The objective of this retrospective investigation was to assess training characteristics, competition preparation habits, and injury profiles of taekwondo athletes. By having the athletes complete a survey, several areas of concern regarding competition preparation and injuries were highlighted.
Training and injuries
When examining the training habits of taekwondo athletes, the current study reviewed several components of performance. Respondents had significant experience in the sport, with over 75% having six or more years of involvement. Training time, measured by number of practices per week and number of hours per practice, was also high. Over 53% of practices were two hours, with over 45% of athletes practicing between two to four times per week. Of importance is the relationship of how training time and competition is affected by injury. Unfortunately, our sample size was too small to have meaningful comparisons.
Other authors have reviewed this relationship. In a study by Feehan and Waller , competitive performance affected by previous injury was examined. On the day of the competition, 35% of respondents had a current injury affecting performance. Some of these required strapping or support in order to perform. Seventeen percent reported continuing to train/compete against medical advice. Even with these injury rates, the authors noted that fight outcome was not significantly associated with current or previous injuries. One conclusion which might be drawn is that the injuries reported were not severe enough to negatively impact the athletes' performance. It can also be assumed that many of those with severe injuries would have chosen to withdraw from or not enter the competition until an appropriate level of health was reached.
Practice activities among the respondents varied. A large proportion of respondents warmed up prior to kicking drills, while less than 25% cooled down. One possible explanation for warm-up participation may be that it is encompassed within the class. On the other hand, cool downs may be left to the discretion of the athlete once training is finished. In the current study, stretching was considered a separate activity from warm-ups and cool-downs. Over 60% of respondents stretched both before and after training, while just over 40% stretched prior to training only. In future studies, it would be interesting to note if stretching occurred after warm-up, which is a newer trend of thinking in the prevention of muscle injury . Within the questionnaire, it was specified that cool down exercises did not include stretching. By doing this, the authors intended to eliminate the overlap between the stretching and cool down items. Future studies should allow subject to specify the various types of cool down activities used, such as light jogging or light-paced jumping jacks. Future studies should also examine the relationship between injury rates and the use of stretching, warm-ups, and cool downs. Due to a limited sample size the current study was not able to make these comparisons. The final training activity examined in the current study was sparring. This was an integral part of taekwondo training, with over 50% of respondents sparring three to four times per week. The current study attempted to examine the relationship between frequencies of sparring when injured, but there were no statistically significant differences. Birrer  reported that most injuries occur during sparring, thus it is an area of training which deserves specific focus. Future studies should focus on both injury type and frequency occurring during sparring, as well as limitations in sparring due to injury.
In the current study, training was most frequently reported as the time of injury and relatively few injuries occurred during competition. Even so, the overall reported injury rate was quite high, at 520/1000 A-E. The injury rates calculated for both training and competition are likely to be skewed. Firstly, respondents were asked to simply report if they had been injured during competition or training. A more accurate representation may have occurred if athletes were asked to report how many competitions they had participated in during the previous year and if they had suffered injuries during any of these. Training injury rates may have also been affected by athletes returning to play prior to complete resolution of their problem. This could make athletes more susceptible to subsequent injuries.
When reviewing injury location reported in the current study, it was not surprising, that the lower extremity received the most injuries. This was also true for all subsequent injuries reported (up to five per athlete). These results are consistent with those of several other studies [2, 5]. The upper limb was the second most frequently injured region, with the head being the least frequently injured. Sprains and strains were the most common injuries, followed by contusions, which is similar to other research . Other reports have listed contusions and concussions as the most common forms of taekwondo-related injuries [3, 6]. Zemper et al.  reported that contusions were the predominant type of injury in his study of injury rates recorded during the 1988 US Olympic team trials for taekwondo.
In general, the number of practices missed decreased with subsequent injuries. Also, there were relatively few athletes who missed a large number of practices. This is perhaps attributable to injury severity. One explanation for fewer missed practices could be that once an athlete experienced one injury, s/he was more likely to increase the use of protective gear, thus avoiding or decreasing future injury severity. Future studies should examine if there is a relationship between increased uses of protective gear following an injury.
