Injuries in martial arts and combat sports: Prevalence, characteristics and mechanisms.

Abstract

Objective.-To measure sports injuries prevalence, types and mechanisms, considering grappling and impact modalities. Equipment and methods.-An observational, descriptive epidemiology study was conducted involving 125 recreational practitioners. Subjects were inquired regarding the type of martial arts and combat sports (MACS), age, practice time and weekly training volume. Results.-From all, 53.6% athletes suffered injury in the last 12 months. The most common were tendon injuries (39%) and sprains (39%), followed by dislocation/subluxation (23%). In grappling MACS, as Judo, joints injuries were the most frequent, especially the knees and shoulders. For striking modalities, such as Karate, muscle injuries were more frequent and the most common sites were feet and toes, followed by hands and fingers. The lower limbs were the most affected site (2 = 67.8, P < 0.001). A higher prevalence of injury was found in combat simulations (43%) than in technical training (26%) and competition (10%). Conclusion.-There was a high percentage of injury in lower limbs for both modality groups, and the higher frequency of injuries in the upper limbs were the shoulders, hands and fingers, while for lower limbs were the feet and toes, ankles and knees. Injury occurred mainly during technical training and, in most cases, without protective equipment.

Full text

Please
cite
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article
in
press
as:
Del
Vecchio
FB,
et
al.
Injuries
in
martial
arts
and
combat
sports:
Prevalence,
charac-
teristics
and
mechanisms.
Sci
sports
(2018),
https://doi.org/10.1016/j.scispo.2018.02.003
ARTICLE IN PRESS
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SCISPO-3179;
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Science
&
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(2018)
xxx,
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ORIGINAL
ARTICLE
Injuries
in
martial
arts
and
combat
sports:
Prevalence,
characteristics
and
mechanisms
Blessures
dans
les
arts
martiaux
et
les
sports
de
combat
:
prévalence,
caractéristiques
et
mécanismes
F.B.
Del
Vecchio,
C.B.
Farias,
R.C.
de
Leon,
A.C.C.A.
Rocha,
L.M.
Galliano,
V.S.
Coswig∗
Superior
School
of
Physical
Education,
Federal
University
of
Pelotas,
Rua
Luiz
de
Camões,
625,
Três
Vendas,
Pelotas/RS
96055-630
Brazil
Received
20
July
2017;
accepted
7
February
2018
KEYWORDS
Martial
arts;
Injuries;
Statistics
and
numerical
data;
Athletes;
Sports
medicine
Summary
Objective.
—
To
measure
sports
injuries
prevalence,
types
and
mechanisms,
considering
grap-
pling
and
impact
modalities.
Equipment
and
methods.
—
An
observational,
descriptive
epidemiology
study
was
conducted
involving
125
recreational
practitioners.
Subjects
were
inquired
regarding
the
type
of
martial
arts
and
combat
sports
(MACS),
age,
practice
time
and
weekly
training
volume.
Results.
—
From
all,
53.6%
athletes
suffered
injury
in
the
last
12
months.
The
most
common
were
tendon
injuries
(39%)
and
sprains
(39%),
followed
by
dislocation/subluxation
(23%).
In
grappling
MACS,
as
Judo,
joints
injuries
were
the
most
frequent,
especially
the
knees
and
shoulders.
For
striking
modalities,
such
as
Karate,
muscle
injuries
were
more
frequent
and
the
most
common
sites
were
feet
and
toes,
followed
by
hands
and
fingers.
The
lower
limbs
were
the
most
affected
site
(2=
67.8,
P
<
0.001).
A
higher
prevalence
of
injury
was
found
in
combat
simulations
(43%)
than
in
technical
training
(26%)
and
competition
(10%).
Conclusion.
—
There
was
a
high
percentage
of
injury
in
lower
limbs
for
both
modality
groups,
and
the
higher
frequency
of
injuries
in
the
upper
limbs
were
the
shoulders,
hands
and
fingers,
while
for
lower
limbs
were
the
feet
and
toes,
ankles
and
knees.
Injury
occurred
mainly
during
technical
training
and,
in
most
cases,
without
protective
equipment.
©
2018
Elsevier
Masson
SAS.
All
rights
reserved.
∗Corresponding
author.
Faculty
of
Physical
Education,
Federal
University
of
Pará,
Castanhal,
Brazil,
Rua
Luiz
de
Camões,
625,
Três
Vendas,
Pelotas/RS,
96055-630
Brazil.
E-mail
address:
vcoswig@gmail.com
(V.S.
Coswig).
https://doi.org/10.1016/j.scispo.2018.02.003
0765-1597/©
2018
Elsevier
Masson
SAS.
All
rights
reserved.

