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BJSM Online First, published on July 27, 2015 as 10.1136/bjsports-2014-094365
Original article

Injuries in national Olympic level judo athletes:

an epidemiological study
Keun-Suh Kim,1 Ki Jun Park,2 Jaekoo Lee,1 Byung Yong Kang3

▸ Additional material is ABSTRACT findings from epidemiology studies in judo revealed

published online only. To view Purpose To present an epidemiological study of that the associated risk in judo may be as large as,
please visit the journal online
(http://dx.doi.org/10.1136/
injuries found among South Korea’s National level Judo or even larger than, that in team sports such as
bjsports-2014-094365). athletes as a foundation for future injury prevention and soccer, volleyball and basketball.5–7 Also, a study
1 skill enhancement in this group. from 1990–2003 in the USA witnessed significant
Department of Sports Science,
Sahmyook University, Seoul, Methods This study is a prospective study on a 4-year annual increases in Emergency Room visits relating
South Korea injury assessment held from January 2010 to December to judo and other martial arts injuries.1
2
Training Planning Department, 2013 at the training centre in South Korea for National Judo athletes are classified into respective weight
Korean Olympic Committee, Level athletes. Athlete’s weight class, gender, injury classes. Different weight classes were intended to
Physical Therapist, Seoul, South
Korea
location and injury grade (grade I=1–3 treatment days, establish equality between opponents in mass and
3
Sahmyook University, grade II=4–7 treatment days, and grade III ≥8 treatment strength in sports such as judo, wrestling and tae
Research Institute for Behavior, days) were analysed. kwon do.8 However, this categorisation has been of
Fitness, and Medicine, Seoul, Results There were a total of 782 injuries recorded much concern as athletes take in extreme measures
South Korea during this period, equalling to four injuries per athlete (fasting, laxatives, vomiting, sauna, etc.) to rapidly
Correspondence to annually. Almost half of these injuries (47%) were grade lose weight to be categorised into a lower weight
Dr Jae Koo Lee, Department of I injuries. Injury occurrence was the highest in the Lower class.9 10 This culture has also been the cause of
Sports Science, Seoul Nowongu body (44.2%). This was then followed by injuries in the multiple deaths throughout history. Some prime
Hwarangrho 815 (Gongreung upper body (29.8%), trunk (20.3%) and head and neck examples involved three US collegiate (NCAA)
2 Dong 26-21) Sahmyook
University Gymnasium 306, (5.6%). Men and women showed similar, non- wrestlers in 1997 and Chung Se-hoon in 1996, a
Seoul, South Korea 139-742; significantly different trends in the proportion of body South Korean judo medallist.11
[email protected] parts injured. Women experienced more grade III injuries This practice of rapid weight loss (RWL) may even
than males ( p=0.0228). Comparison between women in impair the performance of these athletes during com-
Accepted 4 July 2015
different weight classes also showed that heavyweights petition.9 10 Various studies have revealed short-term
incurred more grade III injuries than lightweights and long-term bodily injuries due to this practice,9 10
( p=0.0087). Lightweights had a higher rate of injury and the concern is underscored by the fact that many
than heavyweights in males and females, although this judo athletes start this practice at a young age, leading
was statistically significant only among males ( p<0.001). to possible delayed pubertal development and bone
Conclusions Many body regions are prone to injury in growth retardation.12 Coaches, athletes and the
the elite judo population. Women, especially those in medical team invest much time and energy to place
the heavyweight classification, were more prone to their athlete into a lower weight class.
severe injuries. Lightweights experienced more injuries There have been various studies on the frequency
than heavyweights among male athletes. Specifically, and incidences of injuries in the sport of judo.
further studies are needed to confirm these findings and However, epidemiological studies of the elite com-
to address the impact of rapid weight loss practices on petitive judo population are rare.13 The present
injury risk to implement effective preventive measures. study evaluated the injury patterns of elite judo ath-
letes with the purpose of reducing injuries and pro-
tecting the health of the elite judo population. It
INTRODUCTION has been shown that elite athletes have a different
The purpose of judo is to teach martial art discip- Physiological Profile and Psychological mindset at
line, control and respect.1 The International Judo multiple levels when compared to those participat-
Federation is very much global, with 200 affiliated ing at the collegiate or recreational level.14 15
countries.2 Since its participation in the Olympics, For 4 years ( January 2010–December 2013), an
Judo in Korea has won a total of 40 medals: 11 injury evaluation had been carried out at the training
Gold, 14 Silver and 15 Bronze, averaging over four centre in South Korea for National Level athletes. This
medals per Olympic Games. The training in Korea study is a prospective study analysing the results from
for all the national level judo athletes is also unique this injury evaluation. The first goal was to compare
as they train and prepare together at a specified loca- the injuries among males and females in the elite judo
tion. Training among the athletes has also revealed population. The second goal was to compare the data
that an injury in a judo athlete, although the sport between heavyweight and lightweight injuries, and to
of judo being an individual and not a team sport, analyse if weight and the weight class system might
can have a negative effect on all the athletes simul- have any role in injury causation.
To cite: Kim K-S, Park KJ,
Lee J, et al. Br J Sports Med
taneously as they train and practice together as a
Published Online First: whole for their own personal development. 3 MATERIALS AND METHODS
[please include Day Month Recent studies in the 2008 Summer Olympic Subjects
Year] doi:10.1136/bjsports- Games also identified that a high percentage of A 4-year injury evaluation was held from January
2014-094365 competition injuries occurred in Judo.4 Other 2010 to December 2013 at the training centre in
Kim K-S, et al. Br J Sports Med 2015;0:1–7. doi:10.1136/bjsports-2014-094365 1
Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence.
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Original article

