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EPIDEMIOLOGY of MUAY THAI FIGHT-RELATED INJURIES By EPIDEMIOLOGY OF MUAY THAI FIGHT-RELATED INJURIES by Stephen J. Strotmeyer, Jr. BA, University of Pennsylvania, 1993 MPH, University of Pittsburgh, 1998 Submitted to the Graduate Faculty of Epidemiology Graduate School of Public Health in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh 2014 UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH This dissertation was presented by Stephen J. Strotmeyer, Jr. It was defended on June 12, 2014 and approved by Anthony Fabio, PhD, Assistant Professor, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh Maria Mori Brooks, PhD, Associate Professor, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh Jeffrey Coben, MD, Interim Dean, West Virginia University, School of Public Health Dissertation Advisor: Thomas Songer, PhD, Assistant Professor, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh ii Copyright © by Stephen J. Strotmeyer, Jr. 2014 iii Thomas Songer, PhD EPIDEMIOLOGY OF MUAY THAI FIGHT-RELATED INJURIES Stephen J. Strotmeyer, Jr., PhD University of Pittsburgh, 2014 ABSTRACT Combat sports are generally considered more dangerous and risky compared to other athletic activities, as scoring is inextricably linked to inflicting damage on an opponent. This fundamentally unique intent, to injure an adversary in a contest is replete with injury risks from physical exposures. One combat sport increasingly popular among US youth, known as Muay Thai, yields scant epidemiologic study on fighter injuries. To develop a surveillance system to provide magnitude and scope of injury outcomes in order to frame the public health significance. Three surveillance approaches were utilized to identify eligible participants to complete a web survey regarding Muay Thai fight-related injuries. The target population yielded a convenience sample of 195 fighters participating in sanctioned fights across North America and the UK. Regression analyses were conducted to determine whether the injury outcome was related to additional factors such as experience, protection and pre-existing injury. Depending on the approach, contact rates ranged from 83.3-100%; cooperation rates ranging from 44-80%; response rates ranged from 30-60% and 20-55%. Fighters were aged 18 to 47 years old (median 26); predominantly male (85.9%); and white (72.3%). Respondents were professional (n=96, 49.2%) and amateur (n=99, 50.8%) Fighters reported a range of fight experience from 1-111 total fights, with a mean of 15.83. Of the 195 respondents, 108 (55.4%) reported sustaining an injury during the fight. The primary body region that was injured were the iv extremities (58%). The primary cause or mechanism of the fight injuries was due to being “struck by” the opponent in more than 2/3 of the incidents. Nearly 2/3 (66.7%) of all injured fighters reported that the injury did not interfere with the completion of the fight and was not a factor in the bout outcome (i.e., win, loss, draw). Nearly 25% reported they missed no training time as a result of the injury incurred during the fight. Subsequent regression models yielded several individual level variables of interest relative to the injury outcome. These included fighter status, weight, age, equipment and previous injury. The majority of the injuries incurred by fighters were mild in severity to the extremities, as a result of being struck by or striking the opponent. Lighter, younger, and more experienced fighters were at increased odds for injury within this sample. v TABLE OF CONTENTS PREFACE ................................................................................................................................. XIII 1.0 INTRODUCTION ........................................................................................................ 1 2.0 INJURY DEFINITION ............................................................................................... 9 2.0.1 Introduction ...................................................................................................... 9 2.0.2 Defining Injury ................................................................................................. 9 2.0.3 The Role of Haddon ........................................................................................ 14 2.1 INJURY SURVEILLANCE ............................................................................. 20 2.1.1 National Injury Surveillance Systems.......................................................... 24 2.1.2 State & Local Injury Surveillance Systems ................................................. 42 2.2 EPIDEMIOLOGIC RESEARCH CONCERNING INJURIES .................... 48 2.2.1 Introduction ................................................................................................... 48 2.2.2 Descriptive Epidemiology ............................................................................. 48 2.2.3 Analytic Epidemiology .................................................................................. 51 3.0 SPORTS INJURY EPIDEMIOLOGY ..................................................................... 58 3.1 SPORTS INJURY SURVEILLANCE SYSTEMS ......................................... 62 3.1.1 National Electronic Injury Surveillance System (NEISS-AIP) ................. 63 3.1.2 RIO™ (Reporting Information Online) ...................................................... 63 3.1.3 National Collegiate Athletic Association (NCAA)/Datalys ........................ 65 3.1.4 National Center for Catastrophic Sport Injury Research ......................... 67 3.1.5 National Boy Scout Jamboree ...................................................................... 68 3.1.6 FIS (International Ski Federation) Injury Surveillance System ............... 69 vi 4.0 EPIDEMIOLOGY OF COMBAT SPORTS INJURY ........................................... 70 4.1.1 Boxing ............................................................................................................. 71 4.1.2 Kickboxing ..................................................................................................... 75 4.1.3 Muay Thai ...................................................................................................... 78 4.1.4 Mixed Martial Arts (MMA) .......................................................................... 81 4.1.5 Traditional Martial Arts (TMA) .................................................................. 84 4.1 STUDY METHODS .......................................................................................... 88 5.0 RESEARCH METHODS .......................................................................................... 91 5.1.1 Target Population and Sampling ................................................................. 93 5.1.2 Surveillance Approaches ............................................................................... 96 5.1.3 Injury Definition ............................................................................................ 97 5.1.4 Data Elements ................................................................................................ 98 5.1.5 Data Analysis.................................................................................................. 99 5.1.6 Power Calculations ...................................................................................... 105 6.0 RESULTS ................................................................................................................. 107 6.1.1 Demographic Characteristics ..................................................................... 111 6.1.2 Frequency of Injury..................................................................................... 114 6.1.3 Injury Severity ............................................................................................. 116 6.1.4 Impact of Injury........................................................................................... 118 6.1.5 Treatment of Injury..................................................................................... 120 6.1.6 Fight Experience and Injury ...................................................................... 123 6.1.7 Protective Equipment and Injury .............................................................. 130 6.1.8 Previous Injury ............................................................................................ 133 vii 7.0 DISCUSSION ........................................................................................................... 135 7.1.1 Limitations ................................................................................................... 152 7.1.2 Conclusions................................................................................................... 154 7.1.3 Future Directions ......................................................................................... 155 APPENDIX A : IRB STUDY APPROVAL ............................................................................ 158 APPENDIX B : LETTER OF SUPPORT .............................................................................. 162 APPENDIX C: SURVEY INVITATION................................................................................ 163 APPENDIX D: SURVEY INSTRUMENT ............................................................................. 164 BIBLIOGRAPHY ..................................................................................................................... 172
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