From: Epidemiology of Sports Injuries, D. Caine, C. Caine, K. Lindner (eds.), Champaign, IL: Human Kinetics, pp. 186-195 (1996)

Chapter 12

Fencing

Eric D. Zemper, Ph.D. Exercise Research Associates of Oregon, Eugene

Peter Harmer, Ph.D. Willamette University, Salem OR

 

1. Introduction

Although the sport of fencing has a long history, there is very little research on fencing injury rates and patterns. In an effort to review and summarize the literature on fencing injury epidemiology, a search of English language articles published since 1975 was undertaken (i.e., Medline and SPORT Discus searches using [fencing and (injury or accident) and language=english] for the search request). This search found only three published studies from the United States. Search efforts beyond the U.S. literature turned up a very small number of additional studies, three of which are included in this analysis. Only articles providing data about injury occurrence or rates were selected for this review. In addition, some unpublished data from the authors were included. Differing definitions of a reportable injury (no two studies used the same definition) and the fact that only three of the studies reported any exposure data make analysis of even this small number of studies difficult.

Five of the studies collected injury data on site and thus can be considered prospective studies (6, 8, 10, 11, 15). All of these, except Lanese et al. (10), involved only competitions; the Lanese data covered both competition and practices, but not enough detail was provided to differentiate between them. Only three studies provided any exposure data (8, 10, 15). The Harmer (8) and Roi and Fasci (15) studies provide data on the number of participants and number of bouts, making it possible to calculate rates per 100 fencers and per 1,000 athlete exposures. In this case, an athlete exposure (AE) is one fencer participating in one bout; each bout results in two AE. The Lanese study (10) provided data on the number of participants and was the only study to provide data on the hours of exposure, but since the study covered only one men's and one women's collegiate team (18 men, 6 women) for one season, and involved only eight total injuries, the size of the study was not sufficient to provide any significant data in relation to injury rates based on time of exposure.

The studies by Moyer and Konin (11) and Crawfurd (6) were prospective, collecting data on site at competitions, but the researcher did not provide any information on numbers of participants in these competitions or any other exposure data. Thus, the studies are essentially case series reports. The article published by Moyer and Konin provided only a narrative summary of some of their data analyses, without any tables or other presentation of data. The raw data tabulations from this study were provided to the authors and were used for the analyses of injury sites and types for this review. The remaining two studies (2, 12) were retrospective studies, collecting data by means of surveys requesting information from fencers about previous injuries. Because no exposure data were collected, these studies also are essentially case series reports. The Müller-Sturm article (12) did not state the time period of the survey. The survey of the United States Fencing Association (USFA) membership by Carter, Hell, and Zemper (2) was undertaken as a pilot project to assess the need for a full-scale prospective study of fencing injuries, but it has provided by far the largest current database on fencing injuries.

 

2. Incidence of Injury

Only two published studies (10, 15) present true injury rates (i.e., recorded exposure data). In addition, as yet unpublished data collected by Dr. Peter Harmer (8) provide injury rates during four major national and international competitions. The remaining published studies (2, 6, 11, 12) do not provide exposure data and present only distributions of types and sites of injuries.

2.1 Injury Rates

The study by Lanese et al. (10) involved only one university team for one season, and 18 men and 6 women. With five injuries to the men and three to the women, the injury rates shown in Table 12.1 cannot be considered very representative because of the extremely small study sample. The data reported by Roi and Fasci (15) tabulated 58 "requests for medical attention" or "intervention" in fencing competitions involving 1,365 fencers and 6,802 bouts in 47 competitions during one year in the Lombard region of Italy. From their data it is possible to calculate the injury rates presented in Table 12.1.

Harmer's unpublished data (8) covered four major competitions in 1 year, including the 1989 Pan American and World Championships, and involved 1,031 participants in 7,798 bouts. The injury rates presented in Table 12.1 were based on any request for assistance from the medical staff during the period of the competitions.

