A prospective study of injuries sustained during competitive Muay Thai kickboxing

Alexithymia and Impulsivity in Combat Sports - A Tale of Three Measures

The purpose of this study was to compare the psychometric properties of two measures of alexithymia - the Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ) - as well as the Barratt Impulsiveness Scale 11 measure of behavioural impulsivity because the psychometric properties of these scales have not been established in athletes. As part of a larger study, 298 participants completed an online survey that included the TAS-20, PAQ, and BIS 11, as well personal- (age and gender) and sport-specific (primary combat sport and level of competition) demographic measures. A unidimensional model was retained for the TAS-20. A unidimensional model with the possibility of multidimensional measure was retained for the PAQ, with the viability of a subscale for Generalised Externally Orientated Thinking supported. The only versions of the BIS that were retainable were unidimensional models for the BIS-15 (a 15-item version of the BIS 11) and the BIS-Brief (an 8-item version of the BIS 11). As expected, the measures of alexithymia were highly correlated. The associations between impulsivity and alexithymia as well as age and alexithymia were small in nature, with none these associations moderated by level of gender, level of competition, or primary sport for the participants. No differences in alexithymia or impulsivity according to gender, level of competition, or primary sport were noted for the participants. Implications of these findings for the measures of alexithymia - the TAS-20 and PAQ - and impulsivity - the BIS-15 and BIS-Brief - examined in the present study with athletes (as well as with other populations) are discussed.

Sports-based distribution of facial fractures - findings from a four-season country

OBJECTIVE

The aim of this study was to elucidate the relationship between injury mechanisms and sports-related facial fractures, and to evaluate the changes in incidence rates of facial fractures sustained in sports-related events in a 30-year period.

MATERIAL AND METHODS

This retrospective cohort study included all patients sports-related facial fractures admitted to a tertiary trauma centre during 2013-2018. Specific fracture types, sports, injury mechanisms as well as patient- and injury related variables are presented. The results underwent evaluated statistically with logistic regression analysis.

RESULTS

Facial fractures occurred most frequently while playing ice hockey and football. Unilateral zygomatic-maxillary-orbital and isolated mandibular fractures accounted for 74.2% of all fracture types. In total, 99 patients (46.5%) required surgical intervention for their facial injuries. About 12.7% of patients sustained associated injuries in addition to facial fractures. Overall, the number of sports-related facial fractures has increased during the last three decades mostly due to the surging rates of ice hockey- and football-related facial fractures.

CONCLUSIONS

Sport-related facial fractures have markedly increased in different sports disciplines during the past decades. The use of safety gear to protect the facial area should be enforced particularly in ice hockey.

Effect of Weight Class on Regional Brain Volume, Cognition, and Other Neuropsychiatric Outcomes among Professional Fighters

Traumatic brain injury (TBI) is a common source of functional impairment among athletes, military personnel, and the general population. Professional fighters in both boxing and mixed martial arts (MMA) are at particular risk for repetitive TBI and may provide valuable insight into both the pathophysiology of TBI and its consequences. Currently, effects of fighter weight class on brain volumetrics (regional and total) and functional outcomes are unknown. Fifty-three boxers and 103 MMA fighters participating in the Professional Fighters Brain Health Study (PRBHS) underwent volumetric magnetic resonance imaging (MRI) and neuropsychological testing. Fighters were divided into lightweight (≤139.9 lb), middleweight (140.0–178.5 lb), and heavyweight (>178.5 lb). Compared with lightweight fighters, heavyweights displayed greater yearly reductions in regional brain volume (boxers: bilateral thalami; MMA: left thalamus, right putamen) and functional performance (boxers: processing speed, simple and choice reaction; MMA: Trails A and B tests). Lightweights suffered greater reductions in regional brain volume on a per-fight basis (boxers: left thalamus; MMA: right putamen). Heavyweight fighters bore greater yearly burden of regional brain volume and functional decrements, possibly related to differing fight dynamics and force of strikes in this division. Lightweights demonstrated greater volumetric decrements on a per-fight basis. Although more research is needed, greater per-fight decrements in lightweights may be related to practices of weight-cutting, which may increase vulnerability to neurodegeneration post-TBI. Observed decrements associated with weight class may result in progressive impairments in fighter performance, suggesting interventions mitigating the burden of TBI in professional fighters may both improve brain health and increase professional longevity.