South Korea for National Level athletes. Consent was obtained RESULTS
from all subjects and was conducted according to the At the Training Center, there were a total of 782 injuries
Declaration of Helsinki. These athletes were selected to train at recorded during January 2010 until December 2013 (table 1).
the National training centre with an expectation of representing Around 95% of the total injuries occurred while training at the
South Korea at international sporting events such as the World facility. The other 5% of injuries were treated at the training
Championships and Olympic Games. On average, 24 male ath- centre, but only after the athlete returned from competition and
letes and 24 female athletes trained and competed annually at did not receive adequate treatment prior to arriving at the
the centre. The athletes were divided into two groups (light- centre. Men had a total of 379 injuries during that time (181
weight and heavyweight) to compare injury trends between lightweight injuries and 198 heavyweight injuries). Women had
lighter and heavier athletes. The categories were set by dividing a total of 403 injuries (196 lightweight injuries and 207 heavy-
the weight classes in Olympic Judo. Of the 24 males, 10 were weight injuries). When comparing males and females in their
lightweight athletes and 14 were heavyweight athletes. Of the respective weight categories, the OR (95% CI) value was found
female athletes, 11 were lightweight and 13 heavyweight. Elite to be 1.04 (0.78 to 1.37), and the distribution of injury rate in
athletes were divided into Major (top-ranked) or Minor ( pos- the two categories was analogous to each other. Thus, the differ-
sible candidate athletes). Annually, 25–30% of the athletes were ence in this injury rate between sex and weight category was not
in the Major category and most of them were at the facility statistically significant ( p=0.8060). The total injury rate was 4.1
during the 4 year surveillance. The Minor athletes, on average, injuries/year for each athlete. For men, the annual injury rate
stayed for a year at the facility if they did not qualify higher up was 4.0 injuries/male athlete (4.5 for lightweights and 3.5 for
in the ranking. Athletes trained on average 4.5 h per day, 5 days heavyweights). For women, the annual injury rate was 4.2 injur-
a week. Training during this time included strength and condi- ies/female athlete (4.5 for lightweights and 4.0 for heavy-
tioning, and also judo-specific training. The athletes were weights). As each athlete averaged 975 h of training annually,
present at the facility for 10 months (43.3 weeks) in of the year, the injury rate was 4.2 injuries/1000 h of training per athlete at
totalling 975 h of training annually.

