Journal of Bodywork & Movement Therapies 39 (2024) 590–593

Contents lists available at ScienceDirect

Journal of Bodywork & Movement Therapies
journal homepage: www.elsevier.com/jbmt

Characteristics of injuries related to Kin-Ball sport in Japan: Aquestionnaire study
Kokoro Fukushige a, Yuji Kanazawa b, Moemi Matsuo c, Takashi Higuchi d, *a

Department of Rehabilitation, Settsu Hikari Hospital, Settsu-city, Osaka, Japan
Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa-City, Ishikawa, Japanc
Faculty of Rehabilitation Sciences, Nishi Kyushu University, Kanzaki-City, Saga, JapandDepartment of Physical Therapy, Osaka University of Human Sciences, Settsu-city, Osaka, Japanb

A R T I C L E I N F O

A B S T R A C T

Handling Editor: Dr Jerrilyn Cambron

Introduction: The number of Kin-Ball sport participants is expected to increase in the future. However, there is noreport on the characteristics of the injuries associated with Kin-Ball sport. Objective: The purpose of this study
was to describe the characteristics of injuries relate to Kin-Ball sport. Design: Observational study. Setting: A selfadministered questionnaire was used for data collection. Participants: One hundred ninety Kin-Ball sport par­ticipants were included in this study. Main Outcome Measures: The questionnaire was designed based on
physical characteristics, participation in Kin-Ball sport, and Kin-Ball sport injuries. Participation in Kin-Ball sport
includes the length of time spent playing Kin-Ball sport as well as the playing categories (junior, friendly,champion challenge, champion, over 40). Kin-Ball sport injuries include the presence or absence of injury
experience, the site, type, situation, and current injuries or pain associated with Kin-Ball sport.
Results: One hundred fifty-two players (80%) of Kin-Ball sport participants were injured. The ankle was the mostfrequently visited body site (60; 22.1%), and the elbow was the second most visited body site (40; 14.8%).
Sprains were the most common type of injury.
Conclusion: This is the first study to describe the characteristics of injuries relate to Kin-Ball sport. The findings ofthis study could be beneficial for athletes, coaches, trainers, and clinicians to prevent, or treatment of theinjuries.

1. Introduction
Kin-Ball sport is an alternative team sport invented by Mario Demers
in Canada in 1986 (Federation, I.K.-B.S., 2023). Kin-Ball sport empha­
size teamwork, cooperation, and sportsmanship and are distinguishedby the fact that each game features four players from three teams, andusing a 1.2 m diameter ball (Federation, I.K.-B.S., 2023a, Federation, I.
K.-B.S., 2023b). A team with a ball can hit it as an offense, while theother team, designated by the offense team, is in charge of defense tokeep the ball from touching the floor. When the defending team loses
control of the ball and it touches the ground, the other two teams score(Federation, I.K.-B.S., 2023). Kin-Ball sport is now recognized as bene­
ficial activities that promote physical activity (Lara-Sánchez AJ et al.,2010). According to Hastie et al. (2011), participants engaged inmoderate-to-vigorous physical activity for 72.3% of the game time,
regardless of age or sex. Kin-ball sport is an excellent physical education

activity. According to Ortega (Zurita-Ortega et al., 2020), Kin-Ball sport
improves physical activity and motor skills in people with intellectualdisabilities.
The Kin-Ball sport has an estimated 3.8 million participants world­
wide (Federation, I.K.-B.S., 2023). Kin-Ball sport was introduced inJapan in 1997 (Federation, J.K.-B.S., 2023) and the Japan Kin-Ball sport
federation has been reaching out to the public ever since, including in­duction into physical education in schools. As a result, the number of
Kin-Ball sport participants is expected to increase in the future.
Information about the characteristics of injuries and safety in KinBall sport is one of the most important factors for future outreach pro­motion. To the best of our knowledge, there is no report on the char­acteristics of the injuries associated with Kin-Ball sport. Information
about injuries related to Kin-Ball sport is expected to be useful for further
outreach safety promotion and the development of an injury prevention
strategy. The purpose of this study was to describe the characteristics of* Corresponding author. Department of Physical Therapy, Osaka University of Human Sciences, 1-4-1, Shojaku, Settsu-city, Osaka 566-8501, Japan.
E-mail address: t.higuchi1124@gmail.com (T. Higuchi).
https://doi.org/10.1016/j.jbmt.2024.03.075
Received 26 March 2023; Received in revised form 25 March 2024; Accepted 27 March 2024
Available online 1 April 2024
1360-8592/© 2024 Elsevier Ltd. All rights reserved.

