Incidence of Sport Injuries in the Manchester 2019 World Taekwondo Championships: A Prospective Study of 936 Athletes from 145 Countries.

We aimed to describe injury incidence and patterns at the 2019 World Taekwondo Championships (WTC), and to compare them with those of previous WTCs, based on new World Taekwondo (WT) competition rules, medical codes, and the Protector and Scoring System (PSS). This prospective cohort study utilized data obtained through the WT Injury Surveillance System. All athletes with injuries were evaluated by on-site sports medicine specialists, and ultrasonography was used to assess all musculoskeletal injuries. Of 936 athletes, 60 injuries were recorded (6.4 injuries/100 athletes, 95% confidence intervals [CI]: 4.8-8.0), and 4.5% (n = 42) sustained at least one injury. Males had a higher risk of sustaining injuries than females (incidence rate ratio: 1.57; 95% CI: 0.89-2.76). The most common sites, type, and mechanism were lower extremities (n = 26, 43.33%), contusion/hematoma/bruises (n = 33, 55.0%), and contact with another athlete (n = 50, 83.33%). Overall, the injury patterns associated with the mechanism of injury were similar in both the 2019 and 2017 WTCs. Refined WT competition rules and a re-established PSS at the 2019 WTC reduced the overall and severe injury incidence. Our findings can help revise Taekwondo competition rules, enhance protective equipment, optimize on-site venue medical systems, and develop injury prevention projects.

Mechanisms of Sports Concussion in Taekwondo: A Systematic Video Analysis of Seven Cases.

Sports-related traumatic brain injuries are the most common injury in adolescents and young adults due to recurrent concussion experiences and head shock. Therefore, this study was designed to describe player characteristics and situational factors associated with concussions in the World Taekwondo Championships using systematic video analysis. Athlete injury data were collected using a web-based injury surveillance system at the World Taekwondo Championships organized by World Taekwondo from 2017 to 2019. Seven video footage were independently analyzed by four analysts using a modified Heads-Up Checklist. Descriptive statistical analysis was used. The incidence of concussion was 3.21 per 1000 games. Most players with concussions were shorter than their opponents, and most concussions were caused by a roundhouse kick on the front of the face. Regarding the acceleration direction of the head after the impact, transverse and multiplane directions were the most common. Most players with a concussion have used a closed stance and did not use blocking techniques during the defense. The rate of concussions caused by penalties was 42.9%. Based on our findings, no other injury mechanisms, except for direct blows to the head, were observed. Therefore, education on the risk and symptoms of concussion, the appropriate management and blocking techniques should be emphasized in TKD-S to reduce incidence of concussion.

Functional Reaction Times of a Simulated Blocking Test among Para Taekwondo Athletes.

Para taekwondo is a combat sport martial art that requires fast reaction times for successful defense during fighting. The current classification system is based on the function and the effective length of the upper limbs, which affects the athlete's ability to block. Therefore, this study aimed to investigate the differences between the different classes in the athlete's ability to block and move around the ring. A total of 87 Para taekwondo (K42, K43, and K44) athletes' data were analyzed. Each participant engaged in the blocking reaction time test in a fighting stance with the left leg in front, the right leg in front, and the legs parallel in random order. A foot-stepping reaction test was performed to anlyze how the athletes moved in various directions. The results indicated no significant differences between the classes for the lower body foot stepping reaction times and the upper body blocking performance times. The stimulated blocking time of the Para taekwondo athletes ranged from 0.79 to 0.97 s Furthermore, the neurological group (0.86 ± 0.09 s) was significantly slower than the amputation/dysmelia group (0.81 ± 0.07 s). We thus concluded that the neurologically impaired athletes were disadvantaged and therefore belonged in a separate class.

Altered Biomechanics in Individuals With Chronic Ankle Instability Compared With Copers and Controls During Gait.