Please
cite
this
article
in
press
as:
Del
Vecchio
FB,
et
al.
Injuries
in
martial
arts
and
combat
sports:
Prevalence,
charac-
teristics
and
mechanisms.
Sci
sports
(2018),
https://doi.org/10.1016/j.scispo.2018.02.003
ARTICLE IN PRESS
+Model
SCISPO-3179;
No.
of
Pages
6
2
F.B.
Del
Vecchio
et
al.
MOTS
CLÉS
Arts
martiaux
;
Blessures
;
Statistiques
et
données
numériques
;
Sportifs
;
Médecine
du
sport
Résumé
Objectif.
—
Cette
étude
a
été
conc¸ue
pour
mesurer
la
prévalence,
les
types
et
les
mécanismes
des
lésions
entraînées
par
la
pratique
des
arts
martiaux,
compte
tenu
des
modalités
de
grappling
et
d’impact.
Matériel
et
méthodes.
—
Une
étude
épidémiologique
observationnelle
et
descriptive
a
été
réal-
isée
sur
125
sportifs
amateurs.
Ils
ont
été
interrogés
sur
le
type
d’arts
martiaux
ou
de
sports
de
combat,
l’âge,
le
temps
de
pratique
et
le
volume
d’entraînement
hebdomadaire.
Résultats.
—
Parmi
tous
les
participants,
53,6
%
ont
été
blessés
au
cours
des
12
derniers
mois.
Les
blessures
les
plus
courantes
étaient
les
blessures
aux
tendons
(39
%)
et
les
entorses
(39
%),
suivies
de
la
luxation/subluxation
(23
%).
Dans
les
sports
de
combat
avec
grappling,
comme
le
Judo,
les
blessures
articulaires
étaient
les
plus
fréquentes,
en
particulier
aux
genoux
et
aux
épaules.
Pour
les
sports
de
combat
avec
impact,
comme
le
karaté,
les
blessures
musculaires
étaient
plus
fréquentes
et
les
sites
les
plus
communs
étaient
les
pieds
et
les
orteils,
suivis
par
les
mains
et
les
doigts.
Les
membres
inférieurs
étaient
le
site
le
plus
affecté
(Chi2=
67,8,
p
<
0,001).
Une
prévalence
plus
élevée
de
blessures
a
été
trouvée
dans
les
simulations
de
combat
(43
%)
que
dans
l’entraînement
technique
(26
%)
et
la
compétition
(10
%).
Conclusion.
—
Il
y
avait
un
pourcentage
élevé
de
blessures
des
membres
inférieurs
dans
les
deux
groupes
de
modalités,
et
les
blessures
aux
membres
supérieurs
affectaient
préférentiellement
les
épaules,
les
mains
et
les
doigts.
Aux
membres
inférieurs
les
blessures
prédominaient
aux
pieds
et
aux
orteils,
aux
chevilles
et
aux
genoux.
Les
blessures
survenaient
principalement
lors
de
l’entraînement
technique
et,
dans
la
plupart
des
cas,
en
l’absence
d’équipement
de
protection.
©
2018
Elsevier
Masson
SAS.
Tous
droits
r´
eserv´
es.
1.
Introduction
In
martial
arts
and
combat
sports
(MACS)
universe,
we
high-
lighted
two
wide
groups
of
modalities:
grappling
modalities,
which
involve
projections/throws,
immobilisations,
joint
locks
and
struggles,
and
impact
modalities,
which
involve
punches,
kicks,
elbows
and
knee
blows
[1].
In
grappling
modalities,
a
higher
percentage
of
injury
occurs
in
joints,
and
upper
limbs
are
the
most
vulnerable
site
[2].
However,
recently,
a
higher
prevalence
of
injury
was
shown
in
knees,
mainly
due
to
successive
movements
to
body
rotation
and
the
blocking
process
of
projection
techniques
[3].
In
impact
MACS,
a
higher
prevalence
of
injury
was
shown
in
lower
limbs
[4].
Indeed,
it
should
be
considered
that
there
is
a
reasonable
difference
in
injury
patterns
among
beginners
and
experienced
athletes,
with
the
first
tending
to
injure
the
trunk
more
frequently
and
the
latter
suffering
injuries
in
the
head
more
often
[5].
Muscle
tissue
is
the
most
vulnerable
site
in
impact
MACS,
followed
by
joint
sprains
and
frac-
tures
[4,5],
but
while
even
considering
systematic
review
researches
about
injuries
in
different
MACS
[6],
to
date,
we
found
no
studies
comparing
injury
patterns
among
MACS
athletes
from
grappling
or
impact
modalities.
Assuming
that,
MACS
are
substantially
different
concern-
ing
the
movement
pattern[6],
there
may
be
preferential
distribution
of
injury
when
considering
the
group
of
prac-
tices,
although
this
has
not
been
investigated
previously
in
the
same
study.
