Analysis of water polo injuries during 8904 player matches at FINA World Championships and Olympic games to make the sport safer

A Dual Inertial Measurement Unit System for Classifying Standard Overhead Drill Movements in Elite Women's Water Polo

INTRODUCTION

Water polo upper limb external load monitoring cannot be currently measured accurately because of technological and methodological challenges. This is problematic as large fluctuations in overhead movement volume and intensity may affect performance and alter injury risk. Inertial measurement units (IMU) and machine learning techniques have been shown to accurately classify overhead movements in other sports. We investigated the model accuracy and class precision, sensitivity, and specificity of IMU and machine learning techniques to classify standard overhead drill movements in elite women's water polo.

METHODS

Ten women's water polo players performed standard drills of swimming, blocking, low-intensity throwing and high-intensity throwing under training conditions. Athletes wore two IMU: one on the upper back and the other on the distal forearm. Each movement was videoed and coded to a standard overhead drill movement. IMU and coded video data were merged to verify the IMU-detected activity classification of each movement to that of the video. Data were partitioned into a training and a test set and used to form a decision tree algorithm. Model accuracy and class precision, sensitivity, and specificity were assessed.

RESULTS

IMU resultant acceleration and angular velocity values displayed drill-specific values. A total of 194 activities were identified by the model in the test set, with 8 activities being incorrectly classified. Model accuracy was 95.88%. Percentage class precision, sensitivity, and specificity were as follows: blocking (96.15, 86.21, 99.39), high-intensity throwing (100, 100, 100), low-intensity throwing (93.48, 93.48, 97.97), and swimming (94.81, 98.65, 96.67).

CONCLUSIONS

IMU and machine learning techniques can accurately classify standard overhead drill movements in elite women's water polo.

The Association of Serum Calprotectin with Fitness Indicators and Biochemical Markers in High-Level Athletes: A Continuous Dynamic Monitoring during One Competitive Season

The objective was to determine the associations between several biochemical indicators and the dynamics of concentration change across four physical fitness phases over the period of a competitive season. Furthermore, associations between serum calprotectin and biomarkers of inflammation or muscle injury and physical indicators were examined.

SUBJECTS AND METHODS

Twenty professional male water polo players (median age: 28 (22-42)) were included in this study. Serum creatine kinase activity was determined by the automated photometric UV method. The concentrations of calprotectin, C-reactive protein, and myoglobin were measured using an automated immunoturbidimetric method, while an automated immunochemistry method was employed for interleukin-6, troponin I, and cortisol determination. Tests of repeated strength, maximal strength, and static strength were used to evaluate physical activity.

RESULTS

Serum calprotectin concentrations expressed in median and IQR were significantly different: T1: 2.92 g/mL (2.47; 3.86); T2: 2.35 g/mL (1.26; 2.87); T3: 2.27 g/mL (1.60; 3.27); and T4: 1.47 g/mL (1.04; 2.85) (p = 0.004). Cortisol concentration and CK activity showed significant changes among phases (p = 0.049 and p = 0.014, respectively). Each physical activity examined showed a significant seasonal decrease (all p values were 0.001). Calprotectin serum concentration and indicators of muscular injury, inflammation, and physical activity were found to be correlated during particular stages of the seasonal examination.

CONCLUSIONS

Calprotectin values determined throughout one competitive season decreased as training intensity among water polo players increased. Serum calprotectin concentrations and indicators were related to biochemical markers of inflammation and muscle damage.

Knowledge and Self-Assessment of Dental Injuries and Oral Health among Croatian Professional Water Polo Players: A Cross-Sectional Study

OBJECTIVES/AIM

The purpose of this study was to evaluate oral health knowledge, and the incidence of self-reported dental injuries incidence, the frequency of mouthguard use, oral hygiene habits, and oral health status among professional water polo players.

MATERIALS AND METHODS

During the 2022/2023 season, 114 water polo players from the Croatian First League participated in a questionnaire-based online survey. The data collected included sociodemographic and professional attributes, oral health knowledge questions, dental injury experiences, and practices related to mouthguard use. Respondents also rated their own oral health status and oral hygiene habits. The data were analyzed using descriptive statistics and a regression analysis.

