# Analysis of Severe Spinal Injuries in Korean Elite Female Wrestlers
## 1 Introduction  
Wrestling, a sport in which two competitors engage in physical combat, has long been perceived as a predominantly male sport. However, women's wrestling has been recognized as an international sport after it was first introduced at the 2000 Sydney Olympics and officially included as an event at the 2004 Athens Olympics [1]. The sport is now played worldwide and has become an event in international competitions, including the World Championships [2]. In international competitions, wrestling is contested in Greco-Roman and freestyle; however, only freestyle is contested in women's events [1].  
Freestyle wrestling involves the use of all body parts for offensive and defensive maneuvers, resulting in various techniques and movements [3, 4]. For example, double-leg tackle is a dynamic and fast technique in which the wrestler grabs both the opponent's legs to take them down. Furthermore, techniques such as low single-leg takedown, where the wrestler grabs the opponent's ankle to take it down, or foot sweep, which involvestripping the opponent by hooking their leg, also showcase the unique attack styles of freestyle wrestling. Common defense techniques include front headlock, which stops an opponent's attack by controlling the head and arms, and sprawl, which involves pressing the opponent's head toward the abdomen to push them down to the mat [5]. In terms of posture, freestyle wrestlers maintain a lower stance than Greco-Roman wrestlers, resulting in excessive neck and lower back curvature [6].  
The unique techniques and postures of freestyle wrestling put athletes at greater risk of injury [7]. In particular, men's freestyle wrestling had the highest incidence of severe injuries among the 25 sports categories under the National Collegiate Athletic Association (NCAA), with injuries resulting in a time loss of three weeks or more, accounting for approximately 14.2% of all injuries [7]. The prevalence of head and neck injuries, including concussions and spinal injuries, among freestyle wrestling athletes is reportedly high owing to direct collisions, twisting forces, and techniques such as tackles [8; 9]. Studies investigating spinal injuries in freestyle wrestlers found that approximately 22% of all injuries were severe enough to limit participation in training and competition for more than three weeks [9]. Since spinal injuries are serious issues that threaten athletes' careers and lives [10; 11], it is crucial to understand the injury patterns of freestyle wrestlers and develop effective prevention and management strategies based on generated insights.  
Despite international recognition of sports, research on the epidemiology of injuries in female freestyle wrestlers is still needed. To the best of our knowledge, research focusing on female wrestlers has only involved a few studies on injuries during training sessions of Korean national team athletes, injuries at the Olympic Games, and injuries at the United World Wrestling championships hosted by the Hungarian Wrestling Federation [12; 13]. Moreover, to date, epidemiological studies of injuries within the NCAA have predominantly focused on male wrestlers [8; 14]. Wrestling techniques and tactical actions tend to differ depending on the gender, and the spine is also susceptible to damage in women due to repetitive overload stress. Additionally, once these injuries occur, they require a long recovery time and have a high recurrence rate [15; 16]. Previous research found that the severity of injury in Korean wrestlers is influenced by their weight class [12]. Therefore, this study was conducted to analyze the characteristics of serious spinal injuries in female freestyle wrestlers. The aim of this study was to investigate the characteristics of severe spinal injuries and post-injury management practices in Korean female wrestlers, with a focus on comparisons by weight class.