Injury rates during the 1988 US Olympic Team Trials for taekwondo

Taekwondo Athlete's Bilateral Achilles Tendon Rupture: A Case Report

(1) Background: Achilles tendon rupture is a common sports injury that may result in severe disability. The overall incidence of Achilles tendon rupture is increasing as a result of growing sports participation. However, cases of spontaneous bilateral Achilles tendon rupture with no underlying disease or risk factors, such as systemic inflammatory disease, steroid or (fluoro)quinolone antibiotics use, are rare. (2) Objective: Here, we report a case of a Taekwondo athlete's bilateral Achilles tendon rupture after kicking and landing. By sharing the experience of treatment and the patient's course, we suggest one of the possible treatment options and the need to establish a treatment method. (3) Procedure: A 23-year-old male Taekwondo athlete visited the hospital, presenting foot plantar flexion failure and severe pain in both tarsal joints, which had occurred upon kicking and landing on both feet earlier that day. During surgery, no degenerative changes or denaturation were observed in the ruptured areas of the Achilles tendons. Bilateral surgery was performed using the modified Bunnel method on the right side and minimum-section suturing on the left side was performed using the Achillon system, followed by lower limb casting. (4) Result: Good outcomes were observed on both sides at 19 months postoperatively. (5) Conclusion: The possibility of bilateral Achilles tendon rupture during exercise in young subjects with no risk factors should be acknowledged, especially in association with landing. In addition, in athletes, even if there is a possibility of complications, surgical treatment should be considered for functional recovery.

Rotational and linear head accelerations from taekwondo kicks and punches

The purpose was to compare rotational and linear head accelerations as a result of taekwondo kicks and punches. Taekwondo athletes executed five repetitions of the turning kick, spinning hook kick, hook punch, straight punch, and jab punch to a Hybrid III Crash Test Dummy head-neck complex. A tri-axial accelerometer and an angular rate sensor were mounted inside the Hybrid III head to measure resultant linear (RLA) and rotational accelerations. The Hybrid III was fixed to a height-adjustable frame and fitted with protective taekwondo headgear. Dummy head height was positioned to each participant's standing height. Acceleration data were processed in accordance with SAE J211-1.There was no significant multivariate difference in RLA but the effect was not clear. Univariate follow-up analysis showed a significant difference in RLA but the effect was also not clear. There was no difference in rotational acceleration. The highest RLA and rotational acceleration were produced, in order, by the turning kick, hook kick, hook punch, straight punch, and jab. These data are clinically important as they provide a better understanding of the biomechanical injury measures and support for improved headgear testing methodology.

Injuries in taekwando: systematic review

OBJECTIVES

Assess rates/1000athletic encounters(AE) in Taekwondo of injuries/age/gender/type/location.

METHODS

Searches in 17 electronic, 7 grey-literature databases. Two researchers independently assessed Abstracts/titles and abstracted data. Risk-of-bias assessed with Newcastle-Ottawa scale. Rates/1000AE computed, weighted by study sizes.

RESULTS

Eighteen studies included 3 Olympic, 4 world, 1 European, 13 national, 10 provincial and one national school competition. Seventeen studies provided an injury definition and recorded injuries on forms. Rates are average rate/1000AE, weighted by study size. For ten studies which provided rates by gender, rate for males(n = 9,286) was 58/1000AE and females(n = 3,720) 52.7/1000AE. For six studies which provided data on injuries/1000minutes/exposure by gender rate for males(n = 6,885) was 10.7/1000minutes/exposure and for females(n = 2,539) 10.4. For two studies which provided data by age and gender, rate for males 11-13 years(n = 949) was 29.6, 14-17(n = 512) 53.1 and ≥18(n = 711) 40.7, and for females 11-13 years(n = 472) 30.5, 14-17(n = 338) 72 and ≥18(n = 240) 37.5. For eight studies which provided injury location rates by gender rate for all ages for males(n = 5,856) for head/neck injuries was 13.3, torso 4.2, upper-extremity 9.4 and lower-extremity 21.7 and females(n = 2,126) for head/neck injuries was 14.2, torso 3.1, upper-extremity 7.3 and lower-extremity 26.6. For nine studies which provided injury type rates by gender, rate for all ages for males(n = 7,509) for abrasions/contusions/lacerations was 37.5, for sprains/strains 10.3 and fractures 5.9, and for females(n = 2,852) for abrasions/contusions/lacerations 27.9, for sprains/strains 8.7 and fractures 3.8. For concussions for eight studies for males(n = 9,078) rate was 13.3 and females(n = 3628) 11.4. The majority of injuries occurred to the lower extremities, and in defence (61%).

CONCLUSIONS

There are published data on 20,210 Taekweondo competitors. Only 8/18 studies reported prior injuries. Longitudinal studies are needed of injuries, ascertainment of causes, identify participants with higher rates, measure the results of preventive measures, rule change to exclude head kicks, and encourage non-contact Taekwondo especially for participants with high injury rates.

Rupture of the Extensor Hallucis Longus Muscle Secondary to Repetitive Overuse in a Taekwondo AthleteA Case Report

Closed rupture of the extensor hallucis longus (EHL) tendon is rare, with most cases caused by either direct penetrating trauma or predisposing factors such as corticosteroid injection and iatrogenic trauma incidences. Almost all of the previous case reports have reported on rupture of the EHL tendon rather than the EHL muscle. In this report, we highlight an unusual clinical presentation of a rupture of the EHL muscle and discuss its predisposing factors. This patient was a taekwondo athlete with EHL muscle rupture secondary to repetitive overuse without any underlying systemic or local predisposing factors or direct trauma. Fifteen months after successful surgical treatment, he became fully functional again as an elite taekwondo athlete.

Analysis of Injuries and Risk Factors in Taekwondo during the 2014 Italian University Championship

Purpose  This study aims to analyze the risk factors and type of injuries occurring in Taekwondo athletes participating in a national competition.

Methods  Out of the 127 competitors, 18 athletes got injured during a Taekwondo championship who were analyzed for the following parameters: modality of training; age, weight; belt color; and the type of injury.

