Fracture Injuries in Adult Korean Taekwondo Sparring Athletes
Article information
Abstract
PURPOSE
Fractures are common among Taekwondo-sparring athletes, yet little research has been conducted on these injuries in adult athletes. This study aimed to examine fracture injuries and post-fracture management practices in Taekwondo sparring athletes, with an emphasis on comparing lightweight and heavyweight classes.
METHODS
Data were collected through interviews with 182 adult taekwondo sparring athletes in Korea (95 males and 85 females). The athletes were divided into lightweight and heavyweight groups based on the weight class in which they competed.
RESULTS
Approximately 58.3% of the participants experienced taekwondo-related fractures, with heavyweight players having a significantly higher rate than lightweight players (χ²=3.987, p=.036). Overall, Taekwondo-related fractures occurred most frequently in the hand region during defensive maneuvers, and were caused by contact mechanisms. Fractures were more common among heavyweight athletes during competition and among lightweight athletes during training (χ²=6.395, p=.011). Heavyweight players were more likely to undergo surgery after fractures, whereas lightweights were more likely to receive conservative treatment (χ²=4.270, p=.039). Approximately half of the players (51.4%) returned to play after their fractures without a confirmed diagnosis of bone union, and the most common post-fracture psychological distress was fear of reinjury (57.2%).
CONCLUSIONS
The current findings suggest that the fracture injury characteristics among elite Taekwondo-sparring athletes vary according to weight class, emphasizing the importance of injury prevention and management programs tailored to each specific weight class.
INTRODUCTION
Taekwondo, a traditional Korean martial art, is usually divided into three categories: sparring, poomsae, and demonstration [1]. Sparring, which involves two players competing in an 8 m×8 m area, has been linked to a significantly higher risk of injury. Since the International Olympic Committee implemented the injury surveillance system in 2008, Taekwondo has consistently ranked among the sports with the highest injury incidence in the Olympics [2–5]. A literature review on competition-related injuries among adult Taekwondo athletes found that the overall injury incidence rate for male athletes ranged from 20.6 to 139.5 per 1,000 athlete exposures (AEs), while the rate for female athletes varied from 25.3 to 105.5 per 1,000 AEs [6].
Official Taekwondo sparring matches feature two competitors, one in a blue uniform and the other in red, fighting on a non-slip, elastic mat [7]. Taekwondo sparring allows only hand and foot techniques, with scoring limited to strikes to the body and head [7]. The head, where only foot techniques are permitted in Taekwondo sparring, becomes a primary target for attack because it has the potential to earn the highest scores [8]. As a result, serious injuries, including head fractures, were common in Taekwondo sparring prior to the implementation of electronic scoring systems [9,10]. Currently, athletes competing in competitions are required to wear approved protective gear, which includes a chest protector, headgear, groin protector, arm and leg guards, gloves, and a mouth guard [7].
Several cohort studies have consistently shown that injuries in Taekwondo sparring primarily affect the lower extremities [1,6,11–14] and are caused by contact mechanisms with other athletes [1,11,15,16]. Contusions, sprains, strains, and fractures were identified as the most common injury types, though there was some variation across studies [1,11,12,15]. Notably, in a study of Korean university Taekwondo athletes, Jeong et al. [8] found that sparring athletes had a significantly higher incidence of fractures than poomsae and demonstration athletes. Son et al. [11] found a relatively high incidence of fractures among Korean Taekwondo athletes, accounting for approximately 21% of all injury types.
Although fractures had a slightly lower injury incidence than contusions or ligament injuries among Taekwondo injuries [11,12], they were reported as the injury type that resulted in the longest time loss [13]. In a study of acute Taekwondo injuries, the toes, metatarsals, and fingers were found to be the most common fracture sites. Previous research has found significant links between acute injury and Taekwondo weight class [16,17]. A study analyzing the relationship between weight class and injuries in Taekwondo athletes reported that heavier weights could potentially lead to greater power generation, resulting in more severe injuries for athletes [16]. While fractures, which can result in significant time loss [13,18], are common among Taekwondo sparring athletes [19], there has been little research on these injuries in adult Taekwondo athletes. This study aimed to investigate taekwondo-related fractures and post-injury management practices in Taekwondo sparring athletes, with particular emphasis on comparing the lightweight and heavyweight classes.
