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martial arts

Martial arts injury overview

The Sports Injury Doctor

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Martial arts in their various forms have been practised for centuries. One of the first sports in the ancient Olympics was a Greek martial art called pankration. Each region of the world has its own martial art, with its own ethos and principal goal, many developed and refined over centuries of dedicated practice and evolving belief. For example, tae kwon do mainly uses kicks and standing techniques; judo relies on throws and chokes, jujitsu focuses on grappling and forcing the opponent into submission with painful arm and leg locks, while the fastgrowing form of ‘mixed martial arts’ borrows techniques from all forms and has very few rules.

All martial arts are physically demanding and hazardous. Injuries are seen throughout the spectrum of expertise. Amateur participants are the most likely to sustain sprains and soft-tissue injuries in karate, mixed martial arts and Thai kick boxing; among professional fighters the main risks are fractures and lifethreatening injuries.(2,4,9,11)

With mainstream TV coverage of many tournaments these days, all forms of martial arts are growing in popularity. Sponsorship and higher public exposure drive up the competitive stakes and the levels of aggression seen in tournaments. This will probably result in more injuries at all levels, so sports injury practitioners need to be aware of the vast array of injuries that can occur in all the martial arts, with research reports ranging from minor sprains to life-threatening – and not always apparent – injuries.

Larger series of injury rates are starting to appear in the literature and there are numerous case reports of individual injuries; but the spectrum and severity of injuries is similar across the board, with certain emphases in the different sports correlating to the emphasis of their fighting discipline, such as karate practitioners being more prone to hand injuries, judo to joint dislocations and mixed martial arts to cervical spine injuries.

Injury overview

Mild – This is the largest category, predominantly soft-tissue in nature, ranging from contusions and lacerations to sprains to all joints. Legs and cervical spine are at particular risk.(5,10) In tae kwon do, research has reported rates of 21 incidents of injury per 1,000 athlete exposures, with a higher rate among men than women(9).

Moderate – These include fractures, dislocations, tendon ruptures and neuropraxias (disruption to nerves). Karate participants are at particular risk of hand and foot fractures, with the phalanges being most vulnerable. Judo, mixed martial arts and Thai kick boxing all have reported cases of fractures to long bones, pelvis, radial head and ankle.(2-4,9-11)

Dislocations can occur in any joint, but the most common across the different martial arts are in the shoulder, fingers and toes. Knee dislocations are rare but have been reported(10).

Karate Kid finger – this is a recognised phenomenon in the little finger of karate participants. The ulnar dorsal digital nerve of the little finger is vulnerable to contusion when the hand performs karate chops. Fibrosis within the nerve sheaths and between the fibres may result. and requires surgical intervention. This injury can be the result of overuse or poor technique so it should be borne in mind where participants complain of pain and paraesthesia (abnormal skin sensations, nerve tingling etc) along the ulnar border of the little finger and hand.

Severe – The potential for life-threatening injuries in all forms of martial arts is enormous. If you suspect this type of injury, the fighter should be prevented from continuing in the tournament and taken to the nearest A&E department.

Any martial art using kicks, punches and falls on to the opponent can produce thoracic trauma: rib fractures, bleeding or air escape into the chest.(4,11)

Similarly, all organs within the abdominal cavity are at risk of trauma, with liver, spleen and kidneys most vulnerable. There are also case reports of renal vein thrombosis, testicular injury and iliopsoas haematoma(1).

Head injuries are a substantial risk. In one study, for instance, 57% of participants in tae kwon do had experienced some form of head injury. This could range from mild concussion to intracranial bleeds. Case reports of internal carotid artery dissection, stroke, aphasia (loss of speech from brain lesion), hemiplegia and ophthalmic trauma resulting in loss of vision, appear frequently in the literature of the past ten years(4,6-9).

A survey of four mixed martial arts tournaments over a four-month period revealed 103 episodes of cervical neck injury in 427 respondents. Five cases required hospitalisation and resulted in neurological deficit.

The researchers found that the motion and forces applied to the cervical spine were characteristic of whiplash produced by vehicle impacts. The risk of cervical neck injury, from mild whiplash to quadriplegia is high in all forms of martial arts, caused by situations such as hyper-flexion of the cervical spine on landing on the mat; or lateral flexion of the cervical spine and forced shoulder depression, resulting in a traction injury to the brachial plexus and soft-tissue injury to the paraspinal muscles.

