Analysis of Severe Spinal Injuries in Korean Elite Female Wrestlers
1
College of Sport Science, Sungkyunkwan University, Suwon 16419, Republic of Korea
2
Division of Sports Science, College of Health Science, Suwon University, Hwaseong 18323, Republic of Korea
3
Department of Physical Education, Gangneung-Wonju National University, Gangneung 25457, Republic of Korea
4
Sports Health Care Education, Westminster Graduate School of Theology, Yongin 17092, Republic of Korea
*
Author to whom correspondence should be addressed.
Appl. Sci. 2024, 14(16), 7250; https://doi.org/10.3390/app14167250
Submission received: 5 July 2024
/
Revised: 13 August 2024
/
Accepted: 16 August 2024
/
Published: 17 August 2024
(This article belongs to the Section Applied Biosciences and Bioengineering)
Abstract
:Women’s wrestling is actively practiced in many countries. While severe spinal injuries pose a threat to an athlete’s career and health, research on severe spinal injuries in female wrestlers remains limited. The aim of this study was to investigate the characteristics of severe spinal injuries and post-injury management in Korean female wrestlers. We enrolled 54 female wrestlers participating in the national team selection competition. Interviews were conducted to examine the characteristics of spinal injuries that resulted in a time loss of more than three weeks from training throughout their athletic careers and their post-injury management practices. Approximately 46% of participants experienced severe spinal injuries, and 52% faced re-injuries during their wrestling careers. These injuries predominantly occurred during technical training due to overuse during tackling and standing attacks. The most frequent injuries were lumbosacral disc injuries (72%) and cervical disc injuries (20%), with 36% requiring surgery. Nearly half of the injured athletes received specialized rehabilitation, yet roughly 76% resumed training without medical clearance. Athletes injured during their student years were notably less likely to receive specialized rehabilitation compared with those injured during their professional careers (p = 0.011). On average, athletes returned to play within 2.7 to 3.0 months. Spinal injury characteristics and post-injury management were not significantly different between the light- and heavyweight classes. While Korean female wrestlers are at a high risk of experiencing severe spinal injuries and re-injuries during their careers, appropriate post-injury management is often lacking, highlighting the need for proactive intervention by healthcare professionals to prevent recurrent spinal injuries in female wrestlers and to ensure safe return to training.
1. Introduction
Wrestling, a sport in which two competitors engage in physical combat, has long been perceived as a predominantly male sport. However, women’s wrestling has been recognized as an international sport after it was first introduced at the 2000 Sydney Olympics and officially included as an event at the 2004 Athens Olympics [1]. The sport is now played worldwide and has become an event in international competitions, including the World Championships [2]. In international competitions, wrestling is contested in Greco–Roman and freestyle; however, only freestyle is contested in women’s events [1].
Freestyle wrestling involves the use of all body parts for offensive and defensive maneuvers, resulting in various techniques and movements [3,4]. For example, double-leg tackle is a dynamic and fast technique in which the wrestler grabs both the opponent’s legs to take them down. Furthermore, techniques such as low single-leg takedown, where the wrestler grabs the opponent’s ankle to take it down, or foot sweep, which involves tripping the opponent by hooking their leg, also showcase the unique attack styles of freestyle wrestling. Common defense techniques include front headlock, which stops an opponent’s attack by controlling the head and arms, and sprawl, which involves pressing the opponent’s head toward the abdomen to push them down to the mat [5]. In terms of posture, freestyle wrestlers maintain a lower stance than Greco–Roman wrestlers, resulting in excessive neck and lower back curvature [6].
The unique techniques and postures of freestyle wrestling put athletes at greater risk of injury [7]. In particular, men’s freestyle wrestling had the highest incidence of severe injuries among the 25 sports categories under the National Collegiate Athletic Association (NCAA), with injuries resulting in a time loss of three weeks or more, accounting for approximately 14.2% of all injuries [7]. The prevalence of head and neck injuries, including concussions and spinal injuries, among freestyle wrestling athletes is reportedly high owing to direct collisions, twisting forces, and techniques such as tackles [8,9]. Studies investigating spinal injuries in freestyle wrestlers found that approximately 22% of all injuries were severe enough to limit participation in training and competition for more than three weeks [9]. Since spinal injuries are serious issues that threaten athletes’ careers and lives [10,11], it is crucial to understand the injury patterns of freestyle wrestlers and develop effective prevention and management strategies based on generated insights.
Despite international recognition of sports, research on the epidemiology of injuries in female freestyle wrestlers is still needed. To the best of our knowledge, research focusing on female wrestlers has only involved a few studies on injuries during training sessions of Korean national team athletes, injuries at the Olympic Games, and injuries at the United World Wrestling championships hosted by the Hungarian Wrestling Federation [12,13]. Moreover, to date, epidemiological studies of injuries within the NCAA have predominantly focused on male wrestlers [8,14]. Wrestling techniques and tactical actions tend to differ depending on the gender, and the spine is also susceptible to damage in women due to repetitive overload stress. Additionally, once these injuries occur, they require a long recovery time and have a high recurrence rate [15,16]. Previous research found that the severity of injury in Korean wrestlers is influenced by their weight class [12]. Therefore, this study was conducted to analyze the characteristics of serious spinal injuries in female freestyle wrestlers. The aim of this study was to investigate the characteristics of severe spinal injuries and post-injury management practices in Korean female wrestlers, with a focus on comparisons by weight class.
