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Donnelly RR, Ugbolue UC, Gao Y, Gu Y, Dutheil F, Baker JS. A Systematic Review and Meta-Analysis Investigating Head Trauma in Boxing. Clin J Sport Med 2023; 33:658-674. [PMID: 37862081 PMCID: PMC10597432 DOI: 10.1097/jsm.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Although physical trauma has been reported in boxing since its inception, boxing still appeals to athletes and spectators. This systematic review and meta-analysis assess both acute and chronic neurological and neuropsychological effects that boxing has on the brain. Further assessments in terms of comparisons of the concussion ratio in boxing to other combat sports, as well as the efficiency of wearing headguards, are also performed. DATA SOURCES This systematic review and meta-analysis used the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The outcomes incorporated included physical chronic abnormalities of the brain, neuropsychiatric, and neurological disorders sustained in amateur or professional boxing, in addition to the safety benefits of boxing headguards. Odds ratios, descriptive statistics, and inferential statistics are also reported. MAIN RESULTS From the 84 articles reviewed, the 35 included articles suggested that boxers have a significantly elevated risk of sustaining a concussion compared with other combat sports (risk ratio [RR]: 0.253 vs RR: 0.065, P < 0.001). From the 631 amateur and professional boxers analyzed, 147 (23.30%) had cavum septum pellucidum, whereas 125 of 411 amateur and professional boxers (30.41%) presented with some form of brain atrophy. Dementia or amnesia was observed in 46 of 71 boxers (61.79%), 36 of 70 (51.43%) had various forms and severities of cognitive disorders, and 57 of 109 (52.29%) displayed abnormal computed tomography or electroencephalogram scan results. Utilization of headguards significantly increased the risk for stoppages in amateur bouts, compared with boxers not wearing a headguard (OR: 1.75 vs 0.53, P < 0.050). CONCLUSIONS Boxing is a hazardous sport that has the potential to have fatal and negative life-changing results. Because of the limited reliable data regarding the efficiency of boxing headguards, future research should focus on the overall significance that headguards may have for reducing head trauma.
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Affiliation(s)
- Robert R. Donnelly
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Ukadike Chris Ugbolue
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Yang Gao
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong; and
| | - Yaodong Gu
- School of Health and Life Sciences, Institute for Clinical Exercise & Health Science, University of the West of Scotland, South Lanarkshire, Scotland, United Kingdom
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong; and
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Casson IR, Viano DC. Long-Term Neurological Consequences Related to Boxing and American Football: A Review of the Literature. J Alzheimers Dis 2020; 69:935-952. [PMID: 31156163 DOI: 10.3233/jad-190115] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The long-term effects of repetitive head trauma on the brain have often been studied in boxers and American football players. The medical literature on this topic was reviewed in order to compare the findings related to boxing with those related to football. The evidence gathered from this review indicates that there are significant differences between the clinical and neuropathological descriptions of the chronic brain damage reported in retired boxers compared to those reported in retired football players. Differing biomechanics of head impacts in the two sports may help explain the different clinical and neuropathological consequences of participation in boxing versus football.
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Affiliation(s)
- Ira R Casson
- Department of Neurology, Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
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Di Virgilio TG, Ietswaart M, Wilson L, Donaldson DI, Hunter AM. Understanding the Consequences of Repetitive Subconcussive Head Impacts in Sport: Brain Changes and Dampened Motor Control Are Seen After Boxing Practice. Front Hum Neurosci 2019; 13:294. [PMID: 31551732 PMCID: PMC6746992 DOI: 10.3389/fnhum.2019.00294] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/12/2019] [Indexed: 01/24/2023] Open
Abstract
Objectives The potential effects of exposure to repetitive subconcussive head impacts through routine participation in sport are not understood. To investigate the effects of repetitive subconcussive head impacts we studied boxers following customary training (sparring) using transcranial magnetic stimulation (TMS), decomposition electromyographic (EMG) and tests of memory. Methods Twenty amateur boxers performed three 3-min sparring bouts. Parameters of brain function and motor control were assessed prior to sparring and again immediately, 1 h and 24 h post-sparring. Twenty control participants were assessed following mock-sparring. Results One hour after sparring boxers showed increased corticomotor inhibition, altered motor unit recruitment strategies, and decreased memory performance relative to controls, with values returning to baseline by the 24 h follow up. Conclusion Repetitive subconcussive head impacts associated with sparring resulted in acute and transient brain changes similar to those previously reported in soccer heading, providing convergent evidence that sport-related head impacts produce a GABAergic response. These acute changes in brain health are reminiscent of effects seen following brain injury, and suggest a potential mechanism underlying the damaging long-term effects of routine repetitive head impacts in sport.