In
addition,
a
better
understanding
of
the
injury
characteristics,
such
as
type,
timing
and
severity,
can
contribute
to
the
development
of
preventive
actions,
intended
to
reduce
the
incidence
or
severity
[6,7].
Thus,
this
study
aimed
to
measure
injury
prevalence,
types
and
mech-
anisms,
considering
that
there
may
possibly
be
differences
between
grappling
and
impact
modalities.
2.
Material
and
methods
2.1.
Study
design
and
variables
It
was
an
observational,
descriptive
epidemiology
study,
which
involved
athletes
from
different
MACS,
as
Taekwondo,
Shotokan
Karate,
Contact
Karate,
Wushu,
Boxing,
Hapkido,
Muay
Thai,
Jiu
Jitsu,
Aikido
and
Judo.
Independent
variables
were
as
follows:
type
(grappling
or
striking),
age
(between
18
and
25
years,
26—35
years,
and
above
36
years),
body
mass
index
(BMI),
practice
time
(until
four
years
or
more
than
four
years),
non-competitive
activities
and
weekly
training
hours.
Dependent
variables
included
frequency,
type,
moment
of
injury,
anatomical
site,
severity,
and
recov-
ery
time.
2.2.
Subjects
The
reference
population
for
this
study
consisted
of
MACS
adult
athletes
from
Pelotas/RS,
Brazil.
To
obtain
the
sam-
ple
size,
previous
efforts
to
contact
the
Regional
Council
of
Physical
Education
and
the
Physical
Education
Profession-
als
Association
found
that
in
the
city
there
is
no
numerical
record
of
practitioners
in
gym
clubs
or
associations.
Still,
while
a
licence
for
professional
practice
is
necessary,
many
places
do
not
have
it.
Thus,
the
number
and
name
of
gym
clubs
and
associations
offering
MACS
practices
were
regis-
tered
(n
=
50).
They
were
visited
and
male
practitioners
who
were
18
years
old
or
above,
and
who
agreed
to
participate
in
the
present
study,
were
involved.
Those
with
less
than
three
consecutive
months
of
practice
(n
=
65)
and
competitors
from
other
sports
were
excluded.
The
final
sample
consisted
of
125
subjects
who
were
described
from
body
mass,
height,

Please
cite
this
article
in
press
as:
Del
Vecchio
FB,
et
al.
Injuries
in
martial
arts
and
combat
sports:
Prevalence,
charac-
teristics
and
mechanisms.
Sci
sports
(2018),
https://doi.org/10.1016/j.scispo.2018.02.003
ARTICLE IN PRESS
+Model
SCISPO-3179;
No.
of
Pages
6
Injuries
in
martial
arts
and
combat
sports
3
BMI
and
training
practices
(research
approved
by
the
local
ethics
committee
=
27299814.9.0000.5317/2014).
2.3.
Instrument
and
procedures
2.3.1.
Injury
questionnaire
validation
In
the
present
study,
was
considered
injury
any
physical
complaint
sustained
by
an
athlete
that
results
from
a
MACS
combat
or
MACS
training,
irrespective
of
the
need
for
medi-
cal
attention
or
time-loss
[8].
The
athletes
were
asked
to
provide
detailed
information
concerning
the
most
important
injury
considering
the
last
12
months.
The
validation
process
of
Referred
Morbidity
Inquiry
(RMI)
used
in
the
present
study
was
done
in
three
successive
phases.
Firstly,
the
face
vali-
dation
was
conducted
while
consulting
three
experts
(one
of
them
in
questionnaires,
another
in
physical
education
and
sport
measurements,
and
the
last
in
MACS),
which
pointed
out
their
opinion.
The
second
phase,
test—retest
validation,
was
performed
with
duplicate
application
of
RMI
with
an
interval
of
7
days,
involving
12
MACS
athletes
who
were
not
considered
in
the
final
sample.
After
statements
made
by
the
subjects,
the
instrument
was
improved.
Prior
assessment
noted
that
the
grade
given
by
the
individuals
in
the
first
ver-
sion
was
8
±
0.5
from
10,
and
in
the
second
was
9.5
±
0.4
(P
<
0.05,
t
test
for
paired
samples).
The
last
step
was
con-
ducted
with
a
new
application
of
the
improved
questionnaire
to
other
15
MACS
athletes,
following
the
same
procedures
of
the
second
stage,
which
had
no
additional
comments,
whereby
becoming
the
definitive
version.
For
data
collection,
the
RMI
was
applied
to
125
MACS
athletes
from
Pelotas,
Brazil.
