Competitive Diving Principles and Injuries

Making a Splash: A Closer Look at Early Specialization in Competitive Diving

ABSTRACT

This review article explores the multifaceted aspects of early specialization in diving, focusing on its implications for injury prevalence, performance, and mental health. It highlights the increasing trend of early specialization driven by ambitions for collegiate and Olympic success, despite recommendations advocating for diversification. Divers are at risk for acute and overuse injuries, particularly during high-velocity water entries; however, data on injury patterns, especially among elite divers and early specializers, remains scarce. Recent data suggest a correlation between early specialization and reduced rates of certain injuries among youth divers, but distinguishing between acute and overuse injuries is crucial. Additionally, early specialization may pose mental health risks, with divers facing pressures related to performance, body image, and parental expectations. This article underscores the need for tailored guidelines to mitigate injury risks and promote holistic well-being among youth divers, recognizing the complex interplay between physical and psychological factors in sports specialization.

Injury epidemiology in male and female competitive diving athletes: A four-year observational study

OBJECTIVES

To describe the incidence, severity, burden and sport specific characteristics of injuries reported in elite diving athletes.

DESIGN

Descriptive epidemiology study.

METHODS

Medical attention and time-loss injuries from 63 (43 female, 20 male) Australian national diving programme athletes were prospectively collected over four seasons (September 2018-August 2022). Injury incidence rates and burden were calculated, standardised per 365 athlete days, and compared across groups using negative binomial generalised linear models.

RESULTS

In total 421 injuries were reported (female = 292, male = 129) at an injury incidence rate of 2.36 (95 % confidence interval = 2.14-2.60) per 365 athlete days. Annual injury prevalence ranged from 70.0 to 85.1 %. Approximately two-thirds of injuries (67.2 %) resulted in a period of time-loss. The overall injury burden was 91 days of absence (95 % confidence interval = 81-102) per 365 athlete days. Stress fractures in springboard diving athletes incurred the largest mean days of time-loss compared to other injured tissue types. The majority of injuries were reported to occur during training (79.3 %) as opposed to competition (2.4 %), with more than half (55.3 %) of all reported injuries occurring during pool training sessions. Water entry (30.4 %) or take-off (27.8 %) were the most frequently reported mechanism of injury.

CONCLUSIONS

Annual injury prevalence reported in competitive Australian diving athletes was found to be high. Contrary to existing literature, competitive diving injuries were reported to occur within the daily training environment, with few injuries occurring during competition. Notable injury differences between springboard and platform athletes were observed.

Diving Into Sports Specialization: The Association of Early Specialization on Injury Rates in Youth to Young Adult Divers

OBJECTIVES

This study explored the link between early sports specialization and injury rates in youth divers, a relationship that remains largely unexplored within diving.

DESIGN

Cross-sectional survey.

SETTING

Members of the USA Diving Organization and collegiate male and female divers participated in an online survey, reporting their sports involvement and injury history.

PARTICIPANTS

One hundred eighty-two male and female divers aged 8 to 25 years were recruited through USA Diving or US collegiate team databases.

INDEPENDENT VARIABLES

Early/late specialization (based on age <12 or 12 years or older), gender (M/F), springboard and/or platform divers, experience (junior/senior, regional/zone/national/international), hours of dryland/water training, and prior sport exposure.

MAIN OUTCOME MEASURES

Injury history obtained on questionnaire.

RESULTS

One hundred eighty-two divers were surveyed; 70% female. Age to start diving and age to concentrate solely on diving were significantly associated with certain injuries (P < 0.05). Beginning diving before age 13 years of age was significantly associated with lower odds of injuries in the shoulder and wrist (P = 0.013 and 0.018, respectively), after adjusting for select covariates. Age of specialization was not significantly associated with injuries in any body part (P > 0.05), after adjusting for covariates. Greater years of diving experience was significantly associated with diving injuries in all 11 body parts (P < 0.05).

CONCLUSIONS

This study indicates that early sports specialization is associated with decreased injury rates in elite youth divers who specialized before age 13 years, particularly for head/neck, shoulder, and wrist injuries. Moreover, we observed a positive correlation between experience and injury rate. Further investigation should focus on distinguishing between acute and overuse injuries.

