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The Difference Between Knockout And Concussion

Knockout and concussion are two different things.

Often, we hear the words knockout and concussion used improperly.

They are not the same, and — as a fighter — it is important for you to understand what these words mean. Your continued good health may depend upon it.

Please don’t try to diagnose your head injury by reading articles on the internet. If you get rocked by a punch, see a doctor immediately. Just because you didn’t get knocked unconscious doesn’t mean you are not injured.

What causes a knockout?

The Brain Stem

The brainstem joins the spinal cord at the base of the skull.

We all know what a knockout is in the context of a boxing match: it’s when a fighter falls, then fails to beat the ref’s count.

But this doesn’t tell us why some people get knocked out cold — unconscious — and other don’t.

When someone is hit in a way that causes knockout, their skull is violently jerked around by the blow. The brain’s inertia causes it to smash against the inside of the skull, near the base of the skull.

Areas of the brain — usually the brainstem or cerebellum — bang against the skull resulting in a loss of consciousness and/or motor control.

Although this can be a serious injury, other times it seems fairly benign. Some people liken it to getting hit in the elbow’s funny bone. That is, it’s a temporary trauma to the nerves near the base of the skull.

In how to take a punch, I describe how some folks believe that there are several ways you can increase your ability to resist knockout.

Nevertheless, if you’re not knocked out by a blow, that doesn’t mean you haven’t suffered a brain injury or a concussion.

What is a concussion?


Concussion is different from a cerebral contusion (a bruise on the brain).

Concussion is distinct from knockout in that it’s not necessarily associated with loss of consciousness. And it can involve parts of the brain other than those near the top of the spinal cord.

Simply put, a concussion is damage to the wires that connect different parts of the brain. It reduced the efficiency with which signals travel to affected parts of the brain. Our understanding of the exact mechanism(s) is still in its infancy.

The dangerous thing about concussion is that you can suffer this injury without suffering a knockout. This is especially bad for boxers because it makes it difficult to detect brain injury unless you’re familiar with the symptoms of concussion.

Most boxers are required to abstain from boxing for a minimum of 30 days after suffering a knockout. But since concussion doesn’t always involve loss of consciousness, boxers might not adhere to this mandatory recovery period.

Eric Lindros suffers an extremely bad concussion

Hockey players hit harder than players in any other contact sport. Consequently, they suffer some of the worst concussions.

Many of the deaths associated with brain concussions happen after second concussions suffered by someone who is still not fully recovered from a previous concussion.  In recent years, professional sports teams have focused on the concussion recovery process.  Sometimes, pro players can miss an entire season because of concussion-like symptoms.  But because second concussions are so dangerous, this is a prudent, if frustrating, approach to long-term health.

Pro boxers — at least at the highest levels of the sport — often have many months between bouts.  The same can’t be said of pros in third-world countries who fight week after week just to earn a modest living.  It is these folks who often suffer undiagnosed concussions.

If you think you had a concussion in the past, you have to be especially careful about avoiding additional head trauma.  Check out second impact syndrome for more details.

GIF of Paul Williams KOed by Sergio Martinez

Symptoms of concussion

According to the Mayo clinic, symptoms of concussion can be divided into two groups: those that appear immediately after trauma, and those that may appear days after the injury.

Symptoms that may appear quickly after injury:

  • Confusion
  • Amnesia
  • Headache
  • Dizziness
  • Ringing in the ears
  • Nausea or vomiting
  • Slurred speech
  • Fatigue

Symptoms that may appear later:

  • Memory or concentration problems
  • Sensitivity to light and noise
  • Sleep disturbances
  • Irritability
  • Depression

Learn how to use protective equipment when you spar and fight. It doesn’t make you a tough guy to take blows to the head, it just puts you at risk of a life-altering injury.

Learn more about concussion symptoms, and facts about traumatic brain injury from the US Centers for Disease Control: Concussion Discussion.

Not having any success learning to fight from the internet?
Check out my review of the best boxing training DVD.

{ 6 comments… read them below or add one }

Brenda Bell October 9, 2010 at 12:40 pm

Yes,I agree we all can learn Boxing online,”Mentally” it can be done.My Martial Arts I nstructor will tell me “Physically” anyone can do,thats easy.But “Mentally” we have a different way of thought”Attitude” Therefore,we can learn Boxing online. Thank you for a great article “Difference of Knockout and Cucussions” I’ve been down that raod many times!


Brian February 6, 2011 at 1:52 pm

This article is completely incorrect about knockouts. 100%. A knockout is a concussion, plain and simple. Furthermore, a concussion is not an event prompted by the brain being bruised – such an injury is called a cerebral contusion, and can be much more serious (though additive concussions are certainly serious, too).

Concussions come about because of the sudden snapping of the head to the back (i.e. uppercut or jab, even), to the front (rabbit punch), to the side (hook), or some combination. In medical terms, it probably represents “white matter” injury, from disruption of the fibers that transmit information from nerve cell to nerve cell.

Watch a knockout. Every single one you’ll ever see involves a fighter’s head snapping back.

FWIW, I am a physician with a special interest in sports medicine and head injuries. Good column, overall, but people need to be educated about head injuries. Knockouts/concussions are brain injuries, albeit (hopefully) temporary, and should be treated with respect.


admin February 17, 2011 at 9:47 pm

Thanks Brian for the clarifications. I have made some changes to the article which I hope correct some of the inaccuracies.

However, I’d like to reiterate my main point, which is that just because someone isn’t knocked unconscious doesn’t mean they haven’t suffered a concussion (or other head injury).

Even today, with sports concussions making headlines in the news, many new boxers/MMAers don’t realize that you can get seriously injured from a blow to the head without getting KOed.

Thanks for taking the time to add detail to your comments. (And if you ever want a place to publish a head injury article geared towards beginning martial artists, I’ll be happy to host it).


steve April 21, 2012 at 5:05 pm

hi books or tests for KOs and how to explain to family that dont understand


logan April 29, 2012 at 6:45 pm

is it dangerous to get knocked out at my age (12)


xringone November 18, 2015 at 5:41 pm

it is dangerous to get knocked out at any age. Didn’t you understand what was discussed above? You don’t even have to be knocked out to suffer damage, it sometimes takes years for the damage to manifest itself as a problem. One of the greatest in the sport of boxing Muhammad Ali was never counted out but the accumulated effect of the punishment he took eventually became obvious.


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