While the USFA survey (2) did not provide exposure data, the survey instrument did ask the respondents to provide the total number of injuries they incurred during the previous 12 months, from which it is possible to calculate an injury rate of 92 per 100 fencers per year. This is considerably higher than the rates provided by the other studies in Table 12.1. However, those studies (except for the Lanese study where the rate is distorted by the very small sample size) cover only an extremely limited time frame from a few competitions, while the data from the USFA survey includes the much longer time frame of a full year of participation in both practices and competitions. This illustrates one of the problems of using injury rates per 100 participants rather than a rate based on numbers of exposures or actual amount of time exposed (18).

_______________________________________________________________________________________

Table 12.1 Injury Rates in Fencing

_______________________________________________________________________________________

Study

Duration

# participants

# bouts

# athlete-exposures

# injuries

Injuries/100 participants

Injuries/ 1000 A-E

Lanese et al. (1990)

1 yr

 

 

 

 

 

 

Men

 

18

--

--

5

27.8a

--

Women

 

6

--

--

3

50.0a

--

Roi & Fasci (1988)

47 local and regional competitions during one year

Men

 

952

4,696

9,392

35

3.7

3.7

Women

 

413

2,106

4,212

23

5.6

5.5

Harmer (unpublished)

4 major national and international competitions during one year

Men

 

685

5,173

10,346

80

11.7

7.7

Women

 

346

2,625

5,250

27

7.8

5.1

_______________________________________________________________________________________

Note. All studies in this table were prospective in design, collecting data on-site as the injuries occurred.

aThe rates per 100 participants for the Lanese et al. Study differ greatly from the other studies because it involved an extremely small sample and because it covered daily practices as well as competitions. The other studies covered only the restricted time frame of competitions.

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2.2 Practice vs Competition

Although the small amount of data provided in the Lanese et al. study (10) included exposure in both practices and competition, no distinction was made between them. The larger Roi and Fasci (15) and Harmer (8) data sets involved competitions only, so the rates in Table 12.1 for these studies should be considered competition injury rates. No specific data are available for practice injury rates, although if fencing follows the pattern of most other sports (18), the practice injury rate per 1,000 AE could be projected to be no greater than one third to one fourth of the competition rate.

 

3. Injury Characteristics

The compilations of data on injury type in fencers are presented in Table 12.2. Table 12.2 and Table 12.3 present data from the Roi and Fasci (15) and Harmer (8) studies included in Table 12.1, as well as studies by Crawfurd (6) on injuries "sufficient to cause a fencer to stop a bout" (i.e., the most serious injuries) at competitions during a 4-year period in England, by Moyer and Konin (11) on "acute" injury reports collected at USFA competitions during a two year period, by Müller-Sturm and Biener (12) on "accidents and injuries" reported in a retrospective survey of 105 Swiss and German international competitors, and by Carter, Hell, and Zemper (2) from a retrospective survey of the USFA membership.

3.1 Injury Onset

The only data on the nature of onset of fencing injuries comes from the Carter, Hell, and Zemper study (2), where survey respondents indicated that 67.6% of their worst injuries in the previous year were sudden onset (acute) injuries and the remaining 32.4% were gradual onset in nature. Of the 67.6% sudden onset injuries, 28.5% occurred in competition, 28.7% occurred in practice, and the remaining 10.3% occurred in related training activities (weight lifting, running, etc.). A slightly larger percentage of injuries from this case series appears to occur during practice activities (considerably more time is spent in practices than in competition), but the implication is that the injury rate for competition would be higher than for practice, if exposure data were available. Higher injury rates in competition than in practice is a common pattern seen in nearly all sports (18).

3.2 Injury Type

The distribution by type of injury for the six studies that provided this type of data is presented in Table 12.2. As is the case with most other sports, ligament sprains and muscle strains are the predominant types of injuries, accounting for nearly half the recorded injuries. In several of the studies, contusions accounted for at least one fourth of all recorded injuries. Punctures and lacerations are of concern in fencing, and in the prospective studies in Table 12.2 together account for at least 10% of the injuries. These types of injuries usually are caused by the weapon, with punctures being of particular concern since they often are the result of those occasions when the weapon blade breaks, leaving a sharp unprotected tip capable of piercing protective gear. Another type of injury occasionally noted in fencers, particularly in the Moyer and Konin study (11), is heat illness or heat exhaustion caused by the heavy protective gear that fencers wear during long periods of competition. Tendinitis and torn tendons are relatively common problems for fencers, primarily in the forearm and wrist of the weapon arm and in the Achilles tendon.

