WISCONSIN MEDICAL JOURNAL

A Review of the Effects of

Martial Arts Practice on Health
Thomas W. Woodward, MD

ABSTRACT arts participants in the United States (written commu-

Martial arts are ancient forms of combat, modified for nication, November 2007). Participation increased over
modern sport and exercise. Participation in the martial 28% between 2000 and 2004 for youth.1
arts is increasing, particularly for youth. Martial arts The term martial arts is often broadly applied to sty-
provide health-promoting and meaningful exercise for listically different disciplines. Karate and taekwondo
millions of practitioners. Benefits from this practice emphasize striking with feet and fists. Judo, jujitsu, and
include better overall health and balance, as well as an other similar styles emphasize grappling (wrestling-
improved sense of psychological well being. They do type maneuvers), joint locks, and throwing techniques.
not promote aggression and may be used as a treatment Mixed martial arts (MMA) are modern styles that blend
modality for youth who are at-risk for violence. the techniques previously mentioned. MMA competi-
This article provides an overview of martial arts for tions have been televised nationally for some years and
physicians who may evaluate such injuries in their prac- are increasingly popular. Still other styles emphasize
tice. Physicians may wish to consider recommending practice with weapons, or flowing movements, such
martial arts to patients as a beneficial form of exercise. as tai chi. This article focuses on traditional martial arts,
They are relatively safe compared to many other sports, which are better-studied than the newer MMA styles.
and most martial arts injuries are comparatively minor. Martial artists may participate in sparring (rule-based,
Risks can possibly be reduced by limiting exposure unrehearsed fighting), with variable levels of physical
of inexperienced students, as well as using protective contact between opponents and variable levels of pro-
equipment, including mouthguards, eye/face protec- tective equipment. Many also compete in tournaments.
tion, headgear, and padding.
Martial Arts Practice and General Health
In an era of increasing obesity in both children and
INTRODUCTION
adults, and an epidemic of physical inactivity, it seems
Martial arts have been practiced for thousands of years.
more important than ever for physicians to promote
They are often defined as offensive and defensive
exercise to their patients.2 Physical activity provides
combat systems. These systems may involve unarmed
important health benefits and reduces morbidity and
training and/or practice with weapons. Modern martial
mortality.2 Martial arts are an enjoyable alternative
arts usually have their origins in the Orient, and are
to “traditional exercise” for many and offer unique
typically combat arts that have been modified for
opportunities to learn self-defense and new skills in a
sport, self-defense, and recreation. Traditional martial
group setting.
arts schools often incorporate mental or meditative
While young people commonly practice martial
training into their practice to encourage positive per-
arts, the benefits of martial arts are not confined to the
sonal transformation.
young; middle-aged participants demonstrated signifi-
Many US communities have martial arts schools, with
cantly better aerobic capacity, balance, strength, body
students of all ages. There are about 6.5 million martial
fat percentages, and flexibility compared to sedentary
controls.3 Elderly participants made gains in numbers
Author Affiliation: Dean Medical Center Urgent Care, Madison, of pushups performed, trunk flexion, and balance time
Wis; Assistant Clinical Professor of Family Medicine, University of on 1 foot.4
Wisconsin Department of Family Medicine, Madison, Wis.
Corresponding Author: Thomas W. Woodward, MD, Dean Fall Prevention and Martial Arts Practice
Urgent Care, 1821 S. Stoughton Rd, Madison, WI 53716, phone
608.260.6016; fax 608.824.4919; e-mail tom.woodward@fammed. Every year, there are millions of injuries from falls.
wisc.edu. They are the leading cause of accidental deaths in