Results  Around 89% of the injuries were due to bruising and were found mainly on the lower limbs (61%) during the elimination rounds and during the first match of the day. The higher probability of injury was in the second round (56%), and during the first match of the day (72%). Nearly all the athletes were able to complete the game in which they were injured (83%). Comparing the average age of the athletes suffering an injury (23.6 ± 2.06 years) with their average years of training (8.4 ± 7.05 years) it can be noted that these athletes began this discipline rather late. The more is the training age and the weekly hours of training, the more are the numbers of matches completed, even as injured. Beginners with a low-level belt suffered more injuries than the experienced subjects did.

Conclusion  The following risk factors for injury were found: starting to practice in late age, weekly training sessions with a few number of hours, male sex, low-level belt, elimination rounds, the first match of the day, and second round.

Level of Evidence  Level III, observational analytic study without a control group.

Neurologic Health in Combat Sports

Neurologic injuries of both an acute and chronic nature have been reported in the literature for various combat sport styles; however, reports of the incidence and prevalence of these injury types vary greatly. Combat sports clinicians must continue to strive for the development, implementation, and enforcement of uniform minimum requirements for brain safety. These health care providers must also seize on the honor to provide this oft-underserved population with the health care advocacy they very much deserve, but often do not receive.

Resultant linear acceleration of an instrumented head form does not differ between junior and collegiate taekwondo athletes' kicks

OBJECTIVE

The purpose of this study was to compare the effects of various taekwondo kicks and age (school level) in absolute terms and relative body mass on the resultant linear acceleration (RLA) of an instrumented head form.

METHODS

Forty-eight male (middle school: 16; high school: 16; university: 16) taekwondo athletes were recruited for this study. Subjects performed 10 turning, 10 jump spinning hook, and 10 jump back kicks on a Hybrid II head mounted on a height-adjustable frame.

RESULTS

A 2-way (School × Kick) MANOVA was used to determine the differences in RLA between schools (age groups) by type of kick. There was no univariate School main effect for absolute RLA (η ² = 0.06) and RLA relative to body mass (η ² = 0.06). No univariate Kick main effects were found for absolute (η ² = 0.06) and relative RLA (η ² = 0.06).

CONCLUSION

It is of concern that RLA did not significantly differ between school levels, implying that young taekwondo athletes generate similar forces to their adult counterparts, possibly exposing young athletes to an increased risk for head injuries.

The relationship between Taekwondo training habits and injury: a survey of a collegiate Taekwondo population

Objective

To correlate training habits of Taekwondo (TKD) athletes to risk for injury.

Background

TKD is a Korean marital art that has been growing in popularity, with nearly 2 million individuals practicing the sport in the United States. Because of the combative nature of the sport, injuries are an inherent risk. However, data on proper training habits, types of injuries sustained during training, and recommendations for athletes to avoid injury are lacking. Frequently, studies of TKD evaluate athletes’ injuries during tournaments, but most do not evaluate athletes in training.

Hypothesis

Increased training would potentially create more injuries secondary to increased exposure.

Methods

This is a cross-sectional observational survey of 72 collegiate TKD athletes from the Pacific West Sanctioned Taekwondo Tournaments in the 2008–2009 season. Variables analyzed during training and competitions were training sessions per week, workout habits, belt level, years of experience, and characteristics of injury (location, type, mechanism, situation, treatment, and days missed).

Results

TKD training habits of individuals who practiced four or more times per week (odds ratio [OR], 4.5; P=0.005) or sparred for more than 2 hours (OR, 8.7; P=0.003) were associated with significantly increased odds (risk) of sustaining an injury. Those who had more than 3 years of tournament experience were more likely to sustain an injury (OR, 0.198; P=0.020).

Conclusion

Increased risk for injury with more frequent practice and longer sparring should remind coaches and trainers that monitoring and adjusting the athletes’ training schedules and exposure time could decrease the chance of injury. An athlete that has spent more years in tournaments along with high-frequency and long-duration training was associated with greater risk for injuries. Prevention and education about the risk for exposure to injury may may help athletes and trainers promote prevention strategies and adjust an athletes’ training and tournament schedules to decrease the risk for injury.

Assessment of Injuries During Brazilian Jiu-Jitsu Competition

Background:

Brazilian jiu-jitsu (BJJ) is a unique style of martial arts with rapid growth in the United States and internationally. Although studies have examined injuries in other martial arts and combat sports, to date, no published medical study has examined injuries in BJJ competitions.

Purpose:

(1) To estimate the incidence of injuries in BJJ competitions and (2) to identify and describe the types and mechanisms of injuries associated with competitive BJJ.

Study Design:

Descriptive epidemiology study.

Methods:

Injury data were obtained from records of on-site medical coverage at 8 statewide BJJ tournaments in Hawaii, USA, between 2005 and 2011.

Results:

The identified injury incidence on the day of matches was 9.2 per 1000 exposures (46 injuries out of 5022 exposures, ie, match participations). Orthopaedic injuries were the most common and accounted for 78% of all injuries (n = 36), followed by costochondral or rib injuries (n = 7) and lacerations requiring medical care (n = 3). The elbow was found to be the joint most commonly injured during BJJ competitions, with the arm bar being the most common mechanism. We propose that this BJJ-specific injury mechanism, the “arm bar,” be recognized as another mechanism of hyperextension injury to the elbow in sports.

Conclusion:

Comparison of the BJJ injury data with injury data reported for judo, taekwondo, wrestling, and mixed martial arts showed that BJJ competitors were at substantially lower risk of injury compared with these other sports. With orthopaedic injuries being most common and the elbow being the area most vulnerable to injury in BJJ, it is important that participants, referees, and physicians be properly educated about the unique mechanisms of injury that can occur, particularly to the elbow.

Epidemiology of injuries in elite taekwondo athletes: two Olympic periods cross-sectional retrospective study

OBJECTIVE

Taekwondo injuries differ according to the characteristics of the athletes and the competition. This analytical cross-sectional retrospective cohort study aimed to describe reported taekwondo injuries and to determine the prevalence, characteristics and possible risk factors for injuries sustained by athletes of the Spanish national team. In addition, we compared each identified risk factor-age, weight category, annual quarter, injury timing and competition difficulty level-with its relation to injury location and type.

