RESEARCH ARTICLE Injury S urveillance in Taekw ondo and Judo D uring Physiotherapy C overage of the S eventh A ll A frica G am es

ABSTRACT: Objective: To obtain data relating to the incidence of injuries sustained during taekwondo and judo competitions at the PHILLIPS JS, BSc'; FRANTZ JM \ MSc; 7th All Africa Games. AMOSUN SL, PhD'; WEITZ W 2 Methods: Prospective recording of injuries sustained by athletes who 1 Department of Physiotherapy, University of the Western Cape sought physiotherapy services at the games. Details of type of injury, Sparts Science Institute of South Africa injury sites and injury severity were obtained. Results: Seventy athletes out of 390 participants reported injuries. The overall injury risk ratio was 0.18. Injuries reported were strains/sprains (65,6%), bruises/contusions (16.1%) and dislocations or fractures (12,9%). The upper limbs were more commonly injured. Of the injuries sustained, approximately 18%, 69% and 13% were respectively classified as mild, moderate and severe injuries. Conclusions: The high incidence of moderate to severe injuries highlights the need for injury prevention programs and the presence of medical staff at major tournaments in order to make early diagnosis and appropriate intervention. KEY WORDS: TAEKWONDO; JUDO; INJURIES, PHYSIOTHERAPY, SURVEILLANCE

INTRODUCTION world. In the first All Africa Games other mainstream sports, and martial Taekwondo is a type of fighting system held in Brazzaville, Congo in 1965, over arts are even considered probably safer that originated in Korea and that 2500 athletes participated in 10 sporting than most. In a prospective study to )

. employs kicking, punching and various codes in which 30 independent African determine the incidence of head and neck 3

1 evasive techniques. Judo on the other states were represented. The 7th All injuries in young taekwondo athletes, 0

2 hand emphasizes grappling techniques, Africa Games (AAG) was held in it was found that contusion was the d

e especially those that upset the oppo­ Greater Johannesburg, South Africa, in most frequently occurring injury type t a nent’s balance, in particular gaining September 1999, and saw the conver­ for both girls and boys and that the major d (

leverage, throws, clothes grabbing, joint gence of approximately 6500 athletes injury mechanism was receiving a blow r e locks and strangle holds (Encarta and officials from 52 African countries (Yamamoto and Kigawa, 1993). h s i

l encyclopedia). In 1994, taekwondo, as taking part in 17 sporting codes. The In view of the paucity of data during b

u propagated by the World Taekwondo participants in both judo and taekwondo taekwando and judo competitions, par­ P

Federation, was recognized by the were from 27 African countries. ticularly in Africa, the main purpose of e h International Olympic Committee as a Injuries seem to be an unavoidable this study was to obtain data relating to t

y sport to be included in the regular part of any athletic activity and Asian the incidence and degree of severity b

d Olympic games starting from 2000 in martial arts is no exception (Pieter and of injuries sustained by athletes who e t Sydney, Australia (Pieter and Zemper, Van Ryssegem, 1998). Injuries are espe­ took part in taekwondo and judo compe­ n a 1997a & b). Judo had already gained cially prevalent in contact sports such titions at the 7th AAG, and sought r g Olympic status in 1964. as full-contact taekwondo or full-contact physiotherapy services provided at the e c games venues. In addition, the study n The All Africa Games is one of the karate. However, prospective epidemio­ e c four largest multi-sport events in the logical studies on injuries in young also aimed at determining the injury risk i l

r athletes’ participation in martial sports ratio and the injury rates in terms of e d in general are scarce (Pieter and Zemper, athlete exposure. n u CORRESPONDENCE TO: 1997b; Pieter et al, 1998). Despite the

y METHODS a Mrs JS Phillips popularity of these sports at the Olympic w

e Department of Physiotherapy and All Africa Games, little is known The medical committee for the game t a University of the Western Cape about the injury profiles of the athletes identified different teams of health care G

t Private Bag xl7 competing at these games. Although professionals to provide medical cover­ e

n Bellville the martial arts are generally practised age at various competition venues. There i b 7535 in a safe environment, they are reputed were teams of doctors, physiotherapists, a S

Tel: 27 21 9592542 to be a high-risk activity (Burks and nurses, masseurs and St John’s First Aid y b

