RESOURCES

The information that appears on this page is for information purposes only.  Only a medical doctor can actually diagnose any illness and prescribe treatment. 

Concussion

What is a concussion?

A concussion is an injury to the brain. It's usually caused by a blow to the head. Most of the time it doesn't involve a loss of consciousness.

What are the signs of a concussion?

Symptoms of Concussion

How is it diagnosed?

First a doctor examines you. The doctor will also get information from people who were there when the concussion happened. This is very important, especially if you're confused or if you lost your memory of the injury. The doctor will test your strength, sensation, balance, reflexes and memory. In more serious cases, your doctor will want to get special x-rays of your head, called computed tomographic scans or magnetic resonance images.

Does medicine help?

The treatment for concussion is rest. If you have a headache, you can usually take acetaminophen (brand name: Tylenol). Always ask your doctor before you take any medicine if you've had a concussion.

What should I watch out for?

When can I return to sports?

You should never return to play while you have any signs of concussion, like headache or dizziness. If your concussion was very mild, you may be allowed to return to play after 15 or 20 minutes. If you had memory loss or loss of consciousness, you may not be able to return to play for one to two weeks. After a severe concussion, you may not be able to return to play for a month. If this wasn't your first concussion, your return to play may take even longer.

What are the risks of returning to play too early?

A player returning too early could suffer from "second impact syndrome," which may be fatal. This problem is caused by a loss of the automatic control of blood vessels to the brain. Never return to a sports activity until you are cleared by a doctor.

Are there any lasting effects to a concussion?

Most people get better after a concussion without any permanent damage. People have signs of concussion for weeks to months. Repeated concussions could cause permanent damage. After several concussions, your doctor may talk with you about changing sports.

This handout provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.

Visit familydoctor.org for information on this and many other health-related topics.

THE RETIRED BOXERS FOUNDATION IS PROUD TO INTRODUCE

OUR NEWEST MEMBER OF THE RBF MEDICAL ADVISORY BOARD:

BETH ADAMS

Beth A. Adams M.Ed LRC is a nationally recognized Neurotrauma Rehabilitation Specialist in the Boston area who provides specialized and individualized rehabilitation services to those who have sustained a concussion or traumatic brain injury.

By Beth A. Adams M.Ed LRC, Retired Boxers Foundation Medical Advisory Board Concussion is the most common form of head injury for athletes. A concussion is an external blow or jolt to the head. The outcome (difficulties) varies from person to person. Concussions are associated with disorientation, and sometimes with loss of consciousness followed by amnesia (forgetting) of what happened both immediately before and after the injury. It is very important to note that it is not necessary to lose consciousness when sustaining a concussion, but it is possible to have ongoing difficulties after receiving one. The following information is important for every boxer to read in the event they feel they have sustained a concussion. During the course of their careers, both in sparring and actual fighting, boxers receive countless blows to the head. These blows can result in repeated concussions and can have long lasting and damaging effects to a fighter. Many people recognize that symptoms like slurred speech and an overall "punch drunk" persona are common amongst fighters, but few are aware of the more serious and hidden dangers that these injuries produce. Cognitive problems that your brain might receive after concussions can be described as the following: headaches, irritability, depression, anxiety, sleep difficulties, fatigue, distractibility, inattention, memory problems and disorganization, to name a few. If you have identified yourself or someone you know with any of the above areas as being problematic then you are probably experiencing the results of a concussion. Returning back to the ring without proper rest and treatment is extremely dangerous. Multiple and ongoing concussions are damaging and dangerous and can also have a major impact on your future cognitive functioning. They can also prove to be fatal. The neurotrauma rehabilitation specialist plays an important role in your functional outcome and can put together a cognitive rehabilitation plan to fit your specific needs. Once diagnosed by your Physician, the neurotrauma rehabilitation specialist can implement simple strategies to work with depending on what you are experiencing. These strategies can vary from using a pocket notebook or audio recorder for memory and/or organization to simply taking frequent breaks during your daily routine to deal with cognitive fatigue. The critical component towards improved cognitive functioning is identifying what the problem is and implementing strategies to assist you in getting back to your life as you knew it before the concussion. Once the strategies are put in place it is critical to work with them consistently so that you not only know how to use them effectively but so that they may become a part of your everyday repertoire. Consistency and repetition are critical to a successful outcome. Equally important is the expertise of the specialist you choose to assist you in this area. They must have a background in treating people with brain injuries in addition to a cognitive rehabilitation background. In the event you are a boxer or a boxers loved one and feel you are in need of assistance please do not hesitate to contact this specialist for a confidential discussion regarding your symptoms and possible plan of action. *** Beth A. Adams M.Ed LRC is a practicing Neurotrauma Rehabilitation Specialist in Boston, MA who has been working in the field of brain injury since 1987. She is currently in private practice treating people with brain injuries and also specializes in working with athletes who have sustained concussions. She is the neurocognitive specialist at the Brigham and Women Neurological Sports Injury Center in Boston, MA. She is on the Board of Directors at the Massachusetts Brain Injury Association. She can be reached at (978)741-0100. *** 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, legal, or financial professional whenever a boxer/martial artist or athlete should take. All readers are advised that the information herein is intended solely as a general reference source, and to the fullest extent permitted by law, the information is provided "AS IS" without any warranties of any kind, whether express or implied, including without limitation, warranties merchantability, fitness for a particular purpose and non-infringement. No one may rely on the accuracy, integrity, quality or completeness of the general information herein. Accordingly, neither the author, editor nor anyone else affiliated with this website may be held liable for damages of any kind whatsoever allegedly caused or resulting from any such claimed reliance.