K. Fukushige et al.

Journal of Bodywork & Movement Therapies 39 (2024) 590–593

injuries related to Kin-Ball sport.

Table 1
Participant demographics, Age, Height, Weight, and playing
experience were all expressed as mean ± SD, yo, Years of age.

2. Materials and methods

n = 190

A self-administered questionnaire created in Google Forms (GoogleLLC, Mountain View, CA, USA) was used for data collection. Before
answering the questionnaire, subjects were instructed to thoroughly
read the information in this study, and informed consent was deemedobtained through the questionnaire response. The responses all theparticipants were anonymous and in accordance with Google’s privacy
policies (https://policies.google.com/privacy?hl=en). Any personal in­formation that could be used to identify a person was not allowed to beincluded in their response.

Age (y)<9TeensTwentiesThirties
Forties
Fifties60 <
Sex (number)man/woman/no answer
Height (cm)Weight (kg)
Dominant arm (number)
Rt/Lt/no answer
Dominant leg (number)
Rt/Lt/no answer
Playing experience (years)
Level of competition (number)
JuniorFriendlyChampion challenge
champion
Over 40
Others, no answer
Frequent play (number, percentage)
Hit
Defence
Close
OthersNo answer

2.1. Questionnaire
The questionnaire was first drafted by a group consisting of threephysiotherapists (FK, YK, and TH) including a Japan Women’s National
Team player (KF). After the draft was created, several online meetings
with Kin-Ball sport coaches were held to develop the questionnaire.
The questionnaire was designed based on physical characteristics,participation in Kin-Ball sport, and Kin-Ball sport injuries. Physicalcharacteristics include age, sex, height, weight, and dominant arm andleg. Participation in Kin-Ball sport includes the length of time spentplaying Kin-Ball sport as well as the playing categories (junior, friendly,champion challenge, champion, over 40). Kin-Ball sport injuries include
the presence or absence of injury experience, the site, type, situation,and current injuries or pain associated with Kin-Ball sport. Participants
could only answer four of these questions. Finally, the subjects wereasked to provide any additional information or explanations that wererequired.
To protect their rights and diminish misinterpretations of the ques­
tions, respondents under 18 years of age were required to obtainparental or guardians consent for their responses. To be considered,participants had to play Kin-Ball sport on a local club team. Participants
could not have participated in Kin-Ball sport for more than 6 months,
regularly, or less than once per month, according to the exclusion
criteria.
The Osaka University of Human Sciences Institutional Review Board
approved this study (approval number: 2021–23). Subjects wererecruited between December 2021 to June 2022 via mailings from theJapan Kin-Ball sport federation, announcements on the federation’s
homepage, and personal contacts.

30.5 ± 12.9
1
3971
1736
192
103/86/1
166.2 ± 9.4
61.4 ± 12.2
175/11/4
146/24/20
8.1 ± 4.7
5 (2.6%)39 (20.5%)
13 (6.8%)
96 (50.5%)
21 (11.1%)
16 (8.4%)
74 (38.9%)
82 (43.2%)
14 (7.4%)
17 (8.9%)
3 (1.6%)