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Affiliation(s)
- Thomas G Di Virgilio
- Physiology, Exercise and Nutrition Research Group, University of Stirling, Stirling, United Kingdom
| | - Magdalena Ietswaart
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Lindsay Wilson
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - David I Donaldson
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Angus M Hunter
- Physiology, Exercise and Nutrition Research Group, University of Stirling, Stirling, United Kingdom
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Seifert T, Bernick C, Jordan B, Alessi A, Davidson J, Cantu R, Giza C, Goodman M, Benjamin J. Determining brain fitness to fight: Has the time come? PHYSICIAN SPORTSMED 2015; 43:395-402. [PMID: 26295482 DOI: 10.1080/00913847.2015.1081551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Professional boxing is associated with a risk of chronic neurological injury, with up to 20-50% of former boxers exhibiting symptoms of chronic brain injury. Chronic traumatic brain injury encompasses a spectrum of disorders that are associated with long-term consequences of brain injury and remains the most difficult safety challenge in modern-day boxing. Despite these concerns, traditional guidelines used for return to sport participation after concussion are inconsistently applied in boxing. Furthermore, few athletic commissions require either formal consultation with a neurological specialist (i.e. neurologist, neurosurgeon, or neuropsychologist) or formal neuropsychological testing prior to return to fight. In order to protect the health of boxers and maintain the long-term viability of a sport associated with exposure to repetitive head trauma, we propose a set of specific requirements for brain safety that all state athletic commissions would implement.
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Affiliation(s)
- Tad Seifert
- a 1 Department of Neurology, Norton Healthcare , Louisville, KY, USA.,b 2 Department of Neurology, University of Kentucky , KY, USA.,c 3 Kentucky State Boxing Commission , KY, USA
| | - Charles Bernick
- d 4 Lou Ruvo Center for Brain Health, Cleveland Clinic , Las Vegas, NV, USA
| | - Barry Jordan
- e 5 Department of Neurology, Burke Rehabilitation Hospital , White Plains, NY, USA.,f 6 New York State Athletic Commission , NY, USA
| | - Anthony Alessi
- g 7 Department of Neurology, Backus Hospital , Norwich, CT, USA.,h 8 Department of Neurology, University of Connecticut , CT, USA
| | - Jeff Davidson
- i 9 Department of Emergency Medicine, Valley Hospital , Las Vegas, NV, USA.,j 10 Ultimate Fighting Championship , Las Vegas, NV, USA
| | - Robert Cantu
- k 11 Department of Neurosurgery, Emerson Hospital , MA, USA.,l 12 Sports Legacy Institute , Boston, MA, USA
| | - Christopher Giza
- m 13 Department of Pediatric Neurology, University of California at Los Angeles , CA, USA.,n 14 California State Athletic Commission , CA, USA
| | - Margaret Goodman
- o 15 Headache Center of Southern Nevada , Las Vegas, NV, USA.,p 16 Voluntary Anti-Doping Association , Las Vegas, NV, USA
| | - Johnny Benjamin
- q 17 Department of Orthopedic Surgery, Pro Spine Center , Vero Beach, FL , USA
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Abstract
PURPOSE OF REVIEW Growing public health concern exists over the incidence of chronic traumatic brain injury (TBI) in athletes participating in contact sports. Chronic TBI represents a spectrum of disorders associated with long-term consequences of single or repetitive TBI and includes chronic traumatic encephalopathy (CTE), chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologists should be familiar with the different types of chronic TBI and their diagnostic criteria. RECENT FINDINGS CTE is the most severe chronic TBI and represents the neurologic consequences of repetitive mild TBI. It is particularly noted among boxers and football players. CTE presents with behavioral, cognitive, and motor symptoms, and can only be definitively diagnosed postmortem. Chronic postconcussion syndrome is defined as postconcussion symptoms that last longer than 1 year and do not appear to resolve; it may develop after a single concussive event. Chronic neurocognitive impairment is an all-encompassing clinical term denoting long-term neurologic sequelae secondary to sports-related trauma and can present either within the postconcussion syndrome or years after a symptom-free interval. SUMMARY This article discusses the diagnostic evaluation of chronic TBI, including clinical history, neurologic examination, neuropsychological testing, neuroimaging, and laboratory testing, as well as the distinctions between CTE, chronic postconcussion syndrome, and chronic neurocognitive impairment. Neurologic impairment among athletes exposed to repetitive brain injury appears to be a real phenomenon. Because CTE has no established treatment, prevention is of paramount importance for athletes participating in contact sports.
