FIGHT DOCTOR WHEN TO STEP AWAY By Dr. Margaret Goodman
with Ruslan Provodnikov in The Ring’s 2013 Fight of the Year. He even went to concussion specialists who showed him changes in his brain scan that were due to trauma. They told Bradley to retire, but he fought six more times before hanging up his gloves. Every fighter should have a partner like Monica Bradley. Each time before Tim fought, he would warn his wife, who was also his manager, in the dressing room that when he came back, he might not be the same. “I didn’t want to go to the hospital after every fight. She couldn’t make the decision [to retire] for me, but she put things in perspective. She managed our finances and let me know that we were financially fine.” After finally making the tough decision to leave the ring, Bradley moved on to a great future on the other side of the ropes calling fights for Top Rank events on ESPN. Christy Martin, former WBC titleholder and now president of Christy Martin Promotions, fought 59 times from 1989- 2012. “I had to retire because I had a stroke, but I still fought Mia St. John in [2012] and lost!” said Martin. “It was tough that I made such a poor decision, and losing to a fighter like Mia hurt my career. “I sparred guys through much of my career; I was hit a lot. I definitely had concussions. After I fought Laila Ali, many recommended that I go to the hospital, but my ex-husband said no, as he was afraid I would never be allowed to fight again. Now when I get tired, my speech slows down.” She admits she doesn’t know what the future will hold regarding the punishment she sustained and believes fighters should retire when it becomes a job. “Then you need to not do it anymore. I was chasing money, but you have to not let money be your reason [to continue].” At age 32, Seniesa Estrada retired in October 2024 at the peak of her career, the undisputed 105-pound champion with a record of 26-0. “I started boxing at age 8 and had 104 amateur fights.
My long-term goal was always to turn pro, but I had no idea that the business side of women’s boxing was so tough.” She developed anxiety and depression and believes that 99% of boxing can be “mental”: “My hand and back injuries that I was dealing with made it tough to compete at
loss, confusion, slurred/garbled speech, personality changes, attention deficits and erratic behavior that can include aggression, depression or even suicidal tendencies. On autopsy, athletes with CTE have an abnormal brain protein called “tau,” which leads to impaired communication between the brain nerve cells. It is the hope of researchers that the diagnosis can be made very early by using MRI (magnetic resonance imaging), which looks at brain structure, or PET (positron emission tomography) to evaluate brain metabolism. Dr. Charles Bernick, senior director of cognitive disorders at the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, has been the lead investigator and champion of the Professional Fighters Brain Health Study to examine the cumulative effects of repetitive concussions and subconcussive impacts. Bernick notes: “Starting in 2011, we have evaluated approximately 900 participants with a retention of about 300.” In active fighters, most of the changes seen relate to volume of the deeper portions of the brain like the thalamus, which is like a relay station or “hub” sending out sensory information. In retired fighters, the changes are more visible in the hippocampus, the memory center. “Fighters undergo yearly MRI scanning, cognitive testing and blood testing,” says Bernick. “The blood testing is to identify levels of tau and another marker, NfL (neurofilament light chain), that could be the cause of the brain changes and symptoms.” He hopes the identification of these biomarkers can determine prognosis and reduce risk. Not every boxer with the same longstanding fight history and exposure progresses in the same way or even develops dementia. Genetic factors, including the presence of the gene APOE4, which has been linked to Alzheimer’s disease, are often mentioned. The APOE4-positive boxers seem to have more brain changes. Social determinants such as
where they grew up and comorbidities like excessive alcohol and/or drug use, depression, stress and poor sleep can also make a difference. A Mediterranean diet is recommended, emphasizing less processed foods, lots of fruits and vegetables, whole grains, nuts and legumes (like beans/lentils), healthy fats like olive oil, limiting red meats and sweets, moderate eggs and dairy and limiting alcohol. We have yet to see the influence of performance- enhancing drug use. Bernick’s study looked at whether it was better to get hit a lot or with less force, but there wasn’t a significant difference. “Individuals with more than 25 professional bouts had an increased risk of CTE. Most started complaining in their 50s or 60s. Although mixed martial arts (MMA) fighters also had brain changes, they had less bouts and there were accordingly less MRI changes.” MMA fighters now spar a great deal more, so I would expect more predisposition to CTE as time goes on. I am hoping that Bradley, Martin and Estrada have retired sufficiently early to avoid the possibility of CTE that befalls so many. And hoping that trainers, family members, managers and, yes, promoters celebrate what a fighter has given in every battle, not expect the impossible, put their self- interests aside and admit it’s not worth the risk to witness a glimmer of what the boxer once was. Too many boxers don’t choose to retire on their own. As a former Nevada Athletic Commission Medical Advisory Board Chairman, I still have hope that commissions will accept that an important part of their role is to protect fighters from themselves beyond a win or loss and encourage retirement when necessary, before it’s too late. Dr. Margaret Goodman is a former Nevada State Athletic Commission chief physician, co-hosts the Fighter Health and Safety Podcast and is president of the Voluntary Anti-Doping Association.
