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Epidemiology of injuries in amateur boxing: A systematic review and meta-analysis
Abstract
Objective
To synthesise the best available epidemiological data on competition and training injuries in amateur boxing.
Design
Systematic review and meta-analysis. Pooled estimates of competition injury incidence rates per 1000 athlete-exposures (IIRAE) and per 1000 min of exposure (IIRME), and training injury incidence rates per 1000 h of exposure (IIRHE) were obtained by fitting random-effects models.
Methods
MEDLINE, Embase, AMED, AUSPORT, and SPORTDiscus databases were searched from inception to 27 May 2022. Cohort studies with prospectively collected injury and exposure data from amateur boxing competition or training published in peer-reviewed journals were eligible for inclusion.
Results
Seventeen studies comprising 17 unique cohorts were eligible for inclusion. The competition IIRAE and IIRME summary estimates were 54.7 (95%CI 33.8–88.4) and 6.8 (95%CI 4.2–10.9), respectively. The training IIRHE summary estimate was 1.3 (95%CI 0.2–7.0). The most commonly injured body regions in the competition and training settings were the head and neck (median: 72 %; range: 46 % to 100 %) and upper limb (median: 49 %; range: 40 % to 53 %), respectively. The predominant types of injury were contusions (median: 35 %; range: 5 % to 100 %) and lacerations and abrasions (median: 20 %; range: 0 % to 69 %) in the competition setting, and sprains and strains (median: 60 %; range: 50 % to 81 %) in the training setting.
Conclusions
Amateur boxing athletes sustain, on average, 1 injury every 2.4 h of competition and every 772 h of training. There is a need for identifying mechanisms of injury and modifiable risk factors, which can be targeted by injury prevention initiatives to reduce the burden of injury in amateur boxing.
... Concussion is a traumatic brain injury that occurs due to the impact of biomechanical forces on the head, resulting in temporary or permanent damage (Alevras et al., 2022;Harmon et al., 2013). Due to the risk inherent to the sport, the International Boxing Association (IBA) implemented guidelines to minimize risks and ensure the safety of athletes. ...
... Boxing has a low overall injury rate but a high rate of head injuries, unlike disciplines such as taekwondo and karate. It is estimated that one injury occurs every 2.5 h of competition, or 722 h of training, but the highest number of injuries occurs to the head (Alevras et al., 2022). According to the meta-analysis performed by Donnelly et al. (2023), boxing presents a higher concussion risk than other combat sports (risk ratio: 0.253 vs. 0.065); in addition, ≈30% of amateur boxers showed brain atrophy, ≈61% demonstrate symptoms of dementia and ≈51% present cognitive disorders. ...
... Furthermore, the present study applied an acute protocol, however, the most severe symptoms of concussions occur late. (Alevras et al., 2022;Donnelly et al., 2023;Gallo et al., 2020). So, it is interesting that new protocols investigate whether boxers chronically exposed to NHG combat present worsening of cognition. ...
This study compared acute measures of concussion in Olympic boxers undergoing a combat. This is a case-control study where participants were measured in two conditions: a) using headgear (HG) and b) without using headgear (NHG). Thus, 14 athletes (24.9±5.1 yrs.; 77.1±13.9 kg; 1.7±0.1 m; 14.4±6.4 % body fat) completed this protocol. Tests were carried out before and after the combat (3 rounds of 3' with 1' interval) as indicators of concussion (BtrackS concussion test, automatic and controlled executive function, direct and indirect memory). A technical-tactical analysis protocol was also applied to verify the effect of HG on the actions during the combat. The HG condition showed better performance on the BtrackS concussion test (30.3±11.3 vs. 38.5±12.2; p=0.039), automatic executive function (38.0±6.0 vs. 50.4±11.4; p=0.014), and controlled (55.3±8.1 vs. 76.4±11.5; p=0.016). There was a significant difference in the number of punches connected to the head (38.5±12.0 vs. 51.1±14.7 for HG and NHG respectively; p=0.047). Based on our aims and the results obtained, our data support the acute protective effect of using HG in amateur Olympic male boxing against the concussion indicators. Keywords: Combat sports, Boxing, Olympic Games, Brain concussion, Cognition, Sport rules
... Different authors tend to focus on varied populations in terms of the level of the professionalism of the athletes. In the reviewed boxing publications, all the people were professionals [15][16][17][18][19]. The same is true for judo [9,11,22,23]. ...
... 18-43 [15][16][17][18][19] 15-48 [20,21] 10-35 [9,11,22,23] 15-39,6 [10,12] 6-53 [24][25][26] 10-36 [7,8,27,28] 9-34 [13,14,29] works contain both professionals and amateur participants [7,8]. Publications about wrestling described only professional athletes. ...
Injuries in combat sports can happen to any athlete, regardless of gender, age, training experience or whether he or she is an amateur or a professional. The range of injuries varies from superficial, short-term damage to severe injuries with serious consequences, including death. There are many types of combat sports, each with different rules and specific injuries. Amongst various divisions of combat sports, one of the basic ones is the division into ground and stand-up sports. In the following work, using the available literature, we wanted to present the specifications of several of the most popular combat sports and compare their most common locations of injuries, types of injuries and mechanisms of their formation, paying attention to which of these categories a given sport belongs to. We also discuss differences in the rate of injury for different age, genders, prevalence of injuries during situations of practice and competition. In the end, it is presented what are the possible long-term complications of injuries in combat sports and which actions such as protective gear, bans on certain techniques or behavioural changes might reduce the injury rate to protect the athletes health, well-being and decrease the economic burden on healthcare systems.
... Karate is a popular martial art and combat sport with an estimated 100 million participants worldwide. While the risk of concussion in karate is relatively low compared with other combat sports, [1][2][3][4][5][6][7][8] head injury remains a concern. Ensuring athlete safety in karate remains a priority for the international governing body, the World Karate Federation (WKF), which has introduced preventive measures such as protective gear (eg, face masks for athletes aged 14-15 years and helmets for athletes under 14 years) and age-specific competition rules (eg, prohibiting head contact with fists for athletes under 16 years). ...
Objective
To examine concussion experiences and knowledge among top-level youth karate athletes.
Methods
This cross-sectional study collected data during the 12th World Karate Championships for cadets, juniors and under-21 athletes (held in Konya, Turkey, 2022). All 1414 registered athletes from 95 countries were invited to complete a 16-item paper-based questionnaire assessing demographic data, concussion history and concussion knowledge prior to the competing at the tournament. χ ² and Fisher’s exact tests were used to analyse differences by sex, age group and continental karate federation.
Results
A total of 654 athletes (46.3% response rate), including 286 (43.7%) females and 368 (56.3%) males, participated in the study, with 29.9% reporting one or more concussions during participation in karate training or competition. Older age groups (under 21 years) reported significantly higher concussion rates than younger athletes (56.9% vs 31.1% juniors and 24.7% cadets; p<0.001). Concussion knowledge revealed considerable gaps, with only 24.5% of athletes correctly identifying a concussion and 68.9% believing loss of consciousness was required for a concussion diagnosis. Misconceptions varied significantly across geographical regions, with Asian and African athletes demonstrating the greatest need for targeted education. Female athletes demonstrated better concussion reporting attitudes than males (60.4% vs 48.9%, p=0.004).
Conclusions
This study highlights the prevalence of concussions and significant knowledge gaps among top-level youth karate athletes, emphasising the need for tailored educational interventions to improve concussion recognition and management within the karate community.
... The present study is based on previous work which sought to better understand how perceptual-cognitive skills can be improved in boxing (Romeas et al., 2022). The evaluation and training of in-ring anticipation and decision-making skills in boxers pose significant challenges due to difficulties in maintaining task standardization and the inherent risks of injury to the neck, head, and upper limbs during training sessions (Di Virgilio et al., 2019;Alevras et al., 2022). As such, VR-based solutions would represent a safe alternative to supplement perceptual-cognitive assessment and training in boxing. ...
