Injury & illness prevention in aquatics Dive, Swim, Score, Perform How to prevent injury & illness in the aquatic disciplines Dr. Margo Mountjoy (CAN)

Injury & illness prevention in aquatics

Dive, Swim, Score, PerformHow to prevent injury & illness

in the aquatic disciplines

Dr. Margo Mountjoy (CAN) FINA Sports MedicineDr. Jim Miller (USA) FINA Sports Medicine


Which aquatic discipline would you put your child in?

Setting the context

Dr. Margo Mountjoy


FINA Injury & Illness Surveillance

acute new onset injuries in all team sports

acute new onset injuries in all sports

acute new onset injuries & illnesses in all 5 aquatic disciplines

FINA conducted injury surveillance on water polo in 2004 at the Olympic Games, and all FINA disciplines in 2008 Olympic Games. In 2009 at the FINA World Championships, FINA conducted injury & illness surveillance for all FINA Disciplines.


Acute Injury Results171 acute injuries

6.6% of registered athletes

7.2/1000 in competition

0.8% time loss injury

1.1/1000 in competition

50% training / competition

Female: 8.8%Male : 6.8%

171 new-onset acute injuries were reported in 2009 at the FINA World Championships. This affected 6.6% of all athletes. The time-loss injury rate was 0.8%. Half of the injuries occurred during training and half during competition. Females were more likely to be injured than male athletes.

171 new-onset acute injuries were reported in 2009 at the FINA World Championships. This affected 6.6% of all athletes. The time-loss injury rate was 0.8%. Half of the injuries occurred during training and half during competition. Females were more likely to be injured than male athletes.


Injury Location

Head / Neck10.5%

Upper extremity34.5%

#1 shoulder

Head/Neck10.5%

Trunk22.2%

Lower Extremity26.9%

The injury distribution from the 2009 data is as per the chart.


Overuse: 37.5%

Non-contact trauma: 15.3%

Contact with athlete 14.7%

Injury Mechanism

The Injury Mechanism was mostly overuse (37.5%) followed by non-contact trauma (15.3%) and contact trauma with another athlete (14.7%).

DISCIPLINE ACUTE INJURIES /1000 ATHLETES

Diving W 134.1

Water Polo W 123.9

Diving M 118.6

Synchro W 99.6

Open Water Swim M 98.8

Open water Swim W 94.6

Water Polo M 89.4

Swimming W 34.9

Swimming M 21.8

The comparison of injury incidence by discipline is outlined in the chart.


184 illnesses

7.1% of registered athletes

1.2% time-loss Infection 49.2%

Respiratory: 50%

Gastrointestinal: 19.9%

Environmental: 27.6%

Acute Illness Results

In the 2009 data, there were 184 illnesses reported affecting 7.1% of all athletes. This resulted in a 1.2% time loss from sport. The most common cause was infection (49.2%) of the respiratory tract followed by the GI tract. Environmental causes wasa the 2nd most common cause of illness causing 27.% of all illnesses.


DISCIPLINE ACUTE ILLNESS /1000 athletes

Swimming W 93.7Water Polo W 79.6Swimming M 60.8

Open water W 40.5Diving M 33.9

Water polo M 28.3Synchro W 24.9

Open water M 12.3Diving W 0

For illness incidence by discipline see chart.


Preventing Injury & Illness: Workshop Overview

DivingSwimmingSynchroOpen Water SwimWater Polo


Injury & Illness Preventionin Diving

Dr. Margo Mountjoy


Injury Risk in Diving

Older athleteElite athlete

Higher degree of difficulty

During water entry10m: entry speed = 64km/h

Deceleration forces = 20G

For illness incidence by discipline see chart.


TraumaDry land training

Contact with boards

Fall from 10m:Retinal detachment

Fractured ribsPneumothorax

Tympanic drum rupture

Trauma in diving can be caused by injuries during dry land training and/or contact with the boards. Falls from the 10m tower can result in significant injury due to the forces on impact with the water.


Over use Injuries

Wrist

Carpal ligament sprainsWrist extensor tendonosisScapholunate dislocationsTFCC tears

The wrist is often affected in the diver caused by incorrect technique for the entry into the water.


Over use Injuries

Lumbar Spine

Caused by “ripping” dives‘arching’ to save entry

Mechanical back painSpondylolysis/ listhesis

Overuse injuries to the spine are caused by ripping dives. Most back injuries are either mechanical back pain, or spondylolysis/ listhesis.


Over use Injuries

Shoulder

Caused by forces on entryRotator cuff tendonosis

Over use injuries of the shoulder are also caused from the forces exerted on the shoulder during the entry.

Over use injuries of the shoulder are also caused from the forces exerted on the shoulder during the entry.


Illness PreventionEsthetic Sport

disordered eatingeating disordersfemale athlete triad

Prevention:educationearly intervention

As diving is an esthetic sport, prevention of disordered eating, eating disorders and the female athlete triad are required by all diving clubs.


