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To determine injury rates and risk factors for injury in a cohort of professional boxers. Retrospective cohort design reporting on data collected for a fight statistics database maintained by the Professional Boxing and Combat Sports Board of Victoria, Australia. Data were extracted for the years January 1997 through June 2005. Victoria, Australia. 545 professional boxers (age, 18 to 43 years) who participated in a total of 907 fights over the study period. Independent variables under investigation included age, gender, weight, bout exposure, and location of the bout (within or outside of the State of Victoria). Physician-reported acute boxing injuries occurring during bouts of any region or nature. 214 injuries were sustained over the 8.5 years, corresponding to an injury rate of 23.6 per 100 professional fights. The majority of these injuries were lacerations to the head and face. An increasing age and an increasing number of fights were both significant predictors of injury. Injury reduction strategies for professional boxing might include restrictions of eligibility to fight based on age and boxing bout exposure. Future research using prospective cohort designs and standardized injury definitions are needed to confirm these results. Greater mechanistic detail and more complete data entry are necessary to ensure that optimal injury prevention strategies can be developed and implemented. Upon confirmation of the results of this study, the Professional Boxing and Combat Sports Board of Victoria may consider different criteria upon which to sanction a fight.
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ORIGINAL RESEARCH
Injury Rates and Risk Factors in Competitive
Professional Boxing
Tsharni R. Zazryn, BAppSc(Hons),* Paul R. McCrory, MBBS, PhD,†
and Peter A. Cameron, MBBS, MD‡
Objective: To determine injury rates and risk factors for injury in
a cohort of professional boxers.
Design: Retrospective cohort design reporting on data collected for
a fight statistics database maintained by the Professional Boxing and
Combat Sports Board of Victoria, Australia. Data were extracted for
the years January 1997 through June 2005.
Setting: Victoria, Australia.
Participants: 545 professional boxers (age, 18 to 43 years) who
participated in a total of 907 fights over the study period.
Assessment of Risk Factors: Independent variables under
investigation included age, gender, weight, bout exposure, and
location of the bout (within or outside of the State of Victoria).
Main Outcome Measures: Physician-reported acute boxing
injuries occurring during bouts of any region or nature.
Results: 214 injuries were sustained over the 8.5 years, correspond-
ing to an injury rate of 23.6 per 100 professional fights. The majority
of these injuries were lacerations to the head and face. An increasing
age and an increasing number of fights were both significant
predictors of injury.
Conclusions: Injury reduction strategies for professional boxing
might include restrictions of eligibility to fight based on age and
boxing bout exposure. Future research using prospective cohort
designs and standardized injury definitions are needed to confirm
these results. Greater mechanistic detail and more complete data
entry are necessary to ensure that optimal injury prevention strategies
can be developed and implemented. Upon confirmation of the results
of this study, the Professional Boxing and Combat Sports Board
of Victoria may consider different criteria upon which to sanction
a fight.
Key Words: boxing, bout, professional
(Clin J Sport Med 2009;19:20–25)
INTRODUCTION
Limited epidemiological research has been carried out in
professional boxing. Instead, much of the boxing literature has
focused on the amateur discipline of this sport. As it is
unknown whether the data collected in the amateur discipline
is applicable to the professional cohorts, it is important that
accurate and valid data for professional boxers are obtained.
A general injury profile has emerged from the limited
number of international studies conducted involving pro-
fessional boxers. The head is the most commonly injured body
region, followed by the hands and fingers, and the majority of
the injuries are bruises and lacerations.
1–4
More severe injuries,
such as concussions and fractures, are reported less frequently.
Unfortunately, little is known about injury risk factors for these
participants. Thus, data relating to the rates of injury and the
risk factors for injury development are needed before injury
prevention strategies can be developed and successfully
targeted.
In professional boxing, only 5 studies have been
published that report any injury rates, and no study has
addressed injury risk factors for this population in the past 30
years.
1–5
Rather, what is known about injury risk factors in this
sport has arisen primarily from anecdotal beliefs about
potential injury risks.
6,7
There is a clear need for prospective
studies aimed at determining injury rates and analyzing risk
factors associated with contemporary professional boxing.
The aim of this study was to analyze the injury data
collected during competition by a professional boxing
association to calculate injury rates and determine risk factors
for professional boxing.
METHODS
Design
This study employed a retrospective cohort design using
a fight statistics database maintained by the Professional
Boxing and Combat Sports Board of Victoria (PBCSBV),
Australia. This database is used to collect data on fight
outcomes for all professional boxers registered in Victoria, and
for any professional boxers who come to Victoria to fight.
Participants
All boxers who were registered with the PBCSBV and
had a fight (regardless of the fight location) or those registered
Submitted for publication January 29, 2008; accepted September 12, 2008.
From the *Departments of Health Science and Epidemiology and Preventive
Medicine, Monash University, Frankston, Victoria, Australia; and Centre
for Health, Exercise and Sports Medicine and the Brain Research Institute,
University of Melbourne, Melbourne, Australia.
Tsharni Zazryn was supported by a National Health and Medical Research
Council Postgraduate Scholarship.
The authors state that they have no financial interest in the products mentioned
within this article.
Reprints: Tsharni Zazryn, BAppSc(Hons), Department of Health Science,
Monash University, PO Box 527, Frankston, Victoria 3199, Australia
(e-mail: tsharni.zazryn@med.monash.edu.au).
Copyright Ó2009 by Lippincott Williams & Wilkins
20 Clin J Sport Med Volume 19, Number 1, January 2009
with other Boards but fighting within the State of Victoria for
the 8.5-year period from January 1997 to June 2005 comprised
the study cohort.
Instruments and Procedures
The PBCSBV dataset is maintained within a Microsoft
Access database. Data for the appropriate period were
extracted from the Access database and transferred into
Microsoft Excel 2002. Each fight recorded in the database
potentially had 1 or 2 records.
2
Fights with 1 record in the
database indicated that a Victorian-registered boxer was
fighting against a non-Victorian boxer. Where 2 records for
the 1 fight were recorded, this indicated either 2 Victorian-
registered boxers fighting each other in any location or any
fight in the State of Victoria. In order for accurate injury rates
to be calculated, 2 fight records (1 for each boxer) for every
fight in the database had to exist. A manual search of the
database for each fight was therefore undertaken. Where 2
records for a bout had not been entered into the database, the
missing data were obtained from the paper-based records of
the PBCSBV and added to the database. Conversely, where
multiple records (ie, more than 2) had been entered for 1 bout,
the most complete record was kept and the other(s) deleted.
