Dive, Swim, Score, Perform How to prevent injury & illness in the aquatic disciplines

1. Dive, Swim, Score, PerformHow to prevent injury & illness in the aquatic disciplines Dr. Margo Mountjoy (CAN) FINA Sports Medicine Dr. Jim Miller (USA) FINA Sports Medicine Injury & illness prevention in aquatics

2. Which aquatic discipline would you put your child in?Setting the context Dr. Margo Mountjoy Injury & illness prevention in aquatics

3. FINA Injury & Illness Surveillance acute new onset injuries in all team sports 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 new onset injuries in all sports acute new onset injuries & illnesses in all 5 aquatic disciplines Injury & illness prevention in aquatics

4. Acute Injury Results 171 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 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. Female: 8.8%Male : 6.8% Injury & illness prevention in aquatics

5. The injury distribution from the 2009 data is as per the chart. Injury Location Head / Neck 10.5% Head/Neck 10.5% Upper extremity 34.5% #1 shoulder Trunk 22.2% Lower Extremity 26.9% Injury & illness prevention in aquatics

6. 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%). Overuse: 37.5% Non-contact trauma: 15.3% Contact with athlete 14.7% Injury & illness prevention in aquatics

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

8. Acute Illness Results 184 illnesses 7.1% of registered athletes 1.2% time-loss 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. Infection 49.2% Respiratory: 50% Gastrointestinal: 19.9% Environmental: 27.6% Injury & illness prevention in aquatics

9. For illness incidence by discipline see chart. Injury & illness prevention in aquatics

10. Preventing Injury & Illness: Workshop Overview Diving Swimming Synchro Open Water Swim Water Polo Injury & illness prevention in aquatics

11. Injury & Illness Preventionin Diving Dr. Margo Mountjoy Injury & illness prevention in aquatics

12. Injury Risk in Diving For illness incidence by discipline see chart. Older athlete Elite athlete Higher degree of difficulty During water entry 10m: entry speed = 64km/h Deceleration forces = 20G Injury & illness prevention in aquatics

13. 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. Trauma Dry land training Contact with boards Fall from 10m: Retinal detachment Fractured ribs Pneumothorax Tympanic drum rupture Injury & illness prevention in aquatics

14. The wrist is often affected in the diver caused by incorrect technique for the entry into the water. Over use Injuries Wrist Carpal ligament sprains Wrist extensor tendonosis Scapholunate dislocations TFCC tears Injury & illness prevention in aquatics

15. Overuse injuries to the spine are caused by ripping dives. Most back injuries are either mechanical back pain, or spondylolysis/ listhesis. Over use Injuries Lumbar Spine Caused by “ripping” dives ‘arching’ to save entry Mechanical back pain Spondylolysis/ listhesis Injury & illness prevention in aquatics

16. Over use Injuries Over use injuries of the shoulder are also caused from the forces exerted on the shoulder during the entry. Shoulder Caused by forces on entry Rotator cuff tendonosis Injury & illness prevention in aquatics

17. As diving is an esthetic sport, prevention of disordered eating, eating disorders and the female athlete triad are required by all diving clubs. Illness Prevention Esthetic Sport disordered eating eating disorders female athlete triad Prevention: education early intervention Injury & illness prevention in aquatics

18. PREVENTION: General Principles Vigilant spotting on dry land training Progressive skill development Diving-specific PPE Avoid overtraining Adequate rest / recovery Periodization of training program (volume) Meticulous attention to technique Emphasis on core and eccentric training Prevention strategies in diving are outlined in the chart above. Injury & illness prevention in aquatics

19. PREVENTION: Wrist Injuries Correct flat hand grasp technique Bracing: preventing dorsi-flexion on entry Prevention of wrist injuries are associated with insurance of correct entry technique. Injury & illness prevention in aquatics

20. Injury & Illness Preventionin Swimming Dr. Jim Miller Injury & illness prevention in aquatics

21. Swimming “The” classic example of shoulder overuse syndrome The shoulder is the most common injury in swimming Injury & illness prevention in aquatics

22. 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. Injury & illness prevention in aquatics

23. Rotations Math 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. Injury & illness prevention in aquatics

24. Muscle Imbalance Swimming often results in rotator cuff muscle imbalance which predisposes the athlete to shoulder injury. • Technique intensive • Time intensive, leading to fatigue and small stabilizer failure • Imbalanced sport, stimulating some muscle groups while destabilizing others Injury & illness prevention in aquatics