Introduction
Recent evidence has started to demonstrate that 360°VR, a type of VR that immerses a user within a 360° video, has advantages over two-dimensional (2D) video displays in the context of perceptual-cognitive evaluation and training. However, there is currently a lack of empirical evidence to explain how perceptual-cognitive strategies differ between these two paradigms when performing sports-related tasks. Thus, the objective of this study was to examine and compare the impact of different viewing conditions (e.g., 3D-360°VR and 2D video displays), on gaze behavior and head excursions in a boxing-specific anticipatory task. A secondary objective was to assess the workload associated with each viewing mode, including the level of presence experienced. Thirdly, an exploratory analysis was conducted to evaluate any potential sex differences.
Methods
Thirty-two novice participants (16 females) were recruited for this study. A total of 24 single-punch sequences were randomly presented using a standalone VR headset (Pico Neo 3 Pro Eye), with two different viewing modes: 3D-360°VR and 2D. Participants were instructed to respond to the punches with appropriate motor actions, aiming to avoid punches. Gaze behavior was recorded using a Tobii eyetracker embedded in the VR headset. Workload and presence were measured with the SIM-TLX questionnaire. Fixation duration, number of fixations, saccades, search rate and head excursions (roll, pitch, yaw) were analyzed using linear mixed models.
Results
The results revealed significant shorter fixation durations and more head excursions (roll, pitch) in 3D-360°VR, compared to the 2D viewing mode (ps < 0.05). The sense of presence was found to be much higher in the 3D-360°VR viewing mode (p < 0.05). No sex differences were observed. These results demonstrate that 360°VR elicited shorter fixation durations but mostly greater head excursions and immersion compared to a 2D projection in the context of a boxing-specific task.
Discussion
These findings contribute to the understanding of previous evidence supporting the possible advantages of using 360°VR over 2D for perceptual-cognitive evaluation and training purposes. Further validation studies that compare behaviors and performance in 360°VR with those in the real-world will be needed.
... This puts the assessment of skydiving as a high-risk sport into perspective, especially considering the definition of high-risk sport as a sporting activity in which athletes must accept the possibility of serious injury or death as an immediate part of the sporting activity, especially when comparing these results with other so-called high-risk sports. For example, amateur boxers suffer an injury on average every 2.5 h in competition and every 772 h in training [31], or one in three recreational surfers suffers a traumatic injury within 12 months [32]. ...
Skydiving have gained mainstream popularity over the past decades. However, limited data exist on the injury risk or type associated with skydiving. This systematic review evaluated the injuries and fatalities of civilian skydivers. A PRISMA-guided literature search was performed in MEDLINE, Web of Science, Cochrane Library, and Embase using the following MeSH terms: “skydiving” or “parachute” alone or in combination with “injury” or “trauma” was performed including all studies through June 2022 in both English and German. Additionally, injury reports from the German, American, and British Parachute Associations were reviewed. Of the 277 articles matching the selected search terms, 10 original articles and 34 non-scientific reports from various skydiving associations were included. More than 62 million jumps were evaluated, with an average of 3,200,000 jumps per year, which showed an average injury rate of 0.044% and an average fatality rate of 0.0011%. The most common injuries sustained by recreational skydivers involved the lumbar spine and lower extremities. Injuries were most commonly reported during the landing sequence. With modern equipment and training methods, fatalities occur in less than 1 per 100,000 cases, and serious injuries requiring hospitalization in less than 2 per 10,000 cases. This puts the assessment of skydiving as a high-risk sport into perspective.
Introduction Kickboxing is a heavily participated combat sport within the UK. With the sport involving striking opponents, it is widely perceived to be associated with an elevated risk of maxillofacial injury. However, the research is limited, with gaps that require further investigation. This study aimed to assess the frequency and distribution of these injuries and whether protective modalities, including headgear and mouthguards, help reduce them.Materials and methods In total, 92 kickboxers completed an electronic questionnaire from 11 October to 11 November 2021.Results There was an incidence rate of 71.7% where participants had experienced at least one maxillofacial injury. The lip was the most affected (26.1%; p <0.05). Injury rates per participant for headgears, mouthguards and no protection were 2.1, 2.6 and 4.7, respectively.Conclusions Maxillofacial injuries in kickboxing have a prevalence of 71%. Protective equipment successfully reduced the frequency of maxillofacial injuries (p <0.05). Experience levels are a major contributor in the incidence of these injuries. Updated regulations to mandate protective equipment may significantly reduce incidence of injury. More research is required in relation to variables such as ethnicity and bone density to identify high-risk groups.
Headguard use is appropriate during some combat sports activities where the risks of injury to the face and ears are elevated. Headguards are highly effective in reducing the incidence of facial lacerations in studies of amateur boxers and are just as effective in other striking sports. They should be used in scenarios - especially sparring prior to competitions - where avoidance of laceration and subsequent exposure to potential blood-borne pathogens is important. Headguards are appropriate where avoidance of auricular injury is deemed important; limited data show a marked reduction in incidence of auricular injury in wrestlers wearing headguards.Headguards should not be relied upon to reduce the risk of concussion or other traumatic brain injury. They have not been shown to prevent these types of injuries in combat sports or other sports, and human studies on the effect of headguards on concussive injury are lacking. While biomechanical studies suggest they reduce linear and rotational acceleration of the cranium, changes in athlete behavior to more risk-taking when wearing headguards may offset any risk reduction. In the absence of high-quality studies on headguard use, the Association of Ringside Physicians recommends that further research be conducted to clarify the role of headguards in all combat sports, at all ages of participation. Furthermore, in the absence of data on gender differences, policies should be standardized for men and women.
In 2013, the International Boxing Association (AIBA) prohibited the use of headguards for elite male Olympic boxing competitions. Could the removal of the headguard from elite male boxing competitions potentially cause increased injury risk for boxers? The aim of the literature review is to analyse current knowledge about the use of protective headgear and injury prevention in boxing, in order to determine if there are increased injury risks associated with headguard use. Peer‐reviewed studies (language: English, Norwegian, Swedish, Danish and Dutch) published from 1980 and onwards were considered. Five academic databases and grey literature sources were searched, and articles were assessed for methodological quality. Only studies that included boxers as the study population with headguards as a factor were considered. A total of 39 articles were included in the review. The analysis of the reviewed literature indicates that headguards protect well against lacerations and skull fractures, while less is known about the protective effects against concussion and other traumatic brain injuries. Most of the analysed studies however use indirect evidence, obtained through self‐report or observational techniques with relatively small non‐representative samples. There are almost no randomised control trials, longitudinal research designs or samples from recreational boxing. Therefore, AIBA's decision to remove the headguard has to be seen with caution and injury rates among (male) boxers should be continuously evaluated.
Highlights
Research does not sufficiently support the statement that boxing without protective headgear is safer than boxing with a headguard.
Headguards protect well against facial cuts and skull fractures. The systematic review indicates that headguards provide some protection against linear impacts to the head. The headguards protective effects against concussion are however uncertain.
A research agenda is proposed. Priority areas include a focus on longitudinal research designs, randomized control trials, samples from recreational competitive boxing, as well as further research into coaches' and athletes' experiences and perspectives on headguards and injuries.
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.
Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension—the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
Background
Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date.
Objective
To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension.
Study Design
Consensus statement of the International Olympic Committee (IOC).
Methods
The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019.
Results
This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension—the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS).
Conclusion
The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
Objective
To describe injuries and illnesses across traditional and new sports among the participating athletes of the Buenos Aires 2018 Youth Olympic Summer Games (BA YOG) (6–18 October 2018).
Methods
We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues manned by the BA YOG 2018 medical staff.
Results
In total, 3.984 athletes from 206 NOCs were observed. NOCs and BA YOG 2018 medical staff reported 619 injuries and 334 illnesses, equalling 15.5 injuries and 8.4 illnesses per 100 athletes over the 13-day period. The eight new sports on the Youth Olympic programme (futsal, beach handball, karate, roller speed skating, kitesurfing, BMX freestyle, climbing and break dancing) fell in between the other sports with respect to injury and illness risk. Injury incidence was highest in rugby (43% of all rugby players), followed by boxing (33%) and badminton (24%), and lowest in swimming, archery, roller speed skating, equestrian, climbing and rowing (<5%). The highest incidences of illness were recorded in golf (20%), followed by triathlon (16%), beach volleyball and diving (both 14%). Of the illnesses, 50% affected the respiratory system and 15% the gastrointestinal system. Injury and illness incidences varied between continents with athletes representing Europe having significantly fewer injuries and illnesses compared with other continents, apart from a similar illness incidence to Asian athletes.
