Exploring Injuries In Karate - A Review
Sport injuries usually limit training effects and often ruin athletes’ careers. The goal of this study was to review the results obtained in the studies on injuries in karate athletes.
Author:Suleman ShahReviewer:Han JuMar 07, 2024348 Shares8.6K Views
The results of most of the prospective studies have pointed out that injuries in karate, a combat sport, were mostly recorded in the area of head, face, and neck.
There are three groups of combat sports, depending on the actions permitted with fighting regulations:
a. Group 1 - using weapon as in:
- fencing (sword)
- kendo (Japanese bamboo sword called shinai)
- Historical European Martial Arts/HEMA (longswords, rapiers, and polearms)
b. Group 2 - using punches and/or kicks as in:
- boxing
- karate
- taekwondo
c. Group 3 - using throws, pinning techniques, strangulation, and joint manipulation techniques, such as:
- judo
- wrestling
- aikido
All the three types of motion actions can be also mixed in ju-jitsu.
Undoubtedly, practicing combat sports is risky.
Average rates (percentages of injured athletes of 36 Olympic sports) were similar in:
- male athletes (12.1%)
- female athletes (13.3%)
The rates of injuries in fencing were 13.1% and 5.6% in males and females, respectively.
Opposite patterns were observed in boxing, i.e., 7.3% and 19.4%, in males and females, respectively.
The injury risk (IR = #injuries/#athletes) was:
- the highest in males (51.6%) and females (26.6%) taekwondo (which can be regarded as a Korean variant of karate)
- medium in male (10.9%) and female (12.4%) judo athletes
Injury risk in wrestling was also medium, i.e., 10.5% in males and 13.2% in females.
Injury is a factor that causes trouble winning.
Similarly to taekwondo, boxing, judo, and wrestling, which are Olympic combat sports, the participants of karate competitions fight in these categories:
- gender
- age
- weight
Karate fighting is considered a high-intensity event.
Different karate styles are becoming more and more popular because training regimes are oriented at preparation for fighting during competitions.
World Karate Federation is the largest international governing body of this sport:
- with over 130 member countries
- has more than 10 million members
With this high number of karate practitioners, it seems very important to prevent injuries.
Like other sports, identification of the relationship between the causes and the effects of accidents is very important for the activities aimed at reduction in the injury risk.
It is suggested that in retrospective (R) epidemiological studies, analysis is carried out from the effect towards the cause. However, in prospective (P) studies, analysis is typically conducted from the cause towards the effect.
There have been the findings of the retrospective studies in institutions, providing insurance in hospitals and questionnaire studies among karate athletes, who provided information about injuries in a particular time.
It is essential to combine activities of:
- an observer of an injury mechanism (karate expert), and
- a person who diagnoses (medical doctor)
Doing so is especially important during prospective (P) studies.
The seriousness of the problem of injuries in karate has been supported by the publications, which presented:
- injury rates
- injury types and location
- injury mechanisms
This was the basis for formulation of prevention-related conclusions.
The goal of this study is to review the results obtained in the studies on injuries in karate athletes.
Materials And Methods
A comprehensive search was conducted in international databases of:
- Webof Science
- SPORTDiscus
- Academic Search Premier
- Google Scholar
- the U.S. National Library of Medicine’s MEDLINE
They were used to find the results matching the keywords:
- “karate”
- “injury”
- “retrospective”
- “prospective”
The analysis excluded the data concerning infrequent cases of injuries.
Finally, 20 peer-reviewed studies were qualified.
They described specific characteristics of injury, such as:
- rates
- types
- locations
- mechanism of injury
Number of injuries reported in different studies ranged from 12 cases to 7,431 cases.
Absolute and relative injury rates (IR) were evaluated in different groups of karatekas (a karate practitioner).
Relative injury risk (IRR) was adopted as a ratio of IR in the Group 1 to IR in the Group 2 used in epidemiology.
For the results of retrospective and prospective studies, the authors calculated IRR risk in consideration of:
- gender
- age
- sports skill level
Type, location, and mechanism of injury percentages were presented and compared.
Results
Injury Rate In Male And Female Karate Athletes
Various indices were used to identify the scale of injury rate in karate. Hence the results and their evaluation seemed to be ambiguous.
The findings obtained in the retrospective studies based on institutional documentation (RD) show that the injuries were most frequently observed in men (aged 16-32 years), chiefly during training, while the relative injury rate was 1.95 per 1000 participants per year.
In another study, absolute IR in training was also much higher than the rate of injuries occurring in competitions.
Here are some findings:
- A significantly higher IR was also observed in the group of males compared to females.
- The highest IR was found for the athletes aged 20-24 years (95%CI criterion).
- The youngest karateka in the RD record was nearly 14 months.
