Physical Training Sept 2006

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Address for correspondence:
Eleni Zetou,
Department of Physical Education and Sport Sciences,
Democritus University of Thrace,
69100 Komotini, Greece.
Tel: 030 6945773762.
E-mail: elzet@phyed.duth.gr



Introduction

    Taekwondo is an exciting, fast and dynamic sport which involves both men and women. It belongs to those sports which have their roots in martial arts since it is a sport of body contact-fighting and, ever since it was established as an Olympic game in 2000, has seen its reputation and spectatorship grew stronger and participation of athletes from all ages (started at age 5) develop rapidly. Therefore matters such as the safety of the athletes along with the avoidance of injuries are of great importance.

As for athletes’ safety concerns, the World Taekwondo Federation [1] decreed rules concerning matches, as for example, athletes who participate in Taekwondo should hold “black belt” and should be over 16 years old. Also punches were allowed to the front of the torso in the area covered by the chest protector worn by the athletes. Kicks were allowed to the torso and head, which was covered by a helm. Only one point was given from referees for a successful blow. Athletes could win the match by means of a knockout, so contact was encouraged. In 2003 the rules changed and ever since athletes win 2 points for every kick-punch contact on the opponents head and an additional point for an eight-count knockout [1].

Most studies of Taekwondo injury occurred at single tournaments [1, 2]. Zemper and Pieter [3] found injury rates for American elite male Taekwondo athletes to be 127.4/1,000 athlete-exposures and for females, 90.1/1,000 athlete-exposures. One athlete exposure refers to one athlete being exposed to the possibility of being injured. A study by Pieter, Ryssegem, Lufting, & Heijmans [2] reported injury rates of 139.5/1,000 and 96.5/1,000 athlete-exposures for European men and women, respectively.  In these studies statistical differences between men and women were not reported. In a study which occurred at a recreational tournament the men (51.3/1,000) sustained statistically significantly more injuries than women (47.6/1,000) [4]. But Pieter and Zemper [5] in a tournament found significantly higher injury rates for women (105.1/1,000 versus 95.1/1,000 of men). A recent study Kazemi and Pieter [6] found injury rates of 62.9/1,000 athlete exposures (79.9/1,000 for males, significantly more than the 25.3/1,000 for females).

Regardless to the injury type, as expected in a contact sport, contusions were the most frequently injuries reported by male and female Taekwondo athletes [2, 4].

The body region most frequently affected is the lower extremities, especially the instep of the foot [2, 4], as reported by both recreational and Taekwondo athletes in a single tournament. This was predictable because Taekwondo is characterized by kicking. The most commonly injured body region in men was the lower extremities (25.3/1,000), followed by head and neck (18.3/1,000), but all injuries to women were to the lower extremities and the most common type was a sprain (22.8/1,000) followed by joint dysfunction (13.7/1,000) [6].

There were no studies with gender differences related to body region and body part combined with injury rates [7].  Pieter [8] reported that the head and neck sustained most of the injuries in both elite male and female athletes in karate. There are also no male-female comparisons on body region injured in judo athletes. Pieter [9] reported that in judo the most frequently affected areas were the upper extremities in women, while in the men the head and neck as well as the lower extremities were affected more often [9, 10].

Since the nature of Taekwondo requires the frequent use of the legs, it is predictable that the main injury mechanism was found to be delivering or receiving a kick [3, 5], especially in men the roundhouse kick was often implicated [2, 4, 11].

The aim of this study was to record the injury rate per athlete, the types of injuries that appear in Taekwondo, whether they occurred during training or in competition, the severity of these injuries, the mechanism of cause, and the ways in which they were confronted, as well as to examined the gender differences (if any). The results of this study could help practitioners and clinics to confront better and also to prevent injuries. The main difference with other studies is that in the present study we recorded the injuries in training and in competition for three years, not only in a single tournament as was referred in the other studies.


2. Materials and methods

2.1. Study population

A total of 118 Greek Taekwondo athletes (64 men and 54 women) participating in the Greek Taekwondo national division championships were interviewed during the period 2005-2006. Table 1 gives the age and anthropometric characteristics of the involved participants, table 2 the athletes and the fight-division to which they belong.


Table 1. Age and anthropometric characteristics of the Taekwondo athletes.

Characteristic	Male (n=61)	Female (n=53)
Age (years)	21.44 (3.48)	21.46 (3.14)
Weight (kg)	75.44 (12.18)	62.77 (8.29)
Height (cm)	183.87 (9.50)	172.46 (4.86)

Values are means (SD).

