite, Senior, and Youth category Up to 46–49 kg, 52 kg, 56 kg, 60 kg, 64 kg, 69 kg, 75 kg, 81 kg, 91 kg, 91+ kg
    Females: 10 weight categories in each Elite and Youth category 45–48 kg, 51 kg, 54 kg, 57 kg, 60 kg, 64 kg, 69 kg, 75 kg, 81 kg, 81+ kg
    Elite Women Olympic Boxers : 3 weight categories 48–51 kg, 57–60 kg, 69–75 kg
    Boys and Girls: Junior Boxers–13 weight categories 44–46 kg, 48 kg, 50 kg, 52 kg, 54 kg, 57 kg, 60 kg, 63 kg, 66 kg, 70 kg, 75 kg, 80 kg, 80+ kg
    Prep boxers—Peewee, Bantam, and Intermediate are all arranged similarly; details can be found at

  • Experience and skills of boxers: details can be found at .

Injury Prevention


  • Headgear: Headgear properly fitted by trained coaches is required for amateur competition. Fitted headgear reduces eye injuries, facial fractures, lacerations, “cauliflower ear,” and tympanic membrane perforations.

  • Gloves: Gloves, thumbless and those with thumbs attached, reduce both eye and thumb injuries. Gloves with mobile thumbs are not authorized for use. Heavier gloves have decreased hand injuries and reduce impact forces. Two-toned gloves are easier to see for scorekeepers and referees. Gloves must remain clean and as close to “like new” condition as possible.

  • Hand wrap: The hands must be wrapped under the supervision of an appropriate official. Wrapping prevents injury to the hands and further reduces the force of blows delivered.

  • Mouth guard: Custom-fitted mouth guards prevent dental and temporomandibular joint injuries and are required for the competition. Mouthpieces are also employed to allow the athlete to “set” his or her jaw, reducing the likelihood of knockdowns by reducing the intensity of the blow.

  • Breast protectors: Breast protectors, when used, must be well fitted and not interfere with the boxer’s ability to fight. They should not extend beyond the clavicles or the xyphoid.

Physical Examinations

  • In boxing, an annual physical examination is required for each athlete, performed by a qualified physician. The examination certifies that the athlete is free from injury, disability, or infection, which could jeopardize either the boxer or opponents. The boxer must present, at the physical examination and at weigh-ins, an up-to-date USA Boxing Competition Record Book with correct information and sign-offs by either the Secretary General or the Executive Director of the boxer’s national federation and is not allowed to compete without this document.

  • A prefight physical is intended to reduce risk of injury by identifying medical problems prior to the competition and by monitoring recovery from previous injuries.

Physician Approval, Qualification, and Disqualification

Athletes are required to have approval from their physician prior to competing.

Disqualifying Conditions

  • Acute and chronic infections—examples

    • Illness causing fevers

    • Chest infection

    • Untreated tuberculosis

    • GI conditions with dehydration/malabsorption

    • Hepatitis

    • Open skin conditions; e.g., MRSA, zoster, herpes

    • Mononucleosis within the past month

  • Severe blood dyscrasias, conditions requiring anticoagulation, sickle cell disease

  • Infection with HBV, HCV, or HIV

  • Refractive or intraocular surgery, cataracts, retinal detachment

  • Presence of myopia > 3.50 diopters, uncorrected vision worse than 20/200, or corrected vision worse than 20/60

  • Significant cardiovascular or pulmonary abnormalities, including

    • Severe COPD, uncontrolled asthma with potential for hypoxemia

    • Severe aortic or pulmonic stenosis, myocarditis, pericarditis, recent embolic disease, 3 rd degree heart block, atrial or ventricular tachycardia, coarctation of aorta, PDA, corrected surgical conditions unless cleared by cardiovascular surgery, resting BP >160/100 (if >140/90, the boxer may compete if other BP measures are normal, but physician follow-up is advised for >135/85)

  • Congenital/acquired musculoskeletal problems; e.g., spondylolysis, spinal fractures, atlantoaxial instability, unstable joints, loss of thumb or great toe