4. Discussion
The main findings of this study are as follows: 1) ankle is the mostfrequently injured body site, with elbow coming in second; 2) sprain is
the most common injury type; 3) defense is the most frequently play,with hitting coming second. The ankle is the most commonly injured
body site in sports. Hootman et al. (Hootman JM et al., 2007) used theNCAA database to conduct a survey of injury incidence across multiple
sports and discovered that ankle sprains are the most common injuryacross all sports. Nelson et al. (Nelson AJ et al., 2007) reported that theankle sprains are more common in sports that require jumping and quickchanges of direction. Kin-Ball sport is distinguished by the fact threeteams compete on the same court at the same time, necessitating
jumping and quick changes of direction. As a result, the Kin-Ball sport
has a feature that makes ankle sprains more likely to occur, which isconsistent with other sports such as basketball or soccer. In this study,
the elbow is the second most frequently injured body site (40; 14.8%).
According to Hootman et al. (Hootman JM et al., 2007) the upper ex­tremity accounts for 18.3%–21.4% of all injuries, while the lower ex­tremity accounts for 50%. This finding could imply that the elbow is acommon site of injury in Kin-Ball sport. Kin-Ball sport is played with a
1.2 m diameter, 1 kg weight ball, and the elbow is extended whilehitting. Furthermore, during defense, the elbow is forcedly extended andclose to the hit ball. Repetitive elbow extension load is commonly
thought to be a cause of elbow pain, including triceps tendon pathology,synovitis in the posterior ulnotrochlear articulation, and stress fractureof the olecranon (Furushima et al., 2014; Rahusen et al., 2009; Rettiget al., 2006; van den Bekerom and Eygendaal, 2014). Elbow injuries may
be caused by mechanical stresses on the elbow, and elbow injuries aremore common in Kin-Ball sport. In terms of acute injuries, fractures andjoint dislocations occurred at a rate of 7.2% and 2.4%, respectively.
According to Collins et al. (Collins and Comstock, 2008) the incidence offractures in baseball, which is commonly thought to have a low acuteinjury incidence rate, is 14.2%; this is a two-fold higher rate than in
Kin-Ball sport in this study. This finding indicates that Kin-Ball sport is a

3. Results
A total of 190 Kin-Ball sport players responded to the questionnaire.
Table I depicts participant characteristics and Kin-Ball sport participa­tion. The average age was 30.5 ± 12.9, and 96 (50.5%) of the partici­
pants were champions. The most common play was defense (82; 43.2%),
with the hit coming in second (74; 38.9%). These plays make up 82% ofall plays. Close, on the other hand, is 14 (7.4%).
Table II shows injuries related to Kin-Ball sport. One hundred fiftytwo players (80%) of Kin-Ball sport participants were injured. The
ankle was the most frequently visited body site (60; 22.1%), and theelbow was the second most visited body site (40; 14.8%). Sprains werethe most common type of injury (94; 37.5%), with contusions and othersaccounting for 36 (14.3%) and 64 (25.5%), respectively. Defense was
the most common injury situation (133; 51.2%), and hitting was thesecond most common (80; 30.5%), accounting for 81.9% of all injury
situations. While participating in the Kin-Ball sport, 84 (44.2%) of theparticipants were injured or in pain. The most common is the low back(35; 23.0%), followed by the knee (33; 21.7%) and the shoulder (22;14.5%).

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Journal of Bodywork & Movement Therapies 39 (2024) 590–593

The strength of this study is that this was the first to describe thecharacteristics of injuries related to Kin-Ball sport. Therefore, the find­ings of the current study could contribute as fundamental information
for further study and taking preventive measures. Secondly, data could
be collected from a wide range of ages throughout Japan because thisstudy was conducted in cooperation with the Japan Kin-Ball SportFederation.
The following are the study’s limitations: First, the diagnosis of in­juries reported is unclear. Second, since the type of injury is selfreported, the possibility that it may differ from the actual type ofinjury cannot be excluded. Finally, because the precise frequency orplaying time is unknown, the injury incidence rate, such as player-houror athlete-exposure, cannot be calculated. For determining the safety ofKin-Ball sport, further investigations with detailed data are needed.
In conclusion, this is the first study to describe the characteristics ofinjuries related to Kin-Ball sport. The findings of this study could be
beneficial for athletes, coaches, trainers, and clinicians in preventing, ortreatment of injuries.