METHODS
1. Subjects
This study involved 182 adult Korean Taekwondo athletes (97 men and 85 women) with an average age of 20.6±2.5 years, ranging from 18 to 30 years, and an average playing experience of 9.55±3.2 years, ranging from 5 to 20 years. To minimize career-related biases, those with less than five years of athletic career e (n=2) were excluded, and the remaining 180 participants were included in the final data analysis. Male players had an average height of 181.0±3.4 cm and a weight of 72.8±9.9 kg, while female players had an average of 170.0±6.1 cm and 62.0±9.7 kg. All participants in this study were registered sparring athletes with the Korea Taekwondo Association in 2023 and were affiliated with either university or professional teams in Korea. This study was approved by the Institutional Review Board of Sungkyunkwan University (No. 2023-06-027) prior to commencement. The study was in accordance with the tenets of the Declaration of Helsinki.
2. Data collection
Because of availability and willingness to participate in the research, a convenience sampling method was used to collect data. For the survey, we interviewed five professional teams (Seoul city, Goyang city, Ansan city, Daegu Suseong-gu, and S1) and six collegiate teams (Sejong, Young-san, Yongin, Kyungnam, and Gachon Univertiy) in eight metropolitan areas (Seoul, Busan, Yongin, Changwon, Ansan, Goyang, Seongnam, and Daegu). The data collection period lasted one month, from June 1 to July 1, 2023.
The questionnaire was developed for this study and was conducted in person in an interview by two researchers. First, participants’ general characteristics, such as gender, age, height, weight, dominant hand/foot, competition weight class, competition level (collegiate vs. professional), and fracture experience were investigated. Taekwondo-related fractures were defined as injuries diagnosed by an orthopedic specialist and confirmed by radiographic imaging, excluding stress fractures due to overuse in this study. Second, variables related to Taekwondo-related fractures included event types (practice vs. competition), mechanisms of injury (player contact, surface contact, overuse, others), injured sites (fingers, metacarpals, carpals, radius, ulna, clavicle, scapula, toes, metatarsals, tarsals, tibia, fibula, patella, pelvis, cranial bones, others), activities at the time of injury (attack, defense, stepping, landing, falling, others), and the return to play (RTP) time after injury or surgery. The RTP time was defined as the time between the date of injury and the return to team training. Third, post-fracture management was examined, including whether or not surgical treatment was performed, specialized rehabilitation was undertaken, and the bone union was confirmed by a physician before RTP. Participants were given options for psychological distress caused by the injury, such as concern about reinjury, concern about being assigned to the starting assignment, concern about performance recovery, no psychological distress, and others, and asked to select one primary response.
In this study, participants were asked to report only fractures that occurred after they were registered as registered athletes. We also asked them to report all fractures that occurred during their athletic career (multiple occurrences). Five athletes reported two fractures each during their athletic career, and we considered these as individual data.
3. Statistics
Continuous variables were presented as means and standard deviations, while categorical variables were presented as frequencies and proportions. Frequency analysis was utilized to examine the general characteristics of the study participants. Taekwondo sparring athletes are divided into eight weight classes based on gender. The four heaviest weight classes (men: -74 kg, -80 kg, -87 kg, +87 kg; women: -62 kg, -67 kg, -73 kg, +73 kg) are classified as ‘ heavyweight’, while the four lightest weight classes (men: -54 kg, -58 kg, -63 kg, -68 kg; women: -46 kg, -49 kg, -53 kg, -57 kg) are classified as ‘ lightweight’. Age was divided into two categories: under 21 years and over 21 years. Similarly, playing experience was divided into two categories: under 10 years and over 10 years. The Chi-square test or Fisher exact test was used to compare fracture prevalence and proportions of fracture injury characteristics, as well as post-fracture management, and psychological distress. RTP time was presented as the mean (95% CI) and median (range). The statistical significance level was set at p <.05. All statistical analyses were performed using IBM SPSS ver. 25.0 (IBM Corp., Armonk, NY, USA).
RESULTS
Table 1 summarizes the general characteristics of the study participants. Out of the 180 study participants, 95 (52.8%) were males, 102 (56.7%) were under the age of 21, 97 (53.9%) were in the lightweight category, and 147 (81.7%) were from university teams. Additionally, 94 (52.2%) had less than ten years of playing experience, while 105 (58.3%) had a history of Taekwondo-related fractures.