RESULTS

The respondents demonstrated inadequate knowledge of oral health, with a mean score of 6.4 ± 2.6 out of 12. Better knowledge correlated positively with older age (p ˂ 0.05) and consistent flossing (p = 0.014). Additionally, 27.2% (31 of 114) of reported dental injuries were related directly to incidents which occurred while participating in water polo. These injuries occurred more frequently during games (54.8%) and often involved the anterior maxillary incisors (71.0%) due to player contact (87.1%). Awareness of mouthguards was high (93.9%), whereas their actual use was low (7.0%) because 35.1% of respondents reported discomfort wearing them. The respondents' self-assessments revealed widespread dental problems, including tooth sensitivity (13.3%), erosion (15.8%), calculus (28.1%), and pigmentation (7.9%).

CONCLUSIONS

The research results indicate a lack of adequate knowledge among the respondents regarding oral health. This deficit was not associated with oral hygiene habits or oral cavity conditions. These findings highlight the disparities in oral health awareness and practices associated with water polo participation and emphasize the importance of education and prevention efforts.

Incidence of Concussions in Elite Female Water Polo: A Retrospective Analysis

OBJECTIVE

Current evidence for concussions is mixed in water polo players. Surveys suggest rates as high as 36%, whereas surveillance studies at international competitions often fail to report them at all. The goal of this study was to examine the incidence of concussions in elite female water polo players from surveillance tools implemented longitudinally.

DESIGN

Retrospective chart analysis of 10 years spanning between 2012 and 2022.

SETTING

National teams or professional sports.

PARTICIPANTS

Female players from the Canadian senior national water polo teams that participated in international competitions and trained more than 10 hours per week in a competitive environment.

ASSESSMENT OF RISK FACTORS

Included player position, recurrence, and time loss before full return to play.

MAIN OUTCOME MEASURES

Prevalence of concussion diagnosis.

RESULTS

Forty-three concussions were identified over the 10 years observed at a median count of 3 concussions per year. Cumulative days lost spanned between 25 and 348 days per team*year. Altogether, this produced a median rate of 14.3 injuries per 100 player*years. Goalkeepers in the sample suffered the highest rates of concussion (25.8%), compared with players in other positions (22.8% of centers and 16.7% of drivers).

CONCLUSIONS

This study found evidence for prevalence of concussions in elite female water polo players. Improved guidelines preceded a significant reduction in time loss after the year 2017. This adds to a body of knowledge suggesting that improved surveillance methods are needed to detect and care for concussions in this population.

Epidemiology of Acute and Overuse Injuries in Underwater Rugby

Background

Underwater rugby (UWR) is a team sport. Athletes require a high degree of strength, endurance, speed, and coordination involving intense physical contact. Currently, a paucity of literature exists regarding injury occurrence in UWR.

Purpose

To examine the nature and prevalence of acute and overuse injuries in UWR.

Study Design

Descriptive epidemiology study.

Methods

Between November 2020 and March 2021, a total of 720 German UWR athletes were invited to take an online survey developed by orthopaedic specialists with UWR athletes. Data were recorded regarding general and health-related information, training habits, acute injuries that necessitated an interruption in training and/or doctor consultation, as well as overuse injuries. Overuse injuries were evaluated using the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire. Statistical analyses included t tests or rank sum tests depending on normality of distribution. A nonparametric Kruskal-Wallis 1-way analysis of variance on ranks was used for nonnormally distributed data among several groups.

Results

This study included 161 active athletes (mean ± SD, 36.1 ± 11.9 years old; 75.3% male) for analysis, of whom 90.1% were competing regularly. The performance-level distribution was as follows: first German national league (n = 73), second German national league (n = 46), state league (n = 17), district league (n = 1), and no league (n = 24). The mean ± SD sport-specific training workload was 5.6 ± 3.0 h/wk, including UWR training, additional swimming (n = 71; 44.1%), strength (n = 70; 43.5%), and/or endurance training (n = 102; 63.4%). Acute injuries were recorded in 78.9% of all athletes. The most typical locations for acute injuries were hand/finger (42.4%), head/face (concussion, ruptured eardrum; 18.1%), wrist (5.5%), or spine (5.0%). Overuse injuries were reported by 42.9% of the participants. The predominant locations for overuse injuries were hand/finger (18.8%), shoulder/clavicle (14.1%), spine and wrist (10.7% each), head/face (8.7%), and ankle joint and knee (6.7% each).

