Boxing is a full-contact sport with a high risk of head injury due to repeated exposure to impact and cranial acceleration during training and competition. International evidence shows that boxers, both amateur and professional, have a significant incidence of concussions, facial trauma, and head contusions, with reported head injury rates ranging from 17–25 cases per 100 matches (Loosemore et al., 2015). Repeated head impacts are also associated with long-term cognitive impairment, decreased executive function, and an increased risk of chronic traumatic encephalopathy (CTE) in combat sports athletes (McKee et al., 2016; Bernick et al., 2013). This underscores that preventing head injuries is not merely a performance issue, but a matter of athlete safety and long-term health.

Several international studies have identified key components in preventing head injuries in boxing and martial arts. The use of headguards has been reported to be effective in reducing superficial injuries and lowering direct impact force, although it does not eliminate the risk of concussion (Flynn, 2024; Hanson et al., 2014). Additionally, mastery of basic defensive techniques, such as slipping, blocking, and head movement, has been shown to contribute to reducing the frequency and intensity of blows to the head during training sessions (Del Vecchio et al., 2018; Beattie & Ruddock, 2025; Ruddock et al., 2016). From a post-injury perspective, the latest international guidelines emphasize the importance of a gradual rehabilitation protocol, symptom monitoring, and return-to-play decisions based on medical evaluation to minimize the risk of re-injury (Patricios et al., 2023; Schneider et al., 2017).

Conceptually, the prevention of head injuries in boxing can be understood through a multidimensional approach. Haddon's Matrix maps risk (Figure 1) and protective factors into the dimensions of people, equipment, environment, and policy, making it relevant for analyzing the roles of athletes, coaches, protective equipment, and training systems (Haddon, 1973). The Ecological Model of Sports Injury emphasizes the dynamic interaction between athletes' intrinsic factors and extrinsic environmental factors in the occurrence of injuries (Meeuwisse et al., 2007). Meanwhile, Social Cognitive Theory explains how athletes' safe behaviors are shaped through observation, coaching, and social reinforcement during daily training (Bandura, 1986; Fletcher, 2025). The integration of these three frameworks allows for a more comprehensive analysis of head injury prevention practices in boxing training environments.

Although international literature on concussion mechanisms, the effectiveness of protective equipment, and rehabilitation protocols continues to evolve, a clear research gap remains at the implementation level. Most previous studies have focused on elite athletes, professional competitions, or controlled experimental designs, thus not exploring how head injury prevention strategies are operationalized in small-scale boxing clubs or academies (Ruddock et al., 2016; Flynn, 2024). In particular, there is still limited empirical evidence documenting the defensive practices taught by coaches, the consistency of headguard use in routine training, the implementation of post-injury rehabilitation protocols, and the perceptions of athletes and coaches regarding the effectiveness of these strategies, especially in the context of Southeast Asia. To date, no research has specifically examined the implementation of head injury prevention at the HAN Boxing Academy Malang, an academy with local characteristics, limited resources, and a distinctive training approach.

Based on these gaps, this study aims to explore in depth the strategies and implementation of head injury prevention in boxers at the HAN Boxing Academy in Malang. The research focuses on defensive technique teaching practices, the use of head protection equipment, the role of coach supervision, and the application of post-injury rehabilitation in the local context. The findings of this study are expected not only to contribute contextually to improving athlete safety at the academy level but also to enrich the international literature on the practical implementation of head injury prevention programs in boxing and other combat sports.

This study involved four participants, comprising one coach (P1) and three active boxers (P2–P4) from the HAN Boxing Academy in Malang. All participants had at least one year of training experience and were directly involved in routine training activities, including sparring sessions and the implementation of head injury prevention practices. The coach played a role in planning and supervising training, while the athletes were involved as recipients and direct implementers of injury prevention strategies. Table 1 presents a summary of the main themes, sub-themes, the number of participants who mentioned each sub-theme, and illustrative quotes representing the findings.

This study aims to explore the strategies and implementation of head injury prevention at HAN Boxing Academy in Malang. In general, the findings indicate that head injury prevention efforts at this academy are implemented through a multi-level approach that encompasses mastery of defensive techniques, the use of head protection equipment, continuous supervision by coaches, injury treatment and rehabilitation practices, and athlete awareness of risk factors. The combination of technical, organizational, and individual elements is the primary mechanism employed by the academy to minimize exposure to head impacts during training.