Potential information entered into the fight statistics
database for each bout included the boxer’s name, the
opponent’s name, the date of the fight, weight at weigh-in
24 hours before the contest, the number of scheduled rounds,
the number of completed rounds, the fight result (win, loss, or
draw), the fight result status [decision determined by points,
knock-out (KO) or technical knock-out (TKO)], the location of
the fight (entered as the name of the venue), and any sustained
injuries and any recommendations made by the ringside
physician regarding when the boxer could next fight. This was
linked to the table of personal information for each boxer,
which allowed the date of birth and gender of the boxer to be
determined. Not all of these variables were entered fully, and
thus not all could be used to determine risk factors for injury.
The possible risk factors for injury that could be
determined from the dataset included age at the time of the
fight (determined by using the date of birth of the boxer, which
is entered into the database at registration, and the date of
the fight), gender, weight, the number of fights (determined
by the number of fight records for each boxer in the dataset,
which were ordered from earliest to most current in date), and
location of the fight (as Victorian or non-Victorian, recorded
on the basis of venue).
At all Victorian bouts a ringside physician is required to
undertake pre-bout and post-bout medical checks of partic-
ipants. After each bout, the ringside physician notes any
injuries that were either reported to them by the boxers or
observed/treated by the physician. Therefore, the injury
definition used in this study was any injury reported to or
by a ringside physician after bout participation. The fight detail
form provides 3 lines of space for Any Injuries, and the exact
detail provided by each physician was not standardized. Any
injuries (either physician or boxer reported) will be referred to
as reported injuries in the data below. The injury details were
entered into the Access database in the form of a text narrative
that was copied verbatim from the completed form. For the
8.5-year period of the current data collection, 3 different
doctors were serving as ringside physicians within Victoria.
For Victorian-registrants who fought interstate, they were
required to have a form completed by the appropriate boxing
authority. The form detailed the fight result and any injuries
sustained and had to be returned to the PBCSBV within 1
week of the bout.
Injury details were recoded from the text narrative
according to the guidelines provided by the Australian Sports
Injury Data Dictionary.
8
Only details pertaining to the region
and nature of injury were available for coding. No causes of
injury data were included in the ringside physician notes.
Analysis
The data were transferred into both the Statistical
Package for the Social Sciences (SPSS) version 12.0 and
Intercooled STATA version 9.2 for analysis. A competitive
bout was defined by 2 fight records (ie, both the boxer and
the opponent were included in the analysis). Basic analyses
were conducted for all questions with descriptive statistics
used as appropriate to provide demographic and injury details.
Exposure was quantified in terms of the number of fights
participated in during the study period for each boxer. Injury
rates were calculated in a number of different ways that are
consistent with the previous literature.
9–13
This included injury
rates based on the reported injuries only and injury rates based
on the reported injuries and any fights in which a boxer lost by
TKO or KO. One previous amateur boxing study has stated
that, if a fight has been terminated as a result of a KO or the
referee stopping the contest (RSC in amateurs, similar to
a TKO in professional boxing), the boxer is assumed to have
had evidence of some neurological dysfunction at that time.
10
As such, an injury event is assumed to have occurred.
10
However, study results have shown conflicting evidence of
neurological dysfunction when comparing baseline neuro-
psychological test results to those obtained after a KO or TKO
result.
14–16
Thus, injury rates were calculated using both
reported injuries and situations in which a possible injury may
have occurred (based on a KO or TKO loss).
Univariate and multivariate logistic regressions were
used to identify predictors of injury (for reported injuries
only). Bouts in which a KO or TKO was recorded as the fight
result but no injury was reported were not included as injuries
for the risk factor analysis. For each model, odds ratios, 95%
confidence intervals, and Pvalues were calculated. In analyz-
ing all statistical tests, a significance level of alpha 0.05 was
used. The clustering effect of repeat injuries to a boxer across
different bouts was accounted for by using robust standard
errors in the multivariate logistic regression model.
RESULTS
A total of 907 professional boxing bouts were
participated in by 545 Victorian-registered boxers or within
the State of Victoria for the 8.5-year period. The majority of
the fight participants were male (98.3%), with an average age
at the time of a fight of 27.9 years (range, 18.1 to 43.6 years).
The average age of boxers at their first professional fight
was 27.7 years (SD, 5.1 years; range, 18.1 to 43.3 years). The
q2009 Lippincott Williams & Wilkins 21
Clin J Sport Med Volume 19, Number 1, January 2009 Injury and Risk in Professional Boxing
percentage of fights participated in per person is shown in
Table 1. Over three–quarters of boxers (75.2%) had 3 fights or
fewer over the time period.
Injuries were reported in 177 (19.5%) of the 907 fights.
As multiple injury events occurred in some fights (range, 1 to 3
injuries), the total number of reported injuries was 214. This
corresponds to a reported injury rate of 23.6 per 100
professional fights (Table 2). When KO and TKO losses were
included as an injury, the injury rate increased to 60.7 per 100
professional fights.
The majority of injuries were open wounds/lacerations
to the head region (61.7%), followed by concussions (11.7%)
and fractures, primarily involving the hands/fingers and nose
(8.4%). Table 3 provides details of the regions and natures of
the injuries sustained by this cohort.
One death during the study period also occurred. The
boxer was participating in his third professional fight, but was
registered in another Australian state. This boxer collapsed
during the sixth round of an eight-round fight and sub-
sequently died from complications of a left frontoparietal
subdural hemorrhage with cerebral infarction and associated
oedema. A coronial inquest focused on the issues of weight
loss, dehydration, ambulance delay, and mismatching of the
opponent as factors contributing to the death.
17
The evidence
presented in the inquest did not support any of these factors as
ultimately contributing to the death of the boxer.
17
Injured boxers (whether 1 or more injuries) were
significantly more likely to lose their fights than noninjured
boxers (OR, 2.1; 95% CI, 1.5 to 3.0). Further, injured boxers
were significantly more likely to finish their fight before the
scheduled number of rounds (OR, 1.4; 95% CI, 1.01 to 1.92).