Conclusion

In the current study, 3 of 4 athletes reported at least 1 acute injury, and 2 of 5 athletes reported at least 1 overuse injury. Leading injury regions were the hand/finger, head/ear, wrist, and spine.

Recovery in water polo: how much do we have to know? A systematic review

Water polo (WP) is a high-intensity intermittent aquatic sport, with a predominance of swimming skills and nonswimming activities and incomplete recovery periods. Consequently, recovery after exercise is a fundamental part of sports performance. The main purpose of this systematic review was to evaluate the effects of different recovery strategies in WP performance. The studies were found by searching in the databases of PubMed, Web of Science, and Scopus. Methodological quality and risk of bias were assessed in accordance with the Cochrane Collaboration Guidelines samples. A summary of results including five studies was followed. The results show that supplementation with cherry juice before training does not imply improvements in recovery; the full-body photobiomodulation therapy reduces muscle damage; reducing training load during the season increased the natural logarithm of the root mean square of successive differences and perceived state of recovery, and the heart rate variability stabilizes and could progressively increase at the end of a tournament; and when an increase in internal training load is less than 60%–70% autonomic cardiac disturbances during preseason training do not occur. Recovery in WP is a very limited field of study that needs future research in active recovery, hydrotherapy, massage, rest and sleep to help coaches formulate recommendations.

Injuries Affecting Intercollegiate Water Polo Athletes: A Descriptive Epidemiologic Study

Background

There are few data on injuries suffered by collegiate water polo athletes.

Purpose

To describe the epidemiology of injuries suffered by National College Athletic Association (NCAA) male and female water polo players by using injury surveillance data over a 5-year period.

Study Design

Descriptive epidemiology study.

Methods

Deidentified data on all water polo injuries and illnesses recorded in the Pac-12 Sports Injury Research Archive from July 2016 through June 2021 were obtained and analyzed. Three men's and 4 women's teams were observed for the entire 5-year period, and 1 men's and 1 women's team was observed from July 2018 through June 2021.

Results

During the observation period, 729 injuries were recorded in the database, with no differences in overall injury rates between male and female athletes (relative risk [RR] = 1.0; 95% CI, 0.9-1.2); 33.7% of injuries required a physician encounter, and 3.6% required surgery. The shoulder was the most injured body part, making up 20.6% of all injuries, followed by the head/face (18.8%) and hand/wrist/forearm (11.7%). Shoulder tendinopathy was the most common shoulder injury diagnosis (4.5% of all injuries). Concussion was the most common injury diagnosis overall, making up 11.4% of injuries, and 81.9% of concussions occurred outside of competition. Male athletes were significantly more likely than female athletes to have a concussion in an off-season practice (RR, 3.25; 95% CI, 1.2-8.8) and via contact with another player (RR, 2.9; 95% CI, 1.3-6.4). Half of the 26 surgical procedures occurring over the observation period were for chronic joint trauma of the groin/hip/pelvis/buttock, with 9 of those 13 being for femoroacetabular impingement specifically.

Conclusion

Among NCAA water polo athletes, the shoulder was the most injured body part; however, shoulder injuries rarely required missed time from sport or necessitated surgical intervention. Concussions were the most common injury diagnosis, had the worst return-to-play outcomes among common diagnoses, and were mostly sustained outside of competition. Femoroacetabular impingement was found to be the dominant diagnosis for which surgical intervention was required.

