An epidemiological study of martial arts injuries in patients presenting to US emergency rooms.

INTRODUCTION: With the advent of mixed martial arts (MMA) growing in popularity, there has been a described increase in its participation. The term MMA generally describes the hybridization of combat disciplines including but not limited to: karate, judo, jiu-jitsu, wrestling, taekwondo, boxing, kickboxing, and Muay Thai. With increased participation in MMA and martial arts, differing physical demands are placed on participants. Due to the physical nature of combat sports, there are injuries associated with participation. The purpose of this study is to report the incidence and characteristics of injuries seen from various martial art disciplines presenting to United States Emergency Rooms in order to educate participants and providers alike about risks assumed with participating in martial arts. METHODS: The National Electronic Injury Surveillance System (NEISS) database was queried for martial arts-related injuries from 2009 to 2019. Cases were examined and data including patient age and gender, injury type and location, hospital disposition, and type of martial arts practiced were extracted. RESULTS: A total of 8,400 injuries were recorded, leading to a national estimate of 310,143 martial-arts related injuries over the 11 year period of 2009-2019 (95 % CI 239,063-381,223). The most common types of injuries were strains/sprains (n = 2664, 31.7 %), fractures (n = 1,575, 18.8 %), and contusions/abrasions (n = 1,698, 20.2 %). There were 260 dislocations, with shoulder dislocations being most common (n = 96, 36.9 %). Lower extremities were affected more frequently than upper extremities (n = 3566, 42.5 % versus n = 3026, 36.0 %), with the knee being the single most common location of injury (n = 811, 9.7 %). Males more commonly sustained fractures (19.7 % versus 17.4 %, p = 0.03) and dislocations (3.5 % versus 2.4 %, p = 0.01) when compared to females. Ankle injuries were more common in females than males (10.4 % versus 6.0 %, p < 0.001). Only 2.2 % of patients required admission to the hospital. Risk factors for admission included patients >35 years of age and male sex. CONCLUSION: Martial arts injuries are a significant source of musculoskeletal injuries among patients presenting to US emergency rooms. Lower extremity injuries are seen most frequently, with patients rarely requiring hospital admission. Using this information, both providers and participants may be better equipped to make educated decisions on injury prevention and treatment.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Wrestling: 2014-2015 Through 2018-2019.

CONTEXT: The first men's wrestling National Collegiate Athletic Association (NCAA) Championship was sponsored in 1928; since then, participation has increased. BACKGROUND: Continued study of wrestling injury data is essential to identify areas for intervention based on emerging trends. METHODS: Exposure and injury data collected in the NCAA Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRRs) were used to examine differential injury rates. RESULTS: The overall injury rate was 8.82 per 1000 athlete exposures. The competition injury rate was significantly higher than practice injury rate (IRR = 4.11; 95% CI = 3.72, 4.55). The most commonly injured body parts were the knee (21.4%), shoulder (13.4%), and head/face (13.3%), and the most prevalently reported specific injury was concussion. SUMMARY: These findings provide the most current update to injury incidence and outcomes in NCAA men's wrestling. We identify notable trends that warrant consideration in future research.

CSF and Blood Neurofilament Levels in Athletes Participating in Physical Contact Sports: A Systematic Review.

OBJECTIVE: To evaluate whether participating in physical contact sports is associated with a release of neurofilaments and whether such release is related to future clinical neurologic and/or psychiatric impairment. METHODS: We performed a systematic review of the PubMed, MEDLINE, and Cochrane Library databases using a combination of the search terms neurofilament(s)/intermediate filament and sport(s)/athletes. Original studies, written in English, reporting on neurofilaments in CSF and/or serum/plasma of contact sport athletes were included. This review was conducted following the Preferred Reporting Items for Systematic Review and Analyses guidelines. RESULTS: Eighteen studies in 8 different contact sports (i.e., boxing, American football, ice hockey, soccer, mixed martial arts, lacrosse, rugby, and wrestling) matched our criteria. Elevated light chain neurofilament (NfL) levels were described in 13/18 cohorts. Most compelling evidence was present in boxing and American football, where exposure-related increases were appreciable at the intraindividual level (up to 4.1- and 2.0-fold, respectively) in well-defined groups. Differences in exposure severity (including previous cumulative effects), sampling/measurement time points (with regard to expected peak values), and definitions of the baseline setting are considered as main contributors to the variability in findings. No studies were encountered that have investigated the relationship with the targeted clinical end points; therefore no NfL cutoffs exist that are associated with a poor outcome. CONCLUSION: NfL release can be seen, as a potential marker of neuronal brain damage, in participants of physical contact sports, particularly boxing and American football. The exact significance regarding the risk for future clinical impairment remains to be elucidated.

