Dangers in the ring

“Tough ain’t enough... Protect yourself at all times.” – Clint Eastwood as Frankie Dunn, “Million Dollar Baby”

Sixteen-year-old Jonas Garcia is fighting for his life at the University of Santo Tomas Hospital after lapsing into unconsciousness following his preliminary bout at the CLRAA boxing tournament earlier this week. Previously pronounced brain-dead, Garcia’s tragic plight has stirred another controversy in the sport, renewing calls for a ban on contact sports in schools.

There are three issues here. First is the culpability of the organizers and technical officials. Were there any ignored signs that Garcia was not physically capable of going through with the fight? Remember than unlike in professional boxing, amateur tournaments require combatants to get into the ring every day until only the best remain for the medal matches. If the Amateur Boxing Association of the Philippines was not involved, then who was qualified to check on the boxers and officiate? This is also a problem with sports like arnis, which was required by a 2009 law to be taught in all schools. Without implementing rules and regulations (IRR), who has the responsibility – and more importantly, the capability, to teach this combat sport which uses weapons?

The second issue is not really one of age, but the physical maturity of the boxers themselves. Though boxing is an excellent form of physical fitness, the question is what happens when the boxers get into the ring and actually get hit repeatedly. The headgear only protects the outside of the head. The brain, which floats freely inside the rock-hard skull, gets smashed against the rocklike inner surface again and again, and is subjected to multiple shocks and injuries. In the case of a growing minor’s body, how can we say they will escape unscathed?

Scientific studies have shown that amateur boxing is less dangerous than professional boxing, but that injuries produced even with protective gear on may lead to medical conditions later in life. This was concluded after the “Heidelberg Boxing Study,” which used high-resolution MRI data to search for minute changes in the brains of amateur boxers and a comparison group of non-boxers. These changes are considered likely precursors for later diseases like Parkinson’s or dementia.

The study conducted by the Department of Neurology at the University of Heidelberg Medical Center and releases in 2008 has now been published in the American Journal of Neuroradiology. The study was done with the National Training Center for Boxing in Heidelberg and the Department of Sport Medicine at the University of Heidelberg Medical Center. In three of 42 boxers observed microhemorrhages were found, while in the comparison group of 37 non-boxers there was no such damage. At the time, however, the difference between the two groups was not considered statistically significant.

The following year, another study in Turkey showed more alarming results not just confined to the death of brain cells as a result of participating in amateur boxing.

“The blows seem to lead to a deterioration of nerve cells that lasts for a relatively long time,” says Henrik Zetterberg, Reader at the Department of Psychiatry and Neurochemistry at the Sahlgrenska Academy. “It is important that this is made known to participants in sports that involve kicks and blows to the head and to parents who let their children participate.”

In early 2011, the first nationally representative study on boxing in the US was released by the American Journal of Preventive Medicine, further underscored the risks. The new study, conducted by the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital, examined boxing injuries among participants 6 years of age and older.

During the 19-year study period from 1990 to 2008, an average of 8,700 boxing injuries were treated in United States emergency departments each year, and approximately 2,500 of those injuries were to children and adolescents 6 to 17 years of age. The number of boxing injuries each year increased 211 percent during the study, climbing from 5,361 injuries in 1990 to nearly 17,000 injuries in 2008. This proved a rise in the overall level of participation in the sport.

According to the study, released in February of 2011, the most common injury diagnosed was a fracture (28 percent). The hand was the most frequently injured body region (33 percent), followed by the head and neck (23 percent). While the majority of injuries occurred at a sports or recreation facility (54 percent), one-third of the injuries (34 percent) occurred at home. The most revealing discovery was the similar proportion of concussions /closed head injuries among the age groups (nine percent among 12-17 year olds, eight percent among 18-24 year olds, and nine percent among 25-34 year olds. What alarmed the researchers was the similar rate of closed head injuries (CHIs) among children and adults.

“The fact that young boxers are experiencing a similar proportion of concussions and CHI’s as older boxers is extremely concerning given the potential risk of developing chronic traumatic encephalopathy (CTE) with repetitive brain trauma,” said Gary Smith, MD, DrPH, professor of Pediatrics and senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “These repetitive blows to the head may be placing boxers under 18 years of age at risk for neurological impairment and psychological problems due to CTE. Although there is risk of injury with most sports, boxing is unique because participants are rewarded for intentionally striking their opponent in the face and head with the intent of harming or incapacitating them.”

All other internal and external injuries from boxing and other martial arts visibly and predictably heal. But the human brain is still one pf the great mysteries of medical science, and until we completely figure it out, boxing will have its casualties, as will all other sports that require one to be struck in the head. Almost two decades ago, Philippine professional boxing was plagued by a series of deaths in the ring, mostly due to boxers’ hardheadedness and naiveté, and tournament organizers’ greed. Z Gorres, though still alive, has to live with injuries from his sport. Garcia’s family is clinging to the diminishing hope that he will still come back to them as he was before. We all share that prayer. But boxing’s nature is such that getting hurt is not just a risk, but a certainty.