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Individualizing medical suspension after knockout in boxing-no two knockouts are the same

MOJ Sports Medicine
Nitin K Sethi


Professional boxing carries high risk of acute traumatic brain injuries (TBIs). Subdural hematoma is the most common neurological cause of boxing related mortality. Other acute TBIs in boxing include epidural hematoma, intracranial hematoma, cerebral contusions, dissection of large vessels of the neck and concussion. Concussion or mild TBI is common in a sport like boxing where every punch thrown at the head is thrown with the idea of winning by causing a knockout (KO) which is nothing but a concussive injury of the brain. After a KO, the boxer is typically given a medical suspension. The adequate duration of medical suspension after a KO has neither been determined nor standardized.

Discussion: The duration of medical suspension after KO in boxing should be determined based on the severity of the head impact exposure (s) sustained by the boxer. Concussive properties of the punch such as the force, velocity and way punch was delivered, age of the boxer, fight record of the boxer and history of prior concussions should be factored in when determining the optimal duration of medical suspension.

Conclusion: The optimal duration of medical suspension after a KO injury is currently not standardized and varies from Commission to Commission. It is important for ringside physicians to remember that no two concussive injuries are the same. Individualizing duration of medical suspension after KO shall help to enhance the health and safety of the boxer.


boxing, concussion, knockout, medical suspension