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Table 12.2 A Percent Comparison of Injury Types in Fencers

_______________________________________________________________________________________

 

 

Harmer (unpubl.)

Roi & Fasci, 1988

Crawfurd, 1990

Moyer & Konin, 1992

Careter et al., 1993a

Müller-Sturm & Biener, 1991

 

# injuries:

N = 107

N = 58

N = 15a

N = 322

N = 842

N = 148

 

Study typeb:

Pospective

Prospective

Prosp., CS

Prosp., CS

Retro., CS

Retro., CS

Injury Type

# participants:

N = 1031

N = 1365

N = ???

N = ???

N = 1603

N = 105

Abrasion

 

3.7

3.4

--

0.0

0.0

--

Blister

 

14.0

8.6

--

0.0

0.0

--

Bursitis

 

0.0

--

--

--

2.0

--

Cartilage tear

 

0.0

--

--

--

5.3

1.0

Contusion

 

24.3

24.1

28.0

6.2

0.0

8.0

Fatigue/ cramp

 

0.9

8.6

--

--

0.0

--

Fracture

 

0.0

1.7

--

0.9

2.1

2.0

Heat

 

0.0

1.7

--

18.0

0.0

--

Laceration

 

10.3

32.8

36.0

17.4

3.0

6.0

Puncture

 

1.9

1.7

16.0

0.0

3.3

2.0

Separation/ dislocation

 

0.0

--

--

--

2.7

--

Sprain

 

23.4

10.3

16.0

33.2

23.9

24.0

Strain

 

10.3

5.2

4.0

23.9

26.6

26.0

Stress fracture

 

0.0

--

--

--

2.1

--

Subluxation

 

0.9

--

--

--

0.0

--

Systemic

 

0.0

1.7

--

0.3

0.4

--

Tendinitis

 

4.7

--

--

--

14.5

8.0

Torn tendon

 

0.0

--

--

--

2.4

11.0

Other

 

5.6

--

--

--

12.0

12.0

____________________________________________________________________________________________________

aThe data from the survey by Carter, Hell, and Zemper (1993) represent only the worst injury sustained during the previous 12-month period (therefore, mild injuries such as contusions were not noted). The average number of injuries sustained by the respondents during this period was 0.9.

bStudy type: Prosp. = prospective, data collected on-site as injuries occur; definitions of a reportable injury may vary. Retro. = retrospective, data collected by questionnaire after the fact; subject to recall error. CS = case series, no exposure data collected to allow calculation of injury rates.

____________________________________________________________________________________________________

 

3.3 Injury Location

A summary of the distribution of the site of injuries in fencers is presented in Table 12.3. This table indicates that approximately one half of all injuries to fencers occur in the lower extremities, with the ankle and the knee being the predominant sites. The hand and fingers also account for a major proportion of the injuries. Fencing is an asymmetrical sport involving rapid lunges and retreats that put strain on the legs and lengthy periods of extension and quick movements of the weapon arm, wrist, and hand. The hand and fingers holding the weapon, as well as the nonweapon hand, also are vulnerable to lacerations and contusions from the opponent's weapon.

The head and trunk are reasonably well protected by the equipment a fencer wears, although these areas occasionally sustain injuries from collision contact with an opponent or lacerations from an opponent's weapon. The great majority of injuries occur in the upper and lower extremities, which have the most stress placed upon them during fencing activity and which generally are less well protected.

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Table 12.3 A Percent Comparison of Injury Location in Fencers

_______________________________________________________________________________________

 

 

Harmer (unpubl.)

