The Prevalence and Etiology of Ankle Injury in Professional Karate Players in Iran

* Corresponding Author: Hamidreza Naserpour, PhD. Student. Address: Department of Biomechanics and Sport Injuries, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran. Tel: +98 (936) 6798689 E-Mail: hamidreza.naserpour@gmail.com 1. Department of Biomechanics and Sport Injuries, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran. 2. Department of Sport Injuries and Corrective Exersice, Faculty of Physical Education & Sport Sciences, University of Tehran, Tehran, Iran. *Hamidreza Naserpour1 , Mona Mirjani2


Introduction
thletes are always exposed to the potential harm that can be reduced if being aware of its cause, treatment, and appropriate preventive measures [9]. Low risks and minor injuries associated with karate are commonly believed by athletes [10,11]. Previous research A has reported less injury in karate, compared to other sports [10]. Accordingly, most injuries in karate include blows, sprains, and minor injuries. Serious injuries, including fractures and sprains, are more common in sports, such as football, wrestling, weightlifting, skiing, running, taekwondo, judo, volleyball, and basketball [9,10,12]. It is essential for coaches, athletes, and physicians to understand the relevant etiology, prevention, and treatment; this might help to recognize which body parts are most affected [12,13]. Numerous studies have suggested that the ankle joint is most vulnerable to injury, compared to other body joints [17][18][19][20]; approximately 2% of all injuries are related to this part of the lower limb [19]. To increase safety in sport, a mechanism and its associated factors should be identified, followed by preventive measures to reduce injury [9]. Injury prevention strategies can change the injury profile in different sports through effective interventions. Injury profile widely varies in different sports; therefore, preventive measures must be appropriate to the sport to prevent injury [24]. The current study investigated the prevalence and etiology of ankle injury in professional karate players in Iran.

Participants and Methods
This was a descriptive retrospective study. In coordination with the Karate Federation of the Islamic Republic of Iran, 390 karate players in fighting style (kumite) participants in the national team selection were recruited based on a convenience sampling technique. Data collection tools were: 1. A demographic data form surveying height, weight, age, and Body Mass Index (BMI); 2. Sports Information Questionnaire, surveying sports experience, the number of training sessions, the number of days and hours of training, the duration of training, the type and duration of warm-up; 3. Ankle Injury History Questionnaire, surveying injury history, injured leg (dominant and non-dominant), the causes of injury, the time of injury, and the type of treatment and aftercare treatments; 4. Foot and Ankle Ability Measure (FAAM), i.e. a self-report instrument. It is designed to measure musculoskeletal disorders of the lower extremities as well as physical function in patients with ankle instability and injuries [25]. Table 1 provides information on the history of ankle injury in the study participants. The Mean±SD scores of the two subscales of daily living and sports obtained from FAAM were 86.88±11.31 and 84.29±15.54, respectively. The study subjects' self-reported Mean±SD scores on the subscale of daily living and sports were 87.21±13.11 and 86.59±14.42, respectively. Furthermore, correlation coefficients of the two subscales with self-reported scores were 0.588 (P=0.000) and 0.742 (P=0.000), respectively.

Discussion
The present study investigated the prevalence and etiology of ankle injury among professional karate players in Iran. In this regard, we identified the factors affecting the injury and the extent of ankle joint motor self-awareness in the study subjects. By identifying the causes and factors involved in the ankle injury, then taking preventive measures to reduce the extent of the injury, a comprehensive program could be formulated to reduce its financial and mental burdens. In total, 86% (335) of the study athletes reported a history of an ankle injury, with ˃50% of these injuries occurring over the past year. Ankle injuries in both feet, dominant leg and non-dominant leg were the most frequent injuries, respectively. Of these, 46% reported that they sometimes had impaired sports performance and 25% reported that ankle injuries had no negative impact on their performance. This finding is consistent with those of Rahimi et al. [27], Sahebozamani et al. [28] and Del Vecchio et al. [29]. Given the widespread prevalence of injury in athletes, special strengthening and proprioceptive training programs should be considered for coaches and athletes to reduce the extent of such injuries.

Conclusion
In total, 86% of karate players reported ankle sprains and injuries; the highest injury occurred during the competition. The most common causes of ankle injury were the sudden rotation of the foot and kicking the opponent. Given the prevalence of injuries, it is recommended that proprioceptive and strengthening programs be considered for coaches and athletes to reduce injury risk in this population. Due to the athletes' lack of follow-up for treatment and rehabilitation in most injuries, there is a possibility of re-injury to the ankle; therefore, the recovery process should be performed after injury under the supervision of a physician. Besides, returning to training should occur after a proper interval.

Compliance with ethical guidelines
Prior to the study, participants were informed of the study objectives and methods and an informed consent was obtained from them. They were assured of the confidentiality of their information.

Funding
This research did not receive any financial support from funding agencies in the public, commercial, or not-forprofit organizations.

Conflicts of interest
The authors declare no conflict of interest.