• Boxing is one of the most ancient sports

  • Marquis of Queensbury modified the rules in the early 1800s

  • The 1904 St. Louis Olympic Games saw men’s boxing introduced as a competition sport and women’s boxing as an exhibition sport. Women’s boxing became an official sport at the 2012 London Olympic Games.

  • Boxing is a medically, ethically, and morally controversial sport because of the nature of the sport and risks of head injuries, especially in the pediatric and adolescent population. As such, the American Academy of Pediatrics and Canadian Paediatric Society oppose boxing as a sport for children and adolescents.

General Principles


  • Headgear (required): Headgear should be properly fitted by trained coaches for sparring and competition. Fitted headgear reduces eye injuries, facial fractures, lacerations, cauliflower ear, and tympanic membrane perforations. There is no evidence to suggest protection from concussions.

  • Gloves (required): Gloves, thumbless and those with thumbs attached, reduce both eye and hand injuries. Gloves with mobile thumbs are not authorized for use. Heavier gloves have decreased hand injuries and reduced impact forces. Two-toned gloves are easier to see for scorekeepers and officials. Gloves must remain clean, without scuffs and as close to “like new” condition as possible. In 2013, the Amateur International Boxing Association (AIBA) changed its rules and increased glove size to minimize injury.

  • Hand wrap (required): Hands must be wrapped under supervision of certified official. Wrapping prevents hand injury by consolidating it as one unit and reduces force of blow delivered.

  • Mouth guard (required): Custom-fitted mouth guards prevent dental and temporomandibular joint injuries. Mouthpieces also allow athlete to “set” their jaw, reducing likelihood of knockdowns by reducing intensity of the blow.

  • Cup protector (required for men)

  • Groin protector (not required for women)

  • Breast protectors (not required): Must be well fitted, not extend beyond the clavicles or xyphoid, and not interfere with athlete’s ability to move freely.

Specific Training and Physiology Issues

Amateur Boxing Weight Classifications

  • Divided by age and weight classes ( Table 87.1 ; Box 87.1 )

    Table 87.1
    Amateur Boxing Weight Classes
    Male Olympic Boxers 48–52 kg, 52–57 kg, 57–63 kg, 63–69 kg, 69–75 kg, 75–81 kg, 81–91 kg, 91+ kg
    Female Olympic Boxers 48–51 kg, 57–60 kg, 60–64 kg, 64–69 kg, 69–75 kg
    Male Elite, Senior, and Youth Boxers Up to 49 kg, 52 kg, 56 kg, 60 kg, 64 kg, 69 kg, 75 kg, 81 kg, 91 kg, 91+ kg
    Female Elite and Youth Boxers Up to 48 kg, 51 kg, 54 kg, 57 kg, 60 kg, 64 kg, 69 kg, 75 kg, 81 kg, 81+ kg
    Boys and Girls Junior Boxers Up to 46 kg, 48 kg, 50 kg, 52 kg, 54 kg, 57 kg, 60 kg, 63 kg, 66 kg, 70 kg, 75 kg, 80 kg, 80+ kg
    Boys and Girls PeeWee, Bantam, and Intermediate Boxers (Prep) Details can be found at

    BOX 87.1
    Amateur Boxing age Classes a

    a Age group class determined by actual birth date.

    • 8–14 years: Prep

    • 8–10 years: PeeWee

    • 11–12 years: Bantam

    • 13–14 years: Intermediate

    • 15–16 years: Junior

    • 17–18 years: Youth

    • 19–40 years: Elite

    • 40–45 years: Elite or Masters

  • Experience and skills: details found at

Weight Management

  • Boxers try to compete in lowest weight class possible.

  • Boxers do this to have an advantage over lighter opponents, and this practice is perceived as a psychological advantage of mental toughness.

  • Data suggest heavier athletes are more successful within weight categories.

  • A study of elite Olympic athletes found that the body mass of combat sport athletes was 4.3 ± 3.9% greater than their competitive division 7–21 days before competition, suggesting most athletes undergo significant decrease in body mass in a short amount of time.

  • The most common methods of weight loss include cutting calories, plastic/rubber suits for sweating, and saunas. Less commonly, diuretics and laxatives are used.

  • Rapid weight loss (>5% body mass loss) is known to have dangerous acute and long-term consequences.

    • Physiologic

      • Dehydration, increased heart rate, impaired thermoregulation, decreased plasma volume, muscle glycogen depletion

      • Over 5% of body weight loss in a short period (2 days) is associated with increased rates of injuries

    • Psychological

      • Decreased short-term memory, vigor, concentration, self-esteem

      • Confusion, rage, depression, fatigue, isolation

      • Long-term consequences of attention directed to body and body image have been proposed to have negative impacts, but longitudinal studies have not shown this to be true consistently

      • There is conflicting information on whether rapid weight loss negatively affects performance

        • Some studies report impairment of muscular endurance with moderate dehydration (3%–4% body weight) but not maximal muscular power

        • Other studies show no significant change in aerobic performance in rapid weight loss group versus control

  • Despite known negative effects of rapid weight loss; unlike sports such as wrestling, there is no minimum body fat percentage allowed and weekly weight loss percentage allowed in boxing.