Recently, there has been increased concern regarding head injuries in taekwondo. Koh and Watkinson  reported that when compared to other contact sports, competition Taekwondo had the highest incidence rate of concussions. This might be explained by the fact that athletes are awarded points for head contact. Disturbingly, it was also found that over 30% of concussed athletes suffered more than one significant head blow in the same match. Also, among 99% of the head blows, no evasive manoeuvres were attempted. This would suggest that athletes are poorly trained in blocking skills. Pieter and Zemper  also reported that contusions and cerebral concussions were the leading injury types among young male and female Taekwondo athletes. Again, unblocked attacks were a frequent occurrence in these injuries. Widespread safety education on head injuries, and more specifically concussions, is needed among Taekwondo athletes, trainers, and referees. Improved blocking skills and headgear are a priority in order to help avoid serious injury.
Following injury, a variety of care was sought by the current study's athletes. Interestingly, one quarter of the athletes chose not to seek any form of treatment. This could perhaps be accounted for by the athlete's perception of the injury being relatively minor, or being able to manage it without medical advice. Several health professional were consulted by the injured athletes. These included medical doctors, physiotherapist, chiropractors, acupuncturists, and massage therapists. In addition, several athletes consulted multiple therapists. Athletes are generally anxious to return to their pre-injury status, and often become impatient with long-term therapy. This may explain why multiple health professionals were consulted. Also, some health professionals realize the benefit to a multidisciplinary approach, and use a network of referral sources when necessary.
Not surprisingly, more than half of the competitors in the current study dieted prior to competition in order to make their weight class. Although the questionnaire did not specifically define fasting, the subsequent question provided several categories of fasting, such as "did not eat and drink", "did not drink but eat", and so on. Even with the lack of a clear definition for fasting, fifty percent of the participants reported having completely restricted food intake, while 33% fully restricted food and liquids. Because of the nature of this tournament setting, it was not feasible to weigh athletes prior to their competition. As such, the authors were not able to report actual weight loss occurrence among the athletes. Future studies should focus on intended and actual weight loss among Taekwondo athletes in order to better capture the occurrence of weight cycling in the sport.
Rapid weight loss is a common practice among athletes in weight class sports. Hall and Lane  reported that their boxing subjects lost an average of 5.16% of their body weight within one week. Along with the weight loss, subjects reported higher anger, fatigue, and tension, as well as reduced vigour. Participants were able to maintain their baseline performance of circuit training when at the reduced weight, although the scores were significantly lower than the athletes expected. It can be postulated that athletes have a misplaced sense of improved strength and performance capabilities when weight cycling for competition. Unfortunately, these views may be reinforced if a weight cycling athlete wins a competition, thus increasing the likelihood of using the strategies in the future. In a study by Alderman et al.  examining the prevalence of and weight loss techniques used by high school wrestlers, more successful wrestlers engaged in rapid weight loss (RWL) versus less successful wrestlers. This further reinforces the use of RWL among young competitors.
What is particularly striking are the methods used to induce rapid weight loss. Among high school wrestlers, excessive running was used by almost 92% of individuals practicing RWL. Exercising in rubber/plastic suits and using saunas are prohibited in American high school wrestling, but they continued to be used by 40–60% of wrestlers to achieve RWL . Thirty-six percent of respondents in the current study did aerobic exercise in addition to dieting to make their weight, but specific activities were not asked for in the survey.
Many short term and long term side effects have been reported with rapid weight loss. Alderman et al.  reported multiple symptoms experienced by collegiate weight cycling wrestlers. Over 46% of participants experienced headaches, while over 44% and 42% experienced dizziness and nausea, respectively. Other symptoms included hot flashes, nosebleeds, feverish sensations, disorientation, and increased heart rate. Wenos and Amato  reported that college-level wrestlers also experienced an increased perception of effort as muscle strength and endurance decreased with rapid weight loss.
