A systematic review of prospective epidemiological research into injury and illness in Olympic combat sport

Mental health surveillance in elite Para athletes: early identification and follow-up of athletes at risk of mental health problems

OBJECTIVE

There is a lack of prospective data on mental health of elite Para athletes. The objective was to identify and follow elite Para athletes at risk of mental health problems.

METHODS

In a 124-week prospective cohort study, mental health of German elite Para athletes was monitored using the Patient Health Questionnaire-4 (PHQ-4). In case of positive screening (PHQ-4≥5) over 2 weeks, a follow-up contact was conducted by a sports psychiatrist, who asked the athletes about their mental condition and sources for their mental distress and offered support.

RESULTS

7543 PHQ-4 scores were obtained from 122 Para athletes with a mean weekly response rate of 84%. The PHQ-4 screening was considered positive for symptoms of depression or anxiety with a prevalence of 6.7%, affecting 48.4% (n=59) of all participants at some point during the study period. In 76.6% (n=49) of all follow-up contacts, athletes (n=34) reported at least one mental health problem, most frequently mental distress (n=31), followed by symptoms of depression (n=19) including acute suicidality (n=1). The most common mental stressors cited were related to education and problems with the team, coaches or federation. At follow-up, almost two-thirds of the athletes were either already in professional psychiatric or psychological care (25%) or were recommended to seek such care (32.8%).

CONCLUSION

Our screening and follow-up system revealed high rates of mental health problems in elite Para athletes. Programmes for early identification with mental health monitoring under the supervision of mental health professionals should be considered by sports federations for Para athletes.

Injury Risk Analysis among Judo Athletes with Intellectual Disabilities

The main aim of this study was to evaluate injury prevalence, incidence rate, and burden in judo athletes with intellectual disabilities (ID) who participate in international competitions. This retrospective cross-sectional study analyzed data from the past year for 182 judo athletes with ID. Data was collected using a self-reported questionnaire, adapted from previous research, that included questions about injuries impacting training or competition, injury type, mechanism, severity, diagnosis, and location on the body. The injury prevalence among judo athletes with ID occurred most often during training (68.2%) and primarily affected the lower extremities (35%). Age group and injury prevalence were significantly related (χ2=7.91; P=0.04), while gender, weight, and ability level were not. Results were closer to those previously reported for conventional judo, which is likely due to the lower practice intensity among judo athletes with ID. Injury prevalence was lower than in prior studies, but the incidence rates aligned when considering training time in judo athletes with ID. Injury burden analysis revealed that females had a lower burden than males, while older athletes experienced a higher burden than younger athletes. Most injuries occur during training, which is likely attributable to safety-focused competition rules.

Musculoskeletal disorders among dental assistants: a cross-sectional study

BACKGROUND

This study aims to investigate the prevalence of musculoskeletal disorders (MSDs) and associated sociodemographic and work-related factors among dental assistants (DAs) in the hail province, Saudi Arabia.

METHODS

Participants were 119 DAs with an average age of 28.9 years (SD ± 4.8 years), of whom 86.6% were females. A self-administered questionnaire which included Nordic Musculoskeletal questionnaire and questions on socio-demographic and work-related factors was used. Descriptive statistics were used to calculate the prevalence of MSDs during the past 12 months and 7 days. Multivariate binary logistic regression statistical tests were used to calculate the association between MSDs and socio-demographic and work-related factors.

RESULTS

The overall prevalence of MSDs among DAs was significantly high, with 85.7% reporting symptoms during the past 12 months and 47.9% during the past 7 days. The shoulders, followed by the lower back, were the most common complaints among participants in the past 12 months and 7 days, followed by the upper back and neck. Multivariate binary logistic regression analysis results show significant associations between MSDs and age, Body-Mass-Index (BMI), physical demands during working hours, work environment and posture awareness, and years of experience.

CONCLUSIONS

The prevalence of MSDs among DAs is high, and sociodemographic and work-related factors play an important role in exacerbation of MSDs in DAs.

Martial Arts: Orthopaedic Injuries and Related Biomechanics

Martial arts are various systems of combat skills encompassing striking and grappling. Many styles have evolved into modern sports, and some have been included in the Olympics. The physicality of these can predispose practitioners to musculoskeletal injuries, such as anterior cruciate ligament ruptures; patellar, shoulder, or elbow instabilities; extremity fractures; and hand and spine injuries, which have been studied both clinically and biomechanically. The most common injury related to longer time loss from participation is an anterior cruciate ligament rupture. Higher injury incidence is associated with a higher level of experience and competition. Orthopaedic management of martial arts injuries should reflect the specific needs of each martial artist and the biomechanics of motions common to each style. Full-contact practitioners may benefit from broader surgical indications and special attention to the choice and positioning of implants; nonsurgical treatment may be appropriate for certain pediatric or noncontact practitioners. Approximately 60% of martial artists can return to the preinjury level of participation after a major injury. Injury prevention and rehabilitation programs should optimize neuromotor control and core engagement to ensure proper body mechanics. Gradual incorporation of martial arts movement into the postoperative physical therapy curriculum can benefit physical progress and help gain confidence toward full participation.

Impact of adapted taekwondo vs. multicomponent training on health status in independent older women: a randomized controlled trial

This study, called the TKD and Aging Project, aimed to analyze and compare the effects of an adapted taekwondo program concerning multicomponent training on blood pressure, morphological variables, food consumption frequency, health-related quality of life (HRQoL), physical fitness, handgrip strength, and postural balance in independent older women. A randomized controlled trial study was conducted with parallel groups for 8 weeks (24 sessions of 60 min each), employing a double-blind design and incorporating repeated measures. Twenty-eight older women initially participated in the intervention. Three participants were excluded because they did not participate in the re-assessments. Thus, 14 older women from the adapted taekwondo group (TKD; age: 62.86 ± 2.38 years) and 11 from the multicomponent training group (MCT; age: 63.18 ± 1.94 years) participated in the final analysis. A two-factor mixed analysis of variance (ANOVA) model with repeated measures was performed to measure the time × group effect. The TKD showed significant improvements in the mental health (p = 0.024; ES = 0.91) and general health (p < 0.001; ES = 0.75) dimensions of the HRQoL, as well as in the chair stand (p = 0.001; ES = 1.18), arm curl (p < 0.001; ES = 2.10), 2-min step (p < 0.001; ES = 1.73), and chair sit-and-reach (p = 0.001; ES = 0.91) tests. Additionally, it showed a significant reduction in postural balance for the eyes-closed condition in the center of the pressure area (p = 0.021; ES = 0.89), mean velocity (p = 0.004; ES = 0.79), and mediolateral velocity (p < 0.001; ES = 1.26). However, the MCT showed significant increases in the general health (p = 0.013; ES = 0.95) dimension of the HRQoL and a significant reduction (p = 0.039; ES = 0.28) in the mediolateral velocity of postural balance for the eyes-closed condition. Multiple comparisons showed that the TKD scored significantly higher in the chair stand (p = 0.017; ES = 1.79), arm curl (p = 0.003; ES = 1.77), and 2-min step (p = 0.018; ES = 0.91) tests than the MCT. Compared to multicomponent training, taekwondo improves postural balance and provides better benefits in terms of physical fitness and HRQoL for older women. Therefore, it is possible to recommend it as a safe physical activity strategy, as long as it is well-dosed, since it showed high adherence to intervention in older women.

2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.

Musculoskeletal pains among amateur and professional athletes of five disciplines in Senegal: a preliminary study

BACKGROUND

Musculoskeletal pains (MSPs) in sport are cause of poor performances and loss of competition in athletes. The present study aimed at determining the prevalence of MSPs with regard to sport disciplines and athletic status.

METHODS

A cross-sectional study was conducted among 320 Senegalese professional and amateur athletes practicing football, basketball, rugby, tennis, athletics, and wrestling. Rates of MSPs in the past year (MSPs-12) and week (MSPs-7d) were assessed using standard questionnaires.