2. Materials and Methods
2.1. Study Design
As of 2024, there are 120 registered female wrestlers on the Korea Sports Council. Thirty were in the collegiate division, 65 in the professional division, and the rest were athletes under the age of 19 years. This study initially targeted 60 female freestyle wrestling athletes from collegiate and professional divisions, who participated in national team selection trials. Ultimately, 50 athletes participated in these interviews. Four interviewees reported injuries to different parts of the body, with each injury being treated as a separate data point. Thus, 54 injuries were included in the final analysis, including both national team players and national team candidates (Figure 1). Table 1 summarizes the characteristics of the study participants. The average age of the participants was 24.5 ± 2.8 years, and the average athletic career was 7.7 ± 2.5 years. Among the participants, there were 25 athletes (46.3%) in the lightweight class, and 29 athletes (53.7%) were in the heavyweight class. Specifically, based on the median weight class, the lightweight category included 11 wrestlers in the −50 kg class, 8 in the −53 kg class, and 6 in the −55 kg class; while the heavyweight category included 12 in the −57 kg class, 7 in the −62 kg class, 7 in the −68 kg class, and 3 in the +76 kg class. Before participating in this study, all participants received a detailed explanation of this study’s purpose and procedures and signed a written informed consent form. This study was approved by the Institutional Review Board of Sungkyunkwan University (Approval No. 2023-12-051).
2.2. Data Acquisition
The data used in this study were collected from female freestyle wrestlers who participated in the South Korean national team selection trials. The first data collection period was 13–15 May 2023 during the selection trials for the 2022 Beijing Asian Games, which was postponed. The second data collection period was from 2 to 4 February 2024, during the selection trials for the Paris Olympics. All contestants were asked to participate in the interviews conducted directly by researchers.
The interviews were conducted in three stages. The first stage examined the demographic characteristics of the participants, including their age, height, weight, athletic career, and competitive weight. The second stage focused on severe spinal injuries that required athletes to withdraw from team training, specifically those resulting in a loss of time exceeding three weeks. This section collected detailed information on the presence of injuries, injury timing (student athlete or professional), injury recurrence, and type of activity (technical training, competition, or physical training). In addition, the injury mechanisms (player collision, driven into the mat, non-contact, overuse), specific movements causing the injury (standing attack/defense, tackle attack/defense, ground attack/defense, and physical training), diagnosis, and return-to-play (RTP) time were examined in detail. In the final section, post-injury management was examined, including whether surgery was performed, specialized rehabilitation was undertaken, medical clearance was obtained prior to RTP, and post-injury psychological distress (concerns regarding re-injury, performance decline, rehabilitation failure, and starting assignment).
2.3. Definitions
Severe injury was defined as an injury that resulted in more than three weeks of absence from training or competitions, based on criteria used in previous sports injury epidemiology studies [7]. Participants were strictly required to report only injuries diagnosed by a physician. RTP criteria were defined as the level at which an athlete could fully participate in technical team training. Re-injury was defined as the occurrence of the same injury to the same body part on more than two occasions. In this case, the participants were instructed only to report the case that required the longest period of RTP. However, injuries to different body parts were treated separately. Given the contact nature of wrestling, “overuse” injuries were defined in this study as non-traumatic injuries resulting from excessive repetitive force during training or competition.
2.4. Data Analysis
Continuous variables are presented as means and standard deviations or medians and ranges, as appropriate, while categorical variables are presented as frequencies and percentages. Based on the median weight of the athletes, the weight classes were categorized as lightweight (55 kg or less) and heavyweight (57 kg or more). An independent t-test was used to compare differences in age, height, weight, and athletic career between weight classes. The chi-square test or Fisher’s exact test was used to analyze the characteristics of the injuries and post-injury management variables between the weight class and injury timing groups. Differences in the RTP time between the groups were compared using an independent t-test. The significance level for all hypothesis tests was set at α < 0.05. All the statistical analyses were performed using IBM SPSS Statistics, version 25.0 (IBM Corp., Armonk, NY, USA).
3. Results
The interview response rate was 83.3%. The remaining 16.7% of athletes did not participate because of a lack of time or unwillingness to respond. Approximately 46.3% (25 participants) reported experiencing at least one severe spinal injury during their athletic careers (Table 1). There was no statistically significant difference in the rate of severe spinal injury between the weight classes.