Previous
studies
with
combat
sports
athletes
demonstrated
that
they
can
read,
under-
stand
and
fill
these
instruments
with
high
quality
[9,10].
The
RMI
elaborating
upon
the
present
study
contained
questions
regarding
the
most
important
injury
in
the
last
12
months
and
the
impact
generated
by
this
injury
[10].
The
RMI
was
delivered
to
each
athlete
who
had
continuous
and
proximal
monitoring
to
fill
the
instrument.
The
filling
process
was
conducted
individually
and
independently
in
the
athlete’s
environment.
Regarding
the
memory
bias
control,
we
adopted
a
recov-
ery
time
strategy,
month
by
month
of
suffered
injury.
In
addition,
respondents
were
unaware
of
the
purpose
of
the
study,
with
one
of
the
methods
being
used
to
minimise
the
overestimation
of
the
results.
For
accessibility
bias
control,
we
opted
for
the
listing
and
visitation
of
all
MACS
places
of
the
city
that
have
this
kind
of
practice
and
the
approach
of
individuals
who
signed
informed
consent.
2.4.
Statistical
analysis
Data
are
shown
as
mean
±
standard
deviation,
as
well
as
absolute
and
relative
frequencies.
For
the
comparison
between
groups
(grappling
or
striking
modalities),
an
inde-
pendent
sample
t
test
was
applied.
Differences
between
proportions
were
tested
with
a
chi-square
test;
when
appropriate,
a
Friedman
correction
was
considered.
The
significance
level
was
set
at
5%.
The
procedures
were
con-
ducted
in
SPSS
version
20.0.
3.
Results
The
125
MACS
athletes
exhibited
30.3
±
9.4
years,
174
±
6.5
cm
of
height,
and
78.9
±
11.5
kg
of
body
mass,
and
we
found
no
association
between
BMI
and
total
injury
prevalence
(2=
2.08;
P
=
0.35).
A
small
percentage
was
involved
with
other
non-competitive
physical
activities,
with
22.4%
(n
=
28)
running,
8.8%
(n
=
11)
playing
soccer,
and
4%
(n
=
6)
having
contact
with
hiking,
dance,
cycling
and
yoga.
The
largest
percentage
of
athletes
did
not
practise
resistance
training
(52.8%
(n
=
66),
2=
4.85;
P
=
0.02),
30.4%
(n
=
38)
did
up
to
three
times
a
week,
and
16.8%
(n
=
21)
had
four
or
more
weekly
sessions.
There
were
no
associations
between
different
age
groups
and
injuries
(2
=
2.45;
P
=
0.29).
There
was
a
registered
average
of
6.6
±
8.2
years
of
practice,
and
an
associ-
ation
between
practice
time
and
injury
was
not
found
(2=
0.59;
P
=
0.28).
The
average
duration
of
the
training
was
5.2
±
2.5
hours
a
week
uninterrupted
for
the
past
three
months,
with
statistical
differences
between
injured
and
non-injured
athletes
in
the
last
12
months
(respectively
4.8
±
2.2
h
and
5.5
±
2.8
h
per
week,
P
=
0.04).
Considering
modalities,
72%
of
practitioners
were
involved
with
impact
(n
=
90,
11
subjects
from
Taekwondo,
Shotokan
Karate
=
11,
Contact
Karate
=
11,
Wushu
=
11,
Kick
Boxing
=
8,
Boxing
=
12,
Hapkido
=
13,
and
Muay
Thai
=
13)
and
28%
with
grappling
(n
=
35,
14
subjects
from
Jiu-Jitsu,
12
from
Aikido,
and
9
from
Judo).
About
practice
goals,
76.8%
(n
=
96)
sought
physical
fitness
and
health
improvement,
54.4%
(n
=
68)
practised
for
self-defence,
53.6%
(n
=
67)
for
quality
of
life,
and
only
32%
(n
=
40)
had
a
focus
on
sports
competition,
and
this
goal
has
been
associated
with
the
presence
of
injury
in
the
last
12
months
(2=
5.29;
P
=
0.017).
There
were
67
injuries
in
the
past
12
months
(54%);
of
these,
98.5%
(n
=
66)
were
during
MACS
practice.
Previous
pains
to
a
musculoskeletal
injury
were
indicated
by
20%
(n
=
25)
of
injured
practitioners
and
59.7%
(n
=
40)
of
them
were
on
the
dominant
side.
The
consumption
of
medici-
nal
products
was
necessary
in
55
cases
(82.1%),
23
injuries
(34.8%)
needed
medical
attention,
eight
(11.9%)
demanded
physiotherapy,
and
five
(7.5%)
were
subject
to
surgery.
