Injuries and Illness in Olympic Level Water Polo Athletes – a Three-Season Prospective Study

Problem: Epidemiological data of injuries and illnesses in water polo athletes are limited. This study’s objective was to describe the incidence, prevalence, and severity of health problems among a cohort of elite Players.

Methods: We conducted a prospective cohort study with 24 elite waterpolo athletes over 2.5 years. Health problems were recorded weekly with the Oslo Sports Trauma Research Center Questionnaire on health problems and subsequently categorized into illnesses and injuries according to the recently published International Olympic Committee guidelines. Based on the athlete’s weekly responses, we calculated health problem prevalence, incidence and severity.

Results: A total of 288 health problems were reported, including 76 illnesses and 212 injuries resulting in a weekly prevalence of 30.3% (95% CI: 28.2-32.4) for all health problems. Of these, 115 (39.9%) were categorized as substantial, of which 76 were illnesses, and 39 were injuries. The overall acute injury incidence rate was 1.66 injuries (95% CI: 1.23-2.09) per 1,000 sports exposure hours. The training and competition acute injury incidence rates were, respectively, 1.20 (95%CI: 0.81 – 1.59) per 1,000 training hours and 5.38 (95% CI: 3.18 – 7.58) per 1,000 competition hours.

Conclusion: There was a high prevalence of injuries among this cohort of elite water polo athletes. Future efforts that further improve athlete safety should focus on both acute and repetitive mechanism injuries.

Hintergrund: Epidemiologische Daten über Verletzungen und Krankheiten bei Wasserballspielern sind derzeit begrenzt. Ziel dieser Studie war es, die Inzidenz, Prävalenz und Schwere von Gesundheitsproblemen bei einer Kohorte von Elite-Spielern zu beschreiben.

Methoden: Wir haben eine prospektive Kohortenstudie mit 24 Elite-Wasserball-Spielern über 2,5 Jahre durchgeführt. Gesundheitsprobleme wurden wöchentlich mit dem Fragebogen des Oslo Sports Trauma Research Center für Gesundheitsprobleme erfasst und anschließend gemäß den vor kurzem veröffentlichten Richtlinien des Internationalen Olympischen Komitees in Krankheiten und Verletzungen eingeteilt. Basierend auf den wöchentlichen Antworten der Athleten berechneten wir die Prävalenz, Inzidenz und Schwere von Gesundheitsproblemen.

Ergebnisse: Insgesamt wurden 288 Gesundheitsprobleme gemeldet, darunter 76 Krankheiten und 212 Verletzungen, was zu einer wöchentlichen Prävalenz von 30.3% (95% CI: 28.2-32.4) für alle Gesundheitsprobleme führte. Davon wurden 115 (39,9 %) als erheblich eingestuft, davon waren 76 Erkrankungen und 39 Verletzungen. Die Gesamtinzidenzrate für akute Verletzungen lag bei 1,66 Verletzungen (95% CI: 1,23-2,09) pro 1.000 Sportstunden. Die Inzidenzraten für akute Verletzungen im Training und im Wettkampf betrugen 1,20 (95% CI: 0,81-1,59) pro 1.000 Trainingsstunden bzw. 5,38 (95% CI: 3,18-7,58) pro 1.000 Wettkampfstunden.

Water polo is a team sport that was first played during the 19th century and has been an Olympic discipline since 1900 (4). The sport has gained popularity over the years and is played nowadays by both men and women worldwide. Water polo is a sport in which endurance, strength are essential physical traits that dictate, next to technical skills, individual performance. From the recreational to the elite level, there is a lot of physical contact between players which links to high injury risk (7, 9, 12, 19, 21).

A limited number of studies that report on injuries and illnesses during international competitions illustrate the high injury rates in elite water polo (8, 14, 17, 19, 20). At the 2016 Olympic Games in Rio de Janeiro (Brazil), the injury rate of water polo ranked fifth amongst all sports with 19.4 (95%CI: 14.0–24.8) injuries per 100 athletes (20). Comparing water polo to other aquatic events, Prien et al. described injury and illness rates during three consecutive FINA world championships (19). Although the authors did not report the exact injury and illness rates, water polo had the second-highest injury rate after high diving and the highest illness rate amongst all aquatic disciplines. More comprehensively, Mountjoy et al. summarised across 4 Olympic Games and 4 World Championships, that water polo players sustained 56.2 (95%CI: 49.5–62.9) injuries 1000 match hours (17). Most of these were sustained at the head (25.6%), hand (16.1%), and trunk (12.7%). Despite being high-quality data, reported injuries and illnesses during international events only provide a snapshot of the actual injury risks to which elite water polo players