The Effectiveness of Shoulder Mobility and Strength Programs in Competitive Water-Polo Players

Background: Water-polo is the water sport with the highest incidence of injuries, with shoulder pain being the most common one. The understanding of risk factors and guidance on preventive measures is essential in this sport discipline. The aim of this study was to determine the effects of a specific 6-week training plan on range of motion (ROM) and joint strength levels in a group of professional water-polo players. Methods: Quasi-experimental study with a sample of 28 participants (age: 20.1 ± 2.5 years; height: 176.9 ± 6.2 cm; body mass: 74.6 ± 8.1 kg). Three study groups, which consisted of one control group and two experimental groups, were established. Two repeated measurements, pre and post intervention, were performed. During these measurements, ROM of the glenohumeral joint was analyzed both in external (ER) and internal (IR) rotation, as well as the maximal isometric strength. Conclusions: The application of a training program improved glenohumeral joint ROM. ER and IR evolve differently in both shoulders. ER improved only in the throwing arm only in the group undergoing intervention but for the non-dominant side, improvements were observed in both ER and IR, regardless of whether or not they had followed the intervention plan. No improvements were observed in either the isometric strength or contralateral asymmetries.

Salivary S100 calcium-binding protein beta (S100B) and neurofilament light (NfL) after acute exposure to repeated head impacts in collegiate water polo players

Blood-based biomarkers of brain injury may be useful for monitoring brain health in athletes at risk for concussions. Two putative biomarkers of sport-related concussion, neurofilament light (NfL), an axonal structural protein, and S100 calcium-binding protein beta (S100B), an astrocyte-derived protein, were measured in saliva, a biofluid which can be sampled in an athletic setting without the risks and burdens associated with blood sampled by venipuncture. Samples were collected from men’s and women’s collegiate water polo players (n = 65) before and after a competitive tournament. Head impacts were measured using sensors previously evaluated for use in water polo, and video recordings were independently reviewed for the purpose of validating impacts recorded by the sensors. Athletes sustained a total of 107 head impacts, all of which were asymptomatic (i.e., no athlete was diagnosed with a concussion or more serious). Post-tournament salivary NfL was directly associated with head impact frequency (RR = 1.151, p = 0.025) and cumulative head impact magnitude (RR = 1.008, p = 0.014), while controlling for baseline salivary NfL. Change in S100B was not associated with head impact exposure (RR < 1.001, p > 0.483). These patterns suggest that repeated head impacts may cause axonal injury, even in asymptomatic athletes.

Automatic detection of passing and shooting in water polo using machine learning: a feasibility study

There is currently no efficient way to quantify overhead throwing volume in water polo. Therefore, this study aimed to test the feasibility of a method to detect passes and shots in water polo automatically using inertial measurement units (IMU) and machine-learning algorithms. Eight water polo players wore one IMU sensor on the wrist (dominant hand) and one on the sacrum during six practices each. Sessions were filmed with a video camera and manually tagged for individual shots or passes. Data were synchronised between video tagging and IMU sensors using a cross-correlation approach. Support vector machine (SVM) and artificial neural networks (ANN) were compared based on sensitivity and specificity for identifying shots and passes. A total of 7294 actions were identified during the training sessions, including 945 shots and 5361 passes. Using SVM, passes and shots together were identified with 94.4% (95%CI = 91.8-96.4) sensitivity and 93.6% (95%CI = 91.4-95.4) specificity. Using ANN yielded similar sensitivity (93.0% [95%CI = 90.1-95.1]) and specificity (93.4% [95%CI = 91.1 = 95.2]). The results suggest that this method of identifying overhead throwing motions with IMU has potential for future field applications. A set-up with one single sensor at the wrist can suffice to measure these activities in water polo.

Epidemiology of Musculoskeletal Injuries in Adult Athletes: A Scoping Review

Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the musculoskeletal (MSK) system of adult athletes. Materials and Methods: We performed a scoping review on the Pubmed database limiting our search to 33 Olympic sports. Results: We identified a total of 1022 papers, and of these 162 were examined in full for the purpose of this review. Archery was the sport with the highest risk of injuries to the upper extremities, marathons for the lower extremities, and triathlon and weightlifting for the body bust. In the majority of the sports examined, muscle/tendon strain and ligament sprain were the most common MSK-Is diagnoses, while athletics, karate, and football were the sports with the highest IIRs, depending on the methods used for their calculations. Conclusions: Our scoping review highlighted the general lack and dishomogeneity in the collection of data on MSK-Is in athletes.

Risk Factors for Shoulder Injuries in Water Polo: a Cohort Study

BACKGROUND

Very limited investigations have been conducted exploring risk factors for injury in water polo players. A gap remains in the literature regarding identification of variables that should be considered as part of player screening evaluations.

