Since the Olympic Games in 2012 boxers no longer had to wear head guards. A decision that many believe is a wrong move when it comes to protecting against concussions and TBI. But what does the evidence tell us?
In 2013, the International Boxing Association (AIBA) made the controversial decision to ban the use of headgear in elite Olympic men's boxing competitions. One of the main arguments behind this decision was the AIBA's claim that boxers would take more risks and "head" when boxing with head protection.
Recognition, evaluation and treatment of concussions
Olympic boxing differs from professional boxing in that it consists of 3 x 3-minute rounds with a break of 1 minute and not 12 x 3-minute rounds. The athletes also use more padded gloves and a scoring system that puts technique in the foreground over damage or harm to the opponent. This, along with more protective umpires, means that Olympic boxing is seen as "safer" than professional boxing.
Despite these safety measures, Olympic boxers are still at risk of head injuries and concussions, and therefore the elimination of the mandatory use of head guards remains controversial. But what does the evidence say, a new systematic review has examined whether AIBA made the right decision.
Methods
This systematic review was carried out and reported in accordance with the PRISMA guidelines. Five databases were searched (SPORTDiscus, ERIC, PubMed, PsychINFO and ISI WoS) and selected because they offer insights into biomedical, behavioral and social science research on head injuries in Olympic boxing.
The databases were searched using the following search string: "Boxing" AND "Concussion OR Brain Injury OR Head Injury" AND "Headgear OR Head Armor". A search was made for gray literature, the details of which, however, were not included in the description. This is disappointing as conference or small reports are likely to contain extensive information on the subject.
Studies were included in the review if:
Published in English and in specialist journals
Be an original study, theoretical paper, or review article
Contains a sample / population of boxers
Focused on head protection / head injury while boxing
The risk of bias was assessed and inclusion in the review was assessed by consensus. A total of 39 studies were included in the review and details of the studies are included in the article, which is available free of charge.
Results & clinical significance
It goes without saying that boxing is inherently associated with the risk of traumatic head injuries. There is only limited evidence that they reduce the risk of concussions or traumatic brain injuries.
This limited evidence comes from a lack of studies and data on the effects of head protection use on concussions. However, there is enough data to suggest that head protection reduces the risk of skull fractures or facial cuts. This latter point may contradict AIBA's claim that boxers are less likely to lead.
Brief summary of the systematic review of the use of head protection for Olympic boxing
Head protection effectively protects against facial cuts and skull fractures
There is not enough evidence to suggest that headguards prevent concussion
The incorporation of technology into headgear will help understand the type and magnitude of the forces exerted by boxers
Poorly designed and scaled studies hamper progress in this area
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As stated above in the article, one of the main reasons AIBA decided to move away from the use of head protection is conduct. A study by Davis et al. (2017) shows that fighters make more defensive movements and throw and land fewer blows if they do not wear head protection. They also found that there was a higher rate of knockouts when head protection was not worn, so the results of this review are inconclusive.
This is similar to the rugby argument about the use of headgear, especially scrum caps, to reduce the risk of concussions and the general risk of brain injury. The complexity of the forces in both boxing and rugby makes it very difficult to draw clear conclusions, as there are many situational factors such as type of head wear, direction of travel, rotational forces, to name just a few examples.
What is missing from this review is the voice of the athletes which is invaluable in discussing the risk and use of headgear. After all, if they don't want to use headgear and we don't understand why it doesn't matter how good the headgear is.
