Medical Care for Swimmers

Challenges Confronted by Coaches in Evaluation of Pediatric Athletes: Awareness on Pediatric Sports Medicine

Objective: There are numerous athletes under 18 years of age in our country, whose physical, psychosocial and athletic developments have become more of an issue. The aim was to deter- mine challenges confronted by coaches of pediatric athletes in the referral of pediatric athletes for preparticipation medical clearance, management of injuries, pre- and postparticipation follow-up, and opinions of coaches about whether establishment of Pediatric Sports Medicine (PSM) would be warranted. Materials and Methods: This questionnaire addressed coaches' age, sex, the sport branch they were dealing with, physicians to whom they refer pediatric athletes, challenges experienced with the athlete and his/her parents during preparticipation evaluation (PPE), challenges experienced by parents during PPE, suggested branch for referral, awareness of coaches on PSM abroad, and their opinions on interests of PSM and establishment of PSM in our country. Results: A total of 352 coaches were included. The most common branch of coaching was foot- ball (21.4%). The most common physicians they were referring to were sports medicine special- ists (52.0%), family medicine specialists (44.9%), general pediatricians (33.8%), and pediatric cardiologists (29.3%). Of the participants, 69.0% had never heard about PSM. Regarding areas of interest of PSM, 55.1% stated they had no idea, 37.5% routine follow-up and 25.0% physical examination of pediatric athletes. Of the participants, 90.1% stated that establishment of PSM in our country would definitely contribute to PPE, and 94.9% stated that it should definitely be established. Conclusion: It was concluded that awareness on PSM is low among coaches and that the establishment of PSM would definitely make contribution in Türkiye.

Changes in Shoulder and Lumbar Injury Incidence in Swimmers After Physical Examination and Exercise Programs

Background

Previous injury and physical examination data collected by a physiotherapist were reviewed to investigate the causes of injury among competitive swimmers. Each swimmer received an injury improvement exercise program based on their injury history and physical examination findings.

Purpose

The purpose of this study was to identify trends in the number of shoulder and lumbar injuries and discern the effectiveness of exercise programs in swimmers. The authors hypothesize that these efforts would decrease injury rates.

Study Design

Observational Cohort study.

Methods

Thirty-one male high school and college student swimmers underwent a physical examination. Previous injury was considered as pain that lasted for > three weeks or that caused the participant to stop practicing. A questionnaire was administered to all swimmers at the beginning of the study and one year later. The questionnaire assessed the number of injuries sustained and the daily practice hours over the previous year. The injury rate at the first examination and one-year followup was calculated as the number of injury incidents divided by the total number of player hours (1 h of practice is equivalent to 1) for one year, multiplied by 1,000 to obtain the injury rate per 1,000 hours (1000 player hours: 1,000 ph). Shoulder and hip exercise programs were prescribed based on measurement results and previous research.

Results

The numbers of injuries seen in the group were 12 shoulder and six lumbar at the first examination, and two shoulder and one lumbar at the one-year followup. The 1,000 ph (95% confidence interval) values were 0.32 (0.13-0.50) and 0.16 (0.03-0.29) at the first examination and 0.05 (0.00-0.12) and 0.03 (0.00-0.07) at the one-year followup for the shoulder and lumbar areas, respectively.

Conclusions

The results indicates that exercise programs prescribed after a physical examination may reduce the incidence of injuries in male swimmers over the course of a year.

Level of Evidence

Level 3.

Glenohumeral Internal Rotation Deficit in Young Asymptomatic Elite Swimmers

CONTEXT

Glenohumeral internal rotation deficit (GIRD) may affect overhead athletes and contribute to shoulder injury.

OBJECTIVES

To assess data on passive shoulder range of motion (ROM) in young elite swimmers and to determine the prevalence of anatomical and pure GIRD (aGIRD and pGIRD, respectively) in a large sample size of asymptomatic elite swimmers with a new classification method.

DESIGN

Cross-sectional study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 752 asymptomatic elite swimmers were recruited by voluntary participation (391 males and 361 females; mean age, 15.88 ± 2.31 years). Passive glenohumeral rotational ROM was measured bilaterally to investigate the prevalence of aGIRD and pGIRD. Evaluations were performed with athletes at rest before any training or competition.

