NIOSHTIC-2 Publications Search

Professional Boxing Safety Act of 1996: NIOSH report to Congress, study on health, safety, and equipment standards for boxing.

Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 1998 Jun; :1-116
In accordance with the directive in the Professional Boxing Safety Act of 1996 (enacted by Congress on October 9, 1996), the National Institute for Occupational Safety and Health (NIOSH) reviewed the medical and related literature to develop recommendations for health, safety, and equipment standards for the sport of boxing and professional boxing matches. Certain sports activities such as football and skiing are inherently dangerous and sometimes result in severe injuries and death. But boxing is a uniquely dangerous sport because it requires intentional blows to the head and other vital organs for the purpose of incapacitating the opponent. The following review indicated that such intentional and repeated blows to the head have resulted in irreversible acute and chronic brain damage, neurological impairments, serious eye damage, and premature death. Although amateur boxing was intentionally excluded from the Professional Boxing Safety Act of 1996, the health and safety considerations of both forms of the sport must be compared to understand the basis for the new health, safety, and medical recommendations in the Act. Amateur boxing is fairly well supervised in the United States through several national organizations. Amateur boxing differs from professional boxing in that the fights are shorter (3 versus 4 to 12 rounds); the rules, regulatory policies, and medical evaluations are more stringent; and the use of protective devices is mandatory. Professional boxing is less well controlled in that the supervision of the sport is carried out worldwide through numerous uncoordinated national, State, and local boxing commissions that may have no reliable system of records. Therefore, determining the exact medical history or magnitude of injuries and deaths in professional boxers is difficult. According to a review of the scientific literature, head injuries (including eye injuries) may account for up to 68 percent of all injuries in professional boxers. Although amateur boxing is less dangerous, significant trends in brain injury symptoms correlate with the number of bouts fought. This correlation is much stronger and more pronounced in professional boxers; 87 percent of those examined have symptoms of chronic brain damage. This chronic brain damage is directly related to the number of bouts; fighting more than 20 professional bouts appears to result in permanent damage. Ocular damage is also related to the number of bouts fought and affects as many as 66 percent of the boxers examined. Fighting more than 6 bouts is associated with a steep rise in retinal tears, and fighting more than 100 bouts results in retinal tears for nearly all boxers. Numerous medical organizations have made official statements calling for significant boxing reforms or for a total ban on boxing. In 1984, the American Medical Association called for a ban on all boxing (amateur and professional) in the United States. The British, Canadian, and Australian medical associations, as well as the World Medical Association, have recommended that boxing be banned. Sweden banned professional boxing in 1969; and in 1982, the Swedish government explored the possibility of forbidding amateur boxing. In 1984, the American Academy of Pediatrics opposed boxing in any sports programs for children and young adults [American Academy of Pediatrics 1984]. The American Neurological Association and the American Academy of Neurology have called for a ban on boxing. The Journal of the American Medical Association has printed several opinions calling for the banning of boxing. The U.S. Air Force Academy ended mandatory boxing in 1995. Research reports on the efficacy of safety equipment are scarce. However, from those few studies in the literature, recommendations have been made to use safety equipment for reducing the risk of head and eye injury in the professional boxer. In one study, headgear reduced knockouts (KOs) from a 3 to 4 percent incidence to 0.8 percent and also protected boxers from eye injury, reducing the incidence from 8 to zero percent. However, other studies do not show the same injury reduction from using headgear. No reliable test exists to identify boxers at risk for sudden death or impending brain injury. To reduce this risk, many have recommended central administrative regulations and strict medical supervision for the sport of boxing.
Injuries; Injury-prevention; Traumatic-injuries; Neurological-system; Neuromotor-system-disorders; Neuromuscular-system-disorders; Nervous-system-disorders; Central-nervous-system-disorders; Brain-function; Brain-damage; Brain-disorders; Eye-injuries; Eye-damage; Protective-equipment; Personal-protective-equipment; Personal-protection
Publication Date
Document Type
Fiscal Year
NTIS Accession No.
NTIS Price
NIOSH Division
Source Name
National Institute for Occupational Safety and Health
Page last reviewed: May 11, 2023
Content source: National Institute for Occupational Safety and Health Education and Information Division