Data collection
For this study, an injury was defined as any musculoskeletal Table 1 Body region injuries: men and women
symptom, new or recurring, during their time of stay at the N (%)
training centre, whether it was witnessed, or when the athlete Site Men Women Total
sought medical attention.16 During the athlete’s stay at the train-
Head N/A (0.0) N/A (0.0) N/A (0.0)
ing centre from January 2010 to December 2013, injuries wit-
Face N/A (0.0) N/A (0.0) N/A (0.0)
nessed or reported by the elite judo athletes were examined by
Neck/cervical spine 20 (5.3) 24 (6.0) 44 (5.6)
the facilities’ Sports Physician or by an experienced Sports
Head and neck 20 (5.3) 24 (6.0) 44 (5.6)
Physician of an outside hospital. Any athlete who chose to be
examined at an outside hospital still had to report to the train- Shoulder/clavicle 42 (11.1) 38 (9.4) 80 (10.2)
ing staff and receive all physical therapy at the training centre Upper arms N/A (0.0) N/A(0.0) N/A (0.0)
facility. From 2010 to 2011, one physician was in charge of all Elbow 32 (8.4) 27 (6.7) 59 (7.5)
the injury diagnoses. A new physician took over in 2012 and Forearm 4 (1.1) 7 (1.7) 11 (1.4)
was present till the end of this study. After being diagnosed, the Wrist 18 (4.7) 17 (4.2) 35 (4.5)
athletes received treatment from the physical therapists, where Hand 13 (3.4) 11 (2.7) 24 (3.1)
the plan and duration of treatment were recorded. On average, Finger 12 (3.2) 12 (3.0) 24 (3.1)
8.5 physical therapists were at the medical/rehab centre of the Thumb N/A (0.0) N/A (0.0) N/A (0.0)
facility during the 4 years. Two physical therapists left and were Upper body 121 (31.9) 112 (27.8) 233 (29.8)
replaced by two other therapists during this study period. Data
Sternum/ribs 14 (3.7) 12 (3.0) 26 (3.3)
regarding the site of injury, the athletes’ weight class (light and
Thoracic spine/upper back 29 (7.7) 18 (4.5) 47 (6.0)
heavy), gender and injury grade (grade I=1–3 treatment days,
Abdomen 1 (0.3) N/A (0.0) 1 (0.1)
grade II=4–7 treatment days, and grade III ≥8 treatment
Lumbar spine/lower back 39 (10.3) 46 (11.4) 85 (10.9)
days)17 were extracted and assessed. Injury site was set to the
Pelvic/sacrum/buttock 10 (2.6) 14 (3.5) 24 (3.1)
regions used by the IOC during the London Summer Olympic
Trunk 93 (24.5) 90 (22.3) 183 (23.4)
Games,18 and then subdivided into the head and neck, upper
body, trunk and lower body regions. Hip N/A (0.0) N/A (0.0) N/A (0.0)
Groin N/A (0.0) N/A (0.0) N/A (0.0)
Statistical analysis Thigh 26 (6.9) 29 (7.2) 55 (7.0)
Variables examined included gender, weight class, body regions Knee 40 (10.6) 36 (8.9) 76 (9.7)
and injury grade. Injury rate, injury frequency of each body Lower Leg 32 (8.4) 42 (10.4) 74 (9.5)
region, and incidence of injuries were identified. Data were ana- Achilles 2 (0.5) 5 (1.2) 7 (0.9)
lysed using Microsoft Windows SPSSWINN 21.0. The χ2 test Ankle 28 (7.4) 38 (9.4) 66 (8.4)
was used to test the statistical significance of categorical data. Foot/toe 17 (4.5) 27 (6.7) 44 (5.6)
The Poisson Distribution was used to obtain the Z score by Lower body 145 (38.3) 177 (43.9) 322 (41.2)
assessing the statistical significance of data when the average rate
Multiple body locations N/A (0.0) N/A (0.0) N/A (0.0)
of injury in a fixed interval of time was compared within differ-
N/A N/A (0.0) N/A (0.0) N/A (0.0)
ent groups. To calculate OR and 95% CI values of injury rates
Total 379 (100.0) 403 (100.0) 782 (100.0)
between gender and weight class, logistic regression analysis was
performed. The level of significance in all statistical analyses was Bold typeface denotes sum value of above.
N/A, not applicable.
set at p=0.05.
2 Kim K-S, et al. Br J Sports Med 2015;0:1–7. doi:10.1136/bjsports-2014-094365
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Original article

injuries than total heavyweights (p=0.0078) (see online supple-

mentary tables S1 and S2). Figures 3 and 4 and tables 2 and 3
detail the rate of injury by body region, according to the ath-
lete’s injury grade and weight class. In both males and females,
lightweights experienced more grade I injuries than heavy-
weights in all four regions. Female heavyweights had greater
rates of grade III injuries than female lightweights on the head
and neck, trunk and upper body regions (figure 3). Male heavy-
weights had greater rates of grade III injuries than male light-
weights on the head and neck, upper body and lower body
regions (figure 4).

