Headgear isn't enough to protect boxers from the punches that can adversely affect their thought processes, a study says.
''Headgear doesn't prevent the rotational acceleration that you see in boxing,'' said Dr. Barry D. Jordan, director of the traumatic brain injury program at Burke Hospital in White Plains, N.Y. ''The key to a knockout or a technical knockout is the kind of blow that causes the head to rotate.''
Another doctor who has done research on boxing injuries, however, believes the assertion of risk is overblown and the paper's argument against headgear is unsupported.
The study by Jordan and colleagues in the Netherlands looked at Dutch amateur boxers in what Jordan described as Golden Gloves level of competition. The report was published in the medical journal The Physician and Sportsmedicine.
All of the boxers were given paper-and-pencil tests in such areas as the ability to pay attention, plan and remember. Thirty-eight were tested before and after a bout; 28 were tested before and after doing rounds of punching bag practice. In accordance with Dutch rules, all of the 38 who fought wore headgear in the ring.
In the fights, 35 percent of the competitors received more than 10 punches to the head. Thirteen percent of the bouts ended in a knockout or a technical knockout.
The researchers checked whether the fights affected the boxers' ability to think. And the tests showed the fighters did worse after their bouts, compared with the controls who did not fight, in their abilities to plan, remember and pay attention.
The changes were not so great as to be obvious from the fighters' behavior, but they did indicate concussion, Jordan said. Blows to the head affect the frontal lobes behind the forehead and the temporal lobes behind the eyes, and those regions of the brain are crucial for planning, he said.
Headgear can offer some protection, notably to the ears, but the study indicates headgear does not protect the brain against the impact of dangerous punches to the chin, Jordan said. These blows send the brain sloshing against the inside of the skull, he said.
Dr. R.T. Ross of Memorial Medical Center in Savannah, Ga., said he believes the report overdramatizes the risk of concussion. ''I believe it is a very real problem, but it has a much lower incidence than you might be led to believe,'' he said.
In a separate study, Ross looked at eight years of data on Marine Corps basic trainees for whom boxing was part of training.
This study is not directly comparable to the Jordan research. Although the fighters wore gloves and headgear, they had only three 15-second rounds of trainee-to-trainee fighting. The researchers looked for serious acute brain injuries. They found three among approximately 180,000 participants, said the study in the journal Military Medicine.
''The risk of serious head injury in a well-supervised, instructional boxing program is relatively minimal,'' the paper concluded.
The problem that boxing faces is that injuries get outsized public attention, Ross said.
''The very graphic nature -- and it's a very newsworthy event -- lends itself to attracting a lot of attention,'' he said.
Ross said he considered the Jordan paper's conclusion that headgear is not protective to be ''absolutely unfounded.''
''Common sense would tell you anecdotally that the use of any protective gear is a more safe option,'' Ross said.
To show otherwise would require an experiment in which one group of boxers would fight while wearing headgear while another group would fight without it -- and this would not be allowed for ethical reasons, he said.
A member of the American Medical Association board also supports the use of headgear but would rather see boxing itself outlawed.
''Headgear will protect the area under the headgear, but you are still pounding the head and knocking the brain back and forth in the skull,'' said Dr. Joseph A. Riggs of Haddonfield, N.J.
The acute damage to the brain may lead to chronic deficiencies that could take years to develop, he said.
The AMA's position on boxing is that it should be banned. Until there is a ban, however, blows to the head should be prohibited, the policy statement says. And until blows to the head are prohibited, boxers should wear headgear, it says.
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