Grappling with Wrestling Injuries

January 29, 2015
By Dr. Dawn Comstock

Each month, The Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital provides our sister publication, Training & Conditioning, with an inside look at their studies of high school athletic injuries. In this blog, Dr. Dawn Comstock evaluates wrestling's high injury rates and provides information on how to lower these rates and the high treatment costs that go along with them.
One of the earliest sports known to man, wrestling continues to hold worldwide popularity. In the United States, over one million boys aged six to 17 wrestle every year. Although wrestling can increase physical fitness and self confidence, the sport’s arduous nature has led to high injury rates and an estimated total annual injury cost of over $650 million. This makes it important for athletic directors, coaches, and athletic trainers to familiarize themselves with the sport's injury trends and work to correct corresponding mechanisms of injury.

There are three wrestling styles commonly found in the United States:

• Common during school-sanctioned matches and tournaments
• Developed from freestyle wrestling, emphasizes control over one’s opponent


• Common during club or community-sanctioned matches and tournaments
• Allows holds and attacks to both the lower and upper extremities


• Prohibits lower extremity attacks
• Emphasizes upper body strength and throws

As one might expect, injury patterns differ between these three styles:
Average Injury Rates
• Folkstyle: one injury per every 550 practices and one injury per every 250 matches
• Freestyle: one injury per every 143 matches
• Greco-Roman: one injury per every 200 matches

Most Common Injuries
• Folkstyle: sprains/strains (48.1%), fractures (16.2%), and dislocations (7.6%)
• Freestyle: sprains/strains (45.7%), concussions (12.3%), and fractures (12.3%)
• Greco-Roman: sprains/strains (33.3%) and concussions (24.1%)

Most Commonly Injured Body Sites
• Folkstyle: shoulder (18.6%), knee (15.4%), trunk (12.0%), and elbow (10.1%)
• Freestyle: head/face/neck (28.0%) and knee (23.2%)
• Greco-Roman: head/face/neck (48.1%) and shoulder/clavicle (20.4%)

Most Common Activities Leading to Injury
• Folkstyle: takedown (39.0%) and sparring (14.7%)
• Freestyle: pulling/twisting force (40.8%) and contact with opponent (26.3%)
• Greco-Roman: driven into mat (54.8%) and pulling/twisting force (21.4%)

Because injury patterns differ, each discipline has unique preventive interventions:
• Coaches should attempt to integrate drills of potentially high-risk situations, such as a takedown, into controlled practice conditions that simulate the higher intensity of matches
• Coaches and athletic trainers should keep current with the latest training techniques that yield the best performance while maintaining the highest possible level of safety

• Emphasize methods for protecting knees and ankles
• Referees should be vigilant calling wrestlers for attacking their opponent’s legs with illegal techniques

• Ensure that new wrestlers are technically competent and capable of withstanding the forces exerted on the body while executing and receiving throws
• Emphasize safety during throws among both the attacker and defender
• Certified Athletic Trainers, referees, and parents should be trained in the proper identification and management of concussions

Dr. Dawn Comstock is a principle investigator at the Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital. She is also an assistant professor at The Ohio State University in the College of Medicine and the College of Public Health. Her research interests include the epidemiology of sports, recreation, and leisure activity-related injuries among children and adolescents as well as the life-long health benefits associated with an active childhood. She can be reached at:
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