Exploring the use of mouth guards in Muay Thai: a questionnaire survey

Objective

To identify Muay Thai participants' attitudes towards use of mouth guards and their experiences of dental trauma.

Materials and methods

An online cross-sectional survey was used to record Muay Thai participants' experiences and opinions regarding use of mouth guards. Participants were recruited from a Muay Thai gym in the north east of England.

Results

92 respondents took part in the survey. 3% reported having never worn a mouth guard, whereas 61% reported routinely wearing mouth guards during a fight. Significantly more (73%) younger participants (18-29 years) reported wearing mouth guards during fights compared to those aged 30 years and older (50%) (p < 0.05). Mouth-formed ('boil and bite') were the most frequently used type of mouth guard (60% of users), followed by custom-made mouth guards provided by a dentist (32%). Factors such as protection, breathing, good fit and comfort were all considered important in the choice of mouth guard. 14% of respondents had experienced dental injuries, with chipped/broken teeth being the most common.

Conclusion

Given the risk for dental trauma in Muay Thai, it is important that participants are advised regarding mouth guard use, particularly those that do not routinely wear them.

Injury survey in Choi Kwang Do (CKD) martial art practitioners around the world: CKD is a safe form of training for adults

Among the many sports and activities to choose from, martial arts are becoming increasingly popular for health and fitness. Due to the different nature of the various styles of martial arts, injuries are not uncommon. Though there have been studies on the injury rates of several martial art styles, there have been none regarding Choi Kwang Do (CKD), a noncompetitive martial art with relaxed and fluid movements designed to promote health and fitness for people of all ages. The purpose of this study was to examine the rate of injury for adults training in CKD to find out whether this is a safe style of martial art for adults. This study found the prevalence, causes, severity, and types of injuries from CKD practitioners around the world through an online survey targeting adults (n=122), aged 18 or older, with varying years of training experience. The annual rate of injury was 11.73 for every 100 CKD practitioners. There was no correlation between the length of training experience and injury. Training frequency and duration had no significant relationship with injury rates. A significant positive relationship between training intensity and injury existed (P=0.009). The results of the study found that CKD can be an attractive option for adults of any age who are looking to learn a martial art or choose a physical activity with a low risk of injury, however the training intensity should be kept at a level that is not excessively high.

Kickboxing review: anthropometric, psychophysiological and activity profiles and injury epidemiology

Kickboxing is one of the modern combat sports. The psychophysiological demands of a kickboxing competition require athletes to achieve high thresholds of several aspects of physical fitness. The aim of the current review is to critically analyse and appraise the kickboxer’s anthropometric, physiological, physical and psychological attributes with the activity profile and injury epidemiology in order to provide practical recommendations for training as well as new areas of scientific research. The available information shows that both amateur and elite-level male kickboxers are characterized by a higher proportion of mesomorphy with a well-developed muscle mass and low body fat percentage. While there is some variation in the maximum oxygen uptake of kickboxers, moderate to high cardio-respiratory levels are reported for these athletes. Regardless of kickboxers’ level, a high peak and mean anaerobic power output were reported. High-level kickboxing performance also requires well-developed muscle power in both the upper and lower limbs. Psychological factors contribute to success that requires high levels of self-confidence, motivation, dispositional hope and optimism, mental toughness/resiliency, and adaptive perfectionism. Psychological attributes also distinguished successful from less successful kickboxers. The activity-to-rest ratio was higher in elite (1:1) than both amateur and national-level (from 1:2 to 1:5) kickboxers, with no significant differences between rounds (round 1=1:4, and rounds 2 and 3=1:5) as well as between winners and losers in amateur and national-level simulated combats. These particular psychophysiological characteristics and performance aspects of kickboxers influence performance and could serve as guidance for training. Finally, kickboxing is characterized by chronic repetitive head trauma, which causes hypopituitarism due to traumatic brain injury (TBI). Future investigations into the physical, physiological and psychological characteristics related to age, gender and competitive levels of kickboxers are required to enrich the current knowledge and to help create the most suitable training programme.

