Taekwondo USA Winter 1990

THE OREGON TAEKWONDO RESEARCH PROJECT:

PART II - PRELIMINARY INJURY RESEARCH RESULTS

BY

ERIC D. ZEMPER, PH.D.

WILLY PIETER, PH.D.

Exercise Research Associates of Oregon

Eugene, OR

In the last issue of Taekwondo USA we presented an overview of our research project on taekwondo athletes that is headed by Dr. Willy Pieter and is being supported by the U.S, Taekwondo Union. In that article we briefly described each of the five major parts of the research project (Physiology, Psychology, Biomechanics, Nutrition and Injury Epidemiology). This article will present some of the preliminary results from our study of the epidemiology or patterns of injuries in taekwondo competition at the Junior and Senior levels. Detailed analyses of data such as that presented here will help provide clues to ways of preventing or reducing the severity of injuries through changes in equipment, techniques, or possibly changes in rules.

Data for the injury portion of the project were collected at the 1988 U.S. Olympic Team Trails in Colorado Springs and in Raleigh NC (the Senior competition), at the 1989 U.S. National Junior Taekwondo Championships in Rochester MN and at the 1989 World Junior Championships in Colorado Springs (the Junior competition). The Senior competition involved 48 men and 48 women (age 15 to 37 years) in round-robin competition. The Junior competition involved 1,370 boys and 338 girls (age 6 to 17 years) at the U.S. Championships, and 67 boys and 52 girls (age 13 to 16 years old) at the World Championships. Both Junior competitions were single elimination competition. (We also have collected injury data at the 1989 U.S. Senior National Championships in Columbus OH and at the 1989 U.S. Team Trials in Colorado Springs, but at the time this article was written we had not yet been able to obtain data on the number of competitors and the number of bouts actually fought during these competitions, which is necessary to complete calculations of injury rates.)

Injury data were collected with simple check-off forms that describe the athlete and nature, site, circumstances and severity of the injury. The forms were completed by the research project staff or by the medical staff covering the competition at the time of treatment for every injury for which treatment was sought by the competitors. Exposure data for calculating injury rates were gathered from records of bouts actually fought. For the Seniors, a bout was three rounds of three minutes each; for the Juniors, in most cases a bout was two rounds of two minutes each. Injury rates were calculated based on matches fought (athlete-exposures) and on minutes fought.

One point to keep in mind when reviewing these data is that past research on martial arts injuries has indicated that as many as 50-60% of injuries sustained by competitors are not brought to the attention of medical personnel at the competition. Since we can only record those injuries where the athlete seeks medical attention at the competition site, these rates we are presenting are probably underestimates of the true injury rates. A large number of minor injuries (bruises, muscle strains, etc.) were probably not recorded since the athletes did not have them treated at the competition site. However, with regard to the more serious injuries, such as fractures and concussions, these data are probably quite accurate, since it is unlikely that an athlete could sustain such an injury during competition and not have it called to the attention of the medical staff.

RESULTS OF SENIOR COMPETITION

There were 106 bouts fought by men and 111 bouts by women in the 1988 U.S. Olympic Team Trials. With two competitors in each bout, there were 212 athlete-exposures (A-E) to the possibility of being injured for men and 222 A-E for women. Accounting for instances where a bout was terminated early because of injury, there were 1,881 minutes of competition exposure for men and 1,983 for women (each full 9 minute bout results in 18 minutes of exposure). There were 27 injuries recorded for men and 20 injuries for women. The injury rates for men were 12.74 injuries per 100 A-E, 1,44 injuries per 100 minutes of competition, and 56.3 injuries per 100 competitors. For women the rates were 9.10 injuries per 100 A-E, 1.01 injuries per 100 minutes of competition, and 41.7 injuries per 100 competitors. The injury rate for the Senior men was 40% higher than for women (Table 1).

