Falls Are the Leading Cause of Injuries among Farmers—Limitations of Practicing Judo in Preventing These Incidents

: Beneﬁts related to doing martial arts go beyond health-related and constitute very useful life skills. One of them is ability to fall safely. It is an important skill since falls are a common cause of injuries. The aim of the study is knowledge regarding the burden of falls in a population of farmers. This systematic review was prepared according to PRISMA guidelines. A literature search was conducted in PubMed, Science Direct, Scopus, Springer Link, Web of Science. A total of 21 articles met eligibility criteria. The common general observation was that fall (regardless of type) caused various body injuries in populations of agriculture workers. Fall was the leading cause of injuries in only one population, and the most frequently classiﬁed second or third causes among all other listed injuries. People employed in the agriculture sector constitute an occupational group with an increased risk of injury as a result of accidental fall, which may lead to disability or even death (in extreme situations). Safe fall training would be an important addition to traditional fall prophylaxis applied on farms. The authors indicate the limitations of judo as a base of such a program, such as with superﬁcial analysis of this issue in scientiﬁc publications. There is a need for a critical and wary approach to recommendations that are limited to prophylaxis of the effects of accidental falls that are founded on judo or other combat sports and martial arts.


Introduction
It is justified to state that physical activity is one of the universal means of restoring, sustaining, and enhancing health. This stems from observations of a multitude of negative effects of physical inactivity [1,2] and the positive effects of physical activity [3,4]. The importance of physical activity in human ontogenesis is also reflected in the WHO guidelines on physical activity, which have been determined for various age groups [5], even for children under the age of 5 [6].
In comparison to forms of physical activity such as running or resistance training, martial arts include all recommended types of exercises (aerobic, anaerobic, and strength), of which the relative contribution in particular types of training can be easily modified. There are many health-related benefits to practicing martial arts. For example, those related to Tai Chi include stress reduction, improved agility and balance, posture control, lower extremity strength, impeding a decline of the muscular-skeletal system that occurs with aging and the associated deterioration in functional capacity and an increased risk of falls and hip fractures [7]. Practicing martial arts also has a positive influence on people's mental and social health [8].
Apart from health-related benefits, people practicing martial arts learn self-defense, how to avoid collision with an object in motion (e.g., boxing, fencing, karate, kendo, taekwondo), and safe falling (e.g., hapkido, judo, ju-jitsu, sumo, wrestling). People with such skills are less susceptible to lose their health as a consequence of unfortunate events that happen in every-day life, including assault and falls under various circumstances (at work, doing sports, during leisure time activities, etc.). Therefore, teaching these skills should be considered an important contribution to enhancing people's health capabilities, which, as a whole, constitute a life skills [9].
It may seem that ability to fall safely is more important in the case of urban rather than in rural areas. A cursory analysis of publications related to the burden of injuries in populations of agriculture workers  justifies the statement, that it is also an important public health issue in that occupational group. By extension, martial arts should be considered a serious alternative for other recommended forms of physical activity, and is favorable to health enhancement. Both health prophylaxis and broadly understood survival abilities [31,32] have been taken into account.
The authors of this publication focused on judo because it has many health-related benefits. Training based on the traditional model, Kodokan [33], focuses on the development of all the aforementioned abilities, which are the necessary elements for effective protection of the body in situations where it is endangered, it increases personal sense of safety (associated with quality of life), and increases the likelihood of surviving in situations of physical aggression. Elementary judo education encompasses safe fall exercises (ukemi waza), characteristic stepping patterns (tsugi-ashi) and executing turning movements (tai-sabaki), and sparring (randori). The first set of exercises enhances one's ability to fall safely, the second-balance control, and the third-tolerating imbalances caused by external forces. Additionally, tai-sabaki exercises, together with mastering self-defense techniques, goshin-jitsu-no-kata, enhance one's ability to avoid collisions. This is required of people wanting to obtain higher degrees of initiation (dan) and instructor qualifications.
Moreover, a very important element, from the perspective of the motor safety of people suddenly losing their balance, is the ability to provide security to a falling body purposely thrown off balance. Judoka acquires this ability in two ways: by mastering a technique of particular throws, and with free-style practice-randori. Such types of situations during collective work in agriculture are unavoidable.
If one critical stipulation was not mentioned, recommendations included in this article would have been open to question. The authors of the article would like to stress, that practicing judo on a professional level (participation in tournaments), as with many other contact sports, is associated with being at risk of suffering various body injuries [34], death or irreversible life-long disability [35].
The aim of the study is to determine knowledge about the burden of falls in a population of farmers.