25. 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. Injury & illness prevention in aquatics

26. Unique Injuries Other risks for injury in swimming includ trauma from goggles, starts and medial pain from breast strokers knee. • Goggles • Starts • Breaststroker knee – similar to water polo and synchronized swimming Injury & illness prevention in aquatics

27. 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 areas Is 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. Injury & illness prevention in aquatics

28. 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. Injury & illness prevention in aquatics

29. 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 prevention in aquatics

30. Injury & Illness Preventionin Synchronized Swimming Dr. Margo Mountjoy Injury & illness prevention in aquatics

31. Prevention of asthma includes assurance of a safe training environment, adequate hydration, early identification and appropriate medical treatment. Injuries in Synchro Trauma Fractures Concussion Sprain/strains Hematomas Contusions Disc herniations Acute tears Injury & illness prevention in aquatics

32. Injuries in Synchro: Shoulder Over use injuries of the shoulder are also common. Overuse injury: support skull Supra spinatus Sub acromial bursitis Injury & illness prevention in aquatics

33. Injuries in Synchro: Lumbar Spine Injuries to the lumbar spine are caused by the unique moves of synchronized simmers. back Overuse injury Arching Volume overload Ballistic rocket split boosts Walkouts Knight position Injury & illness prevention in aquatics

34. Injuries in Synchro: Lumbar Spine There are many different pathologies seen in the synchronized swimmer’s bath. SIJ dysfunction Disc herniations Facet dysfunction Myofascial injury Spondylolysis / listhesis Injury & illness prevention in aquatics

35. Medial knee pain is thought to be caused by the overuse of the egg beater kick. Injuries in SynchroKnee Overuse injury Eggbeater kick Patellar femoral syndrome Medial collateral ligament sprain Pes anserine bursitis Injury & illness prevention in aquatics

36. Illnesses in Synchro Prevention: Education Early intervention Esthetic Sport: Disordered eating Eating disorders Female athlete triad Like diving, Synchro is an esthetic sport and these athletes are susceptible to disordered eating, eating disorders and the female athlete triad. Injury & illness prevention in aquatics

37. The prevention of injuries in synchro are outlined in the slide. PREVENTION: General Principles Core strength Periodization of training Avoid over-training Logical skill progression (LTAD model) Vigilant spotting – dry-land & in H2O Injury & illness prevention in aquatics

38. Synchro-specific Pre-Participation Examination PREVENTION Preventative PPE in synchro should focus on the factors outlined on the chart. Injury & illness prevention in aquatics

39. Prevention principles are outlined on the slide. PREVENTION: General Principles Provision of adequate recovery Nutritional support Psychological support Balance non-sport stress Injury & illness prevention in aquatics

40. Injury & Illness Preventionin Open Water Swimming Dr. Jim Miller Injury & illness prevention in aquatics

41. A Very Different World!! Injury & illness prevention in aquatics

42. Open Water OWS athletes are prone to trauma, environmental injuries, heat/cold injuries, electrolyte imbalance and injury from flora/flauna. • Trauma • Environment • Hypothermia • Hyperthermia • Hyponatremia • Plant and animal life that sits, floats & swims …….. Injury & illness prevention in aquatics

43. Boats can also injure the OWS athlete. ............... boats!!!

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

45. Environmental conditions can place an athlete at risk of injury or illness. Environment: Your day may start out sunny and bright…… “A good day for a 25K.” Injury & illness prevention in aquatics

46. Environmental conditions can place an athlete at risk of injury or illness. ……………………and end up like this! Evacuation and reschedule! Injury & illness prevention in aquatics

47. Environmental Challenges Currents Water Quality Other environmental challenges include currents and water quality Injury & illness prevention in aquatics

48. Environmental Challenges Water Quality (The Finish Line!) Air Quality Injury & illness prevention in aquatics

49. Prevention strategies are outlined on the slide. Prevention • Training for conditions • Acclimatization • Nutrition/hydration consumption • Competitors • Rules development and enforcement • Water quality testing Injury & illness prevention in aquatics

50. Adequate safety planning can help prevent injuries/ illness in Marathon swimming.S Safety Planning • Emergency action plan • Lifesaving • Evacuation • Medical coverage: on water, land, transport, hospital (aware and capable) • Course contingencies: postponement, abandonment, shorten, move Injury & illness prevention in aquatics