Con-
cerning
injury
occurrence,
19.4%
(n
=
13)
were
recurring,
56.7%
(n
=
38)
generated
a
sequel,
29.2%
(n
=
19)
needed
up
to
seven
days
of
recovery,
27.6%
(n
=
18)
took
two
weeks
to
a
month,
23.1%
(15)
demanded
less
than
three
months,
and
it
took
more
than
90
days
for
20%
(n
=
13)
of
them.
Considering
the
MACS
practice,
48.8%
(n
=
61)
performed
flexibility
exercises
before
and
after
sessions,
47.2%
(n
=
59)
practised
just
before
training,
and
only
4%
(n
=
5)
at
the
end
of
the
session,
although
its
execution
was
not
associ-
ated
with
injury.
Unexpectedly,
there
was
an
association
between
resistance
training
practice
and
the
presence
of
injury
in
the
last
12
months
(2=
9.78;
P
=
0.002).
Among
all
athletes,
95.2%
(n
=
119)
indicate
that
injury
might
not
be
intensified
with
subsequent
practice
of
MACS,
25.6%
(n
=
32)
of
them
point
out
that
the
presence
of
injury
does
not
mod-
ify
volume,
intensity
or
duration
of
their
training
sessions,
and
60.8%
(n
=
76)
indicate
that
the
injury
was
not
a
barrier
to
daily
practice
of
training.
Only
17
subjects
(26.15%)
were
using
personal
protective
equipment
at
the
moment
of
injury.
Of
the
total,
9.2%
(n
=
6)

Please
cite
this
article
in
press
as:
Del
Vecchio
FB,
et
al.
Injuries
in
martial
arts
and
combat
sports:
Prevalence,
charac-
teristics
and
mechanisms.
Sci
sports
(2018),
https://doi.org/10.1016/j.scispo.2018.02.003
ARTICLE IN PRESS
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SCISPO-3179;
No.
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6
4
F.B.
Del
Vecchio
et
al.
Table
1
Absolute
frequency
(AF)
and
relative
frequency
(RF)
of
the
types
of
injuries
in
combat
sports
by
modality
groups
(n
=
65).
Modality
groups
Type Impact
Grappling
Total
AF
RF
(%)
AF
RF
(%)
AF
RF
(%)
Contusion
11
22
0
0
11
17
Tendon
injury
7
14
4
25
11
17
Muscle
distension
9
18
0
0
9
14
Joint
spraina4
8
5
31
9
14
Fracture
7
14
1
6
8
12
Luxation/subluxation
5
10
2
13
7
11
Chronic
nonspecific
pain
3
6
2
13
5
8
Joint
inflammation
2
4
0
0
2
3
Muscle
contracture
1
2
1
6
2
3
Skin
lesion/cut
0
0
1
6
1
2
Total
49
100
16
100
65
100
2:
17.73;
P:
0.03;
AF:
absolute
frequency;
RF:
relative
frequency.
aSignificant
difference
between
modality
groups
(2=
2.33;
P
=
0.03).
wore
a
band
of
cotton,
9.2%
(n
=
6)
employed
a
mouth
guard,
and
only
7.7%
(n
=
4)
employed
a
shin
guard,
ankle
brace
or
kneepad.
Regarding
the
characteristics
of
reported
injury,
Table
1
shows
a
prevalence
of
injury
tendon
(17%;
n
=
11)
and
sprain
injuries
(14%;
n
=
9),
and
the
percentages
by
modal-
ity
also
explain
a
statistical
difference
in
the
proportion
by
modality
(2=
17.73;
P
=
0.03).
Impact
modalities
show
a
higher
percentage
of
bruises
and
sprains
(40%
combined;
n
=
20),
whereas
the
largest
percentage
of
joint
injuries
were
observed
in
grappling
modalities,
which
showed
a
higher
number
of
sprains
(31%
(n
=
5)
versus
8%
(n
=
4);
2=
2.33,
P
=
0.03).
Anatomically,
there
were
no
differences
between
body
parts
by
modality
(2=
17.34;
P
=
0.49).
It
has
indicated
a
higher
percentage
of
injury
in
the
lower
limbs,
with
38%
(n
=
25)
between
toes,
feet,
ankles
and
knees.
Hands,
fingers
and
shoulders
were
affected
in
22%
(n
=
14)
of
cases.
When
considering
body
segments,
upper
limbs
were
injured
28%
(n
=
14)
in
striking
and
31%
(n
=
5)
in
grappling
(Table
2).
Regarding
the
mechanisms
that
generate
the
injury,
punch
attacks
were
responsible
for
15%
(n
=
10),
while
defending
this
type
of
action
has
generated
8%
(n
=
5)
of
the
injury.
Stretching,
in
general,
was
responsible
for
14%
(n
=
9)
of
the
lesions,
and
running
accounted
for
8%
(n
=
5).
