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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 13  |  Issue : 2  |  Page : 84-89

Injury pattern among fencing players in India


Department of Physiotherapy, Punjabi University, Patiala, Punjabi, India

Date of Submission17-Sep-2018
Date of Decision29-Jan-2019
Date of Acceptance17-May-2019
Date of Web Publication07-Oct-2019

Correspondence Address:
Dr. Nithin Prakash
Lecturer, Alva's College of Physiotherapy and Research Centre, Moodbidri, Dakshina Kannada, Karnataka - 574 227
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PJIAP.PJIAP_42_18

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  Abstract 

BACKGROUND: Fencing is an Olympic game, played in three disciplines of the Epee, the Foil, and the Saber. Despite the long history and international scope, very few epidemiological studies on injuries in modern competitive fencing are available. A study on the injury patterns of Indian fencing players is not yet reported.
OBJECTIVE: The objective of this study is to explore the injury pattern among fencing players and to examine the association of occurrence of injury with certain risk factors.
METHODS: The sample comprised 113 fencers (79 males and 34 females). Scheduled questionnaire was the tool of data collection.
RESULTS: Point prevalence and 2 years prevalence of injuries were 12.38% and 13.27%, respectively. Acute injuries more common (78.5%) than the injuries of gradual onset (21.42%). Lower limb (100%) was the most common site of injuries. The ankle was the most frequently injured body part (64.28%). The event of the Epee had the highest proportion of injuries (15.69%) followed by the Foil (10.36%) and Saber (9.09%). Injured players were found to have spent significantly more time in footwork; although; the age, level of play, sex, and type of events, previous injuries, and training habits were not found significantly associated with the occurrence of injuries.
Conclusion: It is concluded that Indian fencing players presented with a less prevalence of injury, out of which majority of injuries were in the lower limb.

Keywords: Epidemiology, fencing, injury pattern, injury


How to cite this article:
Prakash N, K. Sinha A G. Injury pattern among fencing players in India. Physiother - J Indian Assoc Physiother 2019;13:84-9

How to cite this URL:
Prakash N, K. Sinha A G. Injury pattern among fencing players in India. Physiother - J Indian Assoc Physiother [serial online] 2019 [cited 2020 Feb 23];13:84-9. Available from: http://www.pjiap.org/text.asp?2019/13/2/84/268642




  Introduction Top


Fencing or sword fighting is a sport in which two people attempt to score touchés on one another by using blunted weapons on linear fencing area.[1] This game of great skills and temperament is one of four sports which have featured at every modern Olympic. The sport of fencing requires the speedy movements of the body to avoid being stuck while attempting to strike the opponent to win points. The game is played in three disciplines of the Epee, Foil, and Saber. The weapon and the target area of scoring are different in each discipline. Foil and epee are “point” weapons, where scoring requires touching the opponent with the tip of the weapon through thrusting motions.[2] Saber is a cutting weapon where the scoring occurs when any part of the blade makes contact with opponents with cutting/slashing motions. The area of attack in the Epee is the whole body, the torso in Foil, and above the waist in Saber. All three weapons are fenced by men and women in international contests of Olympics and World Cup.[3]

Despite being the oldest sports discipline in the history of Olympics, the literature on injuries in the game of fencing is sparse.[3] There exist very few well-designed injury studies in the game of fencing worldwide. Need has been expressed to design studies to explore the coordinated set of research questions such as injury rates for various subpopulations (children, youth, veterans, women, and wheelchair) across all three events, and expanding analyses to explore specific risk factors (sex, age, training/experience, etc.).[2] With regard to Indian fencing players, the investigator could not locate any study on the epidemiology of fencing injuries in India. Such study forms the basis of an injury prevention program. Keeping this in mind, the present work intends to study the injury pattern in fencing players of India.


  Methods Top


The sample consisted of 113 fencers (79 males and 34 females) recruited using convenient sampling and snowball technique with the intension of capturing as much fencer as possible. The inclusion criteria were playing age of 2 years within the age group of 18–26. This criterion was adopted to exclude the recreational players. Participants were recruited from Punjabi University Patiala, National Institute of Sports (NIS) Patiala, and from the Fencers who participated in the All India Inter-University Fencing Championship 2017, Guru Nanak Dev University (GNDU), Amritsar. Punjab, India. The data were collected during November 2016–January 2017 through scheduled interview.