Diving Into the Health Problems of Competitive Divers: A Systematic Review of Injuries and Illnesses in Pre-elite and Elite Diving Athletes

CONTEXT

The Olympic sport of diving involves the competitive disciplines of 3 m springboard and 10 m platform. Although it is generally accepted that lumbar spine injuries are common in diving athletes, the existing literature of health problems in diving athletes remains scarce.

OBJECTIVE

To identify the incidence, prevalence, and type of health problems that occur in competitive diving athletes.

DATA SOURCES

Medline, EMBASE, SportsDiscus, PsycINFO, and Google Scholar.

STUDY SELECTION

Studies written in English investigating elite or pre-elite competitive diving (springboard, platform) injuries and/or illnesses were eligible. Two independent reviewers screened for inclusion by title, abstract, and full text in accordance with the eligibility criteria.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Data extraction was completed by 1 author using a structured form. A second author then independently reviewed and verified the extracted data, any discrepancies were resolved through consensus.

RESULTS

The search identified 2554 potential articles, with 28 studies meeting eligibility criteria. The surveillance setting of most studies was restricted to competition-based events, with the reported injury incidence proportion ranging from 2.1% to 22.2%. The reported injury incidence rate ranged from 1.9 to 15.5 per 1000 athlete-exposures. Injuries to the shoulder, lower back/lumbar spine, trunk, and wrist/hand were reported most frequently. The prevalence of low back pain was reported as high as 89% (lifetime), 43.1% (period), and 37.3% (point). The illness incidence proportion ranged from 0.0% to 22.2%, with respiratory and gastrointestinal illness reported most frequently.

CONCLUSION

Up to 1 in 5 diving athletes sustain an injury and/or illness during periods of competition. A reporting bias was observed, with most cohort studies limiting surveillance to short competition-based periods only. This limits the current understanding of the health problems experienced by diving athletes to competition periods only and requires expansion to whole-of-year surveillance.

Pediatric Diving-Related Injuries in Swimming Pools Presenting to US Emergency Departments: 2008-2020

OBJECTIVES

Recreational swimming/diving is among the most common physical activities in US children and a significant cause of morbidity across the United States. This study updates the national epidemiology of diving-related injuries.

METHODS

The Consumer Product Safety Commission's National Electronic Injury Surveillance System database was queried for patients aged 0 to 19 from 2008 to 2020 who presented to any of the 100 National Electronic Injury Surveillance System-participating emergency departments for a diving-related injury. Dive characteristics such as dive height, dive skill, dive direction, and dive sequence were determined from case narratives.

RESULTS

A total of 1202 cases were identified for analysis corresponding to a total national estimate of 37,387 diving related injuries during the period from 2008 to 2020 and a national incidence of 3.6 injuries per 100,000 population. Males accounted for 64% of injuries. The average yearly incidences of injury in the 10 to 14 and 15 to 19 age groups were identical at 5.8 per 100,000. Contact with the diving board or platform was the most common cause of injury (34%). Diving backwards or attempting a flip or handstand dive were associated with increased odds of sustaining an injury resulting from contact with the diving board or platform (odds ratio, 16.0 and 6.9, respectively). In 2020, the incidence of diving-related injury fell to 1.6 per 100,000 population.

CONCLUSIONS

Diving injuries are common in children and adolescents, especially in boys aged 10 to 19. There was a significant reduction in diving-related injury corresponding with the COVID-19 pandemic.

Descriptive Epidemiology of High School Swimming and Diving Injuries

OBJECTIVE

Using data from a longitudinal national sports injury surveillance program, this study aimed to calculate injury rates and describe injury patterns across high school swimmers and divers.

DESIGN

Descriptive Epidemiological Study. Athletic trainers (ATs) from participating high schools reported injuries from swimming and diving programs for the High School Reporting Information Online system.

SETTING

Convenience sample of high school boys and girls' swimming and diving injuries during the 2008 to 2019 school years.