Figure 1 Injury rates per 1000 h of training in male and female judo DISCUSSION
athletes. In men, the rates were 4.6 for lightweights and 3.6 injuries for The purpose of this study was to evaluate long-term injury fre-
heavyweights (z=4.7893, p<0.001). In women, the rates were 4.6 for
quencies and trends among the elite National level judo popula-
lightweights and 4.2 for heavyweights (z=1.9111, p>0.05).
tion of South Korea. To date, there have been very few studies
that have analysed health risks in the elite judo population.
the centre. For men, the injury rate was 4.1 injuries/1000 h of Comparing the results of this study with those of previous
training. When comparing men in their respective weight studies is difficult as the definition of an injury is not standar-
classes, the rates were 4.6 for lightweights and 3.6 injuries for dised, and the methodologies of the study design varied.
heavyweights (z=4.7893, p<0.001). For women, the injury rate However, comparison with previous studies will still provide
was 4.3 injuries /1000 h of training. The comparison of rates in perspectives to injury trends among the elite judo population.
women showed 4.6 for lightweights and 4.2 for heavyweights A previous retrospective study was carried out at the same
(z=1.9111, p>0.05) (figure 1). training centre in South Korea for National Level Athletes from
Almost half of these injuries (47.1%) were grade I injuries November 1996 to December 2000. In total, the study had 172
(1–3 treatment days). Grade II injuries (4–7 treatment days) injuries during that time period. The main difference in data
were 28.6% and grade III injuries (greater than 8 treatment recording between the two studies was that the previous retro-
days) were 24.4%. Injury proportions occurred in the order of spective study only included injuries which required greater
the lower body (44.2%), upper body (29.8%), trunk (20.3%) than 1 clinic visit and/or required a minimum 3 days of treat-
and head and neck (5.6%). Men and women showed similar ment. Therefore, data from the 2010–2013 study was adjusted
trends in body region injuries (figure 2), but this was not statis- by excluding grade I injuries (1–3 days of treatment).
tically significant ( p=0.36). The knee, lower leg, ankle, lumbar Furthermore, only the total men’s and women’s data in this
spine/lower back, shoulder and elbow were the most common study were comparable, as the previous retrospective study did
sites of injury (table 1). not differentiate between weight class or gender.
In tables 2 and 3, regarding the number of injuries athletes During 1996–2000, there were, on average, 28 male and
experienced, women experienced more grade III injuries than female athletes training annually. The injury rate for the 1996–
males ( p=0.0228). However, this was significant only in a com- 2000 study was 1.5 injuries/year for each athlete, whereas with
parison between male heavyweights and female heavyweights the adjustment of the 2010–2013 study, it resulted in 2.2 injur-
( p=0.0041) but not between male lightweights and female ies/year for each athlete. Trends were found to be similar
lightweights ( p=0.6347). Comparison between women in dif- between the two epidemiological studies, although the previous
ferent weight classes also showed that women heavyweights study showed greater injuries to the knee (24.6% vs 10.2%). In
incurred more serious injuries (grade III) than women light- both studies, the order of injury proportion was similar: lower
weights ( p=0.0087). Also, half of all injuries in the female light- extremity (highest injury proportion), upper extremity, trunk,
weight category fell into grade I (similar to the male judo and head and neck (lowest injury proportion).
athletes), whereas only 35% of female heavyweight injuries fell One possible explanation for the decreased knee injury rate
into grade I. Total lightweights also incurred more mild grade 1 but overall increased injury rate in this study is the training
method. Current training methods emphasise more on personal
skill enhancement than previously (learning and attempting new
manoeuvres may broaden the types of injuries an athlete may
experience). Also, an explanation of the increase in injury rate
(from 1.5 to 2.2) may possibly be due to the difference in
recording of the injury and/or a more meticulous data collection
procedure in this study. The lower injury proportion found in
the knee joint (from 24.6% to 10.2%) could be due to prevent-
ive/awareness measures that may have taken place, as knee joint
injuries are more debilitating and also require longer periods of
time off from injury.
Two prior studies on injuries among elite judo athletes were
also compared with this study. The first study was a video ana-
lysis of 124 matches, fought by 83 different judo athletes,
during four international judo tournaments held in 2006 and
2007.19 The second study was of data gathered from the
Figure 2 Comparison of male and female injury percentile at the London Summer Olympic Games.18 The first study only
National Training Center. recorded data during competition, while the second study
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Table 2 Women heavyweight and lightweight: injury grade and values of injury region frequency
N (%)
Greater than 8 treatment
1–3 Treatment days 4–7 Treatment days days Total
Site Light Heavy Light Heavy Light Heavy Light Heavy

