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78 BOXING: MEDICAL
CONSIDERATIONS
John P Reasoner, MD
Francis G O’Connor, MDINTRODUCTION
- Acute traumatic brain injuries and permanent and irre-
versible neurologic dysfunction are the primary med-
ical concerns of boxing and the ringside physician. - Amateur and professional boxing have unique differ-
ences in their approach to providing for the safety of
the boxers. - This chapter discusses the medical considerations
required of the ringside physician.
AMATEUR VS. PROFESSIONAL BOXING
- Amateur and professional boxing have many simi-
larities but also many differences (see Table 78-1).
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 profes-
sional sport. Shorter competitions, termination of a
bout for head blows, and headgear make this under-
standable. - Epidemiologic assessments of chronic neurologic
sequelae are being surveyed by researchers. The U.S.
Olympic Foundation has commissioned the School of
Public Health and Hygiene at Johns Hopkins
University to design and implement a study to investi-
gate if any excessive medical risks are associated with
participation in amateur boxing (U.S. Amateur Boxing,
Inc, 2003).
MEDICAL RESPONSIBILITIES OF THE
RINGSIDE PHYSICIAN (U.S. Amateur
Boxing, 2003)- Prevention and treatment of acute injuries is the pri-
mary role of the physician at ringside. This is accom-
plished through a sound medical plan to cover all
aspects of the event—the precompetition phase, the
ringside observation, and the postbout examination.
PRECOMPETITION PHASE•Evaluation of the competition site is mandatory. An
area for pre- and postbout assessments should be
secure, assessable, and quiet with enough room and
light to perform a neurologic examination, treat an
injured boxer, and place a cot or stretcher for observa-
tion or transportation.- Identify the nearest emergency room with neurosurgi-
cal, ophthalmologic, and dental capabilities. An evac-
uation route should be mapped out, and the hospital
should be notified of the event. Have all emergency
numbers available. - Request to have emergency medical technician(EMT)
services immediately available. If it is impossible,
assure that telephone services are on hand for an
emergency call. - There should be a table large enough to seat ideally
three 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 physi-
cian quick and easy access to the ring apron. - Necessary items for the attending physician are the
following:- Stretcher and head board under the ring
470 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS
TABLE 78-1 Differences in Amateur and Professional
Boxing
AMATEUR PROFESSIONAL- Governing body One Multiple
- Scoring All blows equal Weighted toward
knockdown;
more subjective - Age limit 32 years old None
- Competition 3 to 5 rounds of 4 to 12 rounds of
2 to 3 min each 3 min each - Referee Stops contest early Stops contest late
- Headgear Yes Sparring only
- Standing 8 count 3 in one round Varied
4 total in bout - Lacerations Stops contest Varied
- Retinal tear No further competition Individual
decisions - Medical suspension Uniform periods Varied