CHAPTER 78 • BOXING: MEDICAL CONSIDERATIONS 471
2.Oxygen tank with appropriate adaptors and
tubing
3.A physician’s emergency bag to handle cardiopul-
monary resuscitation (i.e., Ambu bag, oral and nasal
airways) and to manage an unconscious patient
- Sterile gauge pads for cuts and epistaxis
- Disposable examination gloves
- Otoscope and ophthalmoscope
- Penlight
- Blood pressure cuff and stethoscope
- The precompetition physical examination should be
coordinated on the day of the scheduled bouts. The
objective is to assure that the athlete is fully capable
to box—neurologically intact, lacks febrile or conta-
gious conditions, not under the influence of medica-
tions, and essentially pain-free.
- The majority of amateur prebout examinations
include large numbers of anxious athletes who present
without a preparticipation physical examination ques-
tionnaire. Nonetheless, the examination can be
accomplished in a few minutes.
- Important questions to be answered by the boxer:
- When was your last bout?
- Do you have any medical problems?
- Are you using any medications?
- Have you had any recent illness?
- Have you ever been knocked out and when?
- Do you have a headache or pain anywhere on your
body?
•“Yes” to any of these require further investigation for
disqualifying factors.
- The following examinations are recommended for the
prebout evaluation:
- Vital signs
- Examination of the eyes for corneal abrasions and
hyphema. Check for pupil equality and reactivity.
Insure intact visual fields by confrontation to rule
out possible retinal detachment. Soft contact lenses
may be worn in the ring.
- Examination of the ears for tympanic membrane
rupture and infection.
- Examination of the nose for septal deformities or
airway obstruction and of the mouth for loose teeth
and oral hardware (i.e., braces and tongue pierc-
ing). Piercing hardware must be removed before
competition.
- Examination of the skin for impetigo or herpetic
lesions.
- Check heart sounds for murmurs and irregularities.
- Examination of the throat and lungs for infection
and bronchospasm.
- Examination of the central and peripheral nervous
systems for focal signs, such as facial or muscular
weakness, paresthesia, or ataxia.
- Inspect the hands, upper and lower extremities, as
well as the back for any tenderness, swelling, or
deformities.
- Contraindications to boxing—a contact sport (see
Table 78-2)
RINGSIDE OBSERVATION
- During the bout the physician’s role is to study and to
observe the individual boxers and the flow of the
event. One looks for signs of distress in a boxer during
and between rounds. If there is concern, listen and
observe to what is being said in the corner by the
coaches. The physician can go into a boxer’s corner
during the rest period if a closer inspection is
required. A ringside physician has the right to inspect
all first aid equipment intended for use at the event by
trainers who are working the corners.
•Generally, the following are the only things allowed in
a corner: Vaseline, Adrenalin 1:1000 topical, throm-
bin, water, ice, gauze pads, towels, sponges, Q-tips,
pressure plates for soft tissue swelling and scissors.
Artificial skin coverings, liniments, lotions, or any
stimulants (such as smelling salts) are not allowed.
- During the action, the boxer’s stance and ring move-
ment are key indicators of the skill level and balance.
A staggering or running boxer is an indicative of
potential trouble. Since effective defense is necessary
for safety, its absence mandates cessation of a contest.
Early signs of a lapse in defense and of the onset of
fatigue are lowered punch counts, lowered arms, and
increasing clutches.
- Observation of cumulative trauma is important. Facial
swelling, cuts, and epistaxis lead to impaired vision
TABLE 78-2 Boxing Disqualifying Conditions
Acute illnesses: Acute febrile illnesses
Cardiovascular: Uncontrolled, severe hypertension; evidence of
CHF; ectopy (more than 6 per minute)
Respiratory: Acute bronchospasm, evidence of pneumonia or hypoxia;
nasal fracture; septal hematoma
Neurologic: Altered mental status, concussion, headache on the day
following a match—potential risk for second impact syndrome
Eyes: Visual field defect, hyphema, known or history of retinal
detachment, corneal abrasion; uncorrected visual acuity of worse than
20/400 in one or both eyes, or best corrected visual acuity of 20/60 or
worse in either eye. Boxers may be permitted soft contacts.
Musculoskeletal: Acute or chronic muscle or joint pain causing
significant upper or lower extremity dysfunction that may affect
boxer’s ability to defend or compete
Internal organs: Enlarged spleen or liver below the costal margin
Skin: Active herpetic lesions; impetigo; open lacerations of the head
and neck
SOURCE: U.S. Amateur Boxing: Ringside Physicians Certification
Manual. Colorado Springs, CO, U.S. Amateur Boxing, 2003.