Fogelholm et al.  studied the effects of gradual versus rapid weight loss in national wrestlers and judo athletes on nutrient intake, micronutrient status, and physical performance (sprint, jump height, and anaerobic performance). A 5% to 6% reduction in body weight was reported in the gradual and rapid loss groups. Nutrient intake was significantly decreased in both groups in B1, B2, K, Ca, Mg, Fe, and Zn values, compared to baseline measures. Speed, vertical jump, and anaerobic performance were not impaired by either rapid or gradual weight loss. Other studies have also reported that despite nutrient depletion, performance of Olympic level amateur boxers during rapid weight loss was not significantly different versus times of normal dietary behavior. These authors concluded that despite reduced carbohydrate intake, there were other sufficient energy sources to meet performance demands . In contrast, Filare et al.  reported that all mean micronutrient intakes were below recommended values, while triglyceride levels and free fatty acids were increased in weight cycling judo athletes. Left hand grip values and 30-second jump test output were decreased after seven days of food restriction.
By reviewing the literature, some might argue that the evidence of health risks from weight cycling is equivocal. Even so, there are several possibilities that may help explain the lack of supporting data. One possibility is that there may be no effect. Another proposed by Waslen, McCargar, and Taunton , is that the duration, frequency, and severity of food restriction among the judo athletes in their study may not have been sufficient to have an effect. Even with a lack of strong support to illustrate the ill effects of weight cycling, monitoring dietary habits of athletes in weight class sports is recommended. It is more prudent to assume that larger weight losses and more frequent dieting could potentially result in negative physiological and performance consequences. Widespread regulations need to be implemented to control weight cycling practices among weight class sports. Athletes need to be educated regarding the negative effects of the practice on both their health and performance.
Support is often key to athletes at higher levels of competition. The current authors examined athlete support by significant others. The majority of athletes reported receiving support from either their parents, or spouse/partner. Unfortunately, the questionnaire used in this study did not delve into the various aspects of psychological state or support. In this pilot study, respondents were simply asked "Are your parents supportive of your involvement in Taekwondo?" and "Is your spouse or significant other supportive of your involvement in Taekwondo?" It is obvious that neither of these questions addresses the various components involved in support. Future studies need to be more specific in questioning the types and level of support provided to athletes, whether it be emotional, financial, or other various forms of support. As such, these results are of little contributive value. It should be noted that although a large percentage of the athletes felt prepared for the competition, they also reported being nervous. The significance of anxiety and other personality traits in competitive sport has long been studied. It has been reported that winning Taekwondo athletes had lower cognitive and somatic anxiety and higher self-confidence then their losing counterparts . Others found no support for the relationship between competition trait anxiety and Taekwondo performance . Even so, for ultimate personal success, athletes often require a strong support base. This encompasses a sense of understanding, trust, and support from the trainer, and significant others.
In weight class sports, the potential effects of weight cycling must also be kept in mind. As noted above, several studies have reported deleterious effects associated with rapid weight loss. These effects may involve one's mental status. Filaire et al.  reported that confusion, anger, fatigue, and tension were significantly higher after weight loss. Vigor was also significantly lower after food restriction. Thus, when considering the psychological preparedness of an athlete, multiple factors must be measured.
There are a few limitations in the present study which need to be addressed. The most obvious methodological issue in this study is that the questionnaire has not been validated. There is very little reported research regarding precompetition habits among Taekwondo athletes. As such, the authors felt it necessary to develop the questionnaire, knowing that there would be issues with its validity. Because this is a pilot study, the results from this study should be used with caution and as a means to enhance future studies in this area. In addition, the small sample size significantly affected statistical analysis. No correlations were significant and thus specific conclusions regarding associations between training behaviors and injuries could not be made. The response rate was low, likely due to the fact the participants were asked to complete the surveys upon entering the tournament building. Athletes may have neglected to complete or return the surveys because of lack of time or feeling that it was not a priority prior to their match. Also, a self-report retrospective survey may be affected by poor recall and perception bias. For example, the recall of more severe and painful injuries would likely be better than that of minor injuries/trauma. The survey was also completed at a competition, thus those who were injured and not participating were already selected out. With respect to the information gained regarding weight cycling, actual weights were not taken. It would have been more informative to weigh the athletes at the mat just prior to their match and compare the result with that of their tournament weigh-in. As mentioned previously, the questionnaire used in this pilot study was vague regarding several concepts. Key definitions were not provided on the questionnaire. Future studies should ensure that all concepts are clearly defined in order to reduce subject confusion and hopefully avoid missing responses or poor response rates.