CONTEXT: Given that motions of 1 segment affect those of an adjacent segment, the authors of biomechanical studies must thoroughly investigate the kinematics and kinetics of the proximal joints (hip and knee) as well as the ankle joints in patients with chronic ankle instability (CAI). However, few researchers have investigated the altered movement strategies of the lower extremities of patients with CAI compared with lateral ankle-sprain (LAS) copers and control participants throughout the full gait cycle of walking and jogging. OBJECTIVE: To evaluate lower extremity biomechanical differences in patients with CAI, LAS copers, and control individuals during gait. DESIGN: Case-control study. SETTING: Controlled laboratory setting. PATIENTS OR OTHER PARTICIPANTS: A total of 54 participants, consisting of 18 patients with CAI (age = 24.6 ± 2.8 years, height = 173.0 ± 8.0 cm, mass = 67.8 ± 14.6 kg), 18 LAS copers (age = 26.0 ± 4.6 years, height = 173.4 ± 7.5 cm, mass = 66.9 ± 10.3 kg), and 18 control individuals (age = 26.2 ± 2.3 years, height = 172.2 ± 8.2 cm, mass = 63.3 ± 11.2 kg). MAIN OUTCOME MEASURE(S): Three-dimensional kinematics and kinetics of the lower extremity during walking and jogging. RESULTS: The CAI group exhibited dorsiflexion deficits and more inverted ankles compared with the LAS coper and control groups during walking and jogging. In addition, the LAS coper group generated greater knee internal-rotation moments than did the CAI group during jogging. The other variables did not differ among groups. CONCLUSIONS: Participants with CAI demonstrated altered biomechanics, which need to be addressed via intervention programs.

Determination of the Strongest Factor and Component in a Relationship between Lower-Extremity Assessment Protocol and Patient-Oriented Outcomes in Individuals with Anterior Cruciate Ligament Reconstruction: A Pilot Study.

Although the Lower-Extremity Assessment Protocol (LEAP) assesses multidimensional aspects of a patient with anterior cruciate ligament (ACL) injury, there is a need to reduce the dimensionality of LEAP items to effectively assess patients. Therefore, the present study aimed to establish the validity of LEAP and to determine associated factors and components in a relationship between LEAP and the International Knee Documentation Committee (IKDC) questionnaire. Fifteen patients who had ACL reconstruction more than 1 year and less than 5 years earlier were recruited. Patients performed LEAP, including muscular strength, fatigue index, static balance, drop landing, and functional hopping assessment. They also completed the IKDC questionnaire and the Tegner Activity Score. Factor analysis and stepwise regression analysis were performed. The 14 components of LEAP were categorized into four factors (functional task, muscle strength, neuromuscular control, and fatigue), which accounted for 83.8% of the cumulative variance by factor analysis. In the stepwise regression analysis, the functional task (R2 = 0.43, p = 0.008) in factors and single-leg hop (R2 = 0.49, p = 0.004) in components were associated with patient-oriented outcomes, respectively. In conclusion, the functional task and single-leg hop may be used for providing valuable information about knee joints to patients and clinicians.

Types and severity of physical impairments of para taekwondo athletes.

BACKGROUND: Para taekwondo has only recently been added to the Paralympic games scheduled to be held in 2021; however, there is limited research on the classification of the para taekwondo athletes. This study aimed to provide details on the impairments and disabilities of the para taekwondo players. The secondary objective was to investigate the relationship between some of the proposed factors and the athletes' rankings. METHODS: The data of 556 para taekwondo athletes (119 females and 437 males), who had been classified over the past 5 years, were analyzed. RESULTS: The K44 class was the most popular, and 61% of the classified athletes belonged to this class. Acute injury from trauma was the most frequent cause of impairment, and 62.3% of all impairments/disabilities occurred during 0-5 years of age. Approximately 28% of the athletes had <1 year of training prior to international competitions. One-way analysis of variance performed for the combined length of the upper limbs showed significant differences (F(3,311)=455.78, P<0.001) among the K41-K44 classes. There were weak correlations (ρ<0.1) between the ranking and the age of the disability/impairment onset, combined length of the upper limbs, and type of disability. CONCLUSIONS: Continued data collection that provides insights into the impairment profiles of para taekwondo athletes is needed to improve the current classification system in order to enhance the safety and fairness.