SETTINGS

Injury occurrences in taekwondo athletes of the Spanish national team during two Olympic periods at the High Performance Centre in Barcelona were analysed.

PARTICIPANTS

48 taekwondo athletes (22 male, 26 female; age range 15-31 years) were studied; 1678 injury episodes occurred. Inclusion criteria were: (1) having trained with the national taekwondo group for a minimum of one sports season; (2) being a member of the Spanish national team.

RESULTS

Independently of sex or Olympic period, the anatomical sites with most injury episodes were knee (21.3%), foot (17.0%), ankle (12.2%), thigh (11.4%) and lower leg (8.8%). Contusions (29.3%) and cartilage (17.6%) and joint (15.7%) injuries were the prevalent types of injury. Chronological age, weight category and annual quarter can be considered risk factors for sustaining injuries in male and female elite taekwondists according to their location and type (p≤0.001).

CONCLUSIONS

This study provides epidemiological information that will help to inform future injury surveillance studies and the development of prevention strategies and recommendations to reduce the number of injuries in taekwondo competition.

Biomechanics of head injury in olympic taekwondo and boxing

Objective

The purpose was to examine differences between taekwondo kicks and boxing punches in resultant linear head acceleration (RLA), head injury criterion (HIC15), peak head velocity, and peak foot and fist velocities. Data from two existing publications on boxing punches and taekwondo kicks were compared.

Methods

For taekwondo head impacts a Hybrid II Crash Dummy (Hybrid II) head was instrumented with a tri-axial accelerometer mounted inside the Hybrid II head. The Hybrid II was fixed to a height-adjustable frame and fitted with a protective taekwondo helmet. For boxing testing, a Hybrid III Crash Dummy head was instrumented with an array of tri-axial accelerometers mounted at the head centre of gravity.

Results

Differences in RLA between the roundhouse kick (130.11±51.67 g) and hook punch (71.23±32.19 g, d = 1.39) and in HIC15 (clench axe kick: 162.63±104.10; uppercut: 24.10±12.54, d = 2.29) were observed.

Conclusions

Taekwondo kicks demonstrated significantly larger magnitudes than boxing punches for both RLA and HIC.

Injury rates in Iranian taekwondo athletes; a prospective study

Purpose

Taekwondo, as the most popular martial art among Iranian sportsmen, might lead to injury for the athletes of this sport during competitions. We decided to report the incidence rate of injuries sustained by the athletes of this sport during national competitions.

Methods

All competitions of Iran national championship taekwondo league in 2006-2007 with 204 athletes were observed prospectively to detect the occurrence of injuries. The severity of injuries was classified into four groups (mild, moderate, severe, and critical) according to the involvement of medical care team in the contest, ability of the athletes to resume and duration of probable absence of injured athletes from future competitions and training sessions. Athlete-Exposure (A-E) was defined as the number of competitions multiplied by two. On this base, the rate of injury incidence per 1000 A-Es, the rate of injuries per time unit and the rate of injury occurred for each 100 athletes were considered as the major outcomes of this study.

Results

Of totally 1,338 A-Es, 93 injuries were recorded during the competitions. The rate of injury incidence was found to be 69.5 injuries per 1000 A-Es and the rate of injuries per minute of competitions was 0.023 which corresponded to 23.3 injuries per 1000 minutes of competitions. 45.6 injuries were occurred for each 100 athletes during the course of competitions. The most frequent injuries were mild (68.8%) and critical injuries (24.7%), followed by moderate and severe injuries; 4.3% and 2.1%, respectively.

Conclusion

The rate of injury we found was lower than that of western countries. In spite of finding the lower limbs as the most frequent place of injuries in other studies, we found the upper limbs as the most predisposed place of injuries which might be due to difference in the method of combat of Iranian athletes with other athletes.

The attenuation of strike acceleration with the use of safety equipment in tae kwon do

Purpose

The objectives of this study include: (1) Determination of the attenuation of strike acceleration that Tae Kwon Do sparring safety pads provide from kicks from Olympic style TKD fighters, (2) The sex and weight differentiation in acceleration achieved within the thorax model with the roundhouse kicks.

Methods

This prospective, observational study utilized 15 Olympic style fighters from an “elite” team kicking a water core heavy bag thorax model with roundhouse kicks. The model was fitted with a tri-axial accelerometer (GCDC, model X250-2) to measure g acceleration from strikes to the bag. The bag was kicked in three, 10 kick phases by all subjects: kicks without padding; kicks with hogu on heavy bag, and kicks with hogu and instep guards on feet. The g acceleration readings were recorded in all phases.

Results

Kolmogorov-Smirnov failed for all variables. There were 8 female subjects: median age 14 years, median weight 53.4 kg and 7 male subjects: median age 17 years, median weight 70.45 kg. The ANOVA on ranks of the acceleration from kicks against the bag achieved significance, P=0.001. Spearman rank order correlation between the weights of players and acceleration of strike against the hogu without and with insteps pads was significant, P=0.035/r=0.54 and P=0.018/r=0.59, respectively.

Conclusion

Heavier and male subjects tend to produce more force in strikes. Protective chest guard reduces acceleration to the thorax model, but the utility of instep guards is questionable.

Characteristics of martial art injuries in a defined Canadian population: a descriptive epidemiological study

BACKGROUND

The martial arts have emerged as common activities in the Canadian population, yet few studies have investigated the occurrence of associated injuries on a population basis.

METHODS

We performed such an investigation and suggest potential opportunities for prevention. The data source was 14 years (1993 to 2006) of records from the Kingston sites of the Canadian Hospital Injury Reporting and Prevention Program (CHIRPP).

RESULTS

920 cases were identified. Incidence rates were initially estimated using census data as denominators. We then imputed annual injury rates per 10000 using a range of published estimates of martial arts participation available from a national survey. Rates of injury in males and females were 2300 and 1033 per 10000 (0.3% participation) and 575 and 258 per 10000 (1.2% participation). Injuries were most frequently reported in karate (33%) and taekwondo (14%). The most common mechanisms of injury were falls, throws and jumps (33%). Fractures (20%) were the most frequently reported type of injury and the lower limb was the most common site of injury (41%).

