As recently discussed, one of the most important questions in combat sports medicine is how much head trauma is too much?
Although the answer is not known, the current regulatory landscape could use improvement in deciding when regulators should pull the plug on an athlete that is ‘too tough for their own good‘. To this end an important study was published today in the Journal of The Physician and Sports Medicine addressing this issue and calling for regulatory consistency.
In today’s article titled Determining Brain Fitness to Fight: Has the Time Come? the authors highlight the fact that “up to 20-50% of former professional boxers” exhibit symptoms of chronic brain injury. They further note that “the precise threshold of damage required for the production of both acute and chronic neuropathology remains elusive; thus early detection and appropriate management of neurological injury in professional boxing is imperative“.
The note that without central regulation “there is little uniformity with regard to the medical regulation of professional boxing in the United States” with some commissions understanding the perils of head trauma far less than others. The authors call for a uniform set of minimum requirements for brain safety that would be available and shared between states. The recommended standards include –
- Standardized neurological testing
- Use of Neuroimaging
- Adoption of a Fight Exposure Index to identify High Risk Fighters
- To consider looking to biomarkers in future years if their clinical significance becomes clearer
The article ends with the following conclusion –
Unfortunately, acute and chronic brain injuries are the most common injuries sustained by boxers. The sport has long been regulated by state commissions, but currently these governing bodies vary greatly in providing for the neurologic health of boxers. Many states lack best practice medical requirements and enforcement varies widely, which leads to forum shopping by the boxer until a favorable fighting venue is located. State regulation of boxing also results in conflicts of interest because stringent regulation by a state may lead to lost revenues when a bout is scheduled elsewhere. Boxing remains the only major sport in this country that lacks a central regulatory organization. Concussion and lasting brain damage is an especially significant risk for boxers, as the goal of the sport is, in fact, to deliver a concussion to the opponent. With studies estimating that up to half of all boxers will suffer from chronic traumatic brain injuries, the time has come for the development of uniform minimum requirements for brain safety that all states incorporate. The health of boxers and the long-term viability of the sport both depend on it.