A brutal, vicious sport

Sunday, Oct. 23, 2005 | 9:48 a.m.

If you've watched enough professional boxing matches, you've seen the ferocious haymakers that crumple heavily muscled, finely sculpted bodies to the canvas.

If you've listened to former world boxing champions being interviewed years after their careers ended, the physical toll is as unmistakable as it is painful to observe.

But perhaps the most brutal reminder that the "sweet science" is often anything but comes from the dispassionate, clinical description of the American Association of Neurological Surgeons of exactly what it's like to get hit by a punch in the ring.

According to the doctors, the force of a professional boxer's fist is equivalent to being hit with a 13-pound bowling ball traveling 20 mph.

"If you hit the head hard enough, the brain will bounce around the wall of the skull," said exercise physiologist Patrick Bird, dean emeritus of the University of Florida's College of Health and Human Performance.

"Heavier boxing gloves and headgear, I would imagine, would decrease some of that, but the brain will still rattle around. There is nothing you can do on the outside to secure the brain better.

"You can put an egg in a carton but if you rattle it around, you will still break the yolk."

The sobering statistics compiled by the neurological association show how true that is in boxing: 90 percent of all boxers suffer a brain injury, with as many as 40 percent ending up with chronic brain damage, the group has concluded.

That has prompted the question: Are brain-damaged athletes slipping through the cracks of state regulators by being allowed to strap on their gloves once more?

The answer is a resounding "yes," medical experts say, partly because of gaps in health care for boxers in Nevada and elsewhere.

The gaps are aggravated by a lack of uniform medical regulations among the states and nations that send fighters to the United States, critics say.

But the problem has its roots in the very nature of professional boxing.

"At the amateur level, you get points for touching an opponent and it's much more controlled, so you have far fewer people having concussions at lower levels of boxing," said Jeffrey Barth, chief of medical psychology at the University of Virginia.

"The purpose of boxing at the professional level is to knock your opponent out. So the longer you stay in the sport and the higher up you get in the professional ranks, the higher your chances of experiencing a concussion."

Fighters often develop a degenerative condition that affects cognitive thinking, coordination, speech and sensory capabilities. While its technical name is atrophia pugilistica, it is better known as punch-drunk syndrome.

Another common condition is Second Impact Syndrome, brain swelling that occurs when a fighter suffers a second concussion before healing from a prior one.

The most direct solution, advocated by the American Medical Association, is simply to ban boxing. The AMA reached that conclusion following the 1982 death of South Korean boxer Duk Koo Kim four days after a nationally televised championship fight in Las Vegas.

In that fight, Duk was challenging for the World Boxing Association lightweight title held by defending champion Ray Mancini in a scheduled 15-round bout at Caesars Palace. Duk was the early aggressor, but began losing steam in the middle rounds.

When the 13th round opened, Mancini landed more than 40 consecutive unanswered blows. Duk remained on his feet until the 14th round, when he was knocked unconscious and carried away by stretcher, never to recover.

In calling for an outright ban of both professional and amateur fights after the Duk fight, the AMA, noting the obvious, pointed out that in boxing, "the primary objective is to inflict injury."

Dr. Peter Carmel, an AMA board member and chairman of the New Jersey Medical School's Neurological Surgery Department, said there is a good chance the association's 560-member House of Delegates will renew its call for a boxing ban in November based on Nevada's 2005 record. Two fights end in deaths, and two others resulted in major brain injuries to the boxers.

"I would guess there would be some calls from our delegates to come out even more strongly against boxing than we have," Carmel said.

Short of an outright ban, there are bills in Congress to create a national commission to oversee the sport. But boxing federations that sanction ring contests oppose the idea, arguing regulation should be left to the states.

Many physicians like the legislation because it would create a national medical registry with information on every boxer licensed in America. The registry would contain boxers' medical records, medical-related suspensions and key details such as times they have been knocked down or knocked out.

"With a national registry we could find out how many injuries a fighter has had and how serious the injuries are," Carmel said. "Once a fighter has been seriously concussed, his chances of getting a second major concussion within a short period of time are three to four times greater than if he hadn't had the first concussion."

A medical registry would only go so far, though. Medical professionals say boxing needs to take other health care measures to better protect fighters.

Two of boxing's greatest deficiencies, they say, are not using brain scan technology enough and a lack of health insurance, particularly for long-term care.

Brain scans are rarely performed on boxers after they have fought, unless they have suffered obvious head injuries.

"Generally, fighters are checked briefly after a fight, but no one follows them days or weeks later," said Keith Kleven of Las Vegas, an internationally renowned physical therapist. "Maybe there should be follow-up assessments days or weeks after a fight."

