Boxing

Is boxing safe?

It depends on whether you get hit in the head. Bag work, pads and fitness classes are ordinary gym exercise. Competitive boxing is different. In professional bouts worldwide from 2000 to 2019, an Association of Ringside Physicians study counted 84 deaths from brain trauma in 428,904 bouts, about one in every 5,000. With two boxers per bout, that is roughly 100 micromortsMicromortA one-in-a-million chance of death. It lets you compare the risk of very different activities on one scale.More in the glossary for each boxer every time they step into a professional ring.

That is about 25 times the risk of a skydive and a quarter of a BASE jump. And death is the rare outcome. The common one is the slow build-up of brain damage over a career.

How boxers die

Almost all ring deaths are caused by bleeding inside the skull, usually an acute subdural haematoma: a punch spins the head, and veins between the brain and its outer covering tear. A review of the Velazquez collection, the longest-running record of ring deaths, lists 2,076 deaths since the 18th century, about 10 a year, three quarters of them in professional bouts.

The pattern in modern fights is clear:

• Most deaths follow a knockout or stoppage. In 2000–2019, 42% of deaths came after a knockout and 35% after a technical knockout.
• Lighter boxers are over-represented. Fighters at 135 pounds and below had more deaths than heavier classes.
• Young fighters die. The average age at death was 26.
• The collapse may come later. In a study of 339 professional deaths from 1950 to 2007, the fatal event began in the ring in 61% of cases, in the locker room in 17% and outside the arena in 22%.

Deaths have fallen over time. Baird and colleagues found a clear drop after 1983, which they put down to shorter careers, fewer fights and more medical oversight, more than to the cut from 15 to 12 rounds in title fights.

The long-term brain risk

For most professional boxers, the main health risk is not a single fatal night but thousands of blows. Chronic traumatic encephalopathy (CTE) was first described in boxers as "punch drunk" syndrome. Older studies put clinical dementia at about 20% among professionals, and brain scans of active professionals often show changes that grow with the number of bouts. A long career, many fights and boxing past about 28 are the warning signs in the literature.

Amateurs look different. A 2007 systematic review in the BMJ found no strong evidence linking amateur boxing to chronic brain injury, though the quality of studies was poor. Amateur bouts are three rounds of three minutes, and referees stop one-sided fights early.

Injuries short of death

In Victoria, Australia, professional fights in 1997–2005 produced 23.6 injuries per 100 fights, mostly cuts to the face and concussions. Older and more experienced fighters were injured more often. In the US, emergency departments treated an estimated 363,000 boxing injuries between 2000 and 2023. Most (87%) happened in training and were fractures, sprains and soft tissue injuries, but concussions were four times as likely as other injuries to need admission to hospital.

Who should be careful

• Professional and white-collar fighters with little amateur experience. Mismatches and boxers who keep fighting after losing by knockout are a recurring theme in fatal cases.
• Boxers who have lost weight fast. Rapid weight cuts before a weigh-in leave a boxer dehydrated, and the lighter classes see more deaths.
• Older boxers and those with long records. Injury rates rise with age and number of fights.
• Children and teenagers who spar. In the US data, concussions made up 11.7% of boxing injuries among children aged 6 to 11.

How to box more safely

1. Keep head contact out of most sessions. Do technique on pads and bags, and limit hard sparring to a few controlled rounds a week.
2. Wear a headguard and a gumshield when sparring, and 16-ounce gloves. Headguards clearly reduce cuts; their effect on concussion is less certain.
3. Stop after any knockout or concussion. Follow the governing body's mandatory rest period and get a medical check before sparring again.
4. Get a brain scan if one is required, and take symptoms seriously. A headache that worsens, vomiting or confusion after a fight or sparring session needs an emergency department the same day.
5. Avoid extreme weight cuts and unlicensed or "white-collar" events without a ringside doctor.
6. Retire early. The literature on chronic brain injury points to career length and the number of bouts as the main drivers.

How we scored it

Fatality risk (42) reflects about 100 micromortsMicromortA one-in-a-million chance of death. It lets you compare the risk of very different activities on one scale.More in the glossary per professional fight, at the edge of the 20–100 band; training sessions carry far less. Serious injury risk (30) is the weakest factor, mainly because of concussion and chronic brain injury. Controllability (35) is low because blows to the head are the point of the sport, while rescue (75) is good at sanctioned events with ringside doctors. Compare rugby, a contact sport where death is far rarer, and horse riding, where head injury also drives the risk.