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Year : 2016  |  Volume : 16  |  Issue : 2  |  Page : 106-110

Prevalence of injuries in competitive boxers: A retrospective study

Department of Physiotherapy, Tilak Maharashtra Vidyapeeth, Pune, Maharashtra, India

Date of Web Publication13-Apr-2016

Correspondence Address:
Dr. Roshan Gopal Adkitte
Department of Physiotherapy, Tilak Maharashtra Vidyapeeth, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-6308.180154

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Background and Purpose: Several changes have occurred in Olympic boxing in last few decades. In March 2013, the use of headgear was banned to reduce the incidence of cerebral concussion. This reduced the concussion rate to 0.17% but affected the boxer's psychology and also the way boxers and coaches prepare. The boxers feel safer to take the risk wearing headgear that they simply would not do if they are not wearing one. Furthermore, three fatal incidents of professional boxing make it important to find out the prevalence of injuries in competitive boxers. The aim of this study was to find out the prevalence of injuries in national level boxers of India that occurred during the bout or training. Materials and Methods: The study was conducted as a retrospective and was carried on 54 national level boxers ranging between 11 and 35 years. Results: Fifty-four boxers reported with 820 injuries in 2 years. Each boxer sustained 15.18 injuries in 2 years on an average, i.e., 7.59 injuries/year on an average. The injury rate per boxer was 9.64/1000 h of training. The injuries of head and face (42.92%) are more frequent followed by the injuries of upper limb (33.90%). Soft tissue lacerations and contusions are common. Furthermore, frequent low back pain (5%), calf cramp (3.41%), and high ankle sprain (4.4%) were reported because of training. Conclusions: The study suggests that the most common type of injuries in boxers is the soft tissue lacerations and contusions, and the most common site of injury is the head and face region. Common injuries due to training are low back pain, calf cramp, and high ankle sprain.

  Abstract in Arabic 

انتشار الإصابات في الملاكمين تنافسية: دراسة استعادية
الخلفية والغرض: في العقود القليلة الماضية حدثت عدة تغييرات في الملاكمة الاولمبية.
في مارس 2013، تم حظر استخدام أغطية الرأس للحد من حالات ارتجاج دماغي والذى
انخفض معدله إلى 0.17٪ ولكن تأثرت نتيجة ذلك الحالة النفسية للملاكم كذلك طريقة التحضير لدى مدربيهم. ان الملاكم يشعر أكثر أمنا لتحمل المخاطر عند ارتداء أغطية الرأس التي وببساطة لن تفعل إذا لم تكن يرتدي واحدة من قبل. وعلاوة على ذلك، حدثت ثلاثة حوادث مميتة فى ملاكمة المحترفين وهذا يجعل من المهم معرفة مدى انتشار الإصابات بين المشاركين فى الملاكمة تنافسية.
الهدف من الدراسة: الهدف من هذه الدراسة معرفة مدى انتشار الإصابات بين ملاكمين المستوى الوطني فى الهند والتي حدثت أثناء المباراة أو التدريب.
المواد والطرق: أجريت هذه الدراسة في ونفذت بأثر رجعي وعلى 54 من ملاكمي المستوى الوطني تتراوح اعماهم بين 11 و 35 عاما.
النتائج: أربعة وخمسين الملاكمين حدثت لهم 820 إصابة في فترة عامين. بمعدل 15.18 لكل ملاكم اما معدل الإصابة في الملاكم الواحد كان 9.64 / 1000 ساعة من التدريب. إصابات الرأس والوجه (42.92٪) هي أكثرحدوثا وجاءت إصابات الطرف العلوي (33.90٪ ) وكان تهتك الأنسجة اللينة والكدمات شائعا. وعلاوة على ذلك، كان هناك ألما متكررا فى أسفل الظهر (5٪)، واصابات تمزق عضلي في ربلة الساق (3.41٪)، وارتفاع التواء في الكاحل (4.4٪) بسبب التدريب
. الاستنتاجات: تشير الدراسة إلى أن أكثر الإصابات شيوعا بين الملاكمين هو تهتك الأنسجة وكدمات الانسجة الينة، وهى الأكثر شيوعا في الرأس والوجه. اما اصابات أسفل الظهر والكاحل وتشنج عضلات الرجل فتحدث بسبب التدريب ،

