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The International Boxing Association (AIBA) was founded in 1946. In the 70 years since then has never been a death in the over 30 000 AIBA sponsored tournaments. This includes all boxers without head guards, from 1946 to 1985, and with head guards, from 1984, when they were introduced as a means to reduce concussion/cut rates without any real scientific evidence and to meet Olympic demands. From 2012 to the present, elite male boxers have competed without head guards. There were 2 intracranial bleeds since 1946—1 in 2006 and 1 in 2008. Both boxers were wearing a head guard, and both athletes recovered without craniotomy and were neurologically normal.
The International Boxing Association referees who are closest to the action are highly trained to recognize the signs and symptoms of concussion, and at the AIBA tournament level, they will have a great deal of experience. In addition, referees and judges receive a half day seminar on diagnosis and treatment of ringside injuries before each major tournament. Supervisors remove referees who seem slow to recognize concussion. The International Boxing Association repeatedly provides clinics for physicians and referees (coaches, seconds, and athletes may attend) on concussion recognition, management, and treatment. Every effort is made to standardize the system at a safe level, but some human variance in medical diagnosis will always exist.
The International Boxing Association has one of the strictest concussion management programs of any sport. Every boxer stopped for head blows is examined for concussion by the doctor at ringside. A “stunning blow to the head” with no loss of consciousness receives a minimum 1 month suspension from boxing and training to box. The athlete must have no post concussive symptoms and clearance from a physician to return to play. Any loss of consciousness draws a minimum suspension of 90 days. The same is true for athletes who suffer no loss of consciousness but prominent post concussive symptoms. Loss of consciousness in excess within 1 minute disqualifies an athlete for 6 months. If a second stoppage for head blows occurs within a 90 day period of getting off a previous suspension, the boxer will receive double the longest suspension period applicable.
With regard to the removal of head guards from men's AIBA boxing tournaments, according to the Consensus Statement on Concussion in Sport at the Fourth International Conference on Concussion in Sport, Zurich, November 2012:
The statement makes reference to the reduction of impact forces with the use of headgear; this is true for linear forces measured under static conditions; however, no reduction in concussion incidence is seen because there is a strong relationship between concussion and rotational acceleration of the head leading to relative motion of the brain parenchyma and intracranial fluids within the skull,2 This motion in concert with the viscoelastic nature of the brain causes macroscopic injury from stretching and tearing of bridging and intraparenchymal blood vessels, parenchymal contusions with the brain forcefully deforming and colliding with the skull, and importantly, microscopic injury from the strain and resultant secondary injury of axonal fibers. Further blows causing linear acceleration in the lab may be attenuated by reactive motion on the part of the boxer without head guard who may see them better or react more than one who feels their head is protected.
The disparity between biomechanical and clinical findings suggests that factors other than the removal of head guard may play a significant role in the reduction of observable signs of concussion: mainly behavioral and technical changes in boxing.
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