Boxing-related head injuries

The Influence of Sport Impacts on Injuries of the Temporomandibular System: Frontal Impacts

OBJECTIVE

The orofacial injuries (temporomandibular joint (TMJ) injuries, mandible fractures, etc.) represent a high incidence in sports medicine. But the mechanism of injuries caused by sport impacts was poorly studied. This study aimed to fill this gap.

DESIGN

Different frontal impacts were applied to the finite element model. The motions and biomechanical responses of the joint and mandible were analyzed and compared with active open-closing mouth movement in order to evaluate injury causes.

METHODS

Firstly, the maxillofacial morphology and open-closing motion were captured. Then an improved FE maxillofacial model for dynamic analysis was established for impact and mouth open-closing simulations.

RESULTS

The rotation degrees of the mandible and the stress level of the TMJ increased as the impacts got greater. The disc sustained squeeze and the capsule sustained stretch. The mandibular body and ramus sustained greater stretch under impacts over 2000 N.

CONCLUSION

It indicated that the injuries of the TMJ were primarily from excessive squeezing on the disc and stretching on the capsule, caused by excessive displacement of the condyle. The mandibular body and ramus were at great risk of fracture.

Measuring electrophysiological changes induced by sub-concussive impacts due to soccer ball heading

A growing body of research suggests that impacts to the head, including sub-concussive impacts, carry risks for long-term detrimental effects on cognition and brain health. Despite the potential for negative health consequences associated with sub-concussive impacts, there is currently no reliable and objective method used in clinical practice to assess whether a particular sub-concussive impact affected the brain. In this preliminary study, we developed a machine-learning classifier to detect changes in brain electrophysiological activity following sub-concussive impacts that occur during soccer ball heading. We recorded EEG from soccer players before and after they repeatedly headed a soccer ball, and trained classifiers to distinguish between an individual's EEG patterns before and after these sub-concussive impacts. The classifiers were able to identify post-impact EEG recordings with significantly higher accuracy than would be expected by chance, both 1 h and 24 h after the impacts occurred. After controlling for electrophysiological changes attributed to exercise, changes to brain activity attributable to soccer heading were detectable at 24 h post-heading, but not at 1-h post-heading. The observed time-course of EEG changes mirrors a similar pattern seen in traumatic brain injury, in which an inflammatory cascade is manifest 24 to 48-h post-injury; we suggest that EEG changes following sub-concussive impacts may stem from inflammation or some other physiological process that unfolds on a similar timescale. These results are an important step toward developing an EEG-based tool that can assess whether electrophysiological consequences are present following sub-concussive head impacts.

Increase of circulating cell free mitochondrial DNA in amateur boxers after sparring matches

OBJECTIVES

To determine if circulating mitochondrial deoxyribonucleic acid levels increase after sport activity involving blows to the head, such as boxing, and if it could play a role in inflammatory cascade regulation in response to trauma.

DESIGN

Observational, longitudinal.

METHODS

We measured mitochondrial deoxyribonucleic acid levels and integrity in ten non-professional male boxers before and after three weekly sparring matches. We set up a protocol to separate three different plasma fractions enriched in mitochondria-containing vesicles, mitochondrial deoxyribonucleic acid bound to proteins and naked mitochondrial deoxyribonucleic acid. We quantified the levels of the main cytokines involved in inflammatory response and the levels of neurofilament light, a well-known marker of brain damage.

RESULTS

Circulating mitochondrial deoxyribonucleic acid levels increased after each match. In the second fraction, we also observed an increase over the weeks. Mitochondrial deoxyribonucleic acid is less intact after each match if compared with pre-match integrity, especially the naked form which is not protected within vesicles or mitochondria. Circulating levels of interleukin-6, interleukin-1beta and interleukin-10 increased after each match linking traumatic brain injuries to inflammatory state. Neurofilament light chain showed a similar trend to mitochondrial deoxyribonucleic acid.

CONCLUSIONS

As mitochondrial deoxyribonucleic acid displays an inflammatory effect and neurofilament light chain is more specific for brain injury, we concluded that the simultaneous analysis of these two parameters could be helpful to monitor the effects of traumatic brain injury in contact sports, and that mitochondrial deoxyribonucleic acid is a promising candidate biomarker to study the inflammatory state of patients who suffered repeated traumatic brain injuries.

Injury Patterns in Krav Maga Training: A Cross-Sectional Study

This cross-sectional study, conducted from July 2023 to January 2024, examines injury patterns and associated risk factors among Krav Maga athletes to develop tailored prevention strategies for this unique martial art. A survey of 109 participants revealed that 65 injuries were reported, with 59.6% caused by actions from another individual and 24.8% (27 cases) being self-inflicted. The most frequently injured areas were the lower limbs (42 participants, 38.5%), torso (19 participants, 17.4%), and upper limbs (19 participants, 17.4%). Sprains or ligament tears were the most common diagnosis, accounting for 35 cases (32.1%), followed by fractures in 24 cases (22%). Participants ranged in age from 10 to 65 years, with males (95 participants, 87.2%) experiencing more injuries than females. Significant disparities were noted in injury rates based on training intensity (p < 0.05). Recovery periods varied, with 21 participants (19.3%) reporting durations exceeding 30 days. These findings underscore specific injury patterns and risk factors in Krav Maga, highlighting the importance of tailored prevention strategies focusing on flexibility, strength, and proper techniques to reduce injury risks.