PURPOSE

To estimate whether previous injury, changes in strength, range of motion (ROM) or upward scapular rotation (UR) are related to shoulder injuries in water polo players.

STUDY DESIGN

Descriptive cohort study.

METHODS

Thirty-nine international-level players participated (19 males). Shoulder internal (IR) and external rotation (ER) peak torque was measured using an isokinetic device (CONtrex MJ). Shoulder ROM was measured passively using standard goniometry. Scapular UR was measured using a laser digital inclinometer. At baseline players were divided into groups: those with and without previous shoulder injuries. Independent t-tests and Mann-Whitney U tests were used to compare the study variables between groups. After nine months, a second analysis compared the same athletes, who were then grouped by those who had or had not sustained new injuries. Effect sizes were calculated with a Hedge's g. Chi squared analysis compared proportion of injured players with and without previous injury.

RESULTS

Eighteen participants (46%) had previous injuries at baseline. Players with a previous injury showed higher peak torques for IR (0.62±0.15 vs 0.54±0.13N/kg, p=0.04, g=0.60); larger loss of IR ROM (9.9±9.1 vs 4.1±7.5°, p=0.04, g=0.68), but no statistical difference in UR (p=0.70). After nine months, there were no statistical strength differences between groups. Loss of IR ROM was significantly higher in the injured group (9.8±9.8 vs 4.0±6.7°, p=0.04, g=0.68), as well as UR (13.0±3.0 vs 10.4±3.3°, p=0.01, g=0.81). History of previous injury was significantly related to developing a new injury (OR 6.5, p=0.02). Logistic regression found previous injury and UR most important contributors to injury risk.

CONCLUSIONS

Previous injury, changes in IR ROM and UR are related to new shoulder injuries in water polo, but further variables such as rest, training load, or psychosocial factors may explain the incidence of new injuries.

LEVEL OF EVIDENCE

Level 3.

Sink or swim: innovations in aquatic health

Since the first modern Olympic Games in 1896, the aquatic sports have expanded both in participation and innovation over the last century. Beginning with swimming, diving, water polo, and later additions of artistic swimming, open water swimming and high diving, the aquatics sports represent a core pillar of Olympic disciplines. The rapid expansion of aquatic disciplines necessitated the foundation of the Fédération Internationale de Natation (FINA) in 1908, to govern the development of aquatic sports. The amateur spectacle has been slowly replaced with an increased focus on health and performance by dedicated professional athletes and support teams, resulting in the development of new innovations. In the early years, innovations largely centered on technical equipment such as bathing suit and springboard design. In more recent years, research and innovation have shifted focus to health and its impact on performance, including but not limited to changes in training methods, nutrition, injury and illness reduction through surveillance and access to education for athletes, coaches, and support personnel. An increased awareness on factors that affect athlete health have also driven safety innovations including the development of Nutrition and Relative Energy Deficiency in Sport Clinical Assessment Tool, the Sport Mental Health Assessment and Recognition Tools and safeguarding from harassment and abuse through embedding athletes' right to safe sport in underpinning statutory documents. While the future of aquatic health innovations remains undefined, there are many potential opportunities for research and knowledge translation as the aquatic sports continue to evolve and adapt over time.

Prevalence and mechanisms of injuries in water polo: a systematic review

Objective

To summarise the information available in the literature on the prevalence of injuries in water polo and injury risk factors.

Methods

Protocol was registered on Open Science Framework. MEDLINE, CINAHL, Embase and SPORTDiscus databases were searched for keywords relating to water polo and injuries on 3 February 2021. References were searched for additional studies. Only original research papers in English or French were included, and studies without an injured group were excluded. A data extraction file was made based on the Cochrane Collaboration recommendations. Study quality was evaluated with the Newcastle-Ottawa scales for cohorts and a modified version for cross-sectional studies.

Results

The initial search yielded 581 articles, with 5 more added from reference lists, but only 41 remained after removing duplicates and applying inclusion/exclusion criteria. Thirty-one articles identified the head, fingers and shoulders as the most common sites of injury. Ten articles on mechanism of injury focused mainly on the shoulder, with degenerative changes, posture, scapular alignment, strength, flexibility and overhead shooting kinematics as the main injury risk factors. Publication types included cohort studies, cross-sectional studies, and one case series.