Table 2 presents the descriptive statistics for athletes with severe spinal injuries. Of the 25 athletes injured, 10 were in the lightweight and 15 were in the heavyweight categories. Regarding the timing of injuries, 64.0% (16 cases) of injuries occurred during the student-athlete period, while 36.0% (9 cases) occurred during the professional career. There were no statistically significant differences in the timing of injuries between the weight classes. Among the respondents, 52.0% experienced re-injury. There were no statistically significant differences in re-injury rates between the weight classes.
Table 3 details the characteristics of the severe spinal injuries. Injuries occurred mainly during technical training (64.0%), followed by competition (24.0%) and physical training (12.0%). Lumbosacral disc herniation (72.0%) was the most common diagnosis, followed by cervical disc herniation (20.0%) and lumbar sprain (4.0%). The primary cause of injury was overuse (64.0%), followed by driving into the mat (16.0%), player collision (12.0%), and non-contact (8.0%). The specific movements that led to the most injuries were tackle attacks (40.0%), followed by standing attacks (24.0%), ground defense, and physical training (both 12.0%). The variables related to the type of activity, diagnosis, mechanism of injury, and specific movements causing the injury showed no statistically significant differences between weight classes (Figure 2).
Table 4 summarizes the findings of post-injury management, psychological distress, and RTP time by weight class. Of the injured athletes, 36.0% (9 cases) required surgical treatment, and 52.0% (13 cases) underwent specialized rehabilitation. Only 24.0% (6 cases) of athletes obtained medical clearance before returning to training, while the remaining 76.0% (19 cases) resumed training without medical clearance. The most common psychological distress experienced by athletes was concern about re-injury (48.0%), followed by concern about performance decline (36.0%), failure of rehabilitation (12.0%), and starting assignments (4.0%). There were no statistically significant differences between weight classes in terms of the variables related to post-injury management and psychological distress. The mean RTP time after severe spinal injury was 2.7 months, with a median of 3.0 months.
Table 5 summarizes the characteristics of post-injury management, psychological distress, and RTP time status according to the injury timing. Those injured during their student-athlete careers were significantly more likely not to receive rehabilitation than those injured during their professional careers (p = 0.011) (Figure 3A). Additionally, the mean (median) RTP time for this group was shorter than that of the professional athletes; student-athletes: 2.4 (1.0) months vs. professionals: 3.3 (3.0) months (Figure 3B).
4. Discussion
This study investigated severe spinal injury and post-injury management among Korean female freestyle wrestlers. Based on the current study results, nearly half (46.3%) of the participants experienced at least one spinal injury that resulted in a time loss of more than three weeks during their athletic career. More than half (52.0%) of these athletes were re-injured. Most severe spinal injuries occur during technical training in wrestling, particularly during tackling and standing attack maneuvers, primarily because of overuse mechanisms. Lumbosacral disc herniation is the most commonly reported type of injury (Figure 4A,B). Finally, athletes who sustained injuries during their student-athlete years were significantly less likely to receive specialized rehabilitation than those who sustained injuries during their professional careers.
This study found that Korean female wrestlers had a high incidence of severe spinal injuries throughout their athletic careers, regardless of weight class. This finding contradicts the previous study that reported different injury frequencies based on weight classes [9]. They analyzed spinal injuries in male wrestlers using NCAA ISP data from the 2009/2010 to 2013/2014 academic years; spinal injuries in NCAA wrestlers were more frequent in heavyweight wrestlers, particularly in the 75 kg and 89 kg weight classes [9]. In taekwondo sparring, another combat sport, heavyweights are more likely to be injured than lightweights because of their greater power. Several factors may explain the discrepancy between the results of the present study and previous studies. This discrepancy possibly arises because this study only included severe injuries that resulted in a time loss of more than three weeks. In addition, sex differences cannot be ruled out.
In addition, approximately half of the female wrestlers who had experienced severe spinal injury reported at least one recurrence during their athletic careers. These observations are consistent with previous studies that have highlighted the high risk of lumbar spine injury recurrence [17]. For example, the recurrence rate of lumbar spine injuries was approximately 20.7% in a study by Hassebrock et al. [18], who examined the epidemiology of lumbar spine injuries in athletes from 25 NCAA sports teams between 2019/2020 and 2013/2014. Recurrent lumbar disc herniation is the most common complication of open discectomy [17]. Considered together, these findings suggest that female freestyle wrestlers are likely to sustain severe spinal injuries regardless of their weight class, and the likelihood of re-injury is also significant. Therefore, trainers and healthcare providers should regularly monitor athletes’ injury recovery processes and implement follow-up management to prevent recurrence. This will allow early detection of problems and appropriate intervention.
In this study, severe spinal injuries occurred more frequently during technical training than during competitions. These results are consistent with those of Brinkman et al. [9], who analyzed spinal injury patterns in male NCAA wrestlers. Brinkman et al. [9] reported that approximately 81% of spinal injuries in wrestlers occurred during wrestling practice. The high rate of practice injuries was probably due to wrestlers’ exposure to training more often than to competition throughout their careers. However, it is also important to note that the injury rate per athletic exposure (AE) may be higher during competition than during practice. Previous studies that have considered AEs have reported that the injury rate during competition is approximately 2–4 times higher than during practice [9]. Further long-term studies are needed to accurately determine spinal injury incidence in this population, as research on female wrestlers is limited.