Materials and Methods
This systematic review was prepared according to PRISMA guidelines ( Figure 1) [36]. All authors were responsible for publication searches. A literature search was conducted in online databases, such as PubMed, Science Direct, Scopus, Springer Link, and Web of Science. The search string used was "Farmers AND Falls". The language of the papers was restricted to English. The publications met eligibility criteria if they included information concerning at least burden of fall-related injuries. If there were also data concerning the types and frequencies of recorded injuries, and body parts, those were also taken into consideration.  [36].

Results
The common general observation present in all the analyzed articles  was that falls (regardless of type: from the same level, height, machine or animal) caused either various bodily injuries or death (in extreme situations). Given the level of contribution to injuries, falls turned out to be leading cause of injuries (27.9%) in the Korean population [27]. According to data from the rest of the articles, this type of accident was most frequently either second or third among the most prevalent causes among all listed by researches. The authors did not provide a distribution of fall prevalence according to type or part of body injured in the majority of articles. Nevertheless, Paton et al. [21] ascertained that falls (including falls from heights, animals, machinery, and falls on the same level) were the immediate cause of 38.5% and 57% of all head and spine injuries, respectively (Table 1).
Fall was third and second leading cause of machinery (fall from machine) and non-machinery related injuries (15.1% and 24.5% respectively). Falls on the same level (5%), into hole (4.3%), from ladder/scaffold/stairs/steps (2.5%), from one level to the another (1.2%). These types of falls were jointly third leading cause of injuries (13%).
2005 Moshiro et al. [15] 303 persons reported to have been injured in rural area Country: Tanzania A two stage cluster sampling method was adopted in selecting the rural sample. In the first stage, using existing AMMP data on mortality and poverty, 6 out of 51 villages were selected to represent different levels of injury. The basic data was enhanced by a systematic review of the hospital charts. Regional health records personnel verified the information contained in the discharge records and added information about the injury events to standard de-identified abstraction forms. Small-scale commercial-oriented vegetable farmers from ten of the most populated agricultural areas Country: Trinidad Survey was conducted. This study employed a convenience sampling strategy to recruit its participants. The first farmer met was interviewed, followed by every third farmer working in the field at the time of data collection until ten farmers were successfully interviewed. Falling from haystacks and falling from motorized and nonmotorized agricultural vehicles and tools have fourth (9.59%) and fifth (7.53%) position in ranking of 6 (predermined) etiological categories.

IR:
In general (both types are combined) fall has second position (17.12%).

