Morbidity profile of high-performance fencers

Injury Patterns in Fencing Athletes - A Retrospective Review

Background

Fencing is a unique and increasingly popular sport, but limited data exist regarding related injuries.

Purpose

To examine the types of injuries incurred by fencing athletes, and to analyze associations between age, sex, and hand dominance with type and location of injury.

Study Design

Cross-sectional.

Methods

Retrospective chart reviews were performed to evaluate fencing related injuries in athletes evaluated in the sports medicine and orthopedic clinics of a large teaching hospital.

Results

One hundred and eighty-six patients (98 male, 88 female) were included. Average age at time of injury was 14.6 years (range 9 - 32 years). 73% of injuries involved the lower extremity, 16% involved the upper extremity and 10% affected the back. In the lower extremity, the knee (49%), ankle (16%) and hip (11%) were most commonly affected. 80% of injuries were treated with physical therapy. Only 5% required surgical intervention. Injuries of both upper and lower extremities were more commonly seen on the athlete's dominant side, and the majority of injuries (77%) occurred in athletes 13 years or older.

Conclusion

The majority of injuries in these fencing athletes affected the lower extremity, most commonly the knee. Extensor mechanism dysfunction, primarily patellofemoral pain, was the most common diagnosis. Hand dominance, patient age, and patient sex did affect different injury characteristics.

Level of Evidence

2b.

Lower extremity injuries in U.S. national fencing team members and U.S. fencing Olympians

INTRODUCTION

Fencing is growing rapidly in popularity and competitiveness with fencers beginning at a younger age and competing in more tournaments. Even though fencing has a low risk of time-loss injury, fencers are inevitably going to experience injuries if proper athletic training and prevention does not occur. We aim to describe and compare the lower extremity injuries experienced by fencers that have trained at the highest level in the sport. We hypothesized that athletes who fenced longer would suffer more knee and hip injuries and report lower IKDC and HOS scores.

METHODS

This is an epidemiology study distributed to members of the U.S. national team and Olympic team from 1980 to 2018. The electronic survey included questions regarding age, weapon, number of years fencing, number of national and Olympic teams, injuries on the dominant and nondominant hip and knee, time missed due to injury, and methods for treatment. The survey also included the International Knee Demographic Committee (IKDC) and Hip Outcome Score (HOS).

RESULTS

There were 153 national team members between July 1980 and July 2018, 110 with contact information. A total of 77 athletes submitted the survey, consisting of 30 females and 47 males. Female fencers had more hip injuries and lower IKDC and HOS scores than their male counterparts. In total, there were 71 injuries to the dominant (front) knee and 28 injuries to the nondominant (back) knee. There were 32 dominant hip injuries and 5 nondominant hip injuries. Saber fencers reported the most dominant and nondominant hip and knee injuries.

CONCLUSION

The intense, repetitive and asymmetrical movements involved in fencing affect the weight bearing leg and the nondominant leg in all weapons. Special attention should be paid to female fencers as they experience more hip and knee injuries resulting in impaired joint function.

Asymptomatic foot and ankle structural injuries: a 3D imaging and finite element analysis of elite fencers

BACKGROUND

Fencing is a highly asymmetrical combat sport, that imposes high mechanical demands over repeated exposures on the musculoskeletal structures, a primary cause of injuries in fencers. However, there are limited epidemiological studies on the structural injuries of the foot and ankle in fencers. This study aimed to investigate foot and ankle structural injuries, and explore how metatarsophalangeal joint structural changes may affect the mechanisms of foot and ankle injuries in asymptomatic fencers.

METHODS

3D images of foot and ankle morphology using computed tomography were obtained from ten elite fencers. We then constructed finite element models of the first metatarsophalangeal joint in the foot of their trail legs. The validated models were used to simulate stress distribution changes from different ankle joint angles during lunging.

RESULTS

The findings showed that stress distribution changes at the medial and lateral sesamoid may have caused sesamoid fractures, and that habitual and concentrated stress on the metatarsal bones might have flattened the sesamoid groove. This process may damage the integrity of the first metatarsophalangeal joint, and consequently affect the efficiency of the windlass mechanism in fencers. During lunging, different ankle joint angles of the trail foot increased the total stress difference of the medial and lateral foot, and thus influenced the lunging quality and its stability.

CONCLUSIONS

Our findings revealed that the asymmetric nature of fencing might have caused asymptomatic foot and ankle structural injuries, and finite element analysis results indicated that this might increase the incidence of the serious injuries if unattended. Regular computed tomography examination should be introduced to monitor elite fencers' lower limb alterations, permitting unique angle adjustments in the trail foot without sacrificing technical or physiologic properties based on the exam results and reduce the lower limb injury risk.

Prevalence of sports injuries in Korean fencers aged 14-40 years

BACKGROUND

Although sites and types of injury frequently occurring in fencers have been well described, the type of injury caused by the use of fencing movements is still unknown. This study aimed to provide basic data for injury prevention by understanding the sports injury status in fencers.

METHODS

A total of 584 South Korean fencers were included in the survey and were classified according to the injured site, cause of injury, and movement that causes injury. The collected data were analyzed using frequency analysis, χ² tests, and logistic regression analysis to identify differences in sex, event type, age, and career.

