Background: Trauma is an inescapable part of sports competitions. It occurs more frequently in contact sports such as wrestling.



Objectives: The purpose of this study was to determine the frequency of injury in Greco-Roman style wrestling competitions at national level.



Patients and Methods: This descriptive epidemiological research included 50 Greco-Roman style wrestlers who participated in national level competitions between the years 2003 and 2008. A questionnaire was completed by each participant, itincluded; the number of injuries to skin, muscle tissue, bones and joints. The reliability of the instrument was evaluated by a test – retest method (r = 0.83, P = 0.0001).



Results: The most frequent injuries encountered by the wrestlers were; skin lesions (62%), followed by muscle (22%), bone (9%) and joint (7%) injuries, respectively.



Conclusions: Greco-Roman style wrestlers are at high risk of skin injuries.Therefore, they need appropriate instructions on how to avoid injuries and adequate care after their competitions

Akbarnejad, A.

Sayyah, M.

kashan university of medical sciences

Research
 Archives of 
Frequency of Sports Trauma in Elite National Level Greco-Roman Wrestling Competitions
Ali Akbarnejad 1, Mansour Sayyah 2 *
1 College of Physical Education, University of Tehran, Tehran, IR Iran2 Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
A R T I C L E  I N F O A B S T R A C T
Article history:Received: 19 Jun 2012Revised: 04 Jul 2012Accepted: 06 Jul 2012
Keywords:SportsWound and InjuriesWrestling
Article type:Original Article Background: Trauma is an inescapable part of sports competitions. It occurs more fre-quently in contact sports such as wrestling.
Objectives: The purpose of this study was to determine the frequency of injury in Greco-Roman style wrestling competitions at national level.
Patients and Methods: This descriptive epidemiological research included 50 Greco-Roman style wrestlers who participated in national level competitions between the years 2003 and 2008. A questionnaire was completed by each participant, itincluded; the number of injuries to skin, muscle tissue, bones and joints. The reliability of the in-strument was evaluated by a test – retest method (r = 0.83, P = 0.0001). 
Results: The most frequent injuries encountered by the wrestlers were; skin lesions (62%), followed by muscle (22%), bone (9%) and joint (7%) injuries, respectively.
Conclusions: Greco-Roman style wrestlers are at high risk of skin injuries.Therefore, they need appropriate instructions on how to avoid injuries and adequate care after their competitions.
 Please cite this paper as: Akbarnejad A, Sayyah M. Frequency of Sports Trauma in Elite National Level Greco-Roman Wrestling Competitions. Arch Trauma 
Res.2012; 1(2):51-3. DOI: 10.5812/atr.6866 
 Implication for health policy/practice/research/medical education:Identifying the types of injuries in any sport may assist the coaches as well as the wrestlers to take appropriate measures to reduce the likelihood of injuries in future competitions as well as trainings.
Published by Kowsar, 2012. cc 3.0.
1. BackgroundWrestling is a popular sport in many countries around the world. Its origins can be traced back to the Sumerians as early as 5000 BC, and records of ancient Greeks wres-tling in the Olympics in 708 B.C. (1). This sport was played without any particular rules prior to the Olympic move-ment (2). Wrestling is the national sport of Iran and quite popular across the country (3-5). Wrestling has been re-
ferred to as the most intense and physically demanding sport, with a high risk of injury.  This sport has evolved into many different forms all over the world, with three major styles including; freestyle, Greco-Roman and folk styles. In the United States, wrestling participation aver-aged 2.5 million participants per year between 2000-2006, with an average of 1.1 million participants wres-tling more than 50 days per year (6). In this sport, the two 
* Corresponding author: Mansour Sayyah, Trauma Research Center, Kashan University of Medical Sciences, Kashan. IR Iran. Tel.: +98-3615550026, Fax: +98-9121946743. E-mail: mansorsayyah@yahoo.com.
c  2012, Kashan University of Medical Sciences; Published by Kowsar  This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which per-mits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Arch Trauma Res. 2012;1(2)52 Published by Safnek, © 2012 KAUMS & TRC
