International Journal of Sport Studies. Vol., 3 (5), 542- 548, 2013
Available online at http: www.ijssjournal.com
ISSN 2251-7502 © 2013 VictorQuest Publications
Taekwondo Competition Injuries in Iranian Premier League: A
Prospective Study
Mojtaba Ebrahimi varkiani1, Mohammad Hossien Alizadeh2, Mohsen Kazemi3, Hossienali
4
5
Nazari , Abdorreza Ghafoorian
1- MSc, Physical education and sport science faculty, university of Tehran, Iran
2- Associate Professor, Physical education and sport science faculty, university of Tehran, Iran
3- Associate Professor, Canadian Memorial Chiropractic college, Toronto, Canada,
4- International taekwondo coach & referee, Physical education and sport science faculty, university
of Tehran, Tehran, Iran
5- M.D, CFI Doctor, sport medical counselor, Tehran, Iran
*Corresponding Author, E-mail: m.ebrahimi@ut.ac.ir
Abstract
Purpose: The objective of this study was to identify the rate of injuries relative to total number
of injuries, type, body location, mechanism, season periods and their daytime in Iranian`s men
premier league in 2011-2012.
Methods: For this prospective study, 197 athletes with the mean age and body mass of 23.2
year-old and 70.52 kg respectively were studied for injuries incurred. Injuries were recorded on
injury record form to document any injury encountered and treated by the health care
providers. Descriptive statistic was used to analysis the data. Analysis was done by SPSS
Software (Version 14).
Results: The injury incidence was 19.09 per 1000 athlete exposure. In addition, the most
common injury was contusion (6.94/1000 AE) followed by strain (3.47/1000 AE). The upper
extremity (36.4%) was the most injured region followed by lower extremity, head & neck injury
(27.3%). Additionally, most of injuries occurred in early season (45.5%) followed by late season
(36.4%).
Conclusion: Consequently, the injury incidence in Iranian male Taekwondo athletes was lower
than those found in previous studies. It may be due to the new equipments such as electronic
Hugo, specific gloves and socks which were introduced in recent years. Furthermore, upper
extremity should be in priority of preventive measures.
Keywords: Epidemiology, Incidence, Injury, Men, Rate, Taekwondo.
Introduction
Taekwondo is a modern sport in twentieth century and is one of the most popular martial arts with
more than 80 million practitioners worldwide (Kordi and Maffulli, 2009; Pieter et al., 2012). About 201
countries are official members of the World Taekwondo Federation (WTF) which 43 of them are
Asian,(http://www.wtf.org/wtf_eng/site/rules/competition.html; accessed July 4) Iran is one of the most
advanced Asian countries in taekwondo with professional leagues and has had noticeable
improvements recently. Thus, the more the successes, the more the participants and hence, the issue
of safety becomes an integral component in Taekwondo (Kazemi and Pieter, 2004).
The nature of this sport is contact and contains a high risk of injury (Ziaee and Rahmani, 2010).
Lystad et al (2009) reported in a review study that taekwondo had the highest rate of injury in
comparison to American football, soccer, ice hockey and basketball,(Lystad, Pollard, & Graham,
2009); furthermore it was one of the five sports with the highest risk of injury in 2008 Olympics,(Junge
et al., 2009). Prospective studies on Taekwondo injuries sustained at single tournaments have been
conducted before (Kazemi and Pieter, 2004; Pieter, 2010). For instance Bies et al (2001) reported the
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injury rate of 20.55/1000 AE for Greek young and adult athletes (Beis et al., 2001). Kazemi and Pieter
found injury rate of 62.9/1000 athlete-exposures (A-E) for Canadian national taekwondo athletes.
Ziaee et al (2010) reported a rate of 69.5 injuries per 1000 AE in Iranian premier league in 2006-2007
(Ziaee and Rahmani, 2010). Additionally, Junge et al (2009) reported that 27% of all injuries belong to
taekwondo in 2008 Olympic.
