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Epidemiology of injuries in full-contact combat sports

Authors:

Abstract

As in any sport, there is an inherent risk of injury to practitioners of combative martial arts. Notwithstanding the potential for injury, there has not been a concerted effort to clearly elucidate the injury problem in full-contact combat sports. The purpose of this review is to provide an overview of the injury incidence, injury pattern, and injury severity in six popular and commonly practiced full-contact combat sports. Data from a total of 47 observational studies suggest that there is a significant injury problem in full-contact combat sports generally. However, the injury incidence rates and injury patterns vary considerably across different styles, which most likely is a reflection of differences in competition rules. Very little is known about the actual severity of injuries in combat sports. Future studies are strongly encouraged to adopt stronger study methodologies.
Australasian Epidemiologist August 2015 Vol. 22.1
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Round Table
Epidemiology of injuries in full-contact combat sports
Reidar P Lystad
School of Medical and Applied Sciences, Central Queensland University, Australia
Email: r.lystad@cqu.edu.au
Abstract
As in any sport, there is an inherent risk of injury to
practitioners of combative martial arts. Notwit hstanding the
potential for injury, there has not been a concerted eor t to
clearly elucidate the injury problem in full-contact combat
sports. The purpose of this review is to provide an overview
of the injury incidence, injury pattern, and injury sever ity in
six popular and commonly practiced full-contact combat
sports. Data from a total of 47 observational studies suggest
that there is a significant injury problem in f ull-contact
combat sports generally. However, the injury incidence rates
and injury patterns vary considerably across dierent styles,
which most likely is a reflection of dierences in competition
rules. Very little is known about the act ual sever ity of injuries
in combat sports. Future studies are strongly encouraged to
adopt stronger study methodologies.
Introduction
The term combat sports can be used to refer to the subset of
martial ar ts that are practiced for the purpose of competition.
Combat sports typically involve one-on-one combat, either
unarmed or wit h the use of various weapons such as sticks
(e.g. arnis, kali, eskrima), wooden swords (e.g. kendo), small
swords (e.g. modern fencing), or even lances (e.g. jousting).
Unarmed combat sports can be fur ther subdivided into
stri king styles (e.g. boxing, kickboxing, karate, taekwondo),
grappling styles (e.g. wrestling, judo, Brazilian jiu-jitsu), or
hybrid styles combining striking and grappling (e.g. mixed
martial ar ts). Naturally, there is a wide range of rulesets
across the combat sports. These rulesets regulate various
aspects of the contests, for instance: which techniques and
targets are permissible, what protective gear (if any) the
contestants must wear, and whether contests are won by
scoring more points or by disabling an opponent. Reflecting
the amount of force that can be used on an opponent,
combat sports can be divided into light-contact, medium-
contact, and full-contact variants.
Although bot h karate and taekwondo each boast having
almost 100 million practitioners worldwide, it is dicult to
estimate exactly how many people participate in combat
sports worldwide, and, moreover, to ascertain which of them
are the most popular or commonly practised. The ocial
program for the Rio 2016 Olympic Games includes three
unarmed combat sports, namely boxing, judo, and
taekwondo. Noteworthy among the non-Olympic combat
sports is mixed martial arts. Promoters and organisers of
mixed martial arts contests have enjoyed a surging
popularity and widespread coverage in mainstream media
since the early 2000s, but the sport has also at tracted rebuke
from both politicians and medical associations that wish to
see it banned.1
The health benefits of regular physical activity are
undisputed, and the speci fic health benefits of martial arts
practice have been reviewed elsewhere.2-4 However,
participation in sport and active recreation are not without
risk, and injuries can be an adverse outcome. Indeed, sport
injury is identified as a major public health problem,5-7 and
approximately 8% of youths discontinue sporting activ ities
annually because of injury.8 As in any sport, there is an
inherent r isk of injury to practitioners of combative mart ial
arts, in particular in f ull-contact combat sports. The aim of
any sport, therefore, should be to keep the risk of injury at an
acceptable level, and to ensure that t he benefits of
participation outweighs the potential adverse events.