Akbarnejad A et al. Sport Traumas in Elite National Competitions
athletes are expected to struggle together and endeavor 
to put their competitor down onto the mat. There are two 
different rules that distinguish freestyle wrestling from 
its Greco-Roman counterpart. In the Greco-Roman style, 
athletes are forbidden to touch the lower extremities of 
their rivals, while this is not so in the freestyle. However, 
in both types, the athletes must struggle extremely hard 
to gain dominance over the strength of their rival and at 
the same time try to force their opponent to give up their 
defense once he/she is down on the mat. In this competi-
tion all parts of the body are involved in voluntary move-
ments at times and involuntary movements at others, 
which are directed at overcoming the resistance and 
strength of the rival wrestler. During this process, bio-
mechanical forces are imposed on both athletes, which 
in some circumstances may lead to undesirable conse-
quences, including injury to different parts of the body.
(1). According to data from the Center for Injury Research 
and Policy, football and wrestling are the two sports with 
the highest risk of serious injury to athletes (7-9). Con-
sidering the specific types of injury; sprains, strains, and 
contusions were the most commonly reported types (8). 
In a study conducted by Jarret et al. on 800000 athletes 
participating in college level competitions in the United 
States over 11 years, they reported that 6.3% of the trauma 
cases that took place in the competitions needed surgical 
intervention. In addition, the study showed that; sprains, 
strains, contusions and muscle pulls were the most fre-
quent types of injuries, respectively (8). A study on wres-
tling injuries that occurred during the 2008 Olympic 
Games in Beijing, showed a total of 32 injuries occurred 
in 343 athletes during the 406 matches, which is equiv-
alent to an overall incidence rate of 9.3 injuries per 100 
athletes and 7.9 injuries per 100 matches. Among the 2 
styles, freestyle had the highest injury rate (10.1%), and 
female wrestling the lowest rate (7.5%). The overall injury 
rate in the male athletes was slightly higher than in the 
females (9.7% versus 7.5%) (10).
2. Objectives
This research was designed to assess Iranian elite na-
tional level Greco-Roman wrestlers, in regard to their ex-
perience of injury during their careers as wrestlers.
3. Patients and Methods
This descriptive study included 50 former Greco-Roman 
style wrestlers competing at national level in Iran. The 
criteria to enroll these elite athletes in this study includ-
ed an invitation by the National Wrestling Federation for 
the athlete to attend a preparation camp, and record of 
the athlete’s participation in national level competitions, 
Asian Games, world championship tournaments and/or 
the Olympic Games. The data collection form included 
questions regarding demographic information as well 
as the incidence of injury during their competitions. The 
content validity of the questionnaire was confirmed by 
expert opinion, including former wrestlers and universi-
ty professors involved in teaching sport trauma in physi-
cal education and exercise science colleges. The reliabil-
ity of the instrument was examined by a test-retest of 20 
of the wrestlers participating in this project (r = 0.83, P = 
0.0001). All of the subjects completed the final version of 
the questionnaire in the camp where the researcher was 
available to give further instructions, if it was requested.
4. Results
A total of 50 national level Greco-Roman style wrestlers 
completed the study criteria. Mean age of the partici-
pants was 22.2 ± 2.4 year, weight 81.2 ± 9.8 kg and height 
178 ± 3.7cm, respectively. Analysis of the data showed 6514 
cases of injuries overall during the 5 year peak of the ath-
letes’ wrestling career. Out of 6514 injuries, 3794 (62%) of 
the cases reported injuries to their skin, followed by mus-
cle tissue 1448 (22%). Figure 1 shows the sites of injuries.
Further analysis showed that most of the injuries hap-
pened in the upper extremities, followed by the trunk 
and spinal regions. Table 1 presents a distribution of in-
jury cases on the basis of the tissues which were involved. 
Skin, No. (%) Muscle, No. (%) Bone, No. (%) Joint, No. (%) Total, No. (%)
Head and face 1253 (31) - 364 (57) 77 (18) 1694 (26)
Upper extremities 1484 (37) 449 (31) 101 (16) 133 (30) 2167 (33.3)
Spine and trunk 982 (25) 660 (45) 144 (22) 60 (14) 1846 (28.4)