Injury and Illness in World Taekwondo Junior Athletes: An Epidemiological Study.

Taekwondo has been reported to be one of the most injurious sports in the summer Olympics, however, there is a dearth of data about injury profiles for junior athletes. Therefore, we aimed to identify the incidence and profiles of the injuries and illnesses that occurred during the 2018 World Taekwondo Junior Championships and recorded using an online system. Among the 889 athletes, 67 injuries and four illnesses were reported, corresponding to an overall clinical incidence of 7.5 injuries (95% confidence interval [CI]: 5.7-9.3) and 0.5 illnesses (0.1-0.9) per 100 athletes. The most frequent injuries were lower extremity injuries (n = 33, 3.71% of all athletes), mostly in the foot/toe (n = 11, 1.2% of athletes), followed by head and trunk injuries, mostly in the face (n = 14, 1.6% of athletes), and upper extremity injuries, mostly in the fingers (n = 6, 0.7% of athlete). Contusions (n = 37, 4.2% of athlete) were the most frequent injury type, followed by ligament ruptures/sprains and laceration. The most common injury mechanism was contact during an opponent attack (n = 51, 5.7% of athlete). Three mild concussions none resulted in time loss (none required hospital transfer or had prolonged recovery). The respiratory system was the most affected by illness, with pain and fever as symptoms. Environmental factors were the most common cause of illness. This study shows that 7.5 per 100 athletes (38.5/1000 athlete-exposures and 6.9/1000 min-exposures) had new or recurrent injuries, whereas 0.5 per 100 athletes experienced illness. In conclusion, the data shows male athletes reported more injuries than females and the most common cause of injury was due to contact between athletes. Contusions, ligament rupture/sprains, laceration and fractures to the lower extremities, head, and trunk were the most common injury. Knowing these injury profiles of junior taekwondo athletes can help taekwondo stakeholders, especially medical staff to prepare accordingly to ensure the safety of the athletes.

Sports Injuries and Illnesses After Implementation of the Web-Based Surveillance System in World Taekwondo.

CONTEXT: Taekwondo epidemiology studies have been in short supply since the rule changes introduced by World Taekwondo in 2017. OBJECTIVE: To describe injury and illness patterns at the 2017 World Taekwondo Championships (WTC) in Muju, South Korea, after the implementation of the web-based surveillance system by World Taekwondo. DESIGN: Prospective cohort study. SETTING: All injuries and illnesses were recorded during the 2017 WTC using a web-based system developed by the International Olympic Committee. PATIENTS OR OTHER PARTICIPANTS: A total of 971 athletes who participated in the 2017 WTC. MAIN OUTCOME MEASURE(S): Profiles and mechanisms of injury and illness in the 2017 WTC. RESULTS: We analyzed a total of 131 injuries and 26 illnesses, corresponding to an overall clinical incidence of 13.5 (95% CI = 11.2, 15.8) injuries and 2.7 (95% CI = 1.6 3.7) illnesses per 100 athletes and an overall incidence rate of 19.3 (95% CI = 16.0, 22.6) injuries and 3.8 (95% CI = 2.4, 5.3) illnesses per 1000 athlete-days. Most injuries occurred in the lower extremities (n = 61, 46.6%), and knee injuries were most frequent (n = 26, 19.8%). Among head and trunk injuries (n = 39, 29.8%), face injuries (n = 32, 24.4%) were most common, whereas among upper extremity injuries (n = 31, 23.7%), finger injuries (n = 8, 6.1%) were seen most often. Contusions (n = 44, 33.6%) were the most frequent injury type, followed by fractures and ligamentous ruptures or sprains. The most common injury mechanism was contact with another athlete (n = 97, 74.0%), whereas the least common was concussion (n = 5). The major affected system was the respiratory system (n = 11, 42.3%), with major symptoms being pain (n = 11, 42.3%) and fever (n = 7, 26.9%). Environmental factors were the most typical cause of illness (n = 15, 57.7%). CONCLUSIONS: The web-based surveillance system used at the 2017 WTC revealed that 13.5 per 100 athletes (77.8/1000 athlete-exposures, 13.9/1000 minute-exposures) had new or recurrent injuries, whereas 2.7 per 100 athletes became ill.

