Proceedings of the First IOC World Congress on Sport Sciences Colorado Springs: US Olympic Committee pp. 219-220 (1989)
INJURY RATES IN JUNIOR AND SENIOR NATIONAL TAEKWONDO COMPETITION
Zemper, E.D. and W. Pieter. Exercise Research Associates of Oregon, 111 E. 16th Ave. Suite B, Eugene, Oregon 97401 USA.
Although the Korean martial art form of taekwondo became a demonstration sport in the 1988 Seoul Olympic Games, little research on this sport is available. The present study is part of an ongoing multi-disciplinary research project on taekwondo athletes initiated by one of the authors (WP), and supported by the U.S. Taekwondo Union. Data were collected at the 1988 U.S. Olympic Team Trails in Colorado Springs on 10-11 June and in Raleigh NC on 8-9 July (the Senior competition) and at the 1989 U.S. National Junior Taekwondo Championships in Rochester MN on 22-24 June (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) in single elimination competition. 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 authors 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, a bout was two rounds of two minutes each. Injury rates were calculated based on matches fought (athlete-exposures) and on minutes fought.
Results for Senior Competition
There were 106 bouts fought by men and 111 bouts by women. 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 men was 40% higher than for women.
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. Contusions 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. The women recorded a dislocated patella and an anterior cruciate ligament tear resulting in arthroscopic surgery. The men recorded a 2º cerebral concussion and the women a 1º 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 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 men (15%) and three among women (l5%). 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. The results showed a rate of 23.58/1,000A-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, football (soccer), ice hockey, gymnastics, lacrosse and baseball) and six women's sports (gymnastics, football (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 football (soccer) (15.31/1,000 A-E).
Results of Junior Competition
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 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 1º and 2 were 2º). Girls recorded 2 fractures and 4 cerebral concussions (all 1º). 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 150/0 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.
The number of head injuries, specifically 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 1º and 2º concussions, and for Juniors it was 4.37/1,000 A-E for 1º and 0.58 for 2º concussions. The rates for American football, considered to have one of the highest head injury rates in American sports, are 1.30/1,000 A-E for 1º and 0.30/1,000 A-E for 2ºconcussions. 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.