By “Boxing is a sport surrounded by an aura of solemnity and allure. It conceals a magical element that transforms its viewing into a sensory experience, creating mental images that are permanently etched into memory. It is aesthetic, balanced, precise, and complex, and when practiced with meticulousness, it connects with the primal regions of the brain, where the human capacity for fascination with the violent harmony of nature resides.”
Sergio Guadalupe Alarcón
Historias del cuadrilátero. Grandes historias del boxeo
T&B Editores (2011)
By Sandro Angulo Rincón
“Oh! It’s over! My God! Get the doctor up here! What a knockout!” These were the overwhelming words of Salvador “Chava” Rodríguez, a Mexican boxing commentator for ESPN. He has surely witnessed spectacular knockouts in his career, but none as dramatic as the one delivered by Cuban Osleys Iglesias (26 years old) against the Russian Evgeny Shvedenko in Canada on June 6, 2024.
A right-hand hook landed between the left temporal and parietal bones of the 33-year-old Russian just 2 minutes and 48 seconds into the first round of a scheduled 12-round bout. The boxer collapsed onto the canvas, and his convulsing body horrified the spectators at Casino Montreal as well as the viewers watching the live broadcast.
The images of Shvedenko with his head immobilized and his limbs making erratic movements reignite the longstanding debate about the cruelty of this sport. These images clash with Sergio Guadalupe Alarcón’s statement at the beginning of this report, where he describes boxing as an aesthetic, meticulously fascinating, and harmoniously violent sport.
Iglesias (12 fights, 12 wins, 11 by KO) retained the super lightweight title of the International Boxing Organization (76 kilograms) and climbed to ninth place in the category’s rankings. Shvedenko (16 fights, 7 by KO, two losses, and 1 draw) will have to undergo multiple medical examinations to determine if he can continue boxing or if he should retire to avoid further damage.
(In this report, I review the calculations of the speed, power, and force of the punches, the statistics on their deadliness, and both neurological and non-neurological injuries in fighters. I also reflect on regulatory reforms and explore why the sport persists despite ongoing criticism).
Serious injuries and fatalities in boxing
The study conducted by Andrew Jovanovski and Brad Stappenbelt, titled “Measuring the Boxing Punch: Development and Calibration of a Non-Embedded In-Glove Piezo-Resistive Sensor,” identified that the average impact force of a gloved punch delivered by novice boxers was 2.310 kN, with a standard deviation or variability of ± 3.280 kN (kN, abbreviation for Kilo Newton, a unit of force in the International System of Units, SI). The authors add that the success of a punch depends on a combination of speed, power, and force, as well as confidence as a psychological component, precision, high oxygen consumption, and refined technique.
A punch can range between 2,500 and 5,000 Kilo Newtons in professional athletes. To put this into perspective, it is equivalent to what a person would experience in a car crash at a speed of 50-60 km/h (31-37 mph) against a solid object without airbags or a seatbelt. It would to bone fractures, bruising, cervical injuries, or considerable brain damage.
Repeated exposure to punches, combined with a particular state of physical and mental vulnerability, can result in death or irreversible damage. There is no exact figure, but the most conservative estimates suggest that since 1900, approximately 600 boxers have died in the ring or within hours or days after a bout.
The most common and permanent damages in boxing can be classified as neurological and non-neurological (see photomontage).
Neurological Damage
According to Dr. Barry D. Jordan, author of the article “Brain Injury in Boxing,” neurological damages include Acute Traumatic Brain Injury (ATBI) and Chronic Traumatic Brain Injury (CTBI).
ATBI is the immediate neurological consequence of a direct trauma to the head, with the most common in boxing being a concussion, which occurs when the brain strikes the inner walls of the skull. The right hook that impacted the left temporal and parietal areas of the Russian boxer Evgeny Shvedenko triggered a tonic-clonic seizure, which consists of two phases: The tonic phase is characterized by sustained muscle contractions throughout the body, during this time the person loses balance, falls to the ground, and may experience a temporary cessation of breathing due to the rigidity of the respiratory muscles, potentially causing cyanosis (a bluish coloration of the skin due to the lack of oxygen). The clonic phase is observed with rhythmic, repetitive muscle jerking, along with rapid contractions and relaxations that can be violent or uncontrolled.
