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Faculty of Sport and Physical Education, University of Nis, Serbia

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In terms of judo science and practice, injury could be defined as

“damage that affects a part of the body and results in an inability to practice or compete normally”. Injury risk in elite judo athletes is average when compared to the other Olympic sports. However, concerning time loss injuries, judo is ranked second among combat sports at the previous two Olympic Games. Regarding the body region, injuries occur mostly in the upper and lower extremities, with the highest percentage of shoulder and hand/finger injuries in the upper, and knee injuries in the lower extremities. Head and neck injuries have a low incidence in judo compared to lower and upper limb injuries. Despite the low number of occurrences, these are potentially the most harmful injuries. Injury prevalence in judo, through review of published data, indicates that it is necessary to establish a long-term injury surveillance system in order to minimize injury incidence and time loss injuries. Knowledge about injury risk, severity, localization, type, and mechanism of injuries during training and competition is the first step towards adequate injury prevention and specific educational and preventive measures. Moreover, technical development, rule change, change in technique and tactics, and improvement of sports equipment can decrease potential injury risk.

* Corresponding author E-mail: [email protected].

Keywords: injury, injury risk, time loss injuries, injury prevention

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Injury is commonly defined as “hurt, damage or loss sustained” [1]. In sports there is a lack of consensus about injury definition and injury grade, so it was not possible to adopt a standardized definition [2]. The main doubt is whether injury includes any request for medical assistance or those situations that result in withdrawal from training or competition. From our point of view the most suitable definition is “damage that affects a part of the body and results in an inability to practice or compete normally” [3]. Regardless of injury definition problems, long-term surveillance of injuries will help to create injury prevention programs and protect the athletes’ health [4].

In the field of combat sports, the aim is symbolic destruction of your opponent. Judo is a martial art and combat sport in which you defeat your opponent by throwing him on the ground or by utilizing some of the control techniques (pin, choke, or arm lock). When we take into consideration that injury rates are higher in sports that include body contact [5], it is very important to reveal the injury mechanism and suggest prevention methods and/or rules change. Modern sport rules are designed to make competitors safe and to minimize the possibility of sustaining an injury. The Medical Commission of the International Judo Federation has prohibited the number of original judo techniques (kawazu gake, kani basami, do jime) and other actions (any action that may endanger or injure the opponent, especially the opponent’s neck or spinal vertebrae) that expose contestants to the risk of being injured. All these actions are penalized with hansoku make – the direct disqualification– because they may cause severe injuries to contestants. There are also slight infringements of rules that are related to injury prevention, for example: to put a hand, arm, foot, or leg directly on the opponent’s face; to apply leg scissors to the opponent’s trunk (Do jime), neck, or head; and to bend back the opponent’s finger(s) in order to break his grip. These actions are penalized with a shido (warning) because they cannot cause severe injuries. A competitor is allowed to receive three shido penalties during the fight. A fourth shido results in disqualification [6].

Injury risk in elite judo athletes is average when compared to the other Olympic sports (11.75% in judo, 11.25% in all sports). When we consider only

the combat sports at the previous two Olympic Games, taekwondo had the highest percentage of injured athletes (33.05%), followed by boxing (12.05%), judo (11.75%), and wrestling (10.7%). These data imply that striking sports had a higher percentage of registered injuries than grappling sports. The ranking by sport concerning time loss injuries is slightly different, putting judo in the second place among combat sports at the Olympics (taekwondo 12.1%, judo 7.6%, boxing 5.85%, and wrestling 5.5%) [7, 8]. In contrast, judo is ranked highly among the most dangerous sports at Youth Olympic Festivals:

ranked 1^st at the 2^nd Summer Youth Olympic Games (2014) in Nanjing (China) and 4^th at the European Youth Olympic Festival 2013 in Utrecht (the Netherlands) [9, 10]. Also, relatively high injury risk (15.5%) was found in 2012 Paralympics, which ranked judo 7^th among 21 sports [11].

Knowledge about injury risk, severity, localization, and type of injuries during training and competition is the first step towards adequate injury prevention. The next most important step is to reveal the injury mechanism.

By knowing the injury mechanism we can create sport specific educational and preventive measures. Factors such as technical development, rule change, change in technique and tactics, and improvement of sports equipment (tatami, judogi, etc.) can influence potential injury risk. It is necessary to establish a long-term injury surveillance system because of the evolving nature of sports.