It is been claimed that all styles of mar tial arts are safe and
that practitioners are seldom severely injured.9 However,
good quality evidence to support such claims are often
wanting. Moreover, there are good reasons to suspect that
the injury problem varies significantly between dierent
combat sports. Unlike in many other major sports such as
football, rugby, and basketball (to name but a few), there has
not been a long-standing, concerted eor t to clearly elucidate
the injury problem in popular combat sports. It is therefore
dicult to ascertain the true injury risk in these sports,
which in turn precludes athletes from making truly informed
choices. The lack of good quality epidemiological
investigations also precludes the identification of risk factors
that could become targets for injury prevention eor ts,
thereby improving the safety for combat sport athletes.
Fortunately, prospective epidemiological investigations of
injuries in combat sports have star ted to emerge in the
literature. It may therefore be useful to athletes and sport
governing bodies, as well as to sports injury prevention
Australasian Epidemiologist August 2015 Vol. 22.1
15
scientists, if the available data were synthesised in a way that
allowed for meaningful comparisons to be made. Thus, the
main objective of this review is to provide an overview of the
injury incidence, injury pattern, and injury severit y in six
popular and commonly practised full-contact combat sports
(i.e. boxing, kickboxing, judo, karate, taekwondo, and mixed
martial arts).
Methods
Selection criteria
Reports from obser vational studies published in peer-
reviewed literature were eligible for inclusion in this rev iew.
Eligible study designs included prospective or retrospective
cohort studies based on on-site competition injur y
surveillance data, and meta-analyses of similar data. On the
other hand, cross-sectional surveys, case-control studies,
case series and reports, commentaries, editorials, and letters
to the editor were excluded from th is review. Language
restrictions were applied such that only English, German,
French, and Spanish lang uage articles were included. Eligible
studies had to report epidemiological data such as incidence,
distribution, or severity of injuries in either boxing, judo,
karate, kickboxing, mixed martial ar ts, or taekwondo. No
studies were excluded based on sex, age, or any other
characteristics of the study population.
Search strategy
This review used a quasi-systematic approach to identify
relevant st udies. This entailed using the results from
previously conducted, sport-specific systematic literature
searches. Although t here are minor dierences between the
original search strategies (e.g. which databases were utilised,
when the searches were conducted, and which spor t-
specific keywords were used), they all included at a
minimum electronic searching of PubMed and
SPORTDiscus databases from inception to 2013. Moreover,
snowballing strategies were used to identif y additional
studies not captured by the original electronic searches.
Data extraction and analysis
Data from included studies were extracted and tabulated in
an electronic spreadsheet. The data of interest were as
follows: (i) injur y incidence rate per 1,000 athlete-exposures,
(ii) distribution of injuries by anatomical region and by type
of injury, and (iii) injury severity. One athlete-exposure was
defined as one athlete being exposed to the possibility of
incurring an injury while participating in a single contest
(fight or bout). If the included studies did not specifically
report injury incidence rates per 1,000 athletes-ex posures,
they were, if possible, calculated from the available data.
The number of injuries by anatomical region and by ty pe of
injury from individual studies were pooled for each combat
sport and presented as proportions of the total number of
injuries. In an attempt to increase the comparability across
the included studies, injuries were categorised according to
the Orchard Sports Injury Classification System, version 1010 ,
while unspecified injuries were omitted from the pooled
injury proportion calculations.
Similarly, the number of injuries by injur y severity were
presented as propor tions of the total number of injur ies.
Injury severit y was defined in accordance with previous
recommendations,11 that is, as the number of days elapsed
from the date of injury to the date of the athlete’s return to full
participation in training and match play. Injury severity was
categorised as follows: slight (0–1 days), minimal (2–3 days),
mild (4–7 days), moderate (8–28 days), severe (>28 days).
