Wrestling is a contact sporting event that matches two competitors against each other physically and mentally. The origins of the sport date back to ancient Greek and Roman times near 500 B.C.

There are approximately 400,000 wrestlers of all ages in the United States. As the sport has grown in popularity and participation has increased, it has been noted that there are injuries and conditions that are unique to the sport.

Takedown: Points given to a wrestler when advantage is gained from a neutral position on feet. This may be achieved by a trip or throw. Dependent on the style of wrestling, higher point values may be given for the more skillful maneuver to achieve the takedown (3).

Fall: Also known as a pin. Determined by the referee when both shoulders are held to the mat for 1 second. The match is over at this time (3).

Time advantage: This is popularly called riding time. Time of control is recorded for both wrestlers and compared. A point is given to the wrestlers if their time is 1 or more minutes greater than their opponent’s (6).

Sparring: An activity participated in when both of the competitors are in a neutral position on their feet. Usually comprises grappling and blocking in an attempt to achieve a takedown (3).

Leg wrestling: Term used to describe the use of legs while on the mat to attempt to control an opponent (3).

Injury timeout: Amount of time allowed to a wrestler to attempt to recover from an illness or injury. The time allotted is a maximum of 90 seconds throughout the match. Additionally, a competitor may have two timeouts during the match to tend to injuries as long as 90 seconds of total time is not taken (6).

Bleeding timeout: Time allowed for the evaluation of a bleeding injury. This is different from an injury timeout. The amount of time is at the referee’s discretion. Generally, blood timeout has no time limit, but an excessive bleeding injury may be cause for disqualification as determined by the referee and trainer or physician (6).

Greco-Roman: A style that was developed and popularized in Europe. Upper body throws are executed with the goal to touch the opponent’s shoulders to the mat simultaneously. Points are awarded for skill of throws. At no time are the wrestlers allowed to use their own legs to gain advantage or contact their opponent’s legs (3).

Freestyle: Used worldwide and in international wrestling meets. A style of wrestling that combines the use of the upper body and legs to execute maneuvers. Points are awarded for exposure of opponent’s back to the mat, takedowns, and reversals. Execution of a more difficult takedown with emphasis on exposure of opponent’s back to the mat will increase points awarded. The main objective is to pin the opponent’s shoulders to the mat for a 1-second count (3).

High school/collegiate: The style of wrestling that is used in the United States. Considered similar to freestyle because of the use of upper body and legs. A major difference is that points are awarded for time advantage. Also, a wrestler must ensure the safe return of their opponent to the mat after a throw or a takedown. Emphasis is placed on pinning the opponent (3).

Recent National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) data conclude that collegiate wrestling has a relatively high rate of injury at 24.3 per 1,000 athlete exposures for competition and 9.7 per 1,000 athlete exposures for practice, second only to football (7,8). The incidence of injury seems to be highest at the beginning of the season, compared with the latter part of the season. Although injuries are common, there seems to be a consensus that most injuries are not serious on the basis of time lost (> 7 days) or injuries that require surgery. Comparison of the different weight classes has yielded no statistical difference in injury percentages (2).

The knee is the most commonly injured body part in both practice and competition, followed by the shoulder and ankle. The face and neck are the least injured. Sprain is the most common type of injury in practice and competition, with fracture being the least common (2).

Most injuries occur during takedowns and sparring (2).

Contact with the opponent, as compared to contact with the mat, was the most common mechanism of injury (2).

A direct blow from the mat or body contact may result in a laceration or contusion during a takedown or sparring. Potential serious injury may occur after a fall, especially if a competitor lands on an opponent after attempting a throw or other types of takedowns (3).

A friction injury may result in lacerations or abrasions. This can occur with continuous body contact or contact with the mat. This may later result in skin infections or bursitis (3).

Sprains and strains may occur after a wrestler uses twisting or leverage maneuvers to gain advantage over an opponent (3).

A competitor may also incur injury to his or her own person while attempting maneuvers (3).

An often overlooked potential mechanism is overuse injuries (3).

Concussions occur with direct contact with a body part or contact with the mat or floor (3). (See Chapter 43.)

Concussions may occur without loss of consciousness. It is important to evaluate the athlete for any change in behavior or thinking or for physical signs and symptoms (6).

The competitor should be removed from play, evaluated by a trained medical professional who has experience in concussions, and returned to play dependent on the institution’s concussion management protocol (6).

Lacerations and contusion occur frequently from direct blows from the mat and body parts, such as the head, elbow, and knee. The most common areas are the bony areas around the orbits, zygoma, and scalp. Soft tissues around the mouth and ears are also potential sites. During the match, an injury timeout will be called to evaluate the area. Treatment during the injury timeout may include using Steri-strips to provide temporary closure of the wound. Dressing the wound may also be required at this time. The match can continue as deemed by the referee depending on the severity of the injury. After the match, lacerations should be cleaned and dressed properly. Closure of wounds with heavy nylon suture is recommended if necessary (3).

Epistaxis may occur with a direct blow from an opponent or the mat. Blood timeout will be taken to determine the extent of the injury. Direct pressure and ice may be applied to the nares to reduce the hemorrhage. A pledget or nose plug may be inserted to enable the wrestler to continue the match. Nosebleed QR is a recently developed product that can be inserted into the nose with a swab (9

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