PREVENTION: General Principles

Vigilant spotting on dry land trainingProgressive skill developmentDiving-specific PPE Avoid overtrainingAdequate rest / recoveryPeriodization of training program (volume)Meticulous attention to techniqueEmphasis on core and eccentric training

Prevention strategies in diving are outlined in the chart above.


PREVENTION: Wrist InjuriesCorrect flat hand grasp technique

Bracing: preventing dorsi-flexion

on entry

Prevention of wrist injuries are associated with insurance of correct entry technique.Prevention of wrist injuries are associated with insurance of correct entry technique.


Injury & Illness Preventionin Swimming

Dr. Jim Miller

Swimming

“The” classic example of shoulder overuse syndrome


The shoulder is the most common injury in swimming

Shoulder Injury Background

Upper extremity provides up to 90% of the propulsive power in swimming

60-85% of all elite level swimmers will have a painful shoulder requiring a layoff of a week or more counting acute and chronic overuse injuries

FINA surveillance: shoulder accounted for 34.5% of injuries


The shoulder is vulnerable due to its importance in propulsion. The incidence of shoulder injuries is very high.

RotationsMath Works!!

10,000 – 30,000 meters/day

35 rotations (or more) per 50 meters

Over 50,000 - 120,000 rotations per week!!!

Problem with hyperflexible powerful athletes


The cause of shoulder injuries is most often over-use.

Muscle Imbalance Technique intensive

Time intensive, leading to fatigue and small stabilizer failure

Imbalanced sport, stimulating some muscle groups while destabilizing others


Swimming often results in rotator cuff muscle imbalance which predisposes the athlete to shoulder injury.

Prevention Technique training combining science and coaching

Dry land training for shoulder balance – focus on core for power and scapula link to power source – FINA Shoulder Program (to follow)

Avoidance of stretching exercises which may destabilize the shoulder

Early intervention for the ‘painful shoulder’


Prevention involves correction of technique, prevention dry-land exercises, avoidance of stretching and early identification/intervention.

Unique Injuries

Goggles

Starts

Breaststroker knee – similar to water polo and synchronized swimming


Other risks for injury in swimming includ trauma from goggles, starts and medial pain from breast strokers knee.

Illness FINA surveillance: 2 of the top 3 rates of illness

involved pool swimmers High intensity training Multiple training sessions per day Inadequate attention to ‘the basics’ of hydration,

nutrition, and sleep for recovery Crowding in a warm, high humidity environment

such as warm-up and team areasIs there a nutrition plan to balance the training plan?


Illness incidence in swimming was highest of all disciplines. It could be caused by the high intensity of training and inadequate attention to nutrition and recovery principles. There may also be crowding in the athlete recovery areas.

Asthma

Swimming has been recommended to asthmatics for years due to favourable blood and airflow ratios along with humidified air - However………

Intense aerobic training over a long time = increased risk By-products of chlorine and bromine – the most common

pool chemicals – have been a topic of concern Consider aquatic eco-environment to be more than the pool

– air and water temp, humidity, air flow over the water, ‘other chemicals’ in the 30 cm (12 inches) above the water.


Asthma has a high incidence in swimming thought to be due to the inhalation of chloramines, air quality, temperature etc. In addition aerobic training is another risk factor for swimmers.

Prevention

Balanced eco-environment Hydration Early identification of bronchospasm vs. vocal cord dysfunction with documentation and treatment Separation of bronchospasm as presentation of underlying

asthma or reaction to aquatic environment Early therapy with inhaled GCS with or without combination

Beta 2 agonists as well as escape short acting Beta 2 agonists


Prevention of asthma includes assurance of a safe training environment, adequate hydration, early identification and appropriate medical treatment.


Injury & Illness Preventionin Synchronized Swimming

Dr. Margo Mountjoy


Injuries in SynchroTrauma

FracturesConcussion

Sprain/strainsHematomasContusions

Disc herniationsAcute tears

Prevention of asthma includes assurance of a safe training environment, adequate hydration, early identification and appropriate medical treatment.


Overuse injury: support skull

Injuries in Synchro: Shoulder

Supra spinatusSub acromial bursitis

Over use injuries of the shoulder are also common.


back

Overuse injury

ArchingVolume overload

Ballistic rocket split boostsWalkouts

Knight position

Injuries in Synchro: Lumbar Spine

Injuries to the lumbar spine are caused by the unique moves of synchronized simmers.


Injuries in Synchro: Lumbar Spine

SIJ dysfunctionDisc herniations

Facet dysfunctionMyofascial injury

Spondylolysis / listhesis

There are many different pathologies seen in the synchronized swimmer’s bath.


