Injury and injury rates in Muay Thai kick boxing

An analysis of pain intensity, injury incidence, and their associations with socio-demographic factors in high school athletes: A cross-sectional study during the COVID-19 pandemic

This cross-sectional study explored the relationship between pain intensity, injury incidence, and sociodemographic factors in 120 high school athletes (mean age 16.78±0.91) participating in various sports. The aims of this study are to examine the correlation between factors and Verbal Rating Scale (VRS) for pain intensity, to investigate the correlation between sport types and injured region, and to explore the correlation between injured regions and VRS during training and game competition. Using VRS, we found 64 (53.3%) participants experienced pain during training, with varying degrees of intensity. Chi-square analysis revealed a significant association between VRS scores and school grade (p = 0.044) and cool-down practices (p = 0.037). However, no significant associations were found with gender, age, or sport type. In game competition, 29 (24.2%) participants reported experiencing pain. Here, there was no significant association between VRS and any considered variables. Lower limb injuries were predominant (n = 64), particularly to the knee (n = 23) and ankle/foot (n = 18). Certain sports, like Athletics, Karate-Do, Football, and Western Boxing, demonstrated multiple injury sites, whereas Thai boxing was associated primarily with ankle and foot injuries. Pain intensity varied by injury location, with the highest 'worst pain' reported for elbow injuries during training and knee injuries during competition. Significant associations were found between injured region and pain intensity level during both training and competition (p<0.001). Our findings highlight the need for injury prevention strategies and pain management among high school athletes, emphasizing proper cool-down activities. Further research is warranted to confirm these findings and explore underlying mechanisms.

Bennett Angle, Condylar and Jaw Movements in Asymptomatic Athletes with a History of a Blow to One Side of the Mandibula

Sports activities may induce long-lasting changes in mandibular trajectories. The aim was to compare condylar and mandibular movements in athletes with orofacial injuries with values measured in non-injured athletes. The group of 132 athletes without mandibular injury included asymptomatic athletes with a history of a blow to the right side (N = 43) and the group included asymptomatic athletes with a history of a blow to the left side (N = 41) of the mandible. The injured athletes suffered from stiffness/pain and/or limitation of jaw movements. The symptoms disappeared shortly after the injury. Athletes with a history of injury have smaller mean values of Bennett angle on the side of impact, and Bennett angle on the opposite side is greater than the mean found in non-injured athletes. Significantly smaller Bennett angle values in athletes with a history of a blow to one side of the mandible are due to the adaptability of the orofacial system. The larger Bennett angle on the opposite side of the injury is also due to the adaptive mechanism of the TMJ. Clinical Relevance: An individualized approach to TMJ values is mandatory in restorative procedures in every patient, especially in patients with a history of trauma to the orofacial system.

Atypical Presentation of Non-Ossifying Fibroma in a Professional Muay Thai Boxer: A Case Report and a Narrative Review of the Literature

Introduction

Sports injuries occur during sport athletic activities, or exercising. However, there are some lesions which are typically associated to sports, in such a demanding and physical sport like Muay Thai that no typical lesion has been detected yet. We performed a narrative review of the literature to highlight the typical lesions of this sport to analyze the differential diagnosis of those conditions.

Case Report

A 28-year-old female, Muay Thai athlete since 16 years, presented with a 6 months history of a persistent pain in the metaphyseal lateral part of the right tibia. Differentiation between stress injuries, malignant bone tumors, and tumor-like lesions after repetitive microtrauma following sport activities can be difficult. The diagnostic approach involved conventional X-ray, echotomography, computed tomography scan, and magnetic resonance imaging scan with controversial findings. The biopsy confirmed the final diagnosis of non-ossifying fibroma.

Conclusion

The purpose of this case report is to exhibit the challenges in the diagnosis of a professional Muay Thai athlete with tibial pain and to discuss the clinical presentation of this type of patients with a limited population in the literature. Our case illustrates that even modern imaging techniques cannot always distinguish between tumor and tumor-like lesions caused by sports; meanwhile remembered us that we should never be too focused on a particular characteristic forgetting even rare pathologies as adamantinoma.

Characterization of Changes in Subchondral Bone Tissue Density of the Ankle Joint in Taekwondo Players

Background: It has been found that ankle joint impingement can cause articular cartilage injury, and the change of subchondral bone density and distribution under long-term stress loading can reflect the stress interaction of the articular surface and the difference in bone remodeling degree and predict the location of cartilage injury.

Objective: To investigate the bone density distribution pattern of ankle joint subchondral bone under mechanical stress loading of Taekwondo, the volume proportion of bone tissue with different bone densities, and the distribution characteristics of bone remodeling position.

Study design: A controlled laboratory study.

Methods: Computed tomography data were collected from the feet of 10 normal subjects (control group) and 10 high-level Taekwondo athletes. First, the distribution pattern of the high-density area of the articular surface was determined by computed tomography osteoabsorptiometry and the nine-grid anatomical region localization method. Second, the percentage of bone volume (%BTV) and the distribution trend of bone tissue were measured.

Result: In the present study, it was found that there were high-density areas in the 1st, 2nd, 3rd, 4th, 6th, 7th, and 9th regions of the distal tibia of Taekwondo athletes, and the distribution track was consistent with the high-density areas of the talar dome surface (1st, 2nd, 3rd, 4th, 6th, 7th, and 9th regions). In Taekwondo athletes, the percentage of bone tissue volume in the distal tibia and talus with high and moderate bone density was significantly higher than that in the control group (p < 0.05).

