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Neurological tests improve after Olympic-style boxing bouts: a pretournament and post-tournament study in the 2016 Women’s World Boxing Championships
  1. David R Howell1,2,3,
  2. William P Meehan III1,2,3,4,5,
  3. Michael P Loosemore6,7,
  4. Joseph Cummiskey6,
  5. Jean-Paul Grabner von Rosenberg8,
  6. David McDonagh6,8,9
  1. 1 The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
  2. 2 Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, Massachusetts, USA
  3. 3 Brain Injury Center, Boston Children’s Hospital, Boston, Massachusetts, USA
  4. 4 Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  6. 6 AIBA Medical Commission/AIBA Scientific Commission, Maison du Sport, Lausanne, Switzerland
  7. 7 Institute of Sport Exercise and Health, University College Hospital London, London, UK
  8. 8 Department of Orthopedics, St. Olavs Hospital, Trondheim, Norway
  9. 9 Municipal Emergency Department, St. Olav’s Hospital, Trondheim, Norway
  1. Correspondence to Dr David R Howell, The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital. 9 Hope Ave., Waltham, MA, 02453, USA; David.Howell2{at}


Aim To prospectively examine the neurocognitive, postural, dual-task and visual abilities of female Olympic-style boxers before and after participation in a tournament.

Methods Sixty-one females completed the modified Balance Error Scoring System (mBESS), King-Devick test and 3 m timed-up-and-go test in single-task and dual-task conditions. A subset (n=31) completed the CogState computerised neurocognitive test. Initial testing was completed prior to the 2016 Women’s World Boxing Championships; each participant repeated the testing protocol within a day of elimination. No participant sustained a concussion. Pretournament and post-tournament performance variables were compared using paired t-tests or Wilcoxon signed-rank tests.

Results Participants completed a mean of 7.5±4.5 rounds of Olympic-style boxing over 2–8 days. Post-tournament scores were significantly lower than pretournament scores for total mBESS (2.2±1.9 errors vs 5.5±2.9 errors, p<0.001, d=1.23) and King-Devick time (14.2±3.9 s vs 18.0±8.3 s, p=0.002, d=0.53). Processing speed was significantly faster after the boxing tournament (maze chase task: 1.39±0.34 correct moves/second vs 1.17±0.44 correct moves/second, p=0.001, d=0.58). No significant changes across time were detected for the other obtained outcome variables.

Conclusions Female boxers demonstrated either improvement or no significant changes in test performance after competing in an Olympic-style boxing tournament, relative to pretournament performance. As many of the test tasks were novel for the boxers, practice effects may have contributed to improved performance. When there is a short time frame between assessments, clinicians should be aware of potential practice effects when using ringside neurological tests.

  • xing
  • female athlete
  • postural balance
  • mobility
  • vision
  • neurocognition.

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  • Acknowledgements This work was supported by the International Boxing Association. This organisation played no role in the design of the study, or in the collection, analysis and interpretation of the data or in writing of the manuscript.

  • Competing interests Our author disclosure statement includes the following: WPM receives royalties from ABC-Clio publishing for the sale of his book, Kids, Sports, and Concussion: A Guide for Coaches and Parents, and royalties from Wolters Kluwer for working as an author for UpToDate. He is under contract with ABC-Clio publishing for a future book entitled Concussions, and with Springer International publishing for a future book entitled Head and Neck Injuries in Young Athletes. His research is funded, in part, by from the Football Players Health Study at Harvard, which is funded by the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. The other authors have no conflicts of interest to declare related to this study.

  • Patient consent Obtained from patient.

  • Ethics approval Boston Children’s Hospital IRB: Protocol ID P00018178.

  • Provenance and peer review Not commissioned; externally peer reviewed.