Do Headguards Protect against Concussion in Boxing? | Article of The Week #32

Since the 2012 Olympics boxers have not had to use headguards, a decision which many feel is a move in the wrong direction when it comes to the protection against concussion and TBI. But what does the evidence tell us?

In 2013 the International Boxing Association (AIBA) made the controversial decision to prohibit the use of headguards to elite male Olympic boxing competitions. One of the main arguments for this decision was the AIBA’s claim that boxers will take more risks and “lead with the head” when boxing with a headguard.

Recognise, Assess & Treat Concussion

Olympic boxing differs from professional boxing in that it consists of 3 x 3 minute rounds with a 1 minute break rather than 12 x 3 minute rounds. Athletes also use more heavily padded gloves and use a scoring system which emphasises technique over damage or harm to opponent. This along with more protective referees mean that Olympic Boxing is percieved as ‘safer’ than Professional Boxing.

Even with these safety measures Olympic boxers still run the risk of sustaining head injuries and concussion and therefore the removal of mandated use of headguards remains a controversial one. But what does the evidence say, a new systematic review has explored wether the AIBA made the correct decision.


This systematic review was conducted and reported according to PRISMA guidelines. Five databased were searched (SPORTDiscus, ERIC, PubMed, PsychINFO and ISI WoS) and selected because they provide insight into biomedical, behavioural and social science research  on head injuries in Olympic boxing.

The databases were searched using the following search string: “boxing” AND “concussion OR brain injury OR head injury” AND “headgear OR headguard”. Grey literature was searched but the details of this was not included within the write-up. This is disappointing as it is likely that conference or small scale reports have rich information on this topic.

Studies were included within the review if:

  1. Published in Englished and in peer-reviewed journals
  2. Be an original study, theoretical paper or review article
  3. Included a sample / population of boxers
  4. Focussed on protective head gear / head injury in boxing

Risk of bias was assessed and inclusion within the review was assessed by consensus. In total 39 studies were included within the review and details of the studies are available within the article which available for free.

Results & Clinical Importance

It goes without saying that boxing inherently comes with a risk of sustaining traumatic head injuries that being said there is limited evidence to suggest that suggests they reduce the risk of concussion or traumatic brain injuries. 

This limited evidence comes from a lack of studies and data on the impact of the use of head guard for concussion however there is enough data to suggest headguards reduce the risk of skull fracture or facial cuts. This latter point perhaps contradicts the AIBA’s claim that boxers are less likely to lead with their head.

Quick Summary of Systematic Review for Headguard Use for Olympic Boxing

  • A headguard is effective at protecting against facial cuts and skull fractures
  • There is insufficient evidence to suggest that headguards prevent concussion
  • Incorporation of technology into headguards will help understand the type and size of force sustained by boxers
  • Poorly designed and sized studies are hindering progression in this field

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As outlined at the top of th article one of the main reasons for the AIBAs decision to move away from the use of headguards is  for behavioural reasons. A study by Davis et al (2017) demonstrates that fighters make more defensive moves and throw and land fewer punches when not wearing a headguard. They also found there was a higher knockout rate when not wearing a headguard so as with this review results are inconclusive.

This is similar to the argument in rugby about the use of head wear, specifically scrum caps, to reduce concussion risk and reduce overall risk of brain injury. The complexity of forces in both boxing and rugby makes it very difficult to assert firm conclusions as there are a lot of situational factors such as type of head wear, direction of travel, rotational forces to name a few examples.

Something which is missing from this review is the voice of the athletes which is invaluable when discussing risk and use of headwear. Afterall if they don’t want to use headwear and we don’t understand why it won’t matter how good the headwear is.