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

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Effectiveness of Protective Measures and Rules in Reducing the Incidence of Injuries in Combat Sports: A Scoping Review

In recent years, much effort has been made to reduce the injury rate in combat sports. However, the question remains to what extent these measures are effective. Analysis of studies could provide evidence of the effectiveness of measures aimed at reducing the incidence of injuries. This scoping review aims (1) to map research articles dealing with the effectiveness of proper use of protective measures in reducing the incidence of injuries in combat sports; (2) to investigate to what extent the proper use of protective measures and compliance with sports rules help to reduce the incidence of injuries in combat sports; and (3) to identify gaps in the existing literature and suggest future research on this topic. The literature search was conducted on articles published between 2010 and 2023. The main inclusion criteria were studies investigating the effect of sports rules and protective equipment used during training or competition in combat sports on reducing the incidence of injuries. After meeting the criteria, only seven articles from boxing, karate, and taekwondo were included in this study. Results showed that mandatory head guards, along with modern thicker gloves, significantly reduced the rate of knockouts (KOs) and head injuries in boxing despite an increase in the number of head blows. However, the number of facial cuts increased significantly due to the removal of head guards as a piece of mandatory equipment. The use of mouth guards has significantly reduced the number of oral injuries. Changes in rules, such as shortening the duration of bouts, along with the introduction of greater competencies of referees in the supervision of bouts (the standing count, outclassed rule, and medical stops) have helped to reduce the rate of injuries in boxing. The application of a computerised scoring system also contributed to the rate of injuries reduction. The increase in the number of weight divisions had the same effect on U21 karate athletes. However, a higher incentive to attack the head area in taekwondo did not increase the incidence of injuries in youth athletes. It can be concluded that the proper use of protective measures (head and mouth guards) in combination with the rules established for health protection (higher competencies of referees and more weight divisions in competitions) effectively reduces the occurrence of injuries in combat sports. In all Olympic combat sports, the injury incidence should be regularly assessed using the Injury Incidence Rate (IIR) per 1000 min exposures (MEs). Nonetheless, further studies are needed to monitor how established rules (e.g., prohibited behaviour) affect the IIRs.

Comparisons of musculoskeletal injuries among three different modalities of Taekwondo (Kyorugi, Poomsae, and Shibum): a one-year follow-up prospective epidemiologic study

The purpose of the study was to report the injury rates and characteristics (body location, type, mechanism, and severity) of musculoskeletal injuries in Kyorugi, Poomsae, and Shibum. A total of 137 Korean collegiate Taekwondo players - Kyorugi (n = 44), Poomsae (n = 46), and Shibum (n = 47) - were prospectively studied in 2019. Injury rates per 1,000 athlete-exposures (AEs) and time-exposures (TEs) during training and competition were calculated. Additionally, body location, type, mechanism, and severity of injury were analysed. The highest injury rate was recorded in Poomsae (172.0/1,000 AEs and 79.5/1,000 TEs) followed by Kyorugi (47.1/1,000 AEs and 25.9/1,000 TEs) and Shibum (57.5/1,000 AEs and 17.0/1,000 TEs). The frequently injured body location was the thigh (Kyorugi = 17%; Poomsae = 25%; Shibum = 18%). The common injury types were muscle cramps/spasms in Kyorugi (33%) and Poomsae (59%), and sprain in Shibum (41%). The common injury mechanisms were gradual onset in Kyorugi (40%) and Shibum (49%), and non-contact trauma in Poomsae (91%). Regarding the severity, the number of days from the injury onset to recovery > 1 week were higher in the order of Kyorugi (78%), Shibum (54%), and Poomsae (28%). Our data provide preliminary evidence that different injury prevention strategies should be applied to each modality of Taekwondo.