Association between Cigarette Smoking and Physical Fitness Level of Korean Adults and the Elderly.

Although previous studies have examined the relationship between smoking and physical fitness, they only considered current smoking status and the same fitness measurements regardless of age. This study investigated differences in physical fitness based on tobacco smoking habits. A total of 2830 non-elderly adults (NEA; 19-64 years) and 629 elderly (65-89 years) participated in the study, using data extracted from a Korean national database. One-way ANCOVA and ANOVA were conducted to analyze the results. The subjects were classified into three groups (smokers, those who had quit, and never-smokers). In NEA men, a significant difference was observed in 50-m dash (p = 0.003) and 20-m shuttle-run (p < 0.001), while in elderly men differences were only seen in sit-ups (p = 0.015). In the case of NEA and elderly women, no significant differences were observed in physical fitness levels (p > 0.05). The decreased fitness level due to smoking was more noticeable in men than in women, and in NEA more than in elderly persons. A non-smoking policy and customized training based on age or gender are necessary to increase fitness and improve health conditions.

Investigating the influence of Taekwondo body protectors size on shock absorption.

OBJECTIVE: This study aims to compare and analyze the difference of impact force attenuation according to size and impact location on a Taekwondo body protector. METHODS: Body protectors sized 1 to 5, were impact tested by equipment based on the specifications in the European standard manual (EN 13277-1, 3). The impactor release heights were set to match impact energies of 3 and 15 J. The impactor was made from a 2.5 kg cylindrically cut piece of aluminum. Each body protector was impacted 10 times at the two impact energies and two locations. The differences in performance for each body protector size were compared using a two-way analysis of variance with a significance level of p< 005. The effect sizes were investigated using a partial eta squared value (η2). RESULTS: The significant mean differences between the body protector size and impact area (p< 005) and the average impact time of impact strengths 3 and 15 J were 0.0017 and 0.0012 s, respectively In addition, when an impact strength of 15 J was applied, the maximum resulting impact force exceeded 2000 N for both locations on all sizes. Furthermore, at an impact strength of 3 J size 3 significantly reduced the impact force more than the other sizes; however, size 1 showed the greatest shock absorption at an impact of 15 J. CONCLUSION: The results of this study show that the shock absorption of body protectors does not increase according to size; i.e., a larger body protector does not reduce the impact load more effectively. To improve safety performance, we recommend a maximum impact force of 2000 N or less for all body protectors.

Can Neurocognitive Function Predict Lower Extremity Injuries in Male Collegiate Athletes?

The purpose of this study is to demonstrate whether neurocognitive evaluation can confirm the association between neurocognitive level and postural control and to analyze the relationship between neurocognitive level and acute musculoskeletal injury in male non-net sports athletes. Seventy-seven male non-net sports athletes participated in this study. The Standardized Assessment of Concussion (SAC), Landing Error Scoring System (LESS), Balance Error Scoring System (BESS), and Star Excursion Balance Test (SEBT) were used for testing; we collected data related to injury history for six months after testing. Pearson's correlation analysis, logistic regression, and the independent sample t-test were used for statistical analysis. The correlation between SAC and SEBT results was weak to moderate (p < 0.05). Eleven of the seventy-seven participants experienced acute lower limb injuries. SAC, LESS, BESS, and SEBT results have no effect on the occurrence of acute lower extremity injuries (p > 0.05) and were not statistically different between the injured and non-injured groups (p > 0.05). Therefore, using the SAC score alone to determine the risk factor of lower extremity injuries, except in the use of assessment after a concussion, should be cautioned against.