Roi & Fasci, 1988

Crawfurd, 1990

Moyer & Konin, 1992

Careter et al., 1993

Müller-Sturm & Biener, 1991

Injury

# injuries:

N = 107

N = 58

N = 15a

N = 322

N = 842

N = 148

Location

Study typeb:

Pospective

Prospective

Prosp., CS

Prosp., CS

Retro., CS

Retro., CS

Head

 

2.8

10.3

--

5.9

0.6

2.0

Spine/trunk

 

9.3

3.4

46.7

9.0

13.8

23.0

Neck

 

0.0

--

26.7

2.2

1.4

--

Back

 

2.8

1.7

--

6.5

8.1

--

Chest/rib

 

5.6

1.7

6.7

--

2.3

--

Abdomen

 

0.0

--

--

--

0.4

--

Groin

 

0.9

--

13.3

0.3

1.7

--

Upper extremity

 

41.1

55.2

6.7

32.9

30.4

20.0

Shoulder

 

1.9

3.4

--

6.2

5.0

--

Upper arm

 

1.9

1.7

--

1.6

1.5

--

Elbow

 

3.7

--

--

2.8

6.8

--

Forearm

 

2.8

10.3

--

1.2

1.5

--

Wrist

 

0.0

1.7

--

4.7

5.9

--

Hand/finger

 

30.8

37.9

6.7

16.5

9.6

--

Lower extremity

 

46.7

27.6

46.7

40.7

54.6

55.0

Pelvis/hip

 

3.7

1.7

--

0.9

2.5

--

Thigh

 

8.4

1.7

20.0

5.0

9.0

--

Knee

 

4.7

10.3

--

8.1

17.3

--

Lower leg

 

1.8

3.4

--

3.4

4.8

--

Ankle

 

17.8

6.9

26.7

15.8

14.5

--

Heel/Achilles

 

1.9

--

--

1.2

0.0

--

Foot/toe

 

8.4

3.4

--

6.2

6.5

--

Systemic

 

0.0

3.4

--

1.6

0.6

--

____________________________________________________________________________________________________

aOnly 15 of the 25 recorded injuries specified the site in Crawfurd (1990).

bStudy type: Prosp. = prospective, data collected on-site as injuries occur; definitions of a reportable injury may vary. Retro. = retrospective, data collected by questionnaire after the fact; subject to recall error. CS = case series, no exposure data collected to allow calculation of injury rates.

____________________________________________________________________________________________________

 

4. Injury Severity

4.1 Time Loss

Only three of the studies used in this review noted whether or not an individual injury was of sufficient severity to cause any time loss from participation; one retrospective study provided a total of days lost from all reported injuries. The Roi and Fasci study (15) indicated that 3 of their 58 recorded injuries caused the fencer to withdraw from the tournament. The data from Harmer (8) included 5 of 107 injuries that caused the fencer to withdraw from the competition. The remaining 95.2% of the injuries were not of sufficient severity to cause any loss of participation time. Both of these studies involved competition only, and because they both provided exposure data, it is possible to calculate time-loss injury rates of 0.33 per 100 participants and 0.27 per 1,000 AE in competition.

The survey by Müller-Sturm and Biener (12) of 105 German and Swiss international fencers indicated that 36% of the fencers never had an injury and that the 64% who had been injured accumulated 203 days of missed work (average of 1.4 days/injury), 64 days in hospital, and 9 injuries requiring surgery. A more detailed breakdown of these injuries was not presented, and no time frame for the study was given.

The survey of the USFA membership (2) involved both competition and practice injuries, although no exposure data was collected. Survey respondents were asked how many injuries they had sustained in the previous 12 months, how many days of participation were lost due to all injuries, and the impact of injuries on their fencing success. Of 1,603 respondents, 761 (47.5%) said they had sustained no injuries during the previous year. The remaining 842 reported 1,470 injuries, for a mean of 0.92 injuries per fencer (92/100 participants/year) and 1.75 injuries per participant who had an injury. Of the 842 who reported injuries, 181 (21.5%) said they lost no participation time, 30.8% lost 1 to 6 days of participation, 18.7% lost 7 to 14 days, 13.0% lost 15 to 30 days, and the remaining 16.2% lost more than 30 days. Of those who were injured, 61.4% said their injuries caused no interference or only mild interference with their fencing success. In general, it appears from these reports that fencing injuries during competition most often are not severe enough to cause any time loss and that throughout the year in practices and competitions the majority of injuries are not severe enough to cause any significant loss of participation time.