In retrospective studies based on questionnaires (RQ) among adult women, contributions of training vs. competition injuries were nearly fifty-fifty.
In another RQ study, in a club where sparring and competition were not the main training goal, IR in children (aged 6-16 years) was 3.7 injuries per 1,000 hours of karate training.
IR depended on the experience, training hours and rank rather than on age and gender.
IR during competition for young karatekas (aged 7-15 years) was considerably higher, i.e., 13.3-15.3 injuries/100 minutes of athletic exposure (AE), whereas IRvalue in girls was higher than in boys.
Among the prospective studies that investigated injury rate during karate competitions, the most popular measure was IR expressed per 1,000 AE.
The value of #injury/1000 AE in male tournaments ranged from 22.2/1000 AE to 194.0/1000 AE.
In female athletes, IR was from 66.2/1000 AE to 143.2/1000 AE.
The results of observation of karate tournaments recorded by the same authors of prospective studies provided information about the effect of different factors on the level of IR which was not fully consistent.
As a result of application of protective gear in male competition, a four-time reduction in IR was demonstrated (per 100 karate matches).
Other observations did not confirm the optimistic prognosis that resulted from these studies.
When knuckle padding was used in male tournaments, the IRR was similar as without this type of protective gear.
In an international Oyama’s Cup (Kyokushin full-contact style), despite the obligatory use of the protective gear (foot and shin), IR was higher (194.0/1000AE) compared to the national-level tournaments where this gear was not used (148.6/1000 AE), with IRR being 1.3118.
Elevated IR (192.6/1000 AE) was also observed in the members of the male national team that competed in the selection tournaments in the lead up to Asian Karate Championships 2012.
The high sport rank of the Oyama’s Cup might have affected the increase in IRR with respect to the national-level competition.
Adult males were characterized usually by higher IR compared to women that presented the same competitive level.
A decline in IR during world championships organized by the World Karate Federation as a result of changes in fighting regulations was observed.
Consequently, IRR (post-value in relation to pre-value) was 0.64 and 0.46 in males and females, respectively.
In another study, before using protective gear, IR in males was slightly different than IR in females, with IRR that reached 1.05. Using protective gear caused a higher IR in female than male athletes (IRR=0.81).
However, employing an original and more precise index (#injuries/100 minutes AE) showed that IR was lower in male athletes (0.83).
With protective gear, IRR (males to females relation) decreased to 0.73.
In the age category under 18 years in general, the competitors fought significantly safer after the changes in rules had been implemented (IRR = 1.55; pre-IR to post-IR’s relation).
Changes in rules caused a significant reduction in IR during male and female tournaments, which, however, did not affect the frequency of moderate and severe injuries.
Injury Types
Distribution of the frequency of typical injuries depended on the study design.
Percentage comparison of the injury types showed much more frequent fractures observed in RD studies, i.e., from 16.9% to 71.4%.
However, the contribution of sprains and strains ranged from 11.9% to 44.7%.
They were also in contrast to the rate of contusion (from 0.0% to 35.1%) and luxation (from 0.0% to 25.4%).
It was found in RD studies that 17.9% of the patients necessitated hospitalization that took from 2 to 21 days.
In 60.0% of the people, bodily injuries were evaluated (according to Polish regulations) as 1%-9%, whereas in 20%, the medical board evaluated injuries as 10%-15%.
Twenty percent of the injured karatekas were evaluated as returned to entirely healthy status.
The documentation analyzed in RD studies confirmed the fact that it is severe injuries which are reported to hospitals and insurance institutions.
The RQ studies did not find concussions, which were rather rare in RD and prospective studies of karate practitioners. In RQ studies, diagnoses might have been inaccurate since they originated from the injured people rather than from competent doctors.
Prospective studies recorded a higher variety in the classification of sustained injuries than retrospective studies. In prospective studies, the vast majority of injuries were contusions, except for the studies where authors were focused on severe injuries.
The most frequent among time-loss injuries were fractures (58.3%) and, also frequent, concussions (8.3%).
Moderate and severe injuries contribution was only 12.9% of all 497 injuries recorded among elite competitors. In the area of head injuries (n = 64), the highest percentage was found for:
- fractures (31.3%)
- concussions (28.1%)
Frequency of typical injuries depended on the tactical situation, for example, contusions were more frequent in the attacking (81.1%) compared to the attacked athlete (48.7%).
The specific injuries, which occurred exclusively in the attacked athletes included:
- concussion (9.3%)
- wind knocked out (9.3%)
Injury Location
Karate injuries reported in RD studies concerned mainly head, face, and neck as well as upper and lower limbs.
In RQ studies, the percentage of head, face, and neck injuries ranged from 5% in children to 32.4% in adults.