  • Unresolved concussion

  • Significant intracranial mass lesions or bleeding, history of craniotomy, cerebral palsy, hypoxic brain injuries, neuropathies causing balance/coordination problems (benign smaller problems can be cleared by neurosurgery)

  • Seizure within the past 3 years

  • Hepatosplenomegaly, splenomegaly, ascites

  • Pregnancy

  • Uncontrolled diabetes mellitus or thyroid disease

  • Implantable devices interfering with physiologic process/enhancing performance

  • Banned substances: In amateur and Olympic competitions, banned substances such as ergogenic aids and steroids are disqualifying if used. Refer to the appropriate authority (e.g., ) for comprehensive lists of banned substances, medications, and practices.

Nondisqualifying Conditions

  • Deafness—judges/referees must be made aware of conditions, and the referee may tap the boxer on the shoulder to signal “break” or “stop.”

  • Dental braces/orthodontics if the Permission to Box with Braces or Orthodontic Appliances form is attached to the boxer’s passbook.

  • Breast implants if the Permission to Box with Breast Implants form is the attached to boxer’s passbook

  • Sex reassignment in accordance with IOC regulations

    • Prior to puberty: athlete regarded as gender assigned after surgery

    • After puberty: athletes are eligible to participate in new gender provided that

      • All surgical and anatomic changes are completed

      • Legal recognition of new gender is conferred by proper authorities.

      • Hormonal therapy appropriate for the assigned gender has been administered and verified for sufficient length of time to minimize gender-related advantages

      • Eligibility begins no sooner than 2 years after gonadectomy.

Ringside Personnel and Equipment


  • One coach and one assistant are allowed for each fighter.

  • Must remain seated during each round

  • Must not interact with fans or ringside officials

  • Should have first aid supplies, two clean white towels, sterile gauze pads, sterile cotton, cotton swabs, ice, and bags for ice

    • First aid equipment does not include ammonia, ammonia inhalants, or smelling salts, which are banned.


  • Manages bleeding injuries that could otherwise disqualify a boxer during a bout

  • Amateur boxing prohibits the use of any medication to treat bleeding during a bout, but professional boxers are allowed any medication or topical treatment that the cutmen or trainers may have at their disposal.

Controlling Injury and Bleeding

  • One minute is allotted to get the bleeding under control.

  • Any swelling of the eye or face is managed by pressure applied with an enswell, which is an iced metal spatula applied to the hematoma that milks the blood to the surrounding tissues.

  • The prevention of bleeding injuries can be accomplished through the use of petroleum jelly applied to the face.

  • Medications—when allowed—to control bleeding include Avitene, Surgicel, Gelfoam, adrenaline chloride, and thrombin; these are frequently mixed with petroleum jelly and applied with cotton swabs.


  • Serve as a neutral advocate for the boxers

  • Responsible for the care and safety of fighters before, during, and after the match

  • There are one or more physicians at ringside at all times during competition.

  • Two physicians are preferable; this allows for one to attend to an injured boxer after the completion of that boxer’s match, while the other physician attends to the current bout.



  • All contestants should be thoroughly examined immediately before and after each bout.

  • Female participants must now provide a signed Declaration of Non-Pregnancy, as noted in appendix G of the USA Boxing Official Rule Book (previously, signature of an explicit disclaimer stating that the boxer has read Rule 101.9 was required) ( Box 87.2 ).

    • The waiver states the fighter is not pregnant to the best of her knowledge.

      • The team officials bear the responsibility of ensuring that females under 18 years old are certified not to be pregnant and to obtain proper documentation.

    • At the prefight physical, physicians are to note history regarding menstruation, pregnancy, and breast and gynecologic disease/surgical histories.