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Regarding the body region, we can see that injuries occur mostly in the upper and lower extremities (body) (Table 1), with the highest percentage of shoulder and hand/finger injuries in the upper, and knee injuries in the lower extremities. From retrospective studies that followed injury location in adult judokas, it is clear that the biggest share of injuries occur in the knees (up to 26.36%), shoulders (up to 25.53%), and fingers (up to 21.83%) [3, 12]. Knee and shoulder injuries are usually sustained while executing or receiving a throw [3, 13]. It seems that Seoinage technique puts a judoka at high risk of getting injured, acquiring a knee sprain while executing the throw and different shoulder injuries while receiving the throw [2].

One of the main goals of a judo fight is to throw your opponent, so main attention should be paid to these potential risk situations. On average there are 6-7 quality throw attempts during a fight. In these situations tori puts uke

totally out of balance [14-16]. This is the reason why beginners should not engage in randori (training fight) or competition before they properly learn ukemi in order to minimize injury risk. Finger injuries are associated with grip fighting as a potential injury mechanism [17, 18]. Grip fighting is an important part of the fight since the judoka with better kumikata has an advantage during both offensive and defensive maneuvers. High level senior competitors spend more time on kumikata fighting compared to beginners [19] and youths [16].

Finger injuries usually affect competitors from lower weight categories and the expected recovery time is less than seven days [20].

Statistically significant differences between men and women in the number of injuries were not reported [5, 12, 20]. In children, knee injury was ranked 6^th overall, which is encouraging when we consider complications that are associated with this type of injury. At this age measures should be taken to prevent shoulder/upper arm, foot/ankle, and elbow/lower arm injuries [21].

In a study based on Finland’s national sports injury insurance registry data, it was found that around 70% of injuries occurred during training [5], which was in accordance with the results of [12]. As opposed to these data, there were studies claiming competition injuries are more common in judo (ranging from 49% up to 59%) [22, 23]. Findings differ due to a variety of procedures used for data collecting (questionnaires, hospital records, insurance claims, etc.). While questionnaires are affected by memory bias, hospital records and insurance registries usually exclude soft (minor) injuries.

Table 1. Injury location

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L

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Time loss injuries are defined as injuries that produce absence from training or competition for at least one day. Judo is not in a group of high risk sports for sustaining time loss injury at the Olympic Games [7, 8], thus there were 6.4 and 8.9% of judokas with time loss injuries at the Beijing and London Olympics [2]. Likewise, no gender differences were found [7, 8, 24].

Over 2/3 of injuries occurred during competition [5, 7, 8, 22], while only one study found that 70% of injuries happened during training [12]. In some studies it was not clearly pointed out [5, 21], but judging by the method of data collection (insurance and hospital records), we assume that the injuries were time loss.

Injury risk for 1000 athletes’ exposures is often used in the literature.

Different data were found for time loss injuries: 18.9/1000 A-Es male, 10.3/1000 A-Es female ([24]); 4.85/1000 A-Es male and 13.70/1000 A-Es female [25]. Concerning age, the highest injury risk was found for the age between 20 and 24 [5]. This is the period when a judoka starts the senior career and when the intensity of training and competition usually increases. It seems that a judoka’s level manifested by the color of his belt does not influence injury risk [24]. More studies are needed to confirm this hypothesis.

Knee injuries had the highest share of time loss injuries, followed by shoulder injuries [5, 12, 22]. Mean absence from training and competition ranges from 1-7 days at the Olympics (5.7% of competitors received an injury with this level of severity) to 21-29 days during national level competitions [2].

S

H

N

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Incidence

Head and neck injuries have a low incidence in judo (from 0 up to 6% of all injuries) compared to lower and upper limb injuries [3, 20, 26]. Despite the low incidence, these are potentially the most harmful injuries. There is a lack of precise estimation of the number of catastrophic injuries in judo. Most of the cases reported come from Japan, the homeland of judo, with approximately 200,000 registered judokas [27-29]. In the period between 2003 and 2010, 49 severe head and neck injuries were reported to All Japan Judo Federation

through the System for Compensation for Loss or Damage. Incidence of head injuries varied from 0.98 per 100,000 athletes per year in 2004 and 2006, to 3.21 per 100,000 athletes per year in 2009. On average there were 1.96 severe head injuries per 100,000 athletes per year. A lower incidence was registered for severe neck injuries. The highest incidence was reported in 2007 (3.02 per 100,000 athletes), while in 2010 there were no reported cases. On average there were 1.20 severe neck injuries per 100,000 athletes per year. The fatal outcome was registered in 15 cases. Only 4 (13%) athletes with a head injury and 5(26%) with a neck injury fully recovered [29].