WHAT if you could know straightaway whether an athlete had a head injury? After sustaining an impact what if you could get an instant diagnosis of its potential for concussion? It would revolutionise contact sports. It would change the conversation about athlete safety. You might say it would save boxing.

With breakthroughs in technology, that future is possible. The Protecht mouthguard, developed by a company called Sports & Wellbeing Analytics, could be that game changer. It’s being used in rugby and other sports, and is being tested in boxing. Doctor Mike Loosemore is working on the project. Loosemore is a highly credible figure. He’s been the doctor for the GB boxing team for 24 years. As well as being Lead Sports Physician at the English Institute of Sport, he has been the chief medical officer for Team GB overall at an Olympics.

“This could be the future of boxing and improve the safety in boxing and help boxers not get as badly injured during boxing,” he tells Boxing News.

The mouthguard contains chips, a tri-axial accelerometer, the kind of technology that’s used in mobile phones to detect which way up they are, as well as a gyroscope that detects rotational movement, a battery and a transmitter, all of them miniaturised. It picks up the movement of the head, from side to side and back and forth and can transmit that information to an observer nearby. “It’s incredible,” Loosemore says. “It allows you to know how hard the boxer’s been hit in the head. It’s very reliable. There’s lots of research, it’s now very user friendly. It’s robust and reliable.

“[Previously] when people took it out of their mouth and shook it, it got weird results. Now we’ve got sensors, so when you take it out of the mouth it switches off. Although the mouthguard looks incredibly clever, it’s actually the software behind this that cleans up all the data which comes out that is the real big breakthrough.”

“The success is the mass of incredibly clever software that sits behind this bit of kit,” he emphasises.

Essentially it produces data on how many times someone’s been hit, how hard and where. “So you can tell if somebody’s been hit hard in the head and how many times they’ve been hit hard in the head,” Dr Loosemore said. “The other interesting thing about the waveform, it shows you how sharp the hit was. Whether there was a long exposure to the hit or whether there was a short, sharp exposure. That’s also important.

“You can look at total impacts, you can look at the load of the impacts, you can look at how many high impacts they’ve got, you can look at the really big impacts.

“The other thing about this data is it’s instant,” he adds. “As you get hit hard, it shows up.”

The mouthguard has been used by international teams at the Cologne Cup, one of the bigger tournaments on the European circuit. “We got 15 athletes and we sent them kits, and they did their own impressions,” Mike continued. “They were all very happy with the mouthguards, very happy with the fit.

“We don’t have to be right up at ringside, we don’t get in the way of the cameramen, we don’t get in the way of the judges, we’re sitting well back.” Professional boxers have also been testing out the mouthguard. It’s working.

Because it can show what you’ve been hit by and where you’ve been hit, it could be used as a coaching tool. But as a device to mitigate the risks of brain injury it’s really significant. This is what Dr Loosemore has been looking at. “We know that sometimes people can get brain injuries during boxing. Just doing studies on it isn’t going to make that any worse and, you know what, this sort of stuff may actually make it better for the boxers,” he said.

They’ve also been able to compare their findings across different sports. “[In boxing] the average maximum impacts are the same as they are in rugby. But there are some much harder impacts in boxing,” Dr Loosemore said. “Despite the fact that you get a lot more head impacts in boxing and despite the fact that some of those impacts are really hard, we still see much fewer concussions and knockouts in boxing than we do in rugby per blow. Which is a bit odd, because you’d think you’d get more in boxing because you’re being hit harder. Sometimes boxing’s been criticised because boxers go in there with the intention of hitting each other, but I think that’s also why we don’t get so many knockouts and concussions. Because your neck muscles tense because you’re expecting a blow when you get hit, this reduces the amount of energy transferred to the boxer’s brain.”

The data they produce also picks up on the length of time of an impact, in terms of milliseconds. This is important information too. It shows that boxing tends to involve short, sharp impacts. “Research has shown that with brain tissue short impacts do not cause as much damage as long impacts. So it’s a bit like Blu Tack. If you give Blu Tack a quick tug, it doesn’t really deform very much but if you tug it for longer it deforms. So sharp blows are not as damaging as longer blows,” Loosemore said. “Obviously if you get hit hard enough, it doesn’t matter how short the blow is, you’re going to cause some damage. But the sort of blows we’re looking at in sport, we’re thinking [in theory] maybe the shortening of the blow causes less of a problem with the brain.”