CONCLUSIONS

Results provide a foundation for potential interventions with a focus on falls, the use of weapons, participation in tournaments, as well as head and neck trauma.

Chiropractic utilization in BMX athletes at the UCI World Championships: a retrospective study

OBJECTIVE

To examine paramedical (chiropractic, physiotherapy and massage therapy) utilization among high-level BMX athletes following sport-related injury at the 2007 UCI World Championships.

METHODS

Retrospective analysis was conducted on a dataset from international male and female BMX athletes (n = 110) who sustained injury in training and competition at the 2007 BMX World Championships.

RESULTS

Fifty percent of individuals aged 8-17 presented to a chiropractor versus 32% to physiotherapists and 18% to massage therapists. There was a significant difference in paramedical practitioner choice when comparing the sample across the different locations of injury. Specifically, the proportion of individuals presenting for treatment to chiropractors (84%) was much higher than to physiotherapists/massage therapists (16%) for spine or torso complaints.

CONCLUSION

Utilization of chiropractors by BMX athletes may be higher than utilization of other paramedical professionals as suggested by this study. Chiropractors appear to be the paramedical practitioner of choice in regards to spine and torso related complaints.

An addendum to injury rates in Iranian taekwondo athletes; a prospective study

PURPOSE

The objective of this study was to compare the Iranian taekwondo-in statistically in terms of total injury rates to international counterparts as gleaned from the extant literature.

METHODS

The Iranian sample consisted of 204 male taekwondo-in participating in the national championship. The international sample included the participants in national and international tournaments. Validated standard questionnaires were employed at all tournaments to collect injury data that were always diagnosed by the respective tournament physicians. An injury was defined as any circumstance for which assistance was sought from the medical personnel. In addition to injury rates, 95% confidence intervals (CIs) around the rates were computed. To assess which group was at higher risk, odds ratios were calculated, including the 95%CIs.

RESULTS

Compared to Greek counterparts, the injury rate for the Iranian taekwondo-in was statistically significantly higher. The Iranians were also at a higher risk to incur an injury: OR = 11.2 (95%CI: 6.60-18.88, P<0.001, CLR = 2.86). When comparing the Iranian taekwondo-in to their colleagues competing at the 1999 World Championships, the former recorded a statistically significantly lower injury rate but the latter were not at a higher risk (OR = 0.61, 95%CI: 0.41-0.91, P=0.014, CLR = 2.20).

CONCLUSION

A statistical comparison of total injury rates in Iranian and international taekwondo-in revealed no difference between the two groups. However, what is of concern is that the total injury rate across taekwondo studies is significantly higher than those reported for American football.

Nine year longitudinal retrospective study of Taekwondo injuries

This retrospective longitudinal study aims to describe reported Taekwondo injuries and to examine associations between competitor experience level, age and gender, and the type, location, and mechanism of injury sustained. Additionally, we examined whether recent rule changes concerning increased point value of head shots in adult Taekwondo competition had affected injury incidence.This study was a summation of 9 years of data of competition injury reports, which included 904 injury reports spanning 58 individual competitions. The data was collected on standardized injury reports at time of injury during competition. Care was provided to the athletes, but the type of care provided was not included in the study. Participants included athletes injured during competition who sought care by the health care team, and for whom an injury report was filled out. The data analysis was performed at the Canadian Memorial Chiropractic College.The three most common locations of presenting injury were the head (19%), foot (16%), and thigh (9%). The most common mechanism of presenting injury was found to be a defensive kick (44%), followed by an offensive kick (35%). The most commonly diagnosed injuries were contusions (36%), sprains (19%), and strains (15%). Coloured belts had a higher incidence of contusions, while black belts sustained more joint irritation injuries. Black belts were more likely to suffer multiple injuries. Colored belts suffered more injuries while receiving a kick, while black belts had a larger influence of past history of injury. We found no significant difference in location or type of injury when comparing pre versus post rule change. The most common locations of injury are head, foot, and thigh respectively, and are areas for concern when considering preventative measures. Colour belt competitors are more likely to sustain contusions, which the authors believe is due to more aggressive tactics and lack of control. Those more likely to be injured tend to be younger than 18 years. Recent rule changes have no significant effect on head injuries.

Measurement and comparison of taekwondo and yongmudo turning kick impact force for two target heights

The primary purpose of this research was to compare the impact characteristics of Taekwondo (TKD) and Yongmudo (YMD) player's turning kick according to the target height. 5 highly skilled YMD and 5 TKD players participated in this study. To measure the impact force, two accelerometers were fixed to a PVC pipe in a sandbag. Each participant performed 10 turning kicks trunk and face height in random order. Only the trial with the most accurate (most central impact) measurement was used in the statistical analysis (p < 0.05).There was a significant difference for impact force according to the target height approximately 6400 ± 898 N, 6393 ± 1382 N for the mid section and 5419 ± 659 N, 5475 ± 1293 N for the high section of TKD and YMD groups, but not between groups. The swing phase for the TKD group was significantly shorter than the YMD group's. The TKD groups' recovery phase of the trunk height turning kick was significantly shorter. There was a difference in the players' center of mass (COM) movement as the TKD players' moved significantly more forward, suggesting that the TKD players tended to slide towards the target during the execution of the kick. In conclusion, as the turning kick was performed quicker by the TKD players with a similar impact force and more forward motion, it is evaluated to be a better technique of turning kicking. Key PointsThis impact force measuring device had a significantly smaller standard deviation then that of impact force measuring devices.There was a significant difference between the impact forces according to the height approximately 6400 ± 898N, 6393 ± 1382N for the mid section and 5419 ± 659N, 5475 ± 1293N for the high section of TKD and YMD groups.The turning kick was performed quicker by the TKD players with a similar impact force and more forward motion.

Extensor hallucis longus tendon injury in taekwondo athletes

OBJECTIVES

Extensor hallucis longus (EHL) tendon injuries can occur in taekwondo athletes when performing hyperplantarflexed barefoot kicking exercises. A state of full excursion of the extensor tendon is used to strike opponents in which the metatarsal bone and the proximal phalanx area is in contact with the opponent. The purpose of this study is to examine the incidence of extensor hallucis longus tendon injury in taekwondo athletes.