RESULTS

Overall proportions of MSPs-12 and MSPs-7d were 70 and 74.2%, respectively. MSPs-12 were more frequently reported on shoulders (40.6%), neck (37.1%) and hips/thigh (34.4%), while MSPs-7d were predominant on hips/thigh (29.5%), shoulders (25.7%), and upper back (17.2%). Proportions of MSPs-12 and MSPs-7d varied significantly by sport disciplines, with highest values among basketball players. Again, highest MSPs-12 proportions on shoulders (29.7%, P = 0.02), wrists/hands (34.6%, P = 0.001), (40.2%, P = 0.0002), and knees (38.8%, P = 0.002) were seen among basketball players. High proportions of MSPs-7d were seen on shoulders (29.6%, P = 0.04) for tennis players, wrists/hands (29.4%, P = 0.03) for basketball and football players, and hips/thigh (38.8%, P < 0.00001) for basketball players. Football players had reduced risk of MSPs-12 by 75% on lower back (OR = 0.25; 95% CI. 0.10-0.63; P = 0.003) and by 72% on knees (OR = 0.28; 95% CI. 0.08-0. 95; P = 0.04). In contrast, tennis players were more at risk of MSPs-12 on shoulders (OR = 3.14; 95% CI. 1.14-8.68; P = 0.02), wrists/hands (OR = 5.18; 95% CI.1.40-11.13; P = 0.01), and hips/thigh (OR = 2.90; 95% CI. 1.1-8.38; P = 0.04). Professionals were protected from MSPs-12 on neck pain with a significant reduction of risk by 61% (OR = 0.39, 95% CI. 0.21-0.75, P = 0.03).

CONCLUSION

MSPs are a reality among athletes and their risk is modulated by sport disciplines, athletic status and gender.

Incidence Rates and Pathology Types of Boxing-Specific Injuries: A Systematic Review and Meta-analysis of Epidemiology Studies in the 21st Century

Background

To the best of our knowledge, an evidence-based investigation into 21st-century boxing-specific injury rates and types has yet to be performed.

Purpose

To provide an overview and quantitative synthesis of the incidence rates (IRs) and pathological categorizations of boxing-specific injuries in the 21st century.

Study Design

Systematic review; Level of evidence, 3.

Methods

Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched literature published from January 2000 to November 2021 in PubMed and the Cochrane Library systematically for qualifying epidemiology studies of organized boxing activities across the world. Two independent reviewers completed the literature review, data extraction, and quality assessment. The IRs of injuries per 1000 boxers (IR_N), per 1000 competition exposures (IR_E), and per 1000 minutes of competition (IR_C) or training (IR_T) were subsequently calculated. Single-arm meta-analyses were performed for the subgroups of different types of boxing. Sample size weighted means were calculated using a random-effects model in all studies with 95% CIs.

Results

Out of an initial 9584 articles, 14 studies were included, with most (11/14) having a moderate level of quality. The pooled IR_N in overall injuries was 223.9 (95% CI, 157.5-290.4), the IR_E was 233.3 (95% CI, 161.3-305.2), and the IR_C was 13.0 (95% CI, 8.9-17.1). In professional boxing, the IR_N (399.8), IR_E (379.8), and IR_C (23.9) were all significantly higher than in the amateur and female groups. The IR_E (76.6 vs 250.6; P < .000) and IR_C (9.2 vs 15.4; P < .000) in amateur boxing were significantly lower in studies between 2010 and 2019 than in earlier studies. For pathology categorization, the pooled frequencies were 12.3% (95% CI, 8.7%-15.9%) for concussion, 21.4% (95% CI, 14.1%-28.6%) for skin laceration, 30.2% (95% CI, 22.1%-38.2%) for soft tissue contusion, 15.3% (95% CI, 7.7%-22.9%) for sprain and muscle/ligament injury, and 11.4% (95% CI, 2.7%-20.1%) for fracture.

Conclusion

IRs of injury remain high in professional boxing, although they have decreased in the past 10 years in amateur boxing. Soft tissue contusion was the most common injury type. Better exposure measurements and epidemiologic indicators should be applied in future studies.

Registration

CRD42021289993 (PROSPERO).

Epidemiology of Injuries during Judo Tournaments

Objective

To determine the injury incidence proportion, distribution of injuries by anatomical location; injury type; injury severity, time loss; mechanism and situations of injuries; and the relative risk of injuries by gender, age, and weight categories during judo tournaments. Study Design. It is a systematic review. Data Sources. A systematic review of the literature was conducted via searches in PubMed, EMBASE, Web of Science, CINAHL, SPORTDiscus, Google Scholar, and PEDro. Eligibility Criteria. All original studies on the incidence of injuries during judo tournaments were included.

Results

Twenty-five studies were included out of the 1979 studies. Using the modified AXIS tool score for quality assessment, seven were rated as having good quality, nine were rated as having fair quality, and four were rated as having poor quality. The injury incidence proportion during tournaments ranged from 2.5% to 72.5% for injuries requiring medical evaluation and 1.1% to 4.1% for injuries causing time loss (i.e., inability to continue game participation). The most commonly reported injury location was the head, followed by the hand, knee, elbow, and shoulder. The most frequent types of injury were sprains, followed by contusions, skin lacerations, strains, and fractures. In judo tournaments, injuries were more often sustained during standing fights (tachi-waza) than in ground fights (ne-waza).

Conclusion

The tournament injury incidence proportion ranged from 2.5% to 72.5% for injuries requiring medical attention and 1.1% to 4.1% for injuries causing time loss. The head was the most frequently injured body part, and sprain was the most frequent injury type. However, current reports on injuries during judo tournaments are heterogeneous and inconsistent, limiting our understanding of in-match injury risks. Future studies should utilize the guidelines of the International Olympic Committee consensus meeting statement on the methodological approach to injury reporting. We recommend a judo-specific extension of this statement to fit the unique features of judo sports practice.

Which sports have a higher risk of maxillofacial injuries?

OBJECTIVES

Sports etiology is one of the most common causes of maxillofacial injuries. This work aimed to provide an up-to-date review of sports-related maxillofacial injuries.

METHODS

An updated review was conducted on Pubmed and Google Scholar. No publication year and language restrictions were applied. Two different search strategies were performed, the first addressed which sports, generally associated with maxillofacial injuries, and the second search was conducted to determine the frequency of maxillofacial injuries associated with each sport individually.

RESULTS

The first search returned 26 articles distributed across different sports, from different countries, and with varied age distribution. The second search displayed 85 articles on individual sports group. Papers were rated and categorized according by the sport associated to the reported injury. A useful sports risk scale for maxillofacial injuries has been developed. Peculiar themes from all participating sports were evaluated. The use of protective equipment and other preventive measures were highlighted.

CONCLUSIONS

Some sports with ball and cycling can be considered riskier sports for maxillofacial injuries. Athlete education and the mandatory use of mouthguards, helmets, and eye protection, among other things, are crucial to prevent these injuries. Tailor-made mouthguards and protective masks, which are becoming cheaper, are in vogue. The Sports-related Maxillofacial Injuries Risk scale can be useful for athletes, athletic coaches, and maxillofacial surgeons.

A Systematic Review with Meta-Analysis on the Effects of Plyometric-Jump Training on the Physical Fitness of Combat Sport Athletes

We aimed to assess the athletic performance changes in combat sport athletes (CoSAs) after plyometric-jump training (PJT), compared to control conditions, through a systematic review with meta-analysis. Following PRISMA guidelines, three electronic databases were searched for includable articles, according to a PICOS approach. Using a random-effects model, Hedges' g effects sizes (ES) were calculated. Heterogeneity was assessed using the I² statistic, with values of <25%, 25-75%, and >75% representing low, moderate, and high levels of heterogeneity, respectively. Statistical significance was set at p ≤ 0.05. The certainty of evidence was assessed using the GRADE approach. Twelve eligible articles were identified for systematic review, seven of high quality and five of moderate quality, according to the PEDro scale. The studies recruited taekwondo, silat, wrestling, judo, fencing, and karate athletes (292 total participants), including specific-active and active controls. Most participants had a mean age of <18 years and were males (n = 225). Compared to the control, PJT programmes, involving 4-12 weeks and 2-3 sessions per week, induced small to moderate improvements (ES = 0.47 to 1.04) in athletes' maximal strength (e.g., 1RM squat), vertical jump height, change-of-direction speed, and specific performance (e.g., fencing movement velocity), although without meaningful effects on body mass, fat mass, and muscle mass (ES = 0.02 to -0.06). Most (7 of 8) outcomes attained low heterogeneity. The outcome-level GRADE analysis indicated a certainty of evidence from low to moderate. In conclusion, PJT, when compared to control conditions, may improve CoSA athletic performance.

