THE FIGHT DOCTOR
THE AGING FIGHTER By Dr. Margaret Goodman
more susceptible to tearing for a brain with less volume. As a result, older fighters are automatically at increased risk of brain bleeding irrespective of their skill and conditioning. Athletes over 40 face an increased risk of cardiac sudden death due to heart disease, atrial fibrillation (heart
muscle mass. Pituitary dysfunction in older fighters is rarely discussed. The pituitary is a pea-sized gland that sits at the base of the brain behind the eyes, nose and sinuses. It controls several hormones, including growth hormone. It is the most common
(hormone specialist). In a recent article (“A Boxing License is not a Right,” April 2026), I discussed advanced testing required by some commissions when a fighter is over 40, including MRI, MRA, EKG, cardiac echo and yes — neuropsychological testing looking for cognitive issues. You might say the latter
fluttering that includes rapid chaotic rhythms) and what we often see in an “athletic heart” or enlargement or scarring of the left ventricle (the heart’s primary pumping chamber that sends oxygen to the rest of the body). There are risks of stroke, heart failure or death. So, it’s important that older fighters undergo cardiac screening. Bottom line: Staying in shape doesn’t eliminate the risk. They are also prone to joint or musculoskeletal injuries. How often do we hear of older fighters suffering shoulder/ rotator cuff, elbow, hand, knee/ ACL, back stress fractures or Achilles tendonitis requiring corticosteroid injections or even surgery? One reason is that as we age, we have lower bone density (thickness), less elastic ligaments and decreased muscle mass. Over 40, kidney function declines about 1% each year. The associated risks to kidney disease increase with high
testing isn’t necessary, but in sports where repeated head trauma or micro-concussions occur, it’s crucial to look for signs and symptoms. I am not saying that these fighters shouldn’t be licensed to compete, but to make assumptions they’re OK because they were a former well-known name and champion results in commissions ignoring their duty to the athletes. This happened to Muhammad Ali when he was well past his prime demonstrating signs and symptoms of Parkinsonism. Yes, these athletes can sell tickets and attract fans, so it’s easy for commissions to rely on just medical tests. I’ve even heard commissioners say, “I saw him in the gym and he looked good.” I think that I could pass shadowboxing or hitting the heavy bag in a controlled setting. Other excuses include: 1. it’s an
BOXING SEVERITY INDEX (BSI) ACTIVITY (fights in the last 2 years) 1 (or less) ..................................................+1 RECENT RECORD Lost 5 or more in a row .............................. +2 Lost 3 of last 4 ...........................................+1 Won 3 of last 4 ...........................................-1 KO or TKO More than 4 in last 2 years ........................ +3 3 or less in last 2 years .............................. +2 Lost last fight by KO (no time limit) ............+1 AGE Greater than 44 ........................................ +2 Greater than 35 .........................................+1 RING AGE Greater than 500 rounds ............................+1 (One amateur fight = one pro round) Greater than 5 years (amateur and pro combined) . ...............................................+1 TOTAL SCORE:
I t seems that every week we hear about retired boxers like Mike Tyson, Floyd Mayweather, Manny Pacquiao and even MMA fighters like Ronda Rousey and Gina Carano returning to competition. The fact is that there are increased risks, and older fighters should be better scrutinized. Chronological age isn’t automatically the best measuring stick for whether an older fighter has an increased risk compared to his/her younger counterpart. So-called “ring age” and other factors can often be more helpful, as there is typically no one medical test that provides the ultimate answer. Yes, there are laws against age discrimination (that sometimes shouldn’t apply to fighters). Years ago, Dr. Flip Homansky, former Nevada chief physician and commissioner, designed the Boxing Severity Index (BSI). The BSI is not required but is utilized by many commissions:
objective tool to determine suitability to compete. What is happening physiologically and anatomically that increases risks for older athletes? The human brain’s volume begins to shrink 5% per decade after age 40 – although some studies demonstrate this begins in our 30s. Those at risk of neurodegenerative diseases like Alzheimer’s or CTE will see increased atrophy (shrinkage). A more atrophied brain can relate to cognitive and memory problems, and those fighters can be at increased risk for brain bleeds. The brain “floats” within the skull, but it is attached to bridging veins connected to the dura (a protective covering on the brain’s surface). Depending upon the direction of force when the head is struck, these veins can rupture and produce the most common lethal cerebral injury in a boxer – a subdural hematoma. Bridging veins are
3-4 = High Risk Category “C” 5-6 = High Risk Category “B” 7-9 = High Risk Category “A”
Former heavyweight champion Mike Tyson was 58 years old when he fought a pro bout against Jake Paul.
blood pressure, diabetes, heart disease or even medications. Acute irreversible kidney damage is vulnerable to sudden dehydration (from making weight!). Fighters over 40 can have significant decline in testosterone (men) and estrogen/progesterone (women) and have reduced muscle mass, which can increase recovery time in training and from injury. Some of these changes can be improved with nutritional support by consuming increased protein; prioritizing sleep and recovery; lifting heavier weights to combat muscle loss and low bone density; and training changes to lessen fatigue and maintain
exhibition match; 2. he/she is fighting 6-8 rounds or even two-minute rounds; 3. they’re fighting someone with similar age and experience; and 4. they’re using heavier gloves. The best one I’ve heard: “The damage has already been done, so what’s one more fight – the ref won’t let them get hurt.” Reminds me of attending a Rolling Stones concert imagining an 82-year- old Mick Jagger sounding as good as he did in his prime. But Jagger isn’t getting hit in the head repeatedly. Permitting fighters that can’t pass the BSI is just one more black mark on our sport – alongside many others.
Categories A, B and C indicate the fighter needs further clinical evaluation by the commission and their medical advisory board before licensure. This scale is not meant to replace good judgment, but to be utilized as one
hormonal deficiency in athletes subject to head injury – especially in boxing and MMA. Symptoms include fatigue, reduced exercise performance, prolonged recovery and mental health issues such as depression. The problem is that growth hormone is often used for performance enhancement, so diagnosis of deficiency takes detailed evaluation with an endocrinologist
If they fight as scheduled on September 19, Mayweather and Pacquiao will have a combined age of 96.
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