DESIGN

Case-control study.

PARTICIPANTS

50 Athletes from the Korean taekwondo national team and a control group of 50 healthy subjects.

MAIN OUTCOME MEASURES

History of sports participation, the American Orthopaedic Foot and Ankle Society (AOFAS) score and ultrasound imaging of the EHL.

RESULTS

Difference in the AOFAS scores were noted with the control group at 92.95+/-9.18, and the experimental group score at 88.45+/-10.93 (p<0.01). Only one person (one tendon) from the control group demonstrated changes on sonography (2%), whilst 10 subjects from the taekwondo group displayed changes in 16 tendons (20%). EHL thickness of the experimental group (1.52+/-0.16 mm) was greater and the control group (1.46+/-0.11 mm) (p<0.01).

CONCLUSION

Taekwondo athletes have a higher incidence of changes on sonographic imaging of the EHL compared to non-taekwando participating healthy subjects.

Neurologic injuries in boxing and other combat sports

Many sports have neurologic injury from incidental head contact; however, combat sports allow head contact, and a potential exists for acute and chronic neurologic injuries. Although each combat sport differs in which regions of the body can be used for contact, they are similar in competitor exposure time. Their acute injury rates are similar; thus their injuries can appropriately be considered together. Injuries of all types occur in combat sports, with injuries in between one fifth to one half of all fights in boxing, karate, and tae kwon do. Most boxing injuries are to the head and neck region. In other combat sports, the head and neck region are the second (after the lower limbs) or the first most common injury site.

Varus instability of the hallux interphalangeal joint in a taekwondo athlete

The hallux interphalangeal joint is stable in the transverse plane and there have been only a few reports of varus instability of this joint. A case is described of varus subluxation of the hallux interphalangeal joint in a taekwondo athlete and the surgical outcome after reconstruction of the collateral ligament. Taekwondo athletes, who require fast powerful kicks, should be warned about this type of forefoot injury.

Epidemiology of injuries in competition taekwondo: a meta-analysis of observational studies

This paper aims to review and collate the epidemiological data of injuries in competition taekwondo as reported in the literature, make recommendations, and suggest further research. The electronic databases AMED, AusportMed, CINAHL, MEDLINE, PubMed, and SPORTDiscus were searched from inception to March 2008. Fourteen prospective cohort studies reporting the incidence of injuries in taekwondo were included. Two reviewers independently extracted data and assessed trial quality using the STROBE statement. Homogenous studies were combined in a pooled analysis using a Poisson random effects regression model. Poisson regression showed an overall mean injury rate of 79.3 per 1000 athlete-exposures (95% confidence interval 22.8, 275.4). Neither age, gender nor level of play were significant in the analysis. The most common injury location and type were found to be the lower limb and contusion, respectively, and were invariably associated with contact. Although taekwondo players are exposed to a substantial risk of sustaining injuries, the majority of injuries appeared to be of minimal severity. Modifications to the competition rules and protective equipment may be warranted. Future studies should adhere to recommended operational definitions, utilise a standardised injury classification system, and report injury rates using multiple denominators in order to facilitate inter- and cross-sport comparisons.

Chiropractic utilization in Taekwondo athletes

The purpose of the present study was to examine chiropractic utilization following a sport-related injury among National Team members and other high level Taekwondo athletes.

METHODS

Retrospective surveys were conducted among Canadian male and female Taekwondo athletes (Group A, n = 60) competing in a national tournament and National Taekwondo team athletes (Group B, n = 16) at a training camp.

RESULTS

A response rate of 46.7% (Group A) and 100% (Group B) was achieved. Twenty five percent (n = 4) of Group A athletes reported never seen a doctor of chiropractic (DC) regarding their injuries. Over 12% (n = 2) reported visiting a DC often, while just over 6% (n = 1) reported that they usually visited the DC following an injury. When injured, over 36% (n = 7) of the National Team members visit their family physician, over 15% (n = 3) visit a chiropractor or physiotherapist and the remaining athletes (n = 6) equally visit osteopaths, massage therapists, or athletic therapist following an injury.

CONCLUSION

There is a lack of information surrounding chiropractic utilization in the majority of sports and minimal research published regarding the health care utilization of Taekwondo athletes. Chiropractors, and particularly those with extensive athlete contact, should endeavour to further utilization studies.

Taekwondo techniques and competition characteristics involved in time-loss injuries

The purpose of this study was to assess time-loss injuries in young and adult taekwondo athletes. Participants were 2739 children (11-13 years), Junior (14-17 years) and adult males and females (18 years and older) competing in the national Greek championships. Injury data were collected by project staff with all diagnoses made by the tournament physician. Odds ratios were computed as well as 95% confidence intervals around the injury rates. The female Juniors had a higher time-loss injury rate (Fisher's Exact Test p = 0.033) than their adult counterparts. However, they were not at a higher risk of incurring a time-loss injury: OR = 0.143, 95% CI: 0.018-1.124. Collapsed over age, the females as a group recorded more time-loss injuries [11.36/1,000 A-E (95% CI: 6.25-16.47) versus 7.40/1,000 A-E (95% CI: 4.44-10.36)], but this was not significant (OR = 0.703, 95% CI: 0.383-1.293). In the Juniors, the boys only incurred time-loss injuries to the head and neck. There was no difference in the Junior girls in the distribution of time-loss injuries across body region, although they were at higher risk of sustaining an injury to the head and neck (OR = 1.510, 95% CI: 0.422-5.402) but this was not statistically significant. Although there were no statistical differences among age groups within gender, the Junior boys and girls (11-13 years) sustained more cerebral concussions. The Junior boys were at a higher risk of incurring a cerebral concussion than the boys (OR = 7.871, 95% CI: 0.917-67.583, Fisher's Exact Test p = 0.036). In the males, there was no difference between the men and Junior boys in injury rate for swing kicks compared to other techniques (OR = 2.000, 95% CI = 0.397-28.416). There also was no difference between the men and boys (OR = 4.800, 95% CI: 0.141-58.013). To help reduce the incidence of time-loss injuries in taekwondo, especially cerebral concussions, it is suggested for coaches to emphasize blocking skills. Educating referees, coaches and athletes plays an important role in helping to reduce taekwondo time-loss injuries. Key pointsThe purpose of this study was to assess time-loss injuries in young and adult taekwondo athletes.Collapsed over age, the females as a group recorded more time-loss injuries but this was not significant.The Junior boys were at a higher risk of incurring a cerebral concussion than the boys.To help reduce the incidence of time-loss injuries in taekwondo, especially cerebral concussions, it is suggested for coaches to emphasize blocking skills.Educating referees, coaches and athletes plays an important role in helping to reduce taekwondo time-loss injuries.

