Boxing, Parkinson’s diseaseBy Rafael Castillo M.D.
Philippine Daily Inquirer
The ordinary man on the street does not know much of Parkinson’s disease or PD. An elderly patient who was recently diagnosed to have PD thought it was a disease related to boxing.
Muhammad Ali has somehow become the face of PD. Known for his agility and nimbleness in his youth as a heavyweight boxing champion, he is now seen in news features and documentaries with full-blown features of PD—resting hand tremors as if he’s rolling a pill or marble with his fingers, stiffness of the limbs, decrease in facial expression, shuffling or “small steps” when walking.
A related concern was raised for Manny Pacquiao after his knockout loss to Juan Marquez, hence the unsolicited advice that he hang up his gloves for good before it’s too late.
Although PD and Parkinsonism are sometimes interchanged, they’re not exactly the same and some brain experts explain that it’s actually Parkinsonism that is linked more to boxing. Parkinsonism is actually the general condition and PD is just a type of it.
Repetitive head trauma
Permanent injury to the brain cells results from repetitive head trauma. The brain cells or neurons in an area of the brain called substantia nigra deteriorate; hence unable to produce a vital brain chemical known as dopamine. Dopamine serves as a chemical messenger responsible for coordinating smooth and balanced muscle movement. When there’s dopamine deficiency, one loses the ability to control body movements.
In boxing, the head is hit at a high speed and with great force, causing shear movement between different brain tissues, resulting in small bleeding areas called microhemorrhages. This could not be detected with the old CT scans but with modern brain imaging techniques, they’re able to identify these.
Some correlate the risk of developing Parkinsonism in a boxer with the number of boxing matches and the duration of his boxing career. It’s the additive effect of all the fights that he’s been through, and all the head punches that he has endured through the years. So if Manny Pacquiao were to ask me if he should quit boxing at this point, I’d probably tell him that another fight or two won’t likely make a difference anymore because what matters is the cumulative effect. But lining up boxing matches indefinitely ’til he’s able to throw a punch would be unwise and foolhardy.
Although linked to boxing, PD or Parkinsonism could develop as a degenerative disease in anyone. Being a degenerative disease, it’s more common in the elderly. Aside from repetitive head trauma, it can also be caused by prolonged intake of some drugs like major tranquilizers, anti-psychotic drugs and some medicines for nausea and vomiting. Street drugs like heroin derivatives, blood-vessel disorders leading to repeated strokes and infections like HIV-AIDS and encephalitis have also been reported to cause PD-like signs and symptoms.
Despite currently available treatment, the outlook for PD or Parkinsonism doesn’t look good. One experiences a progressive decline in physical function and mobility, such that even activities of daily living become a challenge. However, several studies have recently come out showing that regular physical therapy (PT) exercises may alleviate such progressive deterioration.
In a pooled analysis of 39 well-designed clinical trials (trial-length range, 4–52 weeks), involving more than 1,800 patients, PT was associated with significantly faster walking speed and longer distance walked in 2 or 6 minutes, significant improvements in functional tests, ability to maintain balance and gait. The researchers also noted fewer falls or accidents in the PT group.
The results of these studies show significant positive results such that some treatment guidelines now consider PT as an important alternative or supportive treatment for PD particularly for those who could not tolerate the side-effects of drugs given to reduce its signs and symptoms.
Although researchers are not sure on the long-term outcome with PT for PD patients, the short-term benefits are encouraging and should offer a ray of hope for many of our patients with PD or Parkinsonism.
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