Analysis of injuries in taekwondo athletes

Epidemiology of fractures and care in male collegiate Taekwondo athletes by weight classes

The purpose of this study was to examine the occurrence of fracture injuries and post-fracture management practices by weight classes. A total of 127 male collegiate Taekwondo athletes (64 lightweight athletes and 63 heavyweight athletes) participated in this study. The athletes were classified into lightweight and heavyweight based on their respective competition weight divisions. Logistic regression was used to estimate the odds ratios and 95% confidence intervals. Athletes had experienced fractures to 54.3%. Athletes were more likely to experience fractures during training and defensive movements. Of the fractures reported, 31.9% necessitated surgical intervention. Although 65.1% of the athletes were primarily concerned about the possibility of reinjury, only 36.2% received specialized rehabilitation. The heavyweight athletes had a higher prevalence of fractures (odds ratio=2.40 and 95% confidence interval=1.17-4.90) than the lightweight athletes. The heavyweight athletes had a higher prevalence of fractures during the competition (odds ratio=4.83 and 95% confidence interval=1.54-15.17), in offensive situations (odds ratio=4.67 and 95% confidence interval=1.38-15.99), and in the lower limbs (odds ratio=3.84 and 95% confidence interval=1.12-13.14) than the lightweight athletes. The current evidence that fractures are common in Taekwondo athletes and that fracture patterns may differ between heavyweight and lightweight athletes highlights the need for tailored prevention strategies based on weight classes.

Biomechanical characteristics of ligament injuries in the knee joint during impact in the upright position: a finite element analysis

BACKGROUND

Our study aims to examine stress-strain data of the four major knee ligaments-the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL)-under transient impacts in various knee joint regions and directions within the static standing position of the human body. Subsequently, we will analyze the varying biomechanical properties of knee ligaments under distinct loading conditions.

METHODS

A 3D simulation model of the human knee joint including bone, meniscus, articular cartilage, ligaments, and other tissues, was reconstructed from MRI images. A vertical load of 300 N was applied to the femur model's top surface to mimic the static standing position, and a 134 N load was applied to the impacted area of the knee joint. Nine scenarios were created to examine the effects of anterior, posterior, and lateral external forces on the upper, middle, and lower regions of the knee joint.

RESULTS

The PCL exhibited the highest stress levels among the four ligaments when anterior loads were applied to the upper, middle, and lower parts of the knee, with maximum stresses at the PCL-fibula junction measuring 59.895 MPa, 27.481 MPa, and 28.607 MPa, respectively. Highest stresses on the PCL were observed under posterior loads on the upper, middle, and lower knee areas, with peak stresses of 57.421 MPa, 38.147 MPa, and 26.904 MPa, focusing notably on the PCL-tibia junction. When a lateral load was placed on the upper knee joint, the ACL showed the highest stress 32.102 MPa. Likewise, in a lateral impact on the middle knee joint, the ACL also had the highest stress of 29.544 MPa, with peak force at the ACL-tibia junction each time. In a lateral impact on the lower knee area, the LCL had the highest stress of 22.279 MPa, with the highest force at the LCL-fibula junction. Furthermore, the maximum stress data table indicates that stresses in the ligaments are typically higher when the upper portion of the knee is affected compared to when the middle and lower parts are impacted.

CONCLUSIONS

This study recommends people avoid impacting the upper knee and use the middle and lower parts of the knee effectively against external forces to minimize ligament damage and safeguard the knee.

Effects of the Three-Direction Movement Control Focus Complex Pain Program and Neurodynamic Focus Complex Pain Program on Pain, Mechanosensitivity, and Body Function in Taekwondo Athletes with Non-Specific Low Back Pain: A Preliminary Study

We aimed to determine the effects of three-direction movement control focus complex pain program (3D-MCE) and neurodynamic focus complex pain program (NDT) on pain, mechanosensitivity, and body function in Taekwondo athletes with non-specific low back pain. This study used a two-group pretest-posttest design and was conducted at a university physiotherapy lab and training center. It included 21 Taekwondo athletes with non-specific low back pain from a Taekwondo studio and a University in Busan. Participants were divided into a 3D-MCE group (n = 10) and an NDT group (n = 10). The numerical rating pain scale (NRPS), pain pressure threshold (PPT), movement analysis, and Oswestry Disability Index (ODI) were measured before and after the intervention. The intervention was performed for 45 min twice a week for 4 weeks. Each group performed movement control exercises and neurodynamic techniques. The NRPS, motion analysis, and ODI were significantly changed after the intervention in the 3-DMCE group. The NRPS, PPT, and ODI changed significantly after the intervention in the NDT group. Moreover, the PPT and motion analysis showed significant differences between the two groups. For Taekwondo athletes with non-specific low back pain, 3D-MCE improved the stability control ability of the lumbar spine. It was confirmed that neurodynamic techniques reduce muscle and nerve mechanosensitivity.