Previous studies have reported that wrestling injuries are primarily caused by contact with opponents [8,19]. However, this observation does not fully explain the complex mechanisms underlying spinal injuries. Most injuries are categorized as contact mechanisms because wrestling inevitably involves physical contact during competitions and technical training. For these reasons, this study classified injury mechanisms as player collisions, driven into mat, non-contact, and overuse. This study found that overuse accounted for approximately 64% of all injuries and was the primary cause of lumbosacral disc herniation. A one-year epidemiological study of non-traumatic spinal cord injury (NTSCI) in Ireland found that the incidence of NTSCI was more than twice that of acute spinal cord injury [20]. Biomechanical research has shown that flexion and extension movements combined with axial torque and rotation, which are common during wrestling, can cause tears in the disc annulus and stress in the lumbar region [21]. Injuries to the neck and cervical spine primarily result from direct collisions during sudden tackle attacks or ground defense maneuvers with other players or mats. Mechanisms such as hyperflexion, hyperextension, or compression that cause cervical spine injuries are well documented in various sports, including American football [22,23]. These findings suggest that spinal injuries in wrestlers occur not only from simple contact mechanisms but also from performing various techniques and complex wrestling movements.
This study found that approximately 36.0% of the patients with severe spinal injuries required surgery. Specifically, for lumbosacral disc injuries, 7 out of 18 cases (46.6%) required surgical intervention. This finding contrasts with the results of Brinkman et al. [9], who reported that approximately 1.3% of all spinal injuries in NCAA wrestlers required surgery. These contrasting results are likely because Brinkman et al. [9] included injuries that resulted in a time loss of less than 24 h, whereas our study focused on severe injuries that restricted participation in training for more than three weeks. However, these differences can also be due to a smaller sample size of injuries compared with the study by Brinkman et al. [9]. According to global epidemiology, approximately 48.8% of patients with traumatic spinal injuries (TSI) require surgery [24]. TSI can be career-ending or even fatal for athletes in severe cases because of damage to the bones, ligaments, or neural structures of the spine [10,11]. Female wrestlers with severe spinal injuries are more likely to require surgery, highlighting the need for systematic interventions and effective treatments to prevent and manage these injuries.
According to this study, only approximately half of the injured athletes received specialized rehabilitation, and 76.0% returned to training without medical clearance. These practices were observed regardless of the weight class. Given the high risk of lumbar injuries [25], rehabilitation and medical clearance before returning to sports may be essential strategies to prevent re-injury and improve the safety and health of athletes. Notably, athletes who experienced injuries during their student-athletic years had significantly lower rates of receiving specialized rehabilitation than those injured during their professional careers. While the difference in the need for rehabilitation may be related to the nature and severity of the injuries sustained by each group, our findings imply that increased support for injury management protocols and rehabilitation programs is needed to improve the health and sporting careers of young wrestlers.
Lumbosacral disc injuries are common in Korean female wrestlers regardless of their weight class. Thus, coaches and medical staff responsible for athlete health must develop and implement specialized programs to prevent and treat lumbosacral disc injuries. Based on previous studies [26,27] that have proven the benefits of core stability exercises in preventing and treating lumbar disc injuries, it is essential to develop systematic education and training programs focusing on core stability in these athletes. Ensuring adequate rest and recovery time is essential to prevent overuse injuries. Given that injured athletes have reported significant concerns about re-injury and performance decline, the provision of professional psychological support to address post-injury psychological difficulties and anxiety about returning to competition is essential. These supports should offer regular counseling sessions focused on injury recovery, techniques to cope with the stress of returning to competition, and strategies to rebuild confidence. By embedding these tailored psychological interventions within the broader rehabilitation process, we can address the mental as well as physical aspects of recovery, thereby enhancing overall treatment efficacy and athlete well-being.
This is one of the rare studies in Korea that systematically analyze severe spinal injuries in female freestyle wrestlers and suggest clinically applicable interventions based on these findings. Nevertheless, this study also has some limitations. First, data collection relied on retrospective recall of athletes, which may have biased the reported injury severity and details. We only asked participants to report injuries diagnosed by a physician, but the methodology used in this study may underestimate or overestimate the severity of injuries. Second, the injury frequency may have been underreported because the data collection focused on the most severe cases among athletes with multiple severe spinal injuries. Lastly, this study cannot consider variables affecting the results, such as the characteristics and severity of injuries occurring at different stages of the athletes’ careers and performance levels. In addition, the participants in this study were limited to those who participated in the national team selection and those who passed the regional preliminaries. Therefore, the main limitation of this study is that more cases cannot be analyzed. Future research should include a larger sample size and use prospective studies to address these limitations. This approach will allow for a more accurate understanding of the epidemiology of spinal injuries and facilitate the development of effective prevention and treatment strategies.
