Unique method for analysing pressure distribution accross the knuckles during boxing Mike Loosemore, Joseph Lightfoot, Jay Meswania, Chris Beardsley Objectives: The hand is commonly injured in boxing but it is not clear why some athletes sustain hand injuries while others do not. It is possible that there are differences in the distribution of impact forces at the knuckle during punching between athletes and that certain distribution patterns may be predictive of increased injury risk. We developed a s t method of analysing the distribution of impact forces at the knuckle during punching using n i pressure film. Pressure film allows a calculation of the distribution and magnitude of r P pressure and force between any two surfaces that come into contact. Methods: Pressure e film was inserted into the gloves of three male subjects prior to punching a stationary r P target. After each punch, the pressure film was removed and analysed to determine the distribution of the impact force during each punch across each of the four knuckles. Punches were repeated multiple times for each subject. The proportional distribution of the impact force during punches was compared between knuckles and within subjects. Results: The proportional distribution of the impact force exerted during punches was significantly different between knuckles and within subjects (p < 0.05). Knuckle 2 displayed the largest proportion of impact forces while knuckle 3 displayed the smallest proportion of impact forces. Conclusions: Pressure film inserted into boxing gloves can be used to analyse the distribution of impact forces across the knuckles during punching. Further work is needed to confirm the reliability and validity of the technique and establish whether there is an association between the impact forces at the individual knuckles and hand injury risk during boxing. PeerJ PrePrints | https://dx.doi.org/10.7287/peerj.preprints.917v1 | CC-BY 4.0 Open Access | rec: 22 Mar 2015, publ: 22 Mar 2015 UNIQUE METHOD FOR ANALYSING PRESSURE DISTRIBUTION ACROSS THE KNUCKLES DURING BOXING Corresponding author Michael Loosemore, Institute of Sport Exercise and Health, University College London, The Institute of Sport, Exercise and Health, First Floor, 170 Tottenham Court Road. London, W1T 7HA. Email: [email protected]; Tel: 07768 035975; Fax: 02034479251 Co-authors s t n Joseph Lightfoot, Institute of Sport Exercise and Health, University College London, The i r Institute of Sport, Exercise and Health, First Floor, 170 Tottenham Court Road. London, P W1T 7HA. e r Dr Jay Meswania John Scales Centre for Biomedical Engineering P UCL Institute of Orthopaedics & Musculoskeletal Science .University College London Royal National Orthopaedic Hospital. Brockley Hill, Stanmore, Middlesex, HA7 4LP Chris Beardsley, Strength and Conditioning Research Limited, Suite 34, New House, 67-68 Hatton Garden, Holborn, London, EC1N 8JY PeerJ PrePrints | https://dx.doi.org/10.7287/peerj.preprints.917v1 | CC-BY 4.0 Open Access | rec: 22 Mar 2015, publ: 22 Mar 2015 s t n i r P e r P PeerJ PrePrints | https://dx.doi.org/10.7287/peerj.preprints.917v1 | CC-BY 4.0 Open Access | rec: 22 Mar 2015, publ: 22 Mar 2015 UNIQUE METHOD FOR ANALYSING PRESSURE DISTRIBUTION ACROSS THE KNUCKLES DURING BOXING INTRODUCTION Although many trials have reported that the greatest proportion of injuries in boxing occur to the head and face[1, 2, 3], a small number of studies have found that the upper extremity, particularly the hand, may be equally at risk[4,5]. Timm et al. retrospectively collected injury data in relation to amateur boxers from the Olympic training center in the US over a 15-year period and found that 25% of injuries occurred in the upper extremity[4]. Loosemore et al. s t found that the hand displays the greatest number of injuries by anatomical location in elite- n i r level, amateur boxing[5]. However, most previous explorations have focused on head and P e r face injury during boxing and few have performed any specific investigation into the upper P extremity or hand. In the only published investigation into the nature and causes of boxing hand injury, Noble assessed 100 consecutive boxing injuries to the hand in 86 boxers presenting either post- match or in the office of the South African Boxing Board of Control[6]. Noble divided the hand into three different areas: (A1) the thumb, including the scaphoid and carpometacarpal joint; (A2) the wrist, including both the bases of metacarpals 2 – 5 but excluding the parts included in section A1 for the thumb; and (A3) the fingers, comprising the phalanges and the remaining metacarpals, excluding the parts included in section A2 for the wrist. Noble reported that 39% of all injuries occurred in