Martial Arts


  • Martial arts are bodies of codified practices or traditions of training for unarmed and armed combat, usually without the use of guns and other modern weapons.

  • People study martial arts for various reasons, including improved fitness, self-realization (meditation), mental/character development, and self-defense.


  • There are over 140 martial arts styles practiced worldwide.

  • Participants

    • Approximately 2–8 million participants in the United States

    • The male-to-female ratio is 5:1.

    • Judo, karate, and tae kwon do are now Olympic sports, which has increased the worldwide popularity of each sport.

  • Injuries

    • Approximately 76,000 annual emergency department visits related to combat sports from individuals ages 5–24 years old between 2010 and 2016.

    • The actual incidence of injuries remains unknown because of a lack of reporting of injuries and lack of studies regarding the sport. However, it is thought to be low compared with other sports because most of the instructions and training are noncompetitive and noncontact.

  • Fatalities

    • Catastrophic injuries and even deaths have occurred from participation in martial arts. Most catastrophic injuries involve massive direct trauma or fall with contact to the head or neck leading to an intracranial hemorrhage or a high cervical spine lesion.

Factors Affecting Incidence And Prevalence OF Injury

Form of Participation in the Martial Arts

  • Many participants train several times per week, year round, without a natural break in training for rehabilitation/recovery.

  • Emphasis of training is often on personal development, both physical and mental, and not on competition.

  • Muscle mass and strength are typically not as important as speed, strategy, technique, mental discipline, and flexibility.

  • Individuals of different levels of training may “spar” (i.e., engage in practice competition with another individual to simulate competition or a bout) in practice, exploiting the mismatch in skill levels between participants.

  • Incidence of injury is directly related to the amount of time spent in full-contact sparring, limited-contact sparring, or competition.

  • A competition setting may also influence the injury rate and severity.

  • Martial art style: tae kwon do has more severe injuries and greater incidence of multiple injuries than other disciplines. Three times injury rate and fourfold risk of multiple injuries compared with Shotokan karate

  • Types of martial arts training include:

    • Kata—detailed choreographed patterns of movements/techniques used by practitioners to practice on their own

    • Basic hand strikes

    • Basic kicking

    • Strength training

    • Conditioning

    • Stretching

    • Flexibility

    • Breaking—using striking techniques to break boards or bricks

    • One-step sparring—noncontact sparring to practice techniques used during free sparring or competition

    • Grappling

    • Ground fighting

    • Joint locks—grappling technique involving manipulation of opponent’s joint in such a way that the joint reaches a maximal degree of motion in order to induce submission or to injure opponent

    • Chokes—employed via various mechanisms using upper or lower extremities to temporarily disrupt vascular supply to brain or to compress trachea to prevent breathing

    • Free sparring—to engage in practice competition with another individual to simulate competition or bout

    • Point-scoring competition

    • Full-contact competition

Protective Equipment

  • Mouth guard: Risk of orofacial injury is 1.6–1.8 times greater when mouth guards are not worn. Use does not reduce the risk of concussion. Not widely used in martial arts.

  • Headgear: May reduce peak acceleration forces to the head; different brands have varying safety profiles ( Fig. 86.1 )

    Figure 86.1, Protective equipment.

  • Hand and foot protection: Hand protection (as used in tae kwon do) and foot-padding gear have not been shown to reduce peak acceleration; combination of headgear and hand/foot protection superior to either used alone (see Fig. 86.1 ). Padding may lead to decreased inhibition and poorer control of striking, which may lead to greater number of blows with larger amount of force. Hand and foot padding are thought to decrease amount of superficial injuries, such as lacerations and abrasions, to both attacker and defender. Equipment varies with different martial arts.

  • Padded flooring: Padded flooring may reduce the intensity of a blow by absorbing some of the impact of falls and throws (see Fig. 86.1 ). The surface must be closely monitored for risk factors for fall, such as moisture (e.g., water, blood, or perspiration) or gaps between pads. Mat pads are common reservoirs for fungi and bacteria and therefore must be cared for in a similar manner to wrestling mats in order to prevent the spread of infections (e.g., community-acquired methicillin-resistant Staphylococcus aureus , herpes simplex virus, or tinea corporis).


  • Age is not a reliable predictor of the likelihood of injury, although one study reported decreased incidence of injury in adolescent karate practitioners during elite competitions.


  • Experience and number of hours of participation appear to be associated with higher rates and severity of injury.

  • A previous study reported a greater incidence of head injuries and fractures in professional Muay Thai kickboxers when comparing amateurs with beginners.

  • Individuals with at least 3 years of experience were at twice the risk of injury than less experienced individuals.

  • The number of tournaments and months of practice are directly and significantly associated with the likelihood of injury.


  • Tournament and competitive situations are associated with a lower absolute number of injuries but higher rate of severity. One study showed an injury rate six times higher during competition in tae kwan do compared with noncompetitive situations.

  • Informal training sessions are associated with higher risk and severity of injuries compared with more formal supervised instructions.


  • Males have higher rates and severity of injuries compared with females, probably related to increased aggressiveness, except in karate, where females have a higher injury rate than do males. However, with higher levels of competition, the discrepancy between the two sexes became insignificant.

Weight Class

  • In competition, governing bodies of martial arts have established weight classes. Physicians must be aware of their athletes that are attempting to make different weight classes and provide appropriate counseling for weight maintenance.

  • Muay Thai kickboxing participants who compete at a heavier weight are at a higher risk of injury.


  • American Academy of Orthopedic Surgeons (AAOS) tips for martial arts participants to safely train and compete:

    • Consult with a physician before beginning conditioning to establish readiness.

    • Train under the direction of an instructor who focuses on form and technique rather than competitive strategy.

    • Wear activity-appropriate protective gear (e.g., tae kwon do, a full-contact sport, requires head guard, body protector, forearm and shin guards, and groin guard).

    • Exercises that strengthen rotator cuff muscles and hip adductors/abductors are critical to martial arts for injury prevention, balance, and improved striking ability.

    • Maintain appropriate breathing techniques when practicing martial arts to avoid injury—breathing out during the contraction portion of any stretching movement, and breathing in during the extension portion of any stretching movement.

Coverage of Martial Arts Events

  • General

    • Attending physician must be present when the rules of the competition are reviewed.

    • Important to identify yourself and briefly review certain medical considerations

  • Prefight examinations

    • Perform in a quiet, well-lit environment.

    • Enquire about previous and/or recent concussions and “knockouts.”

  • Match stoppage

    • Typically by referee; however, the referee may consult with physician for medical guidance regarding whether match should continue

    • Interventions required for lacerations and bleeding

  • Cervical spine injuries

    • Often teammates or coaches will want to attend to their fighter and may inappropriately move a fighter with an unstable cervical neck injury

    • Review rationale and need for appropriate cervical spine immobilization with all the participants and their teams

  • Postfight examinations

    • After a loss or a knockout, the participant may be confused, belligerent, or emotional.

    • Important to maintain control of the situation to complete an appropriate examination.

  • Medical kit suggestions: disposable gloves, gauze, silver nitrate, bandages, suture kits, sling, athletic tape, Coban, nonsteroidal antiinflammatory drugs (NSAIDs), cold/flu/allergy medication, antidiarrheal medication, shears, petroleum jelly, nasal plugs, otoscope/ophthalmoscope, tooth saver solution, syringes, needles, lidocaine with/without epinephrine, alcohol swabs, betadine, contact and eye wash solution, splinting material, oral airway, cervical collar, EpiPen, and albuterol

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