MAIN OUTCOME MEASURE(S)

Glenohumeral internal rotation deficit and associated aGIRD and pGIRD in elite youth swimmers by identifying a standard classification procedure.

RESULTS

Glenohumeral internal rotation deficits were found in 136 participants (18.1%). Anatomical GIRD was present in 28 cases (3.7%), whereas pGIRD was observed in 108 cases (14.4%). No significant differences were found regarding GIRD between sex, age, age group, years of training, breathing side, and distance. Swimmers with pGIRD showed significantly less dominant internal rotation, total ROM, and external rotation gain (P < .01) than swimmers with aGIRD; conversely, swimmers with aGIRD showed significantly less nondominant internal rotation, external rotation, and total ROM than swimmers with pGIRD (P < .01).

CONCLUSION

Glenohumeral internal rotation deficit is a relatively common condition in asymptomatic elite youth swimmers; as to not overestimate this condition, aGIRD and pGIRD have to be distinguished. Although they play a role, the respiratory side, dominant limb, and crawl did not have a significant impact on an elite swimmer with GIRD.

Clinical and ultrasound findings of 'swimmer's shoulder' and its association with training history in elite Portuguese swimmers: a cross-sectional study

OBJECTIVES

To assess the prevalence of shoulder injuries and ultrasound findings in elite Portuguese swimmers and their association with symptoms and personal or training-related factors.

METHODS

This cross-sectional study was conducted at the Portuguese Open and Youth Swimming National Championships between 27 and 30th July 2022. Each athlete entered details regarding personal and training history into a questionnaire and underwent a physical and ultrasound shoulder examination.

RESULTS

A total of 102 swimmers out of 662 Portuguese athletes were included in the study. Shoulder pain experienced during the previous season was reported by 42% of the athletes. A high prevalence of shoulder structural abnormalities was noted, specifically supraspinatus tendinosis (91%), tears (29%), and subacromial bursitis (29%). Specific training for injury prevention was associated with higher rates of infraspinatus tendinosis (p = 0.047), and supraspinatus tears were linked to greater swimming distances per week (p < 0.001) and practice (p < 0.001), more years of practice (p = 0.018), shoulder pain at the time of evaluation (p = 0.023), a higher number of missed competitions (p = 0.041), and shoulder injections (p = 0.009). Subacromial bursitis was associated with shoulder pain at the time of evaluation (p = 0.002) and during the previous season (p < 0.001), missed competitions (p < 0.001), and requirement for physical therapy (p = 0.006).

CONCLUSIONS

A high prevalence of shoulder morphological changes was found in surveyed swimmers and there were several associations with training load, regardless of individual characteristics of each athlete. It is essential to understand the true impact of current injury prevention programs and to develop effective measures to protect swimmers' health.

Sink or Swim? Clinical Objective Tests and Measures Associated with Shoulder Pain in Swimmers of Varied Age Levels of Competition: A Systematic Review

BACKGROUND

Swimming is enjoyed by athletes of all ages, and shoulder pain is a common problem. Clinicians identify impairments which impact shoulder pain and these impairments may differ depending on the swimmer's age competition level.

PURPOSE

The purpose of this study was to investigate objective measures utilized to assess swimmers and assess the relationship of test values to shoulder pain in distinct age groups/competition levels. A secondary aim was to report normative/expected values for these tests.

DESIGN

Systematic review.

METHODS

PRISMA methodology was employed to assess studies evaluating clinical tests and measures associated with shoulder pain for swimmers in varied age competition levels. The Methodological Index for Non-Randomized Studies instrument was used to evaluate the quality of the included studies, and a qualitative synthesis of findings was conducted to determine the strength of the evidence in four age competition levels for nine objective measures. Distinct cut points for proposed measures were identified.