_______________________________________________________________________________________

Table 1. Injury Rate Summaries for Taekwondo

_______________________________________________________________________________________

 

MALE

FEMALE

 

Junior*

Senior

Junior*

Senior

Injuries/100 athlete-exposures

7.32

12.74

6.46

9.01

Injuries/100 minutes exposed

1.77

1.44

1.42

1.01

Injuries/100 participants

14.61

56.30

12.56

41.70

_______________________________________________________________________________________

* Combined U.S. and World Junior Championship data

_______________________________________________________________________________________

For men the most frequently injured body part was the foot (18.5% of the total number of injuries), followed by the hand (14.8%), knee (11.1%) and lower leg (11.1%). The most frequently injured body part for women also was the foot (40.0%), followed by the knee (15.0%) and upper leg (15.0%). When various parts of the head are combined (e.g., head, eyes, nose, mouth), both men and women accrued approximately 20% of their injuries to the head. As would be expected, contusions (bruises) were the most predominant type of injury, comprising 63% of the men's injuries and 75% of the women's injuries. More serious injuries for men included four fractures, one each of nose, finger, foot and orbital fracture (a fracture of the bony ridge around the eye). The women recorded a dislocated patella and an anterior cruciate ligament tear resulting in arthroscopic surgery of the knee. The men recorded a 2 cerebral concussion and the women a 1 concussion. Men and women demonstrated differences in the types of situations most often associated with injury. For men it was suffering an unblocked attack by the opponent (41%); for women it was attacking with a kick (40%). It appears women tend to be injured more during offensive moves (primarily kicking) and men most often as a result of defensive moves (or a lack thereof).

Most of the injuries recorded were not of sufficient severity to keep the athlete from continuing to compete in the tournament. A definition of a reportable injury commonly used in studies of the epidemiology of athletic injuries is one that results in the athlete missing one or more days of participation following the injury. In this study there were four such time-loss injuries among the Senior men (15%) and three among the Senior women (15%). To provide a comparison with competition injury rates in other sports, rates were calculated per 1,000 A-E based on the time-loss injuries. (Note that these rates are based on 1,000 A-E, rather than 100 A-E as is done with most of the data presented here. The purpose of this change is so direct comparisons can be made with other sports, where the rates are reported as injuries per 1,000 A-E. For practical purposes, the only difference between these two types of rates is a shift of a decimal point.) The results showed a rate of 23.58/1,000 A-E for men, and 13.51/1,000 A-E for women. Compared with similar data available for seven men's sports (wrestling, American football, soccer, ice hockey, gymnastics, lacrosse and baseball) and six women's sports (gymnastics, soccer, field hockey, lacrosse, softball and volleyball), the taekwondo competition injury rate ranked third in men's sports behind wrestling (31.75/1,000 A-E) and American football (30.97/1,000 A-E). For women, taekwondo also ranked third behind gymnastics (18.09/1,000 A-E) and soccer (15.31/1,000 A-E) (Table 2).

_______________________________________________________________________________________

Table 2. Comparison of Senior Taekwondo Injury Rates With Other Sports

_______________________________________________________________________________________

_______Sport_______

Competition Injury Rate/1000 A-E

MEN

 

Wrestling

31.75

American Football

30.97

Taekwondo

23.58

Soccer

18.67

Ice Hockey

15.72

Gymnastics

14.66

Lacrosse

13.89

Baseball

4.92

WOMEN

 

Gymnastics

18.09

Soccer

15.31

Taekwondo

13.51

Field Hockey

7.22

Lacrosse

6.99

Softball

5.31

Volleyball

4.55

_______________________________________________________________________________________

RESULTS OF JUNIOR COMPETITION

At the U.S. Junior Championships, for boys there were a total of 1,378 bouts fought (2,756 A-E), and girls fought 338 bouts (676 A-E). There were 10,858 minutes of exposure for boys and 2,708 minutes for girls. Boys recorded 190 injuries, while girls recorded 46 injuries. The boys' injury rates were 6.89/100 A-E,1.75/100 minutes of exposure, and 12.93/100 participants. The girls' injury rates were 6.80/100 A-E, 1.70/100 minutes of exposure, and 13.11/100 participants. Unlike their Senior counterparts, injury rates for Junior boys and girls are very similar. There was a distinct trend toward increasing injury rates with increasing age groups and increasing weight categories for boys and girls. While injury rates per 100 A-E and per 100 participants were lower for Juniors compared with Seniors, injury rates per 100 minutes exposed were higher for Juniors. This was due to longer rounds and more rounds per bout for Seniors. However, it does indicate a total risk for injury during competition that is truly greater for Juniors.