Incidence of Sport Injuries in the Manchester 2019 World Taekwondo Championships: A Prospective Study of 936 Athletes from 145 Countries

We aimed to describe injury incidence and patterns at the 2019 World Taekwondo Championships (WTC), and to compare them with those of previous WTCs, based on new World Taekwondo (WT) competition rules, medical codes, and the Protector and Scoring System (PSS). This prospective cohort study utilized data obtained through the WT Injury Surveillance System. All athletes with injuries were evaluated by on-site sports medicine specialists, and ultrasonography was used to assess all musculoskeletal injuries. Of 936 athletes, 60 injuries were recorded (6.4 injuries/100 athletes, 95% confidence intervals [CI]: 4.8-8.0), and 4.5% (n = 42) sustained at least one injury. Males had a higher risk of sustaining injuries than females (incidence rate ratio: 1.57; 95% CI: 0.89-2.76). The most common sites, type, and mechanism were lower extremities (n = 26, 43.33%), contusion/hematoma/bruises (n = 33, 55.0%), and contact with another athlete (n = 50, 83.33%). Overall, the injury patterns associated with the mechanism of injury were similar in both the 2019 and 2017 WTCs. Refined WT competition rules and a re-established PSS at the 2019 WTC reduced the overall and severe injury incidence. Our findings can help revise Taekwondo competition rules, enhance protective equipment, optimize on-site venue medical systems, and develop injury prevention projects.

Lymphocyte and dendritic cell response to a period of intensified training in young healthy humans and rodents: A systematic review and meta-analysis

Background: Intensified training coupled with sufficient recovery is required to improve athletic performance. A stress-recovery imbalance can lead to negative states of overtraining. Hormonal alterations associated with intensified training, such as blunted cortisol, may impair the immune response. Cortisol promotes the maturation and migration of dendritic cells which subsequently stimulate the T cell response. However, there are currently no clear reliable biomarkers to highlight the overtraining syndrome. This systematic review and meta-analysis examined the effect of intensified training on immune cells. Outcomes from this could provide insight into whether these markers may be used as an indicator of negative states of overtraining. Methods: SPORTDiscus, PUBMED, Academic Search Complete, Scopus and Web of Science were searched until June 2022. Included articles reported on immune biomarkers relating to lymphocytes, dendritic cells, and cytokines before and after a period of intensified training, in humans and rodents, at rest and in response to exercise. Results: 164 full texts were screened for eligibility. Across 57 eligible studies, 16 immune biomarkers were assessed. 7 were assessed at rest and in response to a bout of exercise, and 9 assessed at rest only. Included lymphocyte markers were CD3⁺, CD4⁺ and CD8⁺ T cell count, NK cell count, NK Cytolytic activity, lymphocyte proliferation and CD4/CD8 ratio. Dendritic cell markers examined were CD80, CD86, and MHC II expression. Cytokines included IL-1β, IL-2, IL-10, TNF-α and IFN-γ. A period of intensified training significantly decreased resting total lymphocyte (d= -0.57, 95% CI -0.30) and CD8⁺ T cell counts (d= -0.37, 95% CI -0.04), and unstimulated plasma IL-1β levels (d= -0.63, 95% CI -0.17). Resting dendritic cell CD86 expression significantly increased (d = 2.18, 95% CI 4.07). All other biomarkers remained unchanged. Conclusion: Although some biomarkers alter after a period of intensified training, definitive immune biomarkers are limited. Specifically, due to low study numbers, further investigation into the dendritic cell response in human models is required.

Concussion vs. resignation by submission: Technical–tactical behavior analysis considering injury in mixed martial arts

This research study verified the technical–tactical actions during the mixed martial arts (MMA) fights to generate serious enough injury to stop the MMA round, determining technical-tactical potential risk factors for injury in official MMA combats, according to Concussion or Resignation per Submission. A total of 990 rounds with concussions and 627 resignations per submission were considered with severe injury (i.e., a fight ended by a doctor or referee). All injuries were diagnosed and managed by attending ringside physicians during the MMA fights and rounds and had a continuous technical–tactical behavior analysis, p ≤ 0.05. The leading cause of concussion was due to head trauma (~90%), with higher dependence on head strikes scored actions. Comparisons between Concussion and Resignation per Submission combats demonstrated differences between distance head strikes actions [13(6,25) vs. 9(4,18) frequencies], clinch head strikes actions [1(0;4) vs. 1(0;3) frequencies], ground head strikes actions [1(0;8) vs. 2(0;10) frequencies] and takedowns actions [0(0;1) vs. 1(0;2) frequencies]. This information may provide significant evidence regarding the doctor stoppage in concussion combats and when it could be called by officials supervising MMA.

RELATIONSHIP BETWEEN COMPETITION SIMULATION AND TRAINING ON STRENGTH AND DAMAGE INDICATORS IN JIU-JITSU

ABSTRACT Background: The relationship between training and competition is very important and aims at a more specific and adequate preparation in Jiu-Jitsu. Problem and objective: To evaluate the relationship between training and competition through indications of injury and muscle strength. Methods: The study sample included nine subjects (22.54 ± 2.77 years of age) who were submitted to the following two conditions: 1) training simulation and 2) competition simulation. Results: There were no significant differences in the countermovement jump (CMJ) test. However, 48 hours after training there was an indication of values higher than the post-competition ones. Creatine kinase (CK) indicated significant differences in muscle damage after competition in relation to the other conditions and moments (p <0.01) with a high effect. Lactate dehydrogenase (LDH) showed differences in the moments before, during, and after both competition and training conditions (p <0.05) with a high effect. The power of the upper limbs (PUL) showed a medium correlation at 24h (> 0.55) and 48h (0.47) after the intervention. There was high correlation (> 0.70) for all conditions in the squat jump (SJ). LDH showed a high correlation (> 0.70) at 48 hours. Conclusion: There was a good correlation between training and competition simulation, which tends to indicate that the training model used in the study properly prepare Jiu-Jitsu athletes for the demands of competition. Level of evidence I; High-quality randomized clinical trial with or without a statistically significant difference, but with narrow confidence intervals.

Sports injuries in amateur recreational Taekwondo athletes

ABSTRACT Combat sports are very common in sport mega-events. Taekwondo is a combat sport that prioritizes direct contact between participants, specially by kicks and punches, and provides ambiguity in the health-sport relationship, as its practice could be harmful. This study aimed to quantify the prevalence of injuries in amateur Taekwondo athletes, from training or competitions, and assess their association with intrinsic and extrinsic factors. This is a descriptive, observational, and retrospective study that assessed injuries by a reported morbidity inquiry. Information on sports injuries considered the last six months of 2018. Participants were athletes aged from 12 to 25 years old, of both sexes, practicing Taekwondo in the city of Pelotas, Rio Grande do Sul, Brazil. The prevalence of sports injuries in amateur Taekwondo athletes in Pelotas was 26.2% (n=1), without significant differences between sexes. The main reason for the practice was physical conditioning (35.7%). The main mechanism of injury was kick when attacking (45.4%), followed by impact when defending (27.3%). The most frequent type of injury was sprain (27.3%). followed by contusion (18.2%), and the most injured body parts were knees (36.4%) and ankles (36.4%). The prevalence of sports injuries in amateur Taekwondo athletes in Pelotas was lower than the one found in the literature, and it may be due to the nature of the practice, as they are recreational amateur athletes aiming to improve physical conditioning.

Lesões desportivas em atletas recreacionais amadores de taekwondo

RESUMO As modalidades esportivas de combate (MEC) são muito frequentes em megaeventos esportivos e, dentre elas, destaca-se o taekwondo, que prioriza o contato direto entre os participantes principalmente a partir de chutes e socos, e proporciona ambiguidade na relação saúde-desporto, pois sua prática pode ser lesiva. O objetivo do estudo foi quantificar a prevalência de lesões em atletas recreacionais de taekwondo, oriundas de treinos ou competições, e testar sua associação a fatores intrínsecos e extrínsecos. Trata-se de estudo observacional descritivo, de natureza retrospectiva, que empregou inquérito de morbidade referida para registro dos agravos. As informações quanto à lesão desportiva foram registradas considerando os últimos seis meses de 2018. Participaram atletas com idade entre 12 e 25 anos, de ambos os sexos, praticantes de taekwondo na cidade de Pelotas, no Rio Grande do Sul. A prevalência de lesões desportivas em praticantes recreacionais de taekwondo na cidade de Pelotas é 26,2% (n=11), sem diferenças significantes entre sexos. O principal motivo de prática é o condicionamento para saúde (35,7%); o principal mecanismo de lesão foi chute atacando (45,4%), seguido de impacto ao realizar defesa (27,3%); o tipo de lesão mais frequente foi entorse (27,3%), seguido de contusão (18,2%); e os segmentos corporais mais lesionados foram joelho (36,4%) e tornozelo (36,4%). A prevalência de lesões desportivas em praticantes recreacionais de taekwondo da cidade de Pelotas é inferior à encontrada na literatura, e isto pode decorrer da natureza da prática, dado que eles são atletas recreacionais amadores, com a prática direcionada ao condicionamento para a saúde.

