This week's Women's Task Force blog is an exchange between Dr. Martha Dodson, a USAB Ringside & sports medicine physician from El Paso, Texas and member of the USAB Women's Task Force, and Coach Christy Halbert, Chair of USAB's Women's Task Force. The two discuss common injuries experienced by boxers on the local level, particularly the issues of nose bleeds, hand injuries and lacerations.
CH: You've been a ringside physician on the local, regional, national and international levels. What are the three most common injuries you see at the local level?
MD: I mostly see nose bleeds. The second and third most common injuries I see are hand injuries and lacerations (especially those above the eye brow), although these two injuries are certainly not as common as nose bleeds.
CH: Focusing on nose bleeds, is there any way to avoid them?
MD: Nose bleeds are most often caused by a direct blow to the nose, so the most important way to prevent a nose bleed would be a matter of training to defend yourself and avoiding the blows altogether. However, dry and irritated skin inside the nose can also contribute, so it may not take much of a blow for the nose to bleed.
CH: In competition, what kind of nose bleed would prompt the ringside physician to stop a bout?
MD: A fractured nose will stop a bout because the bleeding will be much more significant and the boxer runs the risk of breathing difficulties from blood which may run down the back of the throat. Continuing to spar or box with a fractured nose may also cause additional damage to the bones and sinuses of the face as well as the eye itself; any of which may have been damaged by the initial or subsequent blows. With that said; most nose bleeds do not result in the termination of a bout because most are just small skin tears inside of the nose.
CH: I've heard you talk many times about the safety of the boxer being the most important factor in how a physician determines if/when to stop a bout.
MD: Yes, aside from the fracture itself, the main reason for stoppage is the volume of bleeding. If blood is going down the back of the throat, clots can form, which affect breathing. Safety of the boxer is always at the forefront of any decision by the ringside physician.
CH: Are there other contributing factors to nose bleeds?
MD: Yes, fitness level and fatigability increase the likelihood of injury in general. Injuries occur at the point at which someone becomes so fatigued they can't protect themselves. As boxers improve their stamina they will also improve their ability to protect themselves by maintaining reflex speed and foot work.
Another contributing factor can be irritated skin inside the nose. When the skin becomes dry, it becomes more fragile, and thus will bleed more easily. Dryness can be caused by low humidity (and high altitude), and increases as air moves across the skin inside the nose with each breath thru the nose. So if you are out of shape and huffing and puffing the skin inside your nose will dry out more quickly. Again, maximize your conditioning, be proficient in defensive maneuvers, and condition the skin on the inside of your nose.
CH: How can we condition the nose, given that boxers are prohibited from using certain substances listed on the USADA or WADA lists?*
MD: You don't need to use prohibited substances to condition the skin inside your nose; you can use saline (salt water) and aloe nose sprays which 'moisturize" the skin inside your nose by putting back humidity lost thru nose breathing and dry environmental conditions. Also, before sparring or competition, the boxer can apply a small coat of Vaseline to the skin on the inside of the nose. Before a boxer gloves up they can place a small amount of Vaseline on the tip of their own finger and gently wipe it onto the surface of the inside of their nose. This will help lessen the likelihood of the skin tearing with a direct blow. Avoid Q-tips; you never know where the end of it will end up!
CH: Is it okay to blow your nose after it starts bleeding, or should you avoid blowing the nose altogether?
MD: Do not blow your nose if it may be broken. Otherwise, some studies are now showing that blowing your nose once initially may actually help to slow the bleeding as the act of blowing your nose begins the blood vessels constricting (closing), which is what ultimately helps to stop the nose from bleeding. Then, apply direct pressure (by pinching) just above the nostrils; where the soft tip joins with the hard bone. The trainer can apply pressure the entire minute they're in the corner between rounds or until bleeding stops if you're not in the ring.
If you blow your nose later you'll probably dislodge a clot - a normal process intended to control bleeding - so it could begin to bleed again a little more. You will not worsen the bleeding by blowing your nose but the bleeding may seem to increase as any clot which has already begun to form may be dislodged and so the bleeding starts up again; increased only relative to having slowed down due to clots already forming. If this happens, just apply pressure again as above.
CH: Some boxers seem prone to nose bleeds. Conditioning the nose is a really helpful tip. Are there any other factors that can contribute to nose bleeds?
MD: Dehydration can also dry out all skin surfaces, including those inside the nose; again, the more dry the skin (mucosa) inside the nose the more likely it is to tear with direct blows. Boxers who are cutting weight, or are walking around dehydrated, could therefore be more susceptible to nose bleeds.
CH: You mentioned that you also see some hand injuries on the local level.
MD: Yes, I see hand injuries taking place in training and in the ring, including sprains, strains and breaks.
CH: Any tips on avoiding hand injuries?
MD: There are several ways to minimize risk. First, I would emphasize proper punch technique. Second, is proper hand wrapping technique. Loose wraps are a problem as is inadequate padding on the knuckles. It also seems that most hand injuries I see involve boxers who don't wrap between the fingers. It's important to have wrap between the fingers to provide stability to the fingers. Third, I would say an adequate level of nutrition is critical. This includes vitamins as well as electrolytes. Athletes need calcium (1200 mg /day ) and vitamin D daily. This helps to maintain bone health; to strengthen your bones to prevent fractures and to help heal faster if you do break them. If you think you have broken your hand or your wrist SEE YOUR DOCTOR; it can be difficult for some of these fractures to heal on their own and if not healed properly can cause you pain and problems the rest of your life.
Electrolytes help you to maintain and maximize your stamina. This will assist you in keeping a clear mind and maintaining proper punch techniques and foot work your trainer has taught you and you have trained so hard to perfect.
CH: You also mentioned that you see lacerations on the local level. Any tips?
MD: Again, defend yourself. Also, make sure you are wearing properly fitting, USAB-approved, headgear. Gloves should be in good condition; no cracks or tears in the leather/plastic, and there should be no loose strings. A thin coat of Vaseline on the face will help the glove to slide off, rather than causing a tear in the skin. If a laceration appears during a bout, put pressure on it in the corner between rounds to stop the bleeding. If a cut is severe, or if it is near to your eye, the bout may be stopped by a ringside physician. These lacerations run the risk of enlarging with additional blows, causing further injury to your eye, or even sometimes indicating that there are hidden, more serious injuries below the surface of the cut.
Boxers should be properly hydrated and maintain a high level of physical conditioning. Dehydration causes fatigue and fatigue can lead to injuries. A high level of physical conditioning helps to keep your mind clear during a bout and allows the boxer to concentrate on putting into action all of the skills and strategy they have spent hours of blood, sweat and tears obtaining and perfecting.
CH: Thank you! We'll see you at US Championships in a couple of months.
MD: My pleasure. I look forward to the Championships!
* More information on prohibited substances for Olympic-style athletes can be found on the US Anti-Doping web site at http://www.usantidoping.org and the World Anti-Doping Agency at http://www.wada-ama.org