It was billed as “The Last Hurrah.” For the first time in two years, Muhammad Ali would step back into the ring to reclaim the title held by an undeserving foe in his absence from the sport. But on that October night in 1980, the Greatest finally fell, lasting just 10 of 15 rounds, absorbing punch after punch by Larry Holmes while barely landing 10 of his own. In round nine, a devastating right uppercut had Ali draped against the ropes, and Holmes hit him with a right hook to the kidney that caused the former champion to bellow in agony. Boxing writer Thomas Hauser would later recall it as, “The night when Ali screamed.“
Just three months before, Ali had undergone a two-part physical at the Mayo Clinic amid concerns by the Nevada Athletic Commission for his overall health. In his report, Dr. John Mitchell, tasked with checking Ali’s kidneys, concluded the boxer appeared to be in “excellent general medical health.” The neurological exam was more troubling: Dr. Frank Howard found Ali was having difficulty speaking, hopping on one leg, and touching his finger to his nose. Yet he found no specific reason to prohibit Ali from fighting, and he was granted a boxing license, setting the stage for a brutal fight that never should have happened in the first place. Ali had no reflexes that night, reduced to a human punching bag by Holmes.
It was that fight that Ali would later point to as a possible source of his Parkinson’s, the disease he publicly battled for the last three decades of his life. But in the years since his 1984 diagnosis, there are still more questions than answers surrounding boxing, head injuries, and denegenerative brain disease.
Today, much of national conversation of head trauma in sports concerns not Parkinson’s, but the disease known as chronic traumatic encephalopathy, or CTE, among football players. CTE is also known to be prevalent in sports like hockey, soccer, and rugby, yet the earliest association of the disease was with boxing. In 1928, pathologist Dr. Harrison Martland described “nearly 50 percent of fighters … if they keep at the game long enough” as exhibiting “punch-drunk” symptoms – boxing slang for the various cognitive, behavior, and motor abnormalities observed in many fighters. Those symptoms would come to describe a disease known as dementia pugilistica, a form of CTE.
There’s been much speculation as to the role boxing played in Ali’s development of the disease, about which little was known at the time of diagnosis. The growing body of scientific literature linking CTE to concussions and repetitive head injuries, as well as an increasing association between CTE and Parkinson’s, Alzheimer’s and ALS, have caused many to wonder if Ali, too, suffered from the disease most commonly associated with NFL players. But with no definitive test for Parkinson’s or CTE among the living – with both diseases only being diagnosable using posthumous tissue samples – it will be impossible to truly answer that question without Ali’s family donating his brain for research.
Certainly, stacks of medical studies and common sense suggest that repetitive hits to the head can cause traumatic brain injury. Ali clearly thought this was the case with him: “I’ve been in the boxing ring for 30 years, and I’ve taken a lot of punches, so there is a great possibility something could be wrong,” he said while awaiting his diagnosis, having experienced tremors and slurred speech. Despite Ali later pinpointing the Holmes fight, recent research suggests he might have had it right the first time, fingering not the big blows, but rather the sustained, everyday subconcussive hits over the course of a career for leading to neurodegeneration.
But Parkinson’s remains a clinical diagnosis – that is, one based on symptoms. Those symptoms include tremors, impaired movement, and speech problems. Many symptoms, like balance issues and depression, overlap with those found in CTE cases, opening the possibility for misdiagnosis.
There are many who would point to these and other uncertainties – namely, the incidence of Parkinson’s in non-boxers and the role of genetic factors – to caution against concluding that boxing was directly responsible for causing Ali’s disease. Of course, many of these people, like infamous promoter Don King and Hall of Fame trainer Freddie Roach, have a vested interest in maintaining that uncertainty, protecting yet another sport predicated on the sacrifice of the athletes’ bodies and brains. You can thank the NFL in large part for decades of denials, funding junk science, and obstructing legitimate research that have helped yield the current state of uncertainty about brain disease.
In Ali’s case, the young age at which he was diagnosed with Parkinson’s does suggest genetics played a role. Ali began displaying symptoms in the last years of his fighting career, slurring his speech to reporters, before being diagnosed three years after retiring at the age of 42. The average age of diagnosis is 62; when found in individuals younger than 50, it’s known as Young-Onset Parkinson’s. According to the National Parkinson Foundation, Young-Onset Parkinson’s is more closely associated with genetic factors and exposure to toxins.
Michael Okun, national medical director for the National Parkinson Foundation, pointed to Ali’s age, the fact that his symptoms manifest on one side of his body more than the other, and his responsiveness to dopamine treatment as signs that Ali suffered from Parkinson’s distinct from CTE and that genetics played a role.
Still, as Okun told USA Today, head trauma can “unmask” Parkinson’s in its early stage. A 2013 research review found that people who had suffered concussions from brain injury were 57 percent more likely to develop Parkinson’s. And a 2015 study found Parkinson’s to be 44 percent more prevalent in people over 55 who had suffered from traumatic brain injury.
The only real conclusion here is that everyone’s probably a little right and a little wrong when it comes to theories about Ali’s disease and his boxing career. More research is clearly needed, but we have Ali (and later Michael J. Fox) to thank for much of what we already know. Before Ali helped usher in a new era of awareness and research, Parkinson’s existed largely in the shadows, a disease that carried with it a sense of shame and fear. “The whole world projected their fears for him onto him,” Fox said of Ali over the weekend. “And he took it all with love, with confidence and with humor.”
For the more than one million Americans living with Parkinson’s, the legacy of Ali appearing before Congress to appeal for more research funding will resonate as deeply as the image of him standing over Sonny Liston in triumph. The dollars raised by the Muhammad Ali Parkinson’s Center since its establishment in 1997 will have as lasting an impact on the quality of life of millions worldwide as the memory of watching him fight. The voice given to those who still seek a cure will sound as loudly as the echoes of the man himself: The Greatest.