By Margaret Goodman, MD
Often times I am asked by boxers and the like, “What is a concussion?” The most crucial thing for a fighter to do in the ring is not get hit. Needless to say, that is often not the case. Many boxers are taught to stand in the ring and take punishment to their bodies and head. How harmful is this? Everyone seems to respect the fighter that can take a punch. Somehow that becomes synonymous with the fighter who has a heart. Unfortunately, the fighter with courage is often the same one with a concussion.
It makes perfect sense that head blows are not good for you. The brain, which has the consistency of a hard custard, sits encased in fluid within the skull. The fluid acts like a shock absorber and prevents injury to the brain when the head is struck. Multiple blows, or even a single blow, can result in a concussion.
Concussion refers to a temporary disruption in the brain’s function.... “a short circuiting.” This occurs on a cellular level affecting the brain’s circulation and biochemistry. The fighter, whose bout is stopped from a TKO or KO, will often have a concussion. However, the winner who has taken their fair share of headshots, can also have one. The signs and symptoms can be subtle. They can take some time to appear, and are often overlooked by even the most experienced observers.
A concussion can happen after one round or twelve. Its effects can last days or months depending on its severity. Medically, the severity is judged by whether or not loss of consciousness occurred and/or the presence of amnesia of the events surrounding a fight.
So, how can a ring doctor identify if a fighter has suffered a concussion during the fight? This is tough because it might require a lot of questions, and there certainly isn’t time for that. The minute between rounds is crucial to the boxer’s success. It is important for the doctor to not interfere with those precious moments. Furthermore, a fighter concentrating on the task at hand might have a bit of trouble answering detailed questions.
Conversely, a fighter that can’t find their corner after the bell rings; a fighter that is less alert and staring into space between rounds; or a fighter that is taking a great many punches as the fight continues could each have a concussion. If this is the case, the fight must stop so the boxer can be evaluated medically.
After the fight, it is important for the fighter’s corner and family to know what symptoms to look for that might signify a concussion. These can include: headache, dizziness, ringing in the ears, blurred vision, fatigue/lethargy, weakness, memory loss, trouble with balance/coordination, sleeplessness OR sleepiness, personality changes, and apathy. So, I always recommend that someone be with a fighter for at least 24-48 hours after a tough fight. In Nevada the participants are given a sheet in either Spanish or English listing the symptoms that could signify a head injury and where to seek medical attention.
How can a doctor prove that you have had a concussion? It isn’t always simple. The real diagnosis of a concussion is made by a neurological examination. This will include: evaluating the individual’s memory, concentration, speech, language capabilities, balance, coordination, and strength. If a fighter has a concussion, they will almost always have a normal MRI (Magnetic Resonance Imaging) Scan or a normal CAT (Computerized Axial Tomography) Scan. The MRI is a non-radiographic procedure that shows the brain in three dimensions. The CAT scan is a radiographic test showing the brain in two dimensions. On an acute basis, it is easier to see a blood clot on a CAT Scan.
So why do an MRI or CAT Scan if they are usually normal? Well, if a fighter has a bad KO, doesn’t appear normal after a fight, or has symptoms including headache, the doctor has to send them to the hospital immediately. It is sometimes difficult to differentiate between the fighter with a subdural hematoma (blood clot) or a simple concussion unless you get some picture of the brain. Obviously, failing to recognize the difference could result in death!
How about the gym? So, you are wearing headgear, then you must be safe. NOT TRUE!! Headgear will protect you from cuts and facial swelling, but it can’t protect you from a head injury. A concussion can happen in the gym as easily as during a fight; maybe more so. A fighter spends so many more hours sparring than they could ever spend in actual bouts. These practice rounds can produce a concussion. I hear about fighters that have lost their focus training or sparred way too many rounds. These are often the losers on fight night. No one would argue the importance of extensive training and conditioning. However, punishment will only take away from your ability to succeed.
What is the answer to fix a concussion? REST! The most important thing a boxer can do is take some time and not spar. It is fascinating that many fail to recognize the brain is just like any other part of the body. It takes time to heal. So, if you are a boxer and you might have suffered a concussion, seek medical attention. Tell your trainer and family. Pretending it doesn’t exist will NOT make it go away. Recognizing the situation will help your career, improve your chances of future success, and save a few brain cells in the process.
Dr. Margaret Goodman is a Ringside Physician and Chairman of the Medical Advisory Board of the Nevada State Athletic Commission.
Dr. Margaret Goodman practices in Las Vegas, Nevada, where she is a licensed ringside physician since 1994. Her medical specialty is in the field of Neurology. Dr. Goodman was appointed by Nevada’s Governor, Kenny C. Guinn, in September of 2001, to serve as Chairman of the Medical Advisory Board to the Nevada State Athletic Commission. Although she is Chairman of the Commission’s Medical Advisory Board, all of the views, opinions, and/or recommendations contained herein are solely her own and do not necessarily reflect those of Nevada’s Commission. All readers are strongly cautioned that the information contained herein is not intended to, and never should, substitute for the necessity of seeking the advice of a qualified medical professional whenever a boxer or his/her representatives have specific questions regarding the best course of action that a boxer should take. Furthermore, since it is possible that general information herein may pertain only to a law, regulation, rule or acceptable standard of practice for a particular jurisdiction, a boxer or his/her representatives must always inquire with the appropriate licensing jurisdiction to determine the applicable laws, regulations, rules, and acceptable standards of practice for each jurisdiction.
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