Effects of Complex Pain Control Programs on Taekwondo Athletes with Recurrent Low Back Pain: A Case Study

Background and Objectives: Practitioners of martial arts such as Taekwondo are likelier to experience back pain during training or competition. As the back pain of taekwondo athletes shows various symptoms depending on the athlete's characteristics, such as technique and movement, a case study was conducted to verify the intervention effect suitable for individual traits. We examined the effects of a complex pain control program on pain, mechanosensitivity, and physical function in a Taekwondo athlete with recurrent low back pain (LBP). Materials and Methods: A Taekwondo athlete with LBP was recruited from D University, Busan. The intervention program was performed for 45 min twice a week for 3 weeks, and the patient was followed up with after 2 weeks. The numerical rating pain scale (NRPS), pain pressure threshold, mechanosensitivity, and Oswestry Disability Index (ODI) scores were measured before and after the intervention. Therapeutic massage and nerve stimulation therapy were performed. Lumbar flexion, extension, and rotation were performed in the movement control exercise group, whereas the sliding technique, a neurodynamic technique of the tibial nerve, was applied in the neurodynamic technique group. This effect was verified by comparing the average measured values before and after the intervention. Results: Pain (NRPS) and mechanosensitivity reduced, range of motion and tactile discrimination abilities improved, and physical function (ODI) improved. The effect of the improved intervention lasted 2 weeks. Conclusions: These results indicate that application of complex pain control programs considering the four aspects of pain mechanisms for 3 weeks can be an effective intervention in Taekwondo athletes with recurrent LBP.

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

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

Effects of Taekwondo Training on Growth Factors in Normal Korean Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The growth of children and adolescents is both an important health indicator and a major public health issue. Many recent studies have investigated the effects of taekwondo on growth factors, but no consensus has yet been reached. This meta-analysis aimed to determine the effects of taekwondo on the growth factors in children and adolescents (aged 8 to 16 years). Randomized controlled trials from PubMed, Web of Science, Cochrane Library, the Research Information Sharing Service, the Korea Citation Index, and the Korean-studies Information Service System were analyzed. The effect sizes (standardized mean differences, SMD) were calculated, the risk of bias and publication bias were assessed, and the effect size and subgroup analyses were pooled. We found that the taekwondo group had significantly higher levels of growth hormones (SMD 1.78, 95% confidence interval [CI] 0.98-2.58, and p < 0.001) and insulin-like growth factors (SMD 1.76, 95% CI 0.60-2.92, and p < 0.001) than the control group. For height, a medium effect size was observed (SMD 0.62, 95% CI -0.56-1.80, and p = 0.300), but the between-group difference was not significant. Thus, taekwondo had significant positive effects on the secretion of growth hormones and insulin-like growth factors in Korean children and adolescents. A longitudinal follow-up is necessary to determine the effect on height. This suggests that taekwondo can be recommended as an appropriate physical exercise for maintaining normal growth in children and adolescents.

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

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

Foot and Ankle Injuries in Elite Taekwondo Athletes: A 4-Year Descriptive Analysis

Background:

Foot and ankle injuries are a common but underestimated problem in taekwondo. Detailed data on injury incidence rates (IIRs), patterns, and injury mechanism are missing.

Purpose:

The primary aims were to evaluate the prevalence of foot and ankle injuries and the exposure-adjusted IIR of elite taekwondo athletes during matches while training (ie, sparring) and in competitions. The secondary aims were to evaluate injury site, type, sport-specific mechanism, and time loss.

Study Design:

Descriptive epidemiology study.

