Boxing-Related Head Injuries

Abstract

Fatalities in boxing are most often due to traumatic brain injury that occurs in the ring. In the past 30 years, significant improvements in ringside and medical equipment, safety, and regulations have resulted in a dramatic reduction in the fatality rate. Nonetheless, the rate of boxing-related head injuries, particularly concussions, remains unknown, due in large part to its variability in clinical presentation. Furthermore, the significance of repeat concussions sustained when boxing is just now being understood. In this article, we identify the clinical manifestations, pathophysiology, and management of boxing-related head injuries, and discuss preventive strategies to reduce head injuries sustained by boxers.

Clinical Features of Repetitive Traumatic Brain Injury and Chronic Traumatic Encephalopathy

“…Rotational acceleration (Figure A,B) occurs when a force is eccentric or tangential to the center of gravity of the head. In boxing, when a punch is directed toward the lateral side of an opponent's face (ie, “hook punch”) or chin (ie, “upper cut”), the force of the impact will cause the head to twist and rotate outward along the fixed spinal axis (Figure A) . The sudden rotational acceleration of the skull and hyperextension of the neck causes brain deformation at mechanically rigid inflection points, such as the cerebellopontine angle (Figure B).…”

Injuries in Competitive Boxing. A Prospective Study

“…Boxing is an Olympic sport, but its abolition continues to be the subject of debate [39,41]. It is classified as a dangerous sporting activity, with the serious neurological complications of head injuries especially being discussed in the literature [20,22]. In particular, injuries from boxing in children and adolescents have attracted great attention [41,46].…”

Biomecânica e Traumatologia do Boxe

“…30 Os golpes na cabeça podem ocasionar lesão neuronal direta, focal ou difusa, ou morte, consoante o grau de aceleração rotacional. 6 Os efeitos da aceleração na cabeça poderão ser minimizados através do fortalecimento da musculatura do pescoço, ocasionando maior capacidade de absorção do impacto e redução da força aplicada ao cérebro. 6 Para que ocorra uma concussão num adulto é necessária uma aceleração rotacional de 4500 rad/s2, sendo que para lesão axonal difusa ligeira e moderada são necessários valores de aceleração de 12 500 rad/s2 e 15 500 rad/s2, respetivamente.…”

“…32 A lesão axonal difusa representa uma ampla percentagem das lesões traumáticas do cérebro em pugilistas, na qual se integram também as hemorragias intracerebrais, associadas a contusão intraparenquimal e hemorragias extracerebrais, epidurais e subdurais. 6 As lesões cerebrais causadas por um golpe direto na cabeça, podem ocorrer no local do impacto ou no ponto oposto ao local de impacto. 6 O ponto de impacto direto e a anatomia do crânio imediatamente interior poderão ditar a gravidade destas lesões.…”