A-trait and risk-taking behavior in predicting injury severity among martial arts athletes

Introduction

Trait anxiety (A-trait) can be seen as a multiplicative function of the person-situation interaction. Considering risk-taking behavior (R-TB), literature highlights instrumental and stimulating risk. The aim of the research is to investigate the level of A-trait (in physically dangerous conditions and in new, unusual situations) and the level of R-TB (instrumental and stimulating risk) in athletes, and to verify to what extent A-trait and risk-taking behavior predict injury severity.

Materials and methods

One hundred and fifty-four senior martial arts athletes from grappling combat sports, striking combat sports and mixed martial artists (MMA) participated in the study. For assessing trait anxiety and risk-taking behavior, the Romanian adaptation of the Endler Multidimensional Anxiety Scales (EMAS), respectively the Romanian adaptation of the Makarowski's Stimulating and Instrumental Risk Questionnaire were used.

Results

Using multivariate analysis of variance, significant differences between athletes (according to the sports disciplines practiced), in terms of A-trait and R-TB, were examined. Next, we checked the existing correlations between injury severity, A-trait and R-TB scores in athletes practicing striking combat sports, grappling combat sports and MMA. To verify whether there are significant differences in terms of trait anxiety, stimulating and instrumental risk between athletes who have suffered mild, moderate and/or severe injuries and athletes who have suffered only minor/mild injuries, t-Test for Independent Samples was used. Binomial logistic regression procedures were, also, performed, predicting athletes' likelihood of injury, based on R-TB and A-trait.

Conclusion

A moderate or slightly below average level of anxiety in new, unusual situations and a higher level of instrumental risk are linked with a decreased likelihood of severe injuries in athletes. Martial arts athletes (in entire sample) who have suffered more severe injuries are more adrenaline-seeking in competition and use less rational thinking, taking more pleasure in just performing technical executions, regardless of the outcome.

Mechanisms of Sports Concussion in Taekwondo: A Systematic Video Analysis of Seven Cases

Sports-related traumatic brain injuries are the most common injury in adolescents and young adults due to recurrent concussion experiences and head shock. Therefore, this study was designed to describe player characteristics and situational factors associated with concussions in the World Taekwondo Championships using systematic video analysis. Athlete injury data were collected using a web-based injury surveillance system at the World Taekwondo Championships organized by World Taekwondo from 2017 to 2019. Seven video footage were independently analyzed by four analysts using a modified Heads-Up Checklist. Descriptive statistical analysis was used. The incidence of concussion was 3.21 per 1000 games. Most players with concussions were shorter than their opponents, and most concussions were caused by a roundhouse kick on the front of the face. Regarding the acceleration direction of the head after the impact, transverse and multiplane directions were the most common. Most players with a concussion have used a closed stance and did not use blocking techniques during the defense. The rate of concussions caused by penalties was 42.9%. Based on our findings, no other injury mechanisms, except for direct blows to the head, were observed. Therefore, education on the risk and symptoms of concussion, the appropriate management and blocking techniques should be emphasized in TKD-S to reduce incidence of concussion.

Rotational head acceleration and traumatic brain injury in combat sports: a systematic review

BACKGROUND

Traumatic brain injury (TBI) in combat sports is relatively common, and rotational acceleration (RA) is a strong biomechanical predictor of TBI. This review summarizes RA values generated from head impacts in combat sport and puts them in the context of present evidence regarding TBI thresholds.

SOURCES OF DATA

PubMed, EMBASE, Web of Science, Cochrane Library and Scopus were searched from inception to 31st December 2021. Twenty-two studies presenting RA data from head impacts across boxing, taekwondo, judo, wrestling and MMA were included. The AXIS tool was used to assess the quality of studies.

AREAS OF AGREEMENT

RA was greater following direct head strikes compared to being thrown or taken down. RA from throws and takedowns was mostly below reported injury thresholds. Injury thresholds must not be used in the absence of clinical assessment when TBI is suspected. Athletes displaying signs or symptoms of TBI must be removed from play and medically evaluated immediately.

AREAS OF CONTROVERSY

Methodological heterogeneity made it difficult to develop sport-specific conclusions. The role of headgear in certain striking sports remains contentious.

GROWING POINTS

RA can be used to suggest and assess the effect of safety changes in combat sports. Gradual loading of training activities based on RA may be considered when planning sessions. Governing bodies must continue to work to minimize RA generated from head impacts.