Methods:

Athletes from a single national Olympic taekwondo training center were assessed prospectively for foot and ankle injuries over 4 years (between January 1, 2016, and December 31, 2019). Data were collected regarding number and type of injuries, anatomic location, and total exposure time during training and competition for each athlete. Injury mechanism and dominant foot were assessed via personal interview. Time loss from sport was analyzed retrospectively. The injury prevalence and IIR were calculated. Correlation between mechanism and injury type, location, and dominant foot was evaluated. Time loss according to location and injury type was assessed. The chi-square test and Fisher exact test were used to test for differences in sex, age, and taekwondo experience and for comparison of injury location and type, injury mechanism, and side dominance, respectively. Training and competition IIRs and prevalence were calculated with 95% CIs (for Poisson rates).

Results:

From an initial 107 athletes, 79 (73.8%) were included in the final data set. Of these athletes, 38 were injured (n = 112 injuries) for a prevalence of 48.1% (95% CI, 43%-52%). The overall IIR of the ankle joint was 13.14 injuries per 1000 athletes (95% CI, 1.5-25.9) and was significantly higher during competition versus training (P < .001). Ankle joint injuries were most common (n = 71; 63%). Significantly more noncontact versus contact ankle ligament injuries (n = 46; 83%) occurred (P < .001). The forefoot (n = 18; 66%) was mainly affected by contact injuries (P < .001). Time loss was the highest for midfoot fractures (mean ± SD, 23.0 ± 0.6 days; range, 23-24 days).

Conclusion:

Noncontact ligamentous ankle injuries were most common, with a higher incidence during competition. Improvement of strength, endurance, and postural stability under strain is recommended for prevention.

[Analysis of muscle injuries and return-to-training in elite Taekwondo athletes: results of a prospective cohort study over a period of five years]

BACKGROUND

 Muscle injuries frequently occur in sports involving explosive movement patterns, and they can cause considerable downtime. There is a lack of detailed data on muscle injuries in Olympic elite Taekwondo.

METHODS

 All injuries sustained by 76 elite Taekwondo athletes from a national Olympic training centre during training and competition were prospectively recorded over a period of five years. Data on muscle injuries, including location and time elapsed until return-to-training, were extracted from medical records. Injuries were diagnosed by means of MRI and were classified according to the British Athletes Muscle Injury System. The relationship between MRI classification subgroups and time elapsed until return-to-training was assessed.

RESULTS

 Mean age of athletes was 22.5 ± 3.2 (16-27) years with an average Taekwondo experience of 12.1 ± 4.0 (7-20) years. Hamstring muscles were most commonly injured (48.4 %), followed by quadriceps muscles (32.3 %) and calf muscles (9.6 %). The analysis of MRI injury subgroups showed grade 1 (32.2 %) and grade 2 (41.9 %) injuries in most cases. A positive correlation was found between injury groups and return-to-training (r = 0.56). The comparison between different injury groups and time elapsed until return-to-training also revealed significant differences (p < 0.0001).

CONCLUSION

 Hamstring muscles are the most injured muscles in Taekwondo besides the quadriceps femoris muscle. Most injuries were mild to moderate (grade 1-2). The time needed for return-to-training increased significantly with the severity of injuries diagnosed by MRI.

Effect of Plyometric versus Ankle Stability Exercises on Lower Limb Biomechanics in Taekwondo Demonstration Athletes with Functional Ankle Instability

Background: This study aimed to compare the effects of plyometric and ankle stability exercises on the dynamic balance and lower limb kinematic and kinetic parameters of Taekwondo demonstration athletes with functional ankle instability. Methods: Fourteen subjects participated in this study and were randomly divided into two groups: a plyometric exercise group (n = 7) and an ankle stability exercise group (n = 7). Exercises were performed twice a week for 8 weeks. A Y-balance test was used to measure dynamic balance, and a motion analysis system and force plate were used to collect kinematic and kinetic parameters during single-leg drop landing. A paired t-test was used for intragroup comparisons, and an independent t-test was used for intergroup comparisons. Results: In both groups, exercise increased dynamic balance and shock absorption and reduced postural sway on the anteroposterior displacement (p < 0.05). The plyometric exercise group decreased their ankle dorsiflexion and increased their knee and hip joint flexion at maximum knee flexion (p < 0.05). In contrast, the stability exercise increased their ankle plantar flexion at initial contact (p < 0.05). Conclusions: The plyometric exercise group altered their landing strategies using their knee and hip joints to control ankle instability at landing. This study suggests that the application of plyometric exercises in ankle rehabilitation would improve stability and shock absorption and help prevent injuries during Taekwondo demonstrations.

Musculoskeletal injuries in taekwondo athletes: a nationwide study in Portugal

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.