Background: Mixed martial arts (MMA) has experienced a surge in popularity since emerging in the 1990s, but the sport has also faced concomitant criticism from public, political, and medical holds. Notwithstanding the polarized discourse concerning the sport, no systematic review of the injury problems in MMA has been published to date. Purpose: To systematically review the epidemiologic data on injuries in MMA and to quantitatively estimate injury incidence and risk factor effect sizes. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: Electronic searching of PubMed, Scopus, CINAHL, EMBASE, AMED, and SPORTDiscus databases to identify studies reporting on the epidemiology of injuries in MMA. Random-effects models were used to obtain pooled summary estimates of the injury incidence rate per 1000 athlete-exposures (IIR_AE) and rate ratios with 95% confidence intervals (CIs). Heterogeneity was evaluated with the I² statistic. Results: A total of 6 studies were eligible for inclusion in this review. The IIR_AE summary estimate was found to be 228.7 (95% CI, 110.4-473.5). No studies reported injury severity. The most commonly injured anatomic region was the head (range, 66.8%-78.0%) followed by the wrist/hand (range, 6.0%-12.0%), while the most frequent injury types were laceration (range, 36.7%-59.4%), fracture (range, 7.4%-43.3%), and concussion (range, 3.8%-20.4%). The most notable risk factors pertained to the outcome of bouts. Losers incurred 3 times as many injuries as winners, and fighters in bouts ending with knockout or technical knockout incurred more than 2 times as many injuries as fighters in bouts ending with submission. Conclusion: Notwithstanding the paucity of data, the injury incidence in MMA appears to be greater than in most, if not all, other popular and commonly practiced combat sports. In general, the injury pattern in MMA is very similar to that in professional boxing but unlike that found in other combat sports such as judo and taekwondo. More epidemiologic research is urgently needed to improve the accuracy of the injury incidence estimate, to determine the injury severity, and to identify more risk factors for injury in MMA.

Manual therapy is an intervention commonly advocated in the management of dizziness of a suspected cervical origin. Vestibular rehabilitation exercises have been shown to be effective in the treatment of unilateral peripheral vestibular disorders, and have also been suggested in the literature as an adjunct in the treatment of cervicogenic dizziness. The purpose of this systematic review is to evaluate the evidence for manual therapy, in conjunction with or without vestibular rehabilitation, in the management of cervicogenic dizziness.

Objectives: To describe and compare the epidemiology of competition injuries in unarmed combat sports (ie, boxing, judo, taekwondo and wrestling) in three consecutive Olympic Games. Methods: Prospective cohort study using injury data from the IOC injury surveillance system and exposure data from official tournament records at three consecutive Olympic Games (ie, Beijing 2008, London 2012 and Rio de Janeiro 2016). Competition injury incidence rates per 1000 min of exposure (IIR_ME) were calculated with 95% CIs using standard formulae for Poisson rates. Results: The overall IIR_ME was 7.8 (95% CI 7.0 to 8.7). The IIR_ME in judo (9.6 (95% CI 7.8 to 11.7)), boxing (9.2 (95% CI 7.6 to 10.9)) and taekwondo (7.7 (95% CI 5.6 to 10.5)) were significantly higher than in wrestling (4.8 (95% CI 3.6 to 6.2)). The proportion of injuries resulting in >7 days absence from competition or training was higher in wrestling (39.6%), judo (35.9%) and taekwondo (32.5%) than in boxing (21.0%). There was no difference in injury risk by sex, weight category or tournament round, but athletes that lost had significantly higher IIR_ME compared with their winning opponents (rate ratio 3.59 (95% CI 2.68 to 4.79)). Conclusion: Olympic combat sport athletes sustained, on average, one injury every 2.1 hours of competition. The risk of injury was significantly higher in boxing, judo and taekwondo than in wrestling. About 30% of injuries sustained during competition resulted in >7 days absence from competition or training. There is a need for identifying modifiable risk factors for injury in Olympic combat sports, which in turn can be targeted by injury prevention initiatives to reduce the burden of injury among combat sport athletes.

Objective: The intensive nature of a 5- or 6-week teaching block poses unique problems for adequate delivery of content. This study was designed to compare the delivery of a unit of undergraduate neuroanatomy in a short summer school period, as a traditionally taught unit, with a rendition given in the form of the “Flipped Classroom.” The aim was to evaluate the effectiveness of the flipped classroom in the intensive mode classroom.Methods: The flipped classroom encompassed the same learning outcomes, but students were responsible for covering the content at home in preparation for tutorials that applied their acquired knowledge to higher levels of thinking. The main outcome measures were the final course grades and the level of satisfaction with the course.Results: There were no significant differences between the 2 cohorts in final grades (p = .259), self-rated knowledge (p = .182), or overall satisfaction with the course (p = .892).Conclusion: This particular design of the flipped classroom did not add value to the intensive mode experience. It may be that this mode of delivery is ill suited to intensive classes for subjects that carry a lot of content. The use of the flipped classroom requires further research to fully evaluate its value.

Objective: To report the epidemiology of injuries in Olympic-style karate competitions. Design: Systematic review and meta-analysis. Pooled estimates of injury incidence rates per 1000 athlete-exposures (IIR _AE ) and per 1000 min of exposure (IIR _ME ) were obtained by fitting random-effects models. Data sources: MEDLINE, Embase, AMED, SPORTDiscus and AusportMed databases were searched from inception to 21 August 2019. Eligibility criteria: Prospective cohort studies published in peer-reviewed journals and reporting injury data (ie, incidence, severity, location, type, mechanism or risk factors) among athletes participating in Olympic-style karate competition. Results: Twenty-eight studies were included. The estimated IIR _AE and IIR _ME were 88.3 (95%CI 66.6 to 117.2) and 39.2 (95%CI 30.6 to 50.2), respectively. The most commonly injured body region was the head and neck (median: 57.9%; range: 33.3% to 96.8%), while contusion (median: 68.3%; range: 54.9% to 95.1%) and laceration (median: 18.6%; range: 0.0% to 29.3%) were the most frequently reported types of injury. Despite inconsistency in classifying injury severity, included studies reported that most injuries were in the least severe category. There was no significant difference in IIR _ME between male and female karate athletes (rate ratio 1.09; 95%CI 0.88 to 1.36). Conclusion: Karate athletes sustain, on average, 1 injury every 11 exposures (bouts) or approximately 25 min of competition. The large majority of these injuries were minor or mild in severity.