Study Calls for Need of More Boxing Headgear Concussion Data

Adding to this site’s database of combat sports safety studies, a recent study was published in the European Journal of Sports Science reviewing past data on injury prevention effectiveness for headgear in boxing.

In the study, titled Concussions, cuts and cracked bones: A systematic literature review on protective headgear and head injury prevention in Olympic boxing, the authors examined peer reviewed studies on the topic over the last 4 decades. From the literature they concluded there is ample evidence to support the fact that headguards are effective in reducing cuts along with serious injuries such as skull fractures (by having padding when heads clash with each other or strike another hard object). However they also conclude that the data is lacking in addressing concussion reduction effectiveness. On the concussion point the authors note as follows:

The complexity of studying concussion and traumatic brain injury (TBI) is exemplified in the reviewed literature through the substantial variation in reported concussion rates, from 6.1% (Timm et al., 1993) to 75% (Loosemore et al., 2015a; Zazryn et al., 2006). The difference in concussion rates between studies also supports research indicating that concussions are notoriously under-reported in competitive sports (Kroshus, Garnett, Hawrilenko, Baugh, & Calzo, 2015; Malcolm, 2019). Yet, as Haglund & Eriksson first pointed out in 1993, the literature concerning possible risks of TBI in Olympic boxing is sparse and the results are inconsistent. Hence, it is difficult to compare results from the studies in the reviewed literature and draw conclusions based on it.

However, these studies also demonstrate that current headguards provide less protection against rotational and angular impacts sustained from blows such as hooks, which arguably are dangerous impacts in terms of causing TBI in boxers (Bartsch, Benzel, Miele, Morr, & Prakash, 2012b).

The full abstract reads as follows:

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.


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