Epidemiology of Muay Thai fight-related injuries

Background

Muay Thai is a combat sport of Thailand that uses stand-up striking along with various clinching techniques. Currently, little is known about the injuries and risk factors for injuries among Muay Thai fighters. Gaining more insight into the nature and frequency of injury in this sport provides part of the overall sports injury picture, within the larger burden of injury as a public health issue. Generating this information is a critical first step toward the broader goal of improving the health and safety of Muay Thai fighters engaged in competition.

Methods

This study is based upon a survey of 195 Muay Thai fighters. Participants were asked to complete a retrospective web survey on fight-related injuries. Regression analyses were conducted to determine whether injuries during sanctioned fights were related to factors such as fight experience, use of protective equipment, and injury history.

Results

Participants were aged 18 to 47 years old (median 26), predominantly male (85.9%), and white (72.3%). Respondents were professional (n = 96, 49.2%) and amateur (n = 99, 50.8%). Fighters reported a mean fight experience of 15.8 fights. Of the 195 respondents, 108 (55.4%) reported sustaining an injury during the most recent fight. The primary body region injured was the extremities (58%) versus the head, with a lower amount of self-reported concussions (5.4%). Nearly 2/3 (66.7%) of all injured fighters reported that the injury did not interfere with the bout outcome. Nearly 25% reported they missed no training time as a result of the injury. Injuries were related to professional fighter status (OR = 2.5, 95% CI = 1.4–4.5), fight experience (OR = 2.7, 95% CI = 1.5–4.9), weight class (OR = 0.923 heavy versus light, 95% CI = .86–.99), age (OR = 0.90 > 26 versus ≤26, 95% CI = .85–.95), use of protective equipment (OR = .46, 95% CI = .26–.82) and previous injury (OR = 1.81, 95% CI = .98–3.3). Lighter, younger, and more experienced fighters were at increased odds for injury within this sample.

Conclusions

We identified a preliminary fight-related injury rate and identified fighter characteristics (experience level, protection level, and previous injury) associated with increased odds for fight-related injury outcome. While rigorous research into causality is required, these data provide plausible information that may be used to reduce injury outcomes among fighters.

Youth Participation and Injury Risk in Martial Arts

The martial arts can provide children and adolescents with vigorous levels of physical exercise that can improve overall physical fitness. The various types of martial arts encompass noncontact basic forms and techniques that may have a lower relative risk of injury. Contact-based sparring with competitive training and bouts have a higher risk of injury. This clinical report describes important techniques and movement patterns in several types of martial arts and reviews frequently reported injuries encountered in each discipline, with focused discussions of higher risk activities. Some of these higher risk activities include blows to the head and choking or submission movements that may cause concussions or significant head injuries. The roles of rule changes, documented benefits of protective equipment, and changes in training recommendations in attempts to reduce injury are critically assessed. This information is intended to help pediatric health care providers counsel patients and families in encouraging safe participation in martial arts.

Injuries Sustained by the Mixed Martial Arts Athlete

Context:

Mixed martial arts (MMA) is rapidly growing in popularity in the United States and abroad. This combat sport joins athletes from a wide variety of martial art disciplines, each with characteristic and distinguishing injury profiles, together in competition. Because of increasing participation by professionals and amateurs alike, injuries sustained by MMA athletes have been on the rise.

Evidence Acquisition:

A review of relevant publications using the search term mixed martial arts and each of its component combat sports (eg, Muay Thai, Brazilian jiu-jitsu) from 1980 through 2015 was completed using PubMed and Google Scholar.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

The majority of studies on MMA injuries evaluate those sustained during competition, which range in incidence from 22.9 to 28.6 per 100 fight-participations. Striking-predominant disciplines such as boxing, karate, and Muay Thai have high rates of head and facial injuries, whereas submission-predominant disciplines such as Brazilian jiu-jitsu, judo, and wrestling have high rates of joint injuries.

Conclusion:

Numerous studies have evaluated injuries in athletes who participate in MMA and its component disciplines during competition but much remains to be discovered about injuries sustained during training and in specific patient populations such as adolescents and women.

Injuries to Professional and Amateur Kickboxing Contestants: A 15-Year Retrospective Cohort Study

Background:

Kickboxing is a group of full-contact combat sports that allows both kicking and punching from a standing position. Despite its popularity, there is a scarcity of published data elucidating the injury epidemiology in kickboxing.

Purpose:

To determine the injury incidence, describe the injury pattern, and identify potential risk factors for injury in kickboxing.