40 Wisconsin Medical Journal 2009 • Volume 108, No. 1

 WISCONSIN MEDICAL JOURNAL
older adults; there were 15,800 elderly deaths from of tai chi practice noted gains in self-esteem compared to
falls in 2005.5 In 2000, medical costs related to falls those in a psychosocial support group, who actually had
among the elderly were more than $19 billion in declines in their self-esteem.16 Martial arts practice may
the United States alone.5 A number of interventions be a useful adjunct to traditional psychotherapy.12-14
have been shown to reduce falls, including exercise
Martial Arts and Aggression
programs of varying composition, fall hazard assess-
The popular media often portrays martial arts in a nega-
ments and education, as well as modification of medica-
tive manner, glamorizes stylized “Hollywood” violence,
tion regimens.6-7
and furthers the misconception that martial arts training
Many physicians have recommended tai chi, a tradi-
attracts violent individuals or promotes aggression, par-
tional Chinese martial art, for exercise and fall preven-
ticularly in children.
tion in their elderly patients. Tai chi practice is based
Research demonstrates that martial arts do not gen-
on patterns of smooth, flowing movements. There is
erally attract violent individuals or promote violence.
an emphasis on balance and coordination in this par-
Beginning students who identified their reasons for
ticular martial art, thus it has been proposed that tai chi
pursuing training wanted to learn self-defense, develop
practice may help prevent falls in the elderly. The low-
confidence, participate in exercise, and foster self-disci-
impact movements are readily taught and learned, the
pline.17 Children who began martial arts training did not
exercise is of moderate intensity, and tai chi is also very
score differently than peers on an aggression question-
cost-effective to implement, requiring no equipment.
naire.18 A martial arts program for children at risk for
Systematic reviews demonstrate that tai chi practice
violence and delinquency produced behavior improve-
improves balance, strength, flexibility, and may reduce
ments after 10 weeks of training.19 Levels of aggression
falling in elderly practitioners; however, significant
and hostility were reduced the longer subjects partici-
limitations or biases were noted in many of these stud-
pated in martial arts training.20-22
ies.8-10 One study compared the performance of elderly
Instructors often ask or encourage students to leave
participants with mild balance impairment before and
training when it becomes apparent that the student’s
after a combined balance and stepping training program
behavior or attitude is not compatible with the philos-
(CBST) versus a tai chi program; the CBST participants
ophy of the school. Thus, practitioners who reach an
demonstrated modestly better improvement on a test of
advanced level of achievement may have been selected
balance, stepping, and functional mobility.11
to be less aggressive.
Further well-constructed longitudinal studies should
help determine if tai chi offers any unique fall reduc- Martial Arts and ADHD
tion benefits to practitioners. Tai chi is probably effec- Many parents and martial arts instructors believe that
tive as a very safe and low-cost intervention to help martial arts practice is therapeutic for children who have
reduce falls. Attention-Deficit/Hyperactivity Disorder (ADHD),
which is characterized by impaired concentration and/
Martial Arts Practice and Psychological Health
or impulsive hyperactivity. Martial arts promote con-
Martial Arts and General Well-Being
centration and reduce impulsivity by requiring students
At first glance, martial arts simply seem to be a way to
to focus intensely on a physical activity, follow verbal
blend exercise and self-defense training. However, many
and visual commands, and practice in a controlled, dis-
martial artists see their practice as not only a means to
ciplined environment. There are case reports describ-
achieve these goals, but as a pathway to self-mastery.
ing martial arts as a successful adjunctive treatment for
Traditional martial arts practice usually incorporates
ADHD.22 Certainly this would be an appealing and
an element of meditation and breath control, and takes
low-cost therapy; however, there is little or no research
place in an environment of discipline, self-respect, and
to confirm the validity of this approach, and further
courtesy to others. These practices improve psycho-
study is needed confirm the apparent utility of martial
logical health by promoting relaxation, self-esteem, and
arts as an adjunctive treatment for ADHD.
mind-body coordination.12
Studies report an improvement in psychologi- Martial Arts Injuries
cal health related to martial arts practice, including Martial arts are potentially dangerous. Participants may
improved anger management and sense of well-being, use combat techniques designed to cause harm, though
and decreased depression and sleep disruption.12-15 in a controlled situation. Surprisingly, a large survey
Breast cancer survivors randomly assigned to 12 weeks demonstrated that martial arts are safer than many

