Abstract

Medical aspects of competitive diving: a popular summary of a private literature collection

Watch a video of this presentationTo the spectator diving is a beautiful and potentially dangerous sport. Spectacular accidents can happen and are televised in news bulletins the world over. To diving coaches and participants accidents are not the main concern. They struggle with the daily frustration of overuse injuries that keep divers from optimal training and competition form.

What does the medical literature say on diving accidents and injuries? This review tells you where to find articles on the medical aspects of diving, what is written in them and what is missing.

A private literature collection

Starting in 1985, the author has compiled a bibliography on competitive diving with 3300 references to books and articles. Many of the books and articles have been collected via university libraries, colleagues and the internet. The complete list of titles is directly accessible for everybody through www.springschool.nl

This review of the literature shows diving to be a safe sport with regard to major, catastrophic accidents. The number of reported overuse injuries of the neck, back, shoulders and wrists and possible irreversible damage to the eyes, ears and vestibular organ of divers is very disconcerting. Divers are advised to actively seek medical care for their injuries. Diving federations are encouraged to initiate more research and publications on the medical aspects of diving.

Diving, by Benjamin D. Rubin and Steven Anderson, in: Epidemiology of sports injuries, Dennis J. Caine, published 1996, ISBN 0-87322-466-3, pages 176-185. U.S. Diving safety training manual, second edition, Janet L. Gabriel, editor. US Diving, Indianapolis, Indiana, 1999. Key points:

• Diving literature is available on www.springschool.nl
• Divers have few catastrophic accidents
• Divers have many overuse injuries
• Divers should actively seek more medical care
• Modern research on the medical aspects of diving is needed.

 

Abstract

Injury prevention in swimming

Mr Kevin Boyd MBBS FRCS(Tr&Orth) FFSEM(UK) DipSportsMed
Consultant Trauma and Orthopaedic Surgeon
University Hospitals of Leicester NHS Trust, United Kingdom

Swimming is a highly popluar sport in many countries. Up to 12% of the population of the United Kingdom regularly take part. Epidemiological data suggest that overall injury rates are very low in comparison with other sports. Swimming is often promoted as an ideal activity for the acknowledged benefits of exercise for both those in health and with disease. The spectrum of swimmers, therefore, cover those individuals wishing to improve their health to the committed elite swimmer. It is this latter group that suffer from the preponderance of injuries. The swimmer needs to contend with the fact that they perform in an alien, fluid environment that offers considerable resistance to forward motion and relies largely on the uppper limbs for propulsion. The four strokes differ subtlely in their injury patterns.

Swimming injuries may be either acute or due to overuse. Acute injuries are relatively rare due to the lack of bodily contact and the relatively slow speeds. Discipline in and around the pool, avoidance of over crowding and caution when diving are important. Acute muscle strains can occur following failure to perform an adequate warm-up. Blunt injuries for the majority are minor in nature and self-limiting. The majority of injuries that affect training and performance are overuse in nature. The anatomical and biomechanical demands are far in excess of normal design which, with insufficient preparation and recovery, can result in injury. Training errors are factors in the development of swimming injuries but these can be minimised by individualised, responsive programmes with in-built recovery periods for each physiological system.

Shoulder problems are most common, accounting for approximately 60% of all musculoskeletal problems and are felt to relfect a secondary impingement syndrome due to instability. Swimmers have high levels of flexibility and the shoulder joint relies heavily on dynamic control of the rotator cuff muscles. Strengthening programmes particularly focussed on balancing the internal and external rotators and the scapular stabilisers muscles can lead to lower injury rates. Three dimensional video analysis suggest that some swimmers spend upto 56% of each arm cycle in an impingement position. The knees of Breaststrokers are vulnerable to the combination of flexion, valgus and rotational stresses applied. Quadriceps strengthening programmes should concentrate on closed-chain and terminal range exercises. The streamline position encourages repeated extreme hyperextension of the lumbar spine particularly in Butterfly and the 'undulating' style of Breaststroke. Such actions repetitively load the posterior structures of the spine, which may result in a stres injuries. Kick drills, with the upper body relatively fixed with an arm board, have been noted to exacerbate symptoms. Developmental poor postures with an increased thoracic kyphosis and rounded shoulders are not uncommon.

Optimising technique and avoidance of provocative positions and drills are important. Core stability programmes concentrating on the endurance of the major muscle masses are also key. Understanding the causes of injury allows physicians to work with coaches to minimise risks and allow prompt early intervention to prevent chronicity and underperformance.

Abstract

Common water polo injuries

Dr Larry Drum
Sports Physician, USA

Most sports medicine physicians like to separate injuries into acute injuries and chronic injuries. Most of the acute injuries are lacerations of the skin, eye injuries, and tympanic (eardrum) injuries and, in descending order, sprains of the fingers, elbows, shoulders and knees.

King of water polo injuries.

A concussion, however, is the most important acute injury to care for. A fast moving ball, usually off the cage and into the back of the goalie’s head, or a hand that inadvertently hits the head of another player is usually the cause. Identifying and treating a concussion can be difficult since symptoms tend to be subjective and are hard to objectively measure. Even an astute physician watching a competition carefully can miss a blow to a team member’s head. Any reports of dizziness, headache, confusion, sleepiness and lack of concentration should be treated seriously. In the future, tests that measure mental status and neurological functioning will have a valuable role in objectively measuring the severity of a concussion and will be able to aid us in the decision-making process of returning an athlete back to full-time training and competition.