Survey instrument

After an extensive review of the literature, an interview schedule was developed. The initial draft consisting of 63 questions was shown to a national fencing coach and a senior physiotherapy expert to validate the content, and as per their suggestions, 15 questions were deleted. Thereafter, the questionnaire-containing 48 questions was field tested on 12 fencers. It was observed that eight questions were difficult to comprehend. Therefore, six questions were deleted, and the wording of two questions was modified. The final interview schedule consisted of 42 questions which were further divided into four sections focusing on demographic and training profile, present injuries, past injuries, and opinion of players on the occurrence of injuries in the game.

Survey protocol

After getting the clearance from the Ethical committee, the investigator personally went to Fencing halls and met respective coaches. Coaches were taken into confidence by explaining them in detail about the aims, objectives, purpose, and significance of the study. The data collection at All India Interuniversity Fencing Tournament was done with prior permission from Directorate of Sports, GNDU, Amritsar and Chief Coach of NIS Patiala. The fencers were interviewed during the competition, practice schedule in appropriate break times to not to disturb competitors, and practice session. It was explained to them that the information taken from them would be used only for research purposes and it was assured that no information about the individual player would be revealed to anybody during or after the study. No award, incentives were given to the subject; however, those who had found afflicted with musculoskeletal problem advised going for physiotherapy.

Statistical analysis

Mean, standard deviation, and percentage were used to prepare summary statistics. Independent sample t-test and Chi-square test were used to determine the association of continuous and categorical variables, respectively. Statistical significance was accepted at P < 0.05 level.


  Results Top


Of 113 players, 14 were found afflicted with injury at the time of interview giving the point prevalence of 12.38%. Among the injured 28.5% of players had suffered injury in the past 24 months preceding the time of the survey. Ten players (71.4%) had sustained injuries for the first time giving an incidence rate of 8.84% in the current session [Table 1].
Table 1: The prevalence of current and past injury in the game of fencing

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Acute injuries having sudden onset were more common (78.5%) than the injuries of gradual onset (21.42%) [Table 2]. Lower limb suffered more injuries than the upper limb and ankle was the most frequently injured joint (64.28%), followed by the knee (14.28%) and foot (7.14%). In the opinion of players, knee was the most susceptible part for injury in the game of fencing [Table 3].
Table 2: Distribution of injury according to the onset of injury

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Table 3: Distribution of injury according to body parts on the present injury, past injury, and opinion of players

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The analysis of the association of the risk factors with the present injury [Table 4] revealed that cool down, weekly training hours, monthly training hours, yearly training hour, time spent for target practice, gender, and previous injuries were not significantly associated with the occurrence of present injury. The injured players were found to have spent more time on footwork though the difference was not statistically significant. The number of injuries increased as the level of play goes higher. International players (28%) sustained more injuries than National and University players (2.70%). The event-wise analysis showed the Epee was the game in which there were most injuries (15.69%) followed by the Foil (10.34%) and Saber (9.09%) [Table 4] the nature of data did not permit statistical analysis of categorical data.
Table 4: Association of risk factors with the occurrence of current injuries

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  Discussion Top


The purpose of this study was to study the epidemiology of injuries in the game of fencing with respect to incidence, prevalence, body parts commonly affected and to examine the association of risk factors with the occurrence of injuries.

About 12.38% of the players were found injured during the time of the study and 13.27% of players sustained from injury in the past 2 years. This gives the point prevalence of 12.38 and 2 years prevalence of 13.27%. This finding is largely in disagreement with Trautmann and Rosenbaum[4] who observed that 92.8% of elite and recreational fencing athletes experienced injuries and pain. Previous studies[5],[6] have reported the prevalence of injury as low as 20%–27.5%. However, some studies[7],[8] have reported injury rates as high as 59%–77.8%. These studies used different definitions of injury making it difficult to compare the results. In general, the studies that reported injuries of a single competition[2],[5],[6] reported low prevalence, whereas the studies that included self-reported injuries in fencing career[7],[8] reported high prevalence rates. Investigator could not locate any study on Indian fencing players. This makes the comparison of findings difficult. The very less occurrence of injuries observed in the lend support to the supposition that fencing is a safe game.