The most often injured body part for boys was the toes, involved in 13.6% of the injuries, followed by the head (7.4%), face (7.4%), ankle (6.8%), knee (6.3%) and foot (6.3%). The lower extremities were involved in 46.8% of the injuries, and the head and neck region were involved in 34.2% of the injuries. For girls, the ankle (17.4%) was most frequently injured, followed by the knee (13.0%), head (8.7%) and thumb (8.7%). The lower extremities were involved in 45.7% of their injuries, and the head and neck region in 26.1%. Contusions (36.3%) were the most predominant type of injury among boys, followed by joint sprains (18.9%), while for girls sprains (32.6%) were more common, followed by contusions (28.2%). Boys recorded 17 fractures, most often to fingers, the great toe or the foot (metatarsals). They also recorded 13 cerebral concussions (11 were 1 and 2 were 2). Girls recorded 2 fractures and 4 cerebral concussions (all 1). Suffering an unblocked attack (43.2%) was the most frequent injury situation for boys, followed by attacking with a kick (31.1%), while for girls it was evenly split between those situations at 32.6% each.

Unlike the Seniors, where 15% of the injuries involved time-loss, nearly 50% of the injuries involved time-loss for Juniors. The boys' time-loss injury rate was 33.38/1,000 A-E, and for girls it was 35.50/1,000 A-E, both of which are much higher than the rates for Seniors. This difference may be explained by a tendency for physicians to be more conservative in recommending a period of non-participation following an injury for children and adolescents than they would be for adult competitors.

At the 1989 World Junior Championships there were a total of 56 bouts fought for the boys (112 athlete-exposures and 666 minutes of competition exposure), while the girls had 41 bouts (82 athlete-exposures and 492 minutes). The boys recorded 20 injuries for rates of 17.86 injuries per 100 A-E, 3.00 injuries per 100 minutes of exposure and 29.85 injuries per 100 participants. The girls recorded three injuries, for rates of 3.66 injuries per 100 A-E, 0.61 injuries per 100 minutes of exposure and 5.77 injuries per 100 participants. It is not surprising that these rates differ somewhat from the data from the U.S. Junior Championships, since there were considerably fewer athletes involved and fewer bouts fought in the World Championships, which will result in greater variance in the results.

There were a total of nine time-loss injuries during this competition, eight for the boys and one for the girls. The time loss injury rate was 71.43 injuries per 1,000 A-E for the boys and 12.20 injuries per 1,000 A-E for the girls. (Since the data base for this competition is quite small, the girls' and boys' data will be combined for the following summaries.) Contusions were again the most common type of injury (39% of the total number of injuries), followed by sprains and fractures (17.4% each). All of the fractures were to the fingers and hand. The distribution of injuries to the major body regions was quite even, with 21.7% of the injuries to the lower extremities and 26.1% each to the head and neck, to the upper extremities and to the trunk. With four testicular contusions recorded, this competition had more of this type of injury than had been observed in previous competitions. There were two cerebral concussions recorded, one first degree and one third degree.

The combined data for the U.S. and World Junior Championships shows an injury rate of 7.32 injuries per 100 A-E for the boys (compared with 12.74 injuries per 100 A-E for the Senior men), and 6.46 injuries per 100 A-E for the girls (compared with 9.10 injuries per 100 A-E for the Senior women) (Table 1). The injury rates based on time of exposure were 1.77 injuries per 100 minutes of exposure for the boys (compared with 1.44 for the Senior men), and 1.42 injuries per 100 minutes for the girls (compared with 1.01 for the Senior women). Again, the fact that the Juniors have a lower injury rate per100 A-E, yet have a higher injury rate per 100 minutes of competition exposure can be accounted for by noting that the Seniors have more rounds per bout and more minutes per round than Juniors in each bout (4 minutes per bout for Juniors versus 9 minutes per bout for Seniors). Although the risk of injury per bout is greater for the Seniors, the risk of injury per minute of competition is actually greater for the Juniors.

The number of serious injuries (fractures and head injuries), and specifically the number of cerebral concussions, is a cause for concern. Combining the men and women, the cerebral concussion rate for Seniors was 2.30/1,000 A-E for both 1 and 2 concussions (there were no 3 concussions in this small sample of Seniors), for a total concussion rate of 4.60/1,000 A-E. For the Juniors it was 4.41/1,000 A-E for 1, 0.55 for 2 concussions and 0.28/1,000 A-E for 3 concussions, for a total rate of 5.24 cerebral concussions per 1,000 A-E. The rates for college football, considered to have one of the highest head injury rates in American sports, are 1.30/1,000 A-E for 1, 0.30/1,000 A-E for 2 concussions and 0.09/1,000 A-E for 3 concussions, for a total rate of 1.69 concussions per 1,000 A-E. Combining the Senior and Junior data gives a total concussion rate of 5.17 per 1,000 A-E for taekwondo. In other words, the cerebral concussion rate for taekwondo is 3.2 times as high as that of football (Table 3).