Protecht mouthguard

As well as monitoring individual hits, they can form a cumulative picture of the strains and stresses impacted on the brain over the course of a whole match, season or training camp. The Harlequins rugby club used this tool last season and saw dramatic results in reducing the number of injuries in their squad and increasing the time in competition for their best players. That season they also won the Premiership. “You can say [for example], ‘Actually you had quite a heavy game there, you probably need to take the next game off because you’ve had quite a heavy load.’ And that’s what Harlequins did. They looked at the brain load, reduced it and they reduced their injury rate hugely. You can do the same in boxing. But you can also look not only over a fight but over a season, and you can start to look over a career and say actually, you know what, we’ve looked at your brain now and we think you’ve taken enough of these injuries and it’s time to pack it in,” Loosemore reflected.

With it, boxers will be able to perform better. “What we know from rugby is that if you get concussed your risk of getting a muscular-skeletal injury, not a head injury but something else, is four times greater. So what they did at Harlequins was they reduced the ‘brain strain’ as we call it, because they’re not brain ‘injuries’ as such, they’re just brain strains. If you reduce that then your players do not get as many muscular-skeletal injuries, which means you have more of a squad available, which means you can play your top internationals week in, week out and they’re okay,” Mike noted.

This is equally applicable to boxing training. “[You can say] it has been a heavy training camp, that guy caught you a few times, we’re going to knock sparring on the head tomorrow and give you a chance to recover,” Loosemore suggests. “Then you get a better performance out of your boxer and a safer performance.”

They capture clear data on the exact movement of the head and on whether someone has been hit hard. The next step will be to know if that’s causing a problem. “You can get hit hard and not get knocked out, and you can get hit less hard and get knocked out. You know when you watch boxing, some blows are going to knock someone out and other blows are not going to knock someone out,” Dr Loosemore said. “Someone got knocked out while they were wearing the mouthguard and the actual energy of the blow was much lower [than other punches]. So a hard blow does not necessarily mean a knockout and a hard blow also doesn’t necessarily mean that you get more brain damage.”

Because the brain is made up of tissue of different consistencies, if it’s jolted or rotated quickly, different parts of the brain will move at different speeds. “It’s the forces of those interfaces that tend to get stressed,” Loosemore explains. “It’s that difference in density that causes the sheering force between those areas.”

To gain an understanding of what kind of damage different forces coming from different directions can do to a brain, they needed another set of data. They found it at courtesy of a major study at Imperial College, where they were developing a mathematical model of the brain. This is funded in part by the military, originally to examine head injuries in order to design helmets to better protect against blast forces. But it is equally useful for looking at everything from motorcycle injuries, to elderly people falling and to sportspeople sustaining contact to the head. “They validated [their model] by putting stress electrodes in a fresh brain from somebody who’d died and then moving the brain and seeing which bits moved at different times. They looked at different movements and eventually built up a model of the brain mathematically, whereby when the brain moved, they knew which parts would be stressed,” Mike said. “That’s really in-depth. They built it so they could test helmets on brains without using real people.

“You can virtually move the model around and it’ll tell you where it’s getting stressed.”

They could feed data from use of the mouthguard into that model and draw on a large bank of examples of the clinical outcomes of different impacts on brains. “When you know exactly what part of the brain has been strained, what symptoms that person had and how long it took them to get better, the gumshield almost acts as a diagnostic tool as soon as it happens, to let you know how long the person’s going to be out for or whether you can leave them on,” Mike said.

This is at the research stage, and not available on the market. But the possibilities are exciting. “As we get more and more data these will become more and more accurate because we’re using artificial intelligence and mechanical learning. The computers are learning all the time what means what. What this means is you can have somebody hit in the head on the rugby pitch or the boxing ring and before they hit the ground we will know what has happened to the athlete’s brain. Not now, but in a few years’ time, I’ll be able to tell you whether they need to leave the pitch, whether they can stay on the pitch [or] how long they’re going to be out for, what’s the appropriate treatment to give them to try to get them back quicker or if they need to go to hospital straightaway,” Loosemore continued. “It just gets more and more accurate as time goes on. So in five years’ time it’ll be super accurate, in 10 years’ time it’ll be phenomenally accurate.”

You could also be alerted to a potentially life or career-threatening injury far sooner. “Often these brain bleeds go unseen. The boxer will finish, sometimes they’ve won, sometimes they’ve lost, they’ll go back to the dressing room and they collapse, then all of a sudden it’s panic stations. With this system, as they walk out the ring I could [for example] say that guy needs to go direct to hospital now and get a brain scan because he’s got a 94% chance of a brain bleed,” Loosemore said.

“It’s absolutely game-changing for the sport.”