Results
A total of 47 observational studies were included in this
review. Two studies repor ted on injuries in both taekwondo
and judo. Thus, the total number of injury reports for each
combat sport were as follows: 13 for taekwondo12-24 , 3 for
kickboxing2 5-27, 5 for mixed mar tial arts28-3 2, 6 for boxing33-3 8,
13 for karate39-51, and 7 for judo.24, 51-56 In addition, t wo
meta-analyses (one for mixed martial arts1 and one for
taekwondo11) were identified and included in this review.
Injury incidence rates
Figure 1 shows the injury incidence rates per 1,000 athlete-
exposures as reported by the included studies. The small
circles represents point estimates from indiv idual
observational studies, while the large circles represent pooled
estimates from published meta-analyses. The data suggest
that, among the popular full-contact combat spor ts, t he risk
of injury is lowest in grappling styles such as judo (range:
41.2–115.1); greater in striking styles such as taek wondo
(range: 19.1–138.8), karate (range: 45.2–214.3), kickboxing
(range: 109.7–155.4), and boxing (range: 77.7–250.6); and
greatest in hybrid styles such as mixed martial arts (range:
85.1–2 80 .7 ).
Figure 1. Injury incidence rates per 1,000 athlete-
exposures in full-contact combat spor ts. Small squares
represent point estimates from individual obser vational
studies. Large circles represent pooled estimates from
published meta-analyses
0 50 100 150 200 250 300
Injury incidence rate per 1,000 athlete−exposures
Mi
xed martial arts
B
oxing
Ka
rate
Kickb
oxing
T
aekwondo
J
udo
 
 
 
 
 
 
Injury patterns
Figure 2 shows the proportions of the total number of injuries
by anatomical region across the included combat spor ts. T he
head and neck was the most frequently injured anatomical
region in boxing (84%), karate (74%), mixed mar tial arts (64%),
and kickboxing (55%); whereas the lower limb and upper
limb were the most frequently anatomical regions in
Australasian Epidemiologist August 2015 Vol. 22.1
16
taekwondo (51%) and judo (47%), respectively. The
proportion of trunk injuries was relatively small across
all combat spor ts (2–10%).
Figure 2. Proportions of total number of injuries by
anatomical region in full-contact combat sports
Proportion (%) of total number of injuries by anatomical region
Mi
xed martial arts
B
oxing
Ka
rate
Kickb
oxing
T
aekwondo
J
udo
Head and neck
Trunk
Upper limb
Lower limb
Figure 3 shows the proportions of the total number of injuries
by type of injur y across the included combat sports.
Contusion (which includes bruising and haematoma) was
found to be the most common type of injury in karate (55%),
taekwondo (45%), and kickboxing (40%); while laceration
(which includes abrasion) was the most common type of
injury in boxing (68%) and mixed mart ial ar ts (58%).
Compared to other combat sports, judo was found to have a
greater var iety of injury diagnoses, with joint sprain (31%)
being the most common type of injur y. Concussion
comprised a greater proportion of the total number of injuries
in kickboxing (19%) and boxing (14%) compared to taekwondo
(6%), MMA (4%), and karate (4%). The proportion of fractures,
however, was greater in mixed martial ar ts (27%) than in
taekwondo (8%), boxing (7%), kickboxing (7%), karate (4%), and
judo (2%).
Figure 3. Proportions of total number of injuries by type
of injury in full-contact combat sports
Proportion (%) of total number of injuries by type of injury
Mi
xed martial arts
B
oxing
Ka
rate
Kickb
oxing
T
aekwondo
J
udo
Contusion/Haematoma
Laceration/Abrasion
Joint sprain
Muscle strain
Fracture
Dislocation
Concussion
Other
Injury severity
Figure 4 shows the proportions of the total number of injuries
by injury severity across the included combat spor ts. Although
several of the included st udies mentioned injury severity, only
three of t hese measured injury severity in terms of actual, as
opposed to estimated, time-loss from participation. The
proportion of moderate to severe injuries (i.e. injuries resulting
in more than one week of time lost from play) was 32% in
taekwondo22 , 15% in karate50 , and 7% in judo.53 There were no
studies reporting on the severity of injur ies in boxing,
kickboxing, or mixed mar tial arts.