Maximum Isometric and Dynamic Strength of Mixed Martial Arts Athletes According to Weight Class and Competitive Level

Mixed martial arts (MMA) athletes must achieve high strength levels to face the physical demands of an MMA fight. This study compared MMA athletes’ maximal isometric and dynamic strength according to the competitive level and weight class. Twenty-one male MMA athletes were divided into lightweight professional (LWP; n = 9), lightweight elite (LWE; n = 4), heavyweight professional (HWP; n = 4), and heavyweight elite (HWE; n = 4). The handgrip and isometric lumbar strength tests assessed the isometric strength, and the one-repetition maximum (1RM) bench press and 4RM leg press the dynamic strength. Univariate ANOVA showed differences between groups in absolute and relative 1RM bench press and absolute isometric lumbar strength. Post hoc tests showed differences in 1RM bench press between HWE and LWE (117.0 ± 17.8 kg vs. 81.0 ± 10.0 kg) and HWE and LWP athletes (117.0 ± 17.8 kg vs. 76.7 ± 13.7 kg; 1.5 ± 0.2 kg·BW−1 vs. 1.1 ± 0.2 kg·BW−1). In addition, there was a correlation between 1RM bench press and isometric lumbar strength for absolute (r = 0.67) and relative values (r = 0.50). This study showed that the 1RM bench press and isometric lumbar strength were associated and could differentiate MMA athletes according to their competitive level and weight class. Therefore, optimizing the force production in the upper body and lower back seems important in elite and professional MMA athletes.

Effectiveness of Adapted Taekwondo, Multi-Component Training and Walking Exercise on Health Status in Independent Older Women: Study Protocol for a Randomized Controlled Trial (TKD & Aging Project)

This study protocol aims to analyze and compare the effects of an adapted taekwondo program with respect to multi-component training and walking exercise on health status in independent older women. Secondarily, we analyze the variability of the inter-individual response and compare it according to the designated training system. The sample will consist of 64 women between 60 and 65 years, randomly assigned to experimental group 1 (n = 16; adapted taekwondo), experimental group 2 (n = 16; multi-component training), experimental group 3 (n = 16, walking exercise) or control group (n = 16; no intervention). The experimental groups will perform the designated training for three sessions (60 min per session) per week over 16-weeks, while the control group will not receive any treatment. The main outcome will provide information about (i) blood pressure, (ii) lipid profile, (iii) frequency of food consumption, (iv) body composition, (v) cognitive status, (vi) brain activity, (vii) health-related quality of life (HRQoL) and (viii) physical-functional fitness. Our hypothesis indicates that adapted taekwondo produces more significant effects and greater inter-individual responses in cognitive status, brain activity, HRQoL, and postural balance than the others training methods. If this intervention proves effective, it could be an alternative for older women.

Effects of Olympic Combat Sports on Health-Related Quality of Life in Middle-Aged and Older People: A Systematic Review

Olympic combat sports are unconventional physical activity strategies to train middle-aged and older people with and without health problems. This systematic review aimed to assess the available body of published peer-reviewed articles related to the effects of Olympic combat sports interventions (boxing, fencing, judo, karate, taekwondo, wrestling) on health-related quality of life in adults aged 45 and older. The search was carried out in five generic databases until July 2021 and the protocol was registered in PROSPERO (code: CRD42021244161). The PRISMA guidelines were followed and the Downs and Black checklist was used to assessed the methodological quality of the studies. After reviewing 1,151 records, only seven studies met the inclusion criteria, adding 212 participants (43.4% female) with a mean age of 63.7 years. Six studies (two with middle-aged participants and four with older people) provided data to calculate the effect size (ES) in the Olympic combat sports groups (No research that used taekwondo or wrestling as an intervention modality was found). Three studies reported beneficial changes with a small ES for the total score (d < 0.40) of the health-related quality of life. Two studies reported a beneficial change with a small ES (d = 0.49) and strong ES (d = 4.45) for physical health. One study reported improvements with a small ES for emotional (d = 0.23) and functional (d = 0.26) well-being. In conclusion, interventions based on Olympic combat sports produce beneficial effects with a small and moderate ES on health-related quality of life in male and female aged 45 and older who are healthy participants, participants with Parkinson's disease, and participants with breast cancer. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, PROSPERO: CRD42021244161.

Effectiveness of Olympic Combat Sports on Balance, Fall Risk or Falls in Older Adults: A Systematic Review

Simple Summary

The regular practice of physical activity has achieved greater diffusion in recent years as a strategy for fall prevention and improving or maintaining the general health status of older adults, which contributes to an active and healthy lifestyle. The strategies to promote active and healthy aging need to be reassessed due to the COVID-19 pandemic to promote the safe practice of physical activity among older adults, considering, among other measures, practicing social distancing or training at home. Such a scenario could provide the opportunity to promote physical activity that requires a limited number of participants in reduced spaces for its practice, such as Olympic combat sports. In this review, an overview of the effects of Olympic combat sports on balance, fall risk, or falls in older adults is presented. From 1496 records, eight studies were included, involving 322 older adults (64% female; mean age = 71.1 years). The available evidence does not allow a definitive recommendation for or against Olympic combat sports interventions as an effective strategy to improve balance and reduce the fall risk or falls in older adults. Therefore, more high-quality studies are required to draw definitive conclusions.

Abstract

This systematic review and meta-analysis aimed to assess the available body of published peer-reviewed articles related to the effects of Olympic combat sports (OCS), compared with active/passive controls, on balance, fall risk, or falls in older adults. The TESTEX and GRADE scales assessed the methodological quality and certainty of the evidence. The protocol was registered in PROSPERO (code: CRD42020204034). From 1496 records, eight studies were included, involving 322 older adults (64% female; mean age = 71.1 years). The TESTEX scale revealed all studies with a score ≥ 60% (moderate-high quality). The GRADE scale indicated all studies with at least some concerns, up to a high risk of bias (i.e., was rated very low). Meta-analyses were planned, although the reduced number of studies precluded its incorporation in the final manuscript. Only two from six studies that assessed balance found improvements after OCS compared to controls. No differences were found between OCS vs. control groups for fall risk or falls. The available evidence does not allow a definitive recommendation for or against OCS interventions as an effective strategy to improve balance and reduce the fall risk or falls in older adults. Therefore, more high-quality studies are required to draw definitive conclusions.

Nutritional Considerations for Injury Prevention and Recovery in Combat Sports

Sports participation is not without risk, and most athletes incur at least one injury throughout their careers. Combat sports are popular all around the world, and about one-third of their injuries result in more than 7 days of absence from competition or training. The most frequently injured body regions are the head and neck, followed by the upper and lower limbs, while the most common tissue types injured are superficial tissues and skin, followed by ligaments and joint capsules. Nutrition has significant implications for injury prevention and enhancement of the recovery process due to its effect on the overall physical and psychological well-being of the athlete and improving tissue healing. In particular, amino acid and protein intake, antioxidants, creatine, and omega-3 are given special attention due to their therapeutic roles in preventing muscle loss and anabolic resistance as well as promoting injury healing. The purpose of this review is to present the roles of various nutritional strategies in reducing the risk of injury and improving the treatment and rehabilitation process in combat sports. In this respect, nutritional considerations for muscle, joint, and bone injuries as well as sports-related concussions are presented. The injury risk associated with rapid weight loss is also discussed. Finally, preoperative nutrition and nutritional considerations for returning to a sport after rehabilitation are addressed.

High-Intensity Conditioning for Combat Athletes: Practical Recommendations

Combat sports have been practiced for millennia and today are predominant sports at the Olympic games, with international organizations that host world, continental and national championships at amateur standard. There are also an increasing number of professional combat sports with global audiences. The growing popularity of professional combat sports and their importance at the Olympic games have led to an increase in scientific studies that characterize the physical, physiological, nutritional, biomechanical and training strategies of combat sports athletes. These studies characterize combat sports as high-intensity sports which require training strategies to develop the high-intensity capabilities of athletes. Therefore, the aim of this article is to (i) summarize the physiological demands of combat sports; (ii) present the primary considerations required to program high-intensity conditioning for athletes; (iii) define and present key high-intensity conditioning methods; and (iv) provide guidance for scientists and coaches to help prepare athletes under common but differing circumstances.