4.2 Catastrophic Injury

Injuries resulting in death or permanent disability rarely occur in modern competitive fencing. Only seven fatalities have been recorded since 1937, and most of these have occurred in highly skilled competitors in elite competition (5, 7, 13, 14, 16). All fatalities have been male fencers; five of seven deaths involved epée, with foil and sabre one each, and broken blades were responsible for the fatal wound in six of the seven cases. Four fatalities resulted from penetration of the thorax, with one or both lungs punctured and laceration of at least one major blood vessel in each case. The other three deaths involved neck (one case) and head (two cases) wounds. The two head wounds resulted from broken blades penetrating the mask (13, 16), whereas the mortal neck wound followed a broken blade slipping under the mask and penetrating the trachea and left common carotid artery(5). Two of the thoracic fatalities occurred before plastrons (underarm protectors) were mandatory. The second incident was, in fact, the impetus for the introduction of the plastron (13). Changes in equipment standards (design, strength, type of materials) generally have followed catastrophic incidents. However, all fatalities subsequent to the introduction of the plastron have occurred to fencers utilizing equipment that met at least the minimum standards set by the Fédération Internationale d'Escrime (FIE), the international governing body for the sport. Unfortunately, the force generated by elite athletes seems to be increasing even beyond the accelerating standards for the structural integrity of fencing equipment (4, 7). In the most recent death, the athlete was using the highest standard equipment available (14).

Several characteristics or mechanisms that may contribute (either singly or in combination) to blade breakage, force of penetration, or both and result in death have been postulated based on the seven incidents discussed here. Most often noted are a right-handed fencer fencing a left-handed fencer, the use of orthopaedic grips, and the propensity to make counterattacks (4, 13). Each of these characteristics was present in a majority of the fatalities (although in different combinations). Further research is needed to determine if modifying one or more of these characteristics would decrease the risk of sustaining a catastrophic injury.

Although anecdotal evidence suggests that penetrating wounds (especially thoracic) of varying severity occur more frequently than is generally realized, fatalities or permanent disabilities are extreme aberrations. Without adequate exposure data, it is not possible to calculate accurately the risk of catastrophic injuries in fencing. Given seven fatalities over the tens of thousands of athlete exposures in elite competition during the past 60 years, it seems reasonable to argue that the risk is minimal. During the 25 years from the late 1930s to the early 1960s only three deaths occurred, and none were reported during the next 20 years (early 1960s-early 1980s). However, four catastrophic incidents have been noted in the last 13 years (1982-1994) despite increasingly stringent structural standards applied to fencing equipment. With a fine line separating penetrating wounds and catastrophic injuries, careful monitoring (reporting and recording) of penetrating wounds of all types must be undertaken on an international level to determine whether the risk of significant or mortal injury is changing.

 

5. Injury Risk Factors

The data for this section comes from the USFA survey (2). These data relate to the most severe injury sustained by the fencer during the previous 12 months. Responses to the question about what factors contributed significantly to the fencer's worst injury during the previous year are summarized in Table 12.4. The reader should be aware that what is presented here about risk factors in fencing is derived from this minimally descriptive data and that the proposed factors have not been subjected to risk factor analysis.

_______________________________________________________________________________________

Table 12.4 Factors Contributing to Fencing Injuries

_______________________________________________________________________________________

 

Percent

Personal factors

48.3

Inadequate warm-up

13.2

Poor technique

12.2

Fatigue

11.0

Dangerous tactics

2.4

Other (e.g., inadequate conditioning, overtraining)

9.5

Equipment and facilities

27.9

Fencing strip

9.6

Shoes

9.5

Weapon

4.5

Jacket

0.8

Mask

0.4

Lighting

0.4

Other

2.7

Behavior of others

12.7

Dangerous tactics by opponent

8.5

Poor officiating

1.6

Poor coaching

1.0

Other

1.6

No identifiable contributing factors

11.1

____________________________________________________________________________________________________

Note. Data from Carter, Hell, and Zemper (1993). Percent breakdown of factors contributing to the most significant injury during the previous 12 months, as indicated by survey respondents.