Head and neck 9 (0.20) 5 (0.10) 2 (0.05) 1 (0.02) 3 (0.07) 4 (0.08) 14 (0.32) 10 (0.19)
Upper body 29 (0.66) 21 (0.40) 16 (0.36) 20 (0.38) 10 (0.23) 16 (0.31) 55 (1.25) 57 (1.10)
Trunk 20 (0.45) 19 (0.37) 15 (0.34) 15 (0.29) 5 (0.11) 16 (0.31) 40 (0.91) 50 (0.96)
Lower body 40 (0.91) 28 (0.54) 23 (0.52) 34 (0.65) 24 (0.55) 28 (0.54) 87 (1.98) 90 (1.73)
Total 98 73 56 70 42 64 196 207
Bracketed values indicate rate of injury according to the number of athletes over 4 years.
Women: 44 lightweights, 52 heavyweights.

recorded injuries during competition as well as training activities In regard to spinal injuries, observance at the training centre
during the 17 days of the Olympic Games. showed that these spinal injuries usually occurred during weight
A third study in England during three Senior Collegiate level training or with extreme rotations of the back while the athlete
judo tournaments in 200520 was also used for comparison. attempted throws. A study on lumbar spondylosis showed that
Although the participants were not all at the elite level, the data judo players were significantly prone (20%) to suffer this type
had good correlation with the previous two International studies. of injury.21 It frequently occurred in athletes with repetitive
All three studies had the injuries occur in the order of upper trunk movements. A biomechanical study by Sairyo et al22 may
extremity > lower extremity > head and neck > trunk. This dif- explain this issue as it defines high stress occurring in the back
fered from the previous two epidemiological studies at the Korea during movements of extension and rotation.
National Training Center, as most injuries happened in the The knee, lower back, elbow and shoulders were the main
Lower extremity and the least in the Head and Neck regions. injured body regions found in our study. After much observa-
Another analysed difference was that injuries in the trunk were tion of the athletes, knee injuries happened frequently second-
very rare in the three studies, with none during the 2006–2007 ary to high valgus stress on the joint. The MCL and ACL were
tournaments, only one recorded during the 2012 London found to be the most common knee ligaments injured in judo
Games, and only two injuries in total (1 male and 1 female) athletes,23 as valgus force was found to be a common mechan-
noted in the trunk during the three senior level tournaments in ism of injury to the MCL24 and ACL.25 Lower back injuries
England. At the training centre, 20% of the injuries were in the were found with extreme rotations and imbalance while
trunk, most notably in the lumbar and thoracic spine. attempting throws. Most of the spinal injuries also occurred
Prior studies on injuries also noted major differences in injury secondary to weight training. Shoulder and elbow injuries fre-
trends when comparing training injuries versus competition quently happened when colliding with the mat on the ground
injuries. Studies during the Summer Olympic Games 2008 and or attempting to defend against an attack. Also secondary to
2012 similarly found that injuries in training and in competition the arm bar manoeuvre, elbow injuries were common. It can
differed significantly in all injury characteristics.4 18 be concluded that areas of the body most likely to come into
Since the most common site and mechanism of injury have contact with an opponent are most likely to sustain an injury
been shown to vary in the literature,20 further studies are in judo.20
needed, especially in the elite athletes, to compare specific Women displayed a higher annual injury rate than males (4.2
injury patterns from competitions versus in training to help vs 4.0), and women also sustained more serious grade III injur-
prevent such injuries from occurring. Also, as practice sessions ies than males. This was significant when comparison was made
are quite longer than competition periods, understanding between women and men in the heavyweight class but not
mechanisms of injury due to muscle fatigue and exhaustion may between women and men in the lightweight class. In fact, the
play a key role in having effective preventive measures. female lightweights had the same injury rate as the male

