Should amateur boxers be concerned about long term brain injury? According to an article published in the British Medical Journal (BMJ) the association between amateur boxing and chronic traumatic brain injury is not significant; researchers say it is currently not possible to come to a decisive conclusion.

The authors explain that in the case of professional boxing the risk of long term brain injury is much clearer. However, this does not mean that the safety of amateur boxing should not continue to be questioned.

If the British Medical Association had its way, both professional and amateur boxing would be banned. However, no recent studies have been carried out to evaluate the dangers in amateur boxing. Therefore, Dr Mike Loosemore, Lead Sports Physician, Olympic Medical Institute, Northwick Park Hospital, Harrow, UK, and a team of sports doctors and clinical academics looked at the evidence to decide whether the amateur sport might lead to chronic traumatic brain injury.

36 observational studies were identified – all of them focusing on amateur boxing and its potential link to chronic traumatic brain injury. In order to minimize bias, the researchers took into account study design and quality. Their definition of chronic traumatic brain injury included any abnormality in neurological examination, psychometric testing, brain imaging, or electroencephalography.

15 of all the studies came to the conclusion that abnormalities took place. However, the researchers commented that the quality of proof was generally poor.

The studies deemed to be of the best quality – the ones that included psychometric tests – concluded that there were no long-term effects of boxing on the function of the brain. Of 17 better quality studies, just four identified indications of chronic traumatic brain injury in a small proportion of boxers in their studies.

Six of the studies used magnetic resonance imaging. Just one of them found an abnormality – one boxer had a cyst – which could have been congenital. MRI (magnetic resonance imaging) is normally considered as the best way of determining subtle damage and degenerative change in the brain.

Studies with positive findings were, in general, of bad design and quality.

The authors explain that amateur boxing is becoming more popular. They stress that their aim in this review is neither to support nor oppose the sport. They conclude that the evidence as such is not strong enough to link amateur boxing with chronic traumatic brain injury.

Accompanying Editorial:
Paul McCrory, a neurologist and sports doctor, University of Melbourne, believes that as modern amateur boxers have shorter careers than their peers years ago, and reduced exposure to repetitive head trauma, the chances of this condition developing are fairly slim.

“Amateur boxing and risk of chronic traumatic brain injury: a systematic review of observational studies”
BMJ Online First
“Editorial: Boxing and the risk of chronic brain injury”
BMJ Online First

Written by: Christian Nordqvist