____________________________________________________________________________________________________

 

5.1 Intrinsic Factors

Nearly half of the factors identified in Table 12.4 were personal factors under direct control of the fencer, therefore implying that these injuries were preventable. Most of the factors identified involved inadequate warm-up, poor fencing technique, and fatigue. The use of dangerous tactics was identified 2.4% of the time as causing the fencer's own injury. Other factors mentioned included lack of adequate general conditioning, overtraining, and repetitive movements leading to overuse injuries.

5.2 Extrinsic Factors

Just over one quarter of the factors mentioned in Table 12.4 were problems with equipment and facilities. Problems with the fencing strip and with shoes were the predominant factors at nearly 10% each. Problems with the fencing strip appear to be related to injuries in the lower extremities, particularly ankle and knee injuries. The most common problems with the fencing strip were the use of hard concrete floors, dust and dirt causing slipperiness on wood or rubber floors, lack of adequate means of securing copper fencing strips that tend to "bunch up" and trip the fencer, and raised fencing strips that cause ankle injuries. Problems with shoes most frequently mentioned included lack of adequate cushioning and heel support, and the lack of shoe designs to protect against stresses specific to the sport, such as lunging. The weapon was mentioned less frequently as a causative factor; the grip of the weapon and the bell were the parts most likely to cause injury. There was only occasional mention of other equipment factors such as the fencing jacket, mask, or lighting.

In the factors grouped under the heading of "Behavior of Others," the most frequently mentioned factor was dangerous tactics by an opponent. In written comments, fencers often mentioned the tendency for some fencers to depend more on aggression and brute strength rather than skill and finesse. Poor officiating or poor coaching were seldom mentioned as factors leading to injury.

 

6. Suggestions for Injury Prevention

While major injuries or injuries causing any significant time loss in fencing appear to be relatively rare, there is a real risk of sustaining numerous minor injuries that may be preventable. Because so little research has been done on fencing injuries, at the moment it is impossible to provide injury prevention suggestions derived from solid empirical or analytical data. These suggestions (Table 12.5) for preventing fencing injuries follow directly from information presented in Table 12.4 and from written comments and observations of fencers responding to the survey of USFA members (2). They are essentially common-sense suggestions that should have a reasonable chance of being confirmed in the future by appropriate research. The suggestions fall into three primary areas: actions that can be taken by participants; improvements in equipment and facilities; and administration of fencing competitions.

6.1 Players

It is evident from data that the most predominant types of injuries are sprains and strains (Table 12.2), occurring most frequently in the lower extremities (Table 12.3), and that because the most frequently cited cause of injury was inadequate warm-up (Table 12.4), that proper warm-up and stretching may help prevent fencing injuries. The comments of fencers in the USFA survey provide two important reasons for this. Many admit to "laziness" in doing warm-up and stretching, while a significant number state that instructors and coaches do not place enough emphasis on them or never mention them at all. Therefore, the first recommendation for preventing fencing injuries is to educate fencing instructors and coaches (and thereby the fencers) on the importance of proper techniques of warming up and stretching prior to practice and competition (9). Related to this is the suggestion that instructors and coaches emphasize the need for adequate general physical conditioning before and during the fencing season to prevent injuries caused by fatigue and inadequate conditioning. Although sometimes related to fatigue and improper conditioning, the problem of injuries caused by poor technique is probably best addressed by ensuring the availability of adequately trained and experienced instructors and coaches who can identify and correct faulty technique in this technique-oriented sport, particularly in the novice fencer. Overtraining seems to be a problem limited to elite fencers who train on a daily basis throughout the year.

6.2 Sport

National governing bodies for fencing, through their sports medicine committees, should establish and enforce minimum standards for fencing strips in competitions to reduce the risk of injury in relation to factors noted previously (e.g., prohibit placement of strips on concrete floors without adequate cushioning). Standards should be established and enforced with regard to factors such as minimum spacing between fencing strips and availability of medical coverage.