Injury Profiles in Korean Youth Soccer.

We aimed to analyze injury profiles and injury severity in Korean youth soccer players. Data on all injuries that occurred in U-15 youth soccer players during the 2019 season were collected from 681 players of 22 teams through a medical questionnaire. The questionnaire was based on injury surveillance procedures of the Federation International de Football Association Medical and Research Centre and International Olympic Committee, and it comprised questions on demographic characteristics, training conditions, and injury information. Among all players, defenders accounted for 33.0%, followed by attackers (30.7%), midfielders (26.8%), and goalkeepers (7.9%). Most players played soccer on artificial grounds (97.4%). Injuries occurred more frequently during training (56.3%) than during matches (43.7%). Recurrent injury rate was 4.4% and average days to return to full activities were 22.58. The ankle (26.6%) and knee joints (14.1%) were the most common injury locations, and ligament sprains (21.0%), contusions (15.6%), and fractures (13.9%) were the most frequent injury types. In conclusion, Korean youth soccer players have a high injury risk. Therefore, researchers and coaching staff need to consider these results as a key to prevent injuries in youth soccer players and injury prevention programs may help decrease injury rate by providing injury management.

Injuries in Korean Elite Taekwondo Athletes: A Prospective Study.

This prospective cohort study aimed to identify the incidence and characteristics of Taekwondo-related injuries according to age, sex, and event type (i.e., practice or competition) based on a web-based injury surveillance system (ISS) with a follow-up period of 12 months. A total of 285 members of the Korea Taekwondo Association who competed in the 2016 season participated. Injury incidence rates (IRs) were calculated per 1000 athlete-exposures (AEs). Injury rate ratios (RRs) with 95% confidence intervals were calculated and compared regarding age, sex, and event type. During the season, 336 injuries were reported, resulting in a rate of 6.31/1000 AEs. The most common location, type, and mechanism of injury in Taekwondo athletes were the foot/ankle, ligament sprain, and contact with another player, respectively. The overall injury IRs associated with Taekwondo practicing and competition were 4.79/1000 AEs and 24.86/1000 AEs, respectively. The overall injury RR related to both practice and competition was higher in youth athletes than in adult athletes. However, adult athletes were more likely to sustain more severe injuries. Korean elite Taekwondo athletes were commonly exposed to injury, especially youth and female athletes. Therefore, continuation of the ISS suggests the development of interventions for preventing injuries sustained by Taekwondo athletes.

Safety Evaluation of Protective Equipment for the Forearm, Shin, Hand and Foot in Taekwondo.

The objective of the study was to evaluate and compare different brands of forearm, shin, hand and foot protective equipment used in Taekwondo. The most popular brands of large forearm, shin, hand and foot protectors (D®, A®, K ®), approved by the World Taekwondo and Korean Taekwondo Association, were examined. A drop test was used to test the protective equipment using impact levels of 3J, 9J, 12J and 15J for the forearm and shin guards, and 3J and 9J for the hand and foot protectors. The protective equipment was hit ten times from each of the designated drop heights. The drop test is described in the European standards manual of protective equipment for martial arts (SRPS EN 13277-2). The maximum force (MF) and impulse were lowest for brand K® (2610.3 ± 1474.1 N), and brand A® (9.6 ± 3.1 Ns), respectively, for the forearm guards; for brand A® (2053.4 ± 1267.1 N) and brand K® (9.8 ± 3.5 Ns), respectively, for the shin guards; for brand K® (4486.5 ± 1718.4 N), and brand A® (6.3 ± 1.1 Ns), respectively for the hand protectors; and for brand A® (3733.7 ± 2465.3 N), and brand D® (6.8 ± 0.6 Ns), respectively, for the foot protectors. For the forearm guard brand and impact level, there was a significant interaction effect for the MF (F=42.44, η2=.677, p <0.001) and impulse (F = 33.97, η2 = 0.626, p <0.001). Based on the MF, brand K® performed the best for the forearm guards and hand protectors, and brand A®, for the shin guards and foot protectors. The best results for the impulse were for brand A® (forearm guards and hand protectors), brand K® (shin guards) and brand D® (foot protectors).