Conclusion
The overall injury incidence of 15.5 injuries per 100 athletes was higher, while the overall illness incidence of 8.4 illnesses per 100 athletes was similar to previous youth and Olympic Games. The new sports did not differ significantly compared with the other sports with respect to injury and illness risk.
Physical differences between youth and adults, which include incomplete myelination, limited neck muscle development, and a higher head-body ratio in the youth population, likely contribute towards the increased susceptibility of youth to concussion. Previous research efforts have considered the biomechanics of concussion for adult populations, but these known age-related differences highlight the necessity of quantifying the risk of concussion for a youth population. This study adapted the previously developed Generalized Acceleration Model for Brian Injury Threshold (GAMBIT) that combines linear and rotational head acceleration to model the risk of concussion for a youth population with the Generalized Acceleration Model for Concussion in Youth (GAM-CY). Survival analysis was used in conjunction with head impact data collected during participation in youth football to model risk between individuals who sustained medically-diagnosed concussions (n = 15). Receiver operator characteristic curves were generated for peak linear acceleration, peak rotational acceleration, and GAM-CY, all of which were observed to be better injury predictors than random guessing. GAM-CY was associated with an area under the curve of 0.89 (95% confidence interval: 0.82–0.95) when all head impacts experienced by the concussed players were considered. Concussion tolerance was observed to be lower for youth athletes, with average peak linear head acceleration of 62.4 ± 29.7 g compared to 102.5 ± 32.7 g for adults and average peak rotational head acceleration of 2609 ± 1591 rad/s² compared to 4412 ± 2326 rad/s². These data provide further evidence of age-related differences in concussion tolerance and may be used for the development of youth-specific protective designs.
Kinematic measurements of head impacts are sensitive to sports concussion, but not highly specific. One potential reason is these measures reflect input conditions only and may have varying degrees of correlation to regional brain tissue deformation. In this study, previously reported head impact data recorded in the field from high school and collegiate football players were analyzed using two finite element head models (FEHM). Forty-five impacts associated with immediately diagnosed concussion were simulated along with 532 control impacts without identified concussion obtained from the same players. For each simulation, intracranial response measures (max principal strain, strain rate, von Mises stress, and pressure) were obtained for the whole brain and within four regions of interest (ROI; cerebrum, cerebellum, brain stem, corpus callosum). All response measures were sensitive to diagnosed concussion; however, large inter-athlete variability was observed and sensitivity strength depended on measure, ROI, and FEHM. Interestingly, peak linear acceleration was more sensitive to diagnosed concussion than all intracranial response measures except pressure. These findings suggest FEHM may provide unique and potentially important information on brain injury mechanisms, but estimations of concussion risk based on individual intracranial response measures evaluated in this study did not improve upon those derived from input kinematics alone.
Objectives: The effect of the rules change in 2013 on amateur boxing strategy, technique and safety in comparison to pre-2013 is unknown.
Methods: Pre- and post-2013 3x3 min elite level amateur boxing was compared from video footage of 29 Olympic (pre-2013) and 50 World Championship bouts (post-2013) totalling 99 male boxers (mean ± SD) age: 24.3 ± 3.2 years, height: 177.3 ± 11.3 cm, body mass: 70.7 ± 16.4 kg.
Results: Many techniques that were dominant pre-2013 were used less post-2013, including: total punches thrown, rear hand punches, hook rear hand, punches landed, uppercut punches, total punches to the body, (all P < 0.05), whilst movement around the ring and defensive movements were higher post-2013 (both P < 0.004). Post-2013 boxers have increased their foot movement by 20% to move in and then away from their opponent, combined with long range punches and deliberate defensive movements. The percentage of rounds where standing counts were issued changed from 9% to 3% pre to post-2013. However, pre-2013 1.7% of bouts did not last the full duration due to referee stoppage, post-2013 this increased to 4.2% as a result of two knockouts and eight technical knockouts.
Discussion & conclusion: Boxers should be aware of the large changes in technical demands of boxing. An increased risk of concussive or traumatic brain injury post-2013 is equivocal. However, an increase in skin splits and technical knockouts is apparent. It is likely that boxers’ believe head guard removal has made them more prone to knockouts.
Objective
To describe the pattern of injuries and illnesses sustained during the Games of the XXXI Olympiad, hosted by Rio de Janeiro from 5 to 21 August 2016.
Methods
We recorded the daily incidence of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Rio 2016 medical staff.
Results
In total, 11 274 athletes (5089 women, 45%; 6185 men, 55%) from 207 NOCs participated in the study. NOC and Rio 2016 medical staff reported 1101 injuries and 651 illnesses, equalling 9.8 injuries and 5.4 illnesses per 100 athletes over the 17-day period. Altogether, 8% of the athletes incurred at least one injury and 5% at least one illness. The injury incidence was highest in BMX cycling (38% of the athletes injured), boxing (30%), mountain bike cycling (24%), taekwondo (24%), water polo (19%) and rugby (19%), and lowest in canoe slalom, rowing, shooting, archery, swimming, golf and table tennis (0%–3%). Of the 1101 injuries recorded, 40% and 20% were estimated to lead to ≥1 and >7 days of absence from sport, respectively. Women suffered 40% more illnesses than men. Illness was generally less common than injury, with the highest incidence recorded in diving (12%), open-water marathon (12%), sailing (12%), canoe slalom (11%), equestrian (11%) and synchronised swimming (10%). Illnesses were also less severe; 18% were expected to result in time loss. Of the illnesses, 47% affected the respiratory system and 21% the gastrointestinal system. The anticipated problem of infections in the Rio Olympic Games did not materialise, as the proportion of athletes with infectious diseases mirrored that of recent Olympic Games (3%).
Conclusion
Overall, 8% of the athletes incurred at least one injury during the Olympic Games, and 5% an illness, which is slightly lower than in the Olympic Summer Games of 2008 and 2012.
Background
Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making.
We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature.
Results
Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan.
As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users.
Conclusions
Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
Background:
Rugby union is a collision-based ball sport played at the professional level internationally. Rugby union has one of the highest reported incidences of injury of all team sports.
Purpose:
To identify the characteristics, incidence, and severity of injuries occurring in Australian professional Super Rugby Union.
Design:
Descriptive epidemiology study.
Methods:
The present study was a prospective epidemiology study on a cohort of 180 professional players from 5 Australian Super Rugby teams during the 2014 Super Rugby Union Tournament. Team medical staff collected and submitted daily training and match-play injury data through a secure, web-based electronic platform. The injury data included the main anatomic location of the injury, specific anatomic structure of the injury, injury diagnosis, training or match injury occurrence, main player position, mechanism of injury, and the severity of the injury quantified based on the number of days lost from training and/or competition due to injury.
Results:
The total combined incidence rate for injury during training and match-play across all Australian Super Rugby Union teams was 6.96 per 1000 hours, with a mean injury severity of 37.45 days lost from training and competition. The match-play injury incidence rate was 66.07 per 1000 hours, with a mean severity of 39.80 days lost from training and competition. No significant differences were observed between forward- and back-playing positions for match or training injury incidence rate or severity.
Conclusion:
The incidence of injury for the present study was lower during match-play than has previously been reported in professional rugby union; however, the overall time loss was higher compared with previous studies in professional rugby union. The high overall time loss was due fundamentally to a high incidence of injuries with greater than 28 days' severity.
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews.
Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7].
In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1).
Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA
Completing a Systematic Review Is an Iterative Process
The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
This case illustrates a specific medical risk with this rule change where an amateur boxer suffered an acute subdural haematoma following an Amateur International Boxing Association (AIBA) sanctioned event.