As shown in Table 4, independent predictors of injury
included the age of participants at the time of the fight (with
older boxers more likely to be injured; OR, 1.04; 95% CI, 1.01
to 1.08) and the number of fights each boxer had participated
in (with boxers with a greater number of fights having an
increased risk of injury; OR, 1.07; 95% CI, 1.05 to 1.10).
This increasing risk of injury as fight numbers increased is
depicted in Figure 1. As age increased, a small but consistent
increase in injury risk was seen as demonstrated in Figure 2.
Even after adjusting for other variables in a multivariate
logistic regression and the potential for clustering due to some
boxers having injury events in multiple fights, an increasing
number of fights remained a significant predictor of injury
(Table 5).
DISCUSSION
Almost one–fifth of professional boxing fights resulted
in a reported injury in this study. Only 3 other studies have
reported injury rates per 100 fights in boxing.
3,9,10
Only 1 of
these reported on injuries occurring to professionals, and that
study was carried out over a 1-year period with 14 boxers from
the same cohort that this current study used. The injury rates
were slightly higher in the 1-year study (33.3 injuries per 100
fights).
3
A greater focus on injuries within the 14 boxers in the
cohort study, as well as fewer fights being detailed over that
time, may have led to an increased injury rate within that
group. All other studies reporting injury rates per 100 fights
have been undertaken in children or amateur competitors.
Similar injury rates for the professional boxers in this study
have previously been reported for amateur boxers (15.5, 22.8,
and 25.0 injuries per 100 fights).
3,9,10
When considering reported injuries as well as losses by
KO or TKO, the injury rate was 3 times that calculated for
reported injuries alone, with approximately two–thirds of
fights resulting in an injury. If some form of neurological
dysfunction has in fact occurred to participants who lose a
fight by KO or TKO, it may be that a number of injuries are
remaining undiagnosed, untreated, and unreported in pro-
fessional boxing. A more detailed understanding of the
neurological consequences of KOs or TKOs in boxers is
needed to determine if some form of treatment is required for
this group after a fight.
The risk factors of age, weight, gender, the number of
fights participated in, and the location of the fights were able to
be assessed from the database. Current age, age at beginning
boxing, and age at retirement from boxing have all long been
considered potential risk factors for injury.
6,7
This study was
able to assess current age as a potential risk factor and found
TABLE 1. Number of Fights Participated in Per Person From
1997–2005 (n = 545 Boxers)
Number of
Fights Per Person
Number of
Boxers
Cumulative
Proportion (%)
1 292 53.6
2 72 66.8
3 46 75.2
4 30 80.7
5 17 83.8
6 13 86.2
7 13 88.6
8 8 90.1
9 6 91.2
10 0 91.2
$11 48 100.0
TABLE 2. Injury Rates in Professional Boxing Over a
9-Year Period
Year
Number
of
Fights
Participated
In
Number
of
Reported
Injuries
Reported
Injury
Rate Per
100 Fights
Injury Rate Per
100 Fights
for Reported
Injuries and
Losses by KO/KO
1997 90 17 18.9 52.2
1998 70 17 24.3 50.0
1999 85 25 29.4 68.2
2000 88 29 33.0 73.9
2001 112 32 28.6 59.8
2002 104 27 26.0 62.5
2003 139 35 25.2 65.5
2004 135 25 18.5 62.7
2005* 84 7 8.3 51.2
Total 907 214 23.6 60.7
*Until end June 2005.
22 q2009 Lippincott Williams & Wilkins
Zazryn et al Clin J Sport Med Volume 19, Number 1, January 2009
that increasing age at the time of the fight was an independent
significant predictor of injury, and it remained such when
adjusting for other predictor variables but not when adjusting
for clustering. While a specific age at which an increased risk
becomes apparent was not found in the data, a steady increased
risk for each year of life was found.
While not a modifiable injury risk factor, competitor age
is used to restrict participation in professional boxing, with no
participant allowed to compete if they are younger than 18
years of age at their first fight (they may start at any point after
18 years). Other than that, no age restrictions exist in
professional boxing. The data have shown that there is a
potential for increased injury risk between the age of 18 and
about 23 years of age. The level of risk then plateaus
until approximately 28 years of age when an increased risk is
again apparent until about 35 years of age.
The exposure experienced by professional boxers (in
terms of number of fights) has previously been reported as
a potential injury risk factor.
6,7
This study has shown that an
increasing number of fights does significantly increase the risk
of acute boxing injury (even once all other factors are
accounted for). In particular, when fights are categorized into
5-fight groupings, participants who have had between 11 and
15 fights and 16 or more fights are at almost a 2-fold increased
risk of injury compared to those who have had up to 5 fights.
This study has also shown, however, that this level of exposure
TABLE 3. Regions and Natures of Professional Boxing Injuries Over an 8.5-Year Period (n = 214 Injuries)
Abrasion/
Graze
Bruise/
Contusion
Concussion/
LOC
Dislocation/
Subluxation Fracture
Inflammation/
Swelling
Open Wound/
Laceration/Cut Strain Rupture
Vision
Problem
Not
Specified Total
Head/Neck
Cheek 3.3 0.5 3.7
Eye (NFS) 0.9 1.4 27.1 0.5 29.9
Eyebrow 0.5 17.3 17.8
Eyelid 0.5 5.6 6.1
Ears 0.5 0.9 0.5 1.9
Face (NFS) 0.5 0.5
Intracranial 11.7 11.7
Jaw/chin 0.5 0.5 0.5 0.5 1.9
Mouth 0.9 0.9
Neck 0.5 0.5
Nose 0.5 2.3 0.5 3.3
Scalp 0.5 5.6 6.1
Teeth/gums 0.9 0.9
Tongue 0.5 0.5
Head (NFS) 0.5 0.5
Upper Extremity
Hands/fingers 4.7 0.5 1.9 7.0
Shoulder 0.5 0.5
Arm (NFS) 0.5 0.5
Trunk
Internal 0.9 0.9
Ribs 0.5 0.5 0.9
Lower Extremity
Ankle 0.5 0.5 0.9
Leg (NFS) 0.5 0.5
Not Specified 0.5 2.3 2.8
Total 1.4 4.7 11.7 0.5 8.4 1.4 64.0 0.9 0.9 0.5 5.6 100.0
Percentages do not sum to 100% due to rounding.