However,
differences
in
the
percentage
are
observed
if
considering
the
groups
of
modalities
(2=
67.8,
P
<
0.001).
In
striking
modalities,
the
application
and
receiving
of
punches
(30%;
n
=
15)
and
performing
stretching
and
running
(26%;
n
=
13)
prevailed.
In
grappling
MACS,
spins
and
sudden
stops
were
responsible
for
38%
(n
=
6)
and
throws
were
respon-
sible
for
26%
(n
=
4),
and
we
found
a
statistical
difference
between
modality
groups
in
sudden
stops
(2=
2.99;
P
=
0.01)
(Table
3).
Considering
occurrence,
the
greater
percentage
of
injury
(28%;
n
=
18)
originated
from
attacks,
followed
by
defence
movements
(15%;
n
=
9),
both
in
simulating
combats.
Table
2
Distribution
of
absolute
frequency
(AF)
and
rela-
tive
frequency
(FR)
of
the
anatomical
sites
of
sports
injuries
in
practitioners
of
combat
sports
by
modality
groups
(n
=
65).
Modality
Anatomical
site Impact
Grappling
Total
AF
RF
(%)
AF
RF
(%)
AF
RF
(%)
Knees
6
12
4
25
10
15
Feet
and
toes
8
16
2
13
10
15
Shoulder
4
8
3
19
7
11
Hand
and
fingers
5
10
2
13
7
11
Ankle
3
6
2
13
5
8
Posterior
thigh
5
10
0
0
5
8
Anterior
thigh
3
6
0
0
3
5
Fist
3
6
0
0
3
5
Head
1
2
1
6
2
3
Leg
2
4
0
0
2
3
Calf
2
4
0
0
2
3
Forearm
1
2
0
0
1
2
Elbow
1
2
0
0
1
2
Thorax
2
4
0
0
2
3
Abdomen
1
2
0
0
1
2
Lumbar
spine
1
2
0
0
1
2
Cervical
0
0
1
6
1
2
Hip
0
0
1
6
1
2
Groin
1
2
0
0
1
2
Total
49
100
16
100
65
100
2:
17.34;
P:
0.49;
AF:
absolute
frequency;
RF:
relative
frequency.
Table
3
Distribution
of
absolute
frequency
(FA)
and
rela-
tive
frequency
(FR)
of
the
mechanisms
of
sports
injuries
in
combat
sports
by
modality
groups
(n
=
65).
Modality
Total
Impact
Grappling
Mechanisms
AF
RF
(%)
AF
RF
(%)
AF
RF
(%)
Attacking
punching
10
20
0
0
10
15
Stretching
8
16
1
6
9
14
Defending
punching
5
10
0
0
5
8
Running
5
10
0
0
5
8
Spinning
3
6
2
13
5
8
Sudden
stopa1
2
4
25
5
8
Joint
lock 4
8
1
6
5
8
Attacking
projection 1
2
2
13
3
5
Strangulation
3
6
0
0
3
5
Strength
training
2
4
1
6
3
5
Blow
defending
3
6
0
0
3
5
Defending
projection
0
0
2
13
2
3
Jumping
2
4
0
0
2
3
Counter-blow
2
4
0
0
2
3
Passing
guard
0
0
2
13
2
3
Blow
attacking
0
0
1
6
1
2
Total
49
100
16
100
65
100
2:
37.9;
P:
0.001;
AF:
absolute
frequency;
RF:
relative
frequency.
aSignificant
difference
between
modality
groups
(2=
2.99;
P
=
0.01)

Please
cite
this
article
in
press
as:
Del
Vecchio
FB,
et
al.
Injuries
in
martial
arts
and
combat
sports:
Prevalence,
charac-
teristics
and
mechanisms.
Sci
sports
(2018),
https://doi.org/10.1016/j.scispo.2018.02.003
ARTICLE IN PRESS
+Model
SCISPO-3179;
No.
of
Pages
6
Injuries
in
martial
arts
and
combat
sports
5
Technical
training
with
a
partner
generated
14%
(n
=
9)
of
injury
during
attacks,
with
12%
(n
=
8)
in
defensive
move-
ments.
Technical
training
without
a
partner
generated
11%
(n
=
7)
of
injury,
while
warm-up
and
bearings
also
exhib-
ited
11%
(n
=
7)
of
prevalence.
Competitive
situations
were
responsible
for
10%
(n
=
6)
of
injury,
with
5%
(n
=
3)
during
offensive
actions
and
5%
(n
=
3)
during
defensive
actions.
Furthermore,
it
highlighted
no
difference
in
proportions
between
striking
and
grappling
for
moments
of
occurrence
(2=
4.35;
P
=
0.82).
4.
