martes, 7 de marzo de 2017

The K.O. The eternal contrast of the victor and defeat. An effect that goes beyond the count of ten.




Boxing as contact sport has the scoop: damage and avoid being damaged, also known as the "Sweet Science" is a sport that if something has historically lacked is precisely science. The ultimate goal of a boxer during a fight is deal it rival a Knock Out, is nothing more than a concussion ... An article published in 2015 by The Physician and Sports Medicine presents a serious and outstanding analysis as to brain damage to boxers as the cumulative impact of blows to the head and protocols that exist for treating, monitoring and return to activity in the best possible conditions, and suggest measures to prevent brain injuries. I intend to make a very brief summary and analysis of this article for the general public lover of this beautiful sport, for my medical colleagues, and most importantly, our brave and admired fighters who leaves everything and expose all in the ring. In the huge spectrum of a boxer winning a bag of millions of dollars to one that seeks ways to survive, the only sine qua non that prevails is that of two human beings slapping each other on the hard solitude of a ring to the admirably expectant fans and morbid look.





 

I firmly believe that we are about this sport should and can contribute much more than a shout at fighters.

There is a devastating numbers: 20 to 50% of former boxers have symptoms of permanent chronic brain damage, there is a wide range of long-term brain disorders, to name a few: pugilistic dementia, posttraumatic parkinsonism, chronic dementia syndrome post contusion and encephalopathy chronic traumatic, mainly. In an average race thousands of blows to the head, the type and severity of damage depends on the angle of impact, strength, head movement, relaxation and fatigue of cervical muscles are received when the fights are very advanced and boxer tired, this causes greater rotational and translational acceleration with each stroke. Given these factors is understandable need and responsibility to take preventive measures prior to the fighting and after them, and make the decision to suggest or prescribe retirement from the sport.








This article entitled "Determining brain fitness to fight: Has the time eat?" Quotes the Declaration and Consensus Concussion in Sport, Consensus statement on concussion in sport, held in 2012 in Switzerland and should be part of the daily practice of all Doctors related to sports where the risk of concussion is imminent. This work marks clearly how to handle the gradual return of an athlete, regardless of the discipline that practice, which has suffered a concussion, adhering to these recommendations can have an adequate and safe return to physical activity and sport with a wide range of safety for our patients, and above all, preventing injury or brain damage, or in the worst case scenario damage limitation.





In professional boxing after suffering a KO or TKO, the fighter must keep a full suspension of sporting activity rest within 30-180 days, this variability is depending on the medical or athletic commission where this is the fight, as well as the country or organization to which it belongs boxing the boxer.







So far everything seems to be very clear, but there is a real situation and problems, which becomes a true risk factor in boxing: the different rules and regulations of the commissions of boxing and wrestling in Mexico, many of which medical review is limited to a pre-combat, usually performed on the day of weighing where monitoring of vital signs, pupillary reflexes, review of the oral cavity, chest and hands is performed general medical examination. There is no standardized medical examination nationally for fights professional boxing in Mexico, much less a full neurological assessment linking a ban to fight preventively, further battery imaging studies of examination (CT or Magnetic resonance Imaging), showing the current state of the brain and that can guide or suggest chronic damage, and in some cases, show structural changes that make risky practice a contact sport. If there is a committee that has a comprehensive and correct protocol medical review that is limited to the commission, if a boxer is not allowed to fight as a result of a thorough neurological examination, the fighter can compete in any other state without complying strictly all necessary health standards and will take the ring. This scenario is similar in the United States, where are the best purses and represent "the big leagues of world boxing". There is a great difference between the athletics commissions in the regulation of "boxing, entities such as California, Texas, Nevada, New York and Washington do not share the test battery or the rigor of them to give professional boxing license.





The article to which I refer recommends three major actions intended to increase safety and prevention of chronic brain injury: 1) standardized neurological evaluation by a neurologist or neurosurgeon must be done, supported by brain imaging studies and the use of assessments that measure boxer cognitive function, this as early as possible within the sports career boxers can conduct studies in the future and compare changes as a result of cumulative injury or TKO, KO. 2) Neuroimaging studies as protector of the health and safety of the athlete. There are images that indicate the existence of pre-practice boxing (congenital malformations) lesions with this information can prevent many adverse events. In following boxers if these scans are performed frequently and routinely changes may become apparent brain tissue caused by the accumulation of impacts received and provides evidence of brain injury already established in the fighter. 3) Identify high-risk boxers; able to identify boxers with high number of fights per year, played rounds and losses by KO, I would add to this identification of boxers high risk to those winners fighters who have a record with few, including undefeated or defeats lost fights without suffering KO but they have been subjected to continuous punishment because of his boxing style or technical deficiencies on defense. This identification of the fighters could be done with proper and effective coordination of boxing commissions nationwide to take timely and actual record of reach boxer. It should not surprise the reader that there are boxers who have many more fights disputed that declaring its official record, if these fights are losses will be much better than not reflected in the official record that, in the end, is a tool to promote a boxer.

Realistically the above mentioned will not be performed by any of the boxing commissions of our country, the promoters will not perform these actions from these written handlers, in the best case, invest their time and money on the boxers that represent better future or present and, finally, boxers are subject to the above.

Where do enter the medical task in all this ?. The doctor ring, that mythical character known to all, is a professional who spends his time giving this service mainly from weighing until the end of the boxing function, are admirable knowledge that these doctors have in identifying the many and varied injuries and medical conditions that casts a boxing card. But historically its role is limited to those bittersweet and bloody moments of glory and defeat. These professionals belong to the medical commissions of boxing and wrestling and usually do not accompany the fighters in the transit time between the end of the fight and the beginning of the next period that can range from days to months.

For all above takes relevance  the role of Sports Medicine Doctor within the work team of amateur and professional boxer permanently to monitor and control the activities necessary to observe the progress and health of athletes, and to identify quickly deteriorate and limit the damage. These actions are made all the way between fights, day by day, with monitoring and training camps to the last innermost sacred place and this may be next to his fighter: the corner.

The sports medicine doctor must plan together with the team visits neurological reviews as an element of pre-competitive activities that routinely be performed, remember: resting electrocardiogram, echocardiography, ergometry test , physical therapy and medical injuries that occur, medical supervision of sports training, the legendary and problematic weight control, among many others.

I can not stop imagine myself the ideal of seeing a Mexican boxer, (already a great show), with a true master of boxing as main and only pair, closely supported by a trainer and sports medicine, What could get ?, a longer safe boxing career, probably with fewer injuries and at the end of this, a former physical fighter and mentally full and lucid that you can enjoy and remember the glories of the past, enjoying their defeats, suffering the undeniable negative effects of fame and victory, but with all the mental and cognitive capacity to do so. 

Everyone has the right to be healthy and whole as Julio Cesar Chavez successful interventions in mexican television or Ricardo "El Finito Lopez" flaunting a lot of gray matter in their speeches.

Sincerely I invite boxers to consider this message and take a more active role in their own care medium and long term.


Miguel Angel Nazul Aké Montiel
Sports Medicine Ph.

Ref
:
1. T. Seifert et al. Determining brain fitness to fight: Has the time come? Phys Sportsmed, 2015; Early Online:18
2. McCrory P, Meeuwisse W, Aubrey M, Cantu R, Dvorak J,Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held inZurich, November 2012. Br J Sports Med 2013;47:2508