RESULTS

Twenty-seven studies were included in the analysis and the majority were of moderate quality in adolescent/adult swimmers. Youth swimmers had limited evidence for the development of shoulder pain associated with scapular position/dyskinesia, weakness of periscapular muscles, low endurance of core muscles, and moderate evidence for shoulder pain associated with laxity and altered range of motion (ROM). Adolescent/adult swimmers demonstrated limited evidence for a positive association between developing shoulder pain if there is a low eccentric ER:concentric IR ratio, and moderate evidence for pectoralis minor tightness and glenohumeral laxity. There were limited studies regarding masters swimmers to derive conclusive evidence. Cut points were identified from the included studies but these have not been validated in other studies.

CONCLUSION

Swimmers of various ages may have different objective clinical tests and measures associated with the risk for developing shoulder pain. More studies are needed to fully understand risk factors for shoulder pain in the masters swim competition level, and to validate recommended cut points for various tests and measures.

Key level of evidence

3, Systematic review of mostly Level 3 studies.

The Features of Foot Morphology and Intrinsic Foot Muscle Property in Adolescent Swimmers: An Ultrasound-Based Study

This cross-sectional study aimed to investigate the relationship between foot shape and intrinsic foot muscles (IFMs) in adolescent swimmers compared with other athletes. Foot morphology of swimmers was compared with other athletes of comparable age and a competition level (n = 32 [64 feet]; a total of 64 feet; 128 feet in two groups). Foot morphology and variables of IFMs were measured using a three-dimensional foot scanner and an ultrasound imaging system, respectively. Multiple linear regression analysis with forced entry was performed to clarify the association of the thickness and the cross-sectional area (CSA) of IMFs with the navicular height in both sitting and standing positions. Navicular height in a standing position, the thickness of the abductor hallucis (AbH) and the flexor digitorum brevis (FDB), as well as the CSA were significantly lower in swimmers compared with other athletes (p < 0.05). A larger CSA for the flexor hallucis brevis (FHB) was observed in swimmers than in other athletes (p < 0.01). The navicular height of swimmers in sitting and standing positions was positively correlated with the thickness and the CSA of the FHB and the FDB (p < 0.05). Multiple regression analysis showed that navicular height was associated with the CSA of the FDB in both sitting and standing positions (β = 0.395; p < 0.002, β = 0.201; p < 0.018). This study showed that the navicular height of elite adolescent swimmers was lower than that of other athletes. Furthermore, the swimmers' high navicular height was associated with the CSA of the FDB, suggesting that the FDB might be more involved in the formation of the medial longitudinal arch than the AbH.

Artistic Swimming Injuries in Young Elite Athletes: An 11-year Follow-Up

OBJECTIVE

Artistic swimming is a highly challenging discipline, requiring physical skills and creativity. There are almost no published data on trauma. We aimed to assess the incidence and the nature of injuries in artistic swimmers.

DESIGN

An 11-year retrospective single-center cohort study.

SETTING

Department of Sport Medicine of a University Hospital.

PATIENTS

One hundred and twenty-four elite female artistic swimmers aged 12.9 ± 1.6 years.

INTERVENTIONS

The cohort was divided into 3 groups according to the competition categories (from 9 to 12 years old called "future", 12-15 years old called "youth", 15-19 years old called "junior").

MAIN OUTCOME MEASURES

Injury rate per season and per athlete was assessed.

RESULTS

The injury rate was 0.95 injuries/season/athlete and 1.05 injuries/1000 hours of practice. The most frequent injuries were rotator cuff tendinopathy (13.6%), acute low back pain (13.6%), and patellofemoral syndrome (11.9%). Swimmers in the youth and junior categories had significantly more injuries than those in the future category ( P = 0.009), possibly because of more training hours ( P < 0.001). Twelve major injuries occurred, all in the same group of youth swimmers.

CONCLUSION

This is the first study investigating trauma during artistic swimming practice. A better knowledge of the main injuries is necessary for the physician to provide optimal care for athletes and to develop prevention. Attention should be particularly paid to the swimmers' shoulders and knees.

The perceived knowledge of the menstruation cycle and adjustment of swimming sets by swimming coaches based on menstrual-related issues

Background

Menstruation is the recurring discharge of the endometrial lining of the uterus as menstrual blood and tissue. The menstruation cycle affects most adolescent females and, although largely overlooked, affects women participating in sports.