Conclusion: The impact stress, ground reaction force, intra-articular stress, lower limb movement technology, lower limb muscle, and tendon stress caused by Taekwondo lead to special pressure distribution patterns and bone tissue remodeling in the ankle.

Imaging of neuroinflammation due to repetitive head injury in currently active kickboxers

Purpose

Chronic traumatic encephalopathy refers to a neurodegenerative disease resulting from repetitive head injury of participants in contact sports. Similar to other neurodegenerative diseases, neuroinflammation is thought to play a role in the onset and progression of the disease. Limited knowledge is available regarding the neuroinflammatory consequences of repetitive head injury in currently active contact sports athletes. PET imaging of the 18-kDa translocator protein (TSPO) allows quantification of microglial activation in vivo, a marker of neuroinflammation.

Methods

Eleven rank A kickboxers and 11 age-matched controls underwent TSPO PET using [¹¹C]-PK11195, anatomical MRI, diffusion tensor imaging, and neuropsychological testing. Relevant imaging parameters were derived and correlated with the outcomes of the neuropsychological testing.

Results

On a group level, no statistically significant differences were detected in non-displaceable binding potential (BP_ND) using PET. Individually, 3 kickboxers showed increased BP_NDs in widespread regions of the brain without a correlation with other modalities. Increased FA was observed in the superior corona radiata bilaterally. DTI parameters in other regions did not differ between groups.

Conclusion

Despite negative results on a group level, individual results suggest that neuroinflammation may be present as a consequence of repetitive head injury in active kickboxers. Future studies using a longitudinal design may determine whether the observed TSPO upregulation is related to the future development of neuropsychiatric symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00259-022-05715-x.

Sudden death after facial impacts: Is the brainstem involved?

Three deaths following facial impacts in the presence of witnesses and resulting in brain lesions that were visualized only on pathological examination were studied at the forensic medicine institute of Marseille. Craniofacial impacts, even of low intensity, received during brawls may be associated with brain lesions ranging from a simple knock-out to fatal injuries. In criminal cases that are brought to court, even by autopsy it is still difficult to establish a direct link between the violence of the impact and the injuries that resulted in death. During a facial impact, the head undergoes a movement of violent forced hyperextension. Death may thus be secondary to the transmission of forces to the brain, either by a mechanism involving nerve conduction that may be termed a reflex mechanism (for example by vagal hyperstimulation) or by injury to the central nervous system (axonal damage). In such situations, autopsy does not make it possible to determine the cause of death, but only to suspect it in a context of voluntary violence in the presence of witnesses, with or without violent injury observed on external examination or on superficial incisions to determine the extent of bruises or hematoma. Systemic and comprehensive investigation involving pathology and toxicology is essential in any medicolegal case for positive interpretation and discrimination of other causes of death.

Comparison of CrossFit Barbara and classic resistance trainings for the protection of strength performance during off-season in kickboxers

BACKGROUND: The inability of athletes to train or the decrease in the intensity and frequency of training may cause athletes to lose performance. Particularly in view of the current COVID-19 pandemic, maintaining strength outside the normal framework provides an advantage to athletes for the next competitions. OBJECTIVE: To compare the CrossFit Barbara which can be applied easily at home during the off-season or some situations such as the epidemic limitation to classic resistance training methods used to maintain the strength performance of national kickboxers. METHODS: Forty-three national kickboxers, CrossFit (CF, n= 22), and resistance training (RT, n= 21), participated in this study. While CF performed 20 pull-ups, 30 push-ups, 40 sit-ups, and 50 squat exercises, RT performed bench press, lat pull down, leg press, biceps curl, and triceps extension exercises twice per week for six weeks. Before and after the six weeks, the following variables were measured; body mass (BM) and body fat percentage (FP), VO2max, bench press (BP), squat (SQ), leg strength (LS), hand grip strength (HGS), pull-up, push-up and counter movement jump (CMJ). RESULTS: BP (p< 0.001, F= 41.125, ηp2= 0.501), SQ (p< 0.001, F= 26.604, ηp2= 0.394), LS (p< 0.001, F= 15.234, ηp2= 0.271), push-up (p< 0.001, F= 31.978, ηp2= 0.438) and pull-up (p< 0.001, F= 24.410, ηp2= 0.373) values changed significantly in group-time interaction between CF and RT groups, while there was no significant difference for the BM (p= 0.198, F= 1.715, ηp2= 0.040), Fat (p= 0.265, F= 1.279, ηp2= 0.030), HGS (p= 0.665, F= 0.190, ηp2= 0.005, CMJ (p= 0.054, F= 3.946, ηp2= 0.088) and VO2max (p=0.747, F= 0.106, ηp2= 0.003). Furthermore, according to the before and after study values, BP, SQ, LS, and CMJ decreased significantly (p< 0.05) while BM, FP, HGS, VO2max, pull-up and push-up variables did not in the CF (p> 0.05). In the RT, the pull-up and push-up variables decreased significantly (p< 0.05) while there was no significant difference for BP, SQ, LS, HGS, VO2max, body mass, body fat percentage and CMJ (p> 0.05). CONCLUSION: CF Barbara workout was more effective in maintaining strength endurance performances, and RT in maintaining maximum strength performances. According to the individual performance needs of athletes, reasonable training method can be used to prevent performance decrement in the strength domain.