Injury Incidence and Its Characteristics in Korean Youth and Collegiate Taekwondo Sparring Athletes: A Retrospective Study

This study aimed to identify the incidence of injury and its characteristics in Korean youth and collegiate Taekwondo athletes during 2021 and to provide a suggestion regarding injury incidence. A total of 183 athletes (95 youth and 88 collegiate athletes) who were registered with the Korea Taekwondo Association (KTA) participated. The research was based on the injury questionnaire developed by the International Olympic Committee (IOC). The questionnaire consists of a total of seven items, including four items related to demographic characteristics and three items related to injuries (locations of injury, types of injury, and causes of injury). A frequency analysis was performed to identify the injury characteristics. Additionally, the injury incidence rate (IIR) was calculated based on 1000 athletic exposures (AEs) during 2021. The IIRs for one recent year (2021) showed 4.43/1000 AEs and 3.13/1000 AEs in youth and collegiate Taekwondo athletes, respectively. The frequency analysis showed that finger (youth: 17.3%, collegiate: 14.6%), contusion (youth: 25.3%, collegiate: 23.8%), and contact with other athletes (youth: 57.6%, collegiate: 54.4%) ranked the highest in terms of the locations of injury, types of injury, and causes of injury, respectively. A continuing injury tracking system can play a key role in accumulating big data for identifying risk factors and developing interventions to reduce injury in Taekwondo sparring.

Is Curcumine Useful in the Treatment and Prevention of the Tendinopathy and Myotendinous Junction Injury? A Scoping Review

Physical activity in general and sports in particular, is a mechanism that produces stress and generates great force in the tendon and in the muscle-tendon unit, which increases the risk of injury (tendinopathies). Eccentric and repetitive contraction of the muscle precipitates persistent microtraumatism in the tendon unit. In the development of tendinopathies, the cellular process includes inflammation, apoptosis, vascular, and neuronal changes. Currently, treatments with oral supplements are frequently used. Curcumin seems to preserve, and even repair, damaged tendons. In this systematic review, we focus more especially on the benefits of curcumin. The biological actions of curcumin are diverse, but act around three systems: (a) inflammatory, (b) nuclear factor B (NF-κB) related apoptosis pathways, and (c) oxidative stress systems. A bibliographic search is conducted under the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) as a basis for reporting reliable systematic reviews to perform a Scoping review. After analysing the manuscripts, we can conclude that curcumin is a product that demonstrates a significant biological antialgic, anti-inflammatory, and antioxidant power. Therefore, supplementation has a positive effect on the inflammatory and regenerative response in tendinopathies. In addition, curcumin decreases and modulates the cell infiltration, activation, and maturation of leukocytes, as well as the production of pro-inflammatory mediators at the site of inflammation.

Differences in Sports Injury Types According to Taekwondo Athlete Types (Sparring, Poomsae, and Demonstration)

The objective of this study was to investigate the range of injuries according to the competition format type of Taekwondo (sparring, poomsae, and demonstration) and compare the level of injuries to provide basic data for preventing injuries among Taekwondo athletes. Data were collected through a survey of 472 Taekwondo athletes using convenience sampling and self-administration methods. The most frequently injured body part was the ankle for sparring (54.03%) and demonstration (55.09%) athletes and the pelvis for poomsae (36.36%) athletes (x² = 111.556, p < 0.001). The most frequent injury type was sprain for poomsae (36.40%) and demonstration (52.30%) athletes and fracture for sparring (49.40%) athletes (x² = 127.752, p < 0.001). The most frequently reported cause of injury was excessive training and chronic fatigue (x² = 50.251, p < 0.001). All three types of athletes showed a higher proportion of injury at the training location than at the competition location. The period for the return to training was ≤1 week for sparring (40.80%) and poomsae (64.10%) athletes but 2-3 weeks for demonstration (27.8%) athletes (x² = 45.582, p < 0.001). Diverse strategies, ranging from wearing protective gear to adopting a conditioning strategy and psychological training, are needed for each competition format of Taekwondo to prevent injuries in daily training.

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.

Acute injuries in American collegiate taekwondo competitions: a prospective study spanning four competitive seasons

BACKGROUND

Injury patterns are well-documented for taekwondo competitions prior to the use of an electronic chest protector for scoring tabulation. To see if injury rates and types changed following this rule change that transformed the fighting style in taekwondo, we investigated injuries in collegiate taekwondo competitions in the United States.

METHODS

Data were collected at eight collegiate taekwondo tournaments from April 2018 to December 2019. All injured athletes seen at the first-aid station were invited to complete a survey that included injury location, type, and mechanism of injury. Injury rates were calculated per 1,000 athlete-exposures (A-Es) and minute-exposures (M-Es). Risk factors were modeled using logistic regression and chi-squared analysis.