A systematic review of head, neck and-facial injuries in cricket

This systematic review was conducted to identify the incidence, nature and mechanisms of head, neck and facial (HNF) injuries in cricket and the reported use of helmets. Five databases were searched up to 30th November 2020. From peer-reviewed cricket injury studies published in English, studies reporting on HNF cricket injuries as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were selected. Twenty-nine studies were included. HNF injuries had a cumulative total of 794/5,886 injuries equating to 13% of all injuries. Non- specified HNF injuries (n=210, 26%) were the most prevalent type of injury followed by non-specified head injuries (n=130, 16%), other non-specified fractures (n=119, 15%) and concussions (n=60, 8%).The impact of the ball was reported as the most common mechanism for sustaining HNF injuries in cricket. The use of helmet was reported in only three studies (10%). From studies reporting on HNF cricket injuries, facial fractures, and concussions were the most common specified-types of injury. There is little evidence on reporting of HNF cricket injuries as per the international cricket consensus injury definitions, as well as the use of helmets at the time of injury.

Epidemiology of Musculoskeletal Injuries in Adult Athletes: A Scoping Review

Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the musculoskeletal (MSK) system of adult athletes. Materials and Methods: We performed a scoping review on the Pubmed database limiting our search to 33 Olympic sports. Results: We identified a total of 1022 papers, and of these 162 were examined in full for the purpose of this review. Archery was the sport with the highest risk of injuries to the upper extremities, marathons for the lower extremities, and triathlon and weightlifting for the body bust. In the majority of the sports examined, muscle/tendon strain and ligament sprain were the most common MSK-Is diagnoses, while athletics, karate, and football were the sports with the highest IIRs, depending on the methods used for their calculations. Conclusions: Our scoping review highlighted the general lack and dishomogeneity in the collection of data on MSK-Is in athletes.

Severe knee injuries among karate athletes ranking towards the Tokyo Olympic Games: a retrospective study

BACKGROUND

Injury prevention strategies should be built upon data about the more frequent injuries in each specific sport. Therefore, this study aimed to describe the lifetime prevalence and characteristics of severe knee injuries among world-class karatekas.

METHODS

A retrospective study based on a face-to-face survey was conducted. Participants were athletes who competed in World Karate Senior Championships in Madrid 2018, which was a tournament with the highest value to rank athletes to the Tokyo Olympic Games. A questionnaire was used to collect retrospective information on the prevalence and characteristics of severe knee injuries that occurred along elite karatekas sport careers. Odds Ratio (OR) were calculated to identify the association of sex and karate modality (kata / kumite) with severe knee injury risk.

RESULTS

Out of the 293 athletes surveyed (23.4±4.0 years; 137 female), 71 (24.2%) had suffered a serious knee injury at some point of their careers, without a statistically significant difference between male and female athletes. There was no difference between the percentage of injuries that took place during training (54.9%) or during competition (45.1%) both in male and female athletes. Kumite athletes suffered more knee injuries during competition than training. The most common injury mechanism for both genders was a pivoting or dodging movement (36.4% in males and 39.5% in females).

CONCLUSIONS

The information presented in this study about the prevalence and characteristics (mechanism, anatomical location, moment, time off) of the severe knee injuries in elite karatekas could be useful to design prevention programs to be implemented among karate athletes.

Effects of Olympic Combat Sports on Older Adults' Health Status: A Systematic Review

The aim of this systematic review was to analyse the studies centered on the effects of Olympic combat sports (OCS [i.e., boxing, fencing, judo, karate, taekwondo, wrestling]) on older adults’ physical-functional, physiological, and psychoemotional health status. The review comprised randomised-controlled trials with OCS interventions, including older adults (≥60 years), and measures of physical-functional, physiological, and/or psychoemotional health. The studies were searched through SCOPUS, PubMed/MEDLINE, Web of Science, PsycINFO, and EBSCO databases until 5 January 2021. The PRISMA-P and TESTEX scales were used to assess the quality of the selected studies. The protocol was registered in PROSPERO (code: CRD42020204034). Twelve OCS intervention studies were found (scored ≥ 60% for methodological quality), comprising 392 females and 343 males (mean age: 69.6 years), participating in boxing, judo, karate, and taekwondo. The qualitative analysis revealed that compared to controls, OCS training improved muscle strength, cardiorespiratory capacity, agility, balance, movement, attention, memory, mental health, anxiety, and stress tolerance. Meta-analysis was available only for the chair stand test, and an improvement was noted after OCS training compared to control. In conclusion, OCS interventions improves older adults’ physical-functional, physiological, and psychoemotional health. Our systematic review confirms that OCS training has high adherence (greater than 80%) in older adults.

Prevalence, Patterns, and Characteristics of Eye Injuries in Professional Mixed Martial Arts

Purpose

To describe the frequency and type of eye injuries in fighters in mixed martial arts (MMA) competition.

Methods

Fight result data were collected from the Nevada Athletic Commission database from 2001 to 2020. Any fighters in a professional mixed martial arts (MMA) contest with an eye injury were included. Main outcome measures included frequency and rate of eye injuries per fight and the types of eye injuries. Secondary outcome measures were gender, laterality, decision type, and length of no-contact recommended.

Results

Of the 256 MMA events in the database, 187 events (73.3%) had at least one eye injury. Of a total 2208 fights at these events, there were 363 fighters who sustained 369 eye injuries, with the yearly rate of eye injuries per 100 fighters ranging from 2.56 to 12.22. The most common injuries were eyebrow and eyelid lacerations (n=160, 43%), lacerations around the eye (n=98, 27%), and orbital fractures (n=62, 17%). Most eye injuries were right sided (n=197, 53.3%) and the majority of fighters with eye injuries lost their match (n=228, 62.8%). Fifty-seven fighters were recommended for further ophthalmology clearance after the match. The most common reasons for recommended ophthalmology follow-up was orbital fracture (n=25, 44%) and retinal injury (n=7, 12%). Forty-three fighters received no-contact requirements relating to their injury for an average of 8.9 weeks (range 1–24 weeks).

Conclusion

Ophthalmic injuries in professional MMA were prevalent, were most often lacerations surrounding the eye, and often accompanied the fighter losing their match.

Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training

While competitive training is usually associated with the prevalence of back pain and injuries in athletes, little attention is being paid to the positive effects of sport-specific exercises on core musculature in the prevention of back problems. This scoping review aims (i) to map the literature that addresses the effects on reduction of back problems following athlete training with differing demands on the core musculature and (ii) to identify gaps in the existing literature and propose future research on this topic. The main literature search was conducted on the MEDLINE, PubMed, Web of Science, Scopus, and Cochrane Library databases and was completed on Elsevier, SpringerLink, and Google Scholar. A total of 21 research articles met the inclusion criteria. The findings of 17 studies identified that core strengthening and core stabilization exercises, alone or in combination with athlete training, contribute to the reduction of back pain in athletes, whereas only four studies revealed no significant association of core muscle strength and/or endurance with back problems. Nevertheless, more research is warranted to elucidate the pros and cons of purely sport-specific training with differing demands on the core musculature on back health in athletes. This could help us to design prevention strategies specifically tailored to individual athletes.

Sports Injury and Illness after Implementation of the Web-Based Surveillance System in World Taekwondo

CONTEXT

There is a shortage of Taekwondo epidemiology studies since the rule changes introduced by World Taekwondo in 2017.

OBJECTIVE

To describe injury and illness patterns at the Muju 2017 World Taekwondo Championships (WTC) following the implementation of the web-based surveillance system by World Taekwondo.

DESIGN

Prospective cohort study.

SETTING

All injuries and illnesses were recorded during the 2017 WTC using a web-based system developed by the International Olympic Committee.

PATIENTS OR OTHER PARTICIPANTS

971 athletes who participated in the 2017 WTC.

MAIN OUTCOME MEASURE(S)

A profiles and mechanisms of injury and illness in the 2017 WTC.