Discussion
The
present
study
aimed
to
investigate
the
prevalence
of
injury
in
MACS
and
it
is
the
first
study
to
show
informa-
tion
comparing
striking
and
grappling
modalities.
The
main
findings
indicate
more
frequent
musculoskeletal
injuries
in
striking,
while
joint
and
tendon
injuries
are
more
frequent
in
grappling
MACS,
with
a
statistical
superiority
to
sprains
in
this
last
group.
Additionally,
sudden
stops
were
significantly
higher
in
grappling
ones.
In
addition,
people
who
aimed
to
participate
in
competitions
exhibited
greater
injury
preva-
lence.
Health
benefits
induced
by
physical
exercises
are
strongly
recognised;
however,
active
behaviour
also
exposes
the
practitioner
to
higher
injury
risk
[7,11].
Despite
the
differ-
ences
in
the
studies,
the
percentages
of
injured
athletes
vary
widely
from
2.5%
to
118.5%
between
Judo,
Taekwondo
and
Wrestling
[6].
In
the
present
study,
53.6%
of
MACS
practi-
tioners
presented
an
important
injury
during
the
12
previous
months
(which
is
a
value
in
agreement
with
previous
stud-
ies
that
measured
contact
sports),
and
showed
56.1%
of
injury
[3].
However,
a
lower
incidence
was
observed
in
Taek-
wondo,
Judo
and
MMA
practitioners,
which
showed
30%1,12,
11—12%4
and
8.5%
[13],
respectively.
Considering
recre-
ational
sports
and
activities,
the
prevalence
of
15
to
20%
of
injury
is
expected,
a
percentage
lower
than
the
observed
[14],
probably
caused
by
the
agonistic
objective
of
some
subjects
involved
in
our
study.
No
associations
were
found
between
the
time
of
practice
and
injury
prevalence,
which
counteracts
Brazilian
Jiu-Jitsu
and
Judo
data
that
indicates
that
experienced
athletes
presented
a
greater
frequency
of
injury
[2,15],
probably
due
to
the
superior
exposure
in
training
and
competition.
Regarding
the
severity
of
injury,
it
was
found
that
the
major-
ity
(82.1%)
needed
medications,
34.8%
received
medical
treatment
and,
in
some
cases
(7.5%),
surgery
was
neces-
sary.
Another
investigation,
with
young
Taekwondo
athletes,
observed
that
the
severity
of
injury
led
to
hospitalisation
in
4%
of
the
cases[16],
while
for
boxers,
only
1.6%
needed
hos-
pital
stay
[17].
Considering
Judo
athletes,
64%
of
injury
are
severe
[18];
in
contrast,
another
investigation
indicates
that
severe
injuries
are
rare
in
these
athletes
[4],
showing
dis-
similar
data
concerning
same
subject.
Probably,
differences
between
findings
could
involve
study
designs
and
measure
units
as
exposure
[7].
Despite
limitations
involving
our
study
design,
an
inter-
estingly
association
was
observed
between
resistance
training
practice
and
injury
(P
=
0.002).
In
contrast,
previous
studies
showed
that
strength
level
[19]
and
strength
train-
ing
could
reduce
injury
risks,
including
among
Judo
athletes
[4].
In
this
sense,
the
main
limitation
of
this
study
was
not
to
verify
if
the
beginning
moment
of
strength
training
was
before
or
after
injury.
On
the
other
hand,
it
is
recognised
that
resistance
training
is
used
by
a
large
part
of
the
athletes
and
the
inappropriate
execution
of
exercises
may
increase
the
chance
of
locomotor
system
injuries
[20].
Moreover,
the
relation
between
strength
training
and
injury
frequency
among
combat
sports
athletes
should
be
better
investigated.
It
is
already
known
that
injuries
are
influenced
by
intrin-
sic
factors
such
as
gender,
age,
body
mass,
height,
flexibility
and
coordination,
and
by
extrinsic
factors
such
as
strength
and
conditioning
programmes
and
the
use
of
protection
equipment
[21].
The
knowledge
about
extrinsic
elements
can
contribute
to
injury
prevention,
considering
that
trauma
reduction
was
observed
with
helmet
use
[12,22],
a
groin
protector
and
tatami,
in
addition
to
medical
surveillance
[12,23,24]
and
proper
training
methods
[25].
In
this
context,
it
was
found
that
only
26%
of
practitioners
used
protection
equipment
at
the
moment
of
injury
and
its
prevalence
could
be
smaller
if
they
were
protected
[12].
Regarding
the
injury
type,
tendon
and
sprains
followed
by
luxation/subluxation
and
contusion
were
more
frequent.
