Elsevier

Neurologic Clinics

Volume 26, Issue 1, February 2008, Pages 257-270
Neurologic Clinics

Neurologic Injuries in Boxing and Other Combat Sports

https://doi.org/10.1016/j.ncl.2007.11.004Get rights and content

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

Section snippets

Mechanisms of neurological injuries in combat sports

The mechanism of neurological injury varies depending upon the combat sport discipline. In boxing, head injuries generally occur because of contact between the fist and head, head and head, or head and some part of the boxing ring. In other combat sport disciplines, head contact can occur in all of those manners, and also as a result of striking other surfaces (the palms, fingers, elbows, legs, feet, and so forth). In boxing it is thought that the more serious neurological injuries result from

Acute neurological injuries

Acute neurological injuries (ANI) occurring to combat sport participants have been studied extensively, especially in the sport of boxing. Numerous case studies of particular ANI types have been published (for example, a number of case reports relating to vertebral or carotid artery dissections exist in the combat sport literature) [25], [26], [27]; however, the ANI leading to fatalities and those of concussion have been the focus of the majority of the literature, and are discussed here.

Risk factors for acute neurological injuries in the combat sports

Risk factors for the development of any injuries in the combat sports are not well-established [55]. This is also true for ANI. Although a number of potential risk factors have been hypothesized, well-designed epidemiological studies have not been completed [14], [56]. The majority of factors of interest are anecdotal rather than evidence-based. Some factors common to all combat sport styles have been noted for further attention that may relate to ANI occurrence. These include age, gender,

Chronic neurological injuries

Along with deaths, chronic neurological injuries (CNI) associated with combat sport participation have dominated the published international literature. In particular, boxing has again received the most attention, and such injuries in this sport led to the coining of a term synonymous with CNI in boxing—the “punch-drunk syndrome.” When first coined in 1928 by a physician in the Journal of the American Medical Association, the condition was known in boxing circles and was largely “diagnosed” by

Risk factors for chronic neurological injuries in the combat sports

Table 4 demonstrates the results of the studies undertaken to determine the effect of certain factors on CNI development in the combat sports. These results relate to the sport of boxing, because no studies in other combat sports have been designed to document CNI risk factors. In boxing, studies have shown that having a boxing career greater than 10 years, a greater number of bouts (more than 150), and the presence of the apolipoprotein E4 phenotype all increase the likelihood of chronic

Prevention of neurological injuries in the combat sports

The limited evidence of causes and mechanisms for neurological injuries in the combat sports hinders the ability to make widespread changes that may reduce their likelihood; however, a number of potential strategies have been suggested by various authors, although limited prospective evidence of their effectiveness currently exists.

Table 5 lists some of the commonly suggested injury prevention methods for combat sports, and an evaluation of their current state of evidence.

Summary

Neurological injuries of both an acute and chronic nature have been reported in the literature for various combat sport styles; however, the incidence and prevalence of these injury types vary greatly within the literature, and where they have been measured accurately, limited evidence exists for the causes and mechanisms of these injuries. This hinders any programs aimed at reducing neurological injury occurrence in these sports. Systematic ongoing surveillance systems that detail causes of

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