By Margaret Goodman, MD
PART I: Why do some boxers get knocked out? Is it their chin? Is it their heart? Or, is it something else, something we can’t define. Sometimes a boxer seems invincible, nothing can touch them. All of a sudden some of the household names with a great heart/great chin find themselves on the canvas. Why? Did someone finally stronger, tougher, younger, better than they get their number? These are all interesting questions and probably no one really knows the complete answer. However, if I were a boxer trying to secure a championship belt, I think I would want to explore the possibilities and latch onto the obvious, or at least take advantage of the things I can change.
WHAT IS A KNOCKOUT (KO)/TECHNICAL KNOCKOUT (TKO)?
We all kind of know what a knockout is. It is when the fighter goes down and doesn’t get up. It involves loss of consciousness/passing out from a blow/series of blows to the head. In the sport of boxing, a “Technical Knockout” doesn’t necessarily have to result from head blows. Obviously, TKO can be used as a reason for a stoppage from a cut or body blow, etc. In this context, we will be just dealing with headshots.
For a TKO/KO to occur it has resulted from a disruption to the fighter’s brain suggesting alteration in consciousness (or a change in the fighter’s alertness). Typically, the KO/TKO is either vascular or a direct insult to the brain tissue from it being compressed against the skull. Blows, delivered directly or indirectly, temporarily compress the brain’s circulation. Furthermore, there is a small part of the brainstem (back part of the brain) called the Reticular Activating System or RAS. If head blows result in disruption of the function of this part of the brain, you will also pass out.
Something not too often discussed is the definition of a “stroke.” This is a scary word and thank goodness rarely applies to boxing/boxers. A stroke implies loss of circulation to a part of the brain resulting in “permanent” loss of function. Well, a KO more so than a TKO also results in loss of blood flow. The difference lies in that a stroke is “permanent” and a KO/TKO is temporary. However, the same arteries can be impaired in a stroke victim as in a boxer, but in the former case there is thickening/blockage of the circulation. This sounds frightening doesn’t it? A healthy young person, hopefully the professional/amateur fighter, has no predisposition to a stroke. They are in good shape and have taken care of their bodies, hopefully. Trauma to a fighter resulting in loss of consciousness should be reversible.
So the next time you get upset thinking a referee or doctor has stopped a fight too soon. They certainly are protecting that boxer’s life. They are committing it on the side of caution so that boxer can come back and fight another day.
HOW CAN YOU KNOCK SOMEONE OUT?
The ultimate significance of a blow results from: 1) type (i.e., jab, straight punch, left hook, or right cross), 2) duration, 3) force over time, or 4) where it is delivered (i.e. to the jaw, chin, and temple). Blows causing a TKO/KO are the acceleration or deceleration type.
Acceleration blows refer to a stationary head struck by an accelerated or rapidly moving punch. We all know when we watch a fight on television, we see the fighter’s head move from a significant blow and wait to see if the guy will be standing or hit the canvas. Rotary blows are probably the most serious type of acceleration blow. The head does just what it sounds like, rotates around from one side to the other, and frequently compress the carotid arteries (or arteries that run on either side of the neck). These are the same arteries that when compromised/blocked are frequently implicated in a stroke. A hook or roundhouse punch is the type causing head rotation. It’s force and how well it connects will influence how serious the result will be. An upper cut to the chin, is the second type of acceleration blow. We’ve seen these from time to time when the boxer’s head moves straight up. The fighter will also go down, but this time the circulation to the back of the brain is temporarily compressed.
Deceleration blows are where a fast moving object (the head) strikes a stationary object (the canvas). This form of trauma can also produce loss of consciousness. The same could happen from a head butt, where one fighter’s head hits another with great force.
The crucial, life-threatening importance of all these punches comes into play when a fighter doesn’t go down or even worse gets up without having his “legs under him.” This increases the susceptibility to the next punch that could amplify the reaction and result. A series of punches/relentless punishment will also produce a KO by temporarily disrupting all the circulation to the brain.
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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