Utilizing Creatine for Concussion Management in Boxing
Depending on your source, one could surmise that boxing is either on an upward trend (Ringside, 2020) or that it is facing a downturn (Silverman, 2017). What is less arguable is that contact sports with both mild and substantial blows to the head have an increased risk of concussions and its comorbidities i.e. cognitive dysfunction, mood disorders, and subsequent neurological issues with Oliver et al., (2018) showing that an estimated 1.6 to 3.8 million sports-related concussions occur in the United States per year. While this statistic does not specify boxing as the sole source of these numbers, the sport of boxing is built upon the concept of head blows and knockouts (Davies & Durall, 2017) and the statistics of long-term brain damage in boxers cannot be ignored (Edward-Bytom, 2020). Over the years, equipment technologies; rules and regulations; and safety precautions have improved tremendously, but there have been shown to be potentially more serious secondary detriments at a molecular level to even mild concussions that do not relate to mechanical blows (Dean et al., 2017). It is for this reason that other neuroprotective and injury reduction strategies have been tested, and are proving to be promising as preventative measures alongside potential treatment modalities in managing concussion outcomes.
Concurrent Concussion Condition
The mechanical blows to the head from powerful punches coupled with the contusions that can arise from the head’s impact as it hits the ground in a knockout are the most known source of injury to the brain. A combination of repetitive subconcussive impacts can prove to have a similar effect, and sometimes even worse. What has been overlooked for a long time are the secondary effects that occur from the more superficial wounds of the hard blows as well as the too-quick-return-to-play from the seemingly less intense attacks to the head. The occurrence from either form of injury creates a biological response that induces protective mechanisms such as an increase in inflammatory cytokines and Interleukin-6; a stretching of neuronal fibers which makes them ‘weaker’ and more permeable to particulate and ions that can facilitate other mechanistic forms of apoptosis (Dean et al., 2017). Concurrently, a decrease in cellular respiration occurs and a supercompensation of anaerobic metabolites are triggered for the lowered AMPK and ATP levels, and thus a build-up of residues that increase reactive oxygen species which kill neuronal cells (Oliver et al., 2018). Essentially what happens is a bruise to the brain, whether big or cumulative, can either overload cells and they die, or the biochemical reactions related to the protective mechanism will go haywire trying to compensate and recover at the spot(s) of injury and will shut down the rest of the pathways for life-giving ATP to keep the system working optimally and/or alive. This is where creatine comes in as a promising protective tool or to clean up the damage for a faster recovery of shut down mechanisms.
What and How Creatine Helps Those At-Risk-An Energy Source and Antioxidant
With neuronal depolarization that occurs with trauma to the brain, there becomes a greater need for ATP and its regeneration but the supply does not meet the demand. Creatine is well known to be an exceptional donor to quickly phosphorylate ADP for the regeneration of ATP. According to Dean et al. (2017) creatine can restore membrane potential, can prevent an influx of calcium into cells which would reduce the risk of cell death, improves mitochondrial function, acts as an osmolyte in the brain which prevents edema, and also protects against neurotoxicity. Creatine helps to support oxidative metabolism by transmitting intracellular energy to areas of least availability (Ricci, 2020) which can prevent the ischemia that can occur from the inflammatory responses of a brain contusion while Brown et al. (2017) showed that creatine can reduce the accumulation of lactic acid which corroborates creatine as a means for quick energy regeneration for necessary cognitive and executive functioning; as well as for all of the necessary processes to be alive, as well as acting as an antioxidant as it helps to quickly remover reactive oxygen species that would occur from anaerobic metabolite aggregation.
Recommended Usage and Dosages.
The best option is to prevent concussions by optimizing your defensive training and not get hit! In combat sports like boxing someone does need to absorb the punches so doing all you can to protect yourself is best. All of the referenced authors have shown the potential benefits of creatine use as a prophylactic measure of concussion management. The research is not conclusive on the exact dosing strategies as a possible means of prevention of secondary issues of concussions in boxers, as well as for post-injury recommendations, but it seems to be that creatine monohydrate is the best form, it should be fully dissolved in the beverage of choice (ideally water) but do not consume with highly acidic drinks, it should not be consumed with caffeine, taking it with a high glycemic substrate is ideal for absorption. Below are recommendations made allowing the reader to find what best suits their needs.
|Table 1 Creatine Supplementation Protocols|
|· Loading/maintenance protocol|
|o Ingest 0.3g/kg/day (15-25g/day) for 5-7 days|
|o Ingest 3-5g/day to maintain|
|· High-dose protocol|
|o Ingest 15-25g/day (0.3g/kg/day) during training|
|· Low-dose protocol|
|o Ingest 3-6g/day during training|
Source: Antonio, et al. (2014). Essentials of sports nutrition and supplements. NY: Humana Press.
Source: Dean, et al., (2017). Potential for use of creatine supplementation following mild traumatic brain injury. https://doi.org/10.2217/cnc-2016-0016
Antonio, J., Kalman, D., Stout, J. R., Greenwood, M., Willoughby, D. S., & Haff, G. G. (2014). Essentials of sports nutrition and supplements. NY: Humana Press.
Brown, et al., (2017). (12) Patent Application Publication (10) Pub. No.: US 2017 / 0215756A1. 1(19), 2015–2018.
Dean, P. J., Arikan, G., Opitz, B., & Sterr, A. (2017). Potential for use of creatine supplementation following mild traumatic brain injury. Concussion, 2(2), CNC34. https://doi.org/10.2217/cnc-2016-0016
Davies G.J., & Durall C (2017). Mixed martial arts. Shamus E, & Shamus J(Eds.), Sports Injury Prevention & Rehabilitation, 2e. McGraw-Hill. https://accessphysiotherapy-mhmedical-com.ezproxylocal.library.nova.edu/content.aspx?bookid=1965§ionid=158356565
Edwards-Bytom, J. (2020, January 16). Shocking boxing head injury statistics you shouldn’t ignore. Retrieved October 14, 2020, from https://made4fighters.com/blog/shocking-boxing-head-injury-statistics-you-shouldnt-ignore/
Oliver, J. M., Anzalone, A. J., & Turner, S. M. (2018). Protection Before Impact: The Potential Neuroprotective Role of Nutritional Supplementation in Sports-Related Head Trauma. Sports Medicine, 48(s1), 39–52. https://doi.org/10.1007/s40279-017-0847-3
Ricci, T., Forbes, S. C., & Candow, D. G. (2020). Creatine supplementation: Practical strategies and considerations for Mixed Martial Arts. Journal of Exercise and Nutrition, 3(1), s2.
Ringside. (2020, February 12). Top ways boxing is rising in popularity. Retrieved October 14, 2020, from https://www.worldboxingnews.net/2020/02/12/top-ways-boxing-rising-popularity/
Silverman, S. (2017, October 03). Boxing: Breaking down the steady decline of the sweet science. Retrieved October 14, 2020, from https://bleacherreport.com/articles/1370083-boxing-breaking-down-the-steady-decline-of-the-sweet-science