Full Clinical Position Statement

PINK Concussions and Supporting Medical Professionals

Position Statement on Female Boxing Round Duration

Background

PINK Concussions, in collaboration with the medical professionals who have signed below, supports maintaining the current female boxing rules of 10 two-minute rounds, rather than extending competition to 12 three-minute rounds, due to evidence indicating that longer bouts may increase fatigue, head impact exposure, and overall concussion risk.

A substantial body of research demonstrates clear sex-based differences in concussion incidence, symptom severity, and recovery trajectory. Female athletes have been shown to experience greater susceptibility to concussion, higher symptom scores, and prolonged recovery durations compared to males across multiple sports and levels of competition.¹⁻⁴ The etiology of these sex-based differences is likely multifactorial, with proposed contributors including differences in cervical strength and neck girth,⁵ hormonal influences,⁶⁻⁷ neuroanatomical and axonal structural differences,⁸ and potential discrepancies in symptom reporting behavior.⁹

Clinical Rationale

Given the inherent risk of head trauma in boxing, reducing total exposure time and fatigue-related vulnerability is a clinically supported harm-reduction strategy. A 12-round, three-minute format produces 36 minutes of total exposure, compared to 20 minutes under the current 10-round, two-minute format. Increasing round length exacerbates fatigue, which has been shown to diminish neuromuscular control, reaction time, and defensive reflexes—factors that increase the likelihood and severity of head impacts.¹⁰⁻¹¹

Conclusion

Based on the current scientific understanding of sex-specific concussion vulnerability and the physiological effects of fatigue on head injury risk, PINK Concussions and the supporting medical professionals recommend maintaining the 10 two-minute round structure for female boxing as a clinically informed, evidence-based standard to protect athlete safety and reduce the risk of concussion and cumulative brain injury.

References

  1. Covassin T, Elbin RJ, Bleecker A, Lipchik A, Kontos AP. Are there differences in neurocognitive function and symptoms between male and female soccer players after concussions? Clin J Sport Med. 2013;23(6):426–433.

  2. Broshek DK, Kaushik T, Freeman JR, Erlanger D, Webbe F, Barth JT. Sex differences in outcome following sports-related concussion. J Neurosurg. 2005;102(5):856–863.

  3. Prien A, Grafe A, Rössler R, Junge A, Verhagen E. Epidemiology of head injuries focusing on concussions in team contact sports: a systematic review. Sports Med. 2018;48(4):953–969.

  4. McGroarty NK, Brown SM, Mulcahey MK. Sport-related concussion in female athletes: what is known in 2019?Curr Sports Med Rep. 2019;18(6):222–227.

  5. Tierney RT, Sitler MR, Swanik CB, Swanik KA, Higgins M, Torg JS. Gender differences in head–neck segment dynamic stabilization during head acceleration. Med Sci Sports Exerc. 2005;37(2):272–279.

  6. Wunderle K, Hoeger KM, Wasserman E, Bazarian JJ. Menstrual phase as predictor of outcome after mild traumatic brain injury in women. J Head Trauma Rehabil. 2014;29(5):E1–E8.

  7. Gallagher V, Kramer N, Abbott K, et al. Sex differences in recovery from concussion in adolescents. Clin J Sport Med. 2018;28(1):85–90.

  8. Ingalhalikar M, Smith A, Parker D, et al. Sex differences in the structural connectome of the human brain. Proc Natl Acad Sci USA. 2014;111(2):823–828.

  9. Covassin T, Swanik CB, Sachs ML. Sex differences and the incidence of concussions among collegiate athletes. J Athl Train. 2003;38(3):238–244.

  10. Finnoff JT, Peterson VJ, Hollman JH, Smith J. Increased postural sway in female athletes after fatigue: implications for concussion risk. Clin J Sport Med. 2009;19(5):372–378.

  11. Gabbett TJ. Influence of fatigue on tackling technique in rugby league players. J Strength Cond Res. 2008;22(2):625–632.

Signatories of Supporting Medical Professionals

Anthony G Alessi, MD, MMM, Clinical Professor of Neurology and Orthopedic Surgery, Director, UConn NeuroSport Program, University of Connecticut

Stephanie Alessi-LaRosa, MD, MPH, Medical Director of Hartford HealthCare Sports Neurology Program, Assistant Professor of Neurology at the University of Connecticut 

Robert C Cantu M.D. Medical Director and Director of Clinical Research Dr. Robert C. Cantu Concussion Center, Chief of Neurosurgery Service and Director of Sports Medicine at Emerson Health, Clinical Professor of Neurology and Neurosurgery Clinical Therapeutics Leader AD-CTE Center Boston University Medical Center, Founding Member & Medical Director Concussion Legacy Foundation

Ronald C Savage, EdD, Past Chair, North American Brain Injury Society, Founding Chair, International Pediatric Brain Injury Society, Chair, Board of Directors, PINK Concussions

Katherine Price Snedaker, LCSW, CEO and Founder, PINK Concussions 

David Wang MD, MS, Director of Sports Medicine, Quinnipiac University, Sports Medicine Physician, Connecticut Children’s Medical Center