Poster 113: Epidemiology of Illnesses and Injuries in NCAA Water Polo Players

OBJECTIVES: Water polo is a sport with highly unique physical demands, some of which include treading water, swimming speed and endurance, wrestling strength, and ball coordination. It is an Olympic sport with variable popularity around the globe, with a notable following in regions of Europe. In the United States, water polo is most popular on the west coast, and Pac-12 teams have dominated NCAA water polo for decades. Partially owing to the sport’s scattered distribution around the world, there is a paucity of rigorous data on injuries and illnesses suffered by elite water polo players. The objective of this study is therefore to characterize health events in a large sample of NCAA Pac-12 water polo players over a period of 4.5 years, in order to better understand common pathology and be more equipped to prevent and manage injuries and illnesses in the future. METHODS: Deidentified data was acquired from the Pac-12 Health Analytics Program database on all recorded health events from 4 men’s water polo teams and 5 women’s water polo teams from January 2017 to June 2021. Events were first sorted into injury and illness categories, followed by further analysis into body part, diagnosis, return-to-play, and injury event/general mechanism. Additional analysis includes injury/illness rates as percentage of totals, estimated athlete yearly risk, and risk ratios comparing male versus female risks with accompanying 95% confidence intervals for determining statistically significant differences. RESULTS: For our sample of 142 male athletes and 165 female athletes, 917 health events were recorded over our 4.5-year observation period, with 729 being classified as injuries and 188 as illnesses. The shoulder was the most commonly injured body part (150 events, 20.6%), followed by the head/face (137 events, 18.8%), hand/wrist/forearm (85 events, 11.7%), and groin/hip/pelvis/buttock (83 events, 11.4%). Males had an estimated yearly risk of a shoulder injury of 15.7% compared to 11.6% for females, though this did not reach statistical significance (RR 1.35, 95% CI 0.96-1.9). Male water polo players were significantly more likely than females to injure their spine/neck (RR 2.1, 95% CI 1.2-3.5). The five most common diagnoses were concussion (83 events), shoulder strain/spasm (57 events), shoulder tendinopathy/impingement (52 events), groin/hip strain/spasm (42 events), and finger sprain (37 events). For all these injuries besides concussions, the majority of athletes lost no time away from sport. For concussions however, 75.9% lost time and returned later in the season, and 4.7% lost time and either returned the following season or were unable to return. Males were significantly more likely than females to suffer a concussion in practice (RR 3.3, 95% CI 1.2-8.8) and via contact with another player (RR 2.9, CI 1.3-6.4), though there was no significant difference in concussion risk overall (RR 1.2, CI 0.8-1.9). For illnesses, non-COVID-19 respiratory tract infection was the most common health event (61 events, 32.5% of illnesses, estimated yearly risk of 6.4%), followed by symptomatic COVID-19 (17 events, 9.0% of illnesses), and skin/soft tissue infection (13 events, 6.9% of illnesses). 12 males had symptomatic COVID-19 compared to 5 females, which was statistically significant (RR 2.8, 95% CI 1.01-7.7), however there was no significance difference in asymptomatic COVID-19 (6 males vs. 6 females, RR 1.2, 95% CI 0.4-3.5). CONCLUSIONS: This study sheds much-needed light on the epidemiology of injuries and illnesses in a large sample of elite NCAA water polo players. Some of the highlights include relatively high rates of shoulder, face, and finger injuries, as well as groin injuries, corresponding to exposed above-water body parts and water-treading demands respectively. Other notable findings include a high burden of time loss due to concussions compared to other common injuries, and a high rate of concussions occurring in practice and via player contact for men, representing a prospective target for reducing these injuries. Finally, this study equips players, coaches, trainers, and physicians with a broad outline of injuries and illnesses suffered by water polo players, allowing them to more efficiently manage injuries and develop prevention strategies in the future.