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There is very little information
on this topic, so in order to make an argument you have to piece together
information from several sources. The abstracts have been put into
a loose structure; just one possible way of presenting the material.
1. Provide evidence for falling forces on the martial art(ist) (MA).
2. Provide evidence for injury on the individual when falling.
3. Show differences in forces and injuries with different floor coverings/pads since these are common in the MA.
4. Provide evidence for falling incidences, potential injuries, and risks for a pregnant woman.
5. Other risks.
6. Legal impacts for consideration.
1: <a>J Biomech.</a> 2007;40(2):458-62. Epub 2006 Feb 9
Sint Maartenskliniek Research,
Development & Education, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands;
Institute for Fundamental and Clinical Human Movement Sciences, Vrije
Universiteit, Amsterdam, The Netherlands.
Falls to the side and those
with impact on the hip are risky for hip fractures in the elderly. A
previous study has indicated that martial arts (MA) fall techniques
can reduce hip impact force, but the underlying mechanism is unknown.
Furthermore, the high impact forces at the hand used to break the fall
have raised concerns because of the risk for wrist fractures. The purpose
of the study was to get insight into the role of hand impact, impact
velocity, and trunk orientation in the reduction of hip impact force
in MA techniques. Six experienced judokas performed sideways falls from
kneeling height using three fall techniques: block with arm technique
(control), MA technique with use of the arm to break the fall (MA-a),
and MA technique without use of the arm (MA-na). The results showed
that the MA-a and MA-na technique reduced the impact force by 27.5%
and 30%, respectively. Impact velocity was significantly reduced in
the MA falls. Trunk orientation was significantly less vertical in the
MA-a falls. No significant differences were found between the MA techniques.
It was concluded that the reduction in hip impact force was associated
with a lower impact velocity and less vertical trunk orientation. Rolling
after impact, which is characteristic for MA falls, is likely to contribute
to the reduction of impact forces, as well. Using the arm to break the
fall was not essential for the MA technique to reduce hip impact force.
These findings provided support for the incorporation of MA fall techniques
in fall prevention programs for elderly.
<a>Accid
Anal Prev.</a> 1999
Jan-Mar;31(1-2):85-9.
Faculty of Applied Health
Sciences, Department of Kinesiology, University of Waterloo, Ontario,
Canada.
This report documents the
impact forces measured during trials of dropping an anthropometric dummy
(80.3 kg) (Hybrid III, First Technologies Corporation) in three different
positions onto it's pelvis (gluteal region) from a seated height, which
was meant to simulate a chair being pulled out from an individual in
the process of sitting. Peak forces on the pelvis were measured by a
force plate covered with industrial carpet. These impact forces were
translated to the compressive and shear forces on the lumbar spine.
The peak impact forces during the different body postures were 20000-29900
N (torso upright); 13000-22200 N (torso-legs 45 degrees to floor); 6000-15200
N (layout position). The impact forces generated from falling onto the
pelvis from a seated height, appear to be sufficient to cause injury
as the forces well exceed documented injury tolerance levels.
1: <a>Appl Ergon.</a> 1990 Jun;21(2):107-14
Department of Surgery, University of Toronto: Centre for Studies in Aging, Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
An experimental study was performed to assess to what extent the magnitudes of the impact forces generated in human falling accidents are affected by the nature of the floor covering. Peak decelerations were measured for impacts at the hip and at the hand, using a simple inverted-pendulum anthropomorphic fall simulator. Thirteen different floor coverings were tested, including five hard surfaces and four types of carpet, with and without underpad.
It was found that floor coverings can differ significantly in terms
of the peak impact force occurring during a fall. For hip impacts, the
mean differences between the different floorings ranged up to 23%, with
the padded carpets providing the best impact attenuation. In hand impacts,
the impact forces were found to be relatively independent of the type of floor covering.