TABLE 4. Independent Predictors of Injury for
Professional Boxers
Predictor Variable n Odds Ratio (95% CI) P
Age 1707 1.04 (1.01 to 1.08) 0.014
Weight 1206 1.00 (0.98 to 1.02) 0.880
Male gender 1813 0.63 (0.15 to 2.68) 0.534
Number of fights 1813 1.07 (1.05 to 1.10) ,0.001
Fight categories
1 to 5 (reference)
6 to 10 1.81 (1.22 to 2.68) 0.003
11 to 15 2.48 (1.51 to 4.08) ,0.001
16+ 3.38 (2.07 to 5.53) ,0.001
Location of fight
Victorian (reference) 857
Non-Victorian 547 0.77 (0.55 to 1.08) 0.129
q2009 Lippincott Williams & Wilkins 23
Clin J Sport Med Volume 19, Number 1, January 2009 Injury and Risk in Professional Boxing
is potentially rare, as only 8.8% of boxers in this cohort had
more than 10 fights in the Victorian jurisdiction. However, as
discussed in the study limitations below, it is known that some
skewing of the data towards a lower number of fights is
apparent in this database as a result of interstate or
international competitors only fighting 1 or 2 times within
the Victorian jurisdiction.
Study Limitations
Although this study has been unique in the provision of
injury rates and risk factors for professional boxing, it has been
limited by the use of a database that was not originally
designed for injury surveillance purposes. Thus, the retro-
spective cohort design using a database designed to maintain
fight statistics has hindered the ability to fully explore the
breadth of potential risk factors for boxing injury. Future
iterations of this database should include mechanistic data (in
the form of detailed text narratives), complete entry of the
weight divisions being participated in, complete entry of
the number of rounds scheduled and actually completed in the
bout, and reporting on the use of protective equipment types
and styles in order for it to be adequate for injury prevention
purposes. Further, although only three physicians reported on
the fights detailed in the database, it is important for the
accuracy and integrity of the data that a standardized injury
definition be implemented so that the same information is
being collected regardless of time of collection and identity of
the collector.
This database is also limited in that it provides detail of
only one aspect of boxing exposure in the one state of
Australia and does not detail exposure related to amateur fights
or training times. Finally, boxers who were not Victorian
registrants were included in this dataset; therefore, the
exposure may be skewed towards a lower number of fights,
as their exposure in other states was unknown. Consideration
needs to be given to having a national surveillance system that
documents both amateur and professional careers and that
measures training settings as well as competition. Such
a database would allow better long-term follow-up of boxers
and would avoid issues regarding the exposure of registrants
fighting in other states.
Future Research
Future research should aim to confirm the results of this
study and document other potential risk factors for boxing
injury. Factors such as exposure time (based on the number of
minutes of completed rounds), the exposure experienced
outside of Victoria for non-Victorian registrants, amateur
career exposure, the time between each bout for each boxer,
and some measure of skill (including fighting style and
matching of opponents) should be studied.
6,7
Once confirmed,
the results could be used by the PBCSBV to change current
practice if required. At present, boxers who register with the
Board must get clearance from a general practitioner on an
annual basis to be allowed to fight and must have yearly
serology testing. At registration, these boxers are also required
to have a brain magnetic resonance imaging (MRI) scan, with
this scan then repeated at 3-year intervals regardless of the age
or experience of the boxer. The PBCSBV must sanction each
fight, with promoters providing the Board with proposed fight
FIGURE 2. Smoothed (log transformed) risk of injury with
increasing age.
TABLE 5. Multivariate Analysis of Risk Factors for Professional
Boxing Injuries (n = 1364 Fight Participations)
Predictor Variable Odds Ratio [95% CI] P
Adjusted for All Other Predictor Variables
Age 1.04 (1.01 to 1.08) 0.019
Male gender 0.60 (0.14 to 2.59) 0.497
Number of fights 1.04 (1.02 to 1.07) ,0.001
Non-Victorian fight location 0.78 (0.55 to 1.09) 0.148
Adjusted for All Other Predictor Variables and Potential Clustering of
Multiple Injuries in Multiple Bouts for Boxers
Age 1.04 (1.00 to 1.08) 0.051
Male gender 0.67 (0.20 to 2.29) 0.524
Number of fights 1.04 (1.01 to 1.08) 0.006
Non-Victorian fight location 0.77 (0.55 to 1.07) 0.122
*Standard error adjusted for 389 clusters.
FIGURE 1. Increasing injury risk (as determined by odds ratios)
as fight participation numbers increase.
24 q2009 Lippincott Williams & Wilkins
Zazryn et al Clin J Sport Med Volume 19, Number 1, January 2009
combinations a minimum of 1 month from the proposed date
of the fight. Upon confirmation of the results of this study, the
PBCSBV may consider different criteria upon which to
sanction a fight with regard to a boxer’s age and the number of
bouts they have previously had or any other confirmed risk
factor. Further, greater deliberation of the fight details
(including who the opponent is, the opponents’ age and
experience, and the proposed length of the fight) may be
required in making these decisions.
Additionally, more intensive medical screening and
evaluations of boxers at the start of their professional career
may also be warranted. This screening at registration should
continue to be (at a minimum) a full medical, serology, and
a brain MRI scan to limit the likelihood of boxers fighting
with potential injury risk factors. Neuropsychological testing
could also be performed at this time to provide a baseline
measure for each boxer. This screening should be carried
out annually. For boxers considered at risk of injury on the
basis of their age and experience, more intensive screening
may be warranted.
CONCLUSION
This study has provided details on injury rates and risk
factors obtained from the analysis of a comprehensive boxing
database in Victoria, Australia. The rates are based on over 900
fights over an 8.5-year period. Two hundred fourteen injuries
were reported by either physicians or boxers, corresponding to
an overall injury rate of 23.6 per 100 fights. When fights lost
by KO or TKO were also included in the injury rate, almost
two–thirds of all professional fights resulted in an injury
(60.7 per 100 fights). Injured boxers were more likely to be
older and had participated in more fights than non-injured
boxers. Greater screening of boxers early on in their careers
and once they have surpassed 5 fights may be needed to reduce
the potential risk of injury in this group. Further research into
potential risk factors for injuries is needed for effective injury
prevention strategies to be developed and implemented in pro-
fessional boxing.
