Injuries in taekwondo

Dental injuries in taekwondo athletes practicing in Saudi Arabia

OBJECTIVES

To assess the incidence and awareness of taekwondo athletes in Saudi Arabia regarding oral and maxillofacial (OMF) injuries and their prevention. Methods: In this cross-sectional study, an online questionnaire about the incidence and awareness of OMF injuries and their prevention was developed and distributed to taekwondo athletes in Saudi Arabia via their coaches.  Results: Sixty-eight responses were collected. The mean age of the participants was 29.3±9.1 years and 97% of them were males. Most of the participants (83%) believed that they are vulnerable to OMF injuries during practice. Approximately 23% of the participants reported a previous injury of the OMF area, while approximately 56% reported injuries in other areas. Most dental injuries (94%) were tooth fracture or displacement, while 6% were tooth avulsion. Eight participants (12%) were aware of the possibility of returning an avulsed tooth to its socket. More than 50% of those participants had inadequate knowledge on the appropriate storage media for the avulsed tooth or the maximum time allowed to return it to its socket. Eighty-one percent of the participants knew about the mouthguard, while 56% reported that they are actually using one. The most frequently reported barriers for not using a mouthguard during practice were difficulty in practicing with it, not being convinced of its importance, and lack of information where to get one. Conclusions: Most of the participants are aware of OMF injuries; however, their knowledge and behavior towards preventing and managing them are inadequate.

Rotational and linear head accelerations from taekwondo kicks and punches

The purpose was to compare rotational and linear head accelerations as a result of taekwondo kicks and punches. Taekwondo athletes executed five repetitions of the turning kick, spinning hook kick, hook punch, straight punch, and jab punch to a Hybrid III Crash Test Dummy head-neck complex. A tri-axial accelerometer and an angular rate sensor were mounted inside the Hybrid III head to measure resultant linear (RLA) and rotational accelerations. The Hybrid III was fixed to a height-adjustable frame and fitted with protective taekwondo headgear. Dummy head height was positioned to each participant's standing height. Acceleration data were processed in accordance with SAE J211-1.There was no significant multivariate difference in RLA but the effect was not clear. Univariate follow-up analysis showed a significant difference in RLA but the effect was also not clear. There was no difference in rotational acceleration. The highest RLA and rotational acceleration were produced, in order, by the turning kick, hook kick, hook punch, straight punch, and jab. These data are clinically important as they provide a better understanding of the biomechanical injury measures and support for improved headgear testing methodology.

Injuries in taekwando: systematic review

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Biomechanical head impact characteristics during sparring practice sessions in high school taekwondo athletes

OBJECTIVE The purpose of this study was to monitor head impact magnitude and characteristics, such as impact location and frequency, at high school taekwondo sparring sessions. METHODS Eight male high school taekwondo athletes participated in this study. The head impact characteristics were recorded by X-Patch, a wireless accelerometer and gyroscope, during 6 taekwondo sparring sessions. The outcome measures were the peak linear acceleration ( g = 9.81 msec²), peak rotational acceleration, rotational velocity, and Head Injury Criterion. RESULTS A total of 689 impacts occurred over 6 sessions involving the 8 athletes. There was an average of 24 impacts per 100 minutes, and there were significant differences in the frequency of impacts among both the sessions and individual athletes. In order of frequency, the most commonly hit locations were the side (38.2%), back (35.7%), and front (23.8%) of the head. CONCLUSIONS The data indicate that there is a relatively high number of head impacts experienced by taekwondo athletes during sparring practice. According to the rotational acceleration predicting impact severity published in previous research, 17.1% of the impacts were deemed to be a moderate and 15.5% were deemed to be severe.

Quantification of subconcussive impact forces to the head using a forensic model

Concussive and subconcussive head injury is a global phenomenon that affects millions of people each year. Concussive injury has been extensively studied in sport, which has led to a greater understanding of the biomechanical forces involved and guidelines aimed at preventing athletes from playing while concussed. Subconcussive forces by definition do not meet the threshold for concussion but nonetheless may have significant long term consequences due to the repetitive pattern of injury to the head. Quantifying these impact forces using a forensic head model provides the groundwork for future studies by establishing a range or threshold of subconcussive impact forces that could be correlated with clinical assessments. The use of a forensic head model has distinct advantages in terms of ethics and safety.

