15th FINA World Championships: BCN2013

Injury & Illness Prevention Study

by Dr. Margo Mountjoy MD, CCFP, FCFP, FACSM, Dip Sport Med. FINA Bureau: Sports Medicine Liaison

Introduction

The protection of the aquatic athletes’ health by preventing injuries is an important task for the FINA Sports Medicine Committee. FINA Medical Rules: Preamble Item 1.0:

“FINA, in accomplishing its mission, should take care that sport is practised without danger to the health of the athletes … To that end, it takes the measures necessary to preserve the health of athletes and to minimise the risks of physical injury.”

Injury surveillance is the first step in injury prevention, since it provides information that is a pre-requisite for the development of preventive interventions. Therefore, FINA participated in a study on the frequency and characteristics of injuries in the team sport tournaments during the 2004 Olympic Games. The information learned from this study prompted the development of a concussion education programme for water polo. During the 2008 Olympic Games, FINA took part in the Beijing Injury Prevention Study which included all Olympic summer sports. Results suggested that the aquatic sports are safe compared to many other individual and team sports, however, there was no documentation of the presence of illness which also can significantly affect the health and performance of aquatic athletes. In Rome 2009, FINA undertook both an injury and illness surveillance project. The results indicated that illnesses were more common than injuries during the Championships. This finding was supported in 2012 in the XXX Olympic Games held in London GBR. Another finding from the 2012 Olympic Games study was that diving had the highest incidence of injuries caused by overuse of all Olympic sports.  This finding prompted FINA to look at the presence of injuries prior to and at the beginning of the FINA World Championships.

The aims of the study conducted in Barcelona 2013 at the 15th FINA World Championships were: (1) to assess for the presence and characteristics of injuries and physical complaints of athletes in the four weeks before and at the start of the Championships, and (2) to define the incidence and nature of new onset injuries and illnesses incurred during the Championships in order to facilitate the development of future prevention interventions for athletes in the aquatic disciplines.

Methods

The study involved two components: (a) a retrospective questionnaire on injuries and/or physical complaints in the four weeks prior to the Championships which was completed by the athletes, and (b) a prospective survey on new onset injuries and illnesses reported by the medical teams, the local medical teams in the competition venues and host medical clinics. The athlete questionnaire was available in French, English and Spanish, and the prospective injury and illness report form was available in five languages (English, French, Spanish, Italian and Russian). All information was treated with strict confidentiality.

1. The athletes were ask to report specific details on injuries or physical complaints such as pain, ache, stiffness, swelling, instability/giving way, locking or other symptoms, they had in the 4 weeks prior to and at the start of the 15th FINA World Championships, regardless of whether or not they have had major consequences for their participation in normal training and/or competitio
2. The medical personal were ask to report daily specific details on all injuries and illnesses newly incurred during the FINA World Championships that received medical attention regardless of the consequences with respect to absence from competition or training.

Response rate

Out of the 2223 athletes (177 countries) participating in the Championship just over 50% of the athletes completed the Athlete Questionnaire. The response rate was highest in high diving (81%) and water polo (77%). The daily survey on new onset injuries and illnesses covered 71% of athletes which was a significant improvement from the FINA World Championships in Rome 2009 (50%).

Results

Injuries or physical complaints prior to the Championships

Of the 1116 athletes (50.2%) responding to the survey, one third of the athletes reported a physical complaint during the 4 weeks prior to the Championships. More female athletes (36.7%) than male athletes (28.6%) reported injuries. The duration of injuries/physical complaints ranged from 7 days to 10 years with a mean duration of 85 days. Approximately three quarters of athletes (76%) reported full participation in training despite the ongoing presence of injuries/ complaints; 22% reported reduced participation and 2% were unable to participate in training. An interesting finding was that 70% of all injured athletes were still symptomatic at the onset of the Championships. At least 273 athletes (24% of the responders) competed at the World Championships despite being symptomatic from an injury. There was significant differences between the aquatic disciplines in the proportions of athletes with an injury as illustrated below:

Discipline Specific Injury Rates in the 4 weeks prior to the FINA Championships

Acute Injuries during the Championships

A total of 186 new onset injuries were reported during the FINA World Championships. On average, 8.3% of the registered athletes were injured during the Championship; only 1.4% incurred a time-loss injury. Statistically significant more injuries and more time-loss injuries were reported in Barcelona 2013 than in Rome 2009. There was no difference between male and female athletes. More injuries were incurred during competition than in training. The risk of injury was highest in water polo. The six most severe injuries (estimated absence >14 days) were a fracture of the sternum (OWS) and orbital floor (WP), concussion (WP), and strains of the hip (SW) and back (DV). Water polo had the highest incidence of time loss in- competition injuries, and diving had the highest incidence of time-loss training injuries.

It is evident from this data that the aquatic sports have low risk for the development of acute new onset injuries during the World Championships. For example at the Olympics 2012, the overall injury rate was 12.9 per 100 athletes. However, the FINA Sports Medicine Committee will be investigated the causes for the increasing incidence.

Acute Injury Summary by Discipline

Acute New-Onset Injury Rates by Discipline during the FINA World Championships

Acute Injury Summary by Discipline

Acute Illness during the Championships

A total of 199 new onset acute illnesses were reported during the FINA World Championships. On average, 9.0% of the registered athletes suffered an illness during the Championship; only 1.1% incurred a time-loss illness. Statistically significant more illnesses were reported in Barcelona 2013 than in Rome 2009. The most commonly affected body system by illnesses was the gastrointestinal system (n=44) followed by the respiratory system (n=36). Infections were the most common cause of illness. Of particular interest was the finding of acute infections of the ear across all disciplines, and the presence of jelly fish stings and exhaustion in open water swimming. These data shows that the over 90% of athletes competing at the FINA World Championships remained illness-free.

Acute New-Onset  Illnesses  during  the  FINA  World  Championships  by Discipline

Summary

In conclusion, the response rate illustrates the success of the Injury and Illness Prevention Study conducted at the 15th FINA World Championships in Barcelona 2013. The information learned from these results will be evaluated and incorporated into educational and prevention programmes by the FINA Sports Medicine Committee. In addition to the already existing shoulder injury prevention video, an educational tool on the prevention of knee and back injuries as well as an aquatic specific concussion management guide is in the process of being developed. A meeting of experts will be held in Doha, Qatar in December 2014 to better define the process for assessing injuries and illnesses in and out of competition in the aquatic disciplines. In addition, the FINA Sports Medicine Committee is developing a programme to evaluate the physical complaints of aquatic athletes during training in addition to during Championships.

The discipline specific technical committees of FINA will be informed of the results and the FINA Sports Medicine Committee will look at mechanisms to help decrease the injury incidence and barriers to performance. The data on illness incidence will be used by organising committees of FINA events in the future to plan for health care needs and to develop prevention strategies to minimise risk of illness

during the FINA World Championships. A scientific document summarising the results will be published in the scientific literature to help medical planning for aquatic events around the world.

Acknowledgement

The FINA SMC highly appreciates the cooperation of all team physicians and the medical staff of the FINA World Championships 2013 who volunteered their time to collect the data for this project. The FINA SMC also gratefully acknowledges the expertise of expert consultant researchers, Prof. Astrid Junge (GER) and Prof. Evert Verhagen (NED) for their guidance in the design and implementation of the study and the analysis of the data. We thank FINA for their support and the funding of the study.

Study Group

Dr Margo Mountjoy (Canada) – FINA
Prof Astrid Junge (Germany)  – University of Hamburg
Prof Evert Verhagen (Netherlands) – University of Amsterdam
Enrique Martinez (Spain) – Sports Traumatology, Catholic University
Sarah Benjamin (Great Britain) – University of South Hampton

All FINA Sports Medicine Committee members:

Dr. Cees Rein van den Hoogenband
Dr. Saul Marks
Prof. David Gerrard
Dr. Farhad Shapar Moradi
Dr. Kevin Boyd
Dr. Jim Miller
Dr. Kyriakos Nanousis
Dr. Mohamed Diop
Dr. Jose Veloso