RESULTS

We analyzed total 131 injuries and 26 illnesses, corresponding to an overall clinical incidence of 13.5 ((95% confidence interval (CI): 11.2-15.8)) injuries and 2.7 (95% CI: 1.6-3.7) illnesses per 100 athletes, and an overall incidence rate of 19.3 (95% CI: 16.0-22.6) injuries and 3.8 (95% CI: 2.4-5.3) illnesses per 1,000 athlete-days, respectively. Most injuries occurred in the lower extremities (46.6%, n=61), of which knee injuries were most frequent (19.8%, n=26). Among the head and trunk injuries (29.8%, n=39), face injuries (22.1%, n=29) were most frequent, whereas among upper extremity injuries (23.7%, n=31), finger injuries (6.1%, n=8) were most frequent. Contusions (33.6%, n=44) were the most frequent injury type, followed by fractures and ligament ruptures/sprains. The most common injury mechanism was in contact with another athlete (74.0%, n=97), whereas the least common was concussions (n=5). The major affected system was the respiratory system (30.8%, n=8), with major symptoms being pain (42.3%, n=11) and fever (26.9%, n=7). Environmental factors were the most common cause of illness (57.7%, n=15).

CONCLUSION

The web-based surveillance system used at the 2017 WTC revealed that 13.5/100 athletes (77.8/1,000 athlete-exposures, 13.9/1000 minute-exposures) had new or recurrent injuries, whereas 2.7/100 athletes became ill.

[Analysis of muscle injuries and return-to-training in elite Taekwondo athletes: results of a prospective cohort study over a period of five years]

BACKGROUND

 Muscle injuries frequently occur in sports involving explosive movement patterns, and they can cause considerable downtime. There is a lack of detailed data on muscle injuries in Olympic elite Taekwondo.

METHODS

 All injuries sustained by 76 elite Taekwondo athletes from a national Olympic training centre during training and competition were prospectively recorded over a period of five years. Data on muscle injuries, including location and time elapsed until return-to-training, were extracted from medical records. Injuries were diagnosed by means of MRI and were classified according to the British Athletes Muscle Injury System. The relationship between MRI classification subgroups and time elapsed until return-to-training was assessed.

RESULTS

 Mean age of athletes was 22.5 ± 3.2 (16-27) years with an average Taekwondo experience of 12.1 ± 4.0 (7-20) years. Hamstring muscles were most commonly injured (48.4 %), followed by quadriceps muscles (32.3 %) and calf muscles (9.6 %). The analysis of MRI injury subgroups showed grade 1 (32.2 %) and grade 2 (41.9 %) injuries in most cases. A positive correlation was found between injury groups and return-to-training (r = 0.56). The comparison between different injury groups and time elapsed until return-to-training also revealed significant differences (p < 0.0001).

CONCLUSION

 Hamstring muscles are the most injured muscles in Taekwondo besides the quadriceps femoris muscle. Most injuries were mild to moderate (grade 1-2). The time needed for return-to-training increased significantly with the severity of injuries diagnosed by MRI.

Injury and Illness in World Taekwondo Junior Athletes: An Epidemiological Study

Taekwondo has been reported to be one of the most injurious sports in the summer Olympics, however, there is a dearth of data about injury profiles for junior athletes. Therefore, we aimed to identify the incidence and profiles of the injuries and illnesses that occurred during the 2018 World Taekwondo Junior Championships and recorded using an online system. Among the 889 athletes, 67 injuries and four illnesses were reported, corresponding to an overall clinical incidence of 7.5 injuries (95% confidence interval [CI]: 5.7-9.3) and 0.5 illnesses (0.1-0.9) per 100 athletes. The most frequent injuries were lower extremity injuries (n = 33, 3.71% of all athletes), mostly in the foot/toe (n = 11, 1.2% of athletes), followed by head and trunk injuries, mostly in the face (n = 14, 1.6% of athletes), and upper extremity injuries, mostly in the fingers (n = 6, 0.7% of athlete). Contusions (n = 37, 4.2% of athlete) were the most frequent injury type, followed by ligament ruptures/sprains and laceration. The most common injury mechanism was contact during an opponent attack (n = 51, 5.7% of athlete). Three mild concussions none resulted in time loss (none required hospital transfer or had prolonged recovery). The respiratory system was the most affected by illness, with pain and fever as symptoms. Environmental factors were the most common cause of illness. This study shows that 7.5 per 100 athletes (38.5/1000 athlete-exposures and 6.9/1000 min-exposures) had new or recurrent injuries, whereas 0.5 per 100 athletes experienced illness. In conclusion, the data shows male athletes reported more injuries than females and the most common cause of injury was due to contact between athletes. Contusions, ligament rupture/sprains, laceration and fractures to the lower extremities, head, and trunk were the most common injury. Knowing these injury profiles of junior taekwondo athletes can help taekwondo stakeholders, especially medical staff to prepare accordingly to ensure the safety of the athletes.

High Incidence of Hand Injuries From Blocking in Elite Taekwondo Despite the Use of Protective Gear: A 5-Year Descriptive Epidemiology Study

Background

Hand and wrist injuries are a common but underestimated issue in taekwondo. Detailed data on injury risk, patterns, and mechanism are missing.

Purpose

To evaluate (1) the fight time exposure-adjusted injury incidence rate (IIR) and clinical incidence and (2) injury site, type, sport-specific mechanism, and time loss in taekwondo.

Study Design

Descriptive epidemiology study.

Methods

Athletes from a single national Olympic taekwondo training center were investigated prospectively for hand and wrist injuries during training and competition over 5 years. The Orchard Sports Injury Classification System Version 10 was used to classify injury type, and analysis of the anatomic injury site was performed. The mechanism of injury was classified as due to either striking or blocking techniques.

Results

From a total of 107 athletes, 79 athletes (73.8%) with a total exposure time of 8495 hours were included in the final data set. During the study period, 75 injuries of the hand and wrist region were recorded despite the athletes using protective hand gear. The IIR was 13.9 (95% CI, 10.5-17.5) and was significantly higher during competition. The clinical incidence as an indicator for risk of injury was 60.7% (95% CI, 50.9-70.5). Finger rays were the most affected location (68%), and fractures (43%) and joint ligament injuries (35%) were the most common type of injury. Significantly more injuries were found on the dominant hand side (P < .001). Comparison of injury mechanisms demonstrated significantly more injuries at the finger rays deriving from blocking techniques (P = .0104). The mean time loss for all hand and wrist injuries was 15.7 ± 13.5 days (range, 3-45 days) and was highest for distal radial fractures, with a mean of 39.7 ± 4.8 days (range, 32-45 days).

Conclusion

There was a significantly higher IIR for acute hand and wrist injuries in elite taekwondo athletes during competition, which resulted in considerable time loss, especially when fractures or dislocations occurred. Significantly more injuries to the finger rays were found during blocking despite the use of protective hand gear. Improvement of tactical skills and blocking techniques during training and improved protective gear appear to be essential for injury prevention.

Orthopaedic medical examination for young amateur athletes: a repeated cross-sectional study from 2014 to 2018

OBJECTIVES

Medical examinations for adult elite athletes are performed all over the world, however, no studies in the relevant English literature have reported on orthopaedic medical examinations for young amateur athletes. The purpose of this study was to report the results of orthopaedic medical examinations of the spine and lower extremities in young amateur athletes.

METHODS

This repeated cross-sectional study from 2014 to 2018 included a total of 323 young amateur athletes (age, 12-18 years) who were active in one of the following four sports: boxing, canoeing, weightlifting and track and field. The orthopaedic medical examination consisted of six assessments (physical examinations, the generalised joint laxity, muscle and joint tightness, static alignment and muscle volume of the lower extremities and the medial longitudinal arch of the foot). Questions regarding pain in the spine and lower extremities were also performed.

RESULTS

Among 323 young amateur athletes, 17 (5.3%) had received orthopaedic treatment at the time of the medical examination, with spondylolysis being the most common cause (29.4%, 5/17). Among 306 young athletes who had not received orthopaedic treatment, 61 (19.9%) had at least one positive finding in physical examinations or had pain in the spine or lower extremities. Anterior drawer test of the ankle and Kemp test for the spine accounted for 34% and 28% of positive findings, respectively. Low back pain and knee pain accounted for 58% and 16% of pain, respectively.

CONCLUSIONS

The present study showed that approximately one-fifth of young amateur athletes who had not received orthopaedic treatment had pain in the spine and lower extremities and positive findings in physical examinations that may require orthopaedic treatments. In addition to the early detection of injuries, orthopaedic medical examinations for young amateur athletes provide an opportunity to educate such athletes.

