Martial artists differ in their views of the usefulness of head protection. Some think it protects the competitors from injury, while others think it increases the risk of injury. For example, in no-contact or light-contact sparring without head protectors, attackers must use precise control to insure they do not strike their opponents heads with too much force, and defenders know they must protect their heads. Since both competitors are aware that an accidental injury may occur, both of them are more alert to the possibility and act accordingly; thus excessive contact is rare, and when it does occur, it usually only a causes a minor injury.
In a 1999 British study Injury rates in Shotokan karate by G. R. Critchley, S. Mannion, and C. Meredith in the British Journal of Sports Medicine (1999; 33;174-177), the authors documented the injury rate in 1770 bouts at three British Shotokan karate championships in 1996, 1997, and 1998. Strict rules allowed only “light” or “touch” contact and protective padding for the head, hands, and feet was prohibited. 160 injuries were recorded for an overall rate of injury of 0.09 per bout and 0.13 per competitor. 91 (57%) injuries were to the head. The average age of those injured was 22 years, with an average of nine years of experience in karate.
The study found that although there is evidence that hand protection protects the attacker from hand injuries and that headgear protects the defender from facial contusions, there is insufficient evidence that protective padding protects against brain injury in either the long or short-term., and that, in fact, protective padding can lead to an increase in the frequency and force of contact. The authors concluded that it was not necessary to recommend protective padding for the face or hands for Shotokan karate tournaments. They concluded that a relatively low injury rate may sustained by strict refereeing, a high standard of training of referees and competitors, and strict enforcement of rules of contact. They also found that continuous medical surveillance by doctors with an understanding of karate is necessary.