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Abstract
Clinical decision making for injured boxers follows the same therapeutic principles as the treatment plan for other injured athletes. Just as surgical techniques have improved, so has the scientific basis for implementing therapeutic exercises progressed to return the athletes to their former level of competition.
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Affiliation(s)
- Barry D Jordan
- Brain Injury Program, Burke Rehabilitation Hospital, 785 Mamaroneck Avenue, White Plains, NY 10603, USA.
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Abstract
Many sports have neurologic injury from incidental head contact; however, combat sports allow head contact, and a potential exists for acute and chronic neurologic injuries. Although each combat sport differs in which regions of the body can be used for contact, they are similar in competitor exposure time. Their acute injury rates are similar; thus their injuries can appropriately be considered together. Injuries of all types occur in combat sports, with injuries in between one fifth to one half of all fights in boxing, karate, and tae kwon do. Most boxing injuries are to the head and neck region. In other combat sports, the head and neck region are the second (after the lower limbs) or the first most common injury site.
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Abstract
The sport of boxing has been the source of much debate, with concerns about the neurological risks of participating having led to many calls to ban the sport. This review seeks to establish an evidence base for the development of boxing-related chronic traumatic encephalopathy (CTE) and to determine the relevance of this information to the modern day sport.The clinical features of CTE include various symptoms affecting the pyramidal and extrapyramidal systems, which manifest most often as disturbed gait and coordination, slurred speech and tremors, as well as cerebral dysfunction causing cognitive impairments and neurobehavioural disturbances. Both amateur and professional boxers are potentially at risk of developing CTE. No current epidemiological evidence exists to determine the prevalence of this condition in modern day boxing, despite 17% of professional boxers in Britain with careers in the 1930-50s having clinical evidence of CTE. As medical presence within the sport increases and with modern boxers likely to have shorter careers, a reduced exposure to repetitive head trauma, and improved treatment and understanding of the development of CTE will occur. This should lead to the incidence of CTE diminishing in boxing populations.
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Affiliation(s)
- Paul McCrory
- Centre for Health, Exercise and Sports Medicine and the Brain Research Institute, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
The increased popularity of contact sports worldwide exposes a large number of participants to both acute and chronic traumatic brain injury. Chronic traumatic brain injury (CTBI) represents the cumulative, long-term neurological consequences of repetitive concussive and subconcussive blows to the brain. Although this condition has been described primarily in boxing, it may be anticipated in other contact sports such as soccer, football, ice hockey, and the martial arts. Since treatment options in CTBI are relatively limited, the prevention of CTBI is of paramount importance. Minimizing the frequency and severity of acute brain injury in sport will be instrumental in accomplishing this goal. The prevention of CTBI will need to be sport specific and will undoubtedly rely on limiting the exposure of high-risk athletes, utilizing of protective equipment, enforcing strict rule adherence, training and supervising athletes, and increasing medical surveillance.
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Affiliation(s)
- M H Rabadi
- Brain Injury Program, Burke Rehabilitation Hospital, White Plains, New York 10605, USA
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Jordan BD. Emerging concepts in sports neurology. Ann N Y Acad Sci 1997; 835:395-409. [PMID: 9616789 DOI: 10.1111/j.1749-6632.1997.tb48645.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B D Jordan
- Reed Neurological Research Center, UCLA School of Medicine, USA
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