If a regular martial arts participant complains of generalised, inexplicable arm pain, it should be taken seriously as a possible presentation of Paget-Schroetter syndrome(12). This condition, also known as ‘effort thrombosis’, occurs in athletes who undertake repetitive arm movements. The pressure of the repeated action can cause blood clots in the auxiliary veins under the clavicle, producing thrombosis, pulmonary hypertension and pulmonary embolism.

It is hard to diagnose this serious condition as symptoms may be few and generalised until a pulmonary embolism has occurred, and those affected tend to be young and otherwise healthy.

There may be signs of venous obstruction such as pain, swelling and bluish discoloration. If suspected, the fighter needs urgent hospital attention for clot-busting treatment – and this is likely to end their athletic career. The risk of recurrence is not known.

Prevention

The ethos of most martial arts is combat. To many participants the introduction of safety measures, such as mouth guards, head protection and gloves is the antithesis of the sport. While children’s and adolescents’ tournaments may use protective equipment, it is unlikely for adults.

Inexperienced particpants will often get injured because of their lack of technique, flexibility or general conditioning. They should be taught muscle stretching and sterngthening exercises from the start of their martial arts career and should be advised to continue these protective regimes throughout all levels of combat.

The role of the support professional at a tournament

Because of the violent and aggressive nature of martial arts, if you are in attendance at a tournament, you can expect to be busy throughout the day. Most of your work will be dealing with soft-tissue injuries, fractures and dislocations. However, major injuries do occur and, as noted above, may not always be apparent on first assessment.

Thorough preparation is essential and you should ensure that you have adequate facilities to cope with life and limb-threatening injuries. You will need a sound knowledge of the principles of trauma resuscitation, cervical spine immobilisation and splinting of injured limbs. Above all, do not underestimate the severity of the injuries that you are being asked to assess.

References

  1. Berkovich GY, Ramchandani P, Preate DL Jr, Rovner ES, Shapiro MB, Banner MP. ‘Renal vein thrombosis after martial arts trauma.’ J Trauma. 2001 Jan;50(1):144-5.
  2. Burks JB, Satterfield K. ‘Foot and ankle injuries among martial artists. Results of a survey.’ J Am Podiatr Med Assoc. 1998 Jun;88(6):268-78.
  3. Deshmukh NV, Shah MS. ‘Bilateral radial head fractures in a martial arts athlete.’ Br J Sports Med. 2003 Jun;37(3):270-1; discussion 271.
  4. Gartland S, Malik MH, Lovell ME. ‘Injury and injury rates in Muay Thai kick boxing.’ Br J Sports Med. 2001 Oct;35(5):308-13.
  5. Kochhar T, Back DL, Mann B, Skinner J. ‘The risk of cervical injuries in mixed martial arts.’ Awaiting publication, Br J Sports Med.
  6. McCarron MO, Patterson J, Duncan R. ‘Stroke without dissection from a neck holding manoeuvre in martial arts.’ Br J Sports Med. 1997 Dec; 31(4):346-7.
  7. Meairs S, Timpe L, Beyer J, Hennerici M. ‘Acute aphasia and hemiplegia during karate training.’ Lancet. 2000 Jul 1;356(9223):40.
  8. Pieter W, Zemper ED. ;Incidence of reported cerebral concussion in adult taekwondo athletes.’ J R Soc Health. 1998 Oct;118(5):272-9.
  9. Pieter W, Zemper ED. ‘Head and neck injuries in young taekwondo athletes.’ J Sports Med Phys Fitness. 1999 Jun;39(2):147-53.
  10. Viswanath YK, Rogers IM ‘A noncontact complete knee dislocation with popliteal artery disruption, a rare martial arts injury.’ Postgrad Med J. 1999 Sep;75(887):552-3.
  11. Zazryn TR, Finch CF, McCrory P. ‘A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia.’ Br J Sports Med. 2003;37(5):448-51.
  12. Zell L, Scheffler P, Marschall F, Buchter A. ‘Paget-Schroetter syndrome caused by wrestling’ Sportverletz Sportschaden. 2000 Mar;14(1):31-4.

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