The 2015 U.S. Soccer Federation header ban and its effect on emergency room concussion rates in soccer players aged 10-13

BACKGROUND

In 2015, the U.S. Soccer Federation banned heading for players aged 10-13.

PURPOSE/QUESTION

To assess the change in proportion of children aged 10-13 playing soccer in the US presenting to an Emergency Department (ED) with a concussion in relation to any other injury before and after the ban.

METHODS

Analysis was restricted to soccer athletes between 10-13 years that reported to a National Electronic Injury Surveillance System (NEISS) participating hospital ED following injury in 2013-2014 and 2016-2017. Multivariable logistic regression was performed to assess the association between year of injury and concussion diagnosis in relation to other injury diagnosis after adjusting for age, sex, and ethnicity.

RESULTS

Concussion in relation to other injuries showed a significant increase in 2016-2017 when compared to 2013-2014 after adjustment (OR= 1.286, 95%CI = 1.090-1.517).

CONCLUSIONS

These results suggest that banning heading may not reduce concussion within this population. However, significant confounders, including increased reporting, were not controlled for.

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.

Factors associated with prevalence of pain and musculoskeletal injuries in Brazilian kickboxers: a cross-sectional study

Study aim: The purpose of this study was to determine the prevalence and factors associated with pain and musculoskeletal injuries in Brazilian kickboxers.

Material and methods: This is a cross-sectional study composed of a population of kickboxers from the academies affiliated to the Rio Grande do Norte State Federation of Kickboxing. The study was conducted by means of a questionnaire regarding their demographic data, graduation and level of participation in the modality, routines of procedures during training, and pain/ discomfort regions and respective intensities. In addition, the characteristics, types, and regions of the injuries were evaluated.

Results: Of the 132 kickboxers included, a high prevalence of pain (84.09%) was observed and associated with the female gender (OR = 3.62; CI95% 1.29–10.13) and body mass index (OR = 0.80; CI95% 0.71–0.91). In addition, the kickboxers presented a moderate percentage of injuries (40.91%) that were associated with longer training time (OR = 5.82; CI95% 2.68–12.61) and contact level in the training sessions (OR = 3.53; CI95% 1.85–6.72).

Conclusions: There was a high prevalence of musculoskeletal pain in kickboxers, mainly associated with female gender and with lower body mass. Musculoskeletal injuries were moderately prevalent in kickboxers who trained more than one hour per session and with an intense contact level.

The Relationship Between Fighting Style, Cognition, and Regional Brain Volume in Professional Combatants: A Preliminary Examination Using Brief Neurocognitive Measures

OBJECTIVE

Repetitive head impacts (RHIs) in combat sports are associated with cognitive decline and brain volume reduction. While fighting style differences between boxers, mixed martial artists (MMAs), and martial artists (MAs) have resulted in a broader spectrum of injury, the effects of RHIs on MAs relative to other fighters have not yet been explored. This study aimed to determine a differential effect of fighting style on cognition and brain.

SETTING

A large outpatient medical center specializing in neurological care.

PARTICIPANTS, DESIGN, AND MAIN MEASURES

In total, 40 MAs, 188 boxers, and 279 MMAs were compared on baseline measures of subcortical regional brain volumes, after controlling for total brain volumes, and cognitive performance.

RESULTS

Significant differences between MAs, MMAs, and boxers were observed in subcortical brain structure volumes and cognitive measures. MMAs and MAs consistently had larger volumes and higher scores than boxers. Fighting style significantly moderated the relationship between the number of professional fights and the volumes of various subcortical brain structures and performance on a measure of processing speed at baseline.

CONCLUSIONS

Differences in RHIs across fighting styles may be of clinical significance. Exploring changes over time within the MA, boxer, and MMA cohorts may provide insight into longer-term discrepancies in subcortical regional brain volumes and cognitive functioning across fighting styles.

Musculoskeletal and head injuries in the Ultimate Fighting Championship (UFC)

OBJECTIVES

Mixed martial arts (MMA) has witnessed a surge in popularity worldwide. This study explores the musculoskeletal and head injuries sustained in the professional fights of the Ultimate Fighting Championship (UFC), and establishes associations between injury profiles and impactful contributory factors.

METHODS

The Nevada State Athletic Commission database was screened for ringside physician reports of UFC fights between January 2016 and July 2018. Information on the fighter's gender, weight, injury, way of finish, and match result were collected. Injury rates were calculated and statistical analyses were conducted to determine significant associations among variables. P-values <0.05 were considered significant (95% CI).

RESULTS

A total of 291 injuries were recorded in 285 fights from nine weight divisions. The overall injury rate was 51 per 100 athletic exposures (AE). Males predominantly partook in 249 matches (87%) and had higher injury rates (54 injuries per 100 AE) than females (30 injuries per 100 AE). Decision was the most common way a match ended. Knockouts (KOs) were significantly higher in males (36%) than in females (14%, P = 0.0007). Submissions were significantly higher in females (36%) than in males (16%, P = 0.001). Head injuries (67%) were the most common injuries reported with a rate of 34 per 100 AE. Upper limb injuries were significantly higher in females (40%) than in males (14%, P = 0.0003). Lower limb injuries were significantly higher in males (19%) than in females (5%, P = 0.01). Head injuries were significantly associated with KOs (P < 0.0001). Upper limb injuries (P = 0.032) and lower limb injuries (P = 0.034) were significantly associated with matches that ended with Decision. Trend-line analyses showed that as weight division increases, overall injury rates, head injuries, lower limb injuries, and KOs' frequency increase, whereas upper limb injuries, Submission frequency, and Decision frequency decrease.