A1, 35% in A2, and 26% in A3. Of the 26% of all injuries occurring in A3, 12% involved painful hypertrophy of the metacarpophalangeal joint soft tissues and underlying extensor tendon (i.e. “boxer’s knuckle” injury), while 8% involved metacarpal fractures, both of which were deemed to have occurred subsequent to large impact forces. Impact forces resulting from the punch of an elite boxer can be very large[7,8,9]. Smith et al. developed a boxing dynamometer by combining a tri-axial force measurement system and a PeerJ PrePrints | https://dx.doi.org/10.7287/peerj.preprints.917v1 | CC-BY 4.0 Open Access | rec: 22 Mar 2015, publ: 22 Mar 2015 boxing manikin and used it to compare the maximal punching force of 7 elite, 8 intermediate and 8 novice boxers during straight punches. Maximal punching forces were 4,800, 3,722 and 2,381N for the rear hand in the elite, intermediate and novice groups, respectively[7]. Joch et al. similarly compared 24 elite, 23 national-level and 23 intermediate-level boxers and reported punch forces of 3,453, 3,023 and 2,932N, respectively[8]. Smith reported impact forces during straight punches in senior England international amateur boxers with the lead hand of 1,722 and 1,682N to the head and body, respectively, and punches with the rear hand of 2,643 and 2,646N to the head and body, respectively[9]. Smith also reported impact forces during hook punches with the lead hand of 2,412 and 2,414N to the head and s t body, respectively, and punches with the read hand of 2,588 and 2,555N to the head and n i r body, respectively[9]. Walilko et al. assessed punching force in 31 Olympic boxers using P similar apparatus and found that punch forces ranged from 1,990 to 4,741N while the mean e r force was 3,427N[10]. Atha et al. recorded punch forces of 4,096N in a world-ranked P heavyweight boxer during punches directed at a cylindrical, instrumented target[11]. It seems plausible that these impact forces that are borne mainly upon the knuckles are responsible for the serious hand injuries that have been reported in several case studies[12] and which have lead to the term “boxer’s knuckle” becoming widely used[13]. However, whether it is purely the magnitude of these impact forces or whether the distribution of such impact forces during punching are of any importance is unclear. Moreover, there is currently no standard method for ascertaining the distribution of the impact forces across the knuckles during punching. In order to better understand the aetiology of hand injuries in boxing, there is therefore a need to understand the nature and distribution of the impact forces during punching. Knowledge of how such impact forces differ between athletes and whether any specific profile of force distribution is associated with increased injury risk will help inform successful injury prevention interventions. Therefore, we have developed a way of analysing the distribution of forces at the knuckles during punching using a unique method involving a specific type of pressure film. PeerJ PrePrints | https://dx.doi.org/10.7287/peerj.preprints.917v1 | CC-BY 4.0 Open Access | rec: 22 Mar 2015, publ: 22 Mar 2015 METHODS Ethics approval was obtained through the Department for Health Research Ethics Approval Committee for Health (REACH) at The University of Bath. Written consent was obtained from the volunteers used. The subjects comprised 2 male members of medical staff associated with the GB boxing squad and 1 male boxer from the GB boxing squad. The raters were 3 male members of medical staff associated with the GB boxing squad. The procedure was explained in full to the subjects and raters. Ethical approval for the study was granted by the Department for s t Health Research Ethics Approval Committee for Health (REACH). Each subject performed n i r multiple hand wraps, with and without a punch. The right hand was tested in all cases. The P subjects wore two non-latex medical gloves on top of each other on the hand being tested. e r The fingers were cut off the gloves to ensure no movement of the glove when a fist was P made. The two gloves were used to hold a piece of pressure film in place, with the film sandwiched between the two gloves and the pointed end placed distally on the finger. The two parts of the pressure film (A-film and C-film) were cut into tapered strips 7mm wide, 38mm long on the short side, and 42mm long on the long side. A tapered end was used in order to make locating the film easier. To ensure that the A-film and C-film remained together during punching trials, they were glued together at the proximal end using standard super glue, to avoid slippage of the two pieces of film. The film was placed over each MCP joint from the second to fifth digits.