Biomechanics of Brain Injury in Boxing: New Study Takes Deepest Look to Date

Promises a new window into acute effects of head impacts

By Adam Bartsch, PhD; Jay Alberts, PhD; and Edward Benzel, MD

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The sports concussion crisis has fueled a lot of research assessing concussion through imaging, behavioral evaluation or impact studies, but little to no research has combined these three modalities for a comprehensive look at the acute effects of head impacts in combat sports. Until now.

Boxing Biomechanics Study

Researchers from across Cleveland Clinic’s Neurological Institute are conducting an investigation we call the Boxing Biomechanics Study that uses all three modalities — imaging, behavioral assessment and evaluation of impact dynamics — to begin to pinpoint the dose of head impact that produces brain changes linked to neurodegenerative disease.

Our aim is to assess and refine this three-pronged data-gathering approach in a small group of boxers and mixed martial arts fighters to build toward prospective longitudinal studies in large numbers of athletes tracked over years or decades.

Our team — which draws from Cleveland Clinic staff in the Center for Spine Health, Concussion Center and Lou Ruvo Center for Brain Health — began the Boxing Biomechanics Study in 2013, and we expect to report results later this year.

Intensive evaluation around a sparring session

We have enrolled five boxers and mixed martial artists in Las Vegas who are evaluated over one to two days as follows:

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  • They undergo a baseline brain MRI and a baseline assessment of motor and cognitive functions via Cleveland Clinic’s C3Logix™ app for concussion assessment.
  • They take part in a sparring session wearing the Cleveland Clinic Intelligent Mouthguard (Figure 1) to capture head impact data. The Intelligent Mouthguard, developed by Center for Spine Health and Concussion Center researchers, is equipped with sensors to measure linear and rotational head movement in real time. These data are compared with neurological and motor test results from after the sparring session to drive a computer-based brain model that helps diagnose and pinpoint brain injuries.
  • Right after the session, they undergo a post-sparring C3Logix app assessment and brain MRI.

We are analyzing and correlating data from all three modalities in this initial group of 10 fighters in the hope that this approach will prove to be a comprehensive, “one stop” data collection strategy for assessing and quantifying the dose of head impact causing neurodegenerative changes.



Figure 1. The Intelligent Mouthguard includes sensors for measuring linear and rotational head movement in real time.

Building toward a longitudinal series

After we refine our data collection and technologies based on these findings, our next steps will be to expand the study population closer to 100 fighters and ultimately to 1,000 or more.

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Likewise, we hope to extend follow-up assessments to years and even decades if we can follow fighters who turn professional — a prospect facilitated by the Lou Ruvo Center’s presence in Las Vegas. This presence, paired with Cleveland Clinic’s deep concussion expertise, uniquely positions us to comprehensively pursue new insights into how impact-related brain injury occurs, how it relates to clinical deficits, and which types of impacts do and do not cause concussion or other forms of traumatic brain injury.

Dr. Bartsch is Director of the Spine Research Laboratory in Cleveland Clinic’s Center for Spine Health.

Dr. Alberts is Director of Cleveland Clinic’s Concussion Center and Vice Chair for Health Technology Enablement in the Neurological Institute.

Dr. Benzel is Chairman of the Department of Neurological Surgery.