Incidence of Combat Sport-Related Mild Traumatic Brain Injuries Presenting to the Emergency Department From 2012 to 2016.

OBJECTIVES: We sought to investigate the incidence and characteristics of traumatic brain injuries [mild traumatic brain injury (MTBI)] presenting to the emergency department as a result of boxing, wrestling, and martial arts (MA). DESIGN: Retrospective cross-sectional study of MTBI in combat sport athletes who were evaluated in emergency departments in the United States. SETTING: Patient data were taken from the National Electronic Injury Surveillance System. PARTICIPANTS: All patients with MTBI from 2012 to 2016, which occurred during participation in boxing, MA, or wrestling. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The incidence of combat sport-related MTBI presenting to emergency departments in the United States. RESULTS: The mean annual incidence of MTBI due to wrestling was significantly larger (269.3 per 100 000 person-years) than boxing (85.6 per 100 000 person-years) and MA (61.0 per 100 000 person-years) (P < 0.01). The average age at injury was significantly lower for wrestling compared with boxing and MA (15.0 years [SD ± 3.9] vs 21.7 years [SD ± 8.2] vs 19.9 years [SD ± 10.5]; P < 0.01). A significantly larger proportion of MTBIs (95.3%; P < 0.01) in patients younger than 20 years were related to wrestling, compared with boxing (55.8%) and MA (54.1%). Most patients with combat sport-related MTBIs were treated and discharged (96.3%), with only 1.7% of patients being admitted and 0.6% of patients being held for observation. CONCLUSION: Combat sports athletes are at high risk of sustaining an MTBI. Such athletes presenting to the emergency department for combat sport-related MTBI were more likely to be male and younger than 20 years. Of these athletes, wrestlers experience the highest incidence of MTBI-related emergency department visits.

A systematic review of prospective epidemiological research into injury and illness in Olympic combat sport.

BACKGROUND: Combat sports involve body contact through striking, kicking and/or throwing. They are anecdotally referred to as 'dangerous', yet long-term investigation into specific injury rates is yet to be explored. OBJECTIVE: To describe incidence and prevalence of injury and illness within Olympic combat sports and to investigate risk of bias of prospective injury and illness research within these sports. METHODS: We systematically searched literature published up until May 2016. We included prospective studies of injury/illness in elite combat athletes lasting more than 12 weeks. Risk of bias was assessed using a modified version of the Downs and Black checklist for methodological quality. Included studies were mapped to the Oxford Centre for Evidence-Based Medicine levels of evidence. RESULTS: Nine studies were included, and most (n=6) had moderate risk of bias. Studies provided level 1/2b evidence that the most frequently injured areas were the head/face (45.8%), wrist (12.0%) and lower back (7.8%) in boxing; the lower back (10.9%), shoulder (10.2%) and knee (9.7%) in judo; the fingers (22.8%) and thigh (9.1%) in taekwondo; and the knee (24.8%), shoulder (17.8%) and head/face (16.6%) in wrestling. Heterogeneity of injury severity classifications and inconsistencies inexposure measures prevented any direct comparisons of injury severity/incidence across combat sports. CONCLUSIONS: There is currently a lack of consensus in the collection of injury/illness data, limiting the development of prevention programmes for combat sport as a whole. However, sport-specific data that identify body areas with high injury frequency can provide direction to clinicians, enabling them to focus their attention on developing pathologies in these areas. In doing so, clinicians can enhance the practical elements of their role within the integrated combat sport performance team and assist in the regular update of surveillance records.

Adding Injury to Insult: A National Analysis of Combat Sport-Related Facial Injury.

