Team Coverage, On-Field Care and Injuries in Karate

Rosso Claudio^1,2,3,4, Arnold Roland^2,5, Zenhäusern René^3,6, Willscheid Gernot^1
1 ARTHRO Medics, shoulder and elbow / sports ortho center, Basel, Switzerland
² University of Basel, Basel, Switzerland
³ Swiss Karate Federation, SKF, Switzerland
⁴ Swiss Shotokan Karate-Do Federation, Switzerland
⁵ Hausarztzentrum am Stadtweg, Rheinfelden, Switzerland
⁶ RehaZeno, Praxis für Rehabilitation und Sportmedizin, Zürich, Switzerland

Abstract

In this article, the most important aspects of team coverage of Karate athletes with special focus on medical care of competitions are highlighted. A proposition of what a doctor’s case for martial arts competition should contain is given. According to the Swiss accident insurances, extremities are most frequently seen. During competitions, in our own series, over 70% of injuries are mild and do not need further treatment. However, the physician in charge of a tournament needs to be prepared also for severe injuries. The authors are currently conducting an ongoing, prospective study on injuries during Swiss national competitions since 2011.

Zusammenfassung

In diesem Artikel werden die wichtigsten Aspekte der Teambetreuung im Karate aufgezeigt. Der Hauptfokus liegt jedoch auf der Wettkampfbetreuung. Ein Vorschlag für einen Arztkoffer, der mitgeführt werden sollte, wird aufgeführt. Laut den Schweizerischen Unfallversicherern sind Extremitätenverletzungen am häufigsten anzutreffen. Während Wettkämpfen konnten wir in eigenen Erhebungen ca. 70% leichte Verletzungen, die keine weitere Behandlung bedürfen, feststellen. Als betreuender Arzt muss man jedoch auch auf schwere Verletzungen vorbereitet sein. Die Autoren führen aktuell eine prospektive Studie über Verletzungen an den Schweizer Karate-Meisterschaften seit 2011 durch.

Introduction

Team coverage is generally a broad term covering several, sometimes conflicting parts of a team. We as treating physicians and surgeons are amidst a tension field between the injured athlete, the coach(es), the club and potential sponsors all of which have their particular interests.[1] However, we have the responsibility for the health of the athlete and her or his long-time career.
Having been top athletes ourselves with different injuries sustained in our own career, we have an understanding for the other parties involved. Hence, the tension field (athlete, coach, club, sponsors) is part of all currently available formations in sports medicine (e.g. interdisciplinary focus formation in Sports Medicine (SEMS) or IOC Diploma for Sports Physicians).
The trainees should learn how to act in this environment. With this regard, we have a yearly student course of the University of Basel covering the theory of treating high-level athletes and injuries in martial arts. Additionally, we are currently conducting an ongoing study on injuries in Karate since the coverage of the European Championships 2011 in Zurich and several Swiss Karate Championships. It is of utmost importance to know the injuries that you might encounter in your respective sport and to have the right material ready as a first-responder.[2,3]
Due to the whole-body workout and mental part, martial arts and especially Karate are gaining in popularity over the past decades. The workout and competitions not only involve fighting (“Kumite”) but also basic training and so-called “Kata”, which is a fight against virtual opponents with defined movement patterns.[2] Karate competitions will, for the first time, be part of the Olympic Games in Tokyo 2020. Due to the CoVid19 pandemic, they were postpone and – hopefully – take part in 2021.
This article will cover the aspects of on-field support of Karate tournaments elucidating the importance on knowing the injuries that one might encounter.

Injuries

Karate as practiced at the World, European and Swiss Karate Federation WKF, EKF and SKF, respectively, is considered to be low-impact karate. As can be seen in figure 1, there are many different types of martial arts with different sorts of impact on the opponent’s body. The injuries sustained thus differ. However, the injury patterns and distribution on parts of the body are similar.
As can be seen in table 1, which illustrates the statistics of all accident insurances in Switzerland, injuries in martial arts are frequently seen in the past decade. These statistics, however, do not reflect the injuries sustained during competitions. Data of competitions have been addressed by several authors with a recent meta-analysis summarizing the data.[4] As in our data, the pooled data of Lystad et al. found mainly minor injuries (table 1) and injuries to the extremitites with a similar distribution as shown in table 2.[4] As a team physician, one should keep this data in mind and prepare the material and team accordingly.

Material and Organization

As in almost all sports injuries to the locomotor apparatus, R.I.C.E. (Rest, Ice, Compression, Elevation) is the treatment of choice. Thus, the most important material is crushed ice which is packed into small plastic bags prior to competition day. It is then kept cool in a simple (electric) cooling box. Usually, the ice will not melt until the end of even long competition days (up to 12 hours). Nose tamponades are prepared and can be made of simple paper towels. They should be readily available at the combat area (“tatami”). Knowing the anatomy of the nose is manatory: stick the paper straight into the nose and not up the nose. Circulatory problems, concussions, fractures, tendon, and ligamentous ruptures should be treated according to current guidelines.
In appendix 1, a proposal of the content of our common doctor’s case during competitions is shown. Guidelines of the WKF regulate the number of medical staff during a competition: for each tatami one medical staff (nurse, “Samariter”, medical student or doctor) must be available. One medical staff must be in the medical room in the background to take care of patients and athletes off the field. It is important to have a medical room in which patients can be treated before or after a competition or when severely injured. It should be equipped with a few camp beds.
Besides the own medical staff, the surrounding hospitals must be informed, and the respective telephone number should be readily handy. Also the mobile number of the tournament physician should be given to all medical supporters during the medical briefing.
In international tournaments with many athletes, injuries are first more common but also more severe. At least one ambulance should be situated at the competition site.
In Swiss competitions, we usually take care of tournaments with nurses and “Samariters” and one experienced physician. For the Swiss National Championships, there are usually two physicians taking care of the athletes and spectators. These are supported by medical students of the University of Basel as part of a ECTS-accredited practical project and nurses.