5. Conclusions
It is concluded that severe spinal injuries are relatively common among Korean female wrestlers and tend to recur frequently. These injuries frequently occurred during technical training mainly due to overuse during tackling and standing attacks. Lumbosacral disc injuries were identified as the most common type, regardless of the weight class. While our data suggest that athletes injured during their student years may have had different access to professional rehabilitation compared with those injured at a professional level, it is important to note that we did not account for variations in injury types and severity. These factors may influence the likelihood of receiving rehabilitation and should be considered in future studies.
Author Contributions
Conceptualization, M.S. and Y.C.; methodology, S.Y. (Sangcheol Yoo); formal analysis, S.Y. (Sewoon Yoon), and M.S.; investigation, S.Y. (Sangcheol Yoo) and M.S.; software, S.Y. (Sewoon Yoon) and Y.C.; data curation, Y.C. and M.S.; writing—original draft preparation, S.Y. (Sangcheol Yoo) and M.S.; writing—review and editing, S.Y. (Sewoon Yoon) and M.S.; supervision, S.Y. (Sangcheol Yoo) and M.S. All authors have read and agreed to the published version of the manuscript.
Funding
This research was supported by SungKyunKwan University and the BK21 FOUR (Graduate School Innovation) funded by the Ministry of Education (MOE, Korea) and the National Research Foundation of Korea (NRF).
Institutional Review Board Statement
This study was conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of the Institutional Review Board of Sungkyunkwan University (No. SKKU 2023-12-051).
Informed Consent Statement
Informed consent was obtained from all subjects involved in this study.
Data Availability Statement
The data presented in this study are available upon request from the corresponding author. The data are not publicly available because of privacy and ethical restrictions.
Acknowledgments
We would like to thank Sungkyunkwan University for editing and administrative support. All authors agreed to the acknowledgments.
Conflicts of Interest
The authors declare no conflicts of interest.
References
- Karelin, A.; Tarakanov, B.; Apoiko, R.; Petrov, S.; Koblova, V. Women’s freestyle wrestling in global sports movement: Progress analysis. Theory Pract. Phys. Cult. 2021, 10, 3–5. [Google Scholar]
- Gomboev, B.B.; Surikova, N.V.; Bereza, A.V.; Ryabinina, S.K. Modern Trends in the Development of Women’s Wrestling. J. Sib. Fed. Univ. 2023, 16, 263–273. [Google Scholar]
- Ulupınar, S.; Özbay, S.; Gençoğlu, C.; Ince, I. Performance differences between Greco-Roman and freestyle wrestlers: A systematic review and meta-analysis. J. Strength Cond. Res. 2021, 35, 3270–3279. [Google Scholar] [CrossRef]
- Basar, S.; Duzgun, I.; Guzel, N.A.; Cicioğlu, I.; Çelik, B. Differences in strength, flexibility and stability in freestyle and Greco-Roman wrestlers. J. Back Musculoskelet. Rehabil. 2014, 27, 321–330. [Google Scholar] [CrossRef] [PubMed]
- Yamashita, D.; Arakawa, H.; Wada, T.; Yumoto, K.; Fujiyama, K.; Nagami, T.; Shimizu, S. Whole-Body Mechanics of Double-Leg Attack in Elite and Non-elite Male Freestyle Wrestlers. Front. Sports Act. Living 2020, 2, 58–67. [Google Scholar] [CrossRef]
- Norasteh, A.A.; Bayati, R. Evaluating prevalence of postural changes in freestyle and greco-roman wrestlers: A review of literature. J. Sport Biomech. 2021, 7, 172–187. [Google Scholar] [CrossRef]
- Kay, M.C.; Register-Mihalik, J.K.; Gray, A.D.; Djoko, A.; Dompier, T.P.; Kerr, Z.Y. The epidemiology of severe injuries sustained by National Collegiate Athletic Association student-athletes, 2009–2010 through 2014–2015. J. Athl. Train. 2017, 52, 117–128. [Google Scholar] [CrossRef] [PubMed]
- Powell, J.R.; Boltz, A.J.; Robison, H.J.; Morris, S.N.; Collins, C.L.; Chandran, A. Epidemiology of Injuries in National Collegiate Athletic Association Men’s Wrestling: 2014–2015 Through 2018–2019. J. Athl. Train. 2021, 56, 727–733. [Google Scholar] [CrossRef] [PubMed]
- Brinkman, J.C.; Tummala, S.V.; McQuivey, K.S.; Hassebrock, J.D.; Pagdilao, C.; Makovicka, J.L.; Chhabra, A. Epidemiology of Spine Injuries in National Collegiate Athletic Association Men’s Wrestling Athletes. Orthop. J. Sports Med. 2021, 9, 1–7. [Google Scholar] [CrossRef]
