DEEP IMPACT

There are no clear or easy answers for the deaths that have rocked professional boxing this year. On Wednesday, the death of American Patrick Day revived the age-old debate of boxing’s safety, as well as head injuries in other sports, many of which have only recently admitted to the dangers of concussion injuries.

WHAT IS CONCUSSION?

Derived from the Latin word concusses, concussion means to shake violently. A concussion happens when a force causes the brain to rapidly move back and forth inside the skull. This may be caused by either a direct blow or by a blow to the body that forces the head to quickly rotate. The brain sits in a protective fluid inside the skull, and concussions can happen when the brain collides with the skull, or even simply jolts within its protective fluid without contact with bone. (see figure)

DIAGNOSIS

A concussion diagnosis is made on the basis of external symptoms which include: drowsiness, headache, loss of consciousness, memory loss, irritability, confusion, balance problems, dizziness, difficulty speaking and communicating, depression, nausea and vomiting, and changes in sleep patterns.

These symptoms can occur immediately after impact, or several days later, and are not always obvious.

LONG-TERM CONSEQUENCES

Athletes suffering concussions on-field are most often cleared to play within minutes; those showing more advanced signs of brain trauma often return to their sports within weeks. But more evidence is emerging about the long-term effects of a career spent dealing with impact injuries to the head. In 2017, the US-Canadian National Hockey League settled a case with hundreds of retired players who had sued the league for hiding the dangers of head hits. Several players who had died were found to have a condition called chronic traumatic encephalopathy, a disease caused by repeated head injuries.

PROTOCOLS

Most sports prescribe a series of steps to be followed by doctors in cases of suspected concussion. Following a head injury a player is asked a series of questions (Maddock’s Questions) like the name of the venue, opponents, scorer, last game’s opponents, etc. The player can return to play if cleared. Some sports do more detailed tests, including neuropathological tests on athletes before and after a season, or a particular injury. But there is little parity in protocols followed in various sports, as well as across different leagues in the same sport.

WHICH BRINGS US TO BOXING…

While head trauma is a part of most contact sports, and can even occur in non-contact sports like cricket, in boxing, the very objective of the sport is to inflict head trauma. Here is a sport where a concussion is the desired objective. The 2017 Consensus Statement from the Association of Ringside Physicians, the authority on injuries in combat sports, defines a knockout after a punch to the head as a ‘likely concussion on account of some degree of neurological impairment’.

The statement also states that there are no uniform guidelines followed in combat sports for the management of fighters with concussion. There is no doubt about the damaging effects of boxing on the brain. Deaths after a fight are rare, but they do happen; but it’s the long-term effects of repeated blows to the head that is far more insidious and widespread. Think Muhammad Ali, or Floyd Patterson, or any number of heavyweight greats of the past.