By RBF Medical Advisory Board Member, Dr. John Stiller, Neurologist

"There's no evidence he's at greater risk for a brain bleed than if he ever had the first brain bleed…"

This statement recently made by a prominent neurosurgeon (and supported by some others) is in reference to a boxer who sustained a subdural hematoma (SDH) while boxing and who is currently suing the Nevada State Athletic Commission for denying him a license to continue boxing. This  brings up the apparently contentious issue of whether any boxer who has sustained a SDH while boxing should ever be licensed to box again.

Implicit in the reasoning of those who believe that a boxer such as this should be licensed to fight again (as long as there is a complete resolution of the SDH and the boxer is restored to his normal pre bleed state) is that he would be at no greater risk for a recurrent SDH than a similar boxer who has never sustained a SDH while boxing. Therefore,  he should be licensed as long as he meets all of the usual medical requirements for licensure. 

An analogy that is used is that if a boxer sustained a fractured bone that completely healed, he would be allowed to safely return to competition.

However, what is not considered in this reasoning is the possibility that (known or unknown) factors unique to that boxer ( i.e. “intrinsic factors”) independent of the complete healing/resolution of the original injury may place him at an increased risk for a recurrent SDH.  

An elementary example of this rationale ( i.e. “intrinsic factors” placing a boxer at increased risk for a recurrent injury) is a boxer who cuts frequently and has sharply contoured facial features.  In this case there is an  increased risk of future facial cuts independent of how well the previous cuts healed because of the shape of his face. 

Those who suggest that a boxer who has suffered an SDH while boxing is at increased risk of recurrent bleeds believe that there are likely (analogous to the susceptibility to facial cuts)  “intrinsic factors” that place that boxer at an increased risk for a recurrent SDH.

Unfortunately, we cannot adequately explain why the same blow or blows incurred by one boxer my result in SDH and in another cause no intracranial bleeding.  The explanation may be related to these “intrinsic factors” and include, but are not limited to the complexity and interactions of the various body parts/ tissues involved. More specifically the complex relationships between the brain, meninges (lining of the brain) , skull, neck etc., as well as the individual’s unique reactions to blows to the head.

Can there be a  prospective study to determine whether or not a boxer who has previously suffered a SDH during a boxing match is at increased risk for a recurrent SDH if he continues to box?

We suspect that a prospective study such as this may be deemed ethically questionable and not receive Institutional Review Board (IRB) approval.

One may also argue that even if the boxer is at a somewhat increased risk compared to a similar boxer who has no history of a SDH, the difference is so small that the boxer should have the right to assume this risk.  However, this proposition  brings up numerous other issues.

One thing most experts will agree on is that there is not sufficient scientific data to definitively determine what if any increased risk a boxer who has suffered a SDH faces if he continues to box. From  a commissions standpoint the question that needs to be answered  is whether or not to allow a boxer such as this back in the ring  in the absence of this evidence.

The Nevada Commission has unanimously weighed in with a no ( i.e. the boxer should not be licensed to box again) and this decision is certainly in line with a long medical tradition of erring on safety.  We now await the decision of the courts.

John W. Stiller, M.D.

Co-Director, Neurology Service, St.Elizabeths Hospital; Washington, D.C.

Member, Retired Boxers Foundation Medical Advisory Board

BRAIN INJURIES:  If you suspect a brain injury

Sometimes, boxers suffer from symptoms recognized not only by themselves, but by family members, loved ones, their trainers, managers and others.  If the athlete seeks medical treatment, they often come away without a diagnosis simply because many of the injuries to the brain do not show up in normal diagnostic tests.  If you go to the doctor complaining about balance problems, speech problems, etc., the doctor will first perform a routine exam followed by a basic neurological exam.  A good doctor will refer the patient to a neurologist who will perform extensive testing to determine any damage.  Often, the patient is referred for an MRI.  Unfortunately, the MRI often comes back without any indication of a brain injury. 

