Review Br J Sports Med 2012;46:485–491. doi:10.1136/bjsports-2012-091011 485 1 Department of Taekwondo, Keimyung University, Daegu, Republic of Korea 2 Department of Physical Education, Dong-A University, Busan, Republic of Korea 3 Department of Physical Education, Yonsei University, Seoul, Republic of Korea 4 Department of Physical Education, Chung-Ang University, Anseong, Republic of Korea 5 Department of Physical Education, Seoul National University, Republic of Korea Correspondence to Gabriel P Fife, Dong-A University, College of Sports Science, Department of Physical Education, 180 Hadan 2-dong Sahagu, Busan, Gyeongsangnamdo 604714, Republic of Korea; fi feg.dau.ac.kr@gmail.com Received 31 January 2012 Accepted 23 April 2012 Competition injuries in taekwondo: a literature review and suggestions for prevention and surveillance Willy Pieter, 1 Gabriel Paul Fife, 2,3 David Michael O’Sullivan 4,5 ABSTRACT Objective To review competition injuries in taekwondo and use this information to develop recommendations to reduce the number and severity of injuries in taekwondo competition. Methods The available literature was searched for prospective studies on taekwondo injuries in adult athletes. An injury was defined as any circumstance for which the athlete sought the assistance of the on-site medical personnel. Injury rates were expressed per athlete-exposures (A–E) and 95% CIs calculated. Results Total injury rates for elite men varied from 20.6/1000 A–E (95% CI 11.8 to 29.3) to 139.5/1000 A–E (95% CI 94.0 to 185.1). For elite women, the rates varied from 25.3/1000 A–E (95% CI 3.1 to 47.4) to 105.5/1000 A–E (95% CI 89.8 to 121.1). About one-third of all injuries (29.6%) in the men were to the head and neck region, while almost half of the injuries (44.5%) were to the lower extremities. In women, 15.2% of injuries were to the head and neck and 53.1% to the lower extremities. The vast majority of all injuries were contusions (42.7% in the men and 62.7% in the women). Point estimates of rates of head injuries and concussions were found to be higher in taekwondo than in other contact sports such as football (soccer) and American gridiron football. Time-loss injury rates in the men varied from 6.9/1000 A–E (95% CI 1.8 to 11.9) to 33.6/1000 A–E (95% CI 18.9 to 48.3). In the women, they varied from 2.4/1000 A–E (95% CI 2.3 to 7.2) to 23.0/1000 A–E (95% CI 15.7 to 30.4). The turning kick was most often involved in causing injury: 56.9% of all injuries in the men and 49.8% in the women. Lack of blocking skills was identified as one of the main injury mechanisms. Conclusions Rule changes should be considered and it is recommended that governing bodies employ qualified medical personnel. Establishing an ongoing injury surveillance system in taekwondo should be the first priority. INTRODUCTION Full-contact taekwondo (TKD) has been an offi- cial medal sport since the 2000 Summer Olympic Games (Sydney), while its demonstration status goes back to the 1988 Games (Seoul). To date, the international sport governing body of taekwondo, the World Taekwondo Federation (WTF), boasts over 200 member nations 1 with more than 80 million practitioners worldwide. 2 It was recently reported that the concussion rate in taekwondo over a 15-year period 3 is four times higher than in American gridiron football 4 over a similar time span (16 years): 9.4/1000 A–E, 95% CI 7.1 to 11.7 versus 2.3/1000 A–E, 95% CI 2.2 to 2.4. Furthermore, overall competition injury rates for taekwondo compared to other full-contact and collision sports, such as American gridiron foot- ball and wrestling, are higher. 5–8 This indicates a need for developing approaches to reduce the num- ber and severity of taekwondo injuries through the use of injury surveillance data to design injury prevention measures, as has been done by other sports. However, to this date, a comprehensive worldwide injury surveillance system in conjunc- tion with preventive measures, similar to those of the National Collegiate Athletic Association (NCAA) and Fédération Internationale de Football Association (FIFA) systems, is yet to be instituted for taekwondo. 9 An example of the use of a comprehensive injury surveillance system in successfully devel- oping injury prevention efforts is the NCAA Injury Surveillance System (ISS), which was started nearly 30 years ago with the cooperation of Certified Athletic Trainers employed at univer- sities nationwide in the USA. 10 As a result of the NCAA ISS, important changes in collegiate sport rules were introduced, such as the 1997 spring gridiron football permissible equipment and con- tact rules, the 2003 women’s lacrosse regulation requiring the use of protective eyewear, as well as the 1995 ice hockey hitting and contact rules. A more direct international effect of the NCAA ISS was to highlight the rise in interest in anterior cruciate ligament (ACL) injuries among female basketball and soccer players, 10 thus leading to a better understanding of ACL injury mechanisms. Based on the results of the NCAA ISS, it is evi- dent that the institution of this comprehensive effort to identify at risk sports has been effective. Therefore, the purpose of this article is to review competition injuries in elite adult taekwondo ath- letes based on prospective studies in an effort to provide a rationale for preliminary steps that may be taken to employ a similar ISS in taekwondo, which should also include steps to be taken to reduce the number and severity of taekwondo injuries. To illustrate the dangers of kicks in taekwondo, this review will also highlight the biomechanical implications of these techniques relative to their injury potential. METHODS The available literature was searched electroni- cally using PubMed for prospective studies on tae- kwondo injuries in adult athletes. An injury was defi ned as any circumstance for which the athlete sought the assistance of the on-site medical per- sonnel. This defi nition was the same across all group.bmj.com on June 2, 2012 - Published by bjsm.bmj.com Downloaded from