Discussion
Results of the analysis clearly indicate that the causes of falls among people employed in the farming sector differ from the types of falls that are characteristic of judo. Authors of numerous reports pointed out a fall from height as a cause of death. For instance, "Fall from height was second leading cause of fatal (15.8%) and fourth leading cause of non-fatal (13.1%) injuries" [12]. As height varies (animals, machinery etc.) and circumstances are also manifold.
A considerable number of falls in judo can also be qualified as a fall from height, in a certain sense, especially throwing techniques like koshi-waza (hip throwing techniques) or te waza (hand throwing techniques). A judo practitioner will potentially experience the highest fall during kata guruma (shoulder wheel)-from tori's shoulders (tori is a person who applies a technique in judo training) [33]. This particular throw is rarely used effectively during tournaments (in the cases it is performed, as the thrower needs to greatly lower their center of gravity). During formal practice of judo throws, the aspects of sport ethics and mutual responsibility play a large role (partners take on the role of tori in turn as they become responsible for providing security for their partner's falling body-uke's body).
There is a lack of deeper analysis of the limitations of judo as a method of preventing body injuries resulting from falls [37,38]. The observation made by Arkkukangas et al. [38] that "interventions aiming at reducing both the risk of falls and mitigating fall-related injuries through teaching safe falling techniques are still sparsely investigated" is only partially true. The authors performed a very superficial analysis of available papers. They did not mention original and applicable cognitive achievements of a group of Polish scientists and practitioners, cooperating with Roman M. Kalina, which has been available in the global scientific space since 2018 [39].
The so-called Polish school of safe fall originates from the 1970s. It draws on the physical theory of "soft fall" from 1972 [40], which received additional elements in 2015 [41]. In the meantime, several articles appeared in Polish regional journals. They incorporate methodological essentials for a complementarily developed system of prophylaxis of body injuries resulting from falls (inspired by judo philosophy and practice). Its simplified methodological synthesis is an academic script "Combat sports propaedeutics-basics of judo", published in 2003 (it includes specific motor diagnostic tool: test of making safe falls) [42]. The theoretical and methodological basis of teaching lower-extremity amputees safe falling appeared in the same year [43]. This set of articles provided universal methodological criteria of the assessment of any safe fall training program based on martial arts. They allowed for a precise indication of deficiencies of recommendations concerning the usage of martial arts in fall prophylaxis. For example, limited adaptability of movement and methods and patterns in particular martial arts [31,32,44].
Research conducted on healthy individuals confirmed both the high accuracy of the test of making safe falls and that anyone can learn safe fall techniques (regardless of gender, age, and type of body build) [45]. Clinical research proved the effectiveness of both programs for people with disabilities, the one dedicated for people after amputations of limbs [46] as well as the one focusing on visually impaired and blind patients [47]. Furthermore, the program proved effective for obese people [48], patients with mental impairment, participating for several months in special cognitive-behavioral therapy [49].
At the base of those empirically verified adaptive benefits, there is an attractiveness with respect to proactively therapeutic programs, combining a selection of judo exercises, safe fall, and collision avoidance techniques, providing fun forms of martial arts [50]. The programs have great influence on motor and mental functioning of the participants and incorporate simple non-apparatus diagnostic tests [51]. Along with motor competences in the area of safe falls, and reduced susceptibility to body injuries during a fall, the aforementioned training programs provide further benefits, including the unique ability to diagnose and reduce aggressiveness [52,53]. The broadly indicated multivariate benefits of the programs are one part of the still-improving concept described as innovative agonol-ogy [32,44,54,55]. Still, the most convincing arguments supporting the effectiveness of programs dedicated to safe falls came from participants. On completion of the experiment, over 95% of the surveyed students were convinced that teaching safe fall techniques to healthy participants, and those from increased risk groups, made sense and none of the students denied it. In addition, upon completion of the clinical experiment, all the amputees, and over 83% of the visually impaired patients were of the same opinion; one response from a visually impaired patient (16%) read: "I don't know" and none of the respondents denied the importance of teaching safe fall techniques [56].
On the basis of the evidence for the complementary influence of the innovative methods, the conclusion offered by Arkkukangas et al. [38] seems exaggerated. It was suggested that, as verified by the authors, a 10-week judo-based exercise program may be a novel way of addressing fall-related injuries. At the same time, it is not surprising that: "The Judo4Balance programme had no impact on fall-related self-efficacy in this study sample of active adults".

Conclusions
People employed in the farming sector are at increased risk of disability as a result of accidental falls. Since traditional fall prophylaxis is estimated to be efficient only in 30-40% of cases [57], safe fall training should be recommended as it is an important additional element in this occupational group. It should be adjusted to a person's age, physical and mental capabilities, general health, character of work, as well as training site. Despite their brief presentation, the postulates and benefits of the programs presented within the paper clearly indicate a need for a critical and wary approach to recommendations limited to prophylaxis of the effects of accidental falls founded on judo, or other combat sports and martial arts [58].

Data Availability Statement:
The data presented in this study are available on request from the corresponding author.

Conflicts of Interest:
The authors declare no conflict of interest.