Treatment

The most important point within medical treatment is to protect the athlete from further damage. Sometimes the athlete is willing to continue the bout but has to be protected to further harm her- or himself. The physician has to decide within seconds, if it is possible or not to go on with the bout or the competition. With increasing experience in the treatment of acute trauma to the head and locomotor apparatus, it becomes easier to make this critical decision.

Central points to consider are the following:

1. In young athletes sustaining a blunt trauma to the abdomen, one has to consider a two-stage splenic rupture. We usually perform a sonography (FAST) of the abdomen to rule out intraabdominal bleeding. Alternatively and if in doubt, send the athlete to the hospital.
2. In young athletes with a sustained concussion or even a blow to the head without completely fulfilling the concussion criteria should be taken out of the competition due to the risk of a so-called “second impact syndrome”. Briefly, a second impact syndrome might occur as a second impact on a recently sustained mild brain injury.[5]
3. Any kind of fracture should end the bout, even if it is only a nasal bone fracture. Blow-out fractures are a potentially severe condition and should be sent to hospital.

Our practical approach is usually:

1. Have an overview over all tatamis. With the respective experience and knowing your elite athletes, you know which bout is at risk of an injury. In this way, you can see the pattern of the injury guiding your on-the-field decision.
2. Quickly assess the injury and calm the athlete.
3. Decide with the athlete, if a continuation of the bout is possible.
4. If the athlete is in strong pain, take her or him directly out of the field and into the medical room. If there is a suspicion of a spinal injury, take a stiff neck and a spine board. Be sure that you take the athlete out of sight of the spectators as quickly but also as safe as possible. For Karate, this is the case in high-class fights such as in European or World Championships when cameras are “looking” at you. During the Olympic Games with more international visibility, this is even more important since the world is watching all the physicians’ actions.

Aftercare

After the athlete has been treated on a first-responder basis, be sure that you inform the athlete AND his or her relatives on which steps are needed next: inform about the injury and its potential consequences, inform about red flags, plan X-rays and/or MRIs and when to plan a doctor’s follow-up visit.

Prevention

The best way to treat injuries is to prevent them. Several levels need to be taken into account. If you are the club’s physician, be sure to teach the coaches when injuries occur. In our clubs, the coaches are informed to first train Kumite (free fighting) and then Kata within a training session. This is due to the fact that with increasing exhaustion, the proprioception is deteriorating making the locomotor apparatus more vulnerable to injury.
During competitions, the physicians are always at the referee’s briefing and debriefing. We found this one of the best preventive measures. The referees are a pivotal part of injury prevention in martial arts: if a bout gets out of control, they can easily intervene before an injury is sustained. They are in control of the battle. In the debriefing, we inform the referees about the overall injuries and also on injuries at the various tatamis. This is an important guiding tool if one tatami has notably more injuries than the others. Additionally, the head referee can be contacted at any time during the competition. Communication is important.

This article might lead to misunderstanding that martial arts and especially Karate are dangerous.
The combination between whole-body muscle and cardiovascular workout in conjunction with mental focus is HEALTHY.

Practical implications

• Know your role in team coverage and the tension field between athlete, club, coach and sponsors. Be communicative.
• For competitions:
  – Know the injury patterns that you might encounter (see table 1 and 2).
  – Be prepared for light but also severe injuries (see Appendix 1).
  – Communicate with athletes, coaches and with referees.

Acknowledgments, conflict of interest and ­funding

The authors would like to thank the Swiss Karate Federation and the Swiss Shotokan Karate-Do Federation for the constant effort in making Karate-Do such a magnificent sport.
The authors would also like to thank the SSUV and the SUVA for providing the data of the accidents.
The authors declare that there is no conflict of interest.

Corresponding author

Claudio Rosso, Prof. Dr. med.,
IOC Dipl. Sports Phys.
ARTHRO Medics Corp
Thannerstrasse 45, CH-4054 Basel
Tel: +41 61 301 26 26
Email: arthro@hin.ch

References

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2. Rosso C, Zenhäusern R, Mark Müller A, Valderrabano V. Karate-Do – The Path of the Empty Hand. Sport-Orthopädie – Sport-Trauma­tologie – Sports Orthopaedics and Traumatology. 2012;28(1):12-6.
3. Rosso C ZR, Valderrabano V. [Verletzungen bei Karate-ähnlichen Kampfsportarten]. Sportmedizin und Sporttraumatologie. 2010; 58(2):56-7.
4. Lystad RP, Augustovicova D, Harris G, Beskin K, Arriaza R. Epidemiology of injuries in Olympic-style karate competitions: systematic review and meta-analysis. Br J Sports Med. 2020;54(16):976-83.
5. Engelhardt J, Brauge D, Loiseau H. Second Impact Syndrome. Myth or reality? Neurochirurgie. 2020.