Boxing, by its very nature, carries a risk of injury, particularly brain injury. Within amateur boxing, the AIBA is the international sporting federation that has the governance and medical oversight of all Olympic and international competition. AIBA has been mindful of boxers’ health and has instituted a number of rule changes over the past six decades that have been aimed at improving safety and reducing the injury risk for boxers.1
AIBA has recently changed its rules to remove helmets and head protectors for international competition and is currently proposing similar rule changes for helmets not to be used at the 2016 Rio de Janeiro Summer Olympics Games. The removal of head protectors in amateur boxing has the potential to increase head and brain injury rates and it is prudent to consider the evidence for and against such a proposed change at this level of competition.2
A critical issue in interpreting the available evidence about the use of headgear for preventing head injuries in sport over time is that headgear rules have coincided with other rule changes or implementation that could also have influenced head injury risk.1 Furthermore, the proposed rule changes may change the nature of the way amateur boxing is conducted, which in turn may result in more head impacts from both glove and head to head contact.
This case illustrates a specific medical risk with this rule change where an amateur boxer suffered an acute subdural haematoma following an AIBA sanctioned event.
A 22-year-old male boxer with 5 years senior international experience was competing in a multinational event in the 54 kg division. He won the competition having …
There has been no comprehensive injury report of elite-level amateur boxers in competition and training. We reviewed injuries in training and competition in the Great Britain (GB) amateur boxing squad between 2005 and 2009.
Longitudinal, prospective injury surveillance over 5 years of the GB boxing squad from 2005 to 2009. 66 boxers passed through the squad. The location, region affected, description, and the duration of each injury were recorded by the team doctor and team physiotherapist. We recorded whether the injury occurred during competition or training, and also whether it was a new or a recurrent injury. The injury rate during competition was calculated as the number of injuries per 1000 h.
More injuries affected the hand than any other body location. This was the case overall, in training and competition individually, and for both new and recurrent injuries. More injuries occurred during training than during competition, and most injuries were new rather than recurrent. Total injury rate during competition was 828 per 1000 h and hand injury rate in competition was 302 injuries per 1000 h. Hand injury rate in competition was significantly higher than at the other locations. The incidence of concussion is comparatively low.
Injury prevention should aim to protect the hands and wrists of elite amateur boxers.
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Background: Mixed martial arts (MMA) has experienced a surge in popularity since emerging in the 1990s, but the sport has also faced concomitant criticism from public, political, and medical holds. Notwithstanding the polarized discourse concerning the sport, no systematic review of the injury problems in MMA has been published to date.
Purpose: To systematically review the epidemiologic data on injuries in MMA and to quantitatively estimate injury incidence and risk factor effect sizes.
Study Design: Systematic review and meta-analysis.
Methods: Electronic searching of PubMed, Scopus, CINAHL, EMBASE, AMED, and SPORTDiscus databases to identify studies reporting on the epidemiology of injuries in MMA. Random-effects models were used to obtain pooled summary estimates of the injury incidence rate per 1000 athlete-exposures (IIRAE) and rate ratios with 95% confidence intervals (CIs). Heterogeneity was evaluated with the I 2 statistic.
Results: A total of 6 studies were eligible for inclusion in this review. The IIRAE summary estimate was found to be 228.7 (95% CI, 110.4-473.5). No studies reported injury severity. The most commonly injured anatomic region was the head (range, 66.8%-78.0%) followed by the wrist/hand (range, 6.0%-12.0%), while the most frequent injury types were laceration (range, 36.7%-59.4%), fracture (range, 7.4%-43.3%), and concussion (range, 3.8%-20.4%). The most notable risk factors pertained to the outcome of bouts. Losers incurred 3 times as many injuries as winners, and fighters in bouts ending with knock-out or technical knock-out incurred more than 2 times as many injuries as fighters in bouts ending with submission.
Conclusion: Notwithstanding the paucity of data, the injury incidence in MMA appears to be greater than in most, if not all, other popular and commonly practiced combat sports. In general, the injury pattern in MMA is very similar to that in professional boxing but unlike that found in other combat sports such as judo and taekwondo. More epidemiologic research is urgently needed to improve the accuracy of the injury incidence estimate, to determine the injury severity, and to identify more risk factors for injury in MMA.
There is limited knowledge on epidemiological injury data in judo.
To systematically review scientific literature on the frequency and characteristics of injuries in judo.
The available literature up to June 2013 was searched for prospective as well as retrospective studies on injuries in judo. Data extraction and presentation focused on the incidence rate, injury risk, types, location and causes of injuries.
During the Olympic Games in 2008 and 2012, an average injury risk of about 11-12% has been observed. Sprains, strains and contusions, usually of the knee, shoulder and fingers, were the most frequently reported injuries, whereas being thrown was the most common injury mechanism. Severe injuries were quite rare and usually affected the brain and spine, whereas chronic injuries typically affected the finger joints, lower back and ears. The most common types of injuries in young judo athletes were contusions/abrasions, fractures and sprains/strains. Sex-differences data on judo injuries were mostly inconsistent. Some studies suggested a relationship between nutrition, hydration and/or weight cycling and judo injuries. Also, psychological factors may increase the risk of judo injuries.
The present review provides the latest knowledge on the frequency and characteristics of injuries in judo. Comprehensive knowledge about the risk of injury during sport activity and related risk factors represents an essential basis to develop effective strategies for injury prevention. Thus, the introduction of an ongoing injury surveillance system in judo is of utmost importance.
This prospective cohort study aims to assess the overall incidence of acute and overuse basketball injuries and identifies risk factors associated with ankle sprains and knee overuse injuries. In total, 164 senior players (23.7 years ± 7.0) of all levels of play, and including both men and women, participated voluntarily during one season. A total of 139 acute and 87 overuse injuries were reported, resulting in an overall injury incidence of 9.8 (8.5 to 11.1) per 1,000 hours. The incidence of acute injuries was 6.0/1,000 hours. Ankle sprains (n = 34) accounted for most acute injuries, and 52.9% of all players with ankle sprains reported a previous ankle sprain. Relative Risks (RR) and Odds Ratio (OR) with their 95% Confidence Intervals (CI) were calculated to determine significant differences. Landing on an opponent's foot was the major inciting event, significantly more so than non contact mechanisms (RR=2.1 [95% CI: 1.0-4.2]). Acute knee injuries resulted in the highest playing absence (7 weeks 2 days ± 9 weeks 1 day). Overuse injury incidence was 3.8/1,000 hours. The knee (1.5/1,000 hours) was the most common site. Forward players sustained less knee overuse injuries than players of all other playing positions, and significantly less than center players (OR=0.5 [95% CI: 0.2-0.9]). This study showed that ankle sprains and overuse knee injuries are the most common injuries in basketball, both accounting for 14.8%. Injury prevention programmes however should not concentrate on those injuries only, but might one to consider that acute knee injuries, in spite of the fact that they occur less frequently, also merit further research.
Rugby Union has one of the highest reported incidences of match injuries amongst all professional team sports. The majority of research within this field has focused on elite male cohorts; in this study we present the first meta-analytic review of these data.
The aim of this study was to summarise the incidence and severity of injuries in senior men's professional Rugby Union, and determine the overall effects of level of play, new versus recurrent injuries, playing position, type of injuries, location of injuries, severity of injuries, period of match, and injury incident.
Electronic databases were searched using keywords 'Rugby Union' and 'inj*'. Fifteen papers addressing injuries in senior men's professional Rugby Union (from 1995 through September 2012) were included in the review. A maximum of ten of these papers provided incidence data that could be modelled via a Poisson mixed-effects generalised linear model, while up to nine studies provided severity data that could be modelled via a general linear mixed model. Magnitude based inferences were used to assess differences between factors. A descriptive analysis was provided for studies that could not be included in the pooled analysis due to incongruent injury definitions.