Injuries among judokas during competition

AIMS

To investigate the type and severity of injury sustained during judo competitions, and to investigate any possible correlation between injury rate and gender, grade, weight category and rapid weight loss.

METHOD

Three hundred and ninety-two judokas (284 males, 108 females) competed in three consecutive competitions. A judoka was "injured" if they requested medical treatment or could not continue. Following injury, a questionnaire was completed. Uninjured judokas were asked to complete a questionnaire at one competition to assess risk factors of injury. Follow-up was conducted 6 weeks after each competition.

RESULTS

Fifty-three out of 392 judokas (13.5%) (40 males, 13 females) sustained an injury. No difference was found between injury rates among males (41.3/1000 anthlete-exposures (A-E's)) and females (40.9/1000 A-E's), or between judokas of different weight groups or grades. Rapid weight loss of 5% or more of a judoka's body weight placed the athlete at a higher risk of injury (P=0.022). Most injuries affected the upper extremities. Injuries most often resulted from grip fighting, being thrown, or attempting to throw.

CONCLUSIONS

Judokas are advised not to lose weight before a competition as this increases the risk of injury. Neither grade, nor gender, or weight category are associated with an increase in injury rate.

Varus instability of the hallux interphalangeal joint in a taekwondo athlete

The hallux interphalangeal joint is stable in the transverse plane and there have been only a few reports of varus instability of this joint. A case is described of varus subluxation of the hallux interphalangeal joint in a taekwondo athlete and the surgical outcome after reconstruction of the collateral ligament. Taekwondo athletes, who require fast powerful kicks, should be warned about this type of forefoot injury.

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.

A profile of olympic taekwondo competitors

The purpose of this study was to identify the profile of the Olympic champions and the other competitors who were involved in the Games. The information on each of the athletes was obtained from the "Official Site of the Sydney 2000 Olympic Games, www.olympics.com/eng/sports/TK "and included weight category, weight, height, age, points obtained, warnings, deduction point, defensive/offensive kicks and punches. One hundred and two athletes competed (54 males and 48 females) in the Games. The mean average age and BMI (Body Mass Index) of 16 male winners was 24.4 ± 3.3 years and 21.9 ± 2.4 respectively compared to 25.2 ± 4.3 years and 22.8 ± 3.3 for the 38 male non-winners. The mean average age and BMI of the 16 female winners was 23.1 ± 3.9 years and 20.8 ± 2.3 respectively compared to 24.9 ± 4.7 years and 21.3 ± 2.7 for the 32 female non-winners. For all four types of athletes, offensive kicks accounted for at least 52% of the techniques to score a point. Ninety-eight percent of all techniques used to score were kicks. Although not statistically significant, winners overall tended to be younger in age and taller with slightly lower BMI than their weight category average. Taking into account the literature cited in this article, future studies should be designed to examine the relationship between performance and functional variables such as muscle power, muscle endurance, reaction time and aerobic capacity. Key PointsWinners tended to be younger in age and taller with slightly lower BMI than their weight category average.An offensive technique was used to score slightly more often than a defensive one.Overall, 98% of all techniques used to score were kicks.

Mild head injury in sports

Mild head injury has been recognized as producing numerous "postconcussive" symptoms that temporarily reduce an individual's ability to function. Controversy exists over the short-and long-term effects of mild head injuries, and the effects of repeated concussive blows to the head have not been sufficiently studied. Amateur and professional athletes provide an excellent population for the examination of many aspects of postconcussive syndrome. The nature, incidence, and cognitive and emotional symptoms of mild head injury, are reviewed within, the framework of professional and amateur sports. Particular attention is paid to the few available prospective studies of amateur boxers and collegiate football players.

Do custom-made mouth guards have negative effects on aerobic performance capacity of athletes?

Mouth guards are considered an essential part of equipment for athletes participating in contact sports. The purpose of this study was to evaluate the effect of custom-made mouth guards on the ventilatory gas exchange effects of taekwondo athletes. The subjects were 22 elite athletes aged between 14 and 17 years. To determine the effect of mouth guard use during exercise, oxygen consumption (VO(2)) was measured with a portable gas analysis system while an exercise tolerance test with a shuttle run test protocol was performed. Values with and without mouth guard were compared. Wilcoxon ranks test was used for the statistical analysis. The results show that wearing mouth guards has no significant effect on maximal oxygen uptake (VO(2max)), minute ventilation (VE), tidal volume (VT) and respiratory exchange ratio (RER) while performing maximal exercise (P > 0.05). In conclusion, taekwondo athletes can use custom-made mouth guards without negative effects on their aerobic performance capacity.

Pre-competition habits and injuries in Taekwondo athletes

Background

Over the past decade, there has been heightened interest in injury rates sustained by martial arts athletes, and more specifically, Taekwondo athletes. Despite this interest, there is a paucity of research on pre-competition habits and training of these athletes. The purpose of this pilot study was to assess training characteristics, competition preparation habits, and injury profiles of Taekwondo athletes.

Methods

A retrospective survey of Canadian male and female Taekwondo athletes competing in a national tournament was conducted. Competitors at a Canadian national level tournament were given a comprehensive survey prior to competition. Items on training characteristics, diet, and injuries sustained during training and competition were included. Questionnaires were distributed to 60 athletes.