Conclusions

Most traumatic injuries affect the hands and the head from unexpected contact with the ball or opponents. Conversely, training injuries seem to affect mainly the shoulder area. Low level evidence suggests a correlation between shoulder injuries and lack of strength or flexibility as well as large volumes of overhead throwing. Further prospective research is needed to investigate risk factors for other body areas.

Hand-Held Shoulder Strength Measures Correlate With Isokinetic Dynamometry in Elite Water Polo Players

CONTEXT

Previous authors suggest that lack of strength is an important risk factor for injuries in water polo. Hand-held dynamometers have potential as a clinical tool to measure strength, but they have not been validated in water polo players.

OBJECTIVE

The purpose of this study was to estimate intertrial variability and concurrent validity of hand-held dynamometer shoulder strength measurements in elite water polo players.

METHODS

A total of 19 male and 20 female elite water polo players performed isometric external (ER) and internal (IR) rotation strength tests against a hand-held dynamometer bilaterally in supine position with the shoulder in a 90-90 position. In addition, concentric IR and ER was captured at 90 deg/s with an isokinetic dynamometer, and torque values were determined near the 90-90 position.

MAIN OUTCOME MEASURES

Spearman correlation coefficients were calculated for ER torque, IR torque, and ER/IR ratios between the devices. Two-way mixed-model intraclass correlations were used to assess intertrial variability.

RESULTS

Correlations between the devices were strong to very strong (ρ = .65-.82, P < .01) for absolute IR and ER but low for ER/IR ratios (ρ = .29, P = .07). There was less agreement at higher torque values. Intertrial variability was low with intraclass correlation values .88 to .93, P < .05.

CONCLUSIONS

These results show that hand-held dynamometers are adequate clinical alternatives to measure absolute shoulder strength in water polo players. Stronger players may require stronger evaluators to resist the player's push and obtain reliable results.

Attitudes and opinions towards the prevention of orofacial injuries among water polo coaches in Catalonia: A cross-sectional study

BACKGROUND/AIM

Although orofacial injuries are frequent in water polo, fewer than 10% of players use mouthguards. The aim of this study was to determine the degree to which coaches and sports club managers encourage mouthguard use in water polo and to explore their opinions regarding other strategies designed to reduce the prevalence of orofacial injuries.

MATERIAL AND METHODS

This was a cross-sectional study in which the coaches and sports club managers of 16 water polo clubs in Catalonia were invited to participate. An online questionnaire was administered to the coaches to obtain general data, to determine whether they had recommended mouthguard use to their players and to record their opinions on other strategies designed to reduce the prevalence of orofacial injuries. Sports club managers were interviewed about the facilities offered by their clubs for players to obtain mouthguards and about their attitudes regarding the prevention of orofacial injuries.

RESULTS

The questionnaire was administered to 72 coaches who trained 111 teams during the 2019-2020 season, together with 14 sports club managers. Coaches of only 11 teams (10%) recommended mouthguard use to their players. Two clubs (14%) offered some facilities to their players to obtain mouthguards. Interestingly, only 18% of the coaches believed that mouthguard use should be mandatory, in contrast to 50% of the sports club managers (p = 0.017; Fisher's exact test). Most coaches and sports club managers believe that a video monitoring system should be used to identify dangerous play and that orofacial injuries should be reported under a surveillance programme.

CONCLUSIONS

Few water polo coaches recommend mouthguard use to their players and very few clubs offer facilities to obtain custom-made oral protection. However, most coaches and sports club managers agree that the rules should be modified to protect players from aggressive play.

Hand injuries in sports - a retrospective analysis of 364 cases

BACKGROUND

Hand injuries are common in sports and associated with high dropout rates and costs. Hence, efforts should strive for further risk prevention measures in order to increase safety in sports. This implies knowledge of sports injury risk profiles. So far, major surveillance programs exist mainly in Anglo-American countries, reflecting the specific concerns of sports in this part of the world. Data on sports injuries within Europe are scarce. As sports behaviour appears to vary demographically, we hypothesised that risk injury profiles differ as well.