- Puvanesarajah, V.; Qureshi, R.; Cancienne, J.M.; Hassanzadeh, H. Traumatic sports-related cervical spine injuries. Clin. Spine Surg. 2017, 30, 50–56. [Google Scholar] [CrossRef] [PubMed]
- Aito, S.; Tucci, L.; Zidarich, V.; Werhagen, L. Traumatic spinal cord injuries: Evidence from 30 years in a single centre. Spinal Cord. 2014, 52, 268–271. [Google Scholar] [CrossRef] [PubMed]
- Park, K.J.; Lee, J.H.; Kim, H.C. Injuries in male and female elite Korean wrestling athletes: A 10-year epidemiological study. Br. J. Sports Med. 2019, 53, 430–435. [Google Scholar] [CrossRef] [PubMed]
- Molnár, S.; Hunya, Z.; Gáspár, K.; Szerb, I.; Szabó, N.; Mensch, K.; Körösi, É.; Bacskai, K.; Sántha, Á.K.; Janka, E.A. Moderate and severe injuries at five international olympic-style wrestling tournaments during 2016-2019. J. Sports Sci. Med. 2022, 21, 74. [Google Scholar] [CrossRef]
- Kroshus, E.; Utter, A.C.; Pierpoint, L.A.; Currie, D.W.; Knowles, S.B.; Wasserman, E.B.; Dompier, T.P.; Marshall, S.W.; Comstock, R.D.; Kerr, Z.Y. The first decade of web-based sports injury surveillance: Descriptive epidemiology of injuries in US high school Boys’ wrestling (2005–2006 through 2013–2014) and National Collegiate Athletic Association Men’s wrestling (2004–2005 through 2013–2014). J. Athl. Train. 2018, 53, 1143–1155. [Google Scholar] [CrossRef] [PubMed]
- David, C.; Milorad, D.; Fikrat, K.; Yrui, T.; Bezkorovainyi, D.; Korobeynikov, G. Performance of wrestlers at the Olympic Games: Gender aspect. Pedagog. Phys. Cult. Sports 2023, 27, 487–493. [Google Scholar]
- Chang, D.-G.; Lee, H.J.; Hwang, J.H.; Yang, J.H. Sports-related overuse injuries in spine. Arthrosc. Orthop. Sports Med. 2022, 9, 6–12. [Google Scholar] [CrossRef]
- Lee, J.K.; Amorosa, L.; Cho, S.K.; Weidenbaum, M.; Kim, Y. Recurrent lumbar disk herniation. JAAOS J. Am. Acad. Orthop. Surg. 2010, 18, 327–337. [Google Scholar] [CrossRef]
- Hassebrock, J.D.; Patel, K.A.; Makovicka, J.L.; Chung, A.S.; Tummala, S.V.; Peña, A.J.; Williams, K.E.; Hartigan, D.E.; Chhabra, A. Lumbar spine injuries in national collegiate athletic association athletes: A 5-Season epidemiological study. Orthop. J. Sports Med. 2019, 7, 2325967118820046. [Google Scholar] [CrossRef]
- Yard, E.E.; Comstock, R.D. A comparison of pediatric freestyle and Greco-Roman wrestling injuries sustained during a 2006 US national tournament. Scand. J. Med. Sci. Sports 2008, 18, 491–497. [Google Scholar] [CrossRef]
- Smith, É.; Fitzpatrick, P.; Lyons, F.; Morris, S.; Synnott, K. Epidemiology of non-traumatic spinal cord injury in Ireland—A prospective population-based study. J. Spinal Cord Med. 2022, 45, 76–81. [Google Scholar] [CrossRef] [PubMed]
- Desmoulin, G.T.; Pradhan, V.; Milner, T.E. Mechanical aspects of intervertebral disc injury and implications on biomechanics. Spine 2020, 45, E457–E464. [Google Scholar] [CrossRef]
- Boden, B.P.; Tacchetti, R.L.; Cantu, R.C.; Knowles, S.B.; Mueller, F.O. Catastrophic cervical spine injuries in high school and college football players. Am. J. Sports Med. 2006, 34, 1223–1232. [Google Scholar] [CrossRef] [PubMed]
- Alas, H.; Pierce, K.E.; Brown, A.; Bortz, C.; Naessig, S.; Ahmad, W.; Moses, M.J.; O’Connell, B.; Maglaras, C.; Diebo, B.G. Sports-related cervical spine fracture and spinal cord injury: A review of nationwide pediatric trends. Spine 2021, 46, 22–28. [Google Scholar] [CrossRef] [PubMed]
- Kumar, R.; Lim, J.; Mekary, R.A.; Rattani, A.; Dewan, M.C.; Sharif, S.Y.; Osorio-Fonseca, E.; Park, K.B. Traumatic spinal injury: Global epidemiology and worldwide volume. World Neurosurg. 2018, 113, e345–e363. [Google Scholar] [CrossRef] [PubMed]
- Dave, B.R.; Degulmadi, D.; Krishnan, A.; Mayi, S. Risk factors and surgical treatment for recurrent lumbar disc prolapse: A review of the literature. Asian Spine J. 2020, 14, 113–121. [Google Scholar] [CrossRef] [PubMed]
- Frizziero, A.; Pellizzon, G.; Vittadini, F.; Bigliardi, D.; Costantino, C. Efficacy of core stability in non-specific chronic low back pain. J. Funct. Morphol. Kinesiol. 2021, 6, 37–56. [Google Scholar] [CrossRef] [PubMed]
- Khanzadeh, R.; Mahdavinejad, R.; Borhani, A. The effect of suspension and conventional core stability exercises on characteristics of intervertebral disc and chronic pain in office staff due to lumbar herniated disc. Arch. Bone Jt. Surg. 2020, 8, 445–453. [Google Scholar]
Figure 1.