Dr. Robert Cantu, medical director of the National Center for Catastrophic Sports Injury Research at the University of North Carolina, is one of many who advocate brain scans before and after fights.

"A small percentage of the gate should go to pay for those things," Cantu said.

At a minimum, Cantu believes scans should be done on both contestants in championship fights, which generate large enough revenue to make that testing easily affordable.

"We don't yet have our finger on the pulse as to what is causing the outcomes of these fights," Cantu said of boxing fatalities. "What we know is if you have an injured brain and subject it to more trauma, the damage can be exponential."

More scanning may not be enough, though, because brain scans are basically snapshots in time. Doctors say fighters still risk brain damage -- or worse -- even with a negative scan, a grim fact underscored by the two fatalities in Las Vegas fights this year.

Lightweight Leavander Johnson had a magnetic resonance imaging scan of his brain in May, four months before he died after a September bout. And super lightweight Martin Sanchez, who died a day after his July 1 match, had an MRI only three days before his fight.

Some medical experts see the need for boxing to conduct more thorough testing throughout boxers' careers to better measure changes in their brains over time. A measurable decline in testing results, they note, will allow boxing regulators to step in sooner to prevent a fighter from boxing again.

"The vast majority of what we know about repetitive brain injuries has been based on studies of college-level players in football and soccer," said Dr. David Cifu, medical director of the Rehabilitation and Research Center at the Medical College of Virginia.

"The information we have on boxers is from very small studies and anecdotes. Nobody has any statistics on if you get knocked out, how long it should be before you come back.

"What we need to do is a minimum five- to 10-year study following boxers from age 16 on up. You want to start testing right before they take off their (amateur) headgear."

Lack of health insurance is another problem. Although Nevada law requires fight promoters to provide at least $50,000 worth of insurance to cover the medical care of a boxer injured in a contest, many boxers do not have insurance to cover long-term care to treat chronic brain damage.

Dr. Lonnie Hammargren, a Las Vegas neurosurgeon and former lieutenant governor who operated on Duk after the Mancini fight, said fight promoters should pay into a fund for boxers who do not have insurance.

"What happens to the guy who hasn't made millions of dollars who has brain damage?" Hammargren said. "Often, the county ends up paying for the boxers' care. When fighters have had injuries, the managers somehow disappear."

Kleven, who has had an all-star client list that included former heavyweight boxing champs Joe Louis and Larry Holmes, believes boxers should be thoroughly and repeatedly checked by medical professionals in training camp.

Someone in a fighter's training camp -- preferably someone with a medical background -- also needs to develop a close relationship with the boxer so that the athlete is comfortable discussing his physical condition, he said.

"They need to tell the fighter, 'I care more about you as a person than as a fighter and you need to tell me what's going on,' " Kleven said. "The fighter has to know you're there to help them. They need to know you're honest and will tell them the truth. A fighter likes to know he's ready to fight."

Of 12 boxing-related deaths in Nevada over the past 72 years, nine have occurred since 1982.

The deceased fighters' records, along with news clippings from their final bouts, reveal no clear pattern to the deaths. Some were carried off by stretcher. Others left the ring on their own. One fighter spent the day after his final bout sightseeing on the Las Vegas Strip, went to bed and collapsed in his shower the following morning.

But indicators might have foreshadowed some of the fatalities:

* Johnson went at least 10 rounds in six of his last seven fights, indicating he could have endured substantial physical punishment immediately preceding his final bout. Of his 35 prior fights, he went 10 rounds only twice, according to Boxrec.com, an online boxing records archive.

* Roy Holloway, who died after a Las Vegas bout in November 1975, had lost fights by knockouts in June and August that year. He reportedly suffered a head injury during the August bout, a fifth-round knockout, but stepped into the ring for what would be his last time three months later.

* Duk went into his November 1982 bout against Mancini with a 17-1-1 record, including 12 straight victories. But all of his prior fights were in Asia, raising the question of whether he received adequate medical care in his native country before stepping into a U.S. ring for the first, and last, time.

The same question applies to the deaths in Las Vegas of Sanchez in July, Pedro Alcazar in 2002 and Jimmy Garcia in 1995, all of whom died in their U.S. debuts after long careers in other countries. Sanchez had fought exclusively in Mexico, Alcazar boxed in Panama and Costa Rica, and Garcia fought in Colombia, Panama and Mexico.

The frequency with which foreign boxers fight in the United States points to the need for an international boxing commission, Hammargren said.

"There is so much corruption in the sport and in the manipulation of statistics as the promoters try to build their boxers up," Hammargren said. "Obtaining accurate data on boxers is a worldwide problem."

Steve Kanigher can be reached at 259-4075 or at steve@lasvegassun.com.

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