The overall incidence of injuries in senior men's professional Rugby Union matches was 81 per 1,000 player hours (95 % CI 63-105), and 3 per 1,000 player hours (95 % CI 2-4) during training. Estimated mean severity for match injuries was 20 days (95 % CI 14-27), and 22 days (95 % CI 19-24) for training injuries. A higher level of play was associated with a greater incidence of injuries in matches, with no clear difference in severity. New injuries occurred substantially more often than recurrent injuries, while the severity of recurrent injuries was, on average, 10 days (95 % CI 4-17) greater than new injuries. Trivial differences were found in injury incidence and severity between forwards and backs. Muscle/tendon and joint (non-bone)/ligament injuries were the two most prevalent injury groups, whereas fractures and bone stress injuries had the highest average severity. The lower limb was the body region with the highest injury incidence, while upper limb injuries were most severe. The third quarter (40-60 min) of matches had the highest injury rate, and injuries most commonly occurred as a result of being tackled.
This meta-analysis confirms match injury incidence rates in professional Rugby Union can be considered high in comparison with other team sports, but similar to other collision sports. In order to markedly reduce overall injury burden, efforts should target lower-limb injury prevention strategies and technique during contact, as these may render the largest effect.
Background:
The Olympic Movement Medical Code encourages all stakeholders to ensure that sport is practised without danger to the health of the athletes. Systematic surveillance of injuries and illnesses is the foundation for developing preventive measures in sport.
Aim:
To analyse the injuries and illnesses that occurred during the Games of the XXX Olympiad, held in London in 2012.
Methods:
We recorded the daily occurrence (or non-occurrence) of injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the London Organising Committee of the Olympic and Paralympic Games' (LOCOG) medical staff.
Results:
In total, 10 568 athletes (4676 women and 5892 men) from 204 NOCs participated in the study. NOC and LOCOG medical staff reported 1361 injuries and 758 illnesses, equalling incidences of 128.8 injuries and 71.7 illnesses per 1000 athletes. Altogether, 11% and 7% of the athletes incurred at least one injury or illness, respectively. The risk of an athlete being injured was the highest in taekwondo, football, BMX, handball, mountain bike, athletics, weightlifting, hockey and badminton, and the lowest in archery, canoe slalom and sprint, track cycling, rowing, shooting and equestrian. 35% of the injuries were expected to prevent the athlete from participating during competition or training. Women suffered 60% more illnesses than men (86.0 vs 53.3 illnesses per 1000 athletes). The rate of illness was the highest in athletics, beach volleyball, football, sailing, synchronised swimming and taekwondo. A total of 310 illnesses (41%) affected the respiratory system and the most common cause of illness was infection (n=347, 46%).
Conclusions:
At least 11% of the athletes incurred an injury during the games and 7% of the athletes' an illness. The incidence of injuries and illnesses varied substantially among sports. Future initiatives should include the development of preventive measures tailored for each specific sport and the continued focus among sport bodies to institute and further develop scientific injury and illness surveillance systems.
Background/aim:
Several changes have occurred in Olympic boxing (OB) in the last few decades, influencing the results in official competitions. The aim of this study was to assess how the evolution of rules changed the rate of the results that can influence boxers' health.
Methods:
From a web-research, the results of OB tournaments from 1952 to 2011 were reviewed (29,357 bouts). For each event, rate of knockout (KO), referee-stop contest (RSC), RSC-Head (RSCH), RSC-Injury (RSCI), RSC-Outclassed (RSCO), abandon, disqualification and points decisions were recorded. In our analysis we investigated the changes that occurred after the introduction of the standing-count rule (1964), mandatory head guard (1984), computerised scoring system (1992), RSCO (2000-2009) and modification of bout formula 3×3 min rounds (3×3, until 1997, 5×2 min rounds (5×2) until 1999, 4×2 min rounds (4×2) until 2008, 3×3 from 2009).
Results:
The most important results were: (1) an RSCI rate increase (0.72-2.42%, p<0.03) after the standing-count rule; (2) a lower RSCI (0.60%, p<0.001) and higher RSCH (1.31-4.92%, p<0.001) and RSC (9.71-13.05%, p<0.03) rate with mandatory head guard; (3) a KO rate reduction (6.44-2.09%, p<0.001) with the computerised scoring system; (4) an RSC (13.15-5.91%, p<0.05) and RSCH (4.23-1.41%, p<0.001) rate reduction comparing 5×2-4×2 bouts.
Conclusions:
In the last six decades, along with rule changes in OB, a clear reduction of health challenging results was observed. In the near future, older rules will be adopted (no head guard and a manual scoring system). Continued medical surveillance is important to ensure that new rule changes do not result in poor medical outcomes for the boxers.
To review competition injuries in taekwondo and use this information to develop recommendations to reduce the number and severity of injuries in taekwondo competition.
The available literature was searched for prospective studies on taekwondo injuries in adult athletes. An injury was defined as any circumstance for which the athlete sought the assistance of the on-site medical personnel. Injury rates were expressed per athlete-exposures (A-E) and 95% CIs calculated.
Total injury rates for elite men varied from 20.6/1000 A-E (95% CI 11.8 to 29.3) to 139.5/1000 A-E (95% CI 94.0 to 185.1). For elite women, the rates varied from 25.3/1000 A-E (95% CI 3.1 to 47.4) to 105.5/1000 A-E (95% CI 89.8 to 121.1). About one-third of all injuries (29.6%) in the men were to the head and neck region, while almost half of the injuries (44.5%) were to the lower extremities. In women, 15.2% of injuries were to the head and neck and 53.1% to the lower extremities. The vast majority of all injuries were contusions (42.7% in the men and 62.7% in the women). Point estimates of rates of head injuries and concussions were found to be higher in taekwondo than in other contact sports such as football (soccer) and American gridiron football. Time-loss injury rates in the men varied from 6.9/1000 A-E (95% CI 1.8 to 11.9) to 33.6/1000 A-E (95% CI 18.9 to 48.3). In the women, they varied from 2.4/1000 A-E (95% CI 2.3 to 7.2) to 23.0/1000 A-E (95% CI 15.7 to 30.4). The turning kick was most often involved in causing injury: 56.9% of all injuries in the men and 49.8% in the women. Lack of blocking skills was identified as one of the main injury mechanisms.
Rule changes should be considered and it is recommended that governing bodies employ qualified medical personnel. Establishing an ongoing injury surveillance system in taekwondo should be the first priority.
To assess the injury incidence in elite handball, and if gender and previous injuries are risk factors for new injuries.
Cohort study of 517 male and female elite handball players (age groups under (u)16, u-18 and senior). Participants completed a web survey establishing injury history, demographic information and sports experience, and provided weekly reports of time-loss injuries and handball exposure for 31 weeks by short message service text messaging (SMS). Injuries were further classified by telephone interview.
The weekly response rate ranged from 85% to 90% illustrating the promise of the SMS system as a tool in injury surveillance. Of 448 reported injuries, 165 injuries (37%) were overuse injuries and 283 (63%) traumatic injuries. Knee (19%) and ankle (29%) were the most common traumatic injuries. The injury incidence during match play was 23.5 (95% CI 17.8 to 30.4), 15.1 (95% CI 9.7 to 22.2), 11.1 (95% CI 7.0 to 16.6) injuries per 1000 match hours among senior, u-18 and u-16 players, respectively. U-18 male players had an overall 1.76 (95% CI 1.10 to 2.80) times higher risk of injury compared to females. Having had two or more previous injuries causing absence from handball for more than 4 weeks increased the risk of new injury in the u-16 group (IRR: 1.79 (95% CI 1.03 to 3.11)-2.23 (95% CI 1.22 to 4.10)).
The incidence of time-loss injuries in elite handball was higher during match play than previously reported in recreational handball. Previous injuries were a risk factor for new injuries among u-16 players. Male players had a significant higher injury rate in the u-18 group.
Standardized assessment of sports injuries provides important epidemiological information and also directions for injury prevention.
To analyze the frequency, characteristics, and causes of injuries incurred during the Summer Olympic Games 2008.
Descriptive epidemiology study.
The chief physicians and/or chief medical officers of the national teams were asked to report daily all injuries newly incurred during the Olympic Games on a standardized injury report form. In addition, injuries were reported daily by the physicians at the medical stations at the different Olympic venues and at the polyclinic in the Olympic Village.