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

OBJECTIVE

Taekwondo injuries differ according to the characteristics of the athletes and the competition. This analytical cross-sectional retrospective cohort study aimed to describe reported taekwondo injuries and to determine the prevalence, characteristics and possible risk factors for injuries sustained by athletes of the Spanish national team. In addition, we compared each identified risk factor-age, weight category, annual quarter, injury timing and competition difficulty level-with its relation to injury location and type.

SETTINGS

Injury occurrences in taekwondo athletes of the Spanish national team during two Olympic periods at the High Performance Centre in Barcelona were analysed.

PARTICIPANTS

48 taekwondo athletes (22 male, 26 female; age range 15-31 years) were studied; 1678 injury episodes occurred. Inclusion criteria were: (1) having trained with the national taekwondo group for a minimum of one sports season; (2) being a member of the Spanish national team.

RESULTS

Independently of sex or Olympic period, the anatomical sites with most injury episodes were knee (21.3%), foot (17.0%), ankle (12.2%), thigh (11.4%) and lower leg (8.8%). Contusions (29.3%) and cartilage (17.6%) and joint (15.7%) injuries were the prevalent types of injury. Chronological age, weight category and annual quarter can be considered risk factors for sustaining injuries in male and female elite taekwondists according to their location and type (p≤0.001).

CONCLUSIONS

This study provides epidemiological information that will help to inform future injury surveillance studies and the development of prevention strategies and recommendations to reduce the number of injuries in taekwondo competition.

Mouthguard use in Korean Taekwondo athletes - awareness and attitude

PURPOSE

A survey was performed to identify the level of mouthguard use, awareness, wearability issues and attitude toward mouthguard among elite Korean Taewondo athletes.

MATERIALS AND METHODS

Survey questionnaires were given to 152 athletes participating in the Korea National Taekwondo team selection event for the 2010 Guangzhou Asian Games. Questionnaires consisted of three sections, mouthguard awareness, reasons for not wearing mouthguard and the last section to test the level of acceptance on current mouthguard and when the identified problems were resolved. For analyzing difference among response, χ² test was used and significant level (α) was set up as 0.05.

RESULTS

Responses in each of items showed significant difference (P<.001). Majority of response regarding each question: Majority of respondents believed that mouthguard were effective in preventing injuries (36.4%) but the result suggested that the provision of information on mouthguard to athletes was inadequate (44.0%) and the result showed that respondents were not greatly interested or concerned in relation to the mandatory mouthguard rule (31.6%). Although the responses on the level of comfort and wearability of mouthguard were negative (34.8%), athletes were positively willing to wear mouthguard if the problems rectified (51.2%).

CONCLUSION

Considering the high level of willingness to wear mouthguard if the problems rectified, it is thought that together with efforts in providing more mouthguard information, the work of sports dentistry to research and improve mouthguard will be invaluable in promoting mouthguard to more athletes.

The attenuation of strike acceleration with the use of safety equipment in tae kwon do

Purpose

The objectives of this study include: (1) Determination of the attenuation of strike acceleration that Tae Kwon Do sparring safety pads provide from kicks from Olympic style TKD fighters, (2) The sex and weight differentiation in acceleration achieved within the thorax model with the roundhouse kicks.

Methods

This prospective, observational study utilized 15 Olympic style fighters from an “elite” team kicking a water core heavy bag thorax model with roundhouse kicks. The model was fitted with a tri-axial accelerometer (GCDC, model X250-2) to measure g acceleration from strikes to the bag. The bag was kicked in three, 10 kick phases by all subjects: kicks without padding; kicks with hogu on heavy bag, and kicks with hogu and instep guards on feet. The g acceleration readings were recorded in all phases.

Results

Kolmogorov-Smirnov failed for all variables. There were 8 female subjects: median age 14 years, median weight 53.4 kg and 7 male subjects: median age 17 years, median weight 70.45 kg. The ANOVA on ranks of the acceleration from kicks against the bag achieved significance, P=0.001. Spearman rank order correlation between the weights of players and acceleration of strike against the hogu without and with insteps pads was significant, P=0.035/r=0.54 and P=0.018/r=0.59, respectively.

Conclusion

Heavier and male subjects tend to produce more force in strikes. Protective chest guard reduces acceleration to the thorax model, but the utility of instep guards is questionable.