OBJECTIVES/HYPOTHESIS: To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics. METHODS: The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics. RESULTS: There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting. CONCLUSIONS: The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination.

[Injuries in the Martial Arts Judo, Taekwondo and Wrestling - A Systematic Review]. / Verletzungen in den Kampfsportarten Judo, Taekwondo und Ringen - Eine systematische Übersichtsarbeit.

BACKGROUND: Martial arts such as judo, taekwondo and wrestling are regulated, usually athletic duels. The aim is to score better than your opponent or to win. As with any type of sport, athletes in martial arts sustain minor and major injuries, which may have many negative consequences. In addition, sports injuries and their rehabilitation generate high costs to the healthcare system. In contrast to the FIFA 11+ warm-up program, no preventive programs have been postulated for injury prevention in these martial arts. Therefore, the aim of this systematic review was to summarise the latest research findings and to evaluate whether initial recommendations can be given for the reduction of injuries in the martial arts judo, wrestling and taekwondo. METHODS: To gain an overview of the latest research findings, we searched for systematic reviews in PEDro, PubMed, Cochrane and the internet search engine Google Scholar. The methodological quality of these reviews was assessed using the Critical Appraisal Tool for a Systematic Review (CASP), and data was extracted on the risk of injury, injury location and injury type. RESULTS: It was found that all three review articles are of low to moderate methodological quality. Regarding injury location, it became evident that the extremities are particularly vulnerable to injury in all three martial arts. Effusion was observed to be the most common type of injury. CONCLUSION: Due to the moderate methodological quality and the injury type of effusion, it is not possible to formulate recommendations for injury prevention. Moreover, uniform definitions should be developed to describe sports injuries.

Injuries associated with combat sports, active component, U.S. Armed Forces, 2010-2013.

The practice of combat sports creates a potential for training- and sports-related injuries among military members. During the 4-year surveillance period, there were 12,108 cases of injuries associated with combat sports among active component service members; the overall incidence rate was 21.0 per 10,000 person-years (p-yrs). The rates were higher among service members who were male, Hispanic, in the youngest age groups, in the Army, junior enlisted, and in combat-specific occupations. The rate among recruit/ trainees (779.4 per 10,000 p-yrs) was more than 165 times the rate among all other active component service members (non-recruits) (4.7 per 10,000 p-yrs). Sprains, strains, and contusions accounted for more than one-half of the primary (first-listed) diagnoses associated with combat sports cases. More serious conditions such as concussions/head injuries and skull/face fractures/intracranial injuries were reported among 3.9% and 2.1% of all cases and were more common among boxing-related cases. Hand/wrist fractures were also common among boxing cases. Wrestling had comparatively greater proportions of dislocations and open wounds. Although the combat sport training provides many physical and mental benefits to the individual, safety practices should be enforced to reduce the most frequent and serious injuries.

Episodes of injuries and frequent usage of traditional Chinese medicine for Taiwanese elite wrestling athletes.

Wrestling normally places extreme demands on the body and thus may cause various kinds of injuries. An in-depth understanding of the episodes of injured sites, types, timings, and treatment modalities would help participants be aware of wrestling-related injury occurrences so as to develop effective preventive measures. Therefore, this study aims to investigate the gender-specific injuries among elite wrestling athletes. Subjects were selected from the 2009 Taiwanese National Wrestling Sport Championship. Participants were adolescent wrestling athletes, ages 16-18, who must have received at least one bronze medal at national level tournaments in 2008. A total of 118 respondents, 96 males and 22 females, completed and returned the questionnaire in which demographic data and information about the types, sites, and timings of injuries suffered and treatment modalities adopted were elicited. The data were analyzed with independent t-tests. The questionnaire results revealed a significantly higher injury rate for males than for females. The top three injured sites for males were waist (11.1%), ankle joint (10.1%) and finger (9.6%); while for females were ankle joint (13.6%), knee (12.5%) and waist (11.3%). Contusions were the most frequent type of injury: for males (73.5%) and for females (70.6%); followed by tendon inflammation for males (10.7%) and accumulated injuries for females (15.2%). During training and matching periods, the frequency of injuries for males (69.0%) is lower than that for females (81.8%). Traditional Chinese medicine (TCM) with acupuncture and moxibustion was the most common treatment modalities used for males (51.8%) and for females (68.0%); followed by orthopedics: for males (29.5%) and for females (18.0%). The present study contributed as the first effort to reveal the potency of using TCM with acupuncture and moxibustion in wrestling competitions. To prevent possible brain and body injuries in wrestling, safety education, skills and rules, and scoring systems may require further revision. Increased training of wrestling health professionals and advanced research and development of auxiliary training devices and protective equipment for wrestling athletes are also recommended.