From the comments of fencers in the USFA survey and from published comments that began appearing more than 10 years ago (4), there is a growing concern about the tendency of some fencers to depend more on aggression and brute strength instead of traditional fencing skills and finesse. The resulting use of dangerous tactics by opponents was a factor frequently listed as causing injuries (Table 12.4), and a common complaint was that officials often ignore these tactics even when rules against their use exist. As a result of this concern, it is suggested that national governing bodies make a concerted effort to instruct officials (and coaches) to enforce existing rules against such conduct and, if necessary, institute new rules against inappropriate or dangerous tactics.

Although not mentioned in any of the recent literature, because there are occasions when lacerations and punctures draw blood, there must be concern about prevention of the transmission of the HIV and the Hepatitis B Virus (HBV). Even though the possibility of HIV or HBV transmission in this sport may be relatively remote, it is suggested that national governing bodies immediately institute and enforce policies and competition rules requiring that, any time a participant's skin is broken by laceration or puncture, action be immediately stopped to treat and cover the wound (this should include practices as well as competitions). These policies and rules also should require that any areas where blood has been spilled must be cleaned and, to prevent the possibility of HIV or HBV transmission to later opponents or fencing partners, the blade of any unbroken weapon causing a laceration or puncture should be appropriately cleaned.

6.3 External Environment

The primary equipment and facility problems are related to the fencing strip, shoes, and weapon (Table 12.4). It is recommended that fencing strips provide adequate cushioning for all practices and competition, and specifically that the common use of concrete surfaces for practices and competition be discontinued. Fencing on concrete floors was the most frequent complaint by respondents in the USFA survey and has begun to receive more attention in fencing publications and by sports safety committees such as that of the American Society for Testing and Materials (cf., 3, 17). If raised fencing strips must be used, they should be of low height and of sufficient width to not create a hazard to a fencer who inadvertently leaves the designated competition area of the strip during an attack or retreat. Wooden or rubber surfaces should be cleaned at regular intervals during practices or competition, and fencers should wipe their shoes on a damp towel before beginning each session in order to avoid injuries caused by slipping on dusty or dirty surfaces. Copper fencing strips must be adequately stretched and firmly anchored to prevent injuries caused by the "bunching" of the strip surface. Electric cord reels that are part of the electric touch scoring apparatus must be placed where they do not create a hazard to the retreating fencer and, in general, there must be adequate room between fencing strips during competitions so that placement of scoring tables, officials, equipment bags, etc., do not pose a hazard if fencers leave the strip during the heat of action.

It is suggested that sports medicine committees of fencing's national governing bodies work with shoe manufacturers to develop a fencing shoe with better support and cushioning specifically designed for the stresses of fencing movements. With regard to the weapons, the greatest concern among fencers is puncture wounds, which potentially are fatal, when the tip of a weapon breaks. These breaks occur when a blade is bent beyond its limit during a touch, and the force of the lunge often is more than sufficient to cause the broken tip to penetrate protective gear. Research is now being conducted on blade composition and ways of modifying breaking characteristics that will reduce the risk of penetration by broken blade tips (1), and this research should be continued.

_______________________________________________________________________________________

Table 12.5 Recommendations for Preventing Injuries in Fencing

_______________________________________________________________________________________

Participants

1. Educate fencing instructors, coaches, and fencers as to the importance and proper techniques of warm-up and stretching prior to practice and competition.

2. Instructors and coaches should emphasize the need for adequate general physical conditioning before and during the fencing season.

3. Ensure availability of adequately trained and experienced instructors and coaches who can identify and correct faulty technique, particularly in novice fencers.

4. Develop sports psychology mental training routines to reinforce use of appropriate fencing technique, especially in the face of fatigue or overly aggressive tactics by opponents.

Equipment and facilities

5. Do not allow practices or competitions on concrete surfaces without adequate cushioning.

6. When raised fencing strips are used, they should be of low height and adequate width to reduce risk of ankle injuries.

7. In practices and competitions, wooden and rubber surfaces should be cleaned at regular intervals, and fencers should wipe shoes on a damp towel before beginning each session of activity, to reduce the risk of slipping due to dusty or dirty surfaces.

8. Copper fencing strips should be fully stretched and firmly anchored to prevent "bunching."

9. Electric cord reels and other potential hazards (including officials) should be placed so they do not present a hazard to a fencer during a rapid retreat or when leaving the confines of the fencing strip during action.

