Prevalence and mechanisms of injuries in water polo: a systematic review

OBJECTIVE: To summarise the information available in the literature on the prevalence of injuries in water polo and injury risk factors. METHODS: Protocol was registered on Open Science Framework. MEDLINE, CINAHL, Embase and SPORTDiscus databases were searched for keywords relating to water polo and injuries on 3 February 2021. References were searched for additional studies. Only original research papers in English or French were included, and studies without an injured group were excluded. A data extraction file was made based on the Cochrane Collaboration recommendations. Study quality was evaluated with the Newcastle-Ottawa scales for cohorts and a modified version for cross-sectional studies. RESULTS: The initial search yielded 581 articles, with 5 more added from reference lists, but only 41 remained after removing duplicates and applying inclusion/exclusion criteria. Thirty-one articles identified the head, fingers and shoulders as the most common sites of injury. Ten articles on mechanism of injury focused mainly on the shoulder, with degenerative changes, posture, scapular alignment, strength, flexibility and overhead shooting kinematics as the main injury risk factors. Publication types included cohort studies, cross-sectional studies, and one case series. CONCLUSIONS: Most traumatic injuries affect the hands and the head from unexpected contact with the ball or opponents. Conversely, training injuries seem to affect mainly the shoulder area. Low level evidence suggests a correlation between shoulder injuries and lack of strength or flexibility as well as large volumes of overhead throwing. Further prospective research is needed to investigate risk factors for other body areas.