_______________________________________________________________________________________

Table 3. Cerebral Concussion Rates During Competition in Taekwondo and College Football

_______________________________________________________________________________________

 

__________Concussion Rate/1000 A-E__________

 

________Taekwondo________

 
 

__Jr.__

__Sr.__

College Football

First Degree Concussion

4.41

2.30

1.30

Second Degree Concussion

0.55

2.30

0.30

Third Degree Concussion

0.28

----

0.09

Totals

5.24

4.60

1.69

Combined Junior and Senior Total

5.17

 

_______________________________________________________________________________________

Although more data needs to be collected to confirm these results and to allow more detailed analyses, these preliminary results indicate that the USTU Sports Medicine Committee, in cooperation with the Protective Equipment Committee, should begin consideration of ways to reduce the numbers and severity of these serious injuries. Recommendations that might be considered include requiring rather than recommending the use of a mouth protector (mouth protectors not only reduce the chances of internal mouth and tooth injuries, they also reduce the number and severity of concussions from blows to the mouth and jaw); development of better protective equipment (particularly the helmets); requiring adequate competition mats at every competition (to help reduce the possibility of concussion if the head hits the mat during a fall),. and, of course, in situations like this it is wise to consider ways the rules of the sport could be modified to reduce the potential for serious injury. As with any contact sport, there will always be a certain number of unavoidable injuries to taekwondo competitors. But data such as that being collected in this project combined with careful consideration of the equipment, techniques and rules can lead to modifications that will help reduce the numbers of injuries and reduce the severity of those injuries that do occur, so that the injured athlete can return to full participation sooner in many cases.

SUMMARY

In summary, injury rates were recorded during the 1988 U.S. Olympic Team Trials for taekwondo, during the 1989 U.S. National Junior Taekwondo Championships and during the 1989 World Junior Championships. The injury rate for the Senior men (12.47/100 athlete-exposures) was about 40% higher than for the Senior women (9.01/100 athlete-exposures). For the Junior boys and girls, the injury rates were more nearly equal (7.32/100 A-E and 6.46/100 A-E, respectively). The injury rates per 100 minutes of competition showed a greater risk of injury for the Junior competitors. The foot and the head were the most frequently injured body parts, and contusions were the most frequent type of injury. For the males, suffering an unblocked attack was the most frequent injury situation, while for the females it was attacking with a kick. Approximately 15% of the injuries to Senior competitors resulted in loss of one day or more from participation, while 50% of the injuries to the Junior competitors resulted in time-loss. The rate of cerebral concussions for taekwondo competitors was more than three times greater than for competitors in the sport of American football, which indicates a need to consider equipment and rule modifications to prevent these more serious injuries.

PRELIMINARY RECOMMENDATIONS

Based on the data we have collected and analyzed so far, the following preliminary recommendations can be made to help reduce the number and severity of injuries to taekwondo competitors. Most injuries to taekwondo athletes are contusions of various body parts, and generally do not prevent the athlete from continuing during the competition. Based on the predominant injury situations found in this study, the men are advised to improve blocking skills or to use more evasive maneuvers to avoid injury during competition. The women could benefit from improved kicking skills, assuming that the large number of injuries they incurred while attacking with a kick are related to poor technique. The time-loss injury rates for the Senior taekwondo athletes, when compared with competitors in other U.S. collegiate sports, falls in the mid-range of injury rates. However, among the more serious types of injuries, the number of head injuries, plus the number of fractures seen in these competitions, strongly implies the need for a serious re-evaluation of the protective equipment used in taekwondo, and an exploration of possible rule changes to reduce the frequency and the severity of these injuries.

EPILOGUE

As we collect and analyze more data in the future, we will be able to confirm or modify the results presented here. It may also be possible to monitor the impact of any changes in equipment, techniques or rules that may be adopted in the future. The ultimate goal of this portion of the Oregon Research Project is to improve overall safety for the athletes participating in taekwondo by reducing their chances of being injured. As with any sport, the first step in this process is learning as much as we can about the frequency and the types of injuries incurred by the athletes as they participate.