Injuries in SynchroKnee

Patellar femoral syndromeMedial collateral ligament sprain

Pes anserine bursitis

Overuse injury Eggbeater kick

Medial knee pain is thought to be caused by the overuse of the egg beater kick.


Illnesses in Synchro

Esthetic Sport:Disordered eatingEating disorders

Female athlete triadPrevention:

EducationEarly intervention

Like diving, Synchro is an esthetic sport and these athletes are susceptible to disordered eating, eating disorders and the female athlete triad.


PREVENTION: General PrinciplesCore strength

Periodization of training

Avoid over-training

Logical skill progression (LTAD model)

Vigilant spotting – dry-land & in H2O

The prevention of injuries in synchro are outlined in the slide.


PREVENTION

Synchro-specificPre-Participation

Examination

Preventative PPE in synchro should focus on the factors outlined on the chart.


PREVENTION: General PrinciplesProvision of adequate recovery

Nutritional support

Psychological support

Balance non-sport stress

Prevention principles are outlined on the slide.


Injury & Illness Preventionin Open Water Swimming

Dr. Jim Miller


A Very Different World!!

Open Water

TraumaEnvironmentHypothermiaHyperthermiaHyponatremia Plant and animal life that sits, floats & swims

……..


OWS athletes are prone to trauma, environmental injuries, heat/cold injuries, electrolyte imbalance and injury from flora/flauna.

............... boats!!!

Boats can also injure the OWS athlete.

Trauma

Physical contact with another swimmer can be the cause of traumatic injuries in OWS.

“A good day for a 25K.”Injury & illness

prevention in aquatics

Environmental conditions can place an athlete at risk of injury or illness.

Evacuation and reschedule!Injury & illness

prevention in aquatics

Environmental conditions can place an athlete at risk of injury or illness.


Environmental Challenges

Currents Water Quality

Other environmental challenges include currents and water quality


Environmental Challenges

Water Quality(The Finish Line!)

Air Quality


PreventionTraining for conditions

AcclimatizationNutrition/hydration consumptionCompetitors

Rules development and enforcementWater quality testing

Prevention strategies are outlined on the slide.


Safety Planning

Emergency action planLifesavingEvacuationMedical coverage: on water, land, transport, hospital

(aware and capable)Course contingencies: postponement,

abandonment, shorten, move

Adequate safety planning can help prevent injuries/ illness in Marathon swimming.S


Energy Exchange Principles

ConductionConvectionRadiationEvaporation

Heat and cold regulation are affected by conduction, convection, radiation and evaporation.

All acting at once!



Thermal ChallengesHypothermia and Hyperthermia Variable levels of severity from

shivering/sweating to emergency evacuation for seizure, cardiac consequences

Prevention Acclimatization Double caps (hypo only) Ear plugs (hypo only) Hydration Nutrition (feeds at 20 min

intervals) – mixture affected by hypo vs hyperthermia

Medical readiness/plan

Prevention of thermal injuries are listed on the slide.

Feeding during Open Water Races


Adequate feeding and hydration during the race decreases the risk of injury from water temperature.


Injury & Illness Preventionin Water Polo

Dr. Margo Mountjoy


Injuries in Water PoloIn comparison with aquatic disciplines:

Highest injury rate

Highest traumatic injury rate

Most significant severity (time loss)

Water polo has the highest rate of injuries and the most significant severity when compared with the other aquatic disciplines.


Injuries in Water Polo

In comparison with team sports (Athens 2004):

Most injuries from contact

Most injuries from foul play

Most head injuries

In comparison with other team sports in 2004, Water Polo had the most injuries from contact and foul play and the highest incidence of head injuries.


Injury Location in Water Polo

Head 56%

Upper extremity 28%

Trunk 11%

Lower extremity 6%


Water Polo Injury Trends 2004-2009

Men2004: 27.6/1000 player matches2009: 14.9/1000 player matches

Women2004: 3.57/1000 player matches2009: 28.6/1000 player matches

Injury incidence in men is decreasing over time and is increasing in women.


Injuries in Water Polo:

Over Use Injuries

Shoulder: rotator cuff

Knee: eggbeater kick

Overuse injuries common in water polo include the shoulder and the knee.


PREVENTION: Head Injuries

Concussion Education ProgramPre-Season neuro-cognitive testing

Water polo specific return-to-play guidelines

Prevention principles include attention to concussion identification, treatment and progressive return to play.


PREVENTION: Water Polo

Water Polo Referee Education

Ensuring effective refereeing will result in less traumatic injuries from foul play.


PREVENTION: Water Polo

Shoulder & Knee overuse injuryprevention program

Preventative shoulder and knee programs would help to decrease the incidence of shoulder and knee injuries.


Questions & Answers

Dr. Margo Mountjoy Dr. Jim Miller

Documents

Injury & illness prevention in aquatics Dive, Swim, Score, Perform How to prevent injury & illness in the aquatic disciplines Dr. Margo Mountjoy (CAN)