<a>Medicina (Kaunas).</a> 2006;42(7):586-91.<a href="http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?itool=AbstractPlus-def&PrId=4185&uid=16861842&db=pubmed&url=http://medicina.kmu.lt/0607/0607-09l.pdf" target="_blank"></a>
<a>Links</a>
[Trauma in pregnancy: complications, outcomes, and treatment]
Clinic of Obstetrics and Gynecology, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania. <a href="http://www.aikiweb.com/forums/"mailto:rositaan@hotmail.com" class="external free" title="mailto:rositaan@hotmail.com" rel="nofollow">mailto:rositaan@hotmail.com" target="_blank">rositaan@hotmail.com</a>
The aim of this study was to analyze the effects of the various traumas on mother and fetus and to present the solutions of trauma management. METHODS: A review of data archive of Kaunas University of Medicine Hospital and articles published during the last 13 years (1990-2003) and selected by computerized Medline search. Trauma affects 7-8% of all pregnant women; motor vehicle accidents account for 42%, falls--for 34%, and violence--for 18% of the most frequently cited cases of injuries. Of the 27,715 pregnant females attending antenatal clinics, 372 (1.3%) experienced trauma:
84% of women had blunt injuries and 16% had penetrating injuries. There
were 14 maternal deaths (3.8%) and 35 fetal deaths (9.4%). The success
of pregnancy is associated with severity of maternal trauma. The survival
of the fetus after trauma depends on the mother's condition in regard
to respiratory passage, oxygenation, and hypovolemia. During 1990-2003,
six pregnant patients with severe trauma were treated at Kaunas University
of Medicine Hospital. Traumatic separation of placenta was observed
in two cases. Three women and three fetuses died.
<a>Crit Care Nurs Q.</a> 2006 Jan-Mar;29(1):53-67; quiz 68-9.<a href="http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?itool=AbstractPlus-def&PrId=3159&uid=16456362&db=pubmed&url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00002727-200601000-00005" target="_blank"></a>
<a>Links</a>
Carolinas Medical Center, Charlotte, NC 28216, USA.
Trauma is the leading nonobstetrical cause of maternal death. The effect of trauma on the pregnant woman and unborn fetus can be devastating. The major causes of maternal injury are blunt trauma, penetrating trauma, burns, falls, and assaults. There are specific changes associated with pregnancy that are important for the clinician to consider when providing care to these patients. Initial management of traumatic injuries during pregnancy is essential for maternal and fetal well-being. This review outlines common causes of maternal trauma, the initial assessment of the pregnant trauma patient, and ongoing care for the pregnant trauma patient and unborn fetus.
FALLS
Of the pregnant patients treated for injuries each year, 3% to 31% are related to falls. (4,8,27) Women continue to be active with jobs, families, and activities while they are pregnant. During pregnancy, the gravid female has an increase lordosis of her spine, assisting in keeping the center of gravity over her legs. The incidence of falls increases as the pregnancy progresses because of this change in the center of gravity. The extent of the injury is
dependent on the specifics of the fall, including distance and the specific
body part involved. It is important that the pregnant patient be aware
of these changes in her musculoskeletal system and avoids activities
that could be harmful or cause her to loose her balance.
During the third trimester, overly vigorous activities should be avoided. Exercise that involves a higher risk of falls should be avoided. Contact sports, including hockey, boxing, wrestling, football, and soccer, should also be discouraged.
High-risk sports such as gymnastics, horseback riding, skating, skiing,
hang gliding, and racquet sport are also discouraged because of the
increased risk of falls. (34) When exercising, hydration is very important
to avoid orthostatic symptoms that can cause the gravid patient to lose
balance and fall.
When gravid patients fall,
the patients report falling onto their buttocks or side, or report falling
onto their abdomen, and usually have less than a 10% chance of having
significant fetal or maternal complication. (7) Dunning et al (35) reported
that close to 27% of the pregnant women they surveyed fell during pregnancy,
more than 6% of them while at work. They reported slippery floors, hurrying,
or carrying an object or child as contributing factors for the fall.
The majority of injuries were minor and were described as bruises, cuts,
turned ankles, sprain/strains, and broken bones. El Kady et al (36)
looked at outcomes of pregnant women who were hospitalized for falls
and found that 23% delivered during that admission. Injuries associated
with their falls included preterm labor, abruption, uterine rupture,
low birth weigh, and stillbirths. Those women discharged home without
admission sustained fractures, dislocations, sprains, and strains.