Proprioceptive Training and Outcomes of Patients With Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: To describe the effects of proprioceptive training on pain, stiffness, function, and functional test outcomes among patients with knee osteoarthritis (OA). DATA SOURCES: All studies completed from 1946 to 2017 were obtained from 4 databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus). STUDY SELECTION: Three reviewers independently identified appropriate studies and extracted data. DATA EXTRACTION: Methodologic quality and level of evidence were assessed using the Physiotherapy Evidence Database scale and Oxford Centre for Evidence-Based Medicine guidelines. The standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for pain, stiffness, function, and functional test outcomes. DATA SYNTHESIS: Seven randomized controlled trials involving 558 patients with knee OA met the inclusion criteria. The selected studies had Physiotherapy Evidence Database scores of 6 to 8. All randomized controlled trials had an Oxford Centre for Evidence-Based Medicine level of evidence of 2. Meta-analysis of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (SMD = -0.56; 95% CI = -1.06, -0.07; P = .026), function subscale (SMD = -0.40; 95% CI = -0.59, -0.21; P < .001), and non-WOMAC walking speed test (SMD = -1.07; 95% CI = -2.12, -0.01; P = .048) revealed that proprioceptive training had significant treatment effects. Proprioceptive training was not associated with reductions in WOMAC stiffness subscale scores and did not improve non-WOMAC get-up-and-go scores. CONCLUSIONS: Proprioceptive training effectively promoted pain relief and completion of functional daily activity among patients with knee OA and should be included in rehabilitation programs. Stiffness and other mobility measures were unchanged after proprioceptive training. Modified proprioceptive training programs are needed to target stiffness and improve additional physical function domains.

The effects of an exercise program on anthropometric, metabolic, and cardiovascular parameters in obese children.

BACKGROUND AND OBJECTIVES: Obesity is a chronic disease that requires good eating habits and an active life style. Obesity may start in childhood and continue until adulthood. Severely obese children have complications such as diabetes, hypercholesterolemia, hypertension and atherosclerosis. The goal of this study was to determine the effects of exercise programs on anthropometric, metabolic, and cardiovascular parameters in obese children. SUBJECTS AND METHODS: Fifty four obese children were included. Anthropometric data such as blood pressures, body mass index (BMI) and obesity index (OI) were measured. Blood glucose, total cholesterol, triglycerides, low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), high sensitive-CRP (hs-CRP), brachial-ankle pulse wave velocity (BaPWV) and ankle brachial index (ABI) were measured. Physical fitness measurements were done. Obese children were divided into three groups: an aerobic exercise group (n=16), a combined exercise group (n=20), and a control group (n=18). Obese children exercised in each program for 10 weeks while those in the control group maintained their former lifestyle. After 10 weeks, anthropometric data and cardiovascular parameters were compared with the data obtained before the exercise program. RESULTS: LDL-C, waist circumference, and systolic blood pressure decreased significantly in the aerobic exercise group compared to the control group (p<0.05). Waist circumference and systolic blood pressure decreased significantly in the combined exercise group compared to controls (p<0.05). Physical fitness level increased significantly after the exercise programs (p<0.05 vs. control). PWV did not show a significant change after exercise. CONCLUSION: A short-term exercise program can play an important role in decreasing BMI, blood pressure, waist circumference, LDL-C and in improving physical fitness. Future investigations are now necessary to clarify the effectiveness of exercise on various parameters.

Reconfigured sigmoid colon neourethra: substitution of refractory posterior urethral stricture.

The repair of extensive posterior urethral stricture often poses a therapeutic dilemma, especially when the urethral defect is too extensive to be repaired with traditional methods and the stricture portion has a poor blood supply. This report details the successful substitution of an extensive posterior urethral stricture using a reconfigured sigmoid colon neourethra.