Preserving health and promoting performance: Activities of the FINA Sports Medicine Committee

Since the 15th FINA World Championships in Barcelona, the FINA Sports Medicine Committee has been working on many projects. According to the FINA rules, FINA has the responsibility of protecting the health and well-being of its athletes. As a result of this mandate, the FINA Sports Medicine Committee continues to work at taking necessary measures to preserve the health of athletes and to minimise the risks of physical injury and psychological harm. The FINA Nutrition Consensus Statement in the Aquatic Sports was an example of the action of the FINA Sports Medicine Committee. A meeting of leading sport nutrition experts from around the world was convened in December 2013 in London (GBR). The result of this meeting was an extensive review of the sport nutrition science as it pertains the aquatic disciplines. The group wrote a summary consensus statement. The International Journal of Sport Nutrition and Exercise Metabolism has now published a special edition on sport nutrition in the aquatic disciplines featuring the consensus statement. The aquatic sport specific articles on nutritional recommendation amongst other articles related to the aquatic athlete health and nutrition can be found in a special edition August of 2014. There are articles with nutritional recommendations based on the available science for each of the FINA disciplines along with general articles on energy, eating disorders, and injury prevention. One can Google the journal to see the articles by looking in the archived journals (August, 2014 for free). A detailed article on this project has already been published in the FINA Aquatic World Magazine Medical Corner. New for the World Championships 2015, was be the launch of a summary booklet for coaches and athletes outlining the sport nutrition recommendations. This handy summary publication can be used to guide the nutrition plan for all aquatic athletes to prevent health and injury problems and to enhance performance. This booklet will be available on the FINA website in the FINA Sports Medicine webpages shortly.

The Video Series on the Prevention of Injury of the Lower Back (Lumbar Spine), Knee and Concussions

More recently the FINA Sports Medicine Committee (SMC) has been working on a video series to provide injury prevention information and exercises similar to the already completed “Shoulder Injury Prevention Video”. This video can be found on the FINA Sports Medicine webpages. The new videos will be of a similar style and will focus on the prevention of injuries of the lower back (Lumbar Spine), the Knee and Concussion. Treatment regimes will also be presented. These videos will be completed shortly and will be valuable resources for coaches, athletes, sport therapists and sport medicine specialists. The videos are free to download and can be utilised in local training camps and in sports medicine clinics.

In the fall of 2014, Pinto Pony Productions, Toronto, Ontario was awarded a contract to make three educational videos, similar in style to the “FINA Shoulder Injury Prevention Video”. The scripts for the videos were begun by Dr. Jim Miller and Dr. Saul Marks. After edits, the scripts were reviewed by international experts on each of the topics; lumbar spine, knee injury and concussion and return to play protocol. Filming for the videos was done in late winter/early spring 2015. The first viewing/edit is underway. The Lumbar Spine video describes the spine, its movements and exercises to strengthen the muscles supporting this area of the body to prevent injury in all of the aquatic sports. The knee video is completed in a similar way. Again, exercises to strengthen the muscles supporting the knee will be shown after there is a description of how these muscles can strengthen the knee and protect it from injury. The concussion video will be slightly different in that it will be more educational as to what a concussion is, what signs and symptoms to look for and when the athlete, coach, medical personnel and parent should be concerned. Concussions are seen more commonly in diving, synchronised swimming and in water polo. This video will describe concussions, treatment of them and then different show return to play protocol for all of the at risk aquatic sports. The Videos will be available on the FINA Web Site (Sports Medicine Pages) as well “YouTube” in the future.

Preventing injury and illness in the aquatic disciplines.

Also recently, the FINA SMC held a consensus meeting of experts in the field of injury and illness prevention in Doha (QAT) on December, 7 at the 2014 12th FINA World Swimming Championships (25m). FINA compiled an Injury and Illness Surveillance Expert Working Group comprised of international experts to review the scientific literature in the field of injury and illness prevention in sport. The meeting was convened to provide an opportunity for a review of the existing science, discussion and collaboration, following which recommendations for the monitoring of injuries and illnesses in aquatic sports was made. The outcome is a scientific paper on the methodology of injury and illness surveillance studies which will be adopted by the FINA Sports Medicine Committee in the future for all of the aquatic disciplines both in competition and during training. In this way, injury and illness data in the aquatic sports can be identified consistently around the world and secondarily measures can be taken to minimise the risk of injury and illnesses.