The use of weaponry and martial origin gives the impression that it would be a high-risk sports. However, it should be noted that the game of Fencing is carried out in the bounds of strict rules and regulations. It is strictly forbidden for a fencer to perform any abnormal motion, such as severe hits or opponent collision that may be construed as discourteous and dangerous.[1] The use of approved safety equipment is mandatory during competition and practice. The protective jacket must overlap the knickers (or uniform of Kevlar-type material), a plastron is mandatory, and women must wear breast protectors. The glove must cover at least one-half of the forearm so that the opponent's weapon cannot enter the sleeve. All masks must be checked by an instrument with a spring-loaded point before the competition to ensure that the mask cannot be penetrated by the opponent's blade.[1] Both these factors, i.e., rules and protective gears can be attributed to reduced occurrence of injury.

The acute injuries having sudden onset were more common (78.5%) then the injuries of gradual onset (21.42%). This observation is in agreement with the previous studies. In the study of Moyer and Konin,[9] 55.2% of the injuries were acute and 44.8% were chronic injuries. Carter et al.[8] reported that 67% of the injuries were acute and 33% was overuse injuries having gradual onset. Jager[10] observed that 60.3% of injuries were acute and 39.7% were overuse injuries. Two of these studies were conducted in the USA, whereas one was conducted in Germany.

With regard to the analysis of injuries according to the body part, only injuries of the lower limb was reported in the current session, and no player had reported sustaining injuries either in upper limb or in the trunk and face. However, in the analysis of past injuries up to 2 years, a total of 15 injuries were reported of which, 13.33% were of the upper limb and 20% injuries involved the trunk. All the upper limb injuries were of sudden onset, whereas all the lower limb and trunk injuries were of gradual onset. In fencing literature, the lower extremities were described as the most common site of injury.[11],[12],[13],[14] The result of the present study supports this notion. Rey et al.[14] comparing two championships observed that, lower limb injuries were more frequent during competition in both world championship as well as Olympics. In world championships, lower limb injuries (47) were higher in number than upper limb injuries (33). On comparing the two Olympics, they found that lower limb injuries (29) were higher than that of upper limb injuries (24).

The ankle was the most frequently injured body part in both in the current session (64.28%) as well as the previous two sessions (26.7%). However, in the opinion of players knee was the most frequently injured joint. The literature provides conflicting information on the most commonly injured part. Some studies[11],[15] have reported the highest occurrence of injury in the ankle. However, in the largest prospective, exposure-based study of fencing injury (78,223 participants), Harmer[13] noted that the knee was the most commonly injured region (19.6%). Carter et al.[8] in the largest retrospective self-report study to date involving 1603 respondents reported that the knee (17%–19%) and ankle (14%–14.5%) as the locations of both the worst injury suffered in the previous year and the worst injury suffered in a fencing career. Some studies[6],[5],[16] have also reported that the highest proportion of injuries involved the wrist, hand, and fingers. However, in the present study, no injury to the upper limb was reported during current sessions, whereas in the previous sessions, only two injuries involving forearm and palm were reported.

The event of Epee had the highest proportion of injuries (15.69%) followed by Foil (10.36%) and Saber (9.09%). It is generally believed that owing to rules of the game, the event of epee has more chance of injuries. The total body is the legal target in the épée, and both players can simultaneously score the point due to the absence of no right-of-way rule in this event. Further, in comparison to other weapons, the épée has greater stiffness and weight.[1] However, the literature on this issue provides conflicting information. Majorano and Cesario[5] observed that Foil players sustained twice more injuries than the other style of playing. Harmer[2] reported that foil and epee were not significantly different in the rate of time-loss injuries, but the Saber players have a higher risk of time loss injuries than the other two disciplines. The reason for this discrepancy may lie in the different definition of injury used in different studies. Knowles et al.[1] included all the injuries reported to medical personals, whereas Harmer[13] analyzed only the time loss injuries. In the present study, the injury was defined as any injury sustained by fencer during competition or training that resulted in change in training.