Objectives

The aim of this study was to determine whether coaches were aware of their swimmers' menstrual cycles and whether coaches considered this information when adjusting training sets.

Methods

Within the case study, a partial mixed-method, sequential dominant status approach was used. Data were collected in the form of questionnaires, focus group discussions, and one-on-one interviews. Coaches' awareness of their female swimmers' menstrual cycles was based more on observation than communication from the swimmer.

Results

Coaches explained that training is adjusted based on their observations, but whether this is being done correctly during the menstrual cycle requires more research. Swimmers and coaches alike seem to have minimal knowledge of menstruation, its effects on training, and how to adapt to, or overcome, those effects during training or competition.

Conclusion

In future, this knowledge could ensure the longevity of female swimmers in the sport. Understanding whether coaches and swimmers recognise the effect of the menstrual cycle within training and competition provides a more inclusive approach to ensure athlete longevity after puberty. This approach is grounded in creating an understanding between the swimmer and coach about the effect of menstruation during training and competition. It ensures an extended and more successful participation which may also assist in dealing with the 'taboo' surrounding menstruation and the female athlete.

The Impact of Competitive Swimming on Menstrual Cycle Disorders and Subsequent Sports Injuries as Related to the Female Athlete Triad and on Premenstrual Syndrome Symptoms

Background: An athlete's menstrual cycle may be seriously disturbed when she undertakes a physical activity that exceeds the body's adaptive capacity and/or applies dietary restrictions. The main aim of this study was to assess the impact of swimming training undertaken by participants of sport clubs on disorders of the menstrual cycle.

METHODS

The study involved 64 female athletes. The questionnaire utilized in this study was composed by the authors, however some of the questions were based on Low Energy Availability in Females Questionnaire (LEAF-Q).

RESULTS

31.26% of swimmers reported that the menstrual cycle was stopped for more than 3 months, of which 21.88% had a menstrual absence for more than 6 months and 9.38% between 3 months and 6 months. Years of training were a positive predictor of the 'more profuse bleeding'. There was a negative correlation between the disorders of the menstrual cycle, the body weight of the female participants (p < 0.05) and the body mass index (p < 0.01). It was found that with the severity of the degree of disorder in the menstrual cycle, the number of injuries among the surveyed swimmers increased (p < 0.05).

CONCLUSIONS

The correct body weight of the participants was a positive predictor of the absence of the menstrual cycle disorders among the majority of women practicing swimming. Disorders in the menstrual cycle occurring in a certain percentage of the swimmers positively correlated with the number of injuries recorded among these swimmers. Swimming has been shown to alleviate some of the premenstrual symptoms.

Characterizing Health Events and Return to Sport in Collegiate Swimmers

Background:

There is limited literature characterizing the incidence, variety, and effects of injuries and illnesses observed in elite swimmers.

Purpose:

To describe the epidemiology of injuries and illnesses affecting elite intercollegiate competitive swimmers.

Study Design:

Descriptive epidemiology study.

Methods:

This retrospective study utilized a deidentified injury and illness database of National Collegiate Athletic Association Division I swimmers in the Pacific Coast Conference from the academic years 2016 to 2017 and 2019 to 2020. A health event was defined as an illness or musculoskeletal injury that was identified by an athletic trainer or team physician. Musculoskeletal injuries and nonmusculoskeletal injuries and illnesses were stratified by body location. Injuries were further characterized as career-ending, season-ending, missed time but the athlete returned to sport in the same season, or those that did not cause missed time. Relative risk (RR) was used to compare the percentage of athletes affected between women and men, with statistical significance being defined by a 95% CI not including 1.