Physicians and/or therapists of 92 national teams covering 88% of the 10,977 registered athletes took part in the study. In total, 1055 injuries were reported, resulting in an incidence of 96.1 injuries per 1000 registered athletes. Half of the injuries (49.6%) were expected to prevent the athlete from participating in competition or training. The most prevalent diagnoses were ankle sprains and thigh strains. The majority (72.5%) of injuries were incurred in competition. One third of the injuries were caused by contact with another athlete, followed by overuse (22%) and noncontact incidences (20%). Injuries were reported from all sports, but their incidence and characteristics varied substantially. In relation to the number of registered athletes, the risk of incurring an injury was highest in soccer, taekwondo, hockey, handball, weightlifting, and boxing (all >or=15% of the athletes) and lowest for sailing, canoeing/kayaking, rowing, synchronized swimming, diving, fencing, and swimming.
The data indicate that the injury surveillance system covered almost all of the participating athletes, and the results highlight areas of high risk for sport injury such as the in-competition period, the ankle and thigh, and specific sports. The identification of these factors should stimulate future research and subsequent policy change to prevent injury in elite athletes.
This paper aims to review and collate the epidemiological data of injuries in competition taekwondo as reported in the literature, make recommendations, and suggest further research. The electronic databases AMED, AusportMed, CINAHL, MEDLINE, PubMed, and SPORTDiscus were searched from inception to March 2008. Fourteen prospective cohort studies reporting the incidence of injuries in taekwondo were included. Two reviewers independently extracted data and assessed trial quality using the STROBE statement. Homogenous studies were combined in a pooled analysis using a Poisson random effects regression model. Poisson regression showed an overall mean injury rate of 79.3 per 1000 athlete-exposures (95% confidence interval 22.8, 275.4). Neither age, gender nor level of play were significant in the analysis. The most common injury location and type were found to be the lower limb and contusion, respectively, and were invariably associated with contact. Although taekwondo players are exposed to a substantial risk of sustaining injuries, the majority of injuries appeared to be of minimal severity. Modifications to the competition rules and protective equipment may be warranted. Future studies should adhere to recommended operational definitions, utilise a standardised injury classification system, and report injury rates using multiple denominators in order to facilitate inter- and cross-sport comparisons.
To evaluate the risk of chronic traumatic brain injury from amateur boxing.
Secondary research performed by combination of sport physicians and clinical academics. DESIGN, DATA SOURCES, AND METHODS: Systematic review of observational studies in which chronic traumatic brain injury was defined as any abnormality on clinical neurological examination, psychometric testing,neuroimaging studies, and electroencephalography. Studies were identified through database (1950 to date) and bibliographic searches without language restrictions. Two reviewers extracted study characteristics, quality, and data, with adherence to a protocol developed from a widely recommended method for systematic review of observational studies (MOOSE).
36 papers had relevant extractable data (from a detailed evaluation of 93 studies of 943 identified from the initial search). Quality of evidence was generally poor. The best quality studies were those with a cohort design and those that used psychometric tests. These yielded the most negative results: only four of 17 (24%) better quality studies found any indication of chronic traumatic brain injury in a minority of boxers studied.
There is no strong evidence to associate chronic traumatic brain injury with amateur boxing.
Female boxing has been permitted in Italy since 2001. According to the latest Italian laws, athletes applying to become boxers have to pass a pre-participation medical examination.
To collect novel medical information from the pre-participation visits and mandatory pre-competition and post-competition examinations for all fights involving Italian female boxers in 2002-2003.
A retrospective study on all official female boxing competitions in Italy from January 2002 to October 2003 was conducted. A prospective study on 28 amateur female boxers was also carried out.
Retrospective study: data from 664 examinations were collected. Pre-match examinations were negative. After competitions, 19/645 visits showed some injuries, with mild, soft tissue facial lesions, epistaxis, and hand-wrist problems being the most common. Prospective study: no major lesions were found during the study. One fibroadenoma, one ovarian cyst, and one intramural uterine myoma were found. One boxer was referred to a neurologist because of non-specific electroencephalographic (EEG) abnormalities, which persisted six months later. On a re-admission examination, which was needed because of a contest that was stopped because the referee judged that she was receiving blows to the head that were dangerous, one boxer showed non-specific EEG alterations and nystagmus. A cerebral magnetic resonance imaging scan was normal. She was allowed to participate in competitions again when her EEG returned to normal and clinical signs disappeared. Deviation of the nasal septum was quite common (68%). No major eye injuries were reported.
Probably because of the correct preventive medical approach, female boxing is much safer than expected, and no major lesions (requiring hospital admission) were reported. Any lesions to the breast and reproductive system could not be considered to be boxing related.
Background
Injury surveillance is the cornerstone of any prevention program. However the same pertaining to women’s boxing is meager. We hence intended to analyse the incidence, pattern and characteristics of injuries in female boxers during the 4th Elite Women’s National Boxing Championship, 2019, in India.
Methods
A total of 235 female Indian boxers participated in the tournament. Injuries from the competition injury database maintained in accordance with the injury code proposed by the Australian Sports Injury Data Dictionary were compiled to observe the pattern and analysed. The outcomes measured were incidence in terms of injury rate and injury risk and injury pattern in terms of site, nature, mechanism, severity and time of injury.
Results
The injury rate was observed to be 43.98 injuries per 1000 athlete bouts of exposure (95% confidence interval [CI]: 33.71-54.07) and 293.21 injuries per 1000 athlete hours of competition (95% CI: 225.94-360.47). The most commonly injured site was head, face and neck regions. Most injuries were bruises/contusions followed by cuts and epistaxis. No concussions were reported.
Conclusion
This study observed that women are less prone to injuries than their male counterparts, even though a logical comparison is difficult because of the lack of data and standardization in women's boxing.
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.
Coding in sports medicine generally uses sports-specific coding systems rather than the International Classification of Diseases (ICD), because of superior applicability to the profile of injury and illness presentations in sport. New categories for coding were agreed on in the ‘International Olympic Committee (IOC) consensus statement: Methods for recording and reporting of epidemiological data on injury and illness in sports 2020.’ We explain the process for determining the new categories and update both the Sport Medicine Diagnostic Coding System (SMDCS) and the Orchard Sports Injury and Illness Classification System (OSIICS) with new versions that operationalise the new consensus categories. The author group included members from an expert group attending the IOC consensus conference. The primary authors of the SMDCS (WM) and OSIICS (JO) produced new versions that were then agreed on by the remaining authors using expert consensus methodology. The SMDCS and OSIICS systems have been adjusted and confirmed through a consensus process to align with the IOC consensus statement to facilitate translation between the two systems. Problematic areas for defining body part categories included the groin and ankle regions. For illness codes, in contrast to the ICD, we elected to have a taxonomy of ‘organ system/region’ (eg, cardiovascular and respiratory), followed by an ‘aetiology/pathology’ (eg, environmental, infectious disease and allergy). Companion data files have been produced that provide translations between the coding systems. The similar structure of coding underpinning the OSIICS and SMDCS systems aligns the new versions of these systems with the IOC consensus statement and also facilitates easier translation between the two systems. These coding systems are freely available to the sport and exercise research community.
Objectives:
To evaluate a behavioral intervention to reduce head impact exposure in youth playing American football.
Design:
Nested randomized controlled trial.
Methods:
Participants, ages 14-17 years, wore head impact sensors (SIM-G™) during two seasons of play. Those randomized to the intervention group underwent weekly tackling/blocking drills performed without helmets (WoH) and shoulder pads while the control group trained as normal, matching frequency and duration. Research personnel provided daily oversight to maintain fidelity. Head impact frequency (≥10g) per athlete exposure (ImpAE) was analyzed over time (two 11-week seasons) using mixed effect models or ANCOVA. Secondary outcomes included exposure-type (training, game) and participation level (entry-level versus upper-level secondary education).
Results:
One-hundred fifteen participants (59 WoH, 56 control) met compliance criteria, contributing 47,382 head impacts and 10,751 athlete exposures for analysis. WoH had fewer ImpAE during games compared to control participants at weeks 4 (p=0.0001 season 1, p=0.0005 season 2) and 7 (p=0.0001 both seasons). Upper-level WoH participants had less ImpAE during games than their matched controls at weeks 4 (p=0.017 and p=0.026) and 7 (p=0.037 and p=0.014) in both seasons, respectively. Upper-level WoH also had fewer ImpAE during training at week 7 (p=0.015) in season one.