Epidemiology of injuries in competition taekwondo: a meta-analysis of observational studies

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.

Taekwondo techniques and competition characteristics involved in time-loss injuries

The purpose of this study was to assess time-loss injuries in young and adult taekwondo athletes. Participants were 2739 children (11-13 years), Junior (14-17 years) and adult males and females (18 years and older) competing in the national Greek championships. Injury data were collected by project staff with all diagnoses made by the tournament physician. Odds ratios were computed as well as 95% confidence intervals around the injury rates. The female Juniors had a higher time-loss injury rate (Fisher's Exact Test p = 0.033) than their adult counterparts. However, they were not at a higher risk of incurring a time-loss injury: OR = 0.143, 95% CI: 0.018-1.124. Collapsed over age, the females as a group recorded more time-loss injuries [11.36/1,000 A-E (95% CI: 6.25-16.47) versus 7.40/1,000 A-E (95% CI: 4.44-10.36)], but this was not significant (OR = 0.703, 95% CI: 0.383-1.293). In the Juniors, the boys only incurred time-loss injuries to the head and neck. There was no difference in the Junior girls in the distribution of time-loss injuries across body region, although they were at higher risk of sustaining an injury to the head and neck (OR = 1.510, 95% CI: 0.422-5.402) but this was not statistically significant. Although there were no statistical differences among age groups within gender, the Junior boys and girls (11-13 years) sustained more cerebral concussions. The Junior boys were at a higher risk of incurring a cerebral concussion than the boys (OR = 7.871, 95% CI: 0.917-67.583, Fisher's Exact Test p = 0.036). In the males, there was no difference between the men and Junior boys in injury rate for swing kicks compared to other techniques (OR = 2.000, 95% CI = 0.397-28.416). There also was no difference between the men and boys (OR = 4.800, 95% CI: 0.141-58.013). To help reduce the incidence of time-loss injuries in taekwondo, especially cerebral concussions, it is suggested for coaches to emphasize blocking skills. Educating referees, coaches and athletes plays an important role in helping to reduce taekwondo time-loss injuries. Key pointsThe purpose of this study was to assess time-loss injuries in young and adult taekwondo athletes.Collapsed over age, the females as a group recorded more time-loss injuries but this was not significant.The Junior boys were at a higher risk of incurring a cerebral concussion than the boys.To help reduce the incidence of time-loss injuries in taekwondo, especially cerebral concussions, it is suggested for coaches to emphasize blocking skills.Educating referees, coaches and athletes plays an important role in helping to reduce taekwondo time-loss injuries.

Effect of implementation of safety measures in tae kwon do competition

BACKGROUND

Previous reviews of tae kwon do (TKD) tournaments have documented injury rates of 25/1000 to 12.7/100 athlete exposures. Most injuries have been reported to be to the head and the neck and are occasionally very serious. Many of these studies involved high level TKD competitions with minimal safety precautions. Recently, safety measures have been implemented in many TKD competitions.

OBJECTIVE

To evaluate retrospectively the incidence of injuries in TKD competitions involving a wide range of participants and featuring extensive safety precautions.

METHODS

A total of 2498 participants ranged in age from 18 to 66, included both men and women, and ranged in rank from yellow to black belt. Traumas, defined as any event requiring interaction with medical staff, were documented with respect to mechanism, diagnosis, treatment, and follow up recommendations. An injury was defined as a trauma that prevented a contestant from resuming competition on the day that the trauma occurred, according to National Collegiate Athletic Association criteria.

RESULTS

The injury rate was 0.4/1000 athlete exposures. This is lower than reported in previous studies of TKD tournaments and in many other sports.

CONCLUSION

TKD tournaments that emphasise limited contact, protective equipment, and medical supervision are relatively safe and compare favourably with other sports.

Major international sport profiles

Sports are part of the sociocultural fabric of all countries. Although different sports have their origins in different countries, many sports are now played worldwide. International sporting events bring athletes of many cultures together and provide the opportunity not only for athletic competition but also for sociocultural exchange and understanding among people. This article reviews five major sports with international appeal and participation: cricket, martial arts, field hockey, soccer, and tennis. For each sport, the major aspects of physiological and biomechanical demands, injuries, and prevention strategies are reviewed.