Figure 4. Proportions of total number of injuries by
injury severity in full-contact combat sports
Proportion (%) of total number of injuries by injury severity
Mi
xed martial arts
B
oxing
Ka
rate
Kickb
oxing
T
aekwondo
J
udo
?
?
?< 1 week
> 1 week
Discussion
This review highlights that there is a significant injury
problem in full-contact combat sports generally, that both
injury incidence rates and injury patterns vary considerably
across dierent styles, and t hat very little is known about the
actual severity of injuries in combat sports.
Among full-contact combat sports, t he risk of injur y appears
to be greater in hybrid styles (e.g. mixed mar tial arts),
intermediate in striking styles (e.g. boxing, kickboxing,
karate, and taekwondo), and lower in grappling styles (e.g.
judo), with injury incidence rates of around 230, 120, and 80
injuries per 1,000 athlete-exposures, respectively. However,
there is considerable heterogeneity in study met hodologies
among the included studies. For instance, the included
studies varied in terms of operational injur y and exposure
definitions, data collection methods, setting, and study
population characteristics. Consequently, there may have
been significant underreporting of injuries in some of the
included studies. It is therefore prudent to be cautious when
interpreting the injury incidence rates reported herein.
Furt hermore, all exposures are not equal. For instance, the
typical length of an exposure in most combat sports is
somewhere between 5 and 25 minutes, whereas matches in
team sports such as rugby and soccer may last an hour or
more. Thus, it becomes dicult compare the risk of injur y in
combat sports to other sports without first factoring in the
actual exposure time. Unfortunately, few studies on combat
sports report exposure time-adjusted injury incidence rates.
However, if we assume an average exposure time of 15
minutes, t hen we can estimate the time-adjusted injury
incidence rates for hybrid, striking, and grappling styles to be
approximately 920, 480, and 320 injuries per 1,000 contest-
hours, respectively. By this measure, the injur y risk in
full-contact combat sports is far greater than in popular
sports such as r ugby (80 per 1,000 match-hours)57, soccer
(20–25 per 1,000 match-hours)58, and running (8–18 per
1,000 hours).59 Although this measure provides a more direct
comparison, caution must nevertheless still be exercised
Australasian Epidemiologist August 2015 Vol. 22.1
17
because t here may be significant dierences in the total time
of competition exposure (e.g. annually or lifetime) that is
typical for combat sports and ot her spor ts such as rugby,
soccer, and running.
The included combat sports appear to have unique injur y
patterns, and dierences in competition rules undoubtedly
explain much of these observed variations in injury patterns.
For instance, lower limb injur ies are ver y uncommon in
boxing, but very common in taekwondo. Although it is not
permissible to strike the lower limb in either sport,
taekwondo allows using t he feet to kick the opponent’s trunk
or head. Another example is that head injuries are
uncommon in judo (which disallows strikes to the head), but
exceedingly common in boxing, kickboxing, mixed martial
arts and, to lesser extent, karate where strikes to the bare head
are allowed. The high propor tion of head injuries in some of
these combat sports is a cause for concern, especially
considering that continued repetitive head trauma (not
necessarily limited to clinically observable concussions) is
associated with degeneration in brain structures such as
thalamus, basal ganglia, and hippocampus, with measurable
decline in cognitive function.60
In regard to injury severity, only three of the included st udies
measured actual, as opposed to estimated, time lost to
participation in training or competition. With such scarcity
of data it becomes very dicult to both assess the act ual
burden injuries in combat sports, and, subsequently, to know
where to direct eorts to prevent or mitigate the risk of injury.
Thus, it is strongly recommended that future studies
investigate the sever ity of injuries in combat spor ts using
objective measurements of actual time lost to participation.
It is important to emphasise that this review has concerned
itself with competition injuries only. The injury problem is
expected, as is the case in many other sports, to be very
dierent in the training context, not only in terms of
incidence, but also in regard to injur y pattern and severity.
This disparity in injur y risk between training and
competition should be kept in mind when considering the
costs and benefits of participating in combat sports. It is, for
instance, both possible and reasonable to choose to train in
combat sports without ever participating in contests
or tournaments.