Other concerns.
Change in body dynamics
Hormonal changes affect joint connectivity/stability
1: <a>Am J Obstet Gynecol.</a> 1996 Feb;174(2):667-71.<a href="http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?itool=AbstractPlus-def&PrId=3048&uid=8623804&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9378(96)70447-7" target="_blank"></a>
<a>Links</a>
Department of Obstetrics
and Gynecology, Gundersen Medical Foundation, LaCrosse, WI, USA.
OBJECTIVE: Our purpose
was to evaluate peripheral joint laxity during pregnancy and to determine
whether serum relaxin levels are associated with increased joint laxity.
STUDY DESIGN: A prospective observational study was performed. RESULTS:
A significant increase in joint laxity was found in five of seven peripheral
joints over the course of the pregnancy and post partum. There was no
correlation with serum relaxin levels. There were no significant differences
in joint laxity on the basis of parity, age, or prepregnancy exercise
levels. CONCLUSIONS: Peripheral joint laxity is noted to increase as
pregnancy progresses. The cause of this change is undetermined.
<a>J Law Med.</a> 2006 Aug;14(1):45-63.<a>Links</a>
Law, pregnancy and sport: what are the repercussions when a pregnant lady plays?
Faculty of Law, University of New England. <a href="http://www.aikiweb.com/forums/"mailto:jwerren@une.edu.au" class="external free" title="mailto:jwerren@une.edu.au" rel="nofollow">mailto:jwerren@une.edu.au" target="_blank">jwerren@une.edu.au</a>
This article reflects on
the issue of pregnancy and sport that was brought to the fore in Gardner
v National Netball League (2001) 182 ALR 408; [2001] FMCA 50 and Gardner
v All Australia Netball Association Ltd (2003) 174 FLR 452. It suggests
that these cases did not provide a definitive discussion of the tortious
liability implications that initially led Netball Australia to introduce
a ban on pregnant players. In an attempt to fill some of these gaps,
other case law that deals with liability of sporting organisations and
prenatal injury is discussed. The article primarily focuses on whether
the unborn child when born alive will have an action against her or
his mother as a result of injury occasioned while the mother was playing
sport when pregnant. This examination is undertaken in light of recent
Australian tort reform as well as changes in policy direction. The article
summarises the legal position of the parties involved in sport--sporting
organisations, medical practitioners, other participants and the pregnant
mother--and argues that, with reference to the guidelines and case law,
in only a very small number of cases would liability be found against
the sporting organisation or pregnant mother as a result of injuries
incurred prenatally.
<a>J Sci Med Sport.</a> 2002 Mar;5(1):46-54.<a>Links</a>
Victorian State Trauma Outcomes Registry and Monitoring, Department of Epidemiology and Preventive Medicine, Monash University, Australia.
Although trauma to pregnant women is a potential risk during sport, as there is no published information about the magnitude of this risk, it is presumed to be low. Whilst there is an emerging literature about the risk of adverse outcomes following severe and catastrophic trauma to pregnant women, this literature almost exclusively focuses on road trauma victims or the result of assault. This paper describes the risk of abdominal injuries to women participants across a range of sports in Australia. An extensive search of the available literature could not identify any studies that had discussed this issue specifically in pregnant women. Studies, which have reported injuries
in athletes, have generally found abdominal/chest injuries to account
for fewer than 2% of all injuries, even in contact sports. Most of these
published studies do not differentiate between the chest and abdomen
and provide no specific details on the exact nature or mechanisms of
the injuries. Given the limitations of the published studies, an examination
of data from two Australian general injury databases (one describing
hospital admissions, the other hospital emergency department presentations),
three Australian sports-injury treatment databases (sports medicine
clinic attendances and medical coverage services) and one cohort study
was undertaken to describe sports-related abdominal injuries. These
analyses confirm that the risk of abdominal injury during sport is very
low. In conclusion, currently there is not an adequate evidence-base
for quantifying the risk of abdominal injuries during sport in women,
let alone pregnant women or for justifying a ban of sport on this basis.
