03 July 2007

The perfect knockout punch

What is the anatomy of a perfect knockout, and why? What happens to a boxer's brain with such a blow?

An uppercut, a straight jab to the face as well as a blow angled to either side of the forehead, are the most dangerous blows from the brain’s point of view, and can be THE knock-out punch.

Any of these from a 120 kg force result in the head snapping backward. This has two effects, says Prof Peter Rose-Innes, Cape Town neurosurgeon: “Firstly, the brain collides with the skull, perhaps twisting in the process.

“Secondly, the function of the nerves that control consciousness – situated deep within the brain stem along the middle line of the brain - is arrested momentarily and the boxer is knocked out.

The damage the brain is caused not only by the blow itself, but from the resultant swelling. This pushes the brain against the confines of the skull vault, leading to further damage, Prof Rose-Innes says.

“It’s not completely understood how this works, but the sudden agitation of these nerves will cause the individual to collapse. From his opponent’s point of view this is ideal. But there’s damage to the surface of the brain, and there’s the danger of serious injury to the skull as the boxer falls,” says Prof Rose-Innes.

What happens to the inside of a boxer's skull?
Prof Rose-Innes says a boxer's brain may be buffeted against the sides of his skull. As with all professional boxers who take repeated blows to the head, this will cause tearing and bleeding of the tissue.

“The force of the blow may cause the boxer’s head to turn, which will mean that his entire brain is momentarily deformed and distorted. We’ve seen evidence of this in boxers, even at a microscopic level.

“The brain will recover from a single blow, but during the course of a boxer’s career there’s cumulative damage. The best example of this is Muhammed Ali, who was never knocked out, but who exhibited all the symptoms of brain damage.

“It was obvious to every neurosurgeon in the world what was wrong with him,” says Prof Rose-Innes. He adds that the tragedy is that more damaged boxers’ brains are, the more susceptible they are to being hit.

How hard and how many blows?
Professor Tim Noakes, head of the Sports Science Institute in Cape Town, says the damage sustained depends on how hard the punch is and how many blows there are, rather than where a specific punch lands.

The brain is an essentially jelly-like organ cushioned against its bone-hard enclosure by layers of fluid-filled sacs. It’s a very efficient arrangement, but if the head takes a hard blow, inertia steps in.

”It’s a matter of sudden acceleration and deceleration. The punch will cause the head to move and the brain to accelerate, perhaps even rotate within the skull. When it collides with the other side of the skull, there’s damage,” says Prof Noakes

If the punch is hard enough the brain will strike the skull twice, when the brain starts moving and when it stops moving, Prof Noakes adds.

“The blow to a boxer’s head may not be nearly as hard as that of a cyclist falling, but cyclists wear helmets that shield their brains from the shock. Professional boxers don’t.

“You can save the life of a cyclist with a helmet, but boxers will suffer many seemingly trivial blows to the head that cause brain damage. In fact, being knocked out is not nearly as serious as it seems, because the function that controls consciousness is a very primitive one, deep in the brain. In boxers, it’s the area that controls the intellect, at the front of the brain, that sustains damage over time.”

Prof Noakes points out that amateur boxing is much safer because the pugilists wear protective headgear.

Volatile Tyson
It’s been speculated that the notoriously volatile Mike Tyson has suffered damage to the frontal area of the brain through years of being punched in the head. Tyson’s almost congenital ill-temper has been described as a classic symptom of the damage, which results in a personality change. Prof Noakes counters that Tyson boxes because he’s belligerent, but Prof Rose-Innes contends that it’s vice-versa.

Boxing, the brain and CT scans
According to a study conducted by British neurologists, boxing tops the list of sports most damaging to the brain. They found the occurrence of Chronic Traumatic Encephalopathy (CTE) as follows: 12 jockeys, five soccer players, two rugby players, two professional wrestlers, one parachutist - and 294 boxers.

CTE is essentially a form of brain damage. Its symptoms are similar to those of Alzheimer’s Disease, but can also include personality and behavioural changes, intellectual impairment, and Parkinsonism. The symptoms for the latter are trembling, an expressionless face, shuffling gait and an unmodulated voice. Boxing doesn’t cause Parkinson’s Disease, but the symptoms are very similar. Muhammad Ali is a good example.

A study by the Australian National Health and Medical Research Council in 1994 called for professional boxing to be prohibited. The study concluded that amateur boxing was safer, but that the safety controls introduced in recent years led to a false sense of security among boxers.

“There is however, no safe way to box or kickbox, unless the head is specifically not permitted as a target. These rule changes have not occurred in boxing.”

Boxing remains essentially unchanged since the Queensberry Rules were implemented in the UK in 1865. The rules were introduced, not to make boxing safer, but to broaden its appeal to the upper class, who until then had regarded it a sport not worthy of their attention.

The World Medical Association
Dr Delon Human, the secretary-general of the World Medical Association (WMA), said: "Boxing is quite unlike any other sport in that the basic intent is to cause bodily harm to the opponent. It is impossible to participate in boxing without being hurt."

"It cannot fairly be described as a sport; it is simply a barbaric practice," Human said in a statement.

The WMA, which groups some eight million doctors in 70 countries, first called for a ban on boxing in 1983. Failing a ban, the organisation said ringside physicians should at least be given the power to stop any bout at any stage. It said no boxing bouts should be allowed unless a neurosurgical unit was nearby, or unless resuscitation equipment was available at the ringside.


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