This review is limited by t he paucity of available injur y data
in some of the combat sports, as well as the methodological
quality of the included studies. It is possible the literature
searches failed to identify all relevant studies, while the
exclusion of articles in languages other than English,
German, Spanish, and Italian may have introduced language
bias. However, reviews of the potential impact of language
bias have concluded that language restrictions has generally
little eect on summar y on the overall findings.61 , 62 Lastly, the
included studies were not subjected to a formal risk of bias
assessment, which could, in turn, have been used to provide
preferential weighting when synthesising the data presented
in this review. The findings herein should be interpreted in
light of these limitations. To facilitate cross-study
comparisons, future studies are strongly encouraged to
adhere to the (STrengthening the Reporting of Obser vational
studies in Epidemiology (STROBE) Statement guidelines63 ,
adopt standard injury definitions, and employ standardised
sports injur y classification systems.
Conclusion
There is a significant injury problem in full-contact combat
sports. The risk of injury appears to be greatest in hybrid
styles (e.g. mixed martial arts), intermediate in striking styles
(e.g. boxing, kickboxing, karate, and taekwondo), and lowest
in grappling st yles (e.g. judo), with injury incidence rates
around 230, 120, and 80 injuries per 1,000 athlete-exposures,
respectively. The injury patterns vary considerably across
dierent styles, which most likely is a reflection of dierences
in competition rules. Unfort unately, very little is known
about the actual severity of injuries in combat sports.
Future studies are strongly encouraged to adopt stronger
study methodologies.
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... Those sports, on the other hand, have higher proportions of lower limb and upper limb injuries, respectively. 85 This is perhaps not surprising given that taekwondo athletes wear protective headgear, while striking the head is not permitted in judo. Although contusions and lacerations are relatively common in most full-contact combat sports, the proportion of lacerations is higher in boxing and mixed martial arts compared with karate. ...
... Although contusions and lacerations are relatively common in most full-contact combat sports, the proportion of lacerations is higher in boxing and mixed martial arts compared with karate. 85 Our review underscores the importance of using exposure-time adjusted injury rates when comparing injury risk across subgroups. For instance, although males had a significantly higher IIR AE compared with females (RR AE 1.27, 95% CI 1.03 to 1.55), there was no significant difference in IIR ME between males and females (RR ME 1.09, 95% CI 0.88 to 1.36). ...
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Objective To report the epidemiology of injuries in Olympic-style karate competitions. Design Systematic review and meta-analysis. Pooled estimates of injury incidence rates per 1000 athlete-exposures (IIR AE ) and per 1000 min of exposure (IIR ME ) were obtained by fitting random-effects models. Data sources MEDLINE, Embase, AMED, SPORTDiscus and AusportMed databases were searched from inception to 21 August 2019. Eligibility criteria Prospective cohort studies published in peer-reviewed journals and reporting injury data (ie, incidence, severity, location, type, mechanism or risk factors) among athletes participating in Olympic-style karate competition. Results Twenty-eight studies were included. The estimated IIR AE and IIR ME were 88.3 (95%CI 66.6 to 117.2) and 39.2 (95%CI 30.6 to 50.2), respectively. The most commonly injured body region was the head and neck (median: 57.9%; range: 33.3% to 96.8%), while contusion (median: 68.3%; range: 54.9% to 95.1%) and laceration (median: 18.6%; range: 0.0% to 29.3%) were the most frequently reported types of injury. Despite inconsistency in classifying injury severity, included studies reported that most injuries were in the least severe category. There was no significant difference in IIR ME between male and female karate athletes (rate ratio 1.09; 95%CI 0.88 to 1.36). Conclusion Karate athletes sustain, on average, 1 injury every 11 exposures (bouts) or approximately 25 min of competition. The large majority of these injuries were minor or mild in severity.