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Recreation Victoria; 2002.
q2009 Lippincott Williams & Wilkins 25
Clin J Sport Med Volume 19, Number 1, January 2009 Injury and Risk in Professional Boxing
... In 13 included studies we detected three different study designs: Retrospective cross-sectional study (12)(13)(14)(16)(17)(18)) (n = 6), retrospective case-control study (19) (n = 1), prospective cohort studies (5,6,15,(20)(21)(22) (n = 6). ...
... Sample sizes ranged from 16 to 11,173 included athletes (median = 105), with 5 studies (5,6,(20)(21)(22) including small samples of < 100 athletes, 4 studies (15,(17)(18)(19) including medium samples of 100-1,000 athletes and two studies (13,14) including > 1,000 athletes. Most of the included studies displayed cohorts of male boxers with 4 studies including only males(6, 20-22), 3 studies with at least 90% males (5,17,19), one study including 70% males(18), one study including only females (13), and 3 studies not giving any gender characteristics (12,14,16) (considering however, that these studies have been published before 2000 and females have not been allowed at the Olympic games until 2012, it can be assumed that most cohorts were male). ...
... Sample sizes ranged from 16 to 11,173 included athletes (median = 105), with 5 studies (5,6,(20)(21)(22) including small samples of < 100 athletes, 4 studies (15,(17)(18)(19) including medium samples of 100-1,000 athletes and two studies (13,14) including > 1,000 athletes. Most of the included studies displayed cohorts of male boxers with 4 studies including only males(6, 20-22), 3 studies with at least 90% males (5,17,19), one study including 70% males(18), one study including only females (13), and 3 studies not giving any gender characteristics (12,14,16) (considering however, that these studies have been published before 2000 and females have not been allowed at the Olympic games until 2012, it can be assumed that most cohorts were male). One study reported on a mixed cohort of different combat sports with boxing as a subgroup (22), while the rest of the included study cohorts were boxers only. ...
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Background: High injury rates are to be expected in combat sports. Although case reports and epidemiological studies have documented shoulder injuries in boxers, numbers differ and there is currently no systematic review reporting injury prevalence. Purpose: The aim of this study was to offer an analysis of existing studies documenting shoulder injuries in boxing. Additionally, we wanted to evaluate, if chronic shoulder pathologies seen in former boxers, originate from acute injuries or result from chronic overuse syndromes. Study Design: Systematic Review Methods: We performed a systematic database research according to the PRISMA guidelines on PubMed, Scopus and Google Scholar for the keywords “boxing”, “injury” and “shoulder” or their respective synonyms. Any epidemiological cohort- and cross-sectional studies on boxing, that documented shoulder injuries and were published in German or English language up to January 2020, were included. Statistical analysis including individual and overall proportion with 95% Clopper-Pearson confidence intervals was performed to determine shoulder injury rates for amateur and professional cohorts separately. Results: Methodological quality was assessed using the STROBE statement and a modified Downs&Black's checklist. 13 studies were included, 10 of which met the criteria for statistical analyses. The heterogeneity in study design and cohort characteristics did not allow for detailed quantitative analysis. Overall, shoulder injuries occurred almost twice as often in amateur athletes than in professionals (overall proportion [95% CI]: amateur athletes: 9% [6%; 12%], professionals: 4% [2%; 8%]). Conclusion: No study investigating the long-term effects of boxing on shoulder pathologies was identified. Although specific information on injury type is mostly missing, the few studies addressing it report shoulder dislocations, strains, tendonitis, or chronic impingement syndromes. Unlike head trauma, shoulder injuries do not necessarily lead to cessation of fight, therefore at the ringside gross underreporting of shoulder pathologies must be taken into consideration.
... The bias assessment included four factors: study population and sample, measurement selection and controlling of confounding variables, analysis approaches, funding and disclosure of interest. Among the reviewed literature, eight papers were considered to have a degree of bias (Benson, Hamilton, Meeuwisse, McCrory, & Dvorak, 2009;Davis et al., 2017;Howell et al., 2017;Loosemore et al., 2007;Loosemore et al., 2015a;Siewe et al., 2015;Zazryn, McCrory, & Cameron, 2009;Zazryn et al.2006). The articles with identified bias included bias of sample (Benson et al., 2009;Davis et al., 2017;Howell et al., 2017;Siewe et al., 2015;Zazryn et al., 2009;Zazryn, Cameron, & McCrory, 2006), measurement selection (Davis et al., 2017;Siewe et al., 2014;Zazryn et al., 2006) and analysis approaches (Loosemore et al., 2007;Loosemore et al., 2015a;Zazryn et al., 2009). ...
... Among the reviewed literature, eight papers were considered to have a degree of bias (Benson, Hamilton, Meeuwisse, McCrory, & Dvorak, 2009;Davis et al., 2017;Howell et al., 2017;Loosemore et al., 2007;Loosemore et al., 2015a;Siewe et al., 2015;Zazryn, McCrory, & Cameron, 2009;Zazryn et al.2006). The articles with identified bias included bias of sample (Benson et al., 2009;Davis et al., 2017;Howell et al., 2017;Siewe et al., 2015;Zazryn et al., 2009;Zazryn, Cameron, & McCrory, 2006), measurement selection (Davis et al., 2017;Siewe et al., 2014;Zazryn et al., 2006) and analysis approaches (Loosemore et al., 2007;Loosemore et al., 2015a;Zazryn et al., 2009). Specific descriptions of our assessment of bias in these studies can be found in Table 2. ...
... Among the reviewed literature, eight papers were considered to have a degree of bias (Benson, Hamilton, Meeuwisse, McCrory, & Dvorak, 2009;Davis et al., 2017;Howell et al., 2017;Loosemore et al., 2007;Loosemore et al., 2015a;Siewe et al., 2015;Zazryn, McCrory, & Cameron, 2009;Zazryn et al.2006). The articles with identified bias included bias of sample (Benson et al., 2009;Davis et al., 2017;Howell et al., 2017;Siewe et al., 2015;Zazryn et al., 2009;Zazryn, Cameron, & McCrory, 2006), measurement selection (Davis et al., 2017;Siewe et al., 2014;Zazryn et al., 2006) and analysis approaches (Loosemore et al., 2007;Loosemore et al., 2015a;Zazryn et al., 2009). Specific descriptions of our assessment of bias in these studies can be found in Table 2. ...