Keywords: Competitive boxers, contusions, soft tissue laceration

How to cite this article:
Adkitte RG, Bardgujar S, Yeole U, Gawali P, Gharote G. Prevalence of injuries in competitive boxers: A retrospective study. Saudi J Sports Med 2016;16:106-10

How to cite this URL:
Adkitte RG, Bardgujar S, Yeole U, Gawali P, Gharote G. Prevalence of injuries in competitive boxers: A retrospective study. Saudi J Sports Med [serial online] 2016 [cited 2023 Sep 21];16:106-10. Available from: https://www.sjosm.org/text.asp?2016/16/2/106/180154

  Introduction Top

Boxing was first introduced into the ancient Olympic games in 688 BC. [1],[2] The Oxford Dictionary defines boxing as "The sport or practice of fighting with the fists, especially with padded gloves in a roped square ring according to the prescribes rules." [3] The British boxer Jack Broughton introduced the use of padded boxing gloves (mufflers) for training and exhibition matches after killing an opponent. [4] The Marquess of Queensberry rules is a code of generally accepted rules in the sport of boxing. [4]

Boxing was the sport with highest risk of injuries together with soccer, taekwondo, hockey, handball, and weight lifting during the summer 2008 Olympic. [5],[6] Boxing has become a controversial sport because of the degree of injury, long-term sequel, and occurrence of death during competition. [7] Deaths to boxing participants have been reported in a more comprehensive manner than deaths as a result of any other combat sport type. Furthermore, very limited data exist for deaths occurring in other combat sports. [8],[9] In particular, injuries from boxing in children and adolescents have attracted great attraction. [10],[11],[12] Compared to men's boxing, women's is safe, and it rarely requires hospitalization. [5],[13],[14]

In boxing, head injuries generally occur because of contact between the fist and head, head and head, or head and some part of the boxing ring. A number of factors that affect the outcome of neurological injury in combat sports have been assessed in a laboratory setting. These include the region of the head that receives the contact, the magnitude, force, and direction of the contact, the use of gloves and their associated weights. [9]

It is necessary for the players as well as ringside trainers, referees, coaches to be updated with the different techniques of training with emphasis on preventing the injuries, especially the brain injuries. It is, therefore, necessary to find out the rate and frequency of injuries in boxing. Hence, the aim of this study is to find out the prevalence of injuries in competitive boxers of India and also to find out the most common type and site of injury.

  Materials and Methods Top

Study design

This survey was conducted as a retrospective study. Data were collected based on a questionnaire. Participation in the study was voluntary. Fifty-four national level male boxers were asked to report their injuries occurred in last 2 years, i.e., from August 2013 to July 2015. Only active competitive boxers were recruited.

The study participants gave their written consent before data recording and were provided with detailed study participant information. Parental consent was obtained for underage participants. For the study, the participants filled out an admission questionnaire along with another questionnaire reporting the sustained injuries.


Admission questionnaire

The admission questionnaire collected the following general information: Age, gender, weight, weight class, and boxing years. Data specifically related to training were also collected: Training years, no of training hours per day and total training sessions in a week.

Injury specifics questionnaire

In this questionnaire, all the injuries sustained in last 2 years were recorded, including location (e.g., eyes, arm) and type (e.g., laceration, contusion, and sprain). Then, the participants specified whether the injury occurred during the competition or training session.

Statistical analysis

The descriptive data include percentage, mean, median, standard deviation, and range. Overall injuries were estimated as total number of injuries, average number of injuries per boxer per year, injury rate per boxer per 1000 h of training.

Total injuries occurring because of training hours were also recorded. All the injuries were also divided into four groups: Head and face, upper extremity, thorax and back, and lower extremity. The calculations were done with the help of Microsoft Excel (Microsoft Office 2007).

  Results Top


The participants average age was 18.92 ± 4.25 (median 19, range 11-35 years), with an average weight of 56.51 ± 11.41 kg (median 55; range 28-81 kg). The response rate of the questionnaire was 100%.