Adult men were more often injured in the head, face, and neck compared to women (32.4% vs. 9.2%), among which the most frequent were lower limbs injuries (28.5% vs. 53.7%).
In prospective studies, head, face and neck injuries accounted for 22.9% to 92%.
Contribution of injuries of trunk, upper limbs, and lower limbs ranged from:
- 4% to 31.8%,
- 10.1% to 17.2%; and
- 3.4% to 55.2%, respectively
During the Oyama Cup, where protective gear for feet and shin, the contribution of injuries in the head, face, neck, and trunk was increased compared to the injuries reported in the national-level competition where protective gear was not used.
Similar patterns were observed in a Danish research, but they concerned an increase in the frequency of head, face, and neck injuries.
During karate tournaments, both for women and men, predominant injuries were head, face, and neck injuries (55.4% vs. 57.9%).
Moreover, 15-year-old girl and boy karate athletes had also considerable risk of head injury, i.e., 43.8% vs. 52.6%, respectively.
Causes And Mechanisms Of Karate Injuries
The circumstances in which injuries occurred were frequently identified as:
- punches
- kicks
- blocks
- falling on the ground
In general, it can be concluded that the impact that exceeded tissue strength led to body damage among karatekas.
The most frequent mechanism in RD studies was the impact that occurred during:
a. kicks (33.3%) in the head as well as kicks in the:
- lower limb
- groin
- stomach
- punchbag
b. falling on the ground (25.6%)
c. hitting with the upper extremity (20.5%) against:
- the head
- the upper limb
- a wall
- a board
Mechanism of the injury during kicking was formed through:
- being kicked (26.9%)
- falling (20.8%)
- kicking (18.0%)
In another study, the cause of the body injuries in karatekas were:
- kick/foot strike (38.0%)
- fall/throw/jump (26.0%)
- block (9.0%)
- weapon (5.0%)
- others(12%)
In RQ studies, the most frequent injury mechanism occurred with kicks (47.0%) and punches (43.2%), whereas it was observed less often for falling on the ground (9.8%).
The predominant causes of injuries in prospective studies were punches (from 48.4% to 82.7%).
Therefore, kicks were less frequently recognized as an injury mechanism, i.e., from 7.3% to 29.2%.
Some authors reported injuries during blocking the attack with the frequency of 5.1% to 18.8%.
Death Cases
Death cases should be analyzed if they are typical of a particular sport or, if not, when they occurred during competition or athletic training.
In Japan, only one death case was reported. It occurred as a result of a karate punch at the Ritsumeikan University.
Three deaths were reported in the U.S. as a result of blunt injury of the chest.
First Case
The first death occurred during taekwondo fighting caused by a kick performed by a coach to the lateral part of the chest, the doctors found:
- rib fracture (5th rib on the left)
- pulmonary edema
- congestion
- hepatic exudate
The suffocation was caused by the ingested matter sucked into the trachea.
Second Case
In the second case, a Kempo practitioner received a series of punches on the chest during his tournament fight.
It was in the late evening when he was taken to the hospital because of the serious pain and vomiting, and the doctors diagnosed:
- ruptured spleen
- infectious mononucleosis
The latter illness might have caused the spleen edema, making it extremely susceptible to injuries.
The patient died one hour after a surgical intervention.
Third Case
The third case occurred during the fight with an advanced fighter. The patient received a light roundhouse kick into the solar plexus.
Although resuscitation was performed in the ambulance, the death was recorded after the arrival to the hospital.
Stimulation of the vagus nerve, which caused cardiac dysrhythmia, eventually led to cardiac arrest and was found to be the cause of the death.
The doctors found:
- the effusion to the soft tissue surrounding the vagus nerve
- numerous petechiae in the liver
- numerous hematomas in the lung lobes
- emphysema of both lungs
All the three cases concerned young men with training experience below one year.
In Poland, a death accident was reported for a 17-year-old participant of a training unit.
He had one-year training experience and a low level of advancement in Kyokushin karate (8th kyu).
Practice fights were performed during the training session under supervision of a coach and according to the regulations, which exclude attack to the face.
The students were wearing boxing helmets and shin guards.
When choosing the partners, the coaches divided students according to their age and body height. At the end of the classes, the patient was fighting with an opponent aged 18 years, with training experience of over two years and 6th kyu rank.
The dangerous accident took place when this person was in the corner of the fighting field and moved to the right, turning a little backward to the movement direction.
At this moment, he received a roundhouse kick to the back of the head.
After making a few steps, he staggered but was supported. Then, he lost consciousness for 3 minutes.
After the doctor arrived, he was immediately transferred to the local hospital, where he was diagnosed with:
- head contusion
- concussion
RTG images did not show changes.