A concussion can range from mild to severe and may present cognitive symptoms (amnesia, confusion, unconsciousness, disorientation, fogginess), behavioral symptoms (irritability, psychomotor delay, sleep disturbance, anxiety/nervousness, fatigue), and physical symptoms (headache, dizziness/vertigo, impaired coordination, vacant stare).
A case of cognitive symptoms was documented by J. L. Blonstein and Edwin Clarke in “Further Observations on the Medical Aspects of Amateur Boxing”, where a boxer completed his bout and won by decision, although, surprisingly, he experienced amnesia throughout the entire confrontation. He had taken several blows to the jaw but did not fall down, his condition was stable despite not remembering what had happened in the ring.
Chronic traumatic brain injury (CTBI), also known as pugilistic dementia or “punch-drunk” syndrome, is the cumulative long-term neurological consequence of repetitive blows, both with and without concussions. This syndrome was first described in the scientific literature by Dr. Harrison Martland in 1928 when he diagnosed a 38-year-old retired boxer with advanced Parkinson’s, ataxia (lack of muscle coordination, balance, and control of voluntary movements), pyramidal tract dysfunction (difficulty with precise and fine movements), and behavioral changes. This condition is observed in retired fighters or those nearing the end of their careers and represents one of the most challenging issues in terms of safety and effective treatment in modern boxing.
CTBI involves the deterioration of both motor and behavioral systems. In the psychomotor system, the athlete may exhibit early signs of Parkinson’s disease, mild incoordination, tremors, and dysarthria (a speech disorder). In the behavioral system, they may show symptoms such as violent outbursts, psychosis, paranoia, hypersexuality, disinhibition, morbid behavior, and hypomania (mild euphoria). These symptoms typically appear after the age of 28, usually following more than 10 years of a professional career or after having fought more than 150 bouts.
Muhammad Ali exemplifies a boxer who suffered severe aftereffects during his professional life. In the documentary “Thrilla in Manila”, which describes his third fight against Joe Frazier in 1975, a journalist asked Ferdie Pacheco, Ali’s doctor, “What happened to him after that fight?” He replied, “It was the end of his career. He shouldn’t have fought again, but he wanted to continue; the Muslims and Angelo Dundee (his trainer) wanted him to continue; everyone wanted him to continue, except me. Ali was urinating blood; he couldn’t walk, talk, or see properly; he couldn’t pass a real exam if someone had given him one.”
These concerning clinical conditions could be mitigated if boxers underwent neurological exams before and after a fight to identify individuals predisposed to suffer an acute and potentially chronic catastrophic brain injury. Unfortunately, such exams are only conducted once, as a requirement for obtaining a professional license, or after accidents in the ring, like the ones previously mentioned.
Non-Neurological Damage
According to Domenic Colletta, author of the article “Nonneurologic Emergencies in Boxing,” the most common emergencies are:
Bleeding from Lacerations: This is the most usual occurrence following a concussion. Subcutaneous bleeding from lacerations or hematomas does not constitute a life-threatening emergency. However, if the injury is located in an area that obstructs the athlete’s vision, it makes them more vulnerable and could become an extremely dangerous medical condition.
Fractures: Jawbone fractures are relatively common in boxing and pose a significant risk by obstructing the airway. While a nasal fracture is typically not sufficient reason to stop a fight, severe epistaxis (persistent and severe nosebleed), with the possibility of blood aspiration into the larynx and throat, can lead to respiratory problems.
Although not common, a punch to the front of the neck can fracture the larynx, this can be diagnosed by the presence of subcutaneous emphysema, hoarseness, and difficulty breathing. A vertebral fracture from a strong punch is very painful. While not usually life-threatening, significant injuries can occur, particularly when lower left rib fractures affect the spleen.
