Martial Arts
Leonard A. Wilkerson
The term martial arts means those arts concerned with the waging of war, but in the twenty-first century, martial arts no longer have a military role. Many feel that the study of the martial arts develops character, patience, or higher moral standards. As a result of this change, the martial arts came to mean “the way.” An estimated 1.5 to 2 million Americans (of whom 20% are children) participate in the martial arts with an estimated male to female ratio of 5:1 (1). With such a wide cross-section of Americans participating in an activity about which little is known of the involved physical forces, little thought is given to potential morbidity and mortality. Information generated from a nationwide computer surveillance of emergency departments and surveys mailed to martial arts instructors showed that no deaths and no serious weapon injuries were reported (1). From this information the assertion is made that “all forms of the martial arts are safe.” A review of some of the injuries sustained in practicing the martial arts will find that this information may not necessarily be accurate.
THE SPORT
The two most common martial arts practiced in America are karate (meaning the way of the empty hand), and Tae Kwon Do (Korean, meaning foot, hand, way). Tae Kwon Do became an official Olympic sport in the year 2000. Other martial arts are aikido (the way of harmony), Jiujitsu (compliance techniques), judo (compliant way), and kung fu (skill or art, a form of Chinese self-defense art, like karate). Hapkido is a Korean martial art very similar to aikido (Japanese) that includes kicks and hand strikes.
The study of Tai Chi Chuan is unique in the sense that it marks the historical meeting of many centuries of Taoist study known as Chi Kung (excellence of energy), which was primarily dedicated to physical health and spiritual growth, with the need of the time (approximately 1000 A.D.) for monks to defend themselves against bandits and warlords. The result was, and is, an unusual blend of the healing, martial, and meditative arts, which has been referred to as the internal practice of Tai Chi Chuan.
To understand better the injury trends in Tae Kwon Do tournaments, consider that each round is a 2-minute round. The fighter might fight a new opponent in a single or double elimination, or he or she might fight three 2-minute rounds in a single elimination. In karate, it is usually 3-minute rounds, and like Tae Kwon Do, can be either single elimination, or three 3-minute rounds. In both tournaments kicks to the head are allowed, as well as to the trunk, but not to the back. Punches to the head are prohibited in Tae Kwon Do, although in some karate tournaments, contact to the head with the hands is allowed, but it is supposed to be controlled. Tournaments are otherwise full contact to the body.
Equipment use varies among the different disciplines and tournaments. In Tae Kwon Do, chest protectors are worn, shin and full-arm pads, foot pads, and a groin guard, as well as a head protector. Optional is a mouthguard and hand covers, except at the international level where mouth protection is compulsory. Conversely, in karate, there usually is no chest protector, but shin and forearm pads are worn. Optional are foot pads, and a groin protector is
worn. In some tournaments gloves are prohibited. It has been found that wearing protective gear decreases morbidity. Protective gear is available for the forearms, hands, chest, shins, and feet. The athlete is strongly encouraged to wear a mouthpiece and groin protector, and in Tae Kwon Do head protection is worn, which is discussed later in the chapter.
worn. In some tournaments gloves are prohibited. It has been found that wearing protective gear decreases morbidity. Protective gear is available for the forearms, hands, chest, shins, and feet. The athlete is strongly encouraged to wear a mouthpiece and groin protector, and in Tae Kwon Do head protection is worn, which is discussed later in the chapter.
TABLE 35.1. INJURY RATE PER 100,000 PARTICIPANTS IN VARIOUS SPORTS | ||||||||||||||||||||
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INJURIES
Incidence of injury is higher in the tournament situation. The injury rate per 100,000 participants in various sports is noted in Table 35.1 (2). McLatchie and co-workers reported that some form of injury occurs once in every contest (2), with incapacitating injury severe enough to cause withdrawal from competition once in every ten contests (3). Birrer and Birrer surveyed 6,347 athletes, finding that 59% of injuries were sustained in tournament, as opposed to 41% in nontournament, settings (4,7). They also found that the injury rate and experience were inversely related (4,7). Stricevic et al. confirmed this and also reported that punches have a higher injury rate than kicks, and that protective gear for hands, head, chest, and limbs decreased the morbidity (6).
Injuries are classified into three groups: (1) injuries to the head and face, (2) injuries to the trunk, and (3) injuries to the limbs. In all studies, the most common injuries were contusions, bruises, sprains, and strains (1,2,4,7,8,9,10). Orthopedic injuries result from direct impact, repetitive action, or ballistic and torsional maneuvers. Serious injuries seen are concussions, paralysis, and visceral rupture (6). Table 35.2 is a summary of the injuries by anatomic site reported as percentages from two Tae Kwon Do tournaments.
Zetaruk et al. looked at karate injuries for the 1995-1996 season and found that risk of injury increased with the number of years of training per week and rank, specifically brown belts versus lower belts (11,12). Critchley et al. reported that in 1,770 bouts in three national competitions in 1996, 1997, and 1998, in which light or touch contact was allowed and protective padding for the head, hands, or feet was prohibited, 160 injuries were recorded (12). The overall rate of injury was 0.09 per bout and
0.13 per competitor; 91 injuries (57%) were recorded. They feel that the absence of protective padding does not result in a higher injury rate, but do state that strict refereeing is essential to maintain control and minimize contact.
0.13 per competitor; 91 injuries (57%) were recorded. They feel that the absence of protective padding does not result in a higher injury rate, but do state that strict refereeing is essential to maintain control and minimize contact.
TABLE 35.2. SUMMARY OF INJURIES AT TWO TAE KWON DO TOURNAMENTS BY ANATOMIC SITE
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