The information with regard to extrinsic and intrinsic risk factors in the game of fencing is limited making it difficult to compare the findings. In the present study, an attempt was made to examine the influence of age, level of play, sex, type of events, previous injuries, and training habits on the occurrence of injuries. Except for hours spend on footwork practice, none of the factors was found significantly associated with occurrence of injuries.

Some studies[13] have suggested that women fencer is more susceptible to injuries. Harmer[13] found that women had 35% higher risk for a time-loss injury in competition than men.[13] Wild et al.[12] also observed that women had a three times higher rate of ankle injury than men; however, they did not provide information on the statistical analysis done to reach this conclusion. In the present study, gender was not found associated with the occurrence of injuries. About 11.76% of female fencers (4 of 34) sustained injury in the current session. The proportion of male fencer sustaining injury was 12.65%.

Limitations of the study include a relatively small sample size and one-time interview of the player. Method of inquiry was a retrospective recall having its own limitation. The psychological factor that might have affected the response could not be controlled. There is an urgent need to cross-validate the findings on a larger sample in further prospective studies. In conclusion, this study provides support to the notion that fencing is a safe game with low prevalence of injuries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Knowles JM, Jaffe R, Adrian M. Fencing. In: Fu FH, Stone DA, editors. Sports Injuries: Mechanisms, Prevention, Treatment. 2nd ed. Pennsylvania: Lippincott, Williams and Wilkins; 1994. p. 352-63.  Back to cited text no. 1
    
2.
Harmer PA. Getting to the point: Injury patterns and medical care in competitive fencing. Curr Sports Med Rep 2008;7:303-7.  Back to cited text no. 2
    
3.
Harmer PA. Fencing. Fencing. In: Caine, Harmer, Schiff, editors. Encyclopedia of Sports Medicine. Vol. 16. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 3
    
4.
Trautmann C, Rosenbaum D. Fencing injuries and stress injuries in modern fencing sport- a questionnaire evaluation. Sportverletz Sportschaden 2008;22:225-30. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 4
    
5.
Majorano M, Cesario S. Acute traumatic injuries in practice fencing agnostical sports. Med Dello Sport 1991;44:281-9. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 5
    
6.
Naghavi SH. A study of traumatic events in junior fencing competitions. Escrime 2000;34:12-3. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 6
    
7.
Nye E. Fencing injuries – A New Zealand survey. Aust J Sports Med 1967;2:35-39.as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 7
    
8.
Carter C, Heil J, Zemper E. What hurts and why data from the 1992 USFA fencing injury survey show some common culprits. Am Fencing 1993;43:16-7, 29. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 8
    
9.
Moyer J, Konin J. An overview of fencing injuries. Am Fencing 1992;42:25. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 9
    
10.
Jäger A. Sports injuries and damage while fencing special consideration of the child and adolescence. Sportorthopädie Sporttraumatol 2003;19:253-61. as cited in Harmer PA. Fencing. In: Caine DJ, Harmer PA, Schiff MA. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 10
    
11.
Gambaretti R, Berlusconi M, Lanzani A. Traumatology from fencing: Study of the pathology typical of the discipline in relation to the evolution of the athletic gesture. J Sports Traumatol Related Res 1992;14:139-48. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 11
    
12.
Wild A, Jaeger M, Poehl C, Werner A, Raab P, Krauspe R. Morbidity profile of high-performance fencers. Sportverletz Sportschaden 2001;15:59-61. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 12
    
13.
Harmer PA. Incidence and characteristics of time-loss injuries in competitive fencing: A prospective, 5-year study of national competitions. Clin J Sport Med 2008;18:137-42. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 13
    
14.
15.
Müller-Strum A, Bierner, K. Fechtsportunfälle – Epidemiologie und prävention. Dtsch Z Sportmed 1991;42:49-52. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 15
    
16.
Roi GS, Fasci A. Investigation of traumatic events in races fencing youths. Med Dello Sport 1986;39. as cited in Harmer PA. Fencing. In: Caine, Harmer and Schiff, editor. Encyclopedia of Sports Medicine. Vol. 14. Lausanne: International Olympic Committee; 2011. p. 124-32.  Back to cited text no. 16
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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