The opinion of the surgeon after opening the skull was that:
- the thickness of occipital bone was 3-4 millimeters
- the muscles of the nape were too weak with respect to the age and overall body build
This might have been conducive to craniocerebral trauma.
The patient died on the 5th day after the accident. Its cause was:
- contusion
- cerebellar tear
Physical modifications after head injuries caused by accelerations usually result in:
- elastic deformation of the skull
- rapid acceleration of the head motion
- relative motion of the brain, with respect to the skull bones
A specific characteristic of the above accidents was that they occurred during the fight and concerned beginner karatekas.
The ability to control the fight remains the basic criterion of the exams for individual ranks.
Discussion
The authors have referenced some of their own studies in this review.
These referenced studies have been conducted in accordance with the Declaration of Helsinki (1964) and the protocols of these studies have been approved by the relevant ethics committees related to the institution in which they were performed.
All human subjects, in these referenced studies, gave informed consent to participate in these studies.
In karate, the attacked targets are termed with Japanese word kyusho, which means the places in the human body, where a punch might cause:
- disturbances in function of organs important to health
- loss of consciousness
- death
Knowing these places is of much importance in martial arts.
The frequency of attacks to the vital points in the opponent’s body depended on the fighting regulations.
During the World Open Karate Tournament in Tokyo (full-contact Kyokushin style), kicks represented the principal method of attack (83% of all the techniques that scored points), whereas punches were predominant during the World Championships in Madrid, Spain and Monterrey, Mexico (93.7%).
Severe injuries have been documented primarily in RD studies, where the principal way for determination of IR was the number of injuries with respect to the number of participants.
In prospective studies, IR was understood to mean number of injuries:
- per 100 participants
- per 100 fights
- per 1,000 AE
- per 100 minutes of fighting
Also, in other prospective studies, the authors used the original IR index, with the divisor represented by the number of attacks. IR was:
- 6.3 injuries per 1,000 kicks
- 2.2 injuries per 1,000 punches
The previously postulated prevention activities concerned prevention by control of kicks and strikes, prevention by protective clothing and pre-fight medical examination.
Changes in fighting regulations have produced a positive effect of a reduction in the number of minor injuries.
The striking fact in this review of the results of epidemiological research studies was the young age of the injured people (e.g., 14 months, 6 years, 7-15 years).
In the contemporary opinion of doctors, the minimum age for participation in karate should be older than 14 years.
Conclusion
In karate, injuries are impossible to be entirely eliminated as the impact that exceeds tissue mechanical strength has not been excluded as the main cause of severe injuries yet.
Two important points to remember:
a. Since the target of the attack in karate is vital points in the opponent’s body, modifications of fighting regulations carried out by sports federations can be only partially effective in reduction of the injury risk.
b. Among children, formal exercise (kata) and pre-arranged sparring might represent a safe alternative for karate fights.
It is important to investigate the factors that reduce injuries in karate.
Suleman Shah
Author
Suleman Shah is a researcher and freelance writer. As a researcher, he has worked with MNS University of Agriculture, Multan (Pakistan) and Texas A & M University (USA). He regularly writes science articles and blogs for science news website immersse.com and open access publishers OA Publishing London and Scientific Times. He loves to keep himself updated on scientific developments and convert these developments into everyday language to update the readers about the developments in the scientific era. His primary research focus is Plant sciences, and he contributed to this field by publishing his research in scientific journals and presenting his work at many Conferences.
Shah graduated from the University of Agriculture Faisalabad (Pakistan) and started his professional carrier with Jaffer Agro Services and later with the Agriculture Department of the Government of Pakistan. His research interest compelled and attracted him to proceed with his carrier in Plant sciences research. So, he started his Ph.D. in Soil Science at MNS University of Agriculture Multan (Pakistan). Later, he started working as a visiting scholar with Texas A&M University (USA).
Shah’s experience with big Open Excess publishers like Springers, Frontiers, MDPI, etc., testified to his belief in Open Access as a barrier-removing mechanism between researchers and the readers of their research. Shah believes that Open Access is revolutionizing the publication process and benefitting research in all fields.
Han Ju
Reviewer
Hello! I'm Han Ju, the heart behind World Wide Journals. My life is a unique tapestry woven from the threads of news, spirituality, and science, enriched by melodies from my guitar. Raised amidst tales of the ancient and the arcane, I developed a keen eye for the stories that truly matter. Through my work, I seek to bridge the seen with the unseen, marrying the rigor of science with the depth of spirituality.
Each article at World Wide Journals is a piece of this ongoing quest, blending analysis with personal reflection. Whether exploring quantum frontiers or strumming chords under the stars, my aim is to inspire and provoke thought, inviting you into a world where every discovery is a note in the grand symphony of existence.
Welcome aboard this journey of insight and exploration, where curiosity leads and music guides.
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