CONCLUSION

MMA has a high injury rate. Gender, way of finish, and weight play an important role in predicting fight outcomes and injury profiles. Injury prevention policies must be entertained to limit injury risk in MMA.

Sports-Related Repetitive Traumatic Brain Injury: A Novel Cause of Pituitary Dysfunction

Traumatic brain injury (TBI) is one of the major causes of disability and death, particularly in the young population. Recent clinical studies have demonstrated that TBI-induced pituitary dysfunction occurs more frequently than previously estimated, and this may contribute to delayed diagnosis and treatment of hormonal abnormalities. Today, the popularity of combative sports increases, and athletes who deal with these sports have risks of developing hypopituitarism attributed to repetitive TBIs. Pathogenesis and molecular mechanisms are not completely understood yet. Current studies suggest that athletes who had retired, especially from combative sports, should be screened for hypopituitarism. In this review, we aim to increase the awareness of medical communities, athletes, coaches, and athletic trainers about this issue by sharing the current studies regarding the pituitary dysfunction attributed to repetitive TBI associated with sports.

Classical and non-classical causes of GH deficiency in adults

Growth hormone deficiency (GHD) can develop due to a variety of conditions, and may occur either as isolated or multiple pituitary hormone deficiencies. It has been previously demonstrated that GH is one of the most frequent hormonal deficiencies in adult patients with hypopituitarism. The most frequent classical causes of adult-onset GHD (AO-GHD) are pituitary adenomas and/or their treatment. However, during the last decade an increasing number of studies from different parts of the world have revealed that non-tumoural causes of hypopituitarism are more common than previously known. Therefore, in this review our aim is to briefly summarize the classical and non-classical acquired causes of GHD in adults.

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.

The prevalence of injury in Kendo

OBJECTIVE

Kendo is a Japanese martial art analogous to fencing, which is becoming increasingly popular worldwide. The large number of participants creates a need to assess injury patterns to better train them. The purpose of this study is to describe current injury rates in kendo and compare these rates to other martial arts.

METHODS

This retrospective study used an online questionnaire sent to 500 active members of the All United States Kendo Federation and World Kendo Federation. The questionnaire, based on the NCAA Injury Surveillance System, contains questions regarding location and type of injuries sustained during competition and practice, time lost to training, and competitor demographics. Statistical analyses between competitor demographics and injury rates are provided. Injury rates are expressed as injury rates/minute of competition or practice and by athlete exposures. 95% CIs were calculated.

RESULTS

Responses from 307 of 500 kendo players were received (response rate = 61.4%). 41 (18%) male and 13 (16%) female participants reported injury to only one body region, while 16 (7%) men and one (1%) woman reported no injuries. 166 (74%) males and 70 (83%) females reported injuries to two or more body regions. The most common sites of injury involved the foot/ankle (65.1%), wrist/hand (53.5%) and elbow/forearm (48.8%). Most injuries occurred during practice (87.9% foot/ankle, 89.9% wrist/hand, elbow/forearm 92.2%). The most common injuries were contusions, abrasions, and sprains/strains. Injury rates were 121/1000 A-E (0.025 injuries/min) in tournaments versus 20.5/1000 A-E (0.011 injuries/min) in training. 26% of injuries resulted in time off of participation, with an average recovery time of 15 days (range = 1 day-1 year).

CONCLUSIONS

Although more total injuries occurred in practice than in competition, there was a lower injury rate in kendo than in taekwondo and western-style fencing. This study demonstrates that kendo is a relatively safe sport compared to other martial arts sports.

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.

GH and Pituitary Hormone Alterations After Traumatic Brain Injury

Traumatic brain injury (TBI) is a crucially important public health problem around the world, which gives rise to increased mortality and is the leading cause of physical and psychological disability in young adults, in particular. Pituitary dysfunction due to TBI was first described 95 years ago. However, until recently, only a few papers have been published in the literature and for this reason, TBI-induced hypopituitarism has been neglected for a long time. Recent studies have revealed that TBI is one of the leading causes of hypopituitarism. TBI which causes hypopituitarism may be characterized by a single head injury such as from a traffic accident or by chronic repetitive head trauma as seen in combative sports including boxing, kickboxing, and football. Vascular damage, hypoxic insult, direct trauma, genetic predisposition, autoimmunity, and neuroinflammatory changes may have a role in the development of hypopituitarism after TBI. Because of the exceptional structure of the hypothalamo-pituitary vasculature and the special anatomic location of anterior pituitary cells, GH is the most commonly lost hormone after TBI, and the frequency of isolated GHD is considerably high. TBI-induced pituitary dysfunction remains undiagnosed and therefore untreated in most patients because of the nonspecific and subtle clinical manifestations of hypopituitarism. Treatment of TBI-induced hypopituitarism depends on the deficient anterior pituitary hormones. GH replacement therapy has some beneficial effects on metabolic parameters and neurocognitive dysfunction. Patients with TBI without neuroendocrine changes and those with TBI-induced hypopituitarism share the same clinical manifestations, such as attention deficits, impulsion impairment, depression, sleep abnormalities, and cognitive disorders. For this reason, TBI-induced hypopituitarism may be neglected in TBI victims and it would be expected that underlying hypopituitarism would aggravate the clinical picture of TBI itself. Therefore, the diagnosis and treatment of unrecognized hypopituitarism due to TBI are very important not only to decrease morbidity and mortality due to hypopituitarism but also to alleviate the chronic sequelae caused by TBI.