Conclusions:
Tackling and blocking drills performed without a helmet during training reduced the frequency of head impacts during play, especially during games. However, these differences disappeared by the end of the season. Future research should explore the frequency of behavioral intervention and a dose-response relationship considering years of player experience.
Trial registration:
ClinicalTrials.gov # NCT02519478.
Objective
We performed a systematic review and meta-analysis of epidemiological data of injuries in professional male football.
Method
Forty-four studies have reported the incidence of injuries in football. Two reviewers independently extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement and Newcastle Ottawa Scale. Studies were combined in a pooled analysis using a Poisson random effects regression model.
Results
The overall incidence of injuries in professional male football players was 8.1 injuries/1000 hours of exposure. Match injury incidence (36 injuries/1000 hours of exposure) was almost 10 times higher than training injury incidence rate (3.7 injuries/1000 hours of exposure). Lower extremity injuries had the highest incidence rates (6.8 injuries/1000 hours of exposure). The most common types of injuries were muscle/tendon (4.6 injuries/1000 hours of exposure), which were frequently associated with traumatic incidents. Minor injuries (1–3 days of time loss) were the most common. The incidence rate of injuries in the top 5 European professional leagues was not different to that of the professional leagues in other countries (6.8 vs 7.6 injuries/1000 hours
of exposure, respectively).
Conclusions
Professional male football players have a substantial risk of sustaining injuries, especially during matches.
IntroductionWhere Does Injury Occur?When Does Injury Occur?What Is the Outcome?What Are the Risk Factors?What Are the Inciting Events?Further ResearchReferences
Hand and wrist injuries in martial arts are typically a reflection of the combat nature of this discipline. In striking sports, the axial load mechanism of injury is common and causes fractures and dislocations; in grappling sports, sprain injuries and degenerative changes predominate. There is clear evidence to support that hand protection reduces the risk of hand injury. Traditional training in martial arts on proper technique and target selection in striking sports reduces the risk of hand injury, and is an important component of hand and wrist injury prevention.
Hand and wrist injuries in martial arts are typically a reflection of the combat nature of this discipline. In striking sports, the axial load mechanism of injury is common and causes fractures and dislocations; in grappling sports, sprain injuries and degenerative changes predominate. There is clear evidence to support that hand protection reduces the risk of hand injury. Traditional training in martial arts on proper technique and target selection in striking sports reduces the risk of hand injury, and is an important component of hand and wrist injury prevention.
Objective:
This study looks at the changes in injuries after the implementation of a new rule by the International Boxing Association (AIBA) to remove head guards from its competitions.
Design:
A cross-sectional observational study performed prospectively. This brief report examines the removal of head guards in 2 different ways. The first was to examine the stoppages due to blows to the head by comparing World Series Boxing (WSB), without head guards, to other AIBA competitions with head guards. Secondly, we examined the last 3 world championships: 2009 and 2011 (with head guards) and 2013 (without head guards).
Setting:
World Series Boxing and AIBA world championship boxing.
Participants:
Boxers from WSB and AIBA world championships.
Interventions:
The information was recorded by ringside medical physicians.
Main outcome measures:
Stoppages per 10 000 rounds; stoppages per 1000 hours.
Results:
Both studies show that the number of stoppages due to head blows was significantly decreased without head guards. The studies also showed that there was a notable increase in cuts.
Conclusions:
Removing head guards may reduce the already small risk of acute brain injury in amateur boxing.
The paper presents a novel laboratory method for assessing boxing headguard impact performance. The method is applied to examine the effects of headguards on head impact dynamics and injury risk.
A linear impactor was developed, and a range of impacts was delivered to an instrumented Hybrid III head and neck system both with and without an AIBA (Association Internationale de Boxe Amateur)-approved headguard. Impacts at selected speeds between 4.1 and 8.3 m/s were undertaken. The impactor mass was approximately 4 kg and an interface comprising a semirigid 'fist' with a glove was used.
The peak contact forces were in the range 1.9-5.9 kN. Differences in head impact responses between the Top Ten AIBA-approved headguard and bare headform in the lateral and forehead tests were large and/or significant. In the 8.3 m/s fist-glove impacts, the mean peak resultant headform accelerations for bare headform tests was approximately 130 g compared with approximately 85 g in the forehead impacts. In the 6.85 m/s bare headform impacts, mean peak resultant angular head accelerations were in the range of 5200-5600 rad/s(2) and almost halved by the headguard. Linear and angular accelerations in 45° forehead and 60° jaw impacts were reduced by the headguard.
The data support the opinion that current AIBA headguards can play an important role in reducing the risk of concussion and superficial injury in boxing competition and training.
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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.
Objectives
To survey injury/illness in the National Basketball Association (NBA) over a 25-year period and examine the relationship of injury/illness to team performance.
Design
A retrospective correlational design.
Method
Trends were examined in reported numbers of players injured/ill during a season and games missed due to injury/illness from seasons ending in 1986 through 2005. This period was compared to years 2006-2010, when NBA teams were allowed to increase the total number of players on the team from 12 to 15.
Results
There was a highly significant trend (p <0.0001) of increasing numbers of players injured/ill and games missed from 1986 through 2005. After the team expansion in 2006, these rates fell abruptly by 13% and 39% respectively (both p <0.0001 compared to the previous 5-year period). We also found a significant inverse association between games missed due to injury/illness and percent games won (r = -0.29, p <0.0001).
Conclusions
Results demonstrate an increased rate of injury in the NBA up until the expansion of team size in 2006. Following 2006, team expansion was positively associated with decreased injury/illness rates. The latter finding suggests the importance of maintaining a healthy roster with respect to winning outcomes.
In spite of ample literature pointing to rotational and combined impact dosage being key contributors to head and neck injury, boxing and mixed martial arts (MMA) padding is still designed to primarily reduce cranium linear acceleration. The objects of this study were to quantify preliminary linear and rotational head impact dosage for selected boxing and MMA padding in response to hook punches; compute theoretical skull, brain, and neck injury risk metrics; and statistically compare the protective effect of various glove and head padding conditions.
An instrumented Hybrid III 50th percentile anthropomorphic test device (ATD) was struck in 54 pendulum impacts replicating hook punches at low (27-29 J) and high (54-58 J) energy. Five padding combinations were examined: unpadded (control), MMA glove-unpadded head, boxing glove-unpadded head, unpadded pendulum-boxing headgear, and boxing glove-boxing headgear. A total of 17 injury risk parameters were measured or calculated.
All padding conditions reduced linear impact dosage. Other parameters significantly decreased, significantly increased, or were unaffected depending on padding condition. Of real-world conditions (MMA glove-bare head, boxing glove-bare head, and boxing glove-headgear), the boxing glove-headgear condition showed the most meaningful reduction in most of the parameters. In equivalent impacts, the MMA glove-bare head condition induced higher rotational dosage than the boxing glove-bare head condition. Finite element analysis indicated a risk of brain strain injury in spite of significant reduction of linear impact dosage.
In the replicated hook punch impacts, all padding conditions reduced linear but not rotational impact dosage. Head and neck dosage theoretically accumulates fastest in MMA and boxing bouts without use of protective headgear. The boxing glove-headgear condition provided the best overall reduction in impact dosage. More work is needed to develop improved protective padding to minimize linear and rotational impact dosage and develop next-generation standards for head and neck injury risk.
Summary estimates of treatment effect from random effects meta-analysis give only the average effect across all studies. Inclusion of prediction intervals, which estimate the likely effect in an individual setting, could make it easier to apply the results to clinical practice
To collect medical data on women's boxing.
Cross-sectional and longitudinal study.
Medical examinations requested by Italian laws.
A retrospective study was conducted on all female boxing competitions in Italy from April 2001 to December 2007. Sixty-one amateur female boxers were evaluated longitudinally.
(1) Retrospective study: All pre-/postmatch medical reports were analysed. (2) Prospective study: Breast, gynaecologic, brain, eyes, ear, nose and throat examinations were carried out.