Results

A response rate of 46.7% was achieved. Of those that responded, 54% dieted prior to competition, and 36% dieted and exercised pre-competition. Sixty-four percent of the athletes practised between 4–6 times per week, with 54% practicing 2 hours per session. Lower limb injuries were the most common (46.5%), followed by upper extremity (18%), back (10%), and head (3.6%). The majority of injuries consisted of sprains/strains (45%), followed by contusions, fractures, and concussions. More injuries occurred during training, including 59% of first injuries.

Conclusion

More research needs to be conducted to further illustrate the need for appropriate regulations on weight cycling and injury prevention.

Injuries in martial arts: a comparison of five styles

OBJECTIVE

To compare five martial arts with respect to injury outcomes.

METHODS

A one year retrospective cohort was studied using an injury survey. Data on 263 martial arts participants (Shotokan karate, n = 114; aikido, n = 47; tae kwon do, n = 49; kung fu, n = 39; tai chi, n = 14) were analysed. Predictor variables included age, sex, training frequency (<or=3 h/week v >3 h/week), experience (<3 years v >or=3 years), and martial art style. Outcome measures were injuries requiring time off from training, major injuries (>or=7 days off), multiple injuries (>or=3), body region, and type of injury. Logistic regression was used to determine odds ratios (OR) and confidence intervals (CI). Fisher's exact test was used for comparisons between styles, with a Bonferroni correction for multiple comparisons.

RESULTS

The rate of injuries, expressed as percentage of participants sustaining an injury that required time off training a year, varied according to style: 59% tae kwon do, 51% aikido, 38% kung fu, 30% karate, and 14% tai chi. There was a threefold increased risk of injury and multiple injury in tae kwon do than karate (p<0.001). Subjects >or=18 years of age were at greater risk of injury than younger ones (p<0.05; OR 3.95; CI 1.48 to 9.52). Martial artists with at least three years experience were twice as likely to sustain injury than less experienced students (p<0.005; OR 2.46; CI 1.51 to 4.02). Training >3 h/week was also a significant predictor of injury (p<0.05; OR 1.85; CI 1.13 to 3.05). Compared with karate, the risks of head/neck injury, upper extremity injury, and soft tissue injury were all higher in aikido (p<0.005), and the risks of head/neck, groin, and upper and lower extremity injuries were higher in tae kwon do (p<0.001). No sex differences were found for any of the outcomes studied.

CONCLUSIONS

There is a higher rate of injury in tae kwon do than Shotokan karate. Different martial arts have significantly different types and distribution of injuries. Martial arts appear to be safe for young athletes, particularly those at beginner or intermediate levels.

A prospective study of injuries sustained during competitive Muay Thai kickboxing

OBJECTIVE

To investigate prospectively the type and rate of injuries sustained during amateur Muay Thai competition.

DESIGN

Prospective cohort study collection of data following clinical examination.

SETTING

Amateur Muay Thai competitions in the United Kingdom organized by the International Amateur Muay Thai Federation.

PARTICIPANTS

Amateur Muay Thai boxers. Both sexes. Lightweight to super heavyweight.

RESULTS

There were 92 participants, 12 females and 82 males. The average age was 17.3 years, and the average previous number of bouts was 3.9. A total of 588.5 minutes of competition time was assessed during a total of 10 events. Injury rates were 1.3 injuries per 100 minutes of competition in the lightweight category, 2.25 per 100 minutes of competition in the middleweight category, 30 per 100 minutes of competition in the heavyweight category, and 2.54 per 100 minutes of competition in the super heavyweight category.

CONCLUSIONS

Compared with other reported martial arts, the injury rates are higher in Muay Thai. The head was shown to be the most common site of injury in amateur fighters, but there was an almost complete absence of lower limb injuries, which again is at variance with reported figures for other martial arts.

Injuries at the Canadian National Tae Kwon Do Championships: a prospective study

BACKGROUND

The purpose of this prospective study was to assess the injury rates in male and female adult Canadian Taekwondo athletes relative to total number of injuries, type and body part injured.

METHODS

Subjects (219 males, 99 females) participated in the 1997 Canadian National Taekwondo Championships in Toronto, Canada. Injuries were recorded on an injury form to documents any injury seen and treatment provided by the health care team. These data were later used for this study. The injury form describes the athlete and nature, site, severity and mechanism of the injury.

RESULTS

The overall rate of injuries was 62.9/1,000 athlete-exposures (A-E). The males (79.9/1,000 A-E) sustained significantly more injuries than the females (25.3/1,000 A-E). The lower extremities were the most commonly injured body region in the men (32.0 /1,000 A-E), followed by the head and neck (18.3/1,000 A-E). Injuries to the spine (neck, upper back, low back and coccyx) were the third most often injured body region in males (13.8/1,000 A-E). All injuries to the women were sustained to the lower extremities. The most common type of injury in women was the contusion (15.2/1,000 A-E). However, men's most common type of injury was the sprain (22.8/1,000 A-E) followed by joint dysfunction (13.7/1,000 A-E). Concussions were only reported in males (6.9/1,000 A-E). Compared to international counterparts, the Canadian men and women recorded lower total injury rates. However, the males incurred more cerebral concussions than their American colleagues (4.7/1,000 A-E).

CONCLUSIONS

Similar to what was found in previous studies, the current investigation seems to suggest that areas of particular concern for preventive measures involve the head and neck as well as the lower extremities. This is the first paper to identify spinal joint dysfunction.

Effect of implementation of safety measures in tae kwon do competition

BACKGROUND

Previous reviews of tae kwon do (TKD) tournaments have documented injury rates of 25/1000 to 12.7/100 athlete exposures. Most injuries have been reported to be to the head and the neck and are occasionally very serious. Many of these studies involved high level TKD competitions with minimal safety precautions. Recently, safety measures have been implemented in many TKD competitions.

OBJECTIVE

To evaluate retrospectively the incidence of injuries in TKD competitions involving a wide range of participants and featuring extensive safety precautions.

METHODS

A total of 2498 participants ranged in age from 18 to 66, included both men and women, and ranged in rank from yellow to black belt. Traumas, defined as any event requiring interaction with medical staff, were documented with respect to mechanism, diagnosis, treatment, and follow up recommendations. An injury was defined as a trauma that prevented a contestant from resuming competition on the day that the trauma occurred, according to National Collegiate Athletic Association criteria.