METHODS

To assess whether the described sports injuries of the hand are applicable to the German population, we performed a five-year retrospective, single-centre analysis of sports-related hand injuries, using data from the Enterprise Clinical Research Data Warehouse of the Hannover Medical School.

RESULTS

Notable differences in comparison to other data were observed. Ball sports, cycling and equestrian sports caused most of the recorded hand injuries, which were predominantly fractures of the wrist and hand. Hand injuries in equestrian sports were associated with significantly higher operation and hospitalisation rates as well as a significantly longer inpatient treatment.

CONCLUSION

Risk profiles for sports-related hand injuries appear to differ not only in terms of age- and sex, but also geographically. Nation- and Europe-wide hand trauma registries as well as a broad registry participation are necessary in order to accurately assess the risk patterns in Europe; henceforth reducing hand injuries and their sequelae.

Water polo-related injuries among adolescents and young adults treated at emergency departments

Objectives Water polo is a physically demanding contact sport involving swimming, overhead throwing, and wrestling/defending that can result in acute injuries. The objective of this study was to characterize water polo-related injuries among adolescents and young adults treated at United States (US) emergency departments (EDs). Methods Cases were water polo-related injuries among patients age 13-25 years reported to the National Electronic Injury Surveillance System (NEISS) during 2000-2019. The distribution of the national injury estimates was determined for selected variables. Results A total of 418 water polo-related injuries among patients age 13-25 years treated at US EDs during 2000-2019 were identified, resulting in a national estimate of 15,426 injuries. The patient was age 13-18 years in 73.5% of the injuries, 19-22 years in 20.5%, and 23-25 years in 6.0%; 62.1% of the patients were male and 37.9% female. The injury occurred at a place of recreation or sports in 63.4% of the injuries and a school in 21.4%. The most common diagnoses were a laceration (19.4%), strain or sprain (17.8%), contusion or abrasion (17.6%), or fracture (13.0%). The affected body part was 53.6% head and neck, 31.1% upper extremity, 8.0% trunk, 6.5% lower extremity, and 0.7% other/unknown. The patient was treated, released, or transferred in 98.3% of the injuries. Conclusion The majority of patients were adolescents and male. Most of the injuries occurred at a place of recreation or sports or school. The most commonly reported injuries were laceration and strain or sprain and most often affected the head and neck.

A Dose Relationship Between Brain Functional Connectivity and Cumulative Head Impact Exposure in Collegiate Water Polo Players

A growing body of evidence suggests that chronic, sport-related head impact exposure can impair brain functional integration and brain structure and function. Evidence of a robust inverse relationship between the frequency and magnitude of repeated head impacts and disturbed brain network function is needed to strengthen an argument for causality. In pursuing such a relationship, we used cap-worn inertial sensors to measure the frequency and magnitude of head impacts sustained by eighteen intercollegiate water polo athletes monitored over a single season of play. Participants were evaluated before and after the season using computerized cognitive tests of inhibitory control and resting electroencephalography. Greater head impact exposure was associated with increased phase synchrony [r₍₁₆₎ > 0.626, p < 0.03 corrected], global efficiency [r₍₁₆₎ > 0.601, p < 0.04 corrected], and mean clustering coefficient [r₍₁₆₎ > 0.625, p < 0.03 corrected] in the functional networks formed by slow-wave (delta, theta) oscillations. Head impact exposure was not associated with changes in performance on the inhibitory control tasks. However, those with the greatest impact exposure showed an association between changes in resting-state connectivity and a dissociation between performance on the tasks after the season [r₍₁₆₎ = 0.481, p = 0.043] that could also be attributed to increased slow-wave synchrony [F_{(4, 135)} = 113.546, p < 0.001]. Collectively, our results suggest that athletes sustaining the greatest head impact exposure exhibited changes in whole-brain functional connectivity that were associated with altered information processing and inhibitory control.

Patterns of head impact exposure in men's and women's collegiate club water polo

OBJECTIVES

Recent reports have demonstrated a risk of concussion and subconcussive head impacts in collegiate varsity and international elite water polo. We sought to characterize patterns of head impact exposure at the collegiate club level of water polo.

DESIGN

Prospective cohort study.