Table 3 Men heavyweight and lightweight: injury grade and values of injury region frequency
N (%)
Greater than 8 treatment
1–3 Treatment days 4–7 Treatment days days Total
Site Light Heavy Light Heavy Light Heavy Light Heavy

Head and neck 6 (0.15) 8 (0.14) 2 (0.05) 1 (0.02) 1 (0.03) 2 (0.04) 9 (0.23) 11 (0.20)
Upper body 38 (0.95) 30 (0.54) 12 (0.30) 13 (0.23) 9 (0.23) 19 (0.34) 59 (1.48) 62 (1.11)
Trunk 22 (0.55) 25 (0.45) 16 (0.40) 11 (0.20) 9 (0.23) 10 (0.18) 47 (1.18) 46 (0.82)
Lower body 31 (0.78) 38 (0.68) 22 (0.55) 20 (0.36) 13 (0.33) 21 (0.38) 66 (1.65) 79 (1.41)
Total 97 101 52 45 32 52 181 198
Bracketed values indicate rate of injury according to the number of athletes over 4 years.
Males: 40 lightweights, 56 heavyweight.

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Figure 3 Rate of injury by weight class and injury grade according to the number of athletes over 4 years (women: 44 lightweights, 52
heavyweights). Regions of the head and neck/upper body/trunk/lower body.

Figure 4 Rate of injury by weight class and injury grade according to the number of athletes over 4 years (males: 40 lightweights, 56
heavyweights). Regions of the head and neck/upper body/trunk/lower body.

