Karate injuries in children and adolescents
Introduction
Participation in martial arts has increased dramatically since the mid 1980s (Oler et al., 1991, Pieter and Lufting, 1994) with approximately 1.5–2 million Americans involved, according to Oler et al. (1991). Jaffe and Minkoff (1988) estimate that 20% of these participants are children; however, little research has been conducted to assess the risk of injury in this younger population. The goal of this study was to determine the risk of injury to children and adolescents training in one type of martial art, Uechi–Ryu karate. Critchley et al. (1999) states that karate is one of the most popular martial arts. According to Corcoran and Farkus (1993), Uechi–Ryu is a traditional Okinawan karate style which involves the practice of basic techniques, kata (predetermined combinations of techniques), sparring and body toughening exercises. Students (karateka) train in bare feet on a wooden floor. The uniform (gi) consists of a canvas jacket and pants. Uechi–Ryu is considered a non-contact martial art; therefore, no protective gear is worn. Even within Uechi–Ryu there are a variety of training styles.
Many parents see martial arts as a form of physical activity and discipline for their children, as well as a tool for self-defense. Violan et al. (1997) demonstrated that karate improves balance, flexibility and strength among boys aged 8–13 years. It also develops qualities such as respect, discipline, concentration, patience and self-confidence in the young karateka. Research by Daniels and Thornton, 1990, Daniels and Thornton, 1992 showed that training in martial arts decreases hostility. Layton (1993), who tested reaction time and movement time among black-belts in karate, suggests that karate training may retard the normal deterioration in motor skills that occurs with aging.
McLatchie and Morris (1977) and Oler et al. (1991) have questioned the safety of martial arts, particularly at the tournament level. In many martial arts, tournaments comprise only a fraction of the total time spent training and frequently students do not participate in tournaments at all. On the other hand, a 5-year national survey by Birrer and Halbrook (1988) concluded that the martial arts are safe, with the majority of injuries involving the extremities and being minor in nature. That study examined all martial arts as a group, including those which use weapons.
No published studies have evaluated and reported on the safety of martial arts for children, even though the number of children and adolescents who participate in these activities continues to grow. The purposes of this study were to identify risk factors for injury, to compare the risk of injury from karate with other children’s sports in this age group and to establish injury reduction strategies.
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Subjects
A comprehensive survey of karate-related injuries was completed on 68 students from the Peter McRae Karate School in Plymouth, MA. The school studied does not stress free-sparring (fighting without predetermined techniques) and does not participate in tournaments. All subjects were taught by one instructor, with each session lasting 1 h. Classes began with a 10 min warm-up, primarily stretching, starting with the feet and progressing upwards to the neck. Fifteen minutes were then spent on basic
Statistical analysis
Multivariate logistic regression analysis was conducted to identify risk factors for the presence or absence of injury, with the likelihood ratio χ2 test used to assess the significance of each predictor (Hosmer and Lemeshow, 1989). Odds ratios were computed for each risk factor by exponentiating the regression coefficient and 95% confidence intervals (CI) were constructed using the method described by Schlesselman (1982). A two-tailed P<0.05 was considered statistically significant. Data
Results
A total of 68 questionnaires were completed, 57 by males (84%) and 11 by females (16%). There were 104 students under 17 years of age registered at the club; however not all of the students were training at the time of the survey. Of the students not training regularly at the time of the study, according to the school’s instructor, none had sustained any injuries which might have precluded participation in karate. Those involved in the study were therefore representative of the total membership
Discussion
The most clinically interesting finding of this study is that of the 68 young karateka, none sustained a significant injury in the course of training. A significant injury (major or moderate) as defined by Fetto (1994) referred to any injury that required more than 24 h off training. The vast majority of injuries were minor bruises, likely related to the practice of body toughening. This is an exercise designed to toughen the shins and forearms through rubbing. Only one child (13 year old male)
Conclusions
Children may benefit from participating in martial arts. These benefits include discipline, mental concentration, physical conditioning and fun. There is considerable variability among martial arts styles, as well as differences in teaching philosophies within any given style. This study has focused on only one style; therefore, caution must be exercised in extrapolating the findings to all martial arts. Full contact martial arts, such as Taekwondo (Korean karate), may have very different
Acknowledgements
The authors gratefully acknowledge the young karate students of the Peter McRae Karate School in Plymouth, MA. A special thanks to Peter McRae for his enthusiasm and help in collecting the data. The authors also wish to thank the Children’s Hospital Foundation Sports Legacy Fund, Winnipeg, Manitoba, whose support has facilitated continued work on this project.
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