Division of fighting	Males%	Females%
40-50 kgr.	6.3	14.8
50-60 kgr.	6.3	40.7
60-70 kgr.	6.3	29.6
70-80 kgr.	68.8	14.8
80-100 kgr.	12.5	0
Total	100	100

2.2. Data collection and definition of injury

An orthopaedic surgeon, a physiotherapist, and a trainer made up the questions that were included in the interview. The injury incidence rate, the characteristics of the injuries (severity, diagnosis) and the anatomical location of the muscle skeletal injuries, which occured during practice and competition in all the championship periods were recorded for the last 3 years.

Injury was defined as "any mishap occurring during scheduled competitions or practices that cause an athlete to miss a subsequent competition or practice session" [12]. Injuries were classified into three grades of severity: minor (absence from training or competition for less than one week); moderate (absence from training or competition for one week to one month); major (absence from training or competition for more than one month). This classification has been used in much other research [13, 14, 15, and 16].

The data were statistically analysed using X2 analysis of SPSS statistical package to determine whether any of the previously mentioned factors had a relation to the incidence of injury. In all cases, the null hypothesis was rejected when p <0.05.

3. Results

3.1. Injury rate

The 118 Taekwondo athletes reported 780 injuries during a total exposured time of 1089 h for 3 years (260 injuries for 363 h exposure per year), representing overall incidence injuries per player 2.2 per year. In terms of Taekwondo participation over 36 month the 118 athletes reported 6.6 injuries per 1,000 hours of training (almost 3 years) and 0.9 per 1,000 hours of competition.

Using X2 analysis no difference in injury rates based on the sex of the athletes (X2 = .019, p=.889>.05) were found. The injury rate during training sessions was statistically related in comparison to competition injury rate (X2 = 331, p<.05) but there were not any differences in relation to sex (Table 3).

It is notable that according to the records, 96.6 % of the total Taekwondo athletes were injured in the last 24 months (2 years). 45.1% of the injured athletes were injured twice, 24.3% were injured once,  17.8% three times and 9.4% more than five.

Table 3. Injury in training and competition for Taekwondo athletes (males and females) 

	No cases (%)	Injuries	Injuries in training (cases)	Injuries in competition (cases)
Athletes	118 (100%)	260	212*	48
Male	64 (54.2%)	182	151	31
Female	54 (45.8%)	78	61	17

*Statistical significant

3.3. Type of injury

Table 3 shows, for the total sample, the type of injuries. The most common injury for the athletes was contusion and laceration 41.4% (149 cases), followed by sprain (instep, toes, ankle) 30.5% (110 cases), knee lesions 13.5% (48 cases), broken limbs 11.2% (40 cases), and broken nose 3.4% (12 cases). According to the results, contusion and laceration happened significantly more than the other types of injuries (X2= 561.6   p<0.05).

Table 4. Type of injuries

Type	Injuries %	Cases
Contusion and laceration*	41.4	149
Sprains (instep, toes, ankle)	30.5	110
Knee lesion	13.5	48
Broken limb (leg, arm, fingers)	11.2	41
Nose	3.4	12
Total	100	360

*Significantly higher than in other locations.

3.4. Sex differences

No sex difference (women comparison with men) was found when 292 cases (acute injuries) were analysed in terms of sex occurrence (comparison of injuries in men or in women) (X2 =.019, p=889>.05). Also, no sex difference was found when injuries were analysed in terms of type of injuries (X2 =7.37, p=.496>.05).

3.5. Severity of injury

The severity of injuries is shown in terms of absence from competition or training after the injury. The rate of mild injuries was 3.5% (8 cases), that of moderate injuries was 62.4% (161 cases), and that of major injuries was 30.5 % (78 cases) (there is a significant difference between them, and 13 missing cases (5.6%)). No statistical differences were found between severities of injury in relation to sex (p=0.450). When the 78 major injuries of the participants were analyzed, the data showed that 64% (50 cases) of these did not influence their Taekwondo career (almost the 6.4% of the total injuries).

3.6. Time loss and recurrent injuries

47.5% of the athletes lost time up to 10 days from training or competition because of injury. The recurrent episodes in the 780 cases were analyzed. According to the statistical analysis X2 the recurrent episodes (234 cases) were statistically less, compared with the cases with no recurrent episodes (546 cases) (X2 = 254, p<.05). In addition there were no sex differences when comparing recurrent episodes between sexes (women=34 cases (40%), men=51 cases (60%), (X2 = 3.4,   p=.065 >0.05). Most of the athletes followed a rehabilitation program. Those who did not follow a rehabilitation program were injured again.