RESULTS

Out of 1,096 athletes, 194 athletes reported 275 acute injuries. We found an injury risk of 17.7/100 athletes (95% CI 15.4, 20.0) and injury rate of 68.9/1,000 A-E (95% CI 60.7, 77.0) which was comparable to previous studies. The most common injuries were contusions to the lower limbs. In contrast to prior reports, men were injured more frequently from delivering a kick and women from receiving a kick. Populations at higher risk for injury included those with low belt rank and middle weight class for women.

CONCLUSIONS

It appears that the new fighting style did not affect injury rates. Injury locations and types remain similar, but the mechanisms of injury have reversed as men are more injured from attacking and women from defending. There remains a strong need for research to improve protective equipment and safety rules in taekwondo.

Translation Into Spanish and Proposal to Modify the Orchard Sports Injury Classification System (OSICS) Version 12

Purpose

To publish the Spanish translation of Version 12 of the sports injury classification system called Orchard Sports Injury Classification System and propose a modification to include a numerical code that reflects the impact of the injury on sports functionality.

Methods

The members of the working group on the epidemiology of sports injury, of the Group for the Study of the Muscle-Tendon System (GESMUTE), and of the Spanish Society of Sports Traumatology (SETRADE), carried out a bibliographical review on the epidemiological classification systems of injuries, 3 face-to-face consensus meetings, and various online pieces of work, following the Delphi work methodology.

Results

The Spanish translation of Version 12 of the Orchard Sports Injury Classification System is fully accessible and free of charge at https://gesmute.es/traduccion-espanola-osics-12/. The current project proposes to add, at the end of the current coding system of Version 12, a numerical code (0: No Functional impairment; 1: Limits Sports Activity; 2: Prevents Sports Activity; 3: Limits Daily Life Activities), to indicate any functional repercussions caused by the injury.

Conclusion

We present the Spanish translation of Version 12 of the Orchard Sports Injury Classification System. We propose as an improvement the inclusion of functionality criteria in sports injury classifications; more specifically, our proposal could be an improvement to the Orchard Sports Injury Classification System Version 12.

Investigating the influence of Taekwondo body protectors size on shock absorption

OBJECTIVE

This study aims to compare and analyze the difference of impact force attenuation according to size and impact location on a Taekwondo body protector.

METHODS

Body protectors sized 1 to 5, were impact tested by equipment based on the specifications in the European standard manual (EN 13277-1, 3). The impactor release heights were set to match impact energies of 3 and 15 J. The impactor was made from a 2.5 kg cylindrically cut piece of aluminum. Each body protector was impacted 10 times at the two impact energies and two locations. The differences in performance for each body protector size were compared using a two-way analysis of variance with a significance level of p< 005. The effect sizes were investigated using a partial eta squared value (η2).

RESULTS

The significant mean differences between the body protector size and impact area (p< 005) and the average impact time of impact strengths 3 and 15 J were 0.0017 and 0.0012 s, respectively In addition, when an impact strength of 15 J was applied, the maximum resulting impact force exceeded 2000 N for both locations on all sizes. Furthermore, at an impact strength of 3 J size 3 significantly reduced the impact force more than the other sizes; however, size 1 showed the greatest shock absorption at an impact of 15 J.

CONCLUSION

The results of this study show that the shock absorption of body protectors does not increase according to size; i.e., a larger body protector does not reduce the impact load more effectively. To improve safety performance, we recommend a maximum impact force of 2000 N or less for all body protectors.

Musculoskeletal injuries in taekwondo athletes: a nationwide study in Portugal

OBJECTIVE

Taekwondo is a martial art that emphasizes blows using the feet and fists, and it is characterized by direct and continuous body contact, which subjects their practitioners to a higher number of injuries. This study aimed to determine the incidence of musculoskeletal injuries in Portuguese taekwondo athletes and analyze its associated factors.

METHODS

The sample included 341 taekwondo athletes, aged between 4 and 62 years (18.77±12.77 years), 237 (69.5%) were male, and 104 (30.5%) female. A questionnaire was administered at a national level in taekwondo training and competitions via interview.

