Concussions, cuts and cracked bones: A systematic literature review on protective headgear and head injury prevention in Olympic boxing

Abstract

In 2013, the International Boxing Association (AIBA) prohibited the use of headguards for elite male Olympic boxing competitions. Could the removal of the headguard from elite male boxing competitions potentially cause increased injury risk for boxers? The aim of the literature review is to analyse current knowledge about the use of protective headgear and injury prevention in boxing, in order to determine if there are increased injury risks associated with headguard use. Peer-reviewed studies (language: English, Norwegian, Swedish, Danish and Dutch) published from 1980 and onwards were considered. Five academic databases and grey literature sources were searched, and articles were assessed for methodological quality. Only studies that included boxers as the study population with headguards as a factor were considered. A total of 39 articles were included in the review. The analysis of the reviewed literature indicates that headguards protect well against lacerations and skull fractures, while less is known about the protective effects against concussion and other traumatic brain injuries. Most of the analysed studies however use indirect evidence, obtained through self-report or observational techniques with relatively small non-representative samples. There are almost no randomised control trials, longitudinal research designs or samples from recreational boxing. Therefore, AIBA's decision to remove the headguard has to be seen with caution and injury rates among (male) boxers should be continuously evaluated.

Athletes' and Coaches' Attitudes Toward Protective Headgear as Concussion and Head Injury Prevention: A Scoping Review

“…As Tjønndal et al (2021) have noted, the debate about protective headgear in sport is often too simplistic and reduced to a question of "to wear or not to wear." None of the studies in the reviewed literature distinguished between the different types of headgear (beyond headguard/helmet and mouthguard).…”

“…The low number of studies meeting our inclusion criteria ( n = 18) suggests that despite the increase in knowledge and awareness of head injuries like concussion in athletes and coaches in a wide range of sports (King et al, 2014 ; Follmer et al, 2020 ; Tjønndal et al, 2021 ), there is a need for more knowledge about athletes' and coaches' attitudes toward protective headgear, their wearing of it (athletes) and recommending (or requiring) it (coaches).…”

“…In terms of attitudes toward protective headgear, many athletes claim that they would use protective headgear to a greater extent “if it protected them against head injury” (Finch et al, 2003 , p. 506). This underlines the need for more accurate knowledge about the function of protective headgear in sport, especially in the light of the conflicting results on the impact of headgear wearers vs. non-wearers (Broglio et al, 2003 ; Withnall et al, 2005 ; Mcintosh et al, 2009 ; Rodowicz et al, 2015 ; Baron et al, 2020 ; Tjønndal et al, 2021 ). As updated knowledge shows a reduction in head injuries when wearing protective headgear (Broglio et al, 2003 ; Rodowicz et al, 2015 ; Baron et al, 2020 ), educational programmes directed toward athletes and coaches may be beneficial in terms of increasing the use of headgear in sport.…”

“…As Tjønndal et al ( 2021 ) have noted, the debate about protective headgear in sport is often too simplistic and reduced to a question of “to wear or not to wear.” None of the studies in the reviewed literature distinguished between the different types of headgear (beyond headguard/helmet and mouthguard). Additionally, many athletes in the reviewed literature reported that discomfort and image (“looking bad”) were main reasons for not wearing protective headgear.…”

“…Biomedical and social scientific studies of sport-related concussion include explorations of protective measures, such as programmes to educate coaches and athletes about the symptoms, rule changes in sport to minimise the risk of impacts to the head and the use of protective equipment like headguards and mouthguards. Some studies suggest that headguards, helmets and mouthguards may offer some protection against concussion and other head injuries (King et al, 2014 ; O'Sullivan and Fife, 2016 ; Tjønndal et al, 2021 ). Mouthguards are the most controversial in terms of protecting against injuries other than orodental ones (McCrory, 2001 ; Tiryaki et al, 2017 ).…”