RESULTS

Female (P=0.001) and foil fencers (P=0.015) were more likely to experience injury than male and sabre and epee fencers. The incidence of injury was significantly higher according to age (P=0.001) and career (P=0.001). The ankle was the most frequently injured site (17.71%). Injuries most frequently occur during Fente movement (48.11%). Insufficient warm-up was the most common cause of injury (23.91%) in all groups.

CONCLUSIONS

These results suggest that a specific warm-up program and strengthening exercises of the ankle and knee ligaments should be established to prevent injuries for fencers. Particularly, female, foil, adult, and experienced fencers should be more careful in preventing injuries.

Biomechanics of fencing sport: A scoping review

Objectives

The aim of our scoping review was to identify and summarize current evidence on the biomechanics of fencing to inform athlete development and injury prevention.

Design

Scoping review.

Method

Peer-reviewed research was identified from electronic databases using a structured keyword search. Details regarding experimental design, study group characteristics and measured outcomes were extracted from retrieved studies, summarized and information regrouped under themes for analysis. The methodological quality of the evidence was evaluated.

Results

Thirty-seven peer-reviewed studies were retrieved, the majority being observational studies conducted with experienced and elite athletes. The methodological quality of the evidence was “fair” due to the limited scope of research. Male fencers were the prevalent group studied, with the lunge and use of a foil weapon being the principal movement evaluated. Motion capture and pedabarography were the most frequently used data collection techniques.

Conclusions

Elite fencers exhibited sequential coordination of upper and lower limb movements with coherent patterns of muscle activation, compared to novice fencers. These elite features of neuromuscular coordination resulted in higher magnitudes of forward linear velocity of the body center of mass and weapon. Training should focus on explosive power. Sex- and equipment-specific effects could not be evaluated based on available research.

Foot loading characteristics during three fencing-specific movements

Plantar pressure characteristics during fencing movements may provide more specific information about the influence of foot loading on overload injury patterns. Twenty-nine experienced fencers participated in the study. Three fencing-specific movements (lunge, advance, retreat) and normal running were performed with three different shoe models: Ballestra (Nike, USA), Adistar Fencing Lo (Adidas, Germany), and the fencers' own shoes. The Pedar system (Novel, Munich, Germany) was used to collect plantar pressures at 50 Hz. Peak pressures, force-time integrals and contact times for five foot regions were compared between four athletic tasks in the lunge leg and supporting leg. Plantar pressure analysis revealed characteristic pressure distribution patterns for the fencing movements. For the lunge leg, during the lunge and advance movements the heel is predominantly loaded; during retreat, it is the hallux. For the supporting leg, during the lunge and advance movements the forefoot is predominantly loaded; during retreat, it is the hallux. Fencing-specific movements load the plantar surface in a distinct way compared with running. An effective cushioning in the heel and hallux region would help to minimize foot loading during fencing-specific movements.

Incidence and characteristics of time-loss injuries in competitive fencing: a prospective, 5-year study of national competitions

OBJECTIVE

To estimate the incidence of time-loss injuries in competitive fencing and to characterize these injuries regarding type and location.

DESIGN

A 5-year prospective study.

SETTING

Data were collected at all national events organized by the U.S. Fencing Association (USFA) during the 2001-2006 seasons.

PARTICIPANTS

A total of 78,223 male and female competitors, ranging in age from 8 to above 70, participated in various events in the targeted competitions.

METHODS

Experienced certified athletic trainers (ATC) evaluated and documented all incidents that resulted in withdrawal from competition. Exposure data [athlete exposures (AE)] were calculated from the number of bouts completed in each competition.

MAIN OUTCOME MEASURES

Rate of time-loss injury was calculated per 1000AE. Frequency distributions for types and locations of injuries were used to characterize time-loss injuries.

RESULTS

One hundred eighty-four time-loss injuries were reported during the study, for an overall rate of 0.3 per 1000 AE (95% CI: 0.26-0.35). Of these, 26.1% were recorded as strains and 25.5% were identified as sprains. The knee was the most frequently injured location (19.6%), followed by the thigh (15.2%) and the ankle (13%). Overall, 60% of the injuries were in the lower extremities.

CONCLUSIONS

The rate of time-loss injury in competitive fencing is low. Although there are differences in the distribution of types and location of time-loss injuries by sex and discipline, the predominant characteristics (sprain/strain in the lower extremities) are similar to other sports with ballistic action in stop-start, rapid change-of-direction activity.

Orthopaedic issues in sports for persons with haemophilia

Persons with haemophilia should not feel limited in their ability to participate in sports. After consultation with a physician or other health-care provider and with a proper understanding of the risks involved and the strategies for managing these risks, patients with haemophilia can - and should - enjoy physical activities. We have analysed numerous reports of sports injury statistics and used them to rank a variety of sports according to their degree of injury risk. In addition, we have developed a brief orthopaedic examination and a five-item fitness check that evaluates the level of physical fitness of patients with haemophilia. Using these tools, we can appropriately recommend specific sports activities best suited for each patient. In addition, we recommend that patients who regularly participate in sports maintain adequate levels of clotting factor through the use of regular prophylaxis. With proper physical evaluation and preparation, patients with haemophilia can realize the physical and emotional benefits of participation in sports.