Liver Injury: This injury, often caused by a curved hook or uppercut, is extremely painful and can result in weakness in the legs and difficulty breathing. Striking the liver is devastating because this organ is covered by a capsule of nerves that send information to the autonomic nervous system. Therefore, every time a punch lands in that area, it causes a sudden pressure change that activates all these nerve connections, triggering a chain of chemical and electrical reactions that leave the opponent writhing in pain on the canvas.
Kidney Injury: Renal contusion can occur due to a direct blow to the flank of the abdomen, between the rib cage and the pelvis. A consequence of this can be a significant presence of blood in the urine, which requires urgent examinations to prevent or rule out kidney damage.
Solar Plexus or Pit of the Stomach: A straight or curved punch to the solar plexus causes loss of breath, intense pain, general weakness, disorientation, nausea, and vomiting.
Eye Trauma: According to Gustavo Corrales and Anthony Curreri, authors of “Eye Trauma in Boxing,” ocular trauma is found in 66% to 76% of asymptomatic boxers. Additionally, around 21% to 58% of fighters have serious problems that threaten their vision. Common traumas include retinal tears and detachments, macular and angle injuries, cataracts, and even globe ruptures.
For this reason, the American Academy of Ophthalmology has suggested some reforms to the sport to mitigate these pathologies. These recommendations include conducting eye exams before obtaining a license and after one year of participation in the discipline, after six bouts, or after two losses. Additionally, they suggest removing the thumb from boxing gloves, as its small size can impact the eye socket and cause increased damage.
Why Doesn’t It Stop?
Thomas Hauser, an American journalist, published the book “The Black Lights: Inside the World of Professional Boxing” in 1986, in which he echoed the criticisms that this sport received in the United States during the 1980s. Hauser joined the training camp of super lightweight Billy Costello to explore the inner workings of this cruel and exploitative business. Bloodthirsty fights that were deemed more important than the boxer’s life as well as the sacrifices they had to endure to win, are some of the topics narrated in the book.
The brutality of boxing (the most frequently depicted sport in cinema) was portrayed in the film “Raging Bull” (1980) starring Robert De Niro. This feature film shows how boxers must undergo inhumane diets and training regimens, and how they can suffer from addictions and mental health issues during defeat and retirement. A particularly moving scene shows De Niro, playing the real-life boxer Jake LaMotta, begging for a sip of water in a sauna where he is dehydrating himself to quickly make weight for his category.
Source: Pinterest
Changes to the rules intended to make the sport less violent have often been motivated by fatal incidents rather than by scientific evidence and common sense. One of the most significant modifications occurred after the tragic death of 27-year-old Korean boxer Duk Koo Kim, who was knocked out in the 14th round by American world champion Ray “Boom Boom” Mancini on November 13, 1982, at Caesars Palace in Las Vegas.
Duk Koo Kim/Wikipedia
The Korean fighter, still unconscious, was rushed to the hospital where he died four days later from a brain clot and massive hemorrhage. Mancini retired after this unfortunate incident at the young age of 21. “He died once, and I felt like I was dying every day,” he told the press. But the tragedy did not end there: three months later, Koo’s mother committed suicide, and the following year, the fight’s referee, Richard Greene, also took his own life. As a result, the World Boxing Council (WBC) reduced the number of rounds to 12, as science had already warned that with more minutes of fighting, the high level of dehydration in the human body, combined with fatigue and blows, could be lethal.
Given this background, one might ask: why does boxing continue? Perhaps the more pertinent question is, why do we find it appealing? Professional boxing is not practiced by the children of wealthy families but by young people from disadvantaged backgrounds—those from impoverished northern ghettos or low-income southern regions—who seek to rise above their circumstances and deprivations and achieve fame.
Although boxing can be highly lucrative for its superstars, such as Mexican fighter Saúl “Canelo” Álvarez, who earns $35 million per fight, win or lose, beginners are forced to settle for much less, often earning only $200 per bout.
Furthermore, it is undeniable that boxing, since its professionalization in the United Kingdom in the 19th century, has become a lucrative enterprise, benefiting promoters, media outlets, trainers, and athletes. However, its existence would not be possible without the fascination with danger, victory, and death—primal drives that reside in human beings and transform their violent nature into a form of aesthetic pleasure accessible to any spectator.
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