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In 2013, the International Boxing Association (AIBA) prohibited the use of headguards for elite male Olympic boxing competitions. Could the removal of the headguard from elite male boxing competitions potentially cause increased injury risk for boxers? The aim of the literature review is to analyse current knowledge about the use of protective headgear and injury prevention in boxing, in order to determine if there are increased injury risks associated with headguard use. Peer-reviewed studies (language: English, Norwegian, Swedish, Danish and Dutch) published from 1980 and onwards were considered. Five academic databases and grey literature sources were searched, and articles were assessed for methodological quality. Only studies that included boxers as the study population with headguards as a factor were considered. A total of 39 articles were included in the review. The analysis of the reviewed literature indicates that headguards protect well against lacerations and skull fractures, while less is known about the protective effects against concussion and other traumatic brain injuries. Most of the analysed studies however use indirect evidence, obtained through self-report or observational techniques with relatively small non-representative samples. There are almost no randomised control trials, longitudinal research designs or samples from recreational boxing. Therefore, AIBA’s decision to remove the headguard has to be seen with caution and injury rates among (male) boxers should be continuously evaluated.
... KKU reports of dental and jaw injuries [6] were similar to the prior studies [33,34], which have reported occurrences of injuries to the body as well as to oral cavity and jaw. We found that the location of boxing camps in the upper northeast of Thailand as well as boxing camps in rural area were directly related to dental trauma and injuries among these Thai boxing athletes. ...
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To improve the efficiency of the dental care service system in Thailand. To synthesize content from Khon Kaen University (KKU) staffs and students’ research and presentations from 1984 to 2020 about oral health hygiene and related diseases. Sixteen publications and presentations by KKU staffs and their students about oral health problems and management were retrieved, reviewed and analyzed. Poor oral health of people in the northeast of Thailand is found in every age group: children, adults and the aging, both male and female. There are still many oral health problems of Thai people in the northeast. KKU Field Works, Projects and Research were able to help reduce these oral health problems. An appropriate preventive oral health program needs to be developed and implemented in Northeastern Thailand.
... 7 A frequência de lesão tende ainda a ser superior em combates terminados por knockout ou knockout técnico. 7 As lesões mais comuns registadas foram as feridas e lacerações na cabeça (61,7%), concussão cerebral (11,7%) e fraturas (8,4%). Os autores verificaram ainda uma morte devido a complicações decorrentes de uma hemorragia subdural na região frontoparietal esquerda. ...
Article
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Amateur boxing practiced at the Olympic Games has been evolving in conditions of safety for its athletes. The most common injuries are head wounds and lacerations, brain concussions and fractures. However, professional boxing has not kept up with this trend of revising rules and promoting greater safety, turning their athletes prone to severe injuries, especially head and neck injuries. The knowledge of epidemiology and biomechanics of boxing injuries may allow athletes and coaches to anticipate injuries and adopt effective prevention strategies.
... In our study 96.7% of Tae kwon do and 86.7% of MMA and boxers encountered trauma whilst playing amongst which 93.3% of the taek-wondo players, 70% of MMA and boxers had previous experience in managing trauma cases. This is found in disparity to the study performed by Zazryn TR, McCrory PR, Cameron PA among Australian professional boxers was found to be 23.3% [12] and at the same time 23.6%. in study conducted by Ngai KM, Levy F, Hsu EB among American mixed martial arts competitors [13]. ...
... Within MMA literature, a fight-participation is defined as 1 athlete's experience of 1 fight, and it is used to calculate injury rates relative to the number of participants rather than the number of bouts. The injury rate identified in the present study was approximately 40 injuries per 100 fight-participations, which is notably higher than the injury rates of other combat sports, such as boxing (25 per 100 fight-participations) and kickboxing (11 per 100 fightparticipations). 22,23 In a recent study about MMA injuries, Fares et al 4 identified a slightly higher injury rate of 51 per 100 fight-participations. A similar study by Jensen et al 8 reported an injury rate of 22.9 to 28.6 per 100 fightparticipations. ...
Article
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Background The popularity of mixed martial arts (MMA) continues to grow in the United States. Although prior work has provided valuable insight concerning injuries in the sport, much of the available literature is limited by factors such as small sample sizes, varying athlete demographics, and inconsistent data collection methods. Purpose To report injury rates and types in MMA and analyze potential variance between competition and match variables. Study Design Descriptive epidemiology study. Methods We performed a retrospective review of injuries sustained by fighters during MMA contests between 2018 and 2019 using ringside physician postmatch injury reports from Wisconsin and Arizona. The prevalence of overall injuries and specific injury types was compared by location (Arizona vs Wisconsin), competition level (amateur vs professional), match result (decisions vs any other result), and match winners versus losers. Results In 503 contests, 285 (57%) had at least 1 injury. In these 285 matches, participants experienced 401 injuries: 197 (49%) in professional bouts and 204 (51%) in amateur bouts. The match injury rate was higher in professional bouts than in amateur contests (68% vs 51%; P < .001). Amateur fighters had more contusions and hematomas (31% vs 22%; P < .001), while professional fighters had more lacerations (39% vs 23%; P < .001). Losers exhibited a higher match injury rate than winners (48% vs 24%; P < .001). Winners experienced a higher proportion of fractures (19% vs 9%; P = .005), and losers experienced more concussions (17% vs 2%; P < .001). Conclusion Professional fighters and losers of MMA bouts exhibited higher injury rates relative to amateurs and winners. The prevalence of specific injury types varied by competition level, match result, and match winners versus losers. The results of this study may be used to better understand the current injury profile in MMA and to develop targeted strategies for injury prevention.
... Previous findings on association between weight class and injury have been mixed. Higher rates of injury have been documented in heavyweight Muay Thai 14 and MMA 15 fighters, whereas other studies showed no difference in risk of injury by weight in boxing 16 and MMA. 17 Prior analyses have found differences in fight dynamics by weight division, such as fewer but stronger strikes in heavyweight fighters 18,19 and more time spent in high-intensity combat situations in lightweight fighters. 20 However, few studies have examined the effect of weight class on longitudinal changes subsequent to RHI, such as regional brain atrophy, cognitive decline, and behavioral changes. ...