Results:

Included were 641 collegiate swimmers (301 male, 340 female). There were 1030 health events among 277 women and 173 men, with 635 (61.7%) occurring in women and 395 (38.3%) in men. There were 540 musculoskeletal injuries reported, most of which involved the shoulder (n = 126; 23.3%), spine (n = 95; 17.6%), foot/ankle/lower leg (n = 81; 15.0%), knee/thigh (n = 67; 12.4%), and hand/wrist/forearm (n = 52; 9.6%). A total of 490 nonmusculoskeletal health events were reported and included events such as respiratory tract infections (n = 119; 24.3%), unspecified medical illness (n = 93; 19.0%), concussions (n = 58; 11.8%), ear infections (n = 25; 5.1%), and gastrointestinal illnesses (n = 24; 4.9%). Compared with male swimmers, female swimmers were at a higher risk of sustaining both musculoskeletal injury (RR, 1.5; 95% CI, 1.22-1.83) and nonmusculoskeletal injury/illness (RR, 1.32; 95% CI, 1.04-1.68). There were 58 documented concussions, with 8 (13.8%) being season-ending, but not career-ending and 14 (24.1%) being career-ending. Women had a higher rate of concussion (9.1% vs 4.3% for men; RR, 2.11; 95% CI, 1.13-3.96).

Conclusion:

This retrospective study identified the most common injuries and illnesses observed among elite collegiate swimmers. Awareness of the incidence and outcome of injuries and illnesses that affect competitive swimmers may allow for more targeted analyses and injury prevention strategies.

Traumatic surfing injuries in New Zealand: a descriptive epidemiology study

Background

New Zealand (NZ) has nearly 14,000 km of coastline and a surfing population of approximately 315,000 surfers. Given its popularity, surfing has a high frequency of injury claims, however, there remains a lack of data on traumatic surfing-related injuries from large population studies. The primary purpose of this study was to examine traumatic surfing injuries in NZ specific to injury incidence, duration, location, type, mechanism of injury and associated risk factors.

Methods

A sample of self-identified surfers currently living in NZ participated in an online retrospective cross-sectional survey between December 2015 and July 2016. Demographic and surfing injury data were collected and analysed.

Results

The survey yielded 1,473 respondents (18.3% female); a total of 502 surfers reported 702 major traumatic injuries with an overall incidence proportion of 0.34 (95% CI [0.32-0.37]). When comparing the number of injured surfers who sustained an injury at various body locations, a significantly higher proportion of competitive surfers, compared to recreational surfers, had an injury at the neck (6.8% vs 4%, χ ² (1,1473) = 5.84, P = 0.019); shoulder (7.4% vs 4.3%, χ ² (1,1473) = 6.34, P = 0.017), upper back (1% vs 2.4%, χ ² (1,1473) = 4.77, P = 0.043), lower back (7% vs 3.1%, χ ² (1,1473) = 11.98, P = 0.001) and knee (7% vs 3.4%, χ ² (1,1473) = 9.67, P = 0.003). A significantly higher proportion of surfers who performed aerial manoeuvres compared to those who did not reported a higher proportion of knee injuries (9.7% vs 3.9%, χ ² (1,1473) = 13.00, P = 0.001). With respect to injury duration, the shoulder represented the largest proportion of chronic injuries (>3 months) (44.4%), and the head and face represented the largest proportion of acute injuries (≤3 months) (88%). Muscle and tendon injuries were reported most frequently (25.6%) and direct contact injuries accounted for 58.1% of all injury mechanisms. Key risk factors for traumatic injury included: competitive compared to recreational status (41.0% vs 30.1%, Relative Risk (RR) = 1.36, P < 0.001), ability to perform aerial manoeuvres (48.1% vs 31.8%, RR = 1.51, P < 0.001) and intermediate or above skill level surfers compared to beginner surfers (35.8% vs 22.7%, RR = 1.58, P < 0.001).

Conclusion

One third of recreational surfers sustained a major traumatic injury in the previous 12 months. For competitive or aerialist surfers the risk was greater, with this proportion approximately half. Overall, the head/face was the most common location of traumatic injury, with competitive surfers being more likely to sustain a neck, shoulder, lower back, and knee injury compared to recreational surfers. The shoulder was associated with the highest proportion of injuries of chronic duration. Future research should investigate injury mechanisms and causation using prospective injury monitoring to better underpin targeted injury prevention programs.