RESULTS

One hundred and thirty-two (38.7%) taekwondo athletes reported having suffered an injury since they began their practice, totaling 294 injuries. Seventy-six (22.3%) athletes had an injury in the previous 12-months period, with a total of 112 injuries. There were 2.15 injuries per 1,000 hours of taekwondo training. The most common of all injuries was muscle injury (strain, contusion) (58.6%), in the foot and fingers (18.9%). The attack technique (28.8%) was the most prevalent injury mechanism. Adult athletes presented a higher risk of sustaining taekwondo-related injuries than adolescents (odds ratio = 3.91; 95%CI: 1.13-13.55; p=0.032), and athletes who trained more than 1 hour had a risk 4.20 times greater (95%CI: 1.44-12.29; p=0.009) than those who trained up to 1 hour per session.

CONCLUSIONS

Injuries were frequent among Portuguese taekwondo athletes, with specific body areas affected, mainly caused by the attack technique. It is necessary to create injury prevention strategies, including specific training and the use of protective equipment.

Patterns and Trends of Foot and Ankle Injuries in Olympic Athletes: A Systematic Review and Meta-analysis

INTRODUCTION

Foot and ankle injuries in elite athletes can result in decreased performance, absence from sport and prolonged morbidity. There is paucity of data on foot and ankle injuries in Olympics athletes.

METHODS

We conducted a systematic review of the PubMed and EMBASE databases. Studies in English language that reported the incidence and/or prevalence of foot and ankle injuries in during Olympics games (summer, winter and youth Olympics) were included. Studies in languages other than English, those that looked at injuries other than foot and ankle injuries, studies looking at injuries in non-Olympics events and those looking at Olympics trials were excluded. We determined the injury rates and burden of foot and ankle injuries. We also looked at the patterns and trends of foot and ankle injuries.

RESULTS

A total of 399 foot and ankle injuries from 25 publications were included in the review. Foot and ankle injury rates ranged from 0.09 to 0.42 injuries per athlete-years for summer Olympics and 0.02-0.35 injuries per athlete-years for winter Olympics. Quantitative analysis revealed that foot and ankle injuries contributed to 16.9% of all injuries (95% CI 8.1-31.9%) for summer Olympics and 5.1% of all injuries (95% CI 1.9-12.6%) for winter Olympics; however, a high statistical heterogeneity was noted. The three most common injuries were tendon injuries, ligament injuries and stress fractures. The rates and burden of foot and ankle injuries showed a declining trend.

CONCLUSIONS

Foot and ankle injuries are an important cause of morbidity amongst Olympics athletes. The declining trend amongst these injuries notwithstanding, there is a need for a global electronic database for reporting of injuries in Olympics athletes.

Postural stability for taekwondo athletes with repetitive ankle sprains during a single-leg stance

[Purpose] The purpose of this study is to investigate postural stability in such group of taekwondo athletes by measuring the center-of-pressure variables in both the injured limb and uninjured limb during a single-leg stance with eyes closed. [Subjects and Methods] The study includes eleven taekwondo athletes with repetitive ankle sprains (RASs) and eleven healthy taekwondo athletes (the controls) at the college level participating in taekwondo training sessions. For the controls, the "injured" limb was taken to be the left limb. [Results] The postural stability measured in both the anteroposterior and mediolateral directions using center-of-pressure variables was lower in the uninjured limb of the RAS group than in the control group during a single-leg stance with eyes closed. However, for the injured limb, there were no significant differences between the two groups. Furthermore, compared to the RAS group, the control group had higher stability in the injured limb than in the uninjured limb. [Conclusion] Individuals with RASs should ensure improvements in their proprioceptive and neuromuscular functions, as well as muscle strength, through an adequate period of rehabilitation to reduce the risk of re-injury.

Injuries in taekwando: systematic review

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

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

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

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

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

Analysis of injuries in taekwondo athletes

[Purpose] The present study aims to provide fundamental information on injuries in taekwondo by investigating the categories of injuries that occur in taekwondo and determining the locations of these injuries. [Subjects and Methods] The data of 512 taekwondo athletes were collected. The sampling method was convenience sampling along with non-probability sampling extraction methods. Questionnaire forms were used to obtain the data. [Results] The foot, knee, ankle, thigh, and head were most frequently injured while practicing taekwondo, and contusions, strains, and sprains were the main injuries diagnosed. [Conclusion] It is desirable to decrease the possibility of injuries to the lower extremities for extending participation in taekwondo. Other than the lower extremities, injuries of other specific body parts including the head or neck could be important factors limiting the duration of participation. Therefore, it is necessary to cope with these problems before practicing taekwondo.