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Introduction
Taekwondo is a combative Olympic sport with 80 million participants worldwide 1 in over 204 countries. 2 The concussion incidence in taekwondo is reported to range from 5.5 to 50.2 per 1000 athlete-exposures (A-E). 3-5 Siana et al 6 first reported on injuries from the 1983 World Taekwondo Championships where two mandibular fractures and one fracture of the zygomatic bone (accompanied with a protruding eye ball) were observed. Although no protective headgear was used during the 1983 World Championships, it must be understood that the area of protection provided by taekwondo headgear does not cover the zygomatic bone. Most recently two deaths 7 8 were reported during competition with one victim being a 17-year-old novice. 8 Also severe subarachnoid haemorrhage caused by the axe kick was recently reported. 9
In an effort to improve player safety, protective headgear was first introduced in 1985 and officially used in the 1987 World Taekwondo Federation (WTF) World Championships in Barcelona, Spain. 10 However, McIntosh and McCrory 11 conclude that headgear in rugby, a similar design to that in taekwondo, does not provide any functional protection against concussion or severe head injury. In 1976, the National Operating Committee on Standards for Athletic Equipment (NOCSAE) in the USA was instituted. 12 After its inclusion, and the required safety approval by NOCSAE for all American football (FB) helmets, fatalities in FB decreased 74%. 12 Similarly, the American Society for Testing and Materials (ASTM F-2397) impact attenuation testing standard for martial arts headgear was established in 2004. 13 However, to our knowledge, no taekwondo headgear adheres to or is approved by ASTM and the head injury incidence in taekwondo continues to rise. 14 Therefore, in an effort to better understand the contribution of taekwondo headgear to prevent head injury, the purpose of this study was to evaluate the impact attenuation performance of commercially available taekwondo helmets approved by the Korean Taekwondo Association (KTA) and the WTF.
Methods
As the current study was subject to financial limitations, we adopted a testing methodology in a manner similar to that by Moffitt and Lieu, 15 which was then later adopted as the ASTM standard for testing protective headgear used in martial arts. 13 Where the ASTM methodology calls for the use of a spring-loaded...