Wisconsin Medical Journal 2009 • Volume 108, No. 1 41

 WISCONSIN MEDICAL JOURNAL
other sports, including football, basketball, and wres- fitted mouthguards had less dental trauma than non-
tling.23 This safety record is probably due, at least in users, though the incidence of concussion and oral soft
part, to careful instruction and control in practice and tissue injuries was not statistically different between the
competition. 2 groups.31 A literature survey indicated that evidence
The most common types of martial arts injury are for mouthguard-related reductions in concussions
sprains, strains, and contusions. Less common injuries was inconsistent and no conclusions could be made.30
include fractures, dislocations, and dental injuries.23-25 Certainly mouthguards are inexpensive; their use has
The particular style of martial art practiced impacts the minimal downside, and may help prevent significant
types and rates of injury. This makes intuitive sense; and costly dental injuries.
martial arts vary widely in the techniques they employ
Eye and Face Protection
(kicking, striking, blocking, joint locking, throwing,
Martial arts are contact sports, where participants delib-
etc) and they are often stylistically quite different. For
erately target an opponent’s face with strikes and kicks.
instance, upper extremity injuries were more common
Other sports with less intentional contact to the head
in judo, head and face injuries more common in karate,
actually employ or require eye protection (racquet-
and lower extremity injuries more common in tae-
ball, for instance) whereas most martial arts do not.32
kwondo, a style that emphasizes kicking.25 Taekwondo
Hypema, retinal detachment, lens dislocation, and
practitioners also had a higher injury rate than those
blindness have all been infrequently reported from mar-
practicing aikido, kung fu, karate, or tai chi.26
tial arts injuries.23,33
Prevention of Martial Arts Injuries Many martial arts equipment companies manufac-
General Measures ture clear plastic face guards or padded metal grilles that
Traditionally, many martial arts schools limit the spar- integrate into standard sparring headgear. These devices
ring of lower-ranked or less-experienced students, do provide a significant level of eye and face protec-
because inexperience is associated with injury. Indeed, 1 tion. There are no published studies regarding the use
study found that predisposing factors to injury included of these protectors in martial arts. Hockey visors and
less experience, male sex, and sparring in practice or face protectors have been shown to reduce eye and face
competitions.23 injuries in hockey players, without increasing concus-
sions or neck injuries.34-35
Padding and Headgear
Incorporating eye and face protection into martial
Wearing hand protection reduces the incidence of frac-
arts training and tournaments would likely require
tures and lacerations,27 although research concerning
a major cultural change and a rule requiring this type
boxing injuries clearly indicates that even substantial
of protection. Currently, few martial artists wear this
hand protection will not prevent all hand injuries.28
type of protection, and many participants would likely
Headgear and other protective equipment probably
regard the equipment as a nuisance, or as an impairment
help to prevent minor abrasions, lacerations, and con-
to their vision or breathing.
tusions. It is controversial whether headgear prevents
serious injuries like concussion or intracranial injury. A
CONCLUSION
large survey of martial arts trauma did conclude that use
Martial arts are an increasingly common and important
of protective equipment was associated with a reduced
form of exercise for many individuals. While any form
severity and rate of injury.23
of exercise benefits physical well-being, martial arts may
Mouthguards also improve the practitioner’s sense of psychological
Mouthguards have been recommended for many years well-being and provide self-defense training.
to help prevent dental injuries in sport.29 In the 1920s, Physicians who care for athletes should be aware of
boxing was the first sport to adopt mouthguards for par- martial arts, their benefits and risks, common injuries
ticipants.30 Meta-analyses of studies involving mouth- that may occur during participation, and their preven-
guards indicate that the incidence of orofacial injuries is tion. Physicians may consider recommending martial
1.6-1.9 times higher in non-users.30 arts to patients of all ages who are interested in exer-
Mouthguards have been purported to lower the inci- cise. Tai chi is frequently recommended for patients
dence of concussions by reducing impact transmitted to with mobility restrictions or the elderly because of its
the brain from a blow to the jaw. This is not well-sup- low-impact nature. Physicians who see children with
ported in the literature, however. A survey of college ADHD or who are at-risk for violence may consider
basketball players showed that those who used custom- recommending martial arts as a supplemental treatment

42 Wisconsin Medical Journal 2009 • Volume 108, No. 1

 WISCONSIN MEDICAL JOURNAL
for these conditions. Martial arts might also be a suit- 14. Chou KL, Lee PW. Effect of Tai Chi on depressive symptoms
amongst Chinese older patients with depressive disor-
able adjunctive treatment for some patients with depres-
ders: a randomized controlled trial. Int J Geriatr Psychiatry.
sion or sleep disturbances. These styles of combat and 2004;19:1105-1107.
defense, though ancient in origin, may actually prove 15. Li F, Fisher KJ. Tai Chi and self-rated quality of sleep and
more relevant than ever. These unique forms of exercise daytime sleepiness in older adults: a randomized controlled
trial. J Am Geriatr Soc. 2004;52(6):892-900.
can help address many current community challenges of 16. Mustian KM, Katula JA. Tai Chi Chuan, health-related quality
obesity, inactivity, violence, and aging populations. of life and self-esteem: a randomized trial with breast cancer
How should a prospective student decide which survivors. Support Care Cancer. 2004;12(12):871-876.
17. Twemlow SW, Lerma BH. An analysis of students’ reasons
martial art to practice? No martial art school or style for studying martial arts. Percep Mot Skills. 1996;83(1):99-
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philosophy, quality of instruction, cost, and expecta- 18. Reynes E, Lorant J. Do competitive martial arts attract ag-
gressive children? Percept Mot Skills. 2001;93(2):382-386.
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19. Zivin G, Hassan NR. An effective approach to violence
several schools and decide which style and instructor prevention: traditional martial arts in middle school.
best fit their needs. Low-cost martial arts classes are Adolescence. 2001;36(143):443-459.
often available through community centers or munici- 20. Skelton DL, Glynn MA. Aggressive behavior as a function of
Taekwondo ranking. Percept Mot Skills. 1991;72(1):179-182.
pal programs. No matter where students practice, they 21. Daniels K, Thornton E. Length of training, hostility and the
should wear protective gear when sparring, and martial arts: a comparison with other sporting groups. Br J
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22. Harris MJ. Tai-Kwan-Do in relation to ADD. J Paediatr Child
fied instructors. Health. 1998;34:484.
23. Birrer RB. Trauma epidemiology in the martial arts: the re-
Funding/Support: None declared. sults of an eighteen year international survey. Am J Sports
Financial Disclosures: None declared. Med. 1996;24(6):572-579.
24. Kujala UM, Taimela S. Acute injuries in soccer, ice hockey,
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Wisconsin Medical Journal 2009 • Volume 108, No. 1 43

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