"Protective" equipment?

Protective equipment can at times be not so protective. A good example would be the ear guards that protect the ears above water but damage the ears under. Air can easily escape from the air vents that are manufactured into the plastic molding. Therefore, any body part or ball that hits the ear guard protects the skin of the ear as well as the eardrum. Under water trauma, however, is a different story. An overly used and flexible ear guard can compress under pressure. These forces, coupled with small air vents, won’t allow for the fast exodus of water. This can easily damage or rupture and ear drum. This usually occurs when a player is under water and an opposing player’s foot hits the ear guard on a counter play and forces water into the eardrum.

Women water polo athletes have the added disadvantage for skin injuries because of their suits. Most teams prefer a durable suit that is difficult to tear but as a result of this durability, when these types of suits are pulled from the front, the suit can cut into the back of the athlete’s neck causing either a laceration or abrasion. In the same manner, an opposing players fingers and fingernails can cause lacerations to the chest area as they attempt to use the players suit to gain a tactical advantage. These injuries are quite common in athletes that play or defend the two-meter set position in front of the goal.

Common chronic ailments

Chronic injuries in water polo mainly involve the shoulders and knees. Overtraining, poorly treated injuries or delay in care can contribute to these types of injuries.

Swim strokes in water polo include freestyle with head down, freestyle with head up and the backstroke. These strokes in the horizontal position can contribute to a variety of painful shoulder problems. Rotator cuff tendonitis, impingement syndrome, biceps tendonitis and acromioclavicular joint arthritis are the injuries most encountered.

Once play has set up and the athletes have finished transitioning to offense or defense they assume a vertical position which begins to work the hips and knees. Known as the eggbeater kick, the lower extremities begin to spin in such a way that it puts forces on the inside portion of the athlete’s knees. Medial and lateral collateral ligament strain and medial compartment (cartilage) injury are the most encountered injuries. In general, chronic injuries to the lower extremities are better tolerated than those suffered to the upper extremities. This is especially true when the injury involves the shooting arm.

The most important chronic injury is the same as that of an acute injury – chronic, repetitive head trauma that leads to concussions. Once the head receives its first impact that leads to a concussion it becomes more vulnerable to repeated injury. Second impact syndrome describes the brain’s vulnerability to repeated blows that can lead to permanent damage of the central nervous system and, in rare cases, death. The most difficult decision that a team physician can make in the 21st century is when an athlete can return to play after repeated head traumas.

Treating Water Polo Injuries

The most important position of any medical team is the role of the trainer. It is very important that the team trains and travels with a trainer that has extensive experience with water polo athletes. Typical taping and treatment regimens are altered because of the water environment. Ear and eye injuries are difficult to treat especially if the eardrum is ruptured or the player wears contact lenses since goggles are prohibited. Conditioning of the water polo athlete means swimming long distances during training and can contribute to reflux symptoms that may require treatment and alter their diet. Pool temperature can heat up in warmer clement and should alert the medical staff of premature dehydration.

When travelling, familiarization with other teams and their medical staff is important. I have had the pleasure over the past several years to become friends with the medical staffs of other international teams who have been a great source of information. While on the pool deck, get to know the medical personnel and the location of the backboard and other emergency supplies. Know if and where the facility’s portable defibrillator is and know how to use it. Know if there are stand-by paramedics and emergency transportation. While visiting a foreign country, look around the hotel and training facilities to see where local pharmacies, food markets and hospitals may be located. Some countries have easier access to medications than others and the cost of many of these products can be quite less.

Abstract

Injuries & illnesses in synchronized swimming

Synchronized Swimming is a demanding aquatic sport characterized by acrobatics, strength, power, cardiovascular fitness, flexibility, artistic expression and showmanship. To acquire the skills necessary to perform these intricate physical feats, the synchronized swimmer must undergo an intensive and complex training program. These demands may result in injuries and illnesses that are unique to synchronized swimming. The sports medicine physician has an integral role to play in the prevention of these health concerns by influencing the institution of preventative training guidelines and balance in training program. This presentation will review the physical demands of the synchronized swimmer and the subsequent injuries and illnesses that are commonly seen in the competitive synchronized swimmer. The principles of injury management in synchronized swimming will be reviewed. The presentation will explore the role of the team physician in the prevention of these health issues. Finally, recommendations for the future direction of health care in synchronized swimming will be investigated.

Abstract

The unique challenges of open water medicine

Open Water competition offers many challenges not seen in other venues within the aquatic world. The open water site is a living biosphere that changes quickly and is unpredictable. In fact, change is the rule, not the exception. Water conditions, currents, sun, wind, rain are just part of the environmental changes and challenges facing athletes, staff, and officials alike. In addition, the site is home to many aquatic flora and fauna, many of which do not welcome human invasion.

The Open Water Medical Team prepares for the likely and the unlikely with equal determination and forethought. The athlete also prepares differently, planning for directional challenges, close pack swimming, as well as feedings over events that may last for many hours. This presentation breaks down the necessary elements of this preparation, taking into account the challenges that the athletes uniquely face, helping everyone to make this challenge safer for athletes, staff, and officials.