... Nevertheless, it should be recommended as it can reduce the risk of skull fractures and maxillofacial injuries (Graham et al. 2014). Robust evidence shows increased risk of post traumatic encephalopathy in athlete who had frequent head trauma (concussion) and in athletes that participate in full contact level over long periods, which may present as anxiety, difficulty focusing and early Alzheimers (Rimel et al., 1981;Lystad & Reidar, 2015). This is due to degeneration of brain structure resulting from repetitive trauma involving area of hippocampus, thalamus and basal ganglia and affecting cognitive function of the brain (Lystad & Reidar, 2015). ...
... Robust evidence shows increased risk of post traumatic encephalopathy in athlete who had frequent head trauma (concussion) and in athletes that participate in full contact level over long periods, which may present as anxiety, difficulty focusing and early Alzheimers (Rimel et al., 1981;Lystad & Reidar, 2015). This is due to degeneration of brain structure resulting from repetitive trauma involving area of hippocampus, thalamus and basal ganglia and affecting cognitive function of the brain (Lystad & Reidar, 2015). This highlights the importance of educational programs on concussions which should be delivered repeatedly and in efficient manner not only to athletes, but to coaches and parents as well. ...
Article
This is a study on the prevalence of injuries and illnesses among Sabah SUKMA athletes 2018. This is a retrospective study on injuries and illnesses seen among Sabah athlete who participating in SUKMA 2018 using standardized data registry. Incidence of injury and illness is 16.27 and 16.74 per 100 athletes respectively. Combat sports showed the highest incidence of injuries (45%) mainly involving head and neck region in martial arts event (Muay Thai). Commonly occurring injuries involved were muscle strains and ligament sprains. Concussion rate was 1.85 per 100 full contact athletes. Time loss percentage was 1.4%. The only important illness reported was an isolated case of mumps. There was a high number of injuries in combat sports. There were no report of severe injuries or severe concussions. This could be due to the strict implementation of protective gear during competition. Concussion rate was lower compared to many international studies. Muscle strains was seen more in high speed sprinting and kicking athletes. Contact tracing was activated and no reported Mumps outbreaks in Sabah. There is a need for athlete to learn prevention strategies in combat sports and screening of athlete for infectious diseases prior to participation in national or international sporting event.
... On the other hand, while head injuries are rare in judo, where head contact is prohibited, they are common in karate, boxing, kickboxing, and mixed martial arts, where head contact is allowed. Upper-limb injuries occur most frequently in taekwondo and aikido [65][66][67][68][69]. ...
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Professional football players are exposed to high injury risk due to the physical demands of this sport. The purpose of this study was to characterize the injuries of a professional football team in the First Portuguese League over three consecutive sports seasons. Seventy-one male professional football players in the First Portuguese Football League were followed throughout the sports seasons of 2019/2020, 2020/2021, and 2021/2022. In total, 84 injuries were recorded. Each player missed an average of 16.6 days per injury. Lower limbs were massively affected by injuries across all three seasons, mainly with muscular injuries in the quadriceps and hamstrings and sprains in the tibiotarsal structure. Overall, the injury incidence was considerably higher in matches than in training. The two times of the season that proved most conducive to injuries were the months of July and January. Our results emphasize the importance of monitoring sports performance, including injury occurrence, and assisting in identifying risk factors in professional football. Designing individualized training programs and optimizing prevention and recovery protocols are crucial for maximizing this global process.
... Since combat sports involve striking, throwing, or immobilizing an opponent, the main cause of injuries in combat athletes is mechanical energy leading to musculoskeletal injuries [2,99]. Studies reported that the proportion of fractures is greater in mixed martial arts (27%), wrestling (21.3%), and kickboxing, in which fracture rates may reach 20% [100,101]. In addition, one of the most common bone injuries in athletes is stress fractures, which are different from contact fractures [102]. ...
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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.
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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.