Fax: 27 21 9592804 Salterfield, 1998). The injury rate is staff. Medical clinics were set up at the d e Email: [email protected] reported to compare favourably with venues where the events took place. c u d 32 SA Journal o f Physiotherapy 2001 V o l 57 No 1 o r p e R Injured athletes were initially assessed TABLE 1. Injury data for taekwando competition by medical staff at the ringside or in training areas, and were referred to the Number of: medical clinics for additional attention Athletes 80 or further referral. Physiotherapists were Matches/bouts 179 based in the medical centres at the venues for taekwando and judo, and Athlete-exposures to the possibility of being injured (2 per match) 358 assessed all referred athletes in order Reported injuries 31 to classify the injuries as mild, moderate Total injury rates Per 1000 athlete-exposures (A-E) 86.6 or severe. An injury was defined as any incident occurring during warm-up or compe­ TABLE 2. Injury data for judo competition tition which required medical attention. Injuries were graded as mild, moderate Number of: or severe based on the treatment Athletes 310 required and the outcome of the injury Matches/bouts 309 (Zemper and Pieter, 1989). Mild injuries required first aid treatment only, such Athlete-exposures to the possibility of being injured (2 per match) 618 as ice and bandaging, and athletes were Reported injuries 62 able to compete in their next match. Total injury rates Per 1000 athlete-exposures (A-E) 100.3 Moderate injuries necessitated manage­ ment such as medication, physiotherapy (e.g. ultrasound, interferential, soft tissue TABLE 3. Types of Injuries sustained (n=93) mobilization), immobilization, or required a competitor to miss the next match. Judo Taekwondo Severe injuries required referral to the Strains/sprains 45 17 hospital resulting in prolonged immo­ Bruises/contusions 5 10 ) . bilization, effectively ruling the compe­ Dislocations/Fractures 8 4 3

1 titor out of the competition for the 0 Others 4 0 2

rest of the games. The match doctor later d e confirmed injuries assessed and classi­ t a fied by the physiotherapist, and the d TABLE 4. Distribution of injuries by body part (n=93) ( physiotherapist who assessed the injured r e Sport Upper Limb Lower Limb Trunk Head h athlete completed the data capture sheet. s i l All matches were single elimination Judo 32 (51.6%) 19 (30.6%) 9 (14.5%) 2 (3.2%) b

u competitions. Injury data were recorded

P Taekwondo 10 (32.3%) 19(61.3%) 1(3.2%) 1(3.2%) on a data capture sheet that was similar e h t to the one used at the 6th AAG in y

b Zimbabwe. Information gathered included minutes) for which athletes were taekwondo accounted for 27 injured

d the bio-demographic data of the athlete, exposed to the possibility of sustaining athletes. The injury risk ratios for e t

n and the history, assessment and manage­ an injury (Zemper and Pieter, 1989), judo and taekwondo were 0.2 and 0.15 a r ment of the injury. The overall number using the formula: (number of injuries/ respectively. The summaries of the g

e of athletes who participated in taekwando number of athlete-exposures) x 1000 exposure and injury rates data for taek­ c n and judo was 390, of which 210 athletes = number of injuries per 1000 minutes wando and judo are presented in Tables e c i (121 males, 89 females) participated in of exposure. One athlete-exposure (A-E) 1 and 2 respectively. l

r judo. One hundred and eighty athletes referred to one individual competing in During the tournament, a total of 93 e d (101 males, 79 females) participated one bout where he/she was exposed to injuries were reported of which judo n u

in taekwando. the possibility of being injured. Because accounted for 62 injuries and taekwondo y a The injury risk ratio was determined there are always two people competing 31 injuries. The injuries sustained w e by the number of injured athletes per in any one bout, there are two A-Es included strains and sprains (65.6%), t a number of participants. Exposure data per bout. bruises and contusions (16.1%), dislo­ G

t for calculating injury rates were gathered cations (7.5%) and fractures 5.4% e n from records of bouts actually fought. RESULTS i (Table 3). The distribution of injuries b

a Each bout consisted of three rounds Seventy athletes were injured in taek­ by body part is presented in Table 4. S of three minutes each. Injury rates were wondo and judo events (N=390), giving These areas were further classified into y b