Participant’s inclusion and exclusion of participants.
Figure 2.
Activity type in which injuries occurred (A), diagnosis (B), mechanism of injury (C), and specific maneuver leading to injury (D) by weight class.
Figure 2.
Activity type in which injuries occurred (A), diagnosis (B), mechanism of injury (C), and specific maneuver leading to injury (D) by weight class.
Figure 3.
Comparison of post-injury management (A) and return-to-play (RTP) time (B) according to injury timing.
Figure 3.
Comparison of post-injury management (A) and return-to-play (RTP) time (B) according to injury timing.
Figure 4.
MRI images of lumbar (A) and cervical (B) injuries sustained by the participants.
Table 1.
General characteristics of participants (Mean ± SD).
| Variables | Overall (n = 54) | Light (n = 25) | Heavy (n = 29) | p-Value |
|---|---|---|---|---|
| Age (years) | 24.5 ± 2.8 | 23.8 ± 2.8 | 25.0 ± 2.9 | 0.140 |
| Height (cm) | 161.2 ± 5.3 | 157.5 ± 4.6 | 164.5 ± 3.4 | <0.001 |
| Weight (kg) | 58.7 ± 7.1 | 53.0 ± 2.9 | 63.7 ± 5.6 | <0.001 |
| Career (years) | 7.7 ± 2.5 | 7.2 ± 2.3 | 8.1 ± 2.6 | 0.191 |
| Experience of severe spine injury | ||||
| Yes (%) | 25 (46.3) | 10 (40.0) | 15 (51.7) | 0.389 x2 = 0.742 |
| No 6 | 29 (53.7) | 15 (60.0) | 14 (48.3) |
Table 2.
Descriptive statistics of severe injuries that resulted in a time-loss of more than 3 weeks.
Table 2.
Descriptive statistics of severe injuries that resulted in a time-loss of more than 3 weeks.
| Variables | Overall (n = 25) (n, %) | Light (n = 10) (n, %) | Heavy (n = 15) (n, %) | p-Value (χ2) |
|---|---|---|---|---|
| Time of injury | ||||
| Student-athlete | 16 (64.0) | 6 (60.0) | 10 (66.7) | >0.999 (0.116) |
| Professional | 9 (36.0) | 4 (40.0) | 5 (33.3) | |
| Re-injury | ||||
| Yes | 13 (52.0) | 5 (50.0) | 8 (53.3) | >0.999 (0.027) |
| No | 12 (48.0) | 5 (50.0) | 7 (46.7) |
Table 3.
Comparison of injury statistics of wrestlers with severe spine injuries.
| Variables | Overall (n = 25) (n, %) | Light (n = 10) (n, %) | Heavy (n = 15) (n, %) | p-Value (χ2) |
|---|---|---|---|---|
| Activity type | ||||
| Technical training | 16 (64.0) | 7 (70.0) | 9 (60.0) | 0.434 (2.053) |
| Competition | 6 (24.0) | 3 (30.0) | 3 (20.0) | |
| Physical training | 3 (12.0) | 0 (0) | 3 (20.0) | |
| Diagnosis | ||||
| Lumbosacral disc injury | 18 (72.0) | 8 (80.0) | 10 (66.7) | >0.999 (1.509) |
| Cervical spine disc injury | 5 (20.0) | 2 (20.0) | 3 (20.0) | |
| Low back sprain | 1 (4.0) | 0 (0) | 1 (6.7) | |
| Cervical nerve injury | 1 (4.0) | 0 (0) | 1 (6.7) | |
| Mechanism | ||||
| Overuse | 16 (64.0) | 8 (80.0) | 8 (53.3) | 0.658 (2.141) |
| Player collision | 3 (12.0) | 1 (10.0) | 2 (13.3) | |
| Driven into mat | 4 (16.0) | 1 (10.0) | 3 (20.0) | |
| Non-contact | 2 (8.0) | 0 (0) | 2 (13.3) | |
| Specific maneuver | ||||
| Standing attack | 6 (24.0) | 3 (30.0) | 3 (20.0) | 0.404 (5.297) |
| Tackle attack | 10 (40.0) | 4 (40.0) | 6 (40.0) | |
| Tackle defense | 1 (4.0) | 0 (0) | 1 (6.7) | |
| Ground attack | 2 (8.0) | 2 (20.0) | 0 (0) | |
| Ground defense | 3 (12.0) | 1 (10.0) | 2 (13.3) | |
| Physical training | 3 (12.0) | 0 (0) | 3 (20.0) |
Table 4.
