Since its inauguration in the United States in 1990, mixed martial arts (MMA) is noted as the fastest growing sport in America as evidenced by its annual increase in online interest. However, due to its relatively new infrastructure, there is currently limited injury incidence data available for MMA. Submission wrestling (SW) is a modern combat martial art that employs joint locks during competition to submit an opponent and achieve match victory. This martial art is a gateway sport for Mixed Martial Arts (MMA) and may provide a preview of joint injury patterns expected in future SW and MMA competitions. PURPOSE: The objectives of this investigation were to determine the cumulative injury incidence sustained at an international level SW tournament, and to evaluate the risk of injury by belt rank and body region. METHODS: A total of 951 male athletes, aged 18 to 50 years old, enrolled to compete in the 2009 No-Gi Championships. A reportable injury was defined as any joint injury that occurred during competition for which an athlete received care from the on-site medical staff. Other injuries reported such as back, rib, head, fingers, and skin injuries were also recorded but were not included in the analyses. Data which met the inclusionary criteria were categorized by joint (elbow, shoulder, knee, and ankle) and aggregated. Participants were categorized into belt graduation levels for group comparisons (belt rank progression level: blue [least experienced], purple, brown, and black [most experienced]). Group data were evaluated by rate ratios and 95% confidence intervals (CI). Incidence rates (IR) per 1000 athletic exposures (AEs) and rate ratios (RR) per belt rank RESULTS: Overall, there were 58 reported injuries and 1606 recorded AEs during the tournament. Of these injuries, 40 were joint-related for an overall IR of 24.9 /1000 AEs. The joint IR for each specific belt rank was 21.5/1,000 AEs, 21.3/1,000 AEs, 25.2/1,000 AEs, and 35.1/1,000 AEs for blue, purple, brown, and black, respectively. No significant differences were found for RR of joint injury between individual belt groups (p>0.05). In addition, while the more experienced (brown/black belts) competitors had a higher injury risk compared to the less experienced (blue/purple) competitors, the difference was of borderline significance, RR 1.65, 95% CI: 0.9 to 2.9, p = 0.06). The incidence of joint injury was highest at the knee (7.5/1000 AEs) and elbow (7.5/1000 AEs). CONCLUSIONS: The data from this SW tournament indicate that the risk of joint injury is similar for each belt rank/experience during SW competition. In terms if injury prevention planning, the data suggest the need to examine the mechanisms of increased joint injury which are highest at the knee and elbow. Practical Applications: Future investigation is warranted to determine if specific pre-competition strength training regimens are able to reduce the incidence of injury in SW and MMA competition.
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