It
was
observed
for
impact
MACS
that
musculoskeletal
injuries
are
more
common,
mainly
on
feet
and
toes,
followed
by
hands
and
fingers
and
posterior
thigh.
Considering
Taek-
wondo
athletes,
fractures
are
prominent,
mainly
on
feet
[26].
For
grappling
MACS,
joints
and
tendon
are
highlighted,
mainly
on
knees
and
shoulders.
Judo
athletes
showed
a
greater
injury
frequency
in
knees,
followed
by
shoulders,
feet
and
toes
[18].
In
contrast,
a
review
about
Judo
fight-
ers
indicates
a
predominance
of
shoulders,
knees,
hands
and
feet
injury
[2].
Probably,
this
distinct
prevalence
of
injury
according
to
the
type
of
MACS
and
injury
could
be
related
to
the
nature
of
modalities,
which
require
specific
techniques
different
from
each
other,
and
frequent
usage
of
rotational
force
[4,27].
Concerning
the
body
site,
the
present
study
found
a
higher
percentage
of
injury
in
lower
limbs.
The
most
recur-
rent
injuries
on
upper
limbs
were
shoulders,
hands
and
fingers.
In
lower
limbs
the
more
frequent
injury
were
feet
and
toes,
ankles
and
knees.
The
injury
mechanisms
also
vary
between
MACS,
since
in
striking
modalities,
punch
move-
ments
[24,28],
and
stretching
and
running
prevailed,
while
for
grappling
modalities,
spinning,
sudden
stops
and
throws
prevailed
[4,27].
The
difference
between
the
techniques
used
justifies
the
variation
between
the
body
site,
type
of
injury,
and
mechanisms
of
the
injury.
Striking
MACS
require
kicking
movements,
punching
and
sudden
actions
involving
muscle
power
[1],
while
among
grappling,
throws,
ground
techniques,
immobilisations,
submissions
and
joint
locks
prevail
[2,27].
The
present
study
found
a
higher
frequency
of
injury
from
sudden
stops
in
grappling
MACS,
probably
due
to
the
athletes
trying
to
avoid
being
thrown
by
opponents
[2,4,6,27].
Subjects
showed
a
greater
injury
prevalence
during
simu-
lated
combats
(43%)
than
during
technical
training
(26%)
and
competition
(10%).
In
this
sense,
Judo
athletes
showed
more
injury
during
training
(∼70%)
than
competition
[18,29].
In
addition,
exposure
to
training
is
more
frequent
than
com-
petition
[18],
which
may
explain
our
findings
[6].
The
main
limitation
of
the
present
study
is
the
possibil-
ity
of
memory
bias
[7],
as
athletes
might
have
informed
of

Please
cite
this
article
in
press
as:
Del
Vecchio
FB,
et
al.
Injuries
in
martial
arts
and
combat
sports:
Prevalence,
charac-
teristics
and
mechanisms.
Sci
sports
(2018),
https://doi.org/10.1016/j.scispo.2018.02.003
ARTICLE IN PRESS
+Model
SCISPO-3179;
No.
of
Pages
6
6
F.B.
Del
Vecchio
et
al.
only
injuries
that
caused
relevant
trauma
during
the
last
year,
underestimating
the
incidence
of
injury.
In
addition,
non-respondents
(n
=
60)
could
also
create
a
bias
in
results,
as
the
fact
of
refusal
to
respond
could
be
related
to
a
spe-
cific
characteristic
of
a
different
number
of
injuries,
besides
there
being
no
way
to
obtain
this
information
precisely,
and
further
studies
in
combat
sports
could
try
to
overcome
this
limitation.
5.
Conclusion
There
was
a
high
percentage
of
injury
in
lower
limbs
for
both
modality
groups,
and
the
higher
frequency
of
injuries
in
the
upper
limbs
were
the
shoulders,
hands
and
fingers,
while
the
most
cited
lower
limb
injury
were
the
feet
and
toes,
ankles
and
knees.
Finally,
it
is
indicated
that
injury
occurred
mainly
during
technical
training;
in
most
cases,
the
practitioner
was
not
using
protective
equipment.
In
a
practical
point
of
view,
it
is
suggested,
based
on
our
data,
that
technical-tactical
practices
should
be
reviewed
to
avoid
injury
during
train-
ing.
To
this
procedure,
coaches
and
trainers
could
apply
time-motion
data
to
adapt
sparring
training
while
maintain
physical
and
technical-tactical
specificity.
In
addition,
the
authors
encourage
athletes,
trainers
and
coaches,
to
mon-
itor
over-reaching
and
over-training
variables,
all
together
with
protective
equipment
aiming
the
possibility
of
a
reduc-
tion
in
the
incidence
of
injury.
Disclosure
of
interest
The
authors
declare
that
they
have
no
competing
interest.
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