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Background: Injury to the head and neck are common in combat sport athletes. Impairments of the cervical spine have been found in some athletes who participate in sports with high forces and collisions. There is a lack of research on the effects of combat sports on the cervical spine. Objective: The primary study aim was to investigate differences in cervical spine characteristics between combat athletes and a similarly aged active control group. The secondary aim was to investigate the relationship between symptom-based outcome measures and characteristics of the cervical spine. Design: Cross-sectional. Method: 40 male adult combat sport athletes and 40 male adult control participants were recruited from 4 combat sport clubs and a university campus, Australia. Cervical spine assessments were conducted at a private physiotherapy clinic. The Neck Disability Index and the Post-Concussion Symptom Scale were used as symptom-based outcome measures. Results: Combat sport athletes had a reduced range of cervical motion, but greater isometric strength and endurance compared with a control group (p < 0.05). The Neck Disability Index and Post-Concussion Symptom Scale were negatively correlated with cervical spine range of motion and isometric strength, meaning that higher scores correlated with a reduction in function. Conclusions: Differences were observed in characteristics of the cervical spine in combat sport athletes compared with a control group. Higher symptom-based outcome scores correlated with reduced range of motion and strength of cervical spine muscles. Further investigation to establish clinical cut-off scores for functional impairment may be warranted.
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Background: Due to full contact impacts in combat sports, the risk of injuries is elevated. The aim of this study is to report severe injuries among athletes in Olympic combat sports. Specific injury types, time loss, and the performance level after injury are examined. Methods: Survey to investigate injuries in Olympic combat sports during the time period from 2012-2016. Reported injuries were analyzed by anatomical location, injury type, gender, time loss, and performance level. Results: The three injuries resulting in the longest time loss (ACL rupture: judo= 37 weeks ; karate= 49 weeks ; shoulder dislocation: wrestling= 41 weeks ; shoulder rotator cuff injury: wrestling= 32weeks) also accounted for the largest proportion of athletes with career-ending injuries (ACL rupture: judo= 28% ; karate= 67% ; shoulder dislocation: wrestling= 40% ; shoulder rotator cuff injury: wrestling= 50%). Taekwondo and fencing had the shortest time loss (<12 weeks) among all combat sports. More injuries occurred during training (58%) as compared to competition (42%).Injury prevalence of competitive athletes was significantly higher as compared to recreational athletes. Male athletes suffered significantly more anterior cruciate ligament injuries (72% vs. 56% ; p < 0.05), unspecific shoulder injuries (89% vs. 47% ; p < 0.01), and elbow ligament injuries (57% vs. 30% ; p < 0.05) during training. Conclusions: The study shows that there are important differences between "punshing and kicking" and "throwing" martial arts in terms of specific injury types. In judo and wrestling, the injuries are more likely to affect the joints (knee and shoulder). Therefore, injury prevention these sports should focus on strength training of the muscles surrounding the joints and on defensive reactionary movements to avoid dangerous biomechanical joint angles. In "punshing and kicking" sports, injuries of the hands and feet, due to the large impact forces of strikes and kicks, could be reduced by improved protective equipment on hands and feet.
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Objective The purpose of this study was to describe the concussion-related symptoms reported among combat sport athletes with and without a history of concussion, and a history of neck injury. Design Cross-sectional survey. Setting Data were collected using an online survey instrument. Participants Three hundred and nine adult combat sport athletes. Main outcome measures Self-reported 12-month concussion history and neck injury history and a 22-item symptom checklist. Results A history of concussion was reported by 19.1% of athletes, a history of neck injury was reported by 23.0%, and 13.6% reported both injuries. Neck pain was the most frequently reported symptom. Athletes with a history of injury had significantly greater proportions of ‘high’ total symptoms and symptom severity scores compared with athletes with no history of injury. Athletes with a history of concussion had 2.35 times higher odds of reporting ‘high’ total symptoms and symptoms severity scores. Conclusion Athletes with a history of concussion or neck injury have greater odds of presenting with higher symptom scores. The presence of high total symptom scores and high symptom severity scores may indicate a need for further investigation into domains commonly associated with concussion.
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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.