Lower extremities 277 (7) 339 (24) 25 (5) 165 (38) 807 (12.3)
Total 3996 (62) 1448 (22) 635 (9) 435 (7) 6514 (100)
Table 1. Frequency Distribution of the Type of Injuries According to the Body Part Involved.
0
10
20
30
40
50
60
70
Muscle                      Bone                       Joint                          Skin
A
m
o
u
n
t 
o
f I
n
ju
ri
es
, %
Injured Sites
Figure 1. Frequency Distribution of Injuries in National Level Greco-Ro-
man Wrestlers According to the Tissues Involved.
Arch Trauma Res. 2012;1(2) 53Published by Safnek, © 2012 KAUMS & TRC
Akbarnejad A et al.Sport Traumas in Elite National Competitions
In addition, a one-way analysis of variance (ANOVA) was 
performed to compare the mean value of injuries from 
the four different types of injuries, that is; skin, muscle, 
bone and joints. The results indicated that there was a 
significant difference among the four types of injuries 
found in Greco-Roman style wrestlers (P < 0.0001). A Tur-
key’s post hoc test showed differences between the skin 
and other tissues (P < 0.0001). In addition, there was a 
significant difference found between muscle tissue inju-
ries and bone and joint injuries (P < 0.001). No significant 
difference was found between joint and bone injuries (P 
> 0.05).
5. Discussion
The present study showed that the highest incidence of 
injuries were to the athletes’ skin (62%), followed by mus-
cle (22%), bones (9%) and joints (7%), respectively. These 
results were compatible with what has been reported 
earlier by other researchers (11). Considering the region 
of injury involvement, it was found that 33.3% of the inju-
ries occurred in the upper extremities. Such findings are 
to be expected, since in Greco-Roman style wrestling, the 
wrestlers are restricted to competing with their counter-
part only in this area, so most of the force is concentrated 
in the upper extremities, particularly in the hand itself. 
In a study by Snook, the upper limbs were the most com-
monly injured region (12). Also in a study carried out by 
Lorish et al. in adolescent and preadolescent boys, the pri-
mary areas of injury were to the upper extremities (33%), 
and the neck and back (24%) (2). Such findings can be at-
tributed to the fact that in Greco-Roman style wrestling, 
most of the techniques executed in order to bring the 
opponent down and defeat him, involve the trunk. The 
consequence of such mechanical action on the opponent 
body will be to crash fall onto the mat, with the possible 
likelihood of injurious involvement of the skin, followed 
by extraordinary pressure on the trunk. In addition, fol-
lowing the landing on the mat, additional pressure is ex-
erted to the trunk by rubbing the body on the mat, which 
may lead to simultaneous injuries of the skin, neck and 
trunk, as well. Other types of injuries reported in this 
study may affect other parts of the body, e.g., joints and 
bones, these may be due to a fall, as well as to impact forc-
es at the time of collision between the two wrestlers .Inju-
ries may also occur during the occasions when a wrestler 
collapses involuntarily over his opponent, this may cause 
dislocation of the joints or more seriously, breaking of 
bones. This has been the subject of many investigations 
by different authors (13, 14).  In conclusion, wrestling in 
general as with any other type of sports, has its own risk 
of injury. However, the high incidence of sports trauma 
in wrestling requires special attention and good prepa-
ration by the athletes on one hand and awareness of ap-
propriate care and support by sports authorities, trainers 
and coaches, on the other.
Acknowledgments
The author would like to express his appreciation to the 
national wrestling federation for its cooperation in con-
ducting this research.
Authors’ Contribution
Ali Akbarnejad was in charge of designing and collect-
ing data. Mansour Sayyah was involved in data analysis 
and preparing the manuscript for publication.
Financial Disclosure
No conflict of interest was present.
Funding/ Support
The expense for conducting was paid by Dr. Akbarnejad.
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Frequency of Sports Trauma in Elite National Level Greco-Roman Wrestling Competitions

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Frequency of Sports Trauma in Elite National Level Greco-Roman Wrestling Competitions

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