Contemporary Variables that Impact Sleep and Development in Female Adolescent Swimmers and Gymnasts

The effects of sleep on elite athletes in late adolescence and early adulthood have been well documented in a myriad of sports. However, there is underrepresentation of pre-pubertal and young female adolescent athlete research between the ages of 11-17, and specifically female gymnast and swimmers. Neglecting to understand how high energy demand at a young age relates to sleep and restoration may lead to developmental ramifications for this group, as they display physiological dysfunctions like delayed puberty, amenorrhea and are at risk for the female athlete triad or components of the triad. This review aims to summarize the contemporary variables of blue light emitting screens, social media, and caffeine on quality and quantity of sleep in young athletes while identifying gaps in the literature on how these factors impact the target group of young female swimmers and gymnasts.  The implications of this work include sleep hygiene recommendations for increasing duration and quality of sleep, as well as future research with respect to electronic device usage, social media participation, caffeine consumption, and sport engagement in female early adolescent athletes.

Impact of habitual swimming on the success of lacrimal surgery

PURPOSE

To elucidate how factors associated with swimming affect the lacrimal ducts of swimmers.

STUDY DESIGN

Prospective, interventional cohort study, METHODS: Five hundred seventy four consecutive epiphora patients were surveyed via a questionnaire regarding details of their swimming-pool usage; i.e., frequency, swim-goggles' wear, and type of pool activity (i.e., swimming vs. waist-depth walking). In this cohort, all the swimmers over 20 years old with anatomical lacrimal duct obstruction underwent surgical reconstruction. The surgical success rates at 12-months postoperative were compared using multivariable logistic regression analyses between swimmer/non-swimmer patients, those with a history of high/low frequency of pool usage, and those with high/low amount of conjunctival contact with the swimming-pool water.

RESULTS

Of the patients with anatomical lacrimal duct obstruction, 6.4% were habitual swimmers; nasolacrimal duct obstruction was more common in the swimmers than in the non-swimmers' controls (89.1%/66.7%, P = 0.025). The success rate of lacrimal surgery for the swimmers with anatomical nasolacrimal duct obstruction was lower (60.6%) than of the non-swimmers (83.3%, P = 0.048). A receiver operating characteristic curve analysis of the frequency for the prediction of surgical failure showed that the threshold was 4 days/week. The success rate was statistically lower (26.7%) in the high-frequency swimmers compared to the low-frequency swimmers (88.9%, P = 0.037). However, no statistical difference in the high/low ocular surface contact to the swimming-pool water was observed (71.4%/57.7%, P = 0.56).

CONCLUSION

Habitual swimmers have a high risk of nasolacrimal-duct damage retrogradely from the nasal cavity that lowers lacrimal surgery's success rate.

Heat Injury in Open-Water Swimming: A Narrative Review

ABSTRACT

Swimming is one of the most popular sports in the world with open-water swimming (OWS) gaining more and more prominence since being featured in the Federation Internationale De Natation World Aquatics Championships in 1992 and the Olympic Games in 2000. The aim of this review is to analyze the existing literature on heat injury in OWS. Relevant literature was located via computer-generated citations during November of 2020 through online computer searches of multiple major databases. Athletes participating in OWS are exposed to environmental conditions that place them at risk for unique medical conditions such as heat injury. Clinicians providing care for OWS athletes should be educated and trained to recognize these conditions and minimize risks to optimize athlete safety. This article identifies medical challenges related to heat injury in OWS while investigating water temperature recommendations, physiological effects of hyperthermia, risk mitigation strategies, and treatment measures.

Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes

OBJECTIVE

Nutritional status is important for health and competitive achievement. This area remains understudied among elite-level female athletes and is appropriate for research. We examined nutritional status and cardiovascular health markers of two groups of female athletes of the same age and competition period, involved in weight-bearing and a non-weight-bearing sport: gymnasts (n = 17) and swimmers (n = 14); mean age 17.4 and 16.6 years.

