April 8, 2016
The topic of concussion in sport has once again been thrust into the limelight following the recent fight between middleweight boxers Chris Eubank Jr and Nick Blackwell. The fight was stopped in the 10th round on the advice of the ringside doctor as it became apparent that Blackwell had sustained significant head trauma, developing a massive swelling over his left eye. Blackwell was taken to hospital following the fight where it was found he had suffered a bleed on his brain. He was put into an induced coma. Thankfully after 10 days Blackwell has been slowly brought out of the coma and appears to be showing signs of recovery.
There is an obvious risk of head injury in a number of different sports. Concussion on the pitch has been a big issue for the Rugby Board to overcome in the last couple of years. Given the ongoing debate about head injury in sport, is enough being done by the regulatory bodies to protect those playing competitively?
Professional sports players understand the risk and dangers of their chosen sport and the real possibility of sustaining serious injury. However, regulatory sporting bodies have a duty of care to ensure safety regulations allow for the minimum amount of danger possible, as well as adequate medical care in the event that an injury does occur. As the issue has become more high profile, progress is being made. Last month, Newcastle forward Aleksandar Mitrovic was knocked unconscious during the Tyne-Wear derby with Sunderland. Mitrovic regained consciousness on the sidelines and was desperate to return to the pitch and continue playing. Despite his angry outburst, Newcastle Doctor Paul Catterson refused to let him. Mitrovic later apologized to the doctor acknowledging that he did know what the rules were.
However despite a growing awareness of the long term risks of unchecked head injuries, the Professional Rugby Injury Surveillance Project Report 2014/5 was published last month and reveals that concussion is still the most common injury in English professional rugby.
Although boxing is currently in the limelight, the sport is actually the most strictly regulated when it comes to head injuries. Before each competition, a compulsory medical examination must be undertaken, covering both physical and mental health. Without these checks, a player is not allowed to fight. For every tournament, trained medical professionals must be on hand to cope with any concussive incidents, and an evacuation procedure must also be established prior. In the event of a period of concussion, there are strict rules as to when individuals can return to competition, for example if a boxer has experienced a loss of consciousness for under a minute they must rest for 90 days. After this incident of rest period, the boxer must obtain a certificate of fitness from a physician or neurologist. Compared with other sports such as rugby, football, F1 racing and horse racing these regulations are actually fairly stringent.
What role should the referee have?
But when is the right time to end the fight? That is the challenge currently facing boxing. Under current regulations either the referee or the boxer's coaches can decide when to put a stop to the match. The referee in the Eubank Jr vs Blackwell match, Victor Loughlin has faced criticism for not stopping the fight earlier. Chris Eubank Sr who was ringside during the bout had told his son between rounds 8 and 9 to aim his blows to his Blackwell's body and to avoid his head in order to protect him from any further damage. Eubank Sr has said that he thought of Michael Watson who suffered irreparable brain damage following a fight with him in 1991 as Blackwell was removed from the ring. Both Eubank Sr and Jr have since expressed the view that the fight should have been stopped sooner; however the British Boxing Board have confirmed they were satisfied with the way the fight was conducted by the referee.
Referees in all sports have the power to stop the game, although it happens more frequently in some than others - football matches are often halted many times in one match due to injury, although this scarcely happens in boxing. Boxing coaches in particular have a difficult decision on their hands when contemplating stopping a match, as finances, future fights and emotions can often interfere. Referees tend to stop a match if there is a medical factor, such as a broken jaw or loss of vision that is clearly affecting the individual's ability to participate and protect themselves.
But should England Boxing do more to regulate the safety of boxers, especially in relation to head injuries? Greater education of referees could be the solution. Concussion and internal head injuries can be fatal, yet are much harder to spot than say, a broken jaw (for which referees would immediately stop the match). Given that blows to the head can develop into some of the most life debilitating injuries, it is extremely important that referees are able to spot the signs of head injury and take effective action. Noticing these subtle signs could mean the difference between life and death. Ensuring all referees are educated in how to spot head injuries effectively is key to decreasing the numbers of boxers suffering potentially life changing injuries.
However it remains a difficult issue as acknowledged by Robert Smith, the General Secretary of the British Board of Boxing Control in a recent interview on Radio 5 live "We have everything in place as best we can. But we're never going to make it 100% safe".
Given the potential life-threatening damage concussion in sport presents, does more need to be done to educate all officials present at a match?
As a complex injury solicitor I've dealt with a number of clients who have suffered severe brain injuries and have on occasion witnessed these differences first hand. In some cases, clients are discharged from hospital with little or no support following a life-changing brain injury.