Recommendations for future epidemiological sports injury studies and
the potential for linkages with perinatal morbidity and mortality databases
are given.
<a>J Sci Med Sport.</a> 2002 Mar;5(1):11-9.
There are numerous benefits to pregnant women of remaining active during pregnancy. These include improved weight control and maintenance of fitness. There may also be benefits in terms of reduced risk of development of gestational diabetes meilitus and improved psychological functioning. Moderate intensity aerobic exercise has been shown to be safe in pregnancy, with a number of studies now indicating that for trained athletes it may be possible to exercise at a higher level than is currently recommended by the American College of Obstetricians and Gynecologists. Studies of resistance training, incorporating moderate weights and avoiding maximal isometnc contractions, have shown no adverse outcomes. There may be benefits of increased strength and flexibility. The risk of neural tube defects due to exercise-induced hyperthermia that is suggested by animal studies is less likely in women, because of more effective mechanisms of heat dissipation in humans.
There is accumulating evidence to suggest that participation in moderate
intensity exercise throughout pregnancy may enhance birth weight, while
more severe or frequent exercise, maintained for longer into the pregnancy:
may result in lighter babies. There have been no reports of foetal injury
or death in relation to trauma or contact during sporting activities.
Despite this, a risk of severe blunt trauma is present in some sporting
situations as pregnancy progresses. Exercise and lactation are compatible
in the post-partum period, providing adequate calories are consumed.
Considerations of pelvic floor function and type of delivery are relevant
in planning a return to certain types of exercise at this time.
Banning pregnant netballers--is this the answer? (Pregnancy in Sport).
S. White. British Journal of Sports Medicine. Feb 2002
v36 i1 p15(2).
<a>UCONN Links</a>
<a href="http://sfx5.exlibrisgroup.com:3210/uconn?issue=1&issn=0306-3674&volume=36&sid=Gale%3A+Health+Wellness+Resource+Center&atitle=Banning+pregnant+netballers--is+this+the+answer%3F+%28Pregnancy+in+Sport%29.&aufirst=S.&title=British+Journal+of+Sports+Medicine&spage=15&date=2002-02&aulast=White" target="_blank">UCONN
Links</a>
Full Text: COPYRIGHT 2002 British Medical Association
A forum on a ban of pregnant netballers considered that the ban was discriminatory and that pregnant women should have the right to make decisions about competing in sporting activities.
A recent move by Netball Australia to ban all pregnant netballers at all levels from participating in their sport has been met with a mixture of outrage and sympathy. Those who advocate a woman's right to make decisions about her own pregnancy, including sports participation, have been vocal in their disagreement with this ban. Sporting administrators in fear of litigation and some sporting competitors concerned about playing against a pregnant opponent have welcomed the ban.
The introduction of the ban had an immediate effect, with a national level netballer announcing her pregnancy (first trimester) and applying to the Human Rights and Equal Opportunity Commission for a lifting of the ban on the basis of discrimination. The case is pending.
Such a controversial situation prompted the Australian Sports Commission to hold a national forum with a range of experts and interested parties invited to contribute. Firstly, the available medical evidence was discussed. Associate Professor Caroline Finch, Chair of the National SportSafe Committee and a leading epidemiologist in the area of sports injury, reported that there is not a single case of an adverse outcome in pregnancy related to sports participation in the world literature. Admittedly there are no specific studies on pregnancy
and contact sports, but numerous studies have looked at aerobic activities
and fetal outcome.
A number of papers now concur that women who take moderate exercise (less than four times a week) in fact have larger babies than non-exercisers or more extreme exercisers. (1) None of these studies recorded any problems in terms of labour, delivery, or Apgar scores in any of the groups. There are now even a few studies of cognitive behaviour in newborns and 1 year old and 5
year old children all showing that those whose mothers exercised during pregnancy functioned as well as, or better than, those whose mothers did not. (2)
In terms of contact in sport, the only large body of literature that considers fetal injury in relation to contact is in motor vehicle accidents and domestic violence, neither of which could be considered comparable to a game of netball. To further attempt to quantify a possible risk from sporting contact, Finch used data from two large epidemiological studies on the incidence of types of sporting injuries. In both studies, less than 2% of all injuries,
in a range of sports, involved the chest or abdomen and in both studies all contacts were considered minor.
