The game is similar to Mikey Tyson's Punch-Out!!. Players take the role of the boxer, Wade Hixton, instead of Little Mac as he progresses through the game. After his car broke down in Big Piney, he joins the boxing club and beats seven boxers. When Wade won a match, he buys upgrades from the shop. If players are knocked down four times, they can't get back up. They can punch an opponent, but they can't punch while they duck or dodge or duck.
Note: The game was known as Sadistic Boxing and Sucker Punch before the game was released.