Table 2Information about injuries.
n = 190
Injuries relate to Kin-Ball sport presence/absence
Body part (multiple choices allowed)
NeckShoulder
Upper arm
Elbow
Forearm
Wrist
Finger
Low back
HipThighKnee
CalfAnkle
Foot/toeOthers
Injury typeContusion
Fracture
Dislocation
SprainAbrasion
IncisionStress fracture
Muscle torn
OthersInjured situation
HitDefence
Close
Contact
OthersCurrent pain presence/absence/no answer
Body part (multiple choices allowed)
NeckShoulder
Upper arm
Elbow
Forearm
Wrist
Finger
Low back
Hip
Thigh
Knee
Calf
Ankle
Foot/toe
Others152/385 (1.8%)14 (5.2%)
1 (0.4%)40 (14.8%)
2 (0.7%)16 (5.9%)27 (10.0%)
9 (3.3%)6 (2.2%)8 (3.0%)33 (12.2%)
16 (5.9%)60 (22.1%)
7 (2.6%)27 (10.0%)36 (14.3%)
18 (7.2%)
6 (2.4%)
94 (37.5%)5 (2.0%)1 (0.4%)4 (1.6%)23 (9.2%)
64 (25.5%)

5. Institutional review board
This study has been approved by the ethics committee of Osaka
University of Human Sciences (approval number: 2021–23)
6. Clinical Relevance● Eighty percent of Kin-Ball sport participants were injured.
● The ankle was the most common injured body site, and the elbowwas the second common body site.
● Kin-Ball sport is thought relatively safe sport because the occurrenceof acute sever injuries were low.

80 (30.8%)133 (51.2%)
16 (6.2%)
9 (3.5%)22 (8.5%)
84/71/35

Funding

7 (4.6%)22 (14.5%)
2 (1.3%)18 (11.8%)
1 (0.7%)5 (3.3%)2 (1.3%)35 (23.0%)
0 (0%)
3 (2.0%)33 (21.7%)
4 (2.6%)14 (9.2%)
2 (1.3%)4 (2.6%)

No funding was disclosed by the authors.
CRediT authorship contribution statement
Kokoro Fukushige: Conceptualization, Data curation, Investigation,Methodology, Writing – original draft. Yuji Kanazawa: Validation,Writing – review & editing. Moemi Matsuo: Validation, Writing – re­view & editing. Takashi Higuchi: Conceptualization, Investigation,
Methodology, Project administration, Supervision, Writing – originaldraft.
Declaration of competing interest

relatively safe sport.
Approximately 44.2% of those polled reported experiencing pain
while participating in Kin-Ball sport. Kerr et al. (Kerr ZY et al., 2017)
conducted a survey to determine the incidence of injury in high school
athletes in the United States and discovered that 49.9% have non-timeloss injuries. As a result, it is assumed that the incidence of injury inthis study follows a similar pattern to that of high school athletes in theUnited States. One possible explanation is that 50.5% of the participantsin this study are champions, implying that half of the participants in thisstudy are in the most competitive category. In general, the rate of injury
has increased in tandem with the level of competition. Furthermore, thespecifics of this injury, such as the severity of the pain or whether theinjury was caused by playing Kin-Ball sport or not, are unknown. A large
number of individuals (31.7%) in Japan experience chronic musculo­
skeletal pain (Bouhassira D et al., 2008), especially from 30s to 50s(Nakamura M et al., 2011). In this study, 44.2% of the participants
experienced musculoskeletal pain, which was related to the Kin-Ballsport. The cause of this difference may be an additional overload on
the body based on the common chronic musculoskeletal pain.

The authors have no competing interests to disclose.
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