Prevalence of dental trauma in Pan American games athletes.

The aim of this cross-sectional epidemiological survey was to assess the prevalence of dental trauma in athletes representing 42 countries competing at the most recent Pan American Games (XV Pan Am) held in Rio de Janeiro, Brazil in July of 2007, and to determine prior use and type of mouthguard among this group of athletes. The examiners participated in standardization and calibration training sessions before the field phase began. Invitations were sent to >5500 participating athletes competing in 41 sports and to the Medical Committee of the Pan American Sports Organization before and during the XV PAN. A convenience sample of 409 athletes was recruited. After signing an informed consent, all athletes answered a questionnaire. Data were collected at the clinical examination and recorded on a specific trauma form. The mean age of the athletes was 24.4 +/- 5.3 years. Males comprised 55% of the sample; females 45%. The prevalence of dental trauma among the athletes was 49.6% (n = 203) with no gender-based differences. Most of these injuries (63.6%) were related to activities during training or competition. Sports with the highest injury prevalence were wrestling (83.3%), boxing (73.7%), basketball (70.6%) and karate (60%). The most common injury was enamel fracture (39.8%); root fracture was the least common (0.4%). The teeth most affected were the maxillary permanent central incisors (n = 113), followed by the mandibular central incisors (n = 19). Based on the results of this study, nearly one-half of the subjects had experienced previous dental trauma; the majority related to sports activities. Furthermore, only 17% of the athletes reported prior mouthguard use; the most frequent mouthguards reported were boil-and-bite. These results suggest the importance of enhanced educational efforts and the use of properly fitted mouthguards to reduce dental trauma among athletes in international sports competition, especially in sports where mouthguards are not mandatory.

Efecto de una modificación reglamentaria en la incidencia de lesiones en lucha leonesa / Rules modification effect's in incidence of injuries in lucha leonesa (leonesa wrestling)

ObjetivoConocer la incidencia de lesiones graves en la lucha leonesa y valorar el efecto en éstas de una modificación reglamentaria.Material y métodosEstudio de cohortes retrospectivas (2006–2007) y prospectivas (2008, reglamento modificado). Fueron incluidos todos los luchadores que compitieron en categoría senior (edad media 22±6,8 años) en la liga de invierno durante las temporadas 2006, 2007 y 2008. Las fuentes de información utilizadas fueron las actas de los corros, los partes de accidente y un cuestionario específico cumplimentado por entrevista dirigida a los luchadores. Se entendió como lesión grave cualquiera que se produjera durante el combate y tuviera como efecto una baja superior a 28 días. Se calculó la incidencia de lesiones graves por número de corro, luchadores, combates y caídas.ResultadosParticiparon en las tres temporadas un total de 143 luchadores varones. Se documentaron un total de 14 lesiones que afectaron a 13 luchadores. Las zonas anatómicas más afectadas fueron el hombro y la rodilla, y el tipo de lesión más frecuente observada fue el esguince, seguido de las contusiones y de las luxaciones. En el total de las temporadas estudiadas hubo una lesión grave cada 7 corros, se lesionó de gravedad uno de cada 36 luchadores y se produjo una lesión grave por cada 161 combates o 400 caídas. Se registraron 4 lesiones graves durante las temporadas 2006–2007 y ninguna durante la temporada 2008 (en la que se introdujo una modificación reglamentaria); las diferencias observadas en las incidencias no alcanzaron la significación estadística.ConclusionesLa lucha leonesa presenta una incidencia de lesiones similar a la de otros deportes de combate. El penalizar las sueltas y todas las caídas como enteras y mantener los combates a dos caídas parece ayudar a reducir la incidencia de lesiones graves. Sin embargo, se necesitan otros estudios con series temporales más largas que confirmen ese hallazgo(AU)