Concerning the injury type in taekwondo, sprain (22.8/1000 AE) followed by joint dysfunction
(13.7/1000 AE) were the most common injuries in Canadian championship (Kazemi and Pieter, 2004)
However, Ziaee et al (2010) reported contusion (30.6/1000 AE) as the most common, followed by
sprain and laceration in Iranian league (Ziaee and Rahmani, 2010) Ankle sprain and bruises were the
most common in Greek athletes (Iliana and Savvas, 2011). Likewise, contusion was the most
common in Greek youth and adults (Beis et al., 2001). As it was shown, there were no certain similar
injury types in various studies; nevertheless Lystad (2009) reported contusion as having the highest
mean incidence rate of 36.0 per 1000 AE in review of eight studies.
In relation to body region, upper limb and lower limb injuries were very close to each other in Iranian
league (43% for upper and 41.9% for lower limb) (Ziaee and Rahmani, 2010). However, the lower
limb (32/1000 AE) was the most injured body location in Canadian championship (Kazemi and Pieter,
2004). In addition, head, foot and thigh were identified as the most common locations of injury in a
nine-year longitudinal retrospective study in Canada (Kazemi et al., 2009). Although Iliana and
Savvas (2011) found the head and lower limb as common injuries in Greek athletes,(Iliana and
Savvas, 2011) Greek boys sustained more injuries in their lower limb (22.03/1,000 athlete exposures)
(Beis, et al., 2001). As observed, the most common location of injury was different in various
championships and tournaments. Though in a review by Lystad (2009), lower limb followed by head
and neck were reported as the most susceptible to injury in competition taekwondo (Lystad et al.,
2009). According to the nature of this sport, contact is the mechanism of most injuries. Receiving a
kick was the main cause of injury followed by delivering a kick (Chang et al., 2009; Kazemi et al.,
2009; Kazemi and Pieter, 2004).
There has been a lack of research in Iranian taekwondo injury identification, and because
identification of injury incidence is the first step to injury prevention (Bahr and Engebretsen, 2009), the
present study purposed to identify the rate of injuries relative to the total number of injuries, type, body
location, mechanism , season periods and their daytime in Iranian men national premier league in
2011-2012. The daytime of injuries was investigated because the competitions lasted from morning to
afternoon.
Materials and Methods
Study population
The present study was a prospective study in which 197 athletes in eight weights competed against
each other in 9 teams in 2011-2012 Iranian premier league. The league was held in double round
Robin pattern. There were 576 matches in total.
Injury record form
Injuries were recorded in an injury record form designed by the researcher to document any injuries
seen in the competitions. The first and last authors were those who recorded the injuries according to
the last author’s (the competition`s physician) diagnose. The injury record form was used to collect the
injury type, location, mechanism, season and daytime of injuries. For the purposes of this study, an
athlete was considered injured if any of the following conditions applied,(Kazemi and Pieter, 2004); 1)
any injury circumstance that forced the athlete to leave the competition, 2) any injury circumstance for
which the referee or athlete had to stop the competition, and 3) any injury circumstance for which the
athlete requested medical attention. Injury rates were calculated from matches fought using the basic
rate formula: (# injuries / # athlete-exposures) × 1,000 = # injuries per 1000 athlete-exposures (A-E).
The Colorado concussion classification was utilized in managing the concussions. According to this
classification, a first degree concussion is identified by confusion, no loss of memory and no loss of
consciousness (LOC). A second degree involves confusion, loss of memory but no LOC and the third
degree is when there is LOC (Kazemi and Pieter, 2004).
Statistical analysis
For the statistical analysis, descriptive statistic and Chi-Square test (p<0.05) was used by the statistic
package of SPSS (version 14). Descriptive statistics described the outcome measures (number of
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reported injuries, body part injured, injury mechanism, and season and day time injuries). Chi-Square
test reported the significant difference of injury mechanism and season time.
Results
A total of 197 male Iranian Taekwondo athletes participated in the present study (Age range= 17-32
year-old Mean age=23.2 and Mean weight=70.52 kg) and 1152 athlete-exposures were documented
in the league. The injury incidence rate 19.09 injuries per 1000 athlete exposure were calculated.
