Boxing, brain damage and head protection: why aren’t the boxers at the Olympics wearing head guards?

mike loosemore by clare parkMike Loosemore is Lead Consultant Sports Physician at the English Institute of Sport, Exercise and Health; he is currently at the Rio 2016 Olympics

 

Have you noticed that the male competitors in Boxing don’t have to wear head guards at the Rio 2016 Olympics? This may seem odd, perhaps. However, the requirement to wear head protection has been removed for the first time since it was introduced in 1984 at the Los Angeles games. In the lead up to the 1984 Olympics, concerns about brain damage as result of boxing led to a strong anti-boxing feeling within the medical profession. It was under pressure from the medical profession to make boxing safer that head guards were introduced.

A review of the change in injury patterns in boxing following various rule changes suggested that, when head guards were introduced in 1984, the incidence of knockouts, and bouts stopped due to blows to the head, doubled. Head guards were removed from all senior male boxers in January 2013.

A review of bouts between amateur boxers before the removal of head guards compared to after head guards were removed suggested a marked reduction in knockouts and a reduction in bouts-stopped-due-to-blows-to-the-head. However, in view of the low number of knockouts and bouts-stopped-due-to-blows-to-the-head, a more sensitive measure was required.

Video analysis comparing bouts from the World Championships in 2011, the last world championship with head guards, with bouts from the 2013 World Championships, the first world championships without head guards, sought observable signs of concussion. Similar video analysis techniques had previously been employed in other sports, such as unhelmeted Australian football, elite football, ice hockey and Taekwondo.

Observable signs of concussion are more numerous and so should give more accurate results. This work also showed fewer visible signs of concussion without the head guard, and when this exercise was repeated with the 2015 World Championships the number of visible signs of concussion were 50% lower in the boxers not wearing head guards compared with 2011 where head guards were worn.

So it would seem that wearing a head guard increases your risk of concussion. Mechanical tests on head guards show that they do attenuate the force of a blow and so should reduce concussion, so it must be something else about wearing a head guard that makes a boxer more vulnerable to a concussive event. There are several hypotheses.

Knockouts and concussive blows cause the head to rotate so increasing the diameter of the head may increase the torque experienced by the brain by increasing the movement arm. However, it is pointed out that the head guards are not firmly applied to the head and tend to slip when hit which would reduce the torque experienced by the brain.

Perhaps head guards give the boxers a false sense of confidence which means that they put their heads in vulnerable positions. Studies have shown this to be the case when helmets are worn for  other sports such as skiing and snowboarding, and cycling.

Is the vision of the boxer compromised by the head guard that makes them more likely to be hit by blows coming from the periphery of the boxer’s vision? In a recent study (not yet published) head guards compromised participants reacting to lights on a batak board compared to not wearing a head guard.

It seems that, even as the good doctors where trying to reduce head trauma in the 1984 Los Angeles Olympics, by introducing an equipment change without testing the outcomes first, they condemned amateur boxers to 30 years of increased head trauma, exactly the opposite outcome they had hoped for.

So then why are there still head guards on female boxers?  The concussion rate in female boxers is much lower than in men, head guards protect against cuts so it may be that in the case of female boxers morbidity is reduced more by keeping the head guards on than removing them. The international Olympic Committee has instituted a programme of research to answer this question.

At a time when there is great concern over concussion, other sports would be wise to test any rule changes in head protection before applying the rule change.

 

 

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