10. The national governing body sports medicine committees should work with shoe manufacturers to develop an affordable fencing shoe that is designed specifically for the stresses of fencing.

11. Continue research on better breaking characteristics of weapon blades.

Administration of competitions

12. The national governing bodies should establish and enforce minimum standards for fencing strips, for spacing between fencing strips, and for medical coverage at all sanctioned competitions.

13. The national governing bodies should make a concerted effort to instruct competition officials to enforce existing rules against dangerous or overly aggressive conduct, and, if necessary, institute new rules against such inappropriate or dangerous tactics.

14. In order to prevent the possible spread of HIV and HBV infections, the national governing bodies should immediately institute and enforce rules requiring that action be halted any time a laceration or puncture draws blood, until the wound is covered and the weapon is cleaned.

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7. Suggestions for Further Research

It is obvious from the summary presented here that little research has been completed on the epidemiology of fencing injuries and therefore, as with most other sports, there is much to be done. The studies reviewed illustrate the usual problems of lack of a common definition of a reportable injury, inadequate collection and use of exposure data to generate true injury rates, and the use of a variety of rates that hinder the ability to compare results across studies. The great majority of the data reviewed here comes from studies that essentially are case series, which is the weakest form of epidemiological study.

It is recommended that a basic, large-scale, prospective study of injuries in fencers be conducted to develop initial reliable data on fencing injury rates and patterns in both practices and competitions. None of the studies presented in this review provide an ideal model of what is needed, although the study by Lanese et al. (10) probably comes closest in overall design. Its major shortcomings are the extremely small size of the sample and the fact that it only lasted one year. This future study of fencing injuries should cover a large representative sample of fencers over a sufficient period of time to provide stable results. It should be prospective in design, collecting exposure and injury data as they occur in both practice and competition. Preferably the data should be collected by medically trained personnel, such as on-site athletic trainers, although in this sport the only place where such a situation regularly exists is with collegiate teams. Data still can be collected by medical staff at competitions, as was the case with several of the existing studies, but exposure data must be included in the data collected. Competition data are relatively easy to collect; it is more difficult to collect practice data, and this type of data is needed because essentially no practice-injury data are available. Included in the data should be information on the nature of onset of the injury and information on reinjury, which also are not currently available for fencing.

Future studies should use a common definition of a reportable injury. There finally seems to be a growing consensus to use a definition based on time loss (i.e., an injury that occurs during sports participation, requires some level of medical treatment, and causes the athlete to stop or reduce level of participation for one day or more). As illustrated in this review, most injuries in fencing do not result in loss of participation time. In this case it might be reasonable to collect data on any injury requiring medical attention and analyze total injury rates and time-loss injury rates separately.

Finally, injury rate reports should be based on some measurement of exposure. The minimum standard should be reporting based on number of athlete exposures (injuries/1,000 AE), with one AE being one athlete participating in one practice session or one competition bout. Injury rates based on time of exposure (injuries/100 hours or 1,000 hours) are preferred, although it is difficult to collect such detailed exposure data in large-scale studies. The use of rates per 100 participants does not provide an adequate means for comparisons, since it does not compensate for differing amounts of exposure in practice or competition from one group to the next, as illustrated in this review and as noted previously (18).

Some special areas that need attention in future research on fencing injuries include reinjury and research on the characteristics that seem to be related to risk of catastrophic injury (e.g., right-handed fencer competing against a left-handed fencer, the use of orthopaedic grips, and the propensity to make counterattacks).

In the absence of a large-scale prospective study of fencing injuries, an alternative method for developing information on injury rates and patterns is to combine results from smaller, local studies. However, the only way it will be possible for results from smaller individual studies to be combined will be to use a common definition of a reportable injury, provide adequate exposure data, and use an injury rate based on some measurement of exposure, as suggested here. Still, the most reliable data will come from a well-designed, prospective study of a large, representative population of fencers.

The implementation of such a study would provide a solid basis for confirming or expanding the above suggestions for preventing injuries in fencers and would provide clues as to what specialized studies might be needed to investigate specific types of injuries common or unique to fencers or studies related to specific pieces of fencing equipment.

 

References

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