Ringside Doctor Calls For Standardized Post Concussion Protocols in Boxing

Adding to this site’s data base of combat sports safety studies, a recent article was published in the latest edition of the Journal of Combat Sports Medicine calling for the industry to standardize post concussion protocols in boxing.

Written by Dr. Nitin Sethi, neurologist and chief physician with the New York State Athletic Commission, the physician notes that other sports have developed post-concussion return to play protocols to enhance athlete safety and that professional boxing could use its own set of standardized protocols.

Dr. Sethi recommends the following be adopted by the industry:

Post-concussion return-to-boxing protocol
Once the boxer is symptom free for at least 24
hours and a medical release to return to the gym
has been signed by the treating physician, he/she
can begin a graded return to boxing as detailed
below.

  1. Begin with light aerobic activity (walking or stationary bike for 10 minutes, no resistance training).
  2. If asymptomatic, progress to boxing-specific activities such as jumping rope and shadow
    boxing.
  3. If asymptomatic, progress to non-contact training skill drills (e.g., pad work, speed bag, heavy
    bag, etc.).
  4. If asymptomatic, progress to light sparring with
    full head gear.

There is no fixed time limit on each of the above
steps. If any post-concussion symptoms occur
while in the stepwise return to boxing program,
then the boxer should be instructed to drop back
to the previous asymptomatic level and try to
progress again after a further 24–48-hour period
of rest has passed.

  1. Return to competitive boxing only occurs when
    the period of mandatory medical suspension
    (90 days for a concussion) has expired. There
    should be no exceptions to this rule.
  2. Before return to competitive boxing every boxer should undergo a final neurology clearance
    to fight by an independent, unaffiliated neurologist

As good practice guidelines, the following are further suggested:

  1. The referee, ringside physicians and boxing
    coaches should be skilled in identifying concussions in the ring and in the management of a
    concussed boxer both in the ring and gym.
  2. Establishing a database which tracks the number of concussions sustained by a professional boxer. This goal of the database shall be to accurately record, and report concussions sustained by an individual boxer. This shall help in prognosticating the boxer when to hang up his/her gloves as well as a valuable tool for research on concussion risks, treatment, and management.
  1. Every professional boxer should have a formal
    neuropsychological (neurocognitive) evaluation
    at the time of starting his professional career, at
    the midway point and towards the end of his
    career. A decline in neurocognitive function
    should raise concern and be further assessed
    on a case-by-case basis.
  2. Emphasis should be placed on educating boxers, trainers, and coaches about concussions
    and the reported link between multiple concussions and chronic traumatic encephalopathy
    (CTE)

The full article, titled Standardized Post Concussion Return to Boxing Protocol, can be viewed with membership with the Association of Ringside Physicians.


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