Pituitary dysfunction after traumatic brain injury: a clinical and pathophysiological approach

Traumatic brain injury (TBI) is a growing public health problem worldwide and is a leading cause of death and disability. The causes of TBI include motor vehicle accidents, which are the most common cause, falls, acts of violence, sports-related head traumas, and war accidents including blast-related brain injuries. Recently, pituitary dysfunction has also been described in boxers and kickboxers. Neuroendocrine dysfunction due to TBI was described for the first time in 1918. Only case reports and small case series were reported until 2000, but since then pituitary function in TBI victims has been investigated in more detail. The frequency of hypopituitarism after TBI varies widely among different studies (15-50% of the patients with TBI in most studies). The estimates of persistent hypopituitarism decrease to 12% if repeated testing is applied. GH is the most common hormone lost after TBI, followed by ACTH, gonadotropins (FSH and LH), and TSH. The underlying mechanisms responsible for pituitary dysfunction after TBI are not entirely clear; however, recent studies have shown that genetic predisposition and autoimmunity may have a role. Hypopituitarism after TBI may have a negative impact on the pace or degree of functional recovery and cognition. What is not clear is whether treatment of hypopituitarism has a beneficial effect on specific function. In this review, the current data related to anterior pituitary dysfunction after TBI in adult patients are updated, and guidelines for the diagnosis, follow-up strategies, and therapeutic approaches are reported.

Neurological consequences of traumatic brain injuries in sports

Traumatic brain injury (TBI) is common in boxing and other contact sports. The long term irreversible and progressive aftermath of TBI in boxers depicted as punch drunk syndrome was described almost a century ago and is now widely referred as chronic traumatic encephalopathy (CTE). The short term sequelae of acute brain injury including subdural haematoma and catastrophic brain injury may lead to death, whereas mild TBI, or concussion, causes functional disturbance and axonal injury rather than gross structural brain damage. Following concussion, symptoms such as dizziness, nausea, reduced attention, amnesia and headache tend to develop acutely but usually resolve within a week or two. Severe concussion can also lead to loss of consciousness. Despite the transient nature of the clinical symptoms, functional neuroimaging, electrophysiological, neuropsychological and neurochemical assessments indicate that the disturbance of concussion takes over a month to return to baseline and neuropathological evaluation shows that concussion-induced axonopathy may persist for years. The developing brains in children and adolescents are more susceptible to concussion than adult brain. The mechanism by which acute TBI may lead to the neurodegenerative process of CTE associated with tau hyperphosphorylation and the development of neurofibrillary tangles (NFTs) remains speculative. Focal tau-positive NFTs and neurites in close proximity to focal axonal injury and foci of microhaemorrhage and the predilection of CTE-tau pathology for perivascular and subcortical regions suggest that acute TBI-related axonal injury, loss of microvascular integrity, breach of the blood brain barrier, resulting inflammatory cascade and microglia and astrocyte activation are likely to be the basis of the mechanistic link of TBI and CTE. This article provides an overview of the acute and long-term neurological consequences of TBI in sports. Clinical, neuropathological and the possible pathophysiological mechanisms are discussed. This article is part of a Special Issue entitled 'Traumatic Brain Injury'.

Evaluation of long-term pituitary functions in patients with severe ventricular arrhythmia: a pilot study

INTRODUCTION

Traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), stroke and cerebrovascular disease (CVD) are identified as risk factors for hypopituitarism. Pituitary dysfunction after TBI, SAH, and CVD may present in the acute phase or later in the course of the event. Chronic hypopituitarism, particularly growth hormone (GH) deficiency is related to the increased cardiovascular morbidity and mortality. In patients with serious ventricular arrhythmias, who need cardiopulmonary resuscitation, brain tissue is exposed to short-term severe ischemia and hypoxia. However, there are no data in the literature regarding pituitary dysfunction after ventricular arrhythmias.

PATIENTS AND METHODS

Forty-four patients with ventricular arrhythmias [ventricular tachycardia (VT), ventricular fibrillation (VF)] (mean age, 55.6 ± 1.8 years; 37 men, 7 women) were included in the study. The patients were evaluated after mean period of 21.2 ± 0.8 months from VT-VF. Basal hormone levels, including serum free triiodothyronine (fT3), free thyroxine (fT4), TSH, ACTH, prolactin, FSH, LH, total testosterone, estradiol, IGF-1, and cortisol levels were measured in all patients. To assess (GH)-insulin like growth factor-1 (IGF-1) axis, glucagon stimulation test was performed and 1 µg ACTH stimulation test was used for assessing hypothalamic-pituitary-adrenal (HPA) axis.

RESULTS

The frequencies of GH, gonadotropin and TSH deficiency were 27.2, 9.0, 2.2%, respectively. Mean IGF-1 levels were lower in GH deficiency group, but it was not statistically significant.