One of the main findings of this study is the central role of mastering defensive techniques as the foundation for preventing head injuries. This finding is consistent with international research showing that technical skills—particularly evasion, blocking, and distance control—are important determinants in reducing head impact exposure in boxing (Loosemore et al., 2017; Tjønndal et al., 2022). Previous studies have also reported that athletes with low defensive abilities tend to experience more concussive and sub-concussive blows in the long term (Bernick et al., 2015). The consistency between the findings of this study and the international literature can be attributed to the nature of defensive techniques as skills that can be modified and trained systematically, particularly in the context of amateur athletes with varying levels of experience.

In addition to defensive techniques, participants perceived the use of headguards as an important component in preventing head injuries. This perception is consistent with global evidence indicating that headguards can reduce superficial injuries, such as lacerations, abrasions, and facial bruises, by 60–80% (Dickinson & Rempel, 2016). However, as also reflected in the findings of this study, several studies confirm that headguards have limitations in protecting athletes from internal acceleration forces that contribute to concussions (Al Attar et al., 2024). This duality of function—providing external protection but not completely preventing internal injury mechanisms—explains why participants feel safer when wearing headguards but remain aware of residual risks during training. This reinforces the view that protective equipment-based strategies need to be combined with technical and organizational approaches.

Coach supervision emerged as another important determinant in athlete safety practices. The role of coaches in monitoring fatigue levels, adjusting training intensity, correcting technical errors, and ensuring the use of protective equipment is in line with research findings that confirm that the quality of education and involvement of coaches has a direct effect on the risk of injury in combat sports (Kirk, 2022). In line with studies on Taekwondo and Muay Thai, the findings of this study suggest that consistent feedback and effective training load management by coaches can reduce the risk of injury by maintaining the quality of athletes' defense and mitigating the impact of fatigue on concentration and defensive posture.

In terms of injury management and rehabilitation, practices at HAN Academy tend to be experience-based and not yet fully structured. Although there is an unwritten policy of restricting competition for six months after a serious head injury, the absence of standard procedures, medical screening, and neurocognitive assessment shows a striking difference from international guidelines, such as the AIBA Medical Handbook, which recommends a graded return-to-play and medical clearance before athletes return to training or competition. This difference is likely influenced by the local context, characterized by limited access to sports medicine professionals. These findings are consistent with reports from small boxing clubs in resource-limited settings, where the rehabilitation process often relies on the coach's judgment rather than formal clinical evidence.

In addition to technical and organizational factors, this study also shows that athletes are aware of the role of physical and psychological readiness in the risk of head injuries. These findings support previous literature stating that fatigue and decreased focus significantly increase exposure to head impacts during training and competition (Dunn et al., 2022; Steward et al., 2025; Wu et al., 2025). The influence of these psychological factors confirms that injury prevention cannot be understood solely as a technical or equipment issue, but rather as a multidimensional phenomenon involving interactions between individual behavior, the training environment, and post-injury responses. This understanding aligns with the Ecological Model and Haddon Matrix frameworks, which view injury as the result of complex interactions among human factors, equipment, environment, and management systems.

Overall, the findings of this study suggest that head injury prevention practices at HAN Academy are multifaceted but remain informal and non-standardized. The absence of written protocols, standardized assessment tools, and medical partnerships limits the strength and sustainability of existing practices. This situation also has the potential to affect the generalizability of the findings to a broader academic context or a more regulated system. Nevertheless, this study identifies clear opportunities for improvement, such as developing standard operating procedures (SOPs) for sparring intensity, implementing structured return-to-play guidelines, conducting routine checks of protective equipment, and collaborating with healthcare providers for medical screening and concussion management.

The implications of this research are not only relevant at the academic level. For coaches, implementing evidence-based training and safety protocols can help reduce preventable injuries while supporting the long-term development of athletes. For sports organizations and policymakers, strengthening coach certification, safety education, and equipment regulations are important aspects of maintaining athlete welfare. Meanwhile, for athletes, increasing literacy about concussion symptoms, long-term neurological risks, and safe decision-making strategies can improve self-control over personal safety.

HAN Academy Malang implements a multi-component head injury prevention program, which includes mastering basic defensive techniques, consistently using headguards, and coach supervision during training sessions. These findings indicate that the program is perceived as effective by both coaches and athletes; however, it still requires strengthening through the development of written protocols, integration of medical services, and more systematic evaluation. This study has limitations due to its single-site design and the limited number of participants, so the findings cannot be generalized broadly. Therefore, further research is recommended using a mixed methods approach with a larger sample to assess the program's effectiveness on head injury incidence and athlete safety outcomes.

The researchers would like to thank all participants who have contributed to this study, especially HAN Academy Malang.

The data supporting this study's findings are available on request from the corresponding author. The data are not publicly available because they contain information that could compromise the privacy of research participants

This research does not receive external funding.

The author officially certifies that there are no conflicts of interest with any party with respect to this research.