General characteristics of participants (n=180)
Table 2 shows the differences in the proportions of fractures. Heavyweight players had significantly higher fracture rates than lightweight players (χ²=3.987, p =.036). There were no significant differences in fracture experience based on gender, age, competition level, or playing experience.
Descriptive statistics of Taekwondo sparring athletes with fracture experience (n=105)
Table 3 shows the characteristics of fracture injuries based on weight class. Overall, fracture injuries occurred more frequently during training (65.7%) than during competition (34.3%). Player contact was responsible for 84.8% of all injuries, followed by surface contact (11.4%) and overuse (2.9%). The finger bones (34.3%) were the most common body fracture site, followed by the metacarpals (28.6%), metatarsals (15.2%), and carpal bones (7.6%). Furthermore, most fractures occurred during defense (68.6%), followed by attack (19.0%), stepping (6.7%), and landing (3.8%). Heavyweight players were more likely to suffer fractures during competition, while lightweight players were more likely to suffer fractures during training (χ²=6.395, p =.011).
Comparison of injury statistics of Taekwondo sparring athletes with fracture experience by weight class
Table 4 illustrates the post-fracture management, psychological distress, and RTP time of Taekwondo sparring players by weight class. Of the 105 players who sustained a fracture, 51 (48.6%) underwent surgical treatment, while only 35 (33.3%) received specialized rehabilitation. In addition, only 51 (48.6%) returned to the team after being evaluated by a physician. Heavyweight players were more likely than lightweight players to need surgical treatment after a fracture injury (χ²=4.270, p =.039). They also had a higher tendency to need specialized rehabilitation (χ²=3.742, p =.053). There was no significant difference in medical clearance for RTP between weight classes. Concern about reinjury accounted for 57.2% of all post-fracture psychological distress concerns, followed by no psychological distress (16.2%), concern about being chosen for the starting assignment (13.3%), and concern about performance recovery (11.4%). Finally, RTP time was a mean (median) of 2.6 (2.5) months for heavyweight players and 2.4 (2.0) months for lightweights.
Comparison of post-fracture management and psychological distress of Taekwondo sparring athletes with fracture experience by weight class
DISCUSSION
This study investigated the experience of Taekwondo-related fractures in a sample of Korean Taekwondo sparring athletes. In this study, we found that approximately 58% of the total participants had suffered fractures during Taekwondo training and competition, with heavyweight players having a significantly higher likelihood of fractures than their lightweight counterparts. Heavyweight players were more likely to suffer fractures during competition, while lightweights were more likely to suffer fractures during training. In addition, heavyweight players were more likely to require surgery after fractures than lightweight players. Regard-less of weight class, fractures were more likely to occur in the hand region during defensive maneuvers, typically as a result of player contact.
Our analysis showed that Taekwondo-related fractures were significantly associated with weight class, but not with gender, competition level, age, or athletic career. Despite a lack of fracture-specific studies, these findings are consistent with some relevant studies. By analyzing injuries that occurred during the 2017 Muju World Taekwondo Championships, Jeong et al. [8] reported a comparable fracture injury incidence rate of approximately 20% in both male and female athletes. Schluter-Brust et al. [16] found an increased risk of acute injuries, including fractures, in higher weight classes, particularly in female Taekwondo athletes, after examining acute injuries in 356 Taekwondo athletes of various skill levels.
Schluter-Brust et al. [16] demonstrated that body weight influences athletes' injury profiles, but they did not conclude that weight is inextricably linked to injury rates. However, they speculated that this trend could be attributed to the general assumption that an increase in body weight allows for greater force exertion, potentially leading to greater impacts and, as a result, more severe injuries among athletes. For the same reason(s), we speculate that fracture rates in the current study were higher in heavyweight players than in lightweight players. By contrast, Beis et al. [20] found that overall injury rates, including fractures, varied by weight class in their study of Taekwondo sparring injuries. Given the scarcity of data on Taekwondo-related fractures, more research is needed to better understand the differences in fracture mechanisms between the current and previous studies.