CONCLUSION

The present preliminary study showed that ventricular arrhythmias may result in hypopituitarism, particularly in growth hormone deficiency. Unrecognized hypopituitarism may be responsible for some of the cardiovascular problems at least in some patients.

Subchondral impaction fractures of the non-weight-bearing portion of the lateral femoral condyle

OBJECTIVE

To document the first report of intra-articular, non-weight-bearing, impaction fractures of the lateral femoral condyle.

MATERIALS & METHODS

Institutional Review Board and Regional Ethics Committee approval for this study was obtained and patient informed consent deemed unnecessary. We prospectively documented all potential cases of non-weight-bearing posterior subchondral impaction fractures of the femoral condyles diagnosed on magnetic resonance imaging (MRI) of the knee performed at our institution between January 2006 and December 2011. The cases were reviewed and discussed by three experienced musculoskeletal radiologists and only cases satisfying pre-defined MRI criteria were included.

RESULTS

Sixteen cases of intra-articular impaction fractures in a posterior, non-weight-bearing area of the lateral femoral condyle were diagnosed in patients with a mean age of 40. Eight were associated with recreational sports activities and 4 with repeated kneeling. There were no fractures documented in the non-weight-bearing aspect of the medial femoral condyles. Proposed underlying mechanisms for development of this type of fracture are presented.

CONCLUSION

Awareness, along with a high level of suspicion, that non-specific knee pain, especially in patients involved in athletic activities, could be due to intra-articular impaction fractures of the non-weight-bearing posterior aspect of the lateral femoral condyle is essential and MRI is the mainstay of diagnosis.

Biomechanical analysis of the muscular power of martial arts athletes

This study analyzes the performance of knee extension and flexion of Taekwondo and Kickboxing athletes. The power values were extracted through electromyography obtained by an isokinetic dynamometer at 60 degrees per second. These values are resulted from the square of the electromyography signal. The analysis of kick power was made using a modified wavelet algorithm considering values with 95% significance. Both groups presented equivalent power and torque capacity with different training times and experience, on the other hand, the wavelet analysis showed better results in muscular recruitment performance in athletes with more experience, in other words, power is not only performance but also power plus recruitment produces better results. This study uniquely showed that muscular enhancement capacity is not only related to the power capacity of contraction but also to motor coordination.

Prevalence and patterns of combat sport related maxillofacial injuries

Aim:

This study was designed to assess the prevalence, distribution, and patterns of injury among athletes engaged in combat sports and compare the prevalence, pattern, and types of oral and maxillofacial trauma in these athletes.

Materials and Methods:

A total of 120 male athletes engaged in four combat sports (boxing, taekwondo, kickboxing, and Muay Thai) who had sustained bodily trauma were studied; 95 subjects with at least one traumatic injury to the face requiring treatment were referred to us by the physician team. The type of injury (facial laceration, facial fractures, jaw dislocation, etc.), site of facial injury (jaw, nose, malar bone, teeth, etc.), dental injuries (tooth fracture, displacement, luxation, and avulsion), causative sport (boxing, taekwondo, kickboxing, and Muay Thai) as well as demographic data were recorded. Injuries were examined clinically and radiographically, and treated accordingly by a specialist. Treatment data and demographics were recorded for each subject. Recorded data were assessed, and χ², ANOVA, and Kruskal–Wallis tests were used to statistically analyze and compare the data.

Results:

Of 120 subjects, 95 male subjects (79.2%), aged 18–25 years (avg. 20 years), had at least one traumatic injury to the face requiring medical treatment. These injuries included facial laceration, bone fractures (nose, mandible, and zygoma), dental injuries (displacement, luxation, fracture, and avulsion), and mandibular dislocation which were recorded in 83 (69.2%), 55 (45.1%), 53 (44.2%), and 8 (6.7%) cases respectively. Statistically significant differences were encountered among various injuries and the sports; kickboxing caused the most maxillofacial injuries and was identified as more injurious. Tooth fractures (59.7%) were the most common dental injuries, and the nose (84.7%) was the most frequently fractured facial bone. Lacerations were more common in Thai-boxers (93.3%). Injuries were significantly greater in professional rather than amateur athletes.

Conclusion:

In this study, prevalence of facial injuries from combat sports professionals was significantly high (roughly 80%), especially in kickboxing (in part due to use of less protective gear). Because the nose and teeth sustained the most injuries, they require more attention with regard to prevention. Kickboxing was the most injurious of these combat sports and caused the most significant number of maxillofacial trauma. More safety apparel and protective guards seem warranted in athletes of combat sports if facial injury is to be prevented.

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.