RESULTS

The injury rate was 0.4/1000 athlete exposures. This is lower than reported in previous studies of TKD tournaments and in many other sports.

CONCLUSION

TKD tournaments that emphasise limited contact, protective equipment, and medical supervision are relatively safe and compare favourably with other sports.

Major international sport profiles

Sports are part of the sociocultural fabric of all countries. Although different sports have their origins in different countries, many sports are now played worldwide. International sporting events bring athletes of many cultures together and provide the opportunity not only for athletic competition but also for sociocultural exchange and understanding among people. This article reviews five major sports with international appeal and participation: cricket, martial arts, field hockey, soccer, and tennis. For each sport, the major aspects of physiological and biomechanical demands, injuries, and prevention strategies are reviewed.

Injury and injury rates in Muay Thai kick boxing

OBJECTIVE

To determine the type and number of injuries that occur during the training and practice of Muay Thai kick boxing and to compare the data obtained with those from previous studies of karate and taekwondo.

METHODS

One to one interviews using a standard questionnaire on injuries incurred during training and practice of Muay Thai kick boxing were conducted at various gyms and competitions in the United Kingdom and a Muay Thai gala in Holland.

RESULTS

A total of 152 people were questioned, 132 men and 20 women. There were 19 beginners, 82 amateurs, and 51 professionals. Injuries to the lower extremities were the most common in all groups. Head injuries were the second most common in professionals and amateurs. Trunk injuries were the next most common in beginners. The difference in injury distribution among the three groups was significant (p< or =0.01). Soft tissue trauma was the most common type of injury in the three groups. Fractures were the second most common in professionals, and in amateurs and beginners it was sprains and strains (p< or =0.05). Annual injury rates were: beginners, 13.5/1000 participants; amateurs, 2.43/1000 participants; professionals, 2.79/1000 participants. For beginners, 7% of injuries resulted in seven or more days off training; for amateurs and professionals, these values were 4% and 5.8% respectively.

CONCLUSIONS

The results are similar to those found for karate and taekwondo with regard to injury distribution, type, and rate. The percentage of injuries resulting in time off training is less.

Incidence of reported cerebral concussion in adult taekwondo athletes

The purpose of the present study was to assess the exact conditions under which cerebral concussions occur in full-contact taekwondo competition. Injury data were collected by project staff and tournament medical personnel with simple check-off forms that describe the athlete and nature, site, circumstances and severity of the injury. The Mann-Whitney U test was used to determine the difference in injury rate between men and women. The men (7.04/1,000 athlete-exposures) sustained more cerebral concussions than the women (2.42/1,000 athlete-exposures) (p < 0.001). The dominant injury mechanism in both the males and females was receiving a blow (6.46/1,000 athlete-exposures and 2.42/1,000 athlete-exposures for the men and women, respectively).

Injury rates in children participating in taekwondo competition

OBJECTIVE

To report rates of injuries sustained during Junior taekwondo competitions.

DESIGN

Prospective.

MATERIALS AND METHODS

Data were collected with simple check-off forms that describe the athlete, nature, site, circumstances, and severity of the injury at three major taekwondo tournaments involving a total of 3,341 boys and 917 girls.

MAIN RESULTS

No difference was found between boys (58.34/1,000 athlete-exposures) and girls (56.57/1,000 athlete-exposures) in total injury rate (p > 0.05). Collapsed over gender, significant differences (p = 0.013) in injury rates of body parts were found with the lower extremities (21.83/1,000 athlete-exposures) ranked first. Unblocked attacks are the major cause of injury in both boys and girls.

CONCLUSIONS

Coaches are advised to work on the blocking skills of their Junior taekwondo athletes. No head contact for children in taekwondo competition should also be considered.

Precompetition injury and subsequent tournament performance in full-contact taekwondo

OBJECTIVE

To determine the pattern of injuries sustained by taekwondo competitors, and how previous injury affects performance in sporting competition.

METHODS

Competitors at a major New Zealand full-contact taekwondo tournament were given a comprehensive questionnaire immediately before competition. Self reports of injuries sustained through taekwondo in the previous 12 months were determined.

RESULTS

No significant sex differences were found. The injury prevalence was high, but comparatively less than reported for other contact sports such as rugby football. However, one in 20 injuries was a closed head injury. No significant associations between prior injury and tournament outcome were found.

CONCLUSIONS

Taekwondo can be a source of disabling injury. However, the fact that prior injury did not appear to be associated with impaired competition performance may militate against acceptance of control and regulation by competitors and coaches.

Medical coverage for multievent sports competition: a comprehensive analysis of injuries in the 1994 Star of the North Summer Games

OBJECTIVE

To determine the incidence and type of requests for medical assistance and the treatment required in 21 sports at the 1994 Star of the North Summer Games and to develop a plan, based on these findings, for efficient allocation of medical supplies and staff.

DESIGN

We reviewed our experience with a large multisport amateur athletic event and analyzed the pattern of injuries for participants in the various sports.

MATERIAL AND METHODS

Injury evaluation forms and medical supply kits were given to the health-care volunteers, who received preliminary instructions on classifications and definitions of injuries and on appropriate completion of the forms. When a medical contact occurred, an evaluation form was completed. The data from these forms were subsequently compiled and analyzed.

RESULTS

Of 6,243 athletes who participated in the 1994 Star of the North Summer Games, 55 (0.88%) received medical attention (2 officials also required medical assistance). The sports with the greatest number of medical contacts were soccer and track and field--31 and 16 contacts for medical assistance, respectively. The lower extremities were the anatomic site most frequently involved in injury (62% of the medical contacts). The most common types of injury were contusions, strains, and sprains.

CONCLUSION

Because few injuries were sustained and most were of minor severity, basic medical supplies (such as ice bags and compression wraps) were sufficient. For locations with a scarcity of medical personnel, a triage system can be established in which athletic trainers or registered nurses manage the initial assessments and refer cases, as needed, to physicians for specialized care. An effective communication system can also considerably reduce volunteer hours.