Of all 22 injuries, contusion (31.8%) was the most common followed by strain (18.2%). Joint
dysfunction (13.6%) and epistaxis (13.6%) were in the next ranks of prevalence. There was one first
degree concussion. (Table 1)
Table 1: Distribution of injuries by injury type
Frequency
of Percentage
injuries
Concussion
1
4.5
Joint dysfunction
3
13.6
Laceration & abrasion
2
9.1
Contusion
7
31.8
Sprain
1
4.5
Strain
4
18.2
Fracture
1
4.5
Epistaxis
3
13.6
Total
22
100
The upper extremity possessed most of the injuries (36.4%). Additionally, in upper extremity, hands
and fingers (22.8%) and wrist (13.6%) were injured more respectively. The injuries were equal in
lower extremity and head & neck regions (27.3%). Torso had the least injuries (9.1%). (Table 2 & 3).
Table 2: Distribution of injuries by body location
Frequency of
Percentage (%)
injuries
Head & neck
1
4.5
Eyes
0
0
Nose
3
13.6
Lip
1
4.5
Jaw
1
4.5
Wrist
3
13.6
Hand & fingers
5
22.8
Upper back
0
0
Lower back
2
9.1
Groin
2
9.1
Thigh
2
9.1
Knee
1
4.5
Foot & toes
1
4.5
Total
22
100
Table 3: Percentage of injury by body region
Frequency of
Percent
injuries
Upper extremity
8
36.4
Lower extremity
6
27.3
Head & Neck
6
27.3
Torso
2
9.1
Total
22
100
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As expected, the mechanism of most injuries was contact (81.8%) and significantly higher than noncontact injuries (χ2 =8.909, df=1 P=0.003). There was no significant difference between injuries,
which occurred in morning and afternoon (Both=11). Likewise, early season (45.5%) injuries were
more than mid and late season. Chi-Square test did not detect any significant difference between 3
periods of season (χ2 =2.545, df= 2 P=0.280) (Table 2)
Table 4: Mechanism, daytime and season time of injuries
Variable
Frequency(percentage)
Morning injuries
11(50%)
Afternoon injuries
11(50%)
Mechanism of injury
Contact
18 (81.8%)
Non-contact
4 (18.2%)
Different periods of season
Early season
10 (45.5%)
Mid-season
4 (18.2%)
Late season
8 (36.4%)
Discussion and Conclusion
The present study purposed to investigate the incidence of injuries incurred in Iranian male
taekwondo league athletes in 2011-2012 seasons. As observed in the results, an injury rate of 19.09
per 1000 athlete-exposures was found. Upper extremity (36.4%) and in parts hands and fingers
(22.8/1000 AE) sustained more injuries in comparison to other body locations. Furthermore, contusion
was the most common type of injury (6.94/1000 AE).
Based on World Taekwondo Federation (WTF) rules and regulations, all competitors must wear a
WTF-approved trunk protector (Hugo), groin guard, forearm guards, shin guards, hand protector,
sensing socks (in the case of using electronic trunk protector), a mouth guard and a head protector
(http://www.wtf.org/wtf_eng/site/rules/competition.html; accessed July 4).