Article
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Traumatic brain injury (TBI) is a common source of functional impairment among athletes, military personnel, and the general population. Professional fighters in both boxing and mixed martial arts (MMA) are at particular risk for repetitive TBI and may provide valuable insight into both the pathophysiology of TBI and its consequences. Currently, effects of fighter weight class on brain volumetrics (regional and total) and functional outcomes are unknown. Fifty-three boxers and 103 MMA fighters participating in the Professional Fighters Brain Health Study (PRBHS) underwent volumetric magnetic resonance imaging (MRI) and neuropsychological testing. Fighters were divided into lightweight (≤139.9 lb), middleweight (140.0–178.5 lb), and heavyweight (>178.5 lb). Compared with lightweight fighters, heavyweights displayed greater yearly reductions in regional brain volume (boxers: bilateral thalami; MMA: left thalamus, right putamen) and functional performance (boxers: processing speed, simple and choice reaction; MMA: Trails A and B tests). Lightweights suffered greater reductions in regional brain volume on a per-fight basis (boxers: left thalamus; MMA: right putamen). Heavyweight fighters bore greater yearly burden of regional brain volume and functional decrements, possibly related to differing fight dynamics and force of strikes in this division. Lightweights demonstrated greater volumetric decrements on a per-fight basis. Although more research is needed, greater per-fight decrements in lightweights may be related to practices of weight-cutting, which may increase vulnerability to neurodegeneration post-TBI. Observed decrements associated with weight class may result in progressive impairments in fighter performance, suggesting interventions mitigating the burden of TBI in professional fighters may both improve brain health and increase professional longevity.
Article
Objective: There is a high incidence of concussion and frequent utilization of rapid weight loss (RWL) methods among combat sport athletes, yet the apparent similarity in symptoms experienced as a result of a concussion or RWL has not been investigated. This study surveyed combat sports athletes to investigate the differences in symptom onset and recovery between combat sports and evaluated the relationships between concussion and RWL symptoms. Design: Cross-sectional study. Setting: Data were collected through an online survey. Participants: One hundred thirty-two (115 male athletes and 17 female athletes) combat sport athletes. Interventions: Modified Sport Concussion Assessment Tool (SCAT) symptom checklist and weight-cutting questionnaire. Main outcome measures: Survey items included combat sport discipline, weight loss, medical history, weight-cutting questionnaire, and concussion and weight-cutting symptom checklists. Results: Strong associations (rs = 0.6-0.7, P < 0.05) were observed between concussion and RWL symptoms. The most frequently reported symptom resolution times were 24 to 48 hours for a weight cut (WC; 59%) and 3 to 5 days for a concussion (43%), with 60% to 70% of athletes reporting a deterioration and lengthening of concussion symptoms when undergoing a WC. Most of the athletes (65%) also reported at least one WC in their career to "not go according to plan," resulting in a lack of energy (83%) and strength/power (70%). Conclusions: Rapid weight loss and concussion symptoms are strongly associated, with most of the athletes reporting a deterioration of concussion symptoms during a WC. The results indicate that concussion symptoms should be monitored alongside hydration status to avoid any compound effects of prior RWL on the interpretation of concussion assessments and to avoid potential misdiagnoses among combat athletes.
Article
Background Professional bare-knuckle fighting (BKF) is a variation of boxing which held its first modern legal event in 2018 in Wyoming. Since then, the sport has expanded with state-sanctioned events held in Florida, Missouri, Mississippi, Kansas, and Alabama. The purpose of this study was to evaluate the epidemiology of injuries in bare-knuckle fighting bouts and to discern any trends which may distinguish it from traditional boxing with padded gloves. Methods Observational data collection for all state-sanctioned professional bare-knuckle fighting bouts was conducted sequentially over a two-year period from June of 2018 through November of 2020. Information related to fight outcome, injury diagnosis, and injury location was documented. This data was then analyzed and the incidence rates by injury type and location were calculated. Results There were 141 bouts conducted during the study period. Out of the 282 individual combatants, 105 (36.6%) sustained at least one injury during the event and 123 total injuries were recorded. In total, 98 (34.8%) lacerations were recorded; on average, 6.2 +- 4.5 sutures were required per laceration. There were 5 superficial hand lacerations and 80 facial lacerations. Seventeen (6.0%) fractures occurred, with 8 hand fractures, 6 nasal fractures, 2 orbital fractures, and 2 dental fractures. There were 8 (2.8%) periorbital hematomas sustained by fighters. Transfer to the hospital was required on 5 (1.8%) separate occasions, twice for orbital fractures and 3 times for traumatic brain injuries. In all, there were 8 (2.8%) concussions with symptoms. Conclusion The most frequent injuries in BKF include lacerations and hand fractures. Concussions are relatively uncommon compared to other injuries.
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To document the injury rate in three British Shotokan karate championships in consecutive years. In these tournaments strict rules governed contact, with only "light" or "touch" contact allowed. Protective padding for the head, hands, or feet was prohibited. Prospective recording of injuries resulting from 1770 bouts in three national competitions of 1996, 1997, and 1998. Details of ages and years of karate experience were also obtained. 160 injuries were sustained in 1770 bouts. The overall rate of injury was 0.09 per bout and 0.13 per competitor. 91 (57%) injuries were to the head. The average age of those injured was 22 years, with an average of nine years of experience in karate. The absence of protective padding does not result in higher injury rates than in most other series of Shotokan karate injuries. Strict refereeing is essential, however, to maintain control and minimise contact.
Article
This paper presents the injury statistics for the 1981 and 1982 USA/Amateur Boxing Federation National Championships. These tournaments consisted of 547 bouts with 1,094 participants. Eighty-five injuries of varying degrees of severity were recorded; 52 were considered notable. The most frequent injuries were head blows, soft-tissue hand injuries, and facial lacerations. Forty-eight matches were stopped because of head blows, which occurred at a rate of 4.38%. All other injuries occurred at a rate of 4.75%. Amateur boxing injuries could be reduced if the sport were included in the scholastic milieu and if headgear, mats, and gloves were better designed.