ASSOCIATION BETWEEN LEVELS OF SPORTS PARTICIPATION AND ORAL INJURIES AMONG COMBAT ATHLETES

ABSTRACT Introduction Oral injuries are common traumas in combat sports due to the aggressive nature of both offense and defense. Sports mouth guards are made to reduce the risk of traumatic face and jaw injuries and concussions during sports activities. Objective The objective of this study was to determine the prevalence of oral injuries in combat sports and to examine the association between participation levels and percentage of injury occurrence. Methods One hundred and eight participants (mean age: 22.42 ± 2.162 years) who were involved in sparring events were recruited. Data were collected using a questionnaire consisting of 22 questions about the demographic profile of the athletes, their injury experience and type of injuries sustained, awareness and use of mouth guards in sports activities. Descriptive analysis, Chi-square test, and one-way analysis of variance (ANOVA) were applied for data analysis. Results Almost 77% of participants had experienced oral injuries during sports activities and nearly 90% were aware that oral injuries can be reduced by using mouth guards. In addition, 52.7% of participants complained that the mouth guard is not comfortable to use during sports activities. Findings revealed a significant moderate association between levels of participation and number of oral injuries ( p = 0.013). One-way ANOVA showed a significant mean difference in the rate of oral injury for the four levels of participation groups F (3, 104) = 6.21, p = 0.011. Post-hoc comparisons using the Bonferroni test indicated a significant mean difference between university-state levels ( p = 0.033) and university-national levels ( p = 0.028). Conclusion This study revealed that higher levels of participation in sports have a higher risk of injury. It was also found that the discomfort of using a mouth guard can be reduced if the coaches make the athletes wear proper mouth guards that follow the recommended specifications. Level of evidence IIIb; Case control study.

Illness and infection in elite full-contact football-code sports: A systematic review

OBJECTIVES

Full-contact football-code team sports offer a unique environment for illness risk. During training and match-play, players are exposed to high-intensity collisions which may result in skin-on-skin abrasions and transfer of bodily fluids. Understanding the incidence of all illnesses and infections and what impact they cause to time-loss from training and competition is important to improve athlete care within these sports. This review aimed to systematically report, quantify and compare the type, incidence, prevalence and count of illnesses across full-contact football-code team sports.

DESIGN/METHODS

A systematic search of Cochrane Library, MEDLINE, SPORTDiscus, PsycINFO and CINAHL electronic databases was performed from inception to October 2019; keywords relating to illness, athletes and epidemiology were used. Studies were excluded if they did not quantify illness or infection, involve elite athletes, investigate full-contact football-code sports or were review articles.

RESULTS

Twenty-eight studies met the eligibility criteria. Five different football-codes were reported: American football (n=10), Australian rules football (n=3), rugby league (n=2), rugby sevens (n=3) and rugby union (n=9). One multi-sport study included both American football and rugby union. Full-contact football-code athletes are most commonly affected by respiratory system illnesses. There is a distinct lack of consensus of illness monitoring methodology.

CONCLUSIONS

Full-contact football-code team sport athletes are most commonly affected by respiratory system illnesses. Due to various monitoring methodologies, illness incidence could only be compared between studies that used matching incidence exposure measures. High-quality illness surveillance data collection is an essential component to undertake effective and targeted illness prevention in athletes.

Injury incidence, severity and profile in Olympic combat sports: a comparative analysis of 7712 athlete exposures from three consecutive Olympic Games

OBJECTIVES

To describe and compare the epidemiology of competition injuries in unarmed combat sports (ie, boxing, judo, taekwondo and wrestling) in three consecutive Olympic Games.

METHODS

Prospective cohort study using injury data from the IOC injury surveillance system and exposure data from official tournament records at three consecutive Olympic Games (ie, Beijing 2008, London 2012 and Rio de Janeiro 2016). Competition injury incidence rates per 1000 min of exposure (IIR_ME) were calculated with 95% CIs using standard formulae for Poisson rates.

RESULTS

The overall IIR_ME was 7.8 (95% CI 7.0 to 8.7). The IIR_ME in judo (9.6 (95% CI 7.8 to 11.7)), boxing (9.2 (95% CI 7.6 to 10.9)) and taekwondo (7.7 (95% CI 5.6 to 10.5)) were significantly higher than in wrestling (4.8 (95% CI 3.6 to 6.2)). The proportion of injuries resulting in >7 days absence from competition or training was higher in wrestling (39.6%), judo (35.9%) and taekwondo (32.5%) than in boxing (21.0%). There was no difference in injury risk by sex, weight category or tournament round, but athletes that lost had significantly higher IIR_ME compared with their winning opponents (rate ratio 3.59 (95% CI 2.68 to 4.79)).

CONCLUSION

Olympic combat sport athletes sustained, on average, one injury every 2.1 hours of competition. The risk of injury was significantly higher in boxing, judo and taekwondo than in wrestling. About 30% of injuries sustained during competition resulted in >7 days absence from competition or training. There is a need for identifying modifiable risk factors for injury in Olympic combat sports, which in turn can be targeted by injury prevention initiatives to reduce the burden of injury among combat sport athletes.

Is There a Relationship Between Workload and Occurrence of Back Pain and Back Injuries in Athletes?

The back is subjected to a great deal of strain in many sports. Up to 20% of all sports injuries involve an injury to the lower back or neck. Repetitive or high impact loads (e.g., running, gymnastics, skiing) and weight loading (e.g., weightlifting) affect the lower back. Rotation of the torso (e.g., golf, tennis) causes damage to both, the lumbar and thoracic spine. The cervical spine is most commonly injured in contact sports (e.g., boxing, football). One of the factors that increases the odds of injuries in athletes is excessive and rapid increases in training loads. In spite of currently emerging evidence on this issue, little is known about the balance between physiological loading on the spine and athletic performance, versus overloading and back pain and/or injury in athletes. This scoping review aims (i) to map the literature that addresses the association between the training load and the occurrence of back pain and/or injury, especially between the Acute:Chronic Workload Ratio (ACWR) and back problems in athletes of individual and team sports, and (ii) to identify gaps in existing literature and propose future research on this topic. A literature search of six electronic databases (i.e., MEDLINE, PubMed, Web of Science, SCOPUS, SportDiscus, and CINAHL) was conducted. A total of 48 research articles met the inclusion criteria. Findings identified that fatigue of the trunk muscles induced by excessive loading of the spine is one of the sources of back problems in athletes. In particular, high training volume and repetitive motions are responsible for the high prevalence rates. The most influential are biomechanical and physiological variations underlying the spine, though stress-related psychological factors should also be considered. However, limited evidence exists on the relationship between the ACWR and back pain or non-contact back injuries in athletes from individual and team sports. This may be due to insufficiently specified the acute and chronic time window that varies according to sport-specific schedule of competition and training. More research is therefore warranted to elucidate whether ACWR, among other factors, is able to identify workloads that could increase the risk of back problems in athletes.

Judokas with low back pain have lower flexibility of the hip-spine complex: A case-control study

OBJECTIVE

Study whether male adult judokas with and without low back pain (LBP) have different hip-spine flexibility.

DESIGN

Cross-sectional.

SETTING

Judo training centres.

PARTICIPANTS

Judokas with (n = 29) and without (n = 33) LBP.

MAIN OUTCOME MEASURES

Range of motion (ROM) (passive and active rotations) of hips, lumbar spine (flexion-extension) and fingertip-to-floor distance (FTFD).

RESULTS

The non-dominant hips of judokas with LBP had 6.8 ± 1.2° (ES:1.45, p < 0.001) lower passive and 8.0 ± 1.3° (ES:1.55, p < 0.001) lower active internal rotation. Dominant hips of judokas with LBP had 5.1 ± 1.6° (ES: 0.81, p = 0.002) lower active internal rotation and 8.8 ± 2.9° (ES:0.79, p = 0.003) lower active total rotation. The LBP group showed 8.0 ± 2.8° (ES: 0.73, p = 0.006) lower flexion and 6.0 ± 2.2° (ES: 0.69, p = 0.009) lower extension of the lumbar spine. The FTFD in the LBP group was 7.3 ± 2.6 cm (ES: 0.72, p = 0.007) lower. The multi-level regression analyses showed passive (OR 1.54, 95%CI 1.18-2.00, p = 0.001) and active (OR 1.47, 95%CI 1.16-1.87, p = 0.001) hip internal rotation of the non-dominant leg and lumbar spinal flexion (OR 1.11, 95%CI 1.03-1.20, p = 0.006) and extension (OR 1.16, 95%CI 1.01-1.33, p = 0.035) were related to LBP.

