By Barry Jordan, M.D.
Assistant Medical Director and Director, Brain Injury Program
This summer, amateur, elite male boxers will be back to competing without headgear after nearly three decades of being required to wear one during competition. The headgear rule was put in place by the International Boxing Association (AIBA) before the 1984 Olympics but now, elite, male boxers will be competing in much more professional style.
So what will this mean for concussion rates and concussion risk?
At first glance, it may seem to put boxers at greater risk, however, clinical evidence has shown that headgear does not necessarily reduce the incidence of concussion. The advantage of headgear is that it protects the face and decreases eye injuries, nose injuries and facial lacerations. It does not stop the head from spinning, the primary cause of concussion in boxers.
There actually are four ways that boxers can get brain injury; none of which can be prevented by wearing headgear. These mechanisms include:
- rotational acceleration, which is when the head to twists/spins—usually from a blow to the side of the jaw, cheek or chin—and the brain follows,resulting in the stretching and tearing of axons (this is why knockouts usually come from a severe blow to chin);
- linear acceleration, which is when the brain moves forward/backward—usually from a direct blow to the face—and strikes the skull,resulting in the stretching or tearing of neurons in the brain and brain stem;
- injury to the carotid arteries, which occurs after a sudden flexion of the neck—usually from a direct blow to it—resulting in tears in one or both carotid arteries, allowing blood to travel to the brain and causing a stroke; and
- impact deceleration, which is the rapid slow-down of the brain—usually by hitting an immovable object like the ring floor—resulting in cerebral contusions.
In fact, there is a new, still unpublished AIBA study that suggests the removal of headgear would decrease head injuries like concussions. According to the study spearheaded by its medical commission chairman Charles Butler, the rate of concussion for boxers wearing headgear was 0.38 percent in 7,352 rounds while the rate of concussion for those without headgear was a little less than half that at 0.17 percent in 7,545 rounds.
On the other hand, another recent study by the Cleveland Clinic found that headgear can help decrease linear acceleration and potential for injury from it.
Clearly, there is still much debate on this issue. As amateur boxers start this new phase of competition, experts will be better able to observe changes in concussion rates, if any, and hopefully come to a definitive conclusion as to whether headgear use has any impact at all.