METHODS

Body composition and dietary intake were assessed by bioelectrical impedance and Food Frequency Questionnaire. The concentrations of serum micronutrients (B12, 25-hydroxyvitamin D (25 (OH) D), calcium, magnesium, phosphorus, potassium, and iron), blood lipids, and blood pressure (BP) were measured. Setting and Participants. A cross-sectional study of 31 athletes from Slovenia.

RESULTS

Gymnasts had higher body mass index (21.5 vs. 20.1 kg/m2, p=0.043) and lower fat free mass (42.4 vs. 46.6 kg, p=0.024) than swimmers and comparable body fat percentage (22.5 vs. 22.8%). Both groups had low intake of carbohydrates, fibre, polyunsaturated fats, protein (only gymnasts), and micronutrients (11/13 micronutrients gymnasts and 4/13 swimmers) and high intake of free sugars and saturated fats. Both groups also had significantly lower-than-recommended serum levels of 25 (OH) D. All cardiovascular risk factors were within recommended ranges. Gymnasts had higher LDL cholesterol (2.7 vs. 2.2 mmol/L, p < 0.011), and swimmers had higher systolic BP (126 vs. 107 mmHg, p < 0.001).

CONCLUSIONS

Dietary intake especially in gymnasts was suboptimal, which may reflect in anthropometric and cardiovascular marker differences between gymnasts and swimmers.

The relationship between training load and pain, injury and illness in competitive swimming: A systematic review

BACKGROUND

Research suggests that the frequency of training, combined with the repetitive motion involved in high volume swimming can predispose swimmers to symptoms of over-training. The prevention of pain, injury and illness is of paramount importance in competitive swimming in order to maximise a swimmer's ability to train and perform consistently. A significant factor in the prevention of pain, injury or illness is the appropriate load monitoring and management practices within a training programme.

OBJECTIVE

The purpose of this systematic review is to investigate the relationship between training load and pain, injury and illness in competitive swimmers.

METHODS

The databases SPORTDiscus, CINAHL, Scopus, MEDLINE and Embase were searched in accordance with PRISMA guidelines. Studies were included if they reported on competitive swimmers and analysed the link between training load and either pain, injury or illness. The methodological quality and study bias were assessed using the Joanna Briggs Institute Critical Appraisal Checklist.

RESULTS

The search retrieved 1,959 articles, 15 of which were included for review. The critical appraisal process indicated study quality was poor overall. Pain was the most explored condition (N = 12), with injury (N = 2) and illness (N = 1) making up the remaining articles. There was no evidence of an association between training load and pain, while there may be some evidence to suggest a relationship between training load and injury or illness.

CONCLUSIONS

The relationship between training load and pain, injury or illness is unclear owing to a host of methodological constraints. The review highlighted that youth, masters and competitive swimmers of a lower ability (e.g. club versus international) may need particular consideration when planning training loads. Winter periods, higher intensity sessions and speed elements may also need to be programmed with care. Monitoring practices need to be developed in conjunction with consensus guidelines, with the inclusion of internal training loads being a priority. Future research should focus on longitudinal prospective studies, utilising the session Rating of Perceived Exertion (sRPE) monitoring method and investigating the applicability of Acute/Chronic Workload Ratio (ACWR) and exponentially weighted moving average (EWMA). Improved methods and study design will provide further clarity on the relationship between load and pain, injury, and illness.

An Updated Review of the Epidemiology of Swimming Injuries

OBJECTIVE

To carry out a systematic review to update the scientific evidence on the incidence and prevalence of injuries in the swimming discipline, as well as the location, type, and mechanism of the injuries, and to assess whether studies are meeting methodological recommendations for data collection and injury surveillance. TYPE: Analytical-Systematic review.

LITERATURE SURVEY

The databases of PubMed and Sportdiscus were used to search for studies that describe the epidemiology of injuries in adult swimmers between 2010 and March 2020.

METHODOLOGY

Of the 864 articles identified, 14 studies were finally included in this review. The methodological quality of the studies was analyzed with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

SYNTHESIS

The results showed a high prevalence of shoulder, knee, and lower back injuries among swimmers due to overuse. These injuries were mainly short-term tendon muscles; there were reported data differences between genders.