(1) Retrospective study: Any injury assessed before/after the match. (2) Prospective study: Health problems which could be related to boxing activity.
(1) Retrospective study: Data from 5600 examinations were collected. Precompetition, a medical problem was recorded in three athletes (one conjunctiva hyperemia, one zygomatic bruise, one eyelid haematoma). Post competition, 51/2800 medical checks showed mild common injuries, such as soft tissue facial lesions, epistaxis and hand-wrist problems. Only one concussion was recorded with hospitalisation (for a thorough evaluation). Another athlete was hospitalised for a nasal fracture. (2) Prospective study: Two fibroadenomas, three ovarian cysts and one intramural uterine myoma were diagnosed. In four boxers, non-specific electroencephalographic abnormalities were detected, however, with a normal brain MRI in three (the fourth is still waiting for the radiologic procedure). Nasal septum deviation was common (42.6%) and a transmissive hypoacusia was observed in two athletes. No major eye injuries were reported.
Female boxing seems to be a safe sport with a very low incidence of events requiring hospitalisation. No specific diseases in female boxers could be observed, in particular regarding the breast and reproductive system.
Notwithstanding the healthy influence of sporting activities on risk factors, in particular those of cardiovascular disease, it is becoming increasingly apparent that sports can present a danger to health in the form of sports injuries. The extent of the sports injury problem calls for preventative action based on the results of epidemiological research. For the interpretation of these facts uniform definitions are needed and limitations of research designs should be known. Measures to prevent sports injuries form part of what is called the ‘sequence of prevention’. Firstly the extent of the sports injury problem must be identified and described. Secondly the factors and mechanisms which play a part in the occurrence of sports injuries have to be identified. The third step is to introduce measures that are likely to reduce the future risk and/or severity of sports injuries. This measure should be based on the aetiological factors and the mechanism as identified in the second step. Finally the effect of the measures must be evaluated by repeating the first step.
In this review some aspects of the first and second step of the sequence of prevention are discussed.
The extent of the sports injury problem is often described by injury incidence and by indicators of the severity of sports injuries. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. per 1000 hours of sports participation) in order to facilitate the comparability of research results. However, one should realise that the outcome of research applying this definition of sports injury incidence is highly dependent on the definitions of ‘sports injury’ and ‘sports participation’.
The outcome of such research also depends on the applied research design and research methodology. The incidence of sports injuries depends on: the method used to count injuries (e.g. prospective vs retrospective); the method used to establish the population at risk; and on the representativeness of the sample.
Severity of sports injuries can be described on the basis of 6 criteria: the nature of the sports injury; the duration and nature of treatment; sporting time lost; working time lost; permanent damage; and cost. Here also uniform definitions are important and necessary in order to enhance the comparability of research data. In the second step of the ‘sequence of prevention’ the aetiological factors that play a role in the occurrence of a sports injury have to be identified by epidemiological studies. Epidemiological research on the aetiology of sports injuries requires a conceptual model. The most commonly applied model is a stress/capacity model in which internal (personal) and external (environmental) aetiological factors are identified. In this model stress and capacity must be in balance and preventative measures must be designed to achieve or maintain this balance. However, merely to establish the aetiological factors is not enough; the mechanism by which sports injuries occur must also be identified. Athletes are in constant interaction with their environment and aetiological factors must be approached from this point of view. In a second, more dynamic, conceptual model on the aetiology of sports injuries, the importance of the determinants of sports behaviour, as well as the interaction between the various aetiological factors, is discussed. Whether or not a sports injury results from sports behaviour largely depends on the extent to which ‘prevention’ is incorporated in the determinants of sports behaviour. The drawback of both conceptual models is the fact that neither of them incorporate a time perspective. They can therefore not be applied to research on the aetiology of overuse injuries. In this perspective the application of a stress/strain/capacity model can be useful. This is a more dynamic and time-based 3-phase sequential model in which behaviour, amongst other aetiological factors, plays an important role. In this model an athlete is seen as an active manipulator of stress by whom the amount of strain evoked by sports participation can be altered, thereby influencing the capacity to perform in a certain sports situation, but also influencing the risk to sustain a sports injury, either acute or long term.
Finally, despite the importance of the model of choice in studying the aetiology of sports injuries one should realise that again the choice of research design influences the outcome of such research. Case series usually give no information on the underlying population at risk, so they are of no value in drawing valid conclusions on the risk factors of injuries. Only by relating the injuries to corresponding population denominators can one estimate injury rates and identify important risk factors and high risk sportspeople. As in research on sports injury incidence; research on risk factors should be undertaken on groups that are homogeneous with regard to age, sex, level of competition and type of sport.
To determine the incidence, pattern, and severity of injuries resulting from participation in amateur boxing.
A prospective 5-month survey of injuries which occurred during competitive amateur boxing and training.
Amateur boxing competitions held in Dublin between November 1992 and March 1993, and the six largest amateur boxing clubs in Dublin.
All the competitors in the tournaments and the > 16 year old members of the boxing clubs.
Participation in competitive amateur bouts and/or boxing training.
Incidence, pattern, and severity of injuries sustained in competition and training.
The incidence of injuries in competition was 0.92 injuries per man-hour of play (or 0.7 injuries per boxer per year), while the incidence in training was 0.69 injuries per boxer per year. Cerebral injuries were reported only in competition, most of these being mild concussion. Hand, wrist and facial injuries were related to direct impact and occurred more frequently in competition than training, while injuries to other body parts were predominantly chronic and training-associated. Shoulder and knee injuries were the most debilitating injuries seen.
The yearly risk of injury resulting from participation in amateur boxing is relatively low when compared with other sports. Cerebral injuries, which occur almost exclusively in competition, are predominantly mild concussions.
Injuries can be an adverse outcome of participation in sport and recreational activities. The aim of this study was to determine the public health impact of injury during sports and active recreation injury in a select population in Australia. A random household telephone survey was conducted quarterly over a 12-month period in a well-defined geographic region, the Latrobe Valley, Australia. Information was collected on participation in sport and active recreation and associated injuries over the previous 2 weeks for all household members aged over 4 years. Injury rates were calculated per 10,000 population and per 1000 sports participants. Data were collected on 1084 persons from 417 households. Overall, 648 people reported participating in at least one sport or active recreation and 34 (5.2%, 95% CI: 4.8, 5.6%) of these sustained an injury during this activity. Overall, 51.4% of injured cases had a significant impact: 26.5% sought treatment, 34.4% had their activities of daily living adversely affected and 36.0% had their performance/participation limited. Cricket (51 injuries/10,000 population), horse riding (29/10,000 population) and basketball (25/10,000 population) had the highest injury rates. After adjusting for participation, cricket (242 injuries/1000 participants), horse riding (122/1000 participants) and soccer (107/1000 participants) had the highest injury rates. Cricket and soccer were the sports most associated with 'significant' injuries. Injury prevention efforts should be aimed at team ball sports (especially cricket, soccer and netball) because of their comparatively high rate of both overall and 'significant' injury.
There is concern over the potential for a high incidence of injury in boxing. This is despite a lack of prospective data evaluating the risk for modern day participants. Updated, reliable data with a focus on potential exposure to injury for both amateur and, especially, professional boxers is required.
To determine the epidemiology of injury and exposure of amateur and professional boxers in Victoria, Australia.
A prospective cohort study with one year follow up was carried out over 2004-2005. Thirty three amateur and 14 active professional boxers registered with either Boxing Victoria Inc (amateurs) or the Professional Boxing and Combat Sports Board of Victoria (professionals) volunteered. Exposure at training and competition was measured, and any injuries sustained during this participation were recorded.
Twenty one injuries were sustained by the cohort during the follow up period. Most were to the head region (71%; 95% confidence interval -3.7 to 89.4), with concussion being the most common (33%). An overall injury rate of 2.0 injuries per 1000 hours of boxing was calculated.
The high exposure experienced by the boxers (as a result of considerable training time) indicated that boxing has acute injury rates comparable to, and often lower than, those found in other contact and non-contact sports. Further, acute injuries during training appear to be less common and severe than those sustained in bouts.