Comparison of post-injury management, psychological distress, and RTP time of wrestlers with severe spine injuries.
Table 4.
Comparison of post-injury management, psychological distress, and RTP time of wrestlers with severe spine injuries.
| Variables | Overall (n = 25) (n, %) | Light (n = 10) (n, %) | Heavy (n = 15) (n, %) | p-Value (χ2) | |
|---|---|---|---|---|---|
| Post-injury management | |||||
| Surgery | Yes | 9 (36.0) | 4 (40.0) | 5 (33.3) | >0.999 (0.166) |
| No | 16 (64.0) | 6 (60.0) | 10 (66.7) | ||
| Rehabilitation | Yes | 13 (52.0) | 6 (60.0) | 7 (46.7) | 0.688 (0.427) |
| No | 12 (48.0) | 4 (40.0) | 8 (53.3) | ||
| Medical clearance for RTP | Yes | 6 (24.0) | 2 (20.0) | 4 (26.7) | >0.999 (0.148) |
| No | 19 (76.0) | 8 (80.0) | 11 (73.3) | ||
| Post-injury psychological distress | |||||
| Re-injury | 12 (48.0) | 4 (40.0) | 8 (53.3) | 0.715 (1.927) | |
| Performance decline | 9 (36.0) | 4 (40.0) | 5 (33.3) | ||
| Rehabilitation failure | 3 (12.0) | 1 (10.0) | 2 (13.3) | ||
| Starting assignment | 1 (4.0) | 1 (10.0) | 0 (0) | ||
| RTP time (months) | |||||
| Mean ± SD | 2.7 ± 1.7 | 2.8 ± 1.8 | 2.6 ± 1.7 | p = 0.816 | |
| Median (range) | 3.0 (1.0–7.0) | 3.0 (1.0–7.0) | 2.5 (1.0–6.0) | ||
RTP, return-to-play; CI, confidence interval.
Table 5.
Management, psychological distress, and characteristics based on time of injury.
| Variables | Overall (n = 25) (n, %) | Student-Athlete (n = 16) (n, %) | Professional (n = 9) (n, %) | p-Value (χ2) | |
|---|---|---|---|---|---|
| Post-injury management | |||||
| Surgery | Yes | 9 (36.0) | 5 (31.3) | 4 (44.4) | 0.671 (0.435) |
| No | 16 (64.0) | 11 (68.8) | 5 (55.6) | ||
| Rehabilitation | Yes | 13 (52.0) | 5 (31.3) | 8 (88.9) | 0.011 (7.667) |
| No | 12 (48.0) | 11 (68.8) | 1 (11.1) | ||
| Medical clearance for RTP | Yes | 6 (24.0) | 3 (18.8) | 3 (33.3) | 0.630 (0.672) |
| No | 19 (76.0) | 13 (81.3) | 6 (66.7) | ||
| Post-injury psychological distress | |||||
| Re-injury | 12 (48.0) | 5 (31.3) | 7 (77.8) | >0.999 (0.071) | |
| Performance decline | 9 (36.0) | 7 (43.8) | 2 (22.2) | ||
| Rehabilitation failure | 3 (12.0) | 3 (18.8) | 0 (0) | ||
| Starting assignment | 1 (4.0) | 1 (6.3) | 0 (0) | ||
| RTP time (months) | |||||
| Mean ± SD | 2.7 ± 1.7 | 2.4 ± 1.9 | 3.3 ± 0.9 | p = 0.131 | |
| Median (range) | 3.0 (1.0–7.0) | 1.0 (1.0–7.0) | 3.0 (2.0–5.0) | ||
RTP, return-to-play; CI, confidence interval.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
MDPI and ACS Style
Song, M.; Yoon, S.; Choi, Y.; Yoo, S. Analysis of Severe Spinal Injuries in Korean Elite Female Wrestlers. Appl. Sci. 2024, 14, 7250. https://doi.org/10.3390/app14167250
AMA Style
Song M, Yoon S, Choi Y, Yoo S. Analysis of Severe Spinal Injuries in Korean Elite Female Wrestlers. Applied Sciences. 2024; 14(16):7250. https://doi.org/10.3390/app14167250
Chicago/Turabian StyleSong, Munku, Sewoon Yoon, Yongchul Choi, and Sangcheol Yoo. 2024. "Analysis of Severe Spinal Injuries in Korean Elite Female Wrestlers" Applied Sciences 14, no. 16: 7250. https://doi.org/10.3390/app14167250
APA StyleSong, M., Yoon, S., Choi, Y., & Yoo, S. (2024). Analysis of Severe Spinal Injuries in Korean Elite Female Wrestlers. Applied Sciences, 14(16), 7250. https://doi.org/10.3390/app14167250
Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.
