CHICAGO, ILLINOIS – OCTOBER 12: Patrick Day is taken out of the ring on a stretcher after being knocked out by Charles Conwell in the 10th round of their Super-Welterweight bout at Wintrust Arena | Photo by Dylan Buell/Getty Images
Dr. Jonathan Gelber, orthopedic surgeon and author, discusses some of the issues surrounding these deaths
Patrick Day passed away October 16th, four days after being knocked out in a fight with former Olympian Charles Conwell. Day was only 27 years old.
Dr. Jonathan Gelber, orthopedic surgeon and author, discusses boxing fatalities in his latest book, Tiger Woods’s Back and Tommy Johns’s Elbow: Injuries and Tragedies that Transformed Careers, Sports, and Injuries. Dr. Gelber discusses in detail the death of Duk-koo Kim, a Korean fighter who succumbed to TBI after a long and brutal fight with Ray Mancini. In the wake of Kim’s death, boxing famously shortened championship fights from 15 to 12 rounds.
As Dr. Gelber notes in his book, this change did appear to create a drop in boxing fatalities. However, the deadliest rounds in boxing remain Round 3 and Round 10, and after the rule change there appeared to be a slight increase in deaths in Round 12. Patrick Day was knocked out in Round 10. While it is easy enough to guess as to why Round 10 is dangerous, what with fatigue setting in, it is harder to say why Round 3 is so deadly. When asked, Dr. Gelber acknowledges no one really knows, but hazards a guess that perhaps Round 3 is where significant mismatches are revealed.
To that point, Dr. Gelber’s book also dives into the mismatch issues created by cutting weight. According to a study done in California, 81.9% of MMA fighters and 87.4% of boxers jumped up at least one weight class after weigh in, with 36.4% of MMA fighters and 62.8% of boxers jumping up two weight classes. Even more problematic, only 42.6% of MMA fighters and 32.9% of boxers were fighting in the same weight class as their opponent on fight night.
As a doctor with experience as a ringside physician, Dr. Gelber’s greatest concern is for the journeyman fighters, the fighters living as a perpetual opponent. Medical suspensions do not follow them as they go from one state to the next, and there is no central governing body where medical records are kept. In the pre-fight physical, the doctor has to rely on information given. “They aren’t always going to tell you the truth,” Dr. Gelber says about the fighters. The fighters may carry a book of medical records with them, but that book will not include recent knockdowns in training, for example.
While it is most often the case that deaths are the result of acute trauma, there is also the issue of Second-Impact Syndrome (SIS), where a concussed brain is struck a second time—be it minutes, days, or weeks after the initial injury—and rapid and catastrophic swelling results. Even a mild concussion can precipitate SIS. Years ago, concussions were treated with dark room, quiet, and the absence of sleep. Today, plenty of sleep and both mental and physical stimulation are used to bring the brain back from concussion. Just how much time is needed for a brain to heal, and just how much healing is possible, are still under study.
During the fight, good communication between the referee and ringside physician is key, especially in those states where only the ref is allowed to stop a fight. Unlike in other sports where an athlete can go to the sidelines, the one minute break between rounds offers doctors a brief opportunity to examine fighters. They’re looking for slurred speech, the dragging of feet in lateral movements, sudden change in aggression—either toward passivity or more aggression, stumbling toward the wrong corner, and the classic symptom of knock knees, among other indicators of concussion. Recently it has been posited that a good test for concussion is a task that is both mental and physical, but it is difficult to administer these sorts of tests in that brief time time between rounds.
Hopefully, in the future fighters will be better protected from the worsening of brain injury thanks to neuroimaging, an assessment tool just gaining traction. The Association for Ringside Physicians is currently working toward a consensus statement on their recommendation for neuroimaging of fighters. While keeping track of brain health in this manner is obviously a great way to educate fighters as to when it’s time to put down the gloves, the high cost associated with neuroimaging—and who should cover that cost—make this solution problematic.
In the meantime, education has made an impact on how fighters protect their brain health. Hard sparring in the gym has been dramatically reduced, concussion protocols have been improved, and states such as California have taken steps to reduce drastic weight cutting. Additionally, institutes of higher learning such as the Cleveland Clinic in Las Vegas and Boston University’s CTE Center continue to improve upon our understanding brain health in athletes.