Headgear comes off for amateur boxers

This summer, amateur, elite male boxers are back to competing without headgear after nearly 3 decades of being required to wear it during competition. The headgear rule was put in place by the International Boxing Association (AIBA) before the 1984 Olympics, but now elite, male boxers are beginning to compete in much more professional style.

So what will this mean for concussion rates and concussion risk?

At first glance, it may seem to put boxers at greater risk; however, clinical evidence has shown that headgear does not necessarily reduce the incidence of concussion. The advantage of headgear is that it protects the face and decreases eye injuries, nose injuries, and facial lacerations. It does not stop the head from spinning, the primary cause of concussion in boxers.

There are four ways that boxers can get brain injury, but none of them can be prevented by wearing headgear. These mechanisms include:

• Rotational acceleration. This occurs when the head twists/spins – usually from a blow to the side of the jaw, cheek, or chin – and the brain follows, resulting in the stretching and tearing of axons. (This is why knockouts usually come from a severe blow to the chin.)

• Linear acceleration. This happens when the brain moves forward/backward – usually from a direct blow to the face – and strikes the skull, resulting in the stretching or tearing of neurons in the brain and brain stem.

• Injury to the carotid arteries. This occurs after a sudden flexion of the neck – usually from a direct blow to it – resulting in tears in one or both carotid arteries, causing a stroke.

• Impact deceleration. This is the rapid slowing of the brain inside the skull and is usually caused by hitting an immovable object like the ring floor, resulting in cerebral contusions.

In fact, there is a new, still unpublished AIBA study that suggests the removal of headgear would decrease head injuries, such as concussions. According to the study spearheaded by AIBA medical commission chairman Dr. Charles Butler, the rate of concussion was 0.38% in 7,352 rounds for boxers wearing headgear, compared with 0.17% in 7,545 rounds for those without headgear.

On the other hand, another recent study by the Cleveland Clinic found that headgear can help decrease linear acceleration and the potential for injury from it.

Clearly, there is still much debate on this issue. As amateur boxers start this new phase of competition, experts will be better able to observe changes in concussion rates, if any, and hopefully come to a definitive conclusion as to whether headgear use has any impact at all.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

This summer, amateur, elite male boxers are back to competing without headgear after nearly 3 decades of being required to wear it during competition. The headgear rule was put in place by the International Boxing Association (AIBA) before the 1984 Olympics, but now elite, male boxers are beginning to compete in much more professional style.

So what will this mean for concussion rates and concussion risk?

At first glance, it may seem to put boxers at greater risk; however, clinical evidence has shown that headgear does not necessarily reduce the incidence of concussion. The advantage of headgear is that it protects the face and decreases eye injuries, nose injuries, and facial lacerations. It does not stop the head from spinning, the primary cause of concussion in boxers.

There are four ways that boxers can get brain injury, but none of them can be prevented by wearing headgear. These mechanisms include:

• Rotational acceleration. This occurs when the head twists/spins – usually from a blow to the side of the jaw, cheek, or chin – and the brain follows, resulting in the stretching and tearing of axons. (This is why knockouts usually come from a severe blow to the chin.)

• Linear acceleration. This happens when the brain moves forward/backward – usually from a direct blow to the face – and strikes the skull, resulting in the stretching or tearing of neurons in the brain and brain stem.

• Injury to the carotid arteries. This occurs after a sudden flexion of the neck – usually from a direct blow to it – resulting in tears in one or both carotid arteries, causing a stroke.

• Impact deceleration. This is the rapid slowing of the brain inside the skull and is usually caused by hitting an immovable object like the ring floor, resulting in cerebral contusions.

In fact, there is a new, still unpublished AIBA study that suggests the removal of headgear would decrease head injuries, such as concussions. According to the study spearheaded by AIBA medical commission chairman Dr. Charles Butler, the rate of concussion was 0.38% in 7,352 rounds for boxers wearing headgear, compared with 0.17% in 7,545 rounds for those without headgear.

On the other hand, another recent study by the Cleveland Clinic found that headgear can help decrease linear acceleration and the potential for injury from it.

Clearly, there is still much debate on this issue. As amateur boxers start this new phase of competition, experts will be better able to observe changes in concussion rates, if any, and hopefully come to a definitive conclusion as to whether headgear use has any impact at all.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.

This summer, amateur, elite male boxers are back to competing without headgear after nearly 3 decades of being required to wear it during competition. The headgear rule was put in place by the International Boxing Association (AIBA) before the 1984 Olympics, but now elite, male boxers are beginning to compete in much more professional style.

So what will this mean for concussion rates and concussion risk?

At first glance, it may seem to put boxers at greater risk; however, clinical evidence has shown that headgear does not necessarily reduce the incidence of concussion. The advantage of headgear is that it protects the face and decreases eye injuries, nose injuries, and facial lacerations. It does not stop the head from spinning, the primary cause of concussion in boxers.

There are four ways that boxers can get brain injury, but none of them can be prevented by wearing headgear. These mechanisms include:

• Rotational acceleration. This occurs when the head twists/spins – usually from a blow to the side of the jaw, cheek, or chin – and the brain follows, resulting in the stretching and tearing of axons. (This is why knockouts usually come from a severe blow to the chin.)

• Linear acceleration. This happens when the brain moves forward/backward – usually from a direct blow to the face – and strikes the skull, resulting in the stretching or tearing of neurons in the brain and brain stem.

• Injury to the carotid arteries. This occurs after a sudden flexion of the neck – usually from a direct blow to it – resulting in tears in one or both carotid arteries, causing a stroke.

• Impact deceleration. This is the rapid slowing of the brain inside the skull and is usually caused by hitting an immovable object like the ring floor, resulting in cerebral contusions.

In fact, there is a new, still unpublished AIBA study that suggests the removal of headgear would decrease head injuries, such as concussions. According to the study spearheaded by AIBA medical commission chairman Dr. Charles Butler, the rate of concussion was 0.38% in 7,352 rounds for boxers wearing headgear, compared with 0.17% in 7,545 rounds for those without headgear.

On the other hand, another recent study by the Cleveland Clinic found that headgear can help decrease linear acceleration and the potential for injury from it.

Clearly, there is still much debate on this issue. As amateur boxers start this new phase of competition, experts will be better able to observe changes in concussion rates, if any, and hopefully come to a definitive conclusion as to whether headgear use has any impact at all.

Dr. Jordan is the director of the brain injury program and the memory evaluation treatment service at Burke Rehabilitation Hospital in White Plains, N.Y. He currently serves as the chief medical officer of the New York State Athletic Commission, as a team physician for USA Boxing, and as a member of the NFL Players Association Mackey-White Traumatic Brain Injury Committee and the NFL Neuro-Cognitive Disability Committee.