Injury and injury rates in Muay Thai kick boxing

OBJECTIVE

To determine the type and number of injuries that occur during the training and practice of Muay Thai kick boxing and to compare the data obtained with those from previous studies of karate and taekwondo.

METHODS

One to one interviews using a standard questionnaire on injuries incurred during training and practice of Muay Thai kick boxing were conducted at various gyms and competitions in the United Kingdom and a Muay Thai gala in Holland.

RESULTS

A total of 152 people were questioned, 132 men and 20 women. There were 19 beginners, 82 amateurs, and 51 professionals. Injuries to the lower extremities were the most common in all groups. Head injuries were the second most common in professionals and amateurs. Trunk injuries were the next most common in beginners. The difference in injury distribution among the three groups was significant (p< or =0.01). Soft tissue trauma was the most common type of injury in the three groups. Fractures were the second most common in professionals, and in amateurs and beginners it was sprains and strains (p< or =0.05). Annual injury rates were: beginners, 13.5/1000 participants; amateurs, 2.43/1000 participants; professionals, 2.79/1000 participants. For beginners, 7% of injuries resulted in seven or more days off training; for amateurs and professionals, these values were 4% and 5.8% respectively.

CONCLUSIONS

The results are similar to those found for karate and taekwondo with regard to injury distribution, type, and rate. The percentage of injuries resulting in time off training is less.

Precompetition injury and subsequent tournament performance in full-contact taekwondo

OBJECTIVE

To determine the pattern of injuries sustained by taekwondo competitors, and how previous injury affects performance in sporting competition.

METHODS

Competitors at a major New Zealand full-contact taekwondo tournament were given a comprehensive questionnaire immediately before competition. Self reports of injuries sustained through taekwondo in the previous 12 months were determined.

RESULTS

No significant sex differences were found. The injury prevalence was high, but comparatively less than reported for other contact sports such as rugby football. However, one in 20 injuries was a closed head injury. No significant associations between prior injury and tournament outcome were found.

CONCLUSIONS

Taekwondo can be a source of disabling injury. However, the fact that prior injury did not appear to be associated with impaired competition performance may militate against acceptance of control and regulation by competitors and coaches.

Injury rates during the 1988 US Olympic Team Trials for taekwondo

Injury rates were recorded during the 1988 US Olympic Team Trials for taekwondo involving 48 men and 48 women. The injury rate for men (12.74/100 athlete-exposures) was about 40 per cent higher than the rate for women (9.01/100 athlete-exposures). The foot and the head were the most frequently injured body parts. Contusions were the predominant type of injury, and concussions were recorded for both men and women. A large proportion (41 per cent) of the men's injuries were the result of receiving a blow from an unblocked attack. For the women the most common injury situation (40 per cent) was while attacking with a kick. For both men and women, 15 per cent of the reported injuries were time-loss injuries. The head injuries found in this study are discussed with reference to the high impact velocities and momentum levels generated during taekwondo kicking. Recommendations are made with regard to protective equipment testing and rule changes to reduce the possibility of cerebral injury.

Equipment, drugs and problems of the competition and team physician

Physicians nowadays commonly attend sports competitions or journeys with a sports team. In some competitions the rules ensure the attendance of a physician. The team physician has to take care of all kinds of medical problems within the team, while the competition physician basically takes care of acute complaints. The competition physician must organise the medical coverage of both athletes and spectators, also taking into account medical emergencies. In addition he should inform the teams and spectators about the medical coverage. The team physician must also perform a precompetition health screening of individual team members, and take care of infection prophylaxis before and during journeys. Usually the physician carries drugs for respiratory infections, antibiotics, anti-inflammatory drugs, gastrointestinal medications, antihistamines, eyedrops, local anaesthetics and dermatological medications. The physician's bag should not include banned substances, other than specially labelled emergency medications. The inclusion of other medications and equipment and the need for other medical resources is highly dependent on the length of the journey, the destination, the type of sports, and the number of participants and spectators. Each sport has its characteristic injury profile and there are also sport-specific regulations which the physician must be aware of. Acute injuries are more common in contact sports, and overuse injuries in non-contact sports. In addition to musculoskeletal injuries, other conditions such as heat exhaustion and dehydration may be encountered, while cold can also cause special problems.