Study Design:

Descriptive epidemiology study.

Methods:

Data describing fight outcomes and injuries sustained during professional and amateur kickboxing contests over a 15-year period were obtained from the official records of the Nevada Athletic Commission, United States. Injury incidence rates and rate ratios were calculated with 95% confidence intervals (95% CIs) per 1000 athlete-exposures (AEs) and per 1000 minutes of exposure. The injury pattern was described using frequencies and proportions of injuries by anatomic region and type of injury. In addition, Poisson mixed-effects generalized linear modeling was used to examine the multivariate relationships between injury incidence rates and potential risk factors.

Results:

The sample consisted of 481 unique fighters competing across 57 events, 976 AEs, 9562 minutes of exposure, and 380 injuries. The mean ± SD age of the fighters was 29.0 ± 5.3 years (range, 15-48 years). The overall injury incidence rates were 390.1 injuries (95% CI, 351.9-431.4) per 1000 AEs and 39.7 injuries (95% CI, 35.8-43.9) per 1000 minutes of exposure. The most commonly injured anatomic regions were the head (57.8%) and lower extremity (26.1%), while the most common types of injury were laceration (70.6%) and fracture (20.6%). Professional fighters were 2.5 times more likely to get injured compared with amateurs (rate ratio, 2.51; 95% CI, 1.39-4.55), while defeated fighters were 3.5 times more likely to get injured compared with winners (rate ratio, 3.48; 95% CI, 2.73-4.44).

Conclusion:

Injuries are frequent and often significant in kickboxing, and better injury surveillance is strongly recommended. The scarcity of good-quality epidemiological data in kickboxing, especially pertaining to the severity of injuries, underscores the urgent need for further research, whereupon evidence-informed sport safety and injury prevention policies can be developed.

Mandibular fracture with a mouth formed mouthguard in kickboxing

Reports of injuries caused by kickboxing, one of the contact sports that potentially causes a large number of injuries, are relatively rare. Wearing a mouthguard is obligatory in kickboxing, but the association between maxillofacial injuries and the quality of mouthguards has not been described thus far. In this article, we present a case of mandibular fracture in a 25-year-old male, who was injured during kickboxing despite wearing a mouth formed mouthguard.

Martial arts sports medicine: current issues and competition event coverage

More sports medicine professionals are becoming actively involved in the care of the martial arts athlete. Although there are many different forms of martial arts practiced worldwide, certain styles have shown a potential for increased participation in competitive-type events. Further research is needed to better understand the prevalence and profiles of injuries sustained in martial arts full-contact competitive events. Breaking down the martial art techniques into basic concepts of striking, grappling, and submission maneuvers, including choking and joint locking, may facilitate better understanding and management of injuries. This article outlines this approach and reviews the commonly encountered injuries and problems during martial arts full-contact competitions.

The Martial Arts

Given the increasing popularity of the martial arts, it is likely that physicians in all specialties encounter patients who participate. From pediatric patients, to geriatric patients, to those living with various disabilities, the martial arts may offer physical, psychologic, and therapeutic benefits. An appreciation of the physical demands of the martial arts is crucial to understanding the pathogenesis of injury as well as to planning treatment and prevention strategies and to determining safe return to participation after injury.

No holds barred sport fighting: a 10 year review of mixed martial arts competition

OBJECTIVE

To identify the most salient medical issues that may be associated with mixed martial arts competition by determining the types and proportions of match stoppages.

METHODS

Publicly available video footage of 1284 men competing in 642 consecutive televised matches from November 1993 to November 2003 was reviewed to determine the reasons for which matches were stopped. Matches were sanctioned by either a United States or Japan based mixed martial arts organisation.

RESULTS

Of the 642 matches, 182 (28.3+/-3.4%) were stopped because of head impact, 106 (16.5+/-2.9%) because of musculoskeletal stress, 91 (14.1+/-2.7%) because of neck choke, 83 (12.9+/-2.6%) because of miscellaneous trauma, 173 (27.0+/-3.4%) because of expiration of match time, and seven (1.0+/-0.8%) because of disqualification, where the values in parentheses are percentages+/-95% confidence interval.

CONCLUSIONS

Blunt force to the head resulted in the highest proportion of match stoppages. Further research is warranted to delineate the morbidity associated with participation in mixed martial arts.