3.7. Fight division of the injured Taekwondo athlete- Injury mechanism

The 65-75 kgr. division of athletes presented more injuries than the other divisions (X2 = 83.59, p<0.05). The basic injury mechanism was when athlete received a kick 35.6% (significant), followed by when the athlete delivered a kick, but it didn’t differentiate from sex. (X2 = 665.5,  p<0.05).

4. Discussion

The present study aimed to record the total injury rate of injury per athlete, the types of injuries that appear in the sport of Taekwondo, the severity of injuries, whether they occurred during training or competition, the ways in which they were confronted, as well as what mechanisms that caused these injuries.

From the analysis of the data it was found that injury rate for Greek Taekwondo athletes was only 6.6/1,000 athlete exposures. These results couldn’t be compared to those from other research since that research recorded injuries in a single tournament, whereas the present study used another approach and recorded injuries in training and competitions over three years. No significant differences were found in injury rate for gender, though a lot of researchers [2, 3, 4] found that men had more injuries than women. In contrast, at one Greek national championship, the men’s injury rate (20.6/1,000) was significantly fewer than the women (36.4/1,000) [11]. But all these previous studies recorded injuries which incurred at single tournaments.

Most of the injuries occurred in training and the most injuries occurred within the last two years. It is predictable that athletes spend many more hours in training than in competition and it's reasonable that the injury rate is higher in training. Also, most athletes answered that they were injured twice in one year.

In point of injury type, most of the injuries were acute injuries. The most common injury for the athletes was contusion and laceration, followed by sprain (instep, toes, and ankle), broken body region (arm and leg, fingers, nose), knee dysfunction, and join dysfunction. These results agree with other studies [3, 2, 11]. Contusions were also the most common injury in karate [8, 17].

This seems to be reasonable since the rules of the game allow athletes to wear protection in the chest and a helmet in the head, body parts which are exposed are shoulders and arms. Legs are more susceptible to knocks, and because of the nature of the sport, to contusion and laceration from several parts of the body every time the athlete receives a hit, and injures in the legs (mostly in sprains in toes, instep, or ankle), are especially likely when the athlete attacks.

In relation to the severity of acute injuries which were shown in terms of absence from competition or training after the injury, most of them were moderate injuries followed by major injuries and only a small percentage were mild injuries. No differences between severities of injury in relation to gender were observed. Of the major injuries, analysis of the participant’s answers showed that most of them didn’t influence their Taekwondo career.

Relative to time loss when an athlete was injured, most of the athletes related that they stayed out of training and games for more than ten days. When the recurrent episodes in the total injury cases were analyzed, they were less common in comparison to the cases with no recurrent episodes. In addition there was no sex difference when the recurrent episodes were compared. Most of the athletes followed a rehabilitation program. Those who did not were injured again. In addition, the findings of the present study showed that at present the athletes are informed of the benefits of rehabilitation and when injured both men and women athletes followed the proper procedure. Nowadays each team has a physiotherapist so that the athlete will have immediate and professional aid for every injury. Athletes are also aware of the benefits of prevention by applying appropriate muscular strengthening and streching of the muscles.

Concerning the fighting division of athletes the 65-75 kgr which presented more injuries than others. Regarding the injury mechanism it was found that receiving a kick was the most common mechanism for men and women alike, followed by delivering a kick, with considerable difference from other categories of injuries. This is due to the nature of the sport during which the athletes received or delivered a kick. When the athlete is confronted with such a kick his/her head may be injured as well as the neck or shoulders. When the athlete delivers a kick he/she could also be injured in his/her leg, finger, or knee. Of course injuries depend also on athlete’s level.  A high level athlete has fewer injuries that those who are of lower level.

This result concurs with what was found previously, that the main injury mechanism was delivering or receiving a kick [3, 5]. Pieter, et al [2] and Zemper, et al [3] support that men tended to be injured as a result of receiving a kick more than women. It is suggested that the most likely injury in men is from a roundhouse kick [2, 4, 11]. The fact that injuries occurred as a result of receiving a kick may be partially related to unblocked attacks, so it is recommended that coaches should work on improving the blocking skills of their athletes.

The results of the present study add certain elements regarding the appearance of injuries in the sport of Taekwondo. More research is needed in order that practitioners and clinics may better prevent injuries in training and competitions.

References

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