PATIENTS OR OTHER PARTICIPANTS

High school boy and girl swimmers and divers (aged ∼14-18 years).

INDEPENDENT VARIABLES

Exposure data on gender, location of injury (practice vs competition), mechanism of injury, and sport (swimming vs diving).

MAIN OUTCOME MEASURES

Injury rates, rate ratios (RRs) with 95% confidence intervals, and other descriptive statistics were performed.

RESULTS

563 swimming and diving injuries occurred during 2 171 260 athlete exposures (0.26 per 1000 athlete exposures). Girls had higher injury rates than boys overall (RR 1.57, P < 0.05), in practice (RR 1.53, P < 0.05), and competition (RR 1.81, P < 0.05). In swimmers, most injuries were to the shoulder (48.6%), associated with the freestyle (67.3%), and classified as overuse/chronic (58.0%). Among divers, most injuries were to the head/face (36.6%) and from contact with the playing surface (68.3%).

CONCLUSIONS

Girls had statistically significantly higher injury rates than boys. The shoulder and head/face were the most injured body parts in swimmers and divers, respectively. Swimming injuries were most frequently of an overuse etiology, whereas diving injuries were more likely traumatic. Coaches and ATs should be aware of these findings to develop targeted strategies for injury prevention.

Slamming dynamics of diving and its implications for diving-related injuries

In nature, many animals dive into water at high speeds, e.g., humans dive from cliffs, birds plunge, and aquatic animals porpoise and breach. Diving provides opportunities for animals to find prey and escape from predators and is a source of great excitement for humans. However, diving from high platforms can cause severe injuries to a diver. In this study, we demonstrate how similarity in the morphology of diving fronts unifies the slamming force across diving animals and humans. By measuring a time-averaged impulse that increases linearly with the impact height, we are able to estimate the unsteady hydrodynamic forces that an average human body experiences during the slamming phase of a feet-first, hand-first, or head-first dive. We evaluate whether the unsteady forces put the diver at risk of muscle or bone injuries for a particular diving height. Therefore, this study sheds light on a hydrodynamics-based protocol for safe high diving and an evolutionary driver for animal morphology.

Non-shoulder Injuries in Swimming: A Systematic Review

OBJECTIVE

The shoulder is the most common injury in swimming, followed by the knee and spine. The repetitive nature of swimming training may predispose a swimmer to injury. Several risk factors have been previously identified, but the level of evidence and level of certainty that these risk factors predispose a swimmer to injury risk has yet to be evaluated critically in a systematic review.

DESIGN

Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

Data were obtained through PubMed, Cochrane, and Google Scholar. The database search was limited to articles that were published between January 1980 and December 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Level I, II, and III studies were included in this review. All studies must have been conducted in swimmers or swimming, a description of the specific pathology and provide at least one identified risk factor with an association (P < 0.05).

RESULTS

A total of 19 critically appraised articles identified 28 potential risk factors for musculoskeletal injuries in swimmers. The risk factors were grouped by the anatomical region: neck and back, pelvis and hip, and the knee. Only 2 risk factors were appraised at a moderate level of certainty, both occurring in the knee. The remaining 26 identified risk factors were appraised at a low level of certainty. There is a clear lack of research surrounding nonshoulder injuries in swimmers.

Elite Diving Athlete With Traumatic Growth Plate Injury of the Proximal Humerus: A Case Report

Growth plate injury of the proximal humerus is rare. We herein report a traumatic growth plate injury of the proximal humerus in an elite diving athlete. A 16-year-old female diving athlete injured her left shoulder during 7.5 m platform hands-first diving practice. At the first visit, she presented with upper left shoulder tenderness and left shoulder range-of-motion limitation. There was no fracture or dislocation on X-ray and computed tomography (CT), but magnetic resonance imaging (MRI) showed a high-intensity zone in the left lateral epiphysis of the proximal humerus. We treated her conservatively by rest with sling and rehabilitation. She partially restarted diving practice five weeks post-injury and returned to competition eight weeks post-injury. Even if there is no sign of fracture or dislocation, we should consider MRI for patients who are before the age of growth plate closure.