Boxing Safety

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Boxing is the quintessential contact sport. Like any contact sport (and many non-contact sports), boxing carries a risk of temporary or permanent physical injury and, in the rare case, death.

A 1996 National Safety Council accident report, however, ranked amateur boxing 23rd on its list of injury-producing sports and rated it the safest of all contact sports … safer than football, wrestling, gymnastics and in-line skating. According to Cantu, Boxing and Medicine, Human Kinetics Illinois, 1995, amateur boxing’s fatality rate is 1.3 fatalities per 100,000 participants. Compare this to the fatality rates for college football (3), scuba diving (11), mountaineering (51) and sky-diving (123).

When boxers do get injured, the injuries tend to be hand and wrist injuries, bloody noses, oral or facial lacerations, and bruised ribs. Broken noses and ribs do occur, but are not common. These injuries rarely have permanent consequences.


Repetitive concussive injury in boxing is suspected as a cause of brain dysfunction (so-called “punch-drunk syndrome”). This condition is well-documented among some professional boxers.

Concerned about this issue, USA Boxing Inc. requested the US Olympic Committee to fund a study of this problem in April 1986. The Johns Hopkins Medical Institutes were enlisted for this purpose. Johns Hopkins studied over 500 active amateur boxers, compared their neurological functions with those of non-boxers of the same age and physical condition, and issued its findings in 1994. Although there was some indication of temporary memory loss immediately following bouts, the study found no clinically-significant evidence of permanent impairment of motor skills, loss of coordination or memory, or slurred speech among the active amateur boxers.

An Australian physician, Mark Porter, conducted an exhaustive 9-year study of neurological function in active amateur boxers and non-boxers, finding no difference in neurological function between the two groups.

But what about Muhammad Ali? Assuming that his Parkinson’s syndrome was caused by boxing, it is important to realize that he fought 105 amateur and Olympic bouts (100-5) and 61 professional bouts (56-5) during his career. That is the equivalent of a preposterous 600 amateur bouts in terms of total ring time. Further, Ali fought the best amateurs in six Golden Gloves tournaments, four national Golden Gloves and AAU tournaments, and in the 1960 Olympic Games. Finally, he fought the hardest-hitting pros in the world for 21 long years. His opponents included such giants as George Foreman, Joe Frazier, Sonny Liston, Ken Norton and Leon Spinks.

Amateur careers, on the other hand, tend to be very short. Few reach open division level and, of those who do, few reach national competition. Indeed, among the active boxers in most Indiana and Kentucky clubs, the average experience level is less than 2 years with the club and less than 24 minutes in the ring.

Nonetheless, amateurs who sustain an excessive number of knockouts, or who pursue lengthy amateur careers, should be aware that there may be potential risk. At least one study has raised concerns about the potential chronic effects of amateur boxing:

According to a study published in the January, 2000 issue of The Physician and Sportsmedicine, participation in amateur boxing may result in decreased mental functioning consistent with acute traumatic brain injury or post-concussion syndrome, at least temporarily, despite use of protective head gear. Boxing competitors in the study sustained a median of 8 punches to the head compared to a control group of amateur boxes matched for weight, age, education, boxing level and frequency of participation. The control group engaged in punching bag activity, receiving no blows to the head prior to neuropsychological testing. Compared to the control group, the competitors exhibited decreased performance in planning, attention and memory tasks. Of concern is the permanence or cumulative effects of such activity manifest in permanent brain damage at even a low frequency and severity of blows to the head and the false sense of security provided by wearing protective headgear. (Abstract by Ann Inoue, Jamaica Hospital Medical Center)


The study acknowledges, however, that its positive neurological findings could be temporary in nature. Indeed, Dr. Ed Friedlander has roundly criticized the study, noting that boxers who have just stepped out of a ring are going to be in a “hyperaroused” state — a physical and mental surivival mode — that is inconsistent with good performance on word games and memory tests.

Dr. Friedlander has written an excellent article in support of amateur boxing and discusses a number of medical studies relating to the sport.


Finally, some people point out that amateur boxers are required to sign a release acknowledging that boxing is a dangerous sport with risk of serious injury or death. Parents must sign these releases for amateurs under the age of 18. These releases, however, are no different than the releases signed by participants in organized high school sports such as tennis, swimming, softball, volleyball, field hockey and basketball. Indeed, many high schools have boxing programs. You should take time to visit the home page of Cincinnati Moeller High School’s impressive boxing program.


Some people argue that, even though football is more dangerous than amateur boxing, the object of football is to score points and the object of boxing is to inflict neurological damage on the opponent.

This argument, however, is usually made by people who have never played football. In football, points are scored by hitting, blocking and tackling hard … by knocking people down, pushing them around and basically intimidating them. The result is an injury rate far higher than in amateur boxing.

Think there is no bias against boxing? The AMA attacks boxing as a display of “interpersonal violence” while letting football off the hook despite the fact that football is responsible for 250,000 concussions annually and 95% of all catastrophic injuries in U.S. sports.

Further, the purpose of boxing IS to score points. That is why we have 3 or 5 certified judges counting scoring punches during bouts. Importantly, a punch that results in a standing 8 count or a knockdown counts no more than a routine scoring punch. Bouts are normally stopped by referees long before a knockout can occur.

Of course, if a knockdown results in stoppage of contest, the other boxer wins. But similarly, football teams often win games when opponents lose key players to injury.

The overwhelming majority of amateur boxers win their bouts by outpointing their opponents or by causing stoppage of contest due to standing 8 counts or superiority … and not by knocking out their opponents.


Boxing has an image problem due to injuries and deaths in professional boxing and because of boxing’s negative depiction in the entertainment media. Amateur boxing, however, could not exist if kids and teens were being seriously injured. For amateur boxing to survive, the sport has had to develop rules to protect its participants. Here are some of those rules:

(1) Amateurs box 3 and 4 round bouts, not 12 round bouts as in the pros.

(2) Amateurs box 2 minute rounds, not 3 minute rounds as in the pros.

(3) Amateurs use 10 and 12 ounce shock-absorbing gloves in competition. Pros use 6 and 8 ounce shock-transmitting gloves.

(4) Amateurs wear headgear to protect ears, forehead and cheekbones. Headgear is prohibited in pro boxing.

(5) Amateurs wear jerseys during bouts, to prevent gloves from transferring sweat to the opponent’s eyes.

(6) Referees in amateur bouts make liberal use of the “standing 8 count” to protect boxers. The standing 8 count gives the referee time to assess the ability of a boxer to defend himself or herself after a hit or knockdown. Up to three standing 8s can be administered to a given boxer without the bout being stopped (unless in the same round). This encourages liberal use of the standing 8. Referees also have the power to stop a bout anytime they feel a boxer is overmatched — before the boxer gets hurt or knocked down.

(7) Amateur boxers must undergo a medical exam by a licensed medical doctor both before and after each bout. Physicians performing these exams have the right to “restrict” boxers, i.e. prevent them from sparring and fighting for 30, 60, 90 or even 180 days following suspected concussions or other injuries.

(8) Amateurs are matched up according to THREE criteria to assure fairness — weight, age AND experience level.

(9) Any one of 10 different people can stop a bout at any time — the referee, the ring doctor, either boxer, either boxer’s cornerman, the judges and the sanction holder (event host).