Training information of the participants

The average training hours per day is 2.78 ± 1.12 (range 1-4, median − 2.5).The average number of training days in a week is 5.90 ± 0.52 (range 1-3, median − 6). The study participants trained 65.60 h/month on an average 787.2 h/year on an average. The training was divided into strength training, training with partner, and training without partner.


This survey was carried on 54 national level boxers. During the study period, 54 boxers reported with 820 injuries in total based on the history of past 2 years, i.e., from August 2013 to July 2015. These injuries were occurred during matches as well as during training sessions.

Each boxer sustained 15.18 injuries in 2 years on an average, i.e., 7.59 injuries/year on an average. The injury rate of the individual boxer was 9.64/1000 h of training.

The injuries were divided as injuries of head and face, upper extremity, thorax and back, and lower extremity [Figure 1]. Out of 820 injuries, 42.92% injuries of head and face, 33.90% injuries of upper extremity, 5.85 injuries of thorax and back, whereas 17.33% of lower extremity were recorded. Specific injuries are listed in [Table 1]. Lip laceration is the most common. 41 boxers out of 54 boxers complained of calf cramp after long hours of the training session. 28 boxers complained of low back pain after training sessions. 31 boxers out of 54 boxers showed high ankle sprain and gave a history of ankle twist during the training session.
Figure 1: Prevalence of injuries in 54 boxers

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Table 1: Specific diagnosis and symptoms of injuries

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The injuries of head and face are shown in [Figure 2]. Contusions were seen in many cases. Out of 820 injuries, 332 injuries (40.48%) were contusions which included contusion at various places such as eyebrow, cheekbone, maxillary tooth, lower jaw, wrist, hand, forearm, shoulder, metacarpus, ribs, and lower leg.
Figure 2: Percentage of injuries of head and face in descending order

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Concussion was seen in 33 subjects. Ophthalmological injuries accounted for 7.43%. Tooth subluxation was seen in eight cases. Muscle strain/tear accounted for 7.31%. Metacarpus fractures were reported by 12 boxers. Analysis of data showed no serious injury. The injuries that occurred were either treated physician or physical therapist.

  Discussion Top

Only few studies have been carried out on Indian boxers. Similar study was carried out in Australia and New York. Siewe et al. in their study, injuries in competitive boxers. A Prospective Study carried out in 2014 reported 192 injuries over a period of 1 year in 44 boxers, and the study injury rates and risk factors in competitive professional boxing done by Seiwe et al. reported with 214 injuries over a period of 8.5 years in 545 boxers. [5],[9] Zazryn et al. did a study of 16 years on professional boxers of Australia and reported with 104 injuries in 427 participants. [15] The distribution of injuries in National boxers of India is similar to the study of professional boxers in New York in 2014. The injuries of head and face (42.92%) are more frequent followed by the injuries of upper limb (33.90%). Soft tissue lacerations and contusions are common. Furthermore, frequent low back pain (5%), calf cramp (3.41%), and high ankle sprain (4.4%) were reported due long hours of the training session. Soft tissue laceration is the common type of injury. The rules for professional boxers are similar (although not exactly the same) regardless of the country or state a boxer is fighting in. It would, therefore, be expected that injury data such as those described here for Indian boxers would be similar to those for boxers from other countries. While a study by Bianco et al. in 2013 on amateur boxers concluded that the common site of injury is the upper extremity. [2]

The common injury in head and face region was lip laceration. 81.48% of boxers had lip lacerations. Nasal bone contusion (61.12%), gingival bleeding (61.12%), and cerebral concussion (61.12%) are the second most common injuries in head and face region. In this study, head and face region is the most common site of injury which may be because of: Absence of head guard, different technique of training, the weight of the handcuff, and high-intensity stroke. Cerebral concussion may occur because of violent blow to the head, neck, or upper body which causes the brain to slide forcefully against the inner wall of the skull. Contusions usually occur on the skin as a result of trauma causing rupture of capillaries. Analysis of the database suggests that 10% of the total injuries were around the eye region.