calculated from the total number of actual an overall risk ratio of 0.18. Judo the following regions: shoulder (17%), d e matches fought and the total time (in accounted for 43 injured athletes and hand (17%), wrist (10.7%), ankle c u d o SA Journal o f Physiotherapy 2001 V o l 57 No 1 r 33 p e R (10.8%), lower leg (10.8%), trunk ratio could be higher than what has REFERENCES (10.8%), knee (7.5%), foot (1.2%) and been reported. However, the total injury head (3.2%). Injuries to other parts such rate reported for taekwando in this study Burks J.B, Salterfield K 1998 Foot and ankle injuries among martial artists. Results of a as elbow and forearm, accounted for (86.6/1000 athlete-exposure) compares survey. Journal American Podiatric Medical 11%. Of the injuries sustained, 18.1% favourably with the rates reported by Association 88: 268-278 was classified as mild, 69% as moderate Pieter and Zemper (1997c) for junior and 12.9% as severe injuries. athletes (95.1/1000 athlete-exposure) Bennell K, Crossley K 1996 Musculoskeletal and senior athletes (105.5/1000 athlete- Injuries in Track and Field: Incidence, DISCUSSION exposure). Unfortunately, similar com­ Distribution and Risk Factors. Australian Journal of Science and Medicine in Sport 28: When large numbers of athletes compete parison was not possible for judo. 69-75 intensely over a short period of time, a Injuries sustained at the 7th All Africa variety of injuries are often encountered. Games included strains and sprains, Encarta encyclopedia 2000 Internet site: Thus, safety in sport has become an bruises and contusions, and fractures http://www.k-lusa.com/html/link9.htm; issue of concern as injuries seem to and dislocations. The most frequently accessed January 2000 be an unavoidable part of any athletic occurring types of injury were strains Pieter W, Bercades L.T, Heijmans J 1998 activity, and Asian martial sports are and sprains. This was in contrast to ear­ Competition injuries in Olympic taekwondo. no exception. The cost of injuries to lier studies in which contusions were Kinesiology 30: 22-30 individuals is significant. It becomes identified as the most frequently occur­ increasingly significant when the indi­ ring injury types (Zemper and Pieter, Pieter W, Van Ryssegem G 1998 Serious vidual participates at national and inter­ 1989; Yamamoto and Kigawa, 1993). injuries in karate and taekwondo. Journal of national levels, as it affects not only the Approximately 13% of the injuries Asian Martial Arts 7: 10-26 individual but the team and the country. sustained were dislocations and frac­ Pieter W, Zemper E.D 1997a Head and neck Unfortunately, no information is avail­ tures. This supports the need for injury injuries in adult taekwondo athletes. Coaching able regarding injuries in martial arts in prevention programmes and the impor­ and Sport Science Journal 2: 7-12 South Africa. tance of protective gear. The high Pieter W, Zemper E.D 1997b Time-loss The overall injury risk ratio for this incidence of closed soft tissue injuries injuries in Junior Olympic taekwondo athletes. study was 0.18. This was similar to stu­ (65.6%) highlights the need to have Sports Exercise and Injury 3: 37-42 ) . dies of other sports such as athletics medical staff at major tournaments in 3

1 that indicated an injury risk ratio of order to establish an early diagnosis, Pieter W, Zemper E.D 1997c Injury rates in 0

2 children participating in taekwando compe­ 0.22 during competition (Bennell and with the intention of preventing further d tition. Journal of Trauma: Injury, Infection, e t Crossley, 1996). This supports the opi­ injury. Early intervention to treat and Critical Care 43: 89-96 a

d nion that the injury rate in martial arts inflammation, pain and limited range of (

r compares favourably with other sports. motion will ensure that the athlete can Seto J, Brewster C 1993 Treatment approaches e h However with the logistical set up at the return to competition as soon as possible following foot and ankle injury. Clinics in s i l games’ venues, it was possible that there (Seto and Brewster, 1993). The need for Sports Medicine 13: 695 b u were some injured athletes who did not injury prevention programmes is further

P Yamamoto T, Kigawa A 1993 Effectiveness

e report to the medical center to receive highlighted by the large percentage of of functional ankle taping for judo athletes: h t

physiotherapy. Some of the participating moderate to severe injuries reported in a comparison between judo bandaging and y

b countries came with team physiothera­ the study. They are referred to as time- taping. British Journal of Sports Medicine 27:

d 110-112

e pists who had the sole responsibility loss injuries (Pieter and Zemper, 1997b) t

n of treating their athletes. In addition, since injured athletes are prevented from a Zemper E.D, Pieter W 1989 Injury rates r there were few cases which the match continuing with ongoing bouts and/or g during the 1988 US Olympic Team Trials for

e doctors considered very severe, and were subsequent bouts, and prevented from taekwondo. British Journal of Sports Medi­ c n referred directly to nearby hospitals. returning to practice or competition for cine 23: 161-164 e c i

l Therefore there is a possibility that the at least one day. r

e injury risk ratio could be higher than 0.18. d CONCLUSION n In addition, Zemper and Pieter (1989) u reported that about 60% of martial arts This study identified that most of the y a injuries sustained during competition are injuries sustained in taekwondo and w e

t not reported. This was due to (i) athletes judo during the 7th AAG were moderate a considering injuries to be minor, (ii) ath­ to severe (82%). This justifies the need G t letes thinking that they were indispensable, for availability of medical services at e n i and (iii) the instructor/coach refusing to sporting events involving martial arts. b a accept that the athlete was injured. If The high incidence of injuries sustained S

y similar reasons for not reporting injuries during the games, if not controlled, b at competition were prevalent during the may adversely affect the development of d e

c 7th All Africa Games, the injury risk martial arts in Africa. u d o 34 SA Journal o f Physiotherapy 2001 V o l 57 No 1 r p e R