In order for a complete and accurate diagnosis to happen, the patient needs to carefully explain the symptoms that brought you to the doctors office, along with a history--which includes any substance abuse, alcoholism and of course, your boxing history.  When all else fails, the doctor may refer you to someone who will conduct a complete neuro-psychiatric examination.  We highly recommend this examination because it can pinpoint the areas of the brain that might be damaged and as a result, you may be able to get the kind of medical treatment you need. 

Alex Ramos, the founder of the Retired Boxers Foundation went through all of these tests and found that he had damage to his frontal lobe and to the right temporal lobe.  There are new medications that can help the athlete (and his loved ones) cope with these brain injuries. 

Depakote is just one drug that has worked well with several boxers.  While this drug is primarily for seizure disorders, it has an effect on the frontal lobe, which is where the "executive" processes are.  This is where anger, rage and emotions in general are situated.  When there is damage to this area of the brain, there are misfires in the neurotransmitters that cause the person to react oddly to ordinary circumstances and have difficulty with emotions.  Depakote, for some reason, not only helps the neurotransmitter misfires, it also affects (positively) balance disorders.  The latter is an odd outcome of Depakote, but is documented as a side affect of the drug.

Wellbutrin also works well for people with brain injuries.  Several boxers have found relief from their anger outbursts and rage with Wellbutrin.  It doesn't work for everyone, but for the majority of people that it helps, it is worth the effort.

For more information, go to www.braininjury.com 

http://www.braininjury.com/symptoms.html
 

SYMPTOM CHECKLIST 

A wide variety of symptoms can occur after "brain injury." The nature of the symptoms depends, in large part, on where the brain has been injured. Below find a list of possible physical and cognitive symptoms which can arise from damage to specific areas of the brain:

 

Frontal Lobe: Forehead

• Loss of simple movement of various body parts (Paralysis).
• Inability to plan a sequence of complex movements needed to complete multi-stepped tasks, such as making coffee (Sequencing).
• Loss of spontaneity in interacting with others.
• Loss of flexibility in thinking.
• Persistence of a single thought (Perseveration).
• Inability to focus on task (Attending).
• Mood changes (Emotionally Labile).
• Changes in social behavior.
• Changes in personality.
• Difficulty with problem solving.
• Inability to express language (Broca's Aphasia).

Parietal Lobe: near the back and top of the head
 

• Inability to attend to more than one object at a time.
• Inability to name an object (Anomia).
• Inability to locate the words for writing (Agraphia).
• Problems with reading (Alexia).
• Difficulty with drawing objects.
• Difficulty in distinguishing left from right.
• Difficulty with doing mathematics (Dyscalculia).
• Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads to difficulties in self-care.
• Inability to focus visual attention.
• Difficulties with eye and hand coordination.

Occipital Lobes: most posterior, at the back of the head
 

• Defects in vision (Visual Field Cuts).
• Difficulty with locating objects in environment.
• Difficulty with identifying colors (Color Agnosia).
• Production of hallucinations.
• Visual illusions - inaccurately seeing objects.
• Word blindness - inability to recognize words.
• Difficulty in recognizing drawn objects.
• Inability to recognize the movement of object (Movement Agnosia).
• Difficulties with reading and writing.

Temporal Lobes: side of head above ears
 

• Difficulty in recognizing faces (Prosopagnosia).
• Difficulty in understanding spoken words (Wernicke's Aphasia).
• Disturbance with selective attention to what we see and hear.
• Difficulty with identification of, and verbalization about objects.
• Short term memory loss.
• Interference with long term memory.
• Increased and decreased interest in sexual behavior.
• Inability to catagorize objects (Categorization).
• Right lobe damage can cause persistent talking.
• Increased aggressive behavior.

Brain Stem: deep within the brain
 

• Decreased vital capacity in breathing, important for speech.
• Swallowing food and water (Dysphagia).
• Difficulty with organization/perception of the environment.
• Problems with balance and movement.
• Dizziness and nausea (Vertigo).
• Sleeping difficulties (Insomnia, sleep apnea).

Cerebellum: base of the skull
 

• Loss of ability to coordinate fine movements.
• Loss of ability to walk.
• Inability to reach out and grab objects.
• Tremors.
• Dizziness (Vertigo).
• Slurred Speech (Scanning Speech).
• Inability to make rapid movements.

Recommended Reading

In the process of looking for the latest information on boxing and boxing related injuries, we have comprised a list of articles that you can check out.  Just click on the title and you should get right to the article.

Genetic Susceptibility to Brain Injury in Sports: A Role for Genetic Testing in Athletes

by Barry D. Jordan MD, MPH

BOXING AND THE BRAIN:  The National Parkinsons Foundation (Go to the search bar and type in "boxing."  Go to "Boxing and the Brain.)

SHOULD BOXING BE BANNED:  A REBUTTAL TO THE AMA

ALZHEIMERS MEETS ITS MATCH IN BOXERS:  Article suggests that some boxers are predisposed to early dementia

LORD OF THE RING:  Dr. Van Buren Lemons on Boxing