Players encounter different injuries in competition. Comparing the present study results to others,
injury rate (19.09/1000 AE) was lower in relation to the Canadian national championship (62.9/1000
AE), Iranian league of 2006-2007 (69.5/1000 AE) and Greek young and adult athletes (20.55/1000
AE) (Beis et al., 2001; Kazemi and Pieter, 2004; Ziaee and Rahmani, 2010). Taekwondo competitions
are held in double round robin format in Iran. It means that eight players of each team in eight weights
compete every week for his team. Finally, any team which wins at least 5 matches of 8 wins the
competition. It is evident that the competition sensitivity in single elimination tournament is more than
double round robin pattern, because the player has to win the competition not to be eliminated; thus,
the player may compete more aggressively and may expose himself to a higher risk of injury situation,
consequently the injury rate may be higher, as the rate was higher in some single elimination pattern
championships (Kazemi and Pieter, 2004; Koh and Watkinson, 2001; Pieter, Van Ryssegem et al.,
1995). Another reason for our lower rate of injury may be due in part to the utilization of electronic
trunk protector (Hugo), which was supplied since 2008-2009. The electronic Hugo has more dense
foam compared to non-electronic Hugo. As Gupta (2011) reported, the kick acceleration on the
artificial model designed to investigate the kick acceleration was significantly higher when there was
no padding on the model in relation to the addition of Hugo onto the bag model; dense Hugo may
affect players to pull the kick and not to strike with full force due to the pain produced by direct contact
of foot and Hugo (Gupta, 2011). On the other hand, in competitions with electronic Hugo, there is no
need to deliver a forceful kick to the Hugo, and the players should just touch the Hugo surface
adequately with a moderate force related to their weight by their foot to score. It means that lighter
players need to perform the kick with lower force than heavier players. For instance, a 54 Kg player
needs to enforce only 61 N, while a 87 Kg player should enforce 68 N (IRI. taekwondo federation.
2012). However they had to kick as forceful as possible to score when using non-electronic Hugo.
Reduced kick acceleration and force may decrease the risk of injury incidence. Consequently, the
injury rate may decrease more.
Athlete experience may also affect the injury risk. As Kazemi et al (2009) showed, the proportion of
injuries suffered during a defensive kick to all injuries was significantly higher for colored belt athletes
versus black belt athletes (Kazemi et al., 2009). Thus, as all Iranian athletes participated in the
competitions were black belts; they may expose lower risk of injury.
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As we travel through the time to the present time it seems the injury rate in Taekwondo athletes has
been declining. For instance, the injury rate was 139.5/1000 AE for the 1993 European Taekwondo
Cup (Pieter, et al., 1995), followed by 120.81/1000 AE in 14th World Taekwondo Championships in
1999 (Koh and Watkinson, 2001), followed by 95.1/1000 AE reported in adult American taekwondo
athletes (Pieter and Zemper, 1999a). Afterwards, in Thailand taekwondo championships 2005, it was
39.47/1000 AE (Yiemsiri et al., 2010), followed by 69.51/1000 AE in Iranian taekwondo athletes
(Ziaee and Rahmani, 2010). This decline in injury rate was maybe due to enhancement of safety
equipments, rules and regulation and prevention strategies over the time.
Contusion with the prevalence of 31.8% was the most common type of injury followed by strain
(18.2%). Our findings were consistent with the study of Iranian athletes by Ziaee et al (2010) and a
nine-year longitudinal study in Canadian taekwondo athletes by Kazemi et al (2009) (Kazemi et al.,
2009; Ziaee and Rahmani, 2010). However, it was inconsistent with the men`s championship of
Canada and Greek (Iliana and Savvas, 2011; Kazemi and Pieter, 2004). As expected, due to
competitive nature of the sport and delivering and receiving lots of kicks in the competitions, contusion
could be the most prevalent injury in most championships. Strain could happen, as players have to
kick above their waist and even at extremes ranges of motion (Zetaruk et al., 2005) specially kicking
to the opponent’s head, to gain higher scores. As observed, the amount of contusions declined in
comparison to other studies, the specific gloves and socks provided from 2009 for the taekwondo
players protect player`s forearm and foot from direct contact, because they cover hands, wrist, foot
and ankle. The players were not allowed to utilize any protective equipment or cover on their foot
before the introduction of this rule. Thus, it may be a reason of this injury reduction in the present
study.
Unexpectedly and in disagreement to other studies, upper extremity (36.4%) sustained most of the
injuries. However, lower extremity was the most common site in other studies in Canadian, European
and Greek athletes and inconsistent with the present study (Beis et al., 2001; Kazemi and Pieter,
2004; Pieter, et al., 1995). Ziaee et al (2010) were the only one to concur with our study. Iranian male
Taekwondo athletes maybe use their upper limbs more that other nations to defend against the
opponents’ kicks and as such sustain more injuries. However, further studies are required to
investigate the reason for this finding. Within the upper extremity, hands and fingers sustained more
injuries. Since upper extremity is the primary defensive weapon against strikes, it may endure many
injuries; furthermore as fingers are more exposed to strikes, they may incur more injuries respectively.