The common type of injury was lip laceration which may occur because of: Presence of poor quality mouth guard, most common site for stroke, and wrong techniques of defense. In thorax and back: Low back pain was common, which may be because of long hours of working out in standing position. The upper extremities, as the second most commonly reported injury site, can be injured during punching (especially the wrist, hands, and fingers of the striking fist). A factor that may be important to consider for injury prevention is the weight of the gloves being used.

In lower extremity, high ankle sprain was common, the reason may be change in the technique of training, the type of footwear and the surface of the training ground. Calf cramp was seen, due prolonged training sessions.

  Conclusion Top

This study provides clear evidence that professional male boxing is associated with many injuries. Most common site of injury is the face followed by upper extremity. Thorax and back are affected minimal. The most common type of injury is soft tissue lacerations and contusions. Fractures and eardrum ruptures are rare. There is no evidence of hernia.


The staff of Tilak Maharashtra Vidyapeeth (Department of Physiotherapy) is thanked for their support conception and design of the study, acquisition, analysis, and interpretation of data.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Swaddling J, editor. The Ancient Olympic Games. 3 rd ed. Oxford: Oxford University Press; 2008. p. 54.  Back to cited text no. 1
Bianco M, Loosemore M, Daniele G, Palmieri V, Faina M, Zeppilli P. Amateur boxing in the last 59 years. Impact of rules changes on the type of verdicts recorded and implications on boxers′ health. Br J Sports Med 2013;47:452-7.  Back to cited text no. 2
Available from: "boxing". oxforddictionaries.com. 2015. http://www.oxforddictionaries.com/definition/english/boxing. [Last accessed on 2015 Oct 25].  Back to cited text no. 3
Förstl H, Haass C, Hemmer B, Meyer B, Halle M. Boxing-acute complications and late sequelae: From concussion to dementia. Dtsch Arztebl Int 2010;107:835-9.  Back to cited text no. 4
Siewe J, Rudat J, Zarghooni K, Sobottke R, Eysel P, Herren C, et al. Injuries in competitive boxing. A prospective study. Int J Sports Med 2015;36:249-53.  Back to cited text no. 5
Junge A, Engebretsen L, Mountjoy ML, Alonso JM, Renström PA, Aubry MJ, et al. Sports injuries during the Summer Olympic Games 2008. Am J Sports Med 2009;37:2165-72.  Back to cited text no. 6
Toth C, McNeil S, Feasby T. Central nervous system injuries in sport and recreation: A systematic review. Sports Med 2005;35:685-715.  Back to cited text no. 7
Birrer R. Martial arts. In: Jordan B, editor. Sports Neurology. 2 nd ed. Philadelphia: Lippincott-Raven Publishers; 1998. p. 423-8.  Back to cited text no. 8
Zazryn TR, McCrory PR, Cameron PA. Neurologic injuries in boxing and other combat sports. Phys Med Rehabil Clin N Am 2009;20:227-39.  Back to cited text no. 9
Scott I. Youth boxing ban in some Australian jurisdictions. Inj Prev 1999;5:77.  Back to cited text no. 10
Timsit S, Rougeau T, Grevent D, Chéron G. Boxing-related cranial injury in children: A case report. Arch Pediatr 2012;19:1187-90.  Back to cited text no. 11
Bianco M, Sanna N, Bucari S, Fabiano C, Palmieri V, Zeppilli P. Female boxing in Italy: 2002-2007 report. Br J Sports Med 2011;45:563-70.  Back to cited text no. 12
Bledsoe GH, Li G, Levy F. Injury risk in professional boxing. South Med J 2005;98:994-8.  Back to cited text no. 13
Zazryn TR, McCrory PR, Cameron PA. Injury rates and risk factors in competitive professional boxing. Clin J Sport Med 2009;19:20-5.  Back to cited text no. 14
Zazryn TR, Finch CF, McCrory P. A 16 year study of injuries to professional boxers in the state of Victoria, Australia. Br J Sports Med 2003;37:321-4.  Back to cited text no. 15


  [Figure 1], [Figure 2]

  [Table 1]

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