  • National Collegiate Athletic Association (NCAA), International Olympic Committee (IOC), and American College of Sports Medicine (ACSM) have guidelines to safe weight loss

Physical Examinations

  • In boxing, annual physical examination is required to be performed by a physician to certify that athlete is free of injury, disability, or infection that could jeopardize the boxer or their opponents.

  • All athletes undergo pre- and postbout physicals for every bout.

  • In tournament setting, athlete must have prebout physical and weight check each day they are competing.

  • Ringside physician must clear each athlete and sign the Passbook before competition.

  • At physical examination, pre- and postbout examinations and weigh-ins, boxer must present a USA Boxing Competition Record Book/Passbook with up-to-date information and sign-offs by either the secretary general or executive director of the boxer’s national federation and is not allowed to compete without this document

Physician Clearance, Qualification, and Disqualification

Athletes are required to have clearance from their physician before competing. The American Board of Ringside Medicine and American College of Ringside Physicians both help determine ringside physician responsibilities for USA Boxing.

Disqualifying Conditions

  • Acute and chronic infections (not limited to the list here)

    • Illness causing fevers

    • Chest infection

    • Untreated tuberculosis

    • Gastrointestinal (GI) conditions with dehydration/malabsorption

    • Hepatitis

    • Open skin conditions (e.g., methicillin-resistant Staphylococcus aureus [MRSA], zoster, herpes)

    • Mononucleosis within the past 4 weeks

  • Severe blood dyscrasias, conditions requiring anticoagulation, sickle cell disease

  • Infection with hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV)

  • Refractive or intraocular surgery, cataracts, retinal detachment

  • Presence of myopia >−3.50 diopters, uncorrected vision worse than 20/200, or corrected vision worse than 20/60

  • Significant cardiovascular or pulmonary abnormalities, including:

    • Severe chronic obstructive pulmonary disease (COPD), uncontrolled asthma with potential for hypoxemia, pulmonary hypertension

    • Severe aortic or pulmonic stenosis, myocarditis, pericarditis, recent embolic disease, high-grade atrioventricular (AV) block, complete left bundle branch block (LBBB), atrial or ventricular tachycardia, coarctation of aorta, corrected surgical conditions unless cleared by cardiovascular surgery

    • Uncontrolled resting blood pressure (BP) >160/100 (if >140/90, the boxer may compete if previous BP measures are normal, but physician follow-up is advised for persistent BP >135/85)

  • Congenital/acquired musculoskeletal problems (e.g., spondylolysis, spinal fractures, atlantoaxial instability, and unstable joints)

  • Unresolved concussion symptoms

  • Significant intracranial mass lesions or bleeding, history of craniotomy, cerebral palsy, hypoxic brain injuries, neuropathies causing balance/coordination problems (benign smaller problems can be cleared by neurosurgery)

  • Seizure within the past 3 years

  • Hepatosplenomegaly, splenomegaly, ascites

  • Pregnancy: Female boxers must present a Declaration of Non-Pregnancy. Ringside physician has the discretion to determine if acute conditions (such as abnormal menstrual bleeding or pelvic pain) is a disqualifying condition.

  • Uncontrolled diabetes mellitus or thyroid disease

  • Implantable devices interfering with physiologic process/enhancing performance

  • Banned substances: In amateur and Olympic competitions, use of banned substances such as ergogenic aids and steroids are cause for disqualification. Refer to the appropriate authority (e.g., ) for comprehensive lists of banned substances, medications, and practices

Nondisqualifying Conditions

  • Deafness—officials must be made aware of condition; official may tap boxer on shoulder to signal “break” or “stop”

  • Dental braces/orthodontics if “Permission to Box with Braces or Orthodontic Appliances” form is attached to boxer’s Passbook

  • Single kidney

  • Breast implants if “Permission to Box with Breast Implants” form is attached to boxer’s Passbook

  • Sex reassignment in accordance with IOC Consensus on Sex Reassignment and Hyperandrogenism

Ringside Personnel and Equipment


  • One coach and one assistant are allowed for each boxer in their corner

  • Must remain seated during each round and not interact with fans or ringside officials

  • Should have first aid supplies, clean white towels, sterile gauze pads, sterile cotton, cotton swabs, bags of ice

    • Banned substances include ammonia, ammonia inhalants, or smelling salts


  • Manages minor injuries that could otherwise disqualify a boxer during a bout

  • Amateur boxing prohibits the use of medication to treat bleeding during a bout, but professional boxers are allowed any medication or topical treatment that the cutman or trainers have at their disposal


  • Serves to ensure safety of and hold best interests of boxers in the competition:

    • Ensures that rules of fair play are strictly observed

    • Responsible for maintaining control of athletes at all times

    • Responsible for preventing unnecessary punishment of a weaker opponent

    • Ensures that gloves, mouthpiece, and dress adhere to regulations

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