CONCLUSION

Lower hip internal rotation of the non-dominant leg (passive and active) and lower lumbar flexibility are significantly related to LBP in male adult judokas.

Musculoskeletal injuries in athletes from five modalities: a cross-sectional study

Background

Musculoskeletal injuries (MSK-I) are a serious problem in sports medicine. Modifiable and non-modifiable factors are associated with susceptibility to these injuries. Thus, the aim of this study was to describe the prevalence of and identify the factors associated with MSK-I, including tendinopathy and joint and muscle injuries, in athletes.

Methods

In this cross-sectional observational study, 627 athletes from rugby (n = 225), soccer (n = 172), combat sports (n = 86), handball (n = 82) and water polo (n = 62) were recruited at different sports training centres and competitions. Athlete profiles and the prevalence of MSK-I were assessed using a self-reported questionnaire. Only previous MSK-I with imaging confirmation and/or a positive physical exam by a specialized orthopaedist were considered. The association of the epidemiological, clinical and sports profiles of athletes with MSK-I was evaluated by a logistic regression model.

Results

The mean age was 25 ± 6 years, and 60% of the athletes were male. The epidemiological, clinical and sports profiles of the athletes were different for the five sport groups. The MSK-I prevalence among all athletes was 76%, with 55% of MSK-I occurring in a joint, 48% occurring in a muscle and 30% being tendinopathy, and 19% of athletes had three investigated injuries. The MSK-I prevalence and injury locations were significantly different among sport groups. There was a predominance of joint injury in combat sports athletes (77%), muscle injury in handball athletes (67%) and tendinopathy in water polo athletes (52%). Age (≥30 years) was positively associated with joint (OR = 5.2 and 95% CI = 2.6–10.7) and muscle (OR = 4.9 and 95% CI = 2.4–10.1) injuries and tendinopathy (OR = 4.1 and 95% CI = 1.9–9.3).

Conclusion

There is a high prevalence of tendinopathy and joint and muscle injuries among rugby, soccer, combat sports, handball and water polo athletes. The analysis of associated factors (epidemiological, clinical and sports profiles) and the presence of MSK-I in athletes suggests an approximately 4–5-fold increased risk for athletes ≥30 years of age. The identification of modifiable and non-modifiable factors can contribute to implementing surveillance programmes for MSK-I prevention.

Meniscal Injuries in the Olympic and Elite Athletes

INTRODUCTION

Elite and Olympian athletes are often stretching the upper limits of normal physiology and biomechanics of the musculoskeletal system in their efforts to excel in their sport. For them to get back to their sport at the same level after injury, the management, repair techniques, and rehabilitation protocols should be robust to permit healing of tissues to allow supra-normal loading and performance. The knee and the meniscus are commonly injured in these sports. Yet, the incidence, mechanisms, types of injuries to the meniscus, and their management are not known across different sports in the Olympics.

METHODS

We set out to look into the incidence and the trends of publications on meniscal injuries of the knee in Olympic games. A search of the PubMed and Scopus for these injuries using a search strategy gave 79 and 116 articles, respectively.

RESULTS

There were very few publications giving the incidence of meniscal injuries in the Olympics. Football is the sport with the highest rate of meniscal injuries. Different sports are popular in different countries, and depending on the popularity and the country reporting these injuries, incidences differed. There was data available from India and Brazil for Elite athlete from diverse sports, whereas most data from other countries were for football and soccer. Knee was found to be the second most commonly injured part of the body in both Winter and Summer Olympics as well as the Youth Winter Olympics. Data were not available from the Youth Summer Olympics to make any conclusions. The number of publications on this topic is low. We presented the timeline of publications and citations of articles on this topic. The top country, language, journal, university, and author were USA, English, American Journal of Sports Medicine, Hospital of Special Surgery in New York and Brophy RH, respectively. The data on the risk factors for meniscal injuries were analyzed, discussed, and presented for football, as this was the most extensively studied sport.

CONCLUSIONS

Even though the knee is one of the commonly injured anatomical locations in elite athletes, there is a lack of literature on meniscal injuries in this subset of population. We looked at possible reasons and made recommendations to improve data collection on these injuries.

A 12-Year Cohort Study of Doc-Stoppage in Professional Mixed Martial Arts

Purposes: To determine actions during bouts that generate serious enough injury to stop the bout; verifying the injury incidence, types, and prevalence of doctor stoppages (doc-stoppage); and identify potential risk factors by analyzing technical-tactical profiles for injury in sanctioned mixed martial arts bouts taking place over a 12-y period. Methods: This research analyzed 440 paired mixed martial arts matches separated by doc-stoppage (n = 220) and no doc-stoppage (n = 220) from 2002 to 2014. Technical knockouts for doc-stoppage were diagnosed and managed by attending ringside doctors, and the time–motion variables were categorized into total combat time separated by low- or high-intensity activities per round, stand-up, or groundwork actions, P ≤ .05. Results: The main cause of injuries in doc-stoppage situations was due to facial injuries (>90%), with 87.1% occurring after striking actions during the second round. Lacerations were the leading type of injury, which occurred with 80% frequency. The results showed differences between doc-stoppage and no doc-stoppage for standing combat with low-intensity actions (130.6 [8.5] s vs 83.3 [6.9] s for first round; 115.7 [10.5] s vs 100.1 [9.6] s for second round, and 121.5 [19.5] s vs 106.3 [11.7] s for third round) and total strike attempts (34.5, 23.0–51.8 vs 25.0, 12.0–40.8); in standing combat, head strike attempts (21, 10–33 vs 11, 4–21) and body strikes (2.5, 1.0–5.8 vs 1.0–2), and in groundwork combat, head strikes landed (0.0–3.0 vs 0.0–5.0). Conclusions: This research showed higher values of strike attempts with 2 main orientations, namely the head (on the ground and in stand-up actions) and body (in stand-up actions), and may provide important information regarding the technical knockout and when it can be called by officials supervising mixed martial arts bouts.

Collecting Health and Exposure Data in Australian Olympic Combat Sports: Feasibility Study Utilizing an Electronic System

BACKGROUND

Electronic methods are increasingly being used to manage health-related data among sporting populations. Collection of such data permits the analysis of injury and illness trends, improves early detection of injuries and illnesses, collectively referred to as health problems, and provides evidence to inform prevention strategies. The Athlete Management System (AMS) has been employed across a range of sports to monitor health. Australian combat athletes train across the country without dedicated national medical or sports science teams to monitor and advocate for their health. Employing a Web-based system, such as the AMS, may provide an avenue to increase the visibility of health problems experienced by combat athletes and deliver key information to stakeholders detailing where prevention programs may be targeted.

OBJECTIVE

The objectives of this paper are to (1) report on the feasibility of utilizing the AMS to collect longitudinal injury and illness data of combat sports athletes and (2) describe the type, location, severity, and recurrence of injuries and illnesses that the cohort of athletes experience across a 12-week period.

METHODS

We invited 26 elite and developing athletes from 4 Olympic combat sports (boxing, judo, taekwondo, and wrestling) to participate in this study. Engagement with the AMS was measured, and collected health problems (injuries or illnesses) were coded using the Orchard Sports Injury Classification System (version 10.1) and International Classification of Primary Care (version 2).

RESULTS

Despite >160 contacts, athlete engagement with online tools was poor, with only 13% compliance across the 12-week period. No taekwondo or wrestling athletes were compliant. Despite low overall engagement, a large number of injuries or illness were recorded across 11 athletes who entered data-22 unique injuries, 8 unique illnesses, 30 recurrent injuries, and 2 recurrent illnesses. The most frequent injuries were to the knee in boxing (n=41) and thigh in judo (n=9). In this cohort, judo players experienced more severe, but less frequent, injuries than boxers, yet judo players sustained more illnesses than boxers. In 97.0% (126/130) of cases, athletes in this cohort continued to train irrespective of their health problems.

CONCLUSIONS

Among athletes who reported injuries, many reported multiple conditions, indicating a need for health monitoring in Australian combat sports. A number of factors may have influenced engagement with the AMS, including access to the internet, the design of the system, coach views on the system, previous experiences with the system, and the existing culture within Australian combat sports. To increase engagement, there may be a requirement for sports staff to provide relevant feedback on data entered into the system. Until the barriers are addressed, it is not feasible to implement the system in its current form across a larger cohort of combat athletes.