    Box 87.2

    Female Boxing Rule 101.9

    Female boxers are limited to participation under additional medical restrictions. If any of the following conditions exist, the athlete is not allowed to participate:

    • Confirmed pregnancy; suspected pregnancy must be confirmed or denied before starting or continuing boxing

    • Painful pelvic disease states, such as symptomatic endometriosis

    • Abnormal vaginal bleeding of undetermined etiology

    • Recent secondary amenorrhea of undetermined cause

    • Recent breast bleeding

    • Recently discovered breast masses

    • Recent breast dysfunctions previously not present

    From McCrory P. Cavum septum pellucidi—a reason to ban boxers? Br J Sports Med. 2002;36(3):157-161.


  • All fighters should be examined before each bout to check for new injuries that could impair the safety and ability of the boxer, precluding further participation.

Disqualification During the Competition

  • The following injuries result in disqualification from the bout:

    • Excessive swelling of the face or eyes that impairs vision

    • Suspected or proven fractures of nose, face, or metacarpals

    • Presence or history of a retinal detachment (permanent disqualifier)

    • Lacerations or wounds requiring dressings for control of bleeding

Surveying the Venue

  • The ringside physician must be familiar with the venue, the location of the training room, the location of the emergency medical system (EMS) providers and ambulances, the layout of the facility, the ring, the condition of the padding at the turnbuckles, and the condition of the ropes and mat.

  • The physician should meet with EMS and first aid personnel and be aware of the location of first aid equipment, spine boards, oxygen, cervical collars, advanced cardiac life support equipment (including defibrillators, if available), and ensure adequate proximity to a phone or cellular connections.

  • Physicians at ringside are mandated to have an unobstructed view of the ring and of the matches.

Physicians’ Medical Supplies at Ringside

  • Physicians at amateur bouts are allowed the following at ringside:

    • Flashlight

    • Oral airway

    • Gloves

    • Vaseline

    • Adrenaline chloride (1:1000) to control nosebleeds and cuts

    • Thrombin for dry cuts

    • Avitene (microfiber collagen hemostat) for active bleeding

    • Ice and ice bags

    • Clean sponges

    • Gauze pads

    • Enswell pressure plates for control of hematomas

    • Two clean white towels

    • Scissors

    • Water in a clear plastic container

    • Two buckets, one containing ice and the other empty

    • Adhesive athletic tape

  • Physicians at professional matches may have additional supplies as they deem necessary.

Evaluation During the Bout

  • When called into the ring, the physician should always:

    • Assume a cervical spine injury has occurred and stabilize the athlete as necessary

    • Abide by the “airway–breathing–circulation” principles of basic life support

    • Adhere to appropriate precautions when near blood or body fluids

    • Notify the athlete of his or her presence and title

    • Have athletes not requiring EMS-transfer return for re-evaluation

The Bout

Rounds and Standing Eight Counts

  • Amateur bouts are characterized by up to four rounds of 2 to 3 minutes in length separated by a 1-minute rest interval.

  • The referee can institute a standing eight count whenever it is believed that a fighter has been stunned.

  • Should a fighter incur three standing eight counts in a given period or four in a given match, the fight is discontinued as referee stop contest–head (RSCH) injury.

  • In the case of an unconscious boxer:

    • Referee signals the doctor to enter the ring.

    • Only the referee, physician at ringside, and any assistants the physician deems necessary are allowed into the ring.

  • The referee can stop a fight for other reasons/injuries that may put a fighter at risk:

    • RSC (O)—Fighter is outclassed by opponent and is thus at unreasonable risk.

    • RSC (I)—Fighter is unable to compete because of an injury suffered during the bout.

      • Example: excessive swelling or bleeding that cannot be adequately controlled

  • The injured fighter is referred to physicians for immediate evaluation after the bout.


  • In amateur boxing, points are awarded for blows to the upper body and head regardless of the force applied and whether the struck contestant was knocked down or knocked out.

  • Scores in professional boxing are also tabulated as points scored, but greater weight is given to blows of greater force, knockdowns, and knockouts. Subjective bias can play a role in scoring.

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Jul 19, 2019 | Posted by in SPORT MEDICINE | Comments Off on Boxing
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