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Sports injury is a major concern for athletes. Karate is a form of martial art that is practiced widely across the world. Injuries are inherent in karate as it is a combative sport. Therefore, there is a need of implementation of preventive strategies which play a great role in reducing the injuries. This review aimed to identify common injuries and preventive strategies for injury prevention in karate athletes. An electronic search in Google Scholar, MEDLINE, PubMed, Web of Science and Scopus was conducted by using following keywords: karate athletes, common injuries, prevention and protective equipment. Studies on injury prevention in karate athletes and studies published in English language were included in this review. Reviews and studies with free access to only abstract have been excluded. Protective equipment like mouthguards, groin guards, knuckle protection, gloves and proper padding help in prevention of injury. Strict implementation of rules and specific conditioning programs were found to be effective in injury prevention and should be encouraged for injury prevention in karate athletes. Athletes, parents and coaches should be educated regarding evolving injury prevention methods. Also, it was found that there were very few number of RCT evidence regarding preventive training programs in martial arts and karate.
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Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a che-cklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies.
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Objective: To obtain data relating to the incidence of injuries sustained during taekwondo and judo competitions at the 7th All Africa Games. Methods: Prospective recording of injuries sustained by athletes who sought physiotherapy services at the games. Details of type of injury, injury sites and injury severity were obtained. Results: Seventy athletes out of 390 participants reported injuries. The overall injury risk ratio was 0.18. Injuries reported were strains/sprains (65,6%), bruises/contusions (16.1%) and dislocations or fractures (12,9%). The upper limbs were more commonly injured. Of the injuries sustained, approximately 18%, 69% and 13% were respectively classified as mild, moderate and severe injuries. Conclusions: The high incidence of moderate to severe injuries highlights the need for injury prevention programs and the presence of medical staff at major tournaments in order to make early diagnosis and appropriate intervention.
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No systematic review has identified the incidence of running-related injuries per 1000 h of running in different types of runners. The purpose of the present review was to systematically search the literature for the incidence of running-related injuries per 1000 h of running in different types of runners, and to include the data in meta-analyses. A search of the PubMed, Scopus, SPORTDiscus, PEDro and Web of Science databases was conducted. Titles, abstracts, and full-text articles were screened by two blinded reviewers to identify prospective cohort studies and randomized controlled trials reporting the incidence of running-related injuries in novice runners, recreational runners, ultra-marathon runners, and track and field athletes. Data were extracted from all studies and comprised for further analysis. An adapted scale was applied to assess the risk of bias. After screening 815 abstracts, 13 original articles were included in the main analysis. Running-related injuries per 1000 h of running ranged from a minimum of 2.5 in a study of long-distance track and field athletes to a maximum of 33.0 in a study of novice runners. The meta-analyses revealed a weighted injury incidence of 17.8 (95 % confidence interval [CI] 16.7-19.1) in novice runners and 7.7 (95 % CI 6.9-8.7) in recreational runners. Heterogeneity in definitions of injury, definition of type of runner, and outcome measures in the included full-text articles challenged comparison across studies. Novice runners seem to face a significantly greater risk of injury per 1000 h of running than recreational runners.
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This paper presents the injury statistics for the 1981 and 1982 USA/Amateur Boxing Federation National Championships. These tournaments consisted of 547 bouts with 1,094 participants. Eighty-five injuries of varying degrees of severity were recorded; 52 were considered notable. The most frequent injuries were head blows, soft-tissue hand injuries, and facial lacerations. Forty-eight matches were stopped because of head blows, which occurred at a rate of 4.38%. All other injuries occurred at a rate of 4.75%. Amateur boxing injuries could be reduced if the sport were included in the scholastic milieu and if headgear, mats, and gloves were better designed.
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A large survey of martial arts athletes was conducted, and 24,112 injuries were identified. The areas most commonly injured were the thighs, legs, and digits. Contusions, sprains, and strains were the most common type of injuries. Most injuries occurred in less experienced people, and the number of injuries decreased as expertise and training increased. Only 47 serious injuries were recorded, a rate of 1 in 500 injuries. Most serious injuries, especially head injuries, occurred while sparring and in tournaments. Less than half the injuries that occur during tournaments are brought to the attending physician. This may be because the injuries were minor or because of tournament psychology.