that level. I pushed through not being 100%.” Although Estrada
never complained about brain-injury symptoms like Bradley and Martin and was making the most money of her career, she knew it was the right time. “God gave me a sign that this is the right decision. That depression is still inside me, but I am happy and don’t regret my decision.” She now works with women fighters, is studying acting and hopes to do some commentating. Which boxers develop cognitive decline more than the average person? Can it be prevented by limiting risk factors? The end results hinge upon genetics, anatomy, training history, the age they started sparring and competing, ability to avoid countless punches, number of rounds fought, skill level and past concussions, along with lifestyle circumstances. Chronic traumatic encephalopathy (CTE) seems to have become part of our lexicon through football, but we always knew boxers were at risk, even when we called it “punch-drunk syndrome.” It often begins much before retirement but worsens through the years. No one completely understands why the damage continues once the trauma stops. Many believe it is because it takes years for the brain cells to die, and the risk factors may play more of a role. Experts continue to search for answers as to why some fighters are minimally affected while others develop full-blown CTE. Commissions and ringside physicians would like to think they can direct a fighter to retire sufficiently early before memory loss and psychiatric symptoms exist. It’s almost always too late. CTE symptoms include issues with balance and coordination, memory
E very fighter understands the risks they face in sparring and during a bout, but it’s not always easy to know when it is the right time to retire. Famed HBO commentator Larry Merchant once told me boxers should retire once the public no longer wants to see them fight. From a physician’s perspective, we know the answer. Although a license to compete is a privilege and not a right, it’s often a Herculean effort to prove that a fighter should retire, as medical tests typically won’t demonstrate the changes until it is too late. Former world titleholder and 2023 International Boxing Hall of Fame inductee Tim Bradley says, “We know when we aren’t at our best, but many can’t [retire], because they are not financially set. We know our bodies. I knew when I was a little less of myself.” Bradley officially retired in 2017. “Fighters are adrenaline junkies,” he told me. “The hardest thing in retiring was not having to strive
Tim Bradley (right) and Ruslan Provodnikov brutalized one another.
towards a goal. Since I was 10 years old, there was something to strive upon. I had a hard time [saying no to] that money, but I felt myself deteriorating toward the back end of my career, and I was worried I was not going to have a future.” Bradley’s only two losses out of 36 bouts were against Manny Pacquiao, whom he fought three times. Watching the Filipino legend perform 15 months after the conclusion of their trilogy was the turning point: “I was commentating the 2017 Manny Pacquiao-Jeff Horn bout,” said Bradley. “Now I saw an old lion (Pacquiao) with a ton of scars battling a young buck. I didn’t want to be that guy.” About three weeks later, Bradley announced his intent to retire. He admits he should have walked away after his brutal 12-round slugfest
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