In this study, we found that Taekwondo sparring athletes were more likely to sustain fractures during training than during competition. Notably, more than three-quarters of all fractures in the lightweight class occurred during training. Our findings contradict the findings of a cohort study by Willauschus et al. [13] which found that foot fractures occurred primarily during competition. Although there is no clear explanation for the disparity, we speculate that differences in training exposure time and the use of protective gear during training may be contributing factors.
In this study, most fractures in Taekwondo sparring athletes were caused by acute contact mechanisms (96%). Finger fractures were the most common, accounting for 34.3% of all fractures, followed by metacarpals, metatarsals, and carpals. This aligns with the findings of Willauschus et al. [13] that foot fractures in Taekwondo athletes were significantly linked to contact mechanisms rather than non-contact mechanisms. Given Taekwondo’s emphasis on hand and foot involvement in offensive and defensive actions, these findings are both expected and consistent with previous studies [11,19–21]. Taken together, the current and previous studies show that Taekwondo sparring athletes’ fractures are primarily caused by contact mechanisms during hand and foot movements.
Taekwondo tournaments require athletes to wear protective equipment to avoid injury. Nonetheless, the fact that many fractures occurred in the hand region during defensive maneuvers has important implications. The foot, which can strike the torso and head, was previously the most common fracture site [22]; however, the incidence of fracture appears to have decreased since the introduction of strong foot pads [18]. The majority of blocking actions in Taekwondo are performed on the ulnar side of the forearm, and forearm protectors have been shown to reduce impact in this area [23,24]. Previous research emphasized the development of reinforced hand guards, but current gloves are still deemed insufficient to protect athletes from fractures [8,18]. As a result, there is an urgent need for additional improvements and advancements in protective equipment to prevent hand fractures, and athletes must master proper blocking techniques.
In terms of post-fracture treatment, heavyweight players were more likely to undergo surgery than lightweight players, whereas lightweight players were more likely to receive conservative treatment. The findings of this study suggest that heavyweight players' fractures may be more severe than those of lightweight players. As previously stated, heavyweight players generate more power due to their larger body size, which may result in more serious injuries, such as displaced fractures. Furthermore, despite a high risk of reinjury following fractures (57.2%), athletes tended to return to training without a medical diagnosis of bone union because prolonged absence could impair performance. In addition, only one-third of the participants in this study received specialized rehabilitation following their fracture injury. Given the high rate of fracture recurrence, Taekwondo sparring athletes should have an accurate bone union diagnosis and appropriate rehabilitation to reduce recurrence rates [1].
This study has the following limitations. First, data collected using retroactive memory methods may either underestimate or overestimate fractural injuries due to memory degradation. Second, we cannot rule out the possibility of sampling bias because the method used may not be representative of the population of interest. Third, Taekwondo sparring matches have eight weight classes for both men and women, but this study analyzed them by classifying lightweights and heavyweights. Future research should expand the analysis to include more cases and examine each detailed weight class individually. Furthermore, the current study findings should be confirmed in a well-designed prospective study. Despite its limitations, this study is clinically relevant because it is the first to examine weight-class-based fracture injuries that can result in long-term loss of time. Furthermore, the study findings may be useful in developing an injury prevention and management program tailored to each weight class.
CONCLUSION
In this study, we examined the fracturing experience of Korean Taekwondo sparring athletes and found that most fractures were caused by player contact mechanisms during hand-defense movements. In the study, we also showed that fracture events, fracture incidence, and post-fracture management differed by weight class. These research findings emphasize that Taekwondo sparring athletes need to acquire appropriate defensive techniques for preventing fractures in the hand region and underscore the importance of developing differentiated injury prevention and post-fracture management strategies tailored to each weight class.
ACKNOWLEDGMENTS
The experiments complied with the laws of the country where conducted. We thank all the Korean Taekwondo sparring athletes who participated in this study.
Notes
The authors declare that they do not have conflict of interest.
AUTHOR CONTRIBUTIONS
Conceptualization: M Song, S Yoo; Data curation: S Yoo; Formal analysis: M Song, S Yoo; Funding acquisition: M Song; Methodology: M Song, S Yoo; Project administration: M Song, S Yoo; Visualization: M Song; Writing - original draft: M Song, S Yoo; Writing - review & editing: M Song.