Injury and Illness surveillance studies have been done by the FINA SMC at all FINA World Championships since Rome in 2009. By creating this new Injury and Illness methodology scientific paper, the FINA SMC is attempting to create an even growing body of “consistent” literature regarding athlete health and wellbeing. In this way the FINA SMC can attempt to decrease injury and illness through interventions such as the video series discussed above. Also, consistent knowledge on the aquatic athlete’s health issues both in and out of competition can be disseminated around the globe through methods of communication are already in place.

Examples of this would be the FINA Aquatics World Magazine, FINA Sports Medicine Newsletter, FINA SMC WebPages, Coaches Clinics and Scientific Conferences, including future FINA World Sports Medicine Congresses. The 2015 FINA World Championships in Kazan, Russia, had once again an Injury and Illness Surveillance Study. The methodology of the study utilised, for the first time, the consistent methodology agreed on in meeting in Doha by the expert international group. Last, by publishing this FINA methodological illness and injury surveillance paper in the scientific literature, the FINA SMC is hopeful of supporting the aquatic athlete’s health and wellbeing globally.

Swimmer’s Heart Project

Finally, another exciting project was also undertaken during the 2014 FINA World Swimming Championships (25m). This project is entitled the “Swimmer’s Heart Project”. This project is a pilot study looking at the feasibility of conducting screening for heart problems in swimmers to prevent health consequences during the FINA World Championships. This study was designed to determine if in-competition cardiovascular screening is possible and necessary. Normal values for swimmers’ hearts was collected, as there is no scientific documentation of the changes in the heart muscle that occurs naturally during training for elite swimming. The results of this project will guide the implementation of future screening and facilitate the understanding of cardiac adaptation within this unique population of athletes.

Cardiovascular (heart) pre-participation screening (PPS) is being increasingly adopted by sporting organisations in a bid to facilitate the early detection and prompt management of athletes with underlying cardiovascular pathology and to subsequently to prevent sudden cardiac death in sport. FINA, as an International Sports Federation, currently recommends pre-participation screening for its elite athletes. Completing the cardiac screening can be challenging for some national federations with little funding, infrastructure, expertise and/or equipment. Thus the FINA SMC has decided to investigate to see if such screening is necessary, and if it is possible to provide the service during FINA World Championships. The aim of the study was to firstly carry out whether implementation of such cardiovascular screening is necessary and to establish whether such screening is needed amongst elite swimmers globally.

The project acted as a pilot study only, and allowed FINA to determine that in-competition heart testing, with the appropriate support and organisation in collaboration of the local organising committee, is justifiable. Removing bias, and facilitating the ultimate goal of reducing the prevalence of sudden cardiac death, it importantly allows athletes to undertake screening when it would otherwise not be possible. The process will guide the implementation of future screening and facilitate the understanding of cardiac adaptation within this unique population of athletes. Thus a needs analysis was undertaken to establish the need of starting a cardiovascular screening programme across all FINA events and 2) To establish the prevalence of abnormal results found with the screening protocol, by either history, physical examination or 12 lead ECG, in an international group of elite swimmers during the 12th FINA World Swimming Championships (25m). It importantly offers athletes and national federations without medical facilities in place, access to cardiovascular screening, as recommended by the International Olympic Committee and FINA.

Safe Lower Water Temperature Limit in Open Water Swimming

The FINA SMC is also involved in a research project to find a safe lower limit of water temperature in Open Water Swimming. This project is being done in collaboration with the IOC and the International Triathlon Union. This project is being completed by the University of Portsmouth, Great Britain under the expert guidance of Prof. Mike Tipton with the support of the FINA SMC member, Dr. Kevin Boyd. The scientific publication will be reviewed and subsequent safety rule changes will be recommended depending on the outcome of the scientific research. In field studies were conducted in July/ August 2015 in Canada during the FINA OWS series held in Quebec. The laboratory studies in cold water in the swim flume have already been completed.

FINA was also well represented at the April 2014, Monaco, IOC World Conference on Injury & Illness and prevention promotion of FINA projects and education of aquatic athlete health. Various members of the FINA SMC presented all of the activities undertaken by FINA to protect the health and to promote performance of the aquatic athletes of all the FINA disciplines.