Finch conceded that there is room for more research in this area, but the current available evidence suggests that sport and exercise, if anything, has a beneficial effect on the fetus/child.
Professor Wendy Brown discussed public health issues, in particular female participation rates in sport. Professor Brown is the principal investigator with the Australian Longitudinal Study of Women's Health, involving 40 000 participants. Part of the study focused on sports participation and showed that the biggest fall in participation rates in women is during their 20s and 30s (child bearing years) when there are a number of practical barriers to regular exercise. Couple this with the fact that physical inactivity is one of the largest
contributors to ill health, (3) more so in women, then there is an overwhelming
argument to encourage women to exercise during this time rather than send the wrong message by banning participation in netball (the single largest participation sport for women in Australia).
Dr Michael Sedgley, obstetrician and past chairman of the medicolegal committee of the Royal Australian and New Zealand College Of Obstetricians and Gynecologists, argued that there is no evidence to suggest that exercise during pregnancy is in anyway harmful to the fetus. He also cited research showing that exercise during pregnancy can decrease the incidence of nausea and depression and increase feelings of wellbeing in the mother. Unfortunately there is no evidence that active women have shorter or easier labours, but
it is possible that they may recover more quickly in the post partum period. He advocated the right of the woman to make a choice about sports participation during pregnancy, in conjunction with her medical practitioner.
A legal session involved discussion on the current Australian legislation with regard to anti-discrimination, occupational health and safety, and negligence law. Banning a person from participating in an activity because of their sex, religion, or pregnant state is against the provisions of the Anti-discrimination Act. To do so, a group must either apply for an exemption (which Netball Australia did not do) or show exceptional circumstances (the test case awaits).
In terms of the risks of negligence for sporting organisations, including its administrators, umpires, and opposing players, it has never been tested. The legal expert present stated that "causation" must be shown, and he felt that there was insufficient evidence in the current literature to support this. This point of view was disputed by some who were concerned that in a
trial in which a jury may decide the matter, such an emotive case as
(potential) injury to a child may affect the judgment.
A representative of the insurance industry acknowledged that one of the biggest issues facing sporting organisations in Australia is the rising cost and inaccessibility of public liability insurance, without which an organisation cannot operate. He felt that the current wording of the general policies would cover injuries to a pregnant woman and her fetus but that it had never been
tested. If a case was to occur, this may significantly increase the
premiumsrequired to cover future risk, making such cover beyond the
reach of most sporting organisations and putting their existence in
doubt.
Finally ethicists discussed the issues involving the ban, as well as confidentiality issues in relation to team medical officials in the case of a pregnant athlete involved in a sport that bans participation.
The resultant informal consensus of the forum was that the ban was discriminatory, that women should have the right to make decisions about competing in sporting activities (in conjunction with their medical practitioners), and that it is mandatory to better educate players, officials, and medical practitioners about the current state of knowledge on exercise during pregnancy. Litigation for negligence was considered unlikely from the current evidence in the literature.
Meanwhile Netball Australia continues its ban. This ban has generated much discussion and hopefully inspired researchers and the government to investigate and fund relevant research in this area.
The outcome of the case before the anti-discrimination board will certainly affect future policy, but it is hoped that sensible discussion of the issues, education of all parties involved, and the results of future research will contribute more to the development of participation guidelines than the fear of
litigation.
REFERENCES
(1.) Campbell MK, Mottola MF.
Recreational exercise and occupation activity during pregnancy and birthweight:
a case control study. Am J Obstet Gynecol 2001;184:403-8
(2.) Clapp JF 3rd, Lopez B,
Harcar-Sevcik. Neonatal behavioral profile of the offspring of women
who continue to exercise regularly throughout pregnancy. Am J Obstet
Gynecol 1999;180:91-4.
(3.) Mathers C, Vos T, Stevenson
C. The burden of disease and injury in Australia. Canberra: Australian
Institute of Health and Welfare, 1999:cat no. PHE-17.