Article
Over a two-year period, we reviewed all acute boxing injuries among professional boxers statewide (484 the first year, 422 the second year). During the study period, the boxers fought 3,110 rounds and incurred 376 injuries (262 craniocerebral injuries, 114 other injuries), ie, they incurred 1.2 injuries per 10 rounds fought (0.8 craniocerebral, 0.4 others). Only four boxers required immediate neurological evaluation at a hospital after a fight; one of the four died as a result of bilateral subdural hematomas. Facial lacerations were the most common other type of injury (66 cases), followed by hand and eye injuries (8 cases each). The authors suggest that severe, acute neurological injuries are rare in professional boxing when strict medical supervision is present. However, they caution that their findings should not be used to draw inferences about the development of chronic neurological injuries among professional boxers.
Article
Via neuropsychological testing, this research team found post-match cognitive impairment in amateur boxers despite the fighters' use of headgear. Acute traumatic brain injury (ATBI) represents the neurologic consequence of concussive and subconcussive blows to the head. Evidence suggests that ATBI may be associated with boxing and collision sports such as American football and soccer, thus potentially exposing millions of athletes annually. The objectives of this study were to determine whether significant ATBI occurs in boxers who compete and, if present, the nature of the cognitive impairment. A secondary objective was to determine if headgear could reduce the risk for ATBI in amateur boxing. In this inception cohort study, 38 amateur boxers underwent neuropsychological examination before and shortly after a boxing match and were compared with a control group of 28 amateur boxers who were tested before and after a comparable physical test. The main outcome measures were neuropsychological tests (memory, mental and fine-motor speed, planning, and attention) proven to be sensitive to cognitive changes incurred in contact and collision sports. The boxers who competed exhibited an ATBI pattern of impaired performance in planning, attention, and memory capacity when compared with controls. They had significantly different findings in the Categorization Task Test (P = 0.047); Digit Symbol Test (P = 0.02); Logical Memory: Short Term Memory and Long Term Memory subtests (both tests, P < 0.001); and Visual Reproduction: Short Term Memory subtest (P < 0.001) and Long Term Memory subtest (P < 0.03). Participation in amateur boxing matches may diminish neurocognitive functioning despite the use of headgear. The neurocognitive impairment resembles cognitive symptoms due to concussions. Guidelines are needed to reduce the risk for repeated ATBI.
Article
Eighty six amateur boxers underwent a series of neuropsychological assessments on three occasions--pre bout, immediate post bout and follow up within two years; 31 water polo players and 47 rugby union players acted as controls. The neuropsychological tests were selected as being sensitive to subtle cognitive dysfunction and formed part of a battery of other neurological and ophthalmic assessments. No evidence of neuropsychological dysfunction due to boxing was found, either following a bout or a series of bouts at follow up. None of a range of parameters including number of previous contests, recovery from an earlier bout, number of head blows received during a bout and number of bouts between initial assessment and follow up, were found to be related to changes in cognitive functioning.
Article
To determine the incidence, pattern, and severity of injuries resulting from participation in amateur boxing. A prospective 5-month survey of injuries which occurred during competitive amateur boxing and training. Amateur boxing competitions held in Dublin between November 1992 and March 1993, and the six largest amateur boxing clubs in Dublin. All the competitors in the tournaments and the > 16 year old members of the boxing clubs. Participation in competitive amateur bouts and/or boxing training. Incidence, pattern, and severity of injuries sustained in competition and training. The incidence of injuries in competition was 0.92 injuries per man-hour of play (or 0.7 injuries per boxer per year), while the incidence in training was 0.69 injuries per boxer per year. Cerebral injuries were reported only in competition, most of these being mild concussion. Hand, wrist and facial injuries were related to direct impact and occurred more frequently in competition than training, while injuries to other body parts were predominantly chronic and training-associated. Shoulder and knee injuries were the most debilitating injuries seen. The yearly risk of injury resulting from participation in amateur boxing is relatively low when compared with other sports. Cerebral injuries, which occur almost exclusively in competition, are predominantly mild concussions.
Article
To investigate the location, type, situation and mechanism of head and neck injuries in young taekwondo athletes. Experimental design: Prospective. Setting: National and international taekwondo tournaments. Participants: 3,341 boys and 917 girls, aged 6 to 16 years. Measures: Injury rates per 1,000 athlete-exposures (A-E) for total number of head and neck injuries, location, type, situation, and mechanism of injury. There was a significant difference between young male and female taekwondo athletes in total head and neck injury rate (p < 0.001) with the boys (21.42/1,000 A-E) recording a higher rate than the girls (16.91/1,000 A-E). The head was the most often injured body part (6.10/1,000 A-E and 4.55/1,000 A-E for boys and girls, respectively). The contusion was the most often occurring injury type for both boys (8.41/1,000 A-E) and girls (7.80/1,000 A-E). The cerebral concussion ranked second in both boys (5.11/1,000 A-E) and girls (4.55/1,000 A-E). The unblocked attack was the major injury situation for both boys (19.78/1,000 A-E) and girls (14.96/1,000 A-E). As a consequence, the major injury mechanism was receiving a blow (20.93/1,000 A-E and 16.25/1,000 A-E for boys and girls, respectively). Only the boys (0.66/1,000 A-E) incurred the most serious head and neck injuries that resulted in > or = 21 days away from participation. The national and international taekwondo governing bodies should review their current injury prevention measures. Given the potentially debilitating nature of these injuries, implications for any diagnostic capabilities on site should be carefully reviewed.
Article
Concerns about the significant injury risks in boxers have been well documented. To inform the continuing debate, updated information about the risk of injury for participants, and suitable means of modifying or preventing these risks, need to be identified. Data describing all professional boxing fight outcomes and injuries sustained during competition, from August 1985 to August 2001, were obtained from the Victorian Professional Boxing and Combat Sports Board. A total of 107 injuries were recorded from 427 fight participations, corresponding to an injury rate of 250.6 injuries per 1000 fight participations. The most commonly injured body region was the head/neck/face (89.8%), followed by the upper extremities (7.4%). Specifically, injuries to the eye region (45.8%) and concussion (15.9%) were the most common. About three quarters of all injuries were lacerations/open wounds or superficial. No information was available on the mechanism of injury. Future research should collect information on the mechanism of injury, as this is crucial for the development and implementation of effective injury prevention strategies. A suggested boxing injury report form is provided to facilitate this.