Bradley candid about symptoms

In the immediate aftermath of Timothy Bradley Jr.'s March win over Ruslan Provodnikov -- in which the American eked out a points victory despite having been hurt in the opening round and nearly knocked out in the final frame -- Bradley told HBO's Max Kellerman that he thought he had suffered a concussion early in the fight.

Kellerman asked him why he thought that.

"I'm still dizzy," he replied.

Several months later, again sitting with Kellerman for HBO's "Face-Off" segment to promote this Saturday's clash with Juan Manuel Marquez, Bradley dropped something of a bombshell.

"A few weeks after the fight, I was still affected by the damage that was done," he said. "My speech was a little bit off. I was slurring a little bit. But after about two months, I cleared up and I have my wits about me now."

It was a confession that set cyber-tongues wagging. What kind of physical state was Bradley in? Was he in danger of suffering an acute injury in his next fight? Did his symptoms suggest he was at greater risk of chronic brain damage? In short, should he be allowed to fight Marquez?

But those who study correlations between boxing and brain injury, although not exactly sanguine about Bradley's comments, argue that the most remarkable thing about his symptoms isn't that he suffered them. It's that he has been open about them.

"To say that the symptoms Tim reported are common, I wouldn't necessarily go that far," said Dr. Margaret Goodman, former chair of the Nevada State Athletic Commission's medical advisory board, and now president of the Voluntary Anti-Doping Organization (VADA). "But I would say that I think they happen far more often than we imagine, and that it's very, very rare for an athlete to talk about it. I think it happens after a four-round fight, an eight-round fight, a 10 or a 12 -- it can happen after sparring. And people just don't talk about it. I remember, I would run into boxers after a fight -- and they may not have been fighting on the card; they may have just been at an arena supporting someone else or just watching -- and they would go, 'Yeah, for several weeks, I was off-balance or dizzy.' I'd reply, 'Well, did you seek medical attention?' and they'd say, 'No, that's just what happens.'"

Dr. Charles Bernick, principal investigator for the Professional Fighters Brain Health Study at the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, concurs.

"It probably frequently happens that people, even though they're not knocked out, sustain concussions during a fight to some degree and probably do display residual effects for some time afterward," he said. "How common that is, I don't know. And I don't think the fighters are totally forthright about describing it to professionals such as myself. We do routinely ask fighters, 'Have you ever had your bell rung? Did you ever get dazed, even in sparring?' And they will admit that yes, that happens frequently. But it is a little unusual that Mr. Bradley was so vocal about it, or honest about it, to the press. I think that's kind of an exception."

It's a point that Bradley himself emphasized when discussing the situation with reporters at the Wynn Las Vegas this week.

"A lot of fighters probably go through the same things I went through after certain fights," he said. "I'm here to tell them that there is basically help out there. You can get help. I got the help out there, and I'm here to speak out. A lot of people feel that I shouldn't speak out about it and that I should keep it a secret. But for some reason, I want to talk about it. I went through it and I want to share it with the world. I want to let them know, 'Hey, it is true what they talk about boxing. It is a dangerous sport.' When you come in for a fight, you might not leave the ring the same way."

Bradley previously stated that, in the hospital following the Provodnikov fight, two physicians disagreed as to whether he had a concussion, and an MRI showed no damage. But there are two important points to consider. The first is that a conventional MRI cannot determine the presence or absence of a concussion, according to Bernick.

"For a concussion, if you do an MRI scan with the normal sequences that are done clinically, you won't see any changes," Bernick said. "That's almost by definition. It's really only by doing more sophisticated analysis that you might actually pick up damage from a concussion. So, short of someone bleeding into their brain or suffering damage to that degree, an MRI scan isn't going to clinically tell you that much. It's better to be normal than not, but it doesn't give you comfort that something hasn't happened. And it's not just MRIs -- we don't have any predictors at this point."

As Dr. Robert Cantu, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine, explains, "You can't in most cases tell just from looking [whether a person has a concussion]. In severe cases, such as loss of consciousness and low levels of consciousness, obviously you can tell there's been a concussion just by looking at somebody. But for the majority of people, the concussion is going to be similar to taking a fresh egg and shaking it violently. It looks just like that fresh egg, but when you crack it, you're going to get a scrambled egg. So you have to do tests to determine that somebody's had a concussion."

However, says Goodman, even when the symptoms are evident, the fighter and those around him might not pick up on their significance.

"I've talked to fighters and they can be concussed after a tough sparring session, and it can go unrecognized because people might think, 'Oh, they're tired,' or 'They're losing weight.' There's a million and one excuses you can give," she said.

"The bottom line to me is that it's almost better to assume someone's had a concussion after a tough fight, and to sit down with the fighter and go through the signs and symptoms and say, 'You may have these, you may not have these, but because you got hit in the head, by definition, you've had a concussion.'"

There is a second point to consider. Although the spectacular fights, knockdowns and knockouts garner the most attention, and although ears perked up at Bradley referencing symptoms that are so closely associated with chronic damage, Bernick is at pains to underscore that brain injuries shouldn't be looked at through an either/or filter, in which you either don't have a concussion and are therefore in the clear, or you do have one, in which case you aren't.

"There's probably a spectrum of injury, from 'no injury' to very mild injury of fibers, to being injured enough in certain areas of the brain to cause a loss of consciousness," Bernick said. "My paradigm about this is that head trauma is kind of a spectrum or continuum, and it's where you fall on that continuum. And we don't know if getting many, many sub-concussive blows may be worse over time, when you're looking at long-term complications, than getting a couple of really bad, knock-you-out blows to the head. They may both be really bad, one may be worse than the other, but I don't think anybody knows that for sure."

That is one of the key questions that Bernick and his fellow investigators are seeking to answer with their ongoing study at the Ruvo Center. Somewhere, locked in the brains of participating boxers, are the answers: why some fighters suffer long-term damage and others don't appear to; why some are susceptible to knockouts and others are not; what indicators exist to suggest a fighter is at particular risk of developing chronic traumatic encephalopathy or related disorders. For now, however, the picture remains unclear, and the puzzle is one that contains many small pieces and remains far from complete.

As for Bradley: by recognizing his symptoms early and by being honest with himself about them, by seeking treatment and refraining from training for several months, he almost certainly greatly improved his ability to recover from the punishment Provodnikov meted out. But not every boxer is fortunate enough to have the self-awareness, the support group or the resources that Bradley has. The simple fact is that boxing is a profoundly dangerous undertaking, and too many of those involved -- fans, media and even participants -- can be altogether too cavalier about the degree of risk inherent in a man's skull being repeatedly battered by another man's fists.

That Tim Bradley apparently suffered such severe symptoms after a hellacious fight should certainly be a concern -- as indeed should the fact that his readiness to acknowledge them is so unusual. But it shouldn't necessarily be a surprise.