Aim: To determine the incidence of major injuries sustained in Leon’s wrestling and to evaluate the effect of rules modification on that incidence. Material and methods:This is a retrospective (2006–07) and prospective cohorts (2008, modified rules) study. All wrestlers (mean age 22±6,8 years) who took part in senior competition during winter seasons in 2006, 2007 and 2008, were included in the study. Data were obtained by means of competition records, accident reports and specific and personal questionnaires. Major injuries were considered when they took place while wrestling and as a result, the wrestlers were out of for more than 28 days. Incidence of major injuries was calculated with regard to the number of competitions, combats, takedowns and wrestlers.ResultsA total of 143 male wrestlers took part at least in one of the 3 seasons. 14 injuries were documented affecting to 13 wrestlers. The most frequently injured body regions were shoulder and knee, and the most frequent injuries were sprains followed by contusions and joint dislocations. In the total of analyzed seasons, a major injury was observed every 7 competitions, 161 combats and/or 400 takedowns; and one per 36 wrestlers suffered a major injury. Each of every 4 major injuries were registered during 2006 and 2007, and none during 2008, when a new rule was included. Some differences in the incidence of major injuries were observed, but none of them were statistically significant Conclusions: Leon’s wrestling shows and incidence of injuries similar to other combat sports. A reduction in the incidence of major injuries is observed when all there leases and the falls are interpreted as a ‘‘complete fall’’ and when the fight ends after two falls.However, longer studies are required in order to confirm these findings(AU)

[Ruptures of the pectoralis major muscle - clinical results after operative and non-operative treatment]. / Rupturen des M. pectoralis major - Klinische Ergebnisse nach operativer und konservativer Behandlung.

AIM: Ruptures of the pectoralis major muscle should be treated operatively due to the expected loss of strength following conservative treatment. Minimal-invasive surgery technique using suture anchors can lead to perfect anatomical refixation of the muscle. We report mid-term clinical results. METHODS: We present clinical results of a comparative study concerning ruptures of the pectoralis major muscle. Between 2001 and 2006 a total number of 9 patients were treated operatively using suture anchors. The surgical procedure is described. A control group (n = 4) consisted of patients being treated conservatively in 1999 und 2000. For evaluation of results Bak's score was used. RESULTS: The mean follow-up-time was six months. We found 4 very good and 4 good results, only one patient showed a satisfying result. Among the patients who had followed the conservative treatment regime only one had a good outcome while three patients remained in a satisfying condition. All type-1-ruptures according to Roller showed postoperatively nearly equal strength conditions for both sides. CONCLUSION: The operative treatment of acute ruptures of the pectoralis major muscle in active people and athletes leads to better results concerning restoration of strength than conservative or delayed treatment. The surgical technique depends upon the type of rupture which has to be determined intraoperatively. The use of suture anchors aiming for intraosseous fixation helps to avoid intraoperative complications and leads to stable conditions with nearly full restoration of strength.

[15 years insurance statistics of incidents and accident types of combat sports injuries of the Rhineland-Pfalz Federal Sports Club]. / 15jährige Versicherungsstatistik zu Inzidenzen und Unfallhergangstypen von Kampfsportverletzungen im Landessportbund Rheinland-Pfalz.

The primary intention of this study is the grouping of sports accidents, being described by the athletes in their own words in a classification system of specific accident classes with regard to specific motions and topography. The investigation is based on the data of the sports insurance Gerling-Konzern during a 15-year period in Rhineland Palatinate (1981-1995). The study is based on the insurance documents and clinical protocols if available. 137 accident protocols were related to this 15-year period including weight lifting (n = 1) and martial arts (n = 136). Listed in hierarchical order we received the following results: judo (n = 47), karate (n = 44), wrestling (n = 22), taekwondo (n = 9), boxing (n = 7), ju-jutsu (n = 5), fencing (n = 1) and aikido (n = 1). In accordance to accident types there were no sex related differences. As special preventive measures we suggest the use of protective mouthguards and solid glasses, proprioceptive training and physiological taping for knee, ankle and elbow joints.