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lightweights. Green also found that the two most serious injuries or even also due to their inability to lose weight and overcome
in his study affected the heavyweight judokas.20 extreme hunger and thirst.
The incidence of injuries was found to be higher in the light- In the NCAA weight certification programme, each athlete
weight class than in the heavyweight class for both males and has to be evaluated for minimum weight at the beginning of the
females (4.5>3.5 in males, and 4.5> 4.0 in females). Total season; this would be used to determine the category the athlete
lightweights also incurred more mild grade 1 injuries than total will be able to compete in during the season.33 These regula-
heavyweights ( p=0.0078). Although the comparison of the rate tions have been successful in the athletes’ weight management
of injuries in male lightweights versus male heavyweights was behaviour,33 and should also be considered in the sport of judo
statistically significant ( p<0.001), but not between female light- globally for the protection of the athletes.
weights and female heavyweights ( p>0.05), this may be a In conclusion, nearly half of all injuries in the elite judo popula-
matter of concern as studies have shown that athletes in the tion were considered minor injuries. Many of the more serious
lightweight category practise more extreme weight-loss behav- injuries seem to occur more frequently among the heavyweights,
iour than athletes in the middle and heavyweight categories.26 especially the female heavyweight athletes. The total number of
In the light of a recent death in 2014 of a middle school female injuries occur at a more frequent level among the lightweight ath-
judo athlete secondary to RWL in South Korea, and multiple letes. The exact cause is unknown, however, as lightweights are
studies showing increased risk of injury due to RWL, what per- found to practise more extreme behaviour of RWL, future studies
centage of injuries in judo can be attributed to this practice of are necessary to establish if this may play a role in causation of
RWL? more injuries. Also, a follow-up biomechanical study of move-
This practice of RWL is prevalent in sports with weight cat- ments among the elite judo population will be necessary for imple-
egories. Studies show that 90% of judo athletes have already mentations of an effective injury prevention programme.
rapidly reduced body weight before a competition, with another
study finding showing 63% reducing weight rapidly on a regular LIMITATIONS
basis.11 27 Many combat athletes have lost weight of up to 5– We were not able to factor in the 1 athlete who left the centre
10%, with many also reporting a greater than 10% reduction of on average annually midseason due to a severe injury or for per-
body weight.11 27 28 60% of judo athletes have also started this sonal reasons. However, every injury that did occur at the train-
practice at an early age (12–15), and patterns also show that ing facility had to be reported and seen within the facilities,
RWL among judo competitors are as inappropriate as those which made for consistent data gathering. Our study also did
reported regarding wrestlers before the NCAA’s weight control not measure energy availability or record RWL practices and
programme.11 This can negatively impact an individual’s growth dynamic weight changes as that would have allowed us to
and development, and the rate of obesity was also found to be address the issues of RWL. Menstrual history was also not
more prevalent in former combat athletes.29 Studies have also recorded, which is a vital medical component for all young elite
shown how RWL can have a negative impact on lean body mass female judo athletes. There are also possibilities that injuries
(LBM), strength and performance.30–33 may have been unreported due to the athletes’ fear of having to
Hydration testing revealed that almost half of the athletes lose time in competition if reported. This is a consistent issue
were seriously hypohydrated on the morning of competition faced regularly among the elite athlete population.
day.8 These deficits are known to negatively affect thermoregula-
tion, cardiovascular function and metabolism.34–36 One study
showed that the likelihood of injury significantly increased as What are the new findings?
the body does not have enough time to recover from the
dehydration.20
Dehydration secondary to RWL also affects the immune ▸ This study provides comprehensive data of injury rates and
system. With reduced water in the blood, circulation of the trends among the elite judo population.
immune system related substances was inhibited. Also, testing ▸ Elite judo athletes average roughly four injuries annually.
of neutrophils revealed cell dysfunction with dehydration.37 ▸ Women athletes, especially the heavyweights, incur more
This may be significant as one in five illnesses during the severe injuries than male athletes.
London SOG resulted in absence from training or competi- ▸ Lightweights incur more injuries than heavyweights in the
tion.18 Infection was the most common cause of illness, and elite judo population.
women in particular had a higher incidence of illnesses com-
pared to the male athletes.18 This factor may play a role in pre-
venting the athlete from achieving their lifelong goal at the
Olympics.18 How might it impact on clinical practice in the near future?
Although weight divisions were initially intended to establish
equality between opponents, the focus today seems to be more
▸ Trainers should be alerted to injuries among the women
about being able to alter their power to weight ratio and gaining
heavyweight judo athletes as there is a higher probability
an advantage by classifying into a lower weight division.8 This
that it could be a serious injury.
strategy may work initially at the lower tiers of competition, but
▸ Most injuries are of minor severity in the elite judo
we question the effectiveness if almost all of the athletes practise
population.
RWL before the tournament and compete with each other.
▸ Although many injuries are minor in nature, the Medical Team
Athletes today may be moving up the ladder of competition not
should be aware that serious long-term injuries do occur, such
just for their physical athletic attributes but also because of their
as in the knee, shoulder, cervical and lumbar spine.
willingness to possibly sacrifice their long-term health. It should
▸ Clinicians should address Guidelines and regulations,
also be considered how many talented athletes fail to achieve
acknowledging the short-term and long-term harm of
success and continue in the sport secondary to their unwilling-
continuous rapid weight loss to the body.
ness to rapidly lose body weight within a short period of time,
6 Kim K-S, et al. Br J Sports Med 2015;0:1–7. doi:10.1136/bjsports-2014-094365
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Original article
Acknowledgements The authors would like to acknowledge Dr Leisure Yu, MD, 13 Pocecco E, Ruedl G, Stankovic N, et al. Injuries in judo: a systematic literature
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and K-SK was responsible for the review of all the articles mentioned in the
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17 Goldberg AS, Moroz L, Smith A, et al. Injury surveillance in young athletes a
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London Summer Olympic Games 2012. Br J Sports Med 2013;47:407–14.
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19 Pierantozzi E, Muroni R. Judo high level competitions injuries. Medit J Musc Surv
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20 Green CM, Petrou MJ, Fogarty-Hover ML, et al. Injuries among judokas during
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Kim K-S, et al. Br J Sports Med 2015;0:1–7. doi:10.1136/bjsports-2014-094365 7

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Injuries in national Olympic level judo

athletes: an epidemiological study
Keun-Suh Kim, Ki Jun Park, Jaekoo Lee and Byung Yong Kang

Br J Sports Med published online July 27, 2015

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