Pediatric martial arts injuries presenting to Emergency Departments, United States 1990–2003

Although an estimated 6.5 million United States (US) children aged 6-17 practiced a martial art in 2004, there have been no nationally representative studies comparing pediatric injuries among the three most popular disciplines, karate, taekwondo, and judo. Describe pediatric martial arts injuries presenting to a representative sample of US Emergency Departments (EDs) from 1990 to 2003. We reviewed all martial arts injuries captured by the US Consumer Product Safety Commission's (CPSC), National Electronic Injury Surveillance System (NEISS). An estimated 128,400 children </=17 years were treated in US EDs for martial arts-related injuries from 1990 to 2003. Injured tended to be male (73.0%) and had a mean age of 12.1 years. Most injuries were attributed to karate (79.5%). The most common mechanism of injury was being kicked (25.6%), followed by falling (20.6%) and kicking (18.0%). The majority of injuries occurred to the lower leg/foot/ankle (30.1%) and hand/wrist (24.5%). The most common injury diagnoses were sprains/strains (29.3%), contusions/abrasions (27.8%), and fractures (24.6%). Participants in judo sustained significantly higher proportions of shoulder/upper arm injuries than karate (IPR=4.31, 95% CI: 2.84-6.55) or taekwondo (IPR=9.75, 95% CI: 3.53-26.91) participants. There were also higher proportions of neck injuries sustained by judo participants compared to karate (IPR=4.73, 95% CI: 1.91-11.70) or taekwondo (IPR=4.17, 95% CI: 1.02-17.06) participants. Pediatric martial arts injuries differ by discipline. Understanding these injury patterns can assist with the development of discipline-specific preventive interventions.

Kickboxing sport as a new cause of traumatic brain injury-mediated hypopituitarism

OBJECTIVE

Traumatic brain injury, which is a frequent and a worldwide important public health problem, may result in pituitary dysfunction. Concussion, a common type of lesion after traumatic brain injury, is an injury associated with sports including boxing and kickboxing. Kickboxing is one of the most popular martial arts and approximately 1-million people around the world participate in kickboxing sport. Head is the most common site of injury in amateur and professional kickboxers. Pituitary consequences of chronic repetitive head trauma in kickboxing have not been investigated until now. Therefore, the present study was designed to investigate the pituitary function in both retired and active amateur kickboxers.

PATIENTS AND DESIGN

Twenty-two amateur kickboxers who have boxed in national and international championships (16 men, 6 women) with a mean age of 27.3 +/- 7.1 years, and 22 age- and sex-matched healthy controls were included in the study. Basal hormone levels were obtained from the participants. To assess GH-IGF-I axis, GHRH + GHRP-6 test and glucagon stimulation tests were used. Hypothalamo-pituitary-adrenal axis was assessed by glucagon stimulation test.

RESULTS

When mean basal hormone levels were compared between kickboxers and the controls, IGF-I level was significantly lower in kickboxers (P < 0.05). Five (22.7%) and two (9.1%) of the 22 kickboxers had GH deficiency had ACTH deficiency, respectively. There were significant negative correlations between IGF-I levels and age, duration of sports and number of bouts (P < 0.05).

CONCLUSIONS

Present data clearly demonstrate for the first time that amateur kickboxing is a novel cause of hypopituitarism and kickboxers are at a risk for hypopituitarism especially isolated GH deficiency. Therefore, participants of the combative sports who were exposed to chronic repetitive head trauma need to be screened.

Incidence of injury in professional mixed martial arts competitions

Mixed Martial Arts (MMA) competitions were introduced in the United States with the first Ultimate Fighting Championship (UFC) in 1993. In 2001, Nevada and New Jersey sanctioned MMA events after requiring a series of rule changes. The purpose of this study was to determine the incidence of injury in professional MMA fighters. Data from all professional MMA events that took place between September 2001 and December 2004 in the state of Nevada were obtained from the Nevada Athletic Commission. Medical and outcome data from events were analyzed based on a pair-matched case-control design. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. A total of 171 MMA matches involving 220 different fighters occurred during the study period. There were a total of 96 injuries to 78 fighters. Of the 171 matches fought, 69 (40.3%) ended with at least one injured fighter. The overall injury rate was 28.6 injuries per 100 fight participations or 12.5 injuries per 100 competitor rounds. Facial laceration was the most common injury accounting for 47.9% of all injuries, followed by hand injury (13.5%), nose injury (10.4%), and eye injury (8.3%). With adjustment for weight and match outcome, older age was associated with significantly increased risk of injury. The most common conclusion to a MMA fight was a technical knockout (TKO) followed by a tap out. The injury rate in MMA competitions is compatible with other combat sports involving striking. The lower knockout rates in MMA compared to boxing may help prevent brain injury in MMA events. Key PointsMixed martial arts (MMA) has changed since the first MMA matches in the United States and now has increased safety regulations and sanctioning.MMA competitions have an overall high rate of injury.There have been no MMA deaths in the United States.The knockout (KO) rate in MMA appears to be lower than the KO rate of boxing matches.MMA must continue to be supervised by properly trained medical professionals and referees to ensure fighter safety in the future.

Evidence of nationalistic bias in muaythai

MuayThai is a combat sport with a growing international profile but limited research conducted into judging practices and processes. Problems with judging of other subjectively judged combat sports have caused controversy at major international tournaments that have resulted in changes to scoring methods. Nationalistic bias has been central to these problems and has been identified across a range of sports. The aim of this study was to examine nationalistic bias in MuayThai. Data were collected from the International Federation of MuayThai Amateur (IFMA) World Championships held in Almaty, Kazakhstan September 2003 and comprised of tournament results from 70 A-class MuayThai bouts each judged by between five and nine judges. Bouts examined featured 62 competitors from 21 countries and 25 judges from 11 countries. Results suggested that nationalistic bias was evident. The bias observed equated to approximately one round difference between opposing judges over the course of a bout (a mean of 1.09 (SE=0.50) points difference between judges with opposing affilations). The number of neutral judges used meant that this level of bias generally did not influence the outcome of bouts. Future research should explore other ingroup biases, such as nearest neighbour bias and political bias as well as investigating the feasibility adopting an electronic scoring system. Key PointsNationalistic bias is evident in international amateur MuayThai judging.The impact on the outcome of bouts is limited.The practice of using a large number of neutral judges appears to reduce the impact of nationalistic bias.