AREAS TIMELY FOR DEVELOPING RESEARCH

Prospective research collecting real-time RA data is required to further understanding of TBI in combat sports.

Adverse Health and Psychosocial Repercussions in Retirees from Sports Involving Head Trauma: Looking at the Sport of Boxing

Academic scholarship has steadily reported unfavourable clinical findings on the sport of boxing, and national medical bodies have issued calls for restrictions on the sport. Yet, the positions taken on boxing by medical bodies have been subject to serious discussions. Beyond the medical and legal writings, there is also literature referring to the social and cultural features of boxing as ethically significant. However, what is missing in the bioethical literature is an understanding of the boxers themselves. This is apart from their brain injuries, the debates about the degenerative brain disease known as chronic traumatic encephalopathy (CTE), and related issues about the disease. This article argues that the lives of boxers, their relationships, their careers, and their futures, also requires its own research, particularly in telling stories about their lives, and those lives and futures which boxing affects. The article uses two approaches. First, to imagine a more enduring “whole of life viewpoint” by using an extended future timeframe. Second, to consider perspectives of a person’s significant others. After reviewing the boxing literature, the article discusses social settings and then explores the hidden social relationships in life after boxing. With these longer time and close relationship viewpoints, three important themes emerge: family and kinship; age, stage and career; and the effects of boxing fatalities. These analyses are used in conjunction with relevant clinical findings which complement the telling of stories to improve medical information, and engages professional and public empathy for people’s experience of illness and difficulties in coping.

Epidemiology of boxing-related upper extremity injuries in the United States

OBJECTIVE

The incidence of boxing-related upper-extremity (UE) injuries in the United States has not been well characterized. Recent rule changes have been made to make participation safer for athletes, although the consequences of such rule changes on injury rates is unclear. Therefore, we sought to determine the incidence, characteristics, and trends of boxing-related UE injuries.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried for the years 2012-2016. All UE injuries related to boxing from 2012 to 2016 that occurred during organized boxing participation were selected. Examined variables included injured body party, injury diagnosis, patient age, and sex. Annual injury incidence rates by body part and diagnosis were calculated.

RESULTS

The mean incidence of boxing-related UE injuries from 2012 to 2016 was 673 injuries (95% CI 537-809) per 100,000 person-years, with hand fractures being the most common injury (132 (95% CI 130-135) per 100,000 person-years). The incidence of UE injury significantly declined from 865 (95% CI 846-884) per 100,000 person-years in 2012 to 656 (95% CI 642-671) per 100,000 person-years in 2016 (p < 0.01). Injuries to the hand exhibited the largest decrease, declining by 33%. The majority of boxers sustaining UE injuries were male (84.4%) and between the ages of 20-39 (59.9%).

CONCLUSIONS

Injuries to the UE due to participation in boxing accounted for thousands of emergency department visits in the United States annually, with males younger than 20 years of age, most susceptible to injury. Injuries to the hand, wrist and shoulder occurred at the highest rate. Finally, following rule changes made by sanctioning organizations in 2013, a significant decline in boxing-related UE injuries were observed.

Clinical features of repetitive traumatic brain injury and chronic traumatic encephalopathy

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by a distinct pattern of hyperphosphorylated tau (p-tau). Thought to be caused by repetitive concussive and subconcussive injuries, CTE is considered largely preventable. The majority of neuropathologically confirmed cases have occurred in professional contact sport athletes (eg, boxing, football). A recent post-mortem case series has magnified concerns for the public's health following its identification in six high school level athletes. CTE is diagnosed with certainty only following a post-mortem autopsy. Efforts to define the etiology and clinical progression during life are ongoing. The goal of this article is to characterize the clinical concepts associated with short- and long-term effects of repetitive traumatic brain injury, with a special emphasis on new clinical diagnostic criteria for CTE. Utilizing these new diagnostic criteria, two cases of neuropathologically confirmed CTE, one in a professional football player and one in a professional boxer, are reported. Differences in cerebellar pathology in CTE confirmed cases in boxing and football are discussed.

Chronic traumatic encephalopathy

Sports-related concussion has gained increased prominence, in part due to media coverage of several well-known athletes who have died from consequences of chronic traumatic encephalopathy (CTE). CTE was first described by Martland in 1928 as a syndrome seen in boxers who had experienced significant head trauma from repeated blows. The classic symptoms of impaired cognition, mood, behavior, and motor skills also have been reported in professional football players, and in 2005, the histopathological findings of CTE were first reported in a former National Football League (NFL) player. These finding were similar to Alzheimer's disease in some ways but differed in critical areas such as a predominance of tau protein deposition over amyloid. The pathophysiology is still unknown but involves a history of repeated concussive and subconcussive blows and then a lag period before CTE symptoms become evident. The involvement of excitotoxic amino acids and abnormal microglial activation remain speculative. Early identification and prevention of this disease by reducing repeated blows to the head has become a critical focus of current research.