IN THE CORNER WITH THE RING DOC: Traumatic brain injury and the future of Pac-Man

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Written by Beau B Hightower DC, MS, CSCS, CES

Where did he go? One second Manny Pacquiao was picking away at Juan Manuel Marquez , controlling the momentum of the fight as he usually does even while recovering from an earlier knockdown at the hands of Marquez. The next moment, he disappeared.

Manny lay face down, and without a replay immediately, my mind went to a terrible place. Was he hit with an elbow? I hope he didn’t just have a heart attack was my second thought. It took several minutes before the fine folks over at HBO PPV finally allowed us to witness in slow motion the brutal blow that literally shut Pacquiao’s brain off at the breaker box. It is always a strange combination of emotions between the desire to witness a knockout and the sickening feeling in your stomach when you see a boxer or MMA fighter’s legs go stiff and their heads bounce off of the mat.

So what happens to the body when someone is literally knocked out? Patients often ask me about concussions, sub-concussions, dementia pugilistica (boxer’s brain), and of course knock-outs. The brain functions via a complicated network of neurons (nerves) and blood vessels. These blood vessels are responsible for bringing glucose (sugar) to the neurons so that they may function properly. The brain uses a tremendous amount of sugar to function, and will almost immediately shut down the cortical brain (the area that separates our brains from animals) if this sugar supply runs low. This is what happens when someone faints either from blood pressure changes or from nutritional deficiencies. When a fighter is “choked out” the blood supply to the brain is temporarily compromised due to the opponents arm pressing on the arteries in the neck, and the fighter immediately goes limp, loses consciousness, and sometimes will even go into mini seizures.

As with the strike landed by Marquez, a knock-out involves an immediate concussion response from the brain. The human brain floats in a liquid substance known as CSF which keeps it separate from the bony, hard skull. When a fighter lands such a hard strike (particularly to the jaw, temple, or cheek) a shock wave is transmitted along the bone which knocks the skull backwards. Being that the brain is floating in liquid, the front of the skull immediately makes contact with the brain, disrupting the “electrical connections” from one area to another. The brain literally bounces back and forth against the skull tearing nerve tissue, blood vessels, and allowing bleeding internally. This impact immediately makes the fighter lose consciousness and fall to the floor. Manny’s aggressive offensive style has always left him open for a beating, but all it took was one upward and straight -on blow to conceivably end the career of one of the greatest champions of our generation.

Remember the old punch-line about Lennox Lewis? The guy couldn’t be beaten. Well, he couldn’t be beaten except when big punchers like Oliver Mcall and Hasim Rahman found his jaw line. When someone is said to have a “Glass-jaw”, what they are really saying is that the structure of his jaw line is angled more severely towards the brain itself. This makes fighters like Lewis more susceptible to one punch knockouts. While anyone can be knocked out given the right angle and force, it takes a very specific blow to render an opponent “knocked out”

Will Manny ever fight again? Time will tell, and it usually takes a long period of time for the brain to heal from concussions. Particularly as we age, our metabolic rates decrease, as does our healing factors and ability to recover from any type of injury.

I would caution Freddy Roach and company to consider Muhammad Ali’s fight with Larry Holmes. A sustained beating after severe brain trauma can truly put an end to a hall of fame fighter’s personality, charisma, and persona. Sometimes a life is more important than a legacy.

Hopefully you have taken the time to appreciate what Manny Pacquiao has done for boxing, and how fantastic his career has been. Saturday night Manny disappeared. He may never appear in the ring again.

(If you or a loved one have experience a severe blow to the head, it is imperative that you get to a hospital immediately. Concussions and traumatic brain injuries can lead to brain damage, permanent disability, and death)

Dr. Beau Hightower is a former collegiate athlete and avid fight fan. He serves as the President of Elite Ortho-Therapy and Sports Medicine LLC, the premier injury resolution center in New Mexico.