Concussion in professional football: comparison with boxing head impacts--part 10

OBJECTIVE

This study addresses impact biomechanics from boxing punches causing translational and rotational head acceleration. Olympic boxers threw four different punches at an instrumented Hybrid III dummy and responses were compared with laboratory-reconstructed NFL concussions.

METHODS

Eleven Olympic boxers weighing 51 to 130 kg (112-285 lb) delivered 78 blows to the head of the Hybrid III dummy, including hooks, uppercuts and straight punches to the forehead and jaw. Instrumentation included translational and rotational head acceleration and neck loads in the dummy. Biaxial acceleration was measured in the boxer's hand to determine punch force. High-speed video recorded each blow. Hybrid III head responses and finite element (FE) brain modeling were compared to similarly determined responses from reconstructed NFL concussions.

RESULTS

The hook produced the highest change in hand velocity (11.0 +/- 3.4 m/s) and greatest punch force (4405 +/- 2318 N) with average neck load of 855 +/- 537 N. It caused head translational and rotational accelerations of 71.2 +/- 32.2 g and 9306 +/- 4485 r/s. These levels are consistent with those causing concussion in NFL impacts. However, the head injury criterion (HIC) for boxing punches was lower than for NFL concussions because of shorter duration acceleration. Boxers deliver punches with proportionately more rotational than translational acceleration than in football concussion. Boxing punches have a 65 mm effective radius from the head cg, which is almost double the 34 mm in football. A smaller radius in football prevents the helmets from sliding off each other in a tackle.

CONCLUSION

Olympic boxers deliver punches with high impact velocity but lower HIC and translational acceleration than in football impacts because of a lower effective punch mass. They cause proportionately more rotational acceleration than in football. Modeling shows that the greatest strain is in the midbrain late in the exposure, after the primary impact acceleration in boxing and football.

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.

Central nervous system injuries in sport and recreation: a systematic review

Many sports have been associated with a variety of neurological injuries affecting the central nervous system (CNS), with some injuries specific to that sport. A systematic review of sport-specific CNS injuries has not been attempted previously, and could assist in the understanding of morbidity and mortality associated with particular sporting activities, either professional or amateur. A systematic review of the literature was performed using PubMed (1965-2003) examining all known sports and a range of possible CNS injuries attributable to that sport. Numerous sporting activities (45) have associated CNS injuries as reported within the literature. The sports most commonly associated with CNS injuries are: football, boxing, hockey, use of a trampoline, and various winter activities. A number of sporting activities are associated with unique CNS injuries or injury-related diseases such as heat stroke in auto racing, vertebral artery dissection in the martial arts, and dementia pugilistica in boxing. Neurological injuries of the CNS due to sport comprise a wide collection of maladies that are important for the neurologist, neurosurgeon, orthopaedic surgeon, physiatrist, sports medicine doctor, athletic trainer and general physician to recognise.

Biomechanics of the head for Olympic boxer punches to the face

OBJECTIVE

The biomechanics of the head for punches to the jaw and the risk of head injury from translational and rotational acceleration were studied. [figure: see text]

METHODS

Seven Olympic boxers from five weight classes delivered 18 straight punches to the frangible face of the Hybrid III dummy. Translational and rotational head acceleration, neck responses, and jaw pressure distribution were measured. High speed video recorded each blow and was used to determine punch velocity. Equilibrium was used to determine punch force, energy transfer, and power.

RESULTS

Punch force averaged 3427 (standard deviation (SD) 811) N, hand velocity 9.14 (SD 2.06) m/s, and effective punch mass 2.9 (SD 2.0) kg. Punch force was higher for the heavier weight classes, due primarily to a higher effective mass of the punch. Jaw load was 876 (SD 288) N. The peak translational acceleration was 58 (SD 13) g, rotational acceleration was 6343 (SD 1789) rad/s(2), and neck shear was 994 (SD 318) N.

CONCLUSIONS

Olympic boxers deliver straight punches with high impact velocity and energy transfer. The severity of the punch increases with weight class.

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.

A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia

OBJECTIVES

To determine the rate and type of injuries occurring to registered professional kickboxers in Victoria, Australia over a 16 year period.

METHODS

Data describing all fight outcomes and injuries sustained during competition for the period August 1985 to August 2001 were obtained from the Victorian Professional Boxing and Combat Sports Board.

RESULTS

A total of 382 injuries were recorded from 3481 fight participations, at an injury rate of 109.7 injuries per 1000 fight participations. The most common body region injured was the head/neck/face (52.5%), followed by the lower extremities (39.8%). Specifically, injuries to the lower leg (23.3%), the face (19.4%), and intracranial injury (17.2%) were the most common. Over 64% of the injuries were superficial bruising or lacerations.

CONCLUSION

The nature of kickboxing, whereby kicking the opponent is the prime movement and the head a prime target, is reflected in the distributions of body regions most commonly injured by participants. Further research into injury patterns in different styles of kickboxing and the mechanism of injury occurrence is required. Exposure adjusted prospective studies are needed to monitor injury rates over time.