Dr. Margaret Goodman

Fight Doctor: Head butts are means to unsatisfying end

Head butts, whether accidental or intentional, can change fights in an instant.

Ask Devon Alexander, who lost his perfect record and 140-pound title in January of last year when he was unable to see following an accidental butt by Timothy Bradley in the 10th round. Or ask Mike Tyson, who endured two severe accidental butts in Rounds 6 and 7 of his first fight with Evander Holyfield, leaving Tyson defenseless to legal blows that finished him in the 11th.

And it’s not difficult to understand their devastating effect when you consider old-fashioned physics.

The laws of motion described in the late 1600s by Sir Isaac Newton, one of most celebrated physicists of all time, actually explain the mechanics of head-butt injuries. The impairment caused by a head butt is based on: (1) the acceleration rate (change in velocity) at which the head travels; (2) the deceleration (slowing) speed once the opponent’s head is struck; and (3) the boxer’s mass (weight). This force, along with the direction of the butt, determines the severity and type of injury (possibly a cut or concussion).

Cuts from butts are almost always deeper, more irregular and larger than those from a punch.  They frequently occur in places such as the forehead or scalp, where a punch would never produce a cut.

Said respected Chief Maryland Ring Physician and neurologist Dr John Stiller: “I believe boxing glove to head vs. head to head is less likely to cause cuts because the boxing glove is more compliant – dissipates the force, and decreases the risk to the soft tissues of the face as compared to head vs. head, where the soft tissues of the face are at greater risk.”

Television analyst and writer, Steve Farhood agrees.

“The bloodiest fight we ever had in 10 years on ShoBox was this year:  Sharif Bogere-Ray Beltran. All the cuts were the result of head butts, and all the butts were unintentional.”
Although we tend to believe that no boxer reacts to pain when they are in the heat of a fight, a bony skull striking your face or head certainly hurts more than a glove. In 2009, former welterweight champ Vivian Harris collapsed after an unintentional head butt in the second round against Noe Bolanos on ESPN’s Friday Night Fights. Harris’ post-fight brain scan was normal, so it is likely he passed out from excruciating pain.

Following his loss, Alexander told the press, “You can’t work in the gym for a head butt. You can’t train to get head butted and get your eye all messed up. You can train for what game plan your coach has set down for you.” Alexander’s trainer, Kevin Cunningham, warned Michigan referee Frank Garza that Bradley leads with his head, but it is the element of surprise that makes a head butt unavoidable.

Garza had no option other than to stop the Alexander fight when the fighter said he couldn’t see from the flow of blood. If a boxer says he can’t see, whether from blood in his eye or potential damage to the eye itself, game over! In this instance, it was the athlete’s inexperience with cuts that lost him the fight. And while I agree with Alexander that a boxer can’t train for a butt, not enough trainers have their boxers prepare should they have to fight with a swollen eye socket or blood in one eye. Has no one thought of sparring with an eye patch as a training tool?

Although we traditionally don’t associate head butts with a concussion, the seriousness of even an unintentional butt cannot be overlooked. I have always believed that Shane Mosley’s poor performance against Vernon Forrest in their first fight could be attributed in part to a clash of heads in the second round.

Indeed, the head can be a very dangerous weapon. In a 2007 issue of Police: The Law Enforcement Magazine, Michael T. Rayburn discusses the effectiveness of head butts as a second line of defense when deadly force or counter strikes don’t work and one needs to end a fight as quickly as possible.

No one has studied the concussion-producing effects of head butts in boxing, but they have in other sports. A 2002 Erasmus University study of soccer, in which heading the ball is an integral part of game, determined that almost 50 percent of players incurred some form of concussion during their career and that an accumulation of headers during one season placed players at risk for memory impairment.

Intentional head butts must be dealt with harshly to create a deterrent. Referee Joe Cortez ruled that Victor Ortiz’s head butt of Floyd Mayweather Jr. was intentional but docked him only one point, which sent the wrong message to all fighters.

“Intentional butts are usually obvious to both the referee and the fans,” Farhood said. “I believe a ref should deduct two points for an intentional foul and then determine the extent of the injury, if there is one. If the doctor rules that the injured fighter can’t go on [regardless of whether that determination is made at the moment or in the subsequent round], the fight should go to the scorecards. If the injured fighter is ahead, he wins. If he’s behind, the bout should be ruled a technical draw.”

Then there’s the issue of distinguishing between a punch and a head butt, which isn’t always easy.

Farhood believes that boxing needs to catch up with technology and that instant replay can be implemented to make that determintion when a fight is filmed or televised. Instant replay can also help determine whether a butt was intentional.  
“The producer and director in the TV truck usually know whether it was a punch or butt before the referee, doctors, the TV announcers, the fans or anybody else,” Farhood said.

In boxing, all too often the referee and physician approach a head butt superficially – looking only for a cut. The physician should also assess the athlete for concussion between rounds or right after the butt occurs. It is a tough sell to the fans, but if the athlete is concussed, he shouldn’t be allowed to continue.

Lastly, a serious butt should also be taken into account when giving a medical suspension – time off before a fighter is allowed to resume training or schedule another bout. Too often, boxers receive insufficient time off after a tough fight. Absorbing one or more head butts during the course of a bout increases the need for additional rest. 

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