The athletes may have held their hands open instead of making a fist and hence exposing the fingers
to further injury. However, the injury rate was declined due in part to the utilization of specific gloves
which cover the knuckles and fix the wrist. They protected wrist and fingers from direct contact and
dislocation. These gloves were provided from 2009 for players.
Our study showed the lowest injury rate among Iranian male Taekwondo athletes compared to
previews studies (Koh and Watkinson, 2001; Pieter, et al., 1995; Pieter and Zemper, 1999b; Yiemsiri,
et al., 2010). This may be due to improvement of safety equipments, rules and regulations over time,
or that the Iranian athletes may not have reported their injures. It should not be ignored that about
60% of martial arts injuries during competition and practice are not reported. This may be due to the
minority of the injuries or the athlete may think that it is not invincible or the instructor may not accept
that the athlete is injured,(Birrer and Birrer, 1983; Birrer and Halbrook, 1988).
Lower extremity (27.3%) and head & neck (27.3%) had a similar rate of injury. Our study also showed
a lower rate of injury for lower extremity (5.2/1000 AE) when compared to other studies (Kazemi and
Pieter, 2004; Koh and Watkinson, 2001; Pieter and Zemper, 1999a) The addition of socks
simultaneously with electronic Hugo since 2008 in Iran, may have protected foot and ankle from
injury. They cover to the lower part of shin and keep the foot and toes firmly, while players could not
wear anything on their foot and even on the ankle before the introduction of this rule. In addition, Della
Corte (1997) reported that the sock gives compression and support for muscles, tendons and
ligaments and helps reduce the chance of injury (Della Corte et al., 1997)
As expected, there was a significant difference between contact and non-contact injuries (P=0.030),
which most injuries were caused by contact (81.8%). One of the limitations of present study was lack
of reported mechanism of injury for instance delivering or receiving a kick. Likewise, no data was
available on the severity of injuries due to inability to follow up the player’s injuries.
The additional variables investigated in the present study were injury daytime and season periods of
injury, in which no difference was observed between morning and afternoon injuries. It may be due to
any athlete having only one or at most two matches a day. For this reason he was fresh for every
competition and maybe fatigue had little effect to make the athlete susceptible to injury. Of the season
periods, most injury occurrences were in the early season (45.5%) followed by late season (36.4%).
Although the number of early season injuries were higher than other periods, there was no significant
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difference between three periods (P=0.280). Our study is the first one to investigate these variables in
taekwondo. Softball and baseball players showed a similar pattern which the authors contributed to
the massive and heavy concentration of the practices in the early season (Shanley et al., 2011) This
might be true in our study as well.
Limitation
This study was subject to some limitations, first the severity of the injuries were not reported due to
inability to follow up the athletes incurred injury. Second, the mechanism of injuries were not recorded
in detail, because no suitable situation was provided to observe the injuries at the time of happening.
The total injury rates for Iranian athletes were lower than those reported in the literature. It may be
due in part to enhancement of safety equipments, rules and regulations, competition format or
players’ experience over time. Contusions followed by strains were the two most common injury types
in Iranian male Taekwondo league athletes. Unlike other studies, upper extremity was the most
common site of injury which should be in preventive measures priority. This may be due to using
upper extremity more than other nations as a defensive techniques and hence more injuries to the
area. Likewise, early season injuries were higher and no difference was found between injuries
occurring in the morning and afternoon. It is delightful to see a reduction in rate of injury in
Taekwondo over time when comparing the early reports to the recent ones. It is hoped to mitigate
injuries by considering the present study and the results of the other consistent studies, and introduce
preventive measures to control the risk of injuries in acceptable levels.
Acknowledgment
We would like to thank IRI taekwondo federation for their cooperation and permission.
Conflict of interest none declared.
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