Primary Injury Types in Water Polo

Article review by Chris Barber

This is a review of the article:
Franić M, Ivković A, Rudić R. Injuries in water polo. Croat Med J. 2007 Jun;48(3):281-8. Review. No abstract available.

The game of water polo is very demanding on the body and the mind. Water polo is a mixture of swimming, throwing and martial arts. It can be very taxing on the body because it demands all out burst of less than 15 seconds and the low intensity intervals of less than 20 seconds. You would not think water polo is a major physical sport but over the years it has been more than ever.

The affects of an intense sport are the number of acute traumatic events like lacerations, sprains, dislocations or fractures. The non-contact and repetitive injuries that can happen are from maximum effort throws, swims and kicks. These are classified as overuse injuries. This article is based on the most important acute and overuse in water polo by describing the four different areas of the body.

Head Injuries
Head injuries are common in most sports unfortunately. In water polo some athletes can throw the ball up to 60-70 km/h and this can lead to head and facial injuries. Even a minor head injury, if the right precautions are not taken, can be life-threatening. If an athlete has a head injury during the game it can be challenging for a physician to reach them. Team-work is very crucial and must be taken seriously while getting them to safety.

Facial Injuries
Injuries to the face are usually lacerations broken bones to the region above the eyes and they require immediate treatment. If you have injuries to your head or face, the player must be closely examined for a decrease in disorientation, poor balance and coordination. Swimmers ear or Otitis externa is an inflammatory of the external auditory canal. This is a common problem with swimmers in the pool for hours. Treatment for this is a thorough cleaning of the auditory canal with acidification with a topical solution of 2% acetic or boric acid, combined with hydrocortisone for inflammation.

Ear Injuries
An injury to the ear drum is some what common in water polo. A slap on the side of the head with a cupped palm is a result of this injury. This causes a tear and development of a hole without any serious problems. The athlete should be kept out of the water or they can wear ear plugs and a cap in the pool.

Eye Injuries
The most common eye injuries are the corneal abrasion, hyphema and the blow out fracture of the orbita. The corneal abrasion is a scratch on the eye by a fingernail or a foreign object. Antibiotic eye drops and padding for the eye are good ways for treatment. Hyphemia is bleeding into the anterior chamber of the eye that results from a ruptured iris vessel. This can cause uncontrollable glaucoma or blood staining of the cornea. The athlete needs bed rest for 3 to 5 days. Blow out fracture of the orbita is the result from a direct blow caused by a fist or ball. You may need surgery to release the trapped muscles and repair any broken bones.

Spine Injuries
Spine injuries can be difficult to determine due to the fact that many structures in the spine may be the source of pain. In freestyle swimming, repetitive cervical spine rotation for breathing can lead to neck pain. This pain can cause sudden sharp pain and limit the range of motion in the neck. Some other causes of injury can be sudden, quick movement or on walking. If you have a direct blow to the head, acute acceleration/deceleration injuries to the cervical spine can occur. Headache, shoulder and upper arm pain can be caused by neck pain, this can be very important in diagnosing.

Low Back Injuries
Low back pain can be caused by the amount of rotational forces during throwing and passing. Pain-producing structures of the lumbar spine may cause low back pain. Long practices and abnormalities of the ligaments of the intervertebral joints, muscles and fascia, as well as neural structures. Hypermobility of one or more intervertable segments usually causes back pain. Correction of segmental hypomobility forms an important part of the treatment program. There are a number of different techniques available to correct spine abnormalities like manual therapy to the joints (mobilization, manipulation, traction), muscles (massage therapy and dry needling) and neural structures (neural stretching).

Shoulder injuries
Shoulder trauma to water polo players can consist of traumatic dislocations and subluxations of the glenohumeral and the acromioclavicular joints from contact with the opponent or the ball. Both injuries are usually caused by contact with the throwing arm from shooting or passing. Swimmers shoulder is a multifactorial clinical entity of a hypermobile glenohumeral joint, which allows increased translation of the humeral head in the gleniod. There can also be impingement against the undersurface of the acromion, the coraco-acromial ligament, and it can also be the coracoid process. Rotator cuff injuries can include tendinopathies, partial thickness and full thickness tears. Superior labrum from anterior to posterior (SLAP) are lesions in the area behind the biceps tendon insertion to the glenoid labrum and extends anteriorly to the half of the glenoid. A fall or a direct blow to the shoulder are common injuries from SLAP but repetitive biceps tension from overhead activities.

Elbow Injuries
Elbow pain is a problem in most overhand sports. There are different conditions that have be attributed to the overhand motion, The ulnar collateral ligament injuries, valgus extension overload syndrome with impingement are most frequent in water polo. If you do not treat this right away the injury will get worse and further damage and complete rupture to the joint may happen. Treatments can include rest, nonsteroidal anti-inflammatory medications (NSAIDs) and local therapy modalities.

Hand Injuries
In the hands dislocations of the joint of the fingers or the hands are caused by dorsal dislocations of the proximal interphalangeal joint or without a fracture in the middle finger. The mechanism of this injury is usually hyperextension of the joint that comes from catching a ball or a blocked shot.

Groin Injuries
Lower body injuries are not uncommon in water polo, groin pain is tendon enthesitis of the adductor longus, illiopsoas, and abdominal muscles can be present. It is important that the adductors and the abdominal muscles are balanced, and the elasticity of the pubic symphisis. The most common cause of groin pain is weakness in the abdominal muscles. History of chronic groin pain that is not feeling better during treatment could be a sportman’s injury. Adductor muscle strains can be caused by sudden changes of directions. It is important not to rush back into practice or games because it can lead to a worse condition.

Knee Injuries
In water polo leg work accounts for 40 to 55% of the game, depending on the position. Breaststrokers have long been complaining about medial knee pain. Water polo players hardly use the “whip kick” but the right leg rotates counterclockwise while the left rotates clockwise is the “eggbeater” kick. The rotation places compression on the medial region of the joint. This causes degenerative changes. There may be pain along or over the origin and insertion of the medial collateral ligament and is categorized as chronic stress and overuse syndrome of the eggbeater. Correcting improper technique with a proper warm up, ice and ultrasound may be beneficial.

Chris Barber graduated from Concordia University Irvine with a degree in Exercise Sport Science. He has been a personal trainer for 3 years and is certified by the National Council of Strength and Fitness. In April, he completed an internship in strength and conditioning at the COR PT.

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