METHODS

Head impact sensors (SIM-G, Triax Technologies) were worn by men's (n=16) and women's (n=15) collegiate club water polo players during 11 games. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) of head impacts were recorded by the sensors. Two streams of competition video were used to verify and describe the nature of head impacts.

RESULTS

Men's players sustained 52 verified head impacts of magnitude 39.7±16.3g PLA and 5.2±3.2 krad/s² PRA, and women's players sustained 43 verified head impacts of magnitude 33.7±12.6g PLA and 4.0±2.8krad/s² PRA. Impacts sustained by men had greater PLA than those sustained by women (p=.045). Athletes were impacted most frequently at the offensive center position, to the back of the head, and by an opponent's torso or limb.

CONCLUSIONS

Our cohort of male and female athletes sustained relatively infrequent head impacts during water polo competitions played at the collegiate club level. The amount of head impact exposure in our cohort was dependent on player position, with offensive centers prone to sustaining the most impacts. Head impact sensors are subject to large amounts of false positives and should be used in conjunction with video recordings to verify the validity of impact data.

Patterns and Trends of Foot and Ankle Injuries in Olympic Athletes: A Systematic Review and Meta-analysis

INTRODUCTION

Foot and ankle injuries in elite athletes can result in decreased performance, absence from sport and prolonged morbidity. There is paucity of data on foot and ankle injuries in Olympics athletes.

METHODS

We conducted a systematic review of the PubMed and EMBASE databases. Studies in English language that reported the incidence and/or prevalence of foot and ankle injuries in during Olympics games (summer, winter and youth Olympics) were included. Studies in languages other than English, those that looked at injuries other than foot and ankle injuries, studies looking at injuries in non-Olympics events and those looking at Olympics trials were excluded. We determined the injury rates and burden of foot and ankle injuries. We also looked at the patterns and trends of foot and ankle injuries.

RESULTS

A total of 399 foot and ankle injuries from 25 publications were included in the review. Foot and ankle injury rates ranged from 0.09 to 0.42 injuries per athlete-years for summer Olympics and 0.02-0.35 injuries per athlete-years for winter Olympics. Quantitative analysis revealed that foot and ankle injuries contributed to 16.9% of all injuries (95% CI 8.1-31.9%) for summer Olympics and 5.1% of all injuries (95% CI 1.9-12.6%) for winter Olympics; however, a high statistical heterogeneity was noted. The three most common injuries were tendon injuries, ligament injuries and stress fractures. The rates and burden of foot and ankle injuries showed a declining trend.

CONCLUSIONS

Foot and ankle injuries are an important cause of morbidity amongst Olympics athletes. The declining trend amongst these injuries notwithstanding, there is a need for a global electronic database for reporting of injuries in Olympics athletes.

Head impacts sustained by male collegiate water polo athletes

Water polo is a contact sport that is gaining popularity in the United States and carries a risk of repeated head impacts and concussion. The frequency and magnitude of sport-related head impacts have not been described for water polo. We aimed to compare patterns of empirically measured head impact exposure of male collegiate water polo players to patterns previously reported by a survey of current and former water polo athletes. Participants wore water polo caps instrumented with head impact sensors during three seasons of collegiate water polo. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) were recorded for head impacts. Athlete positions were recorded by research staff at the occurrence of each head impact. Head impacts were sustained by athletes in offensive positions more frequently than in defensive and transition positions (246, 59.9% vs. 93, 22.6% vs. 72, 17.5%). 37% of all head impacts during gameplay were sustained by athletes playing the offensive center position. Impact magnitude (means ± SD: PLA = 36.1±12.3g, PRA = 5.0±2.9 krads/sec²) did not differ between position or game scenario. Among goalies, impact frequency and magnitude were similar between games (means ± SD: 0.54±.51 hits/game, PLA = 36.9±14.2g, PRA = 4.3±4.2 krads/sec²) and practices (means ± SD: 0.96±1.11 hits/practice, PLA = 43.7±14.5g, PRA = 3.9±2.5 krads/sec²). We report that collegiate water polo athletes are at risk for sport-related head impacts and impact frequency is dependent on game scenario and player position. In contrast, magnitude does not differ between scenarios or across positions.