CONCLUSIONS

Despite the publication of an injury surveillance single and multisport events document and a consensus on data collection and injury surveillance in swimming, there are huge methodological limitations that do not allow firm conclusions. As such, more epidemiological studies following guidelines for data collection and injury surveillance are needed to establish differences by gender, age group, and swimming stroke.

Modelling Training Adaptation in Swimming Using Artificial Neural Network Geometric Optimisation

This study aims to model training adaptation using Artificial Neural Network (ANN) geometric optimisation. Over 26 weeks, 38 swimmers recorded their training and recovery data on a web platform. Based on these data, ANN geometric optimisation was used to model and graphically separate adaptation from maladaptation (to training). Geometric Activity Performance Index (GAPI), defined as the ratio of the adaptation to the maladaptation area, was introduced. The techniques of jittering and ensemble modelling were used to reduce overfitting of the model. Correlation (Spearman rank) and independence (Blomqvist β) tests were run between GAPI and performance measures to check the relevance of the collected parameters. Thirteen out of 38 swimmers met the prerequisites for the analysis and were included in the modelling. The GAPI based on external load (distance) and internal load (session-Rating of Perceived Exertion) showed the strongest correlation with performance measures. ANN geometric optimisation seems to be a promising technique to model training adaptation and GAPI could be an interesting numerical surrogate to track during a season.

Predicting health risk from exposure to trihalomethanes in an Olympic-size indoor swimming pool among elite swimmers and coaches

Disinfection by-products (DBP) such as trihalomethanes (THM) are formed when chlorine and bromine interact with natural organic materials in chlorine-treated swimming pools. Epidemiological evidence demonstrated an association between exposure to swimming pool environment and adverse health effects. Therefore, this study aimed to assess carcinogenic and non-carcinogenic risk of long-term exposure of elite swimmers and their coaches. In an Olympic-size indoor chlorinated swimming pool, THM levels were determined in water (21-69 µg/L), in the boundary layer above the water surface (59-397 µg/m³), and in the air surrounding the pool (28-390 µg/m³). These values were used to predict multi-pathway chronic daily intake (CDI), cancer risk (CR) and hazard index (HI). Oral and dermal CDI for swimmers were 2.4 × 10^-6 and 2.0 × 10^-8, respectively. The swimmers' inhalation CDI (1.9 × 10^-3 mg/kg/day) was estimated to be sixfold higher than levels obtained for coaches (3.3 × 10^-4 mg/kg/day). According to guidelines, the HI was acceptable, but CR exceeded the recommended limit for both, coaches (CR: 5.5 × 10^-7-8.5 × 10^-5; HI: 6.5 × 10^-4-1 × 10^-1) and swimmers (CR: 1.4 × 10^-5-3.6 × 10^-4 HI: 1.6 × 10^-2-4.3 × 10^-1). Our findings provide further support to the need to develop comprehensive guidelines to safeguard the health of individuals involved in elite swimming.

Anterior Shoulder Dislocation during Breaststroke Swimming Technique: A Case Report and Review of the Literature

A 36-year-old woman presented with anterior shoulder dislocation as a result of breaststroke swimming training. She complained of pain and restriction of movement. A radiograph revealed the shoulder was dislocated, and the patient was treated successfully with closed reduction. The mechanism of injury seemed to be a relation between the initial pull phase of breaststroke technique and the weakest position of the shoulder in extension and external rotation. In our experience, if a patient has a history including a shoulder dislocation, this needs to be considered carefully before incorporating aquatic therapy into the rehabilitation program. Attention must also be given to the crucial timing of initiating swimming training.

Evaluation of the Heart Function of Swimmers Subjected to Exhaustive Repetitive Endurance Efforts During a 500-km Relay

Aim: Knowledge of the human body's ability to adapt to repeated endurance efforts during swimming is limited. We echocardiographically assessed the impact of an exhausting and repetitive swimming effort on cardiac activity. Materials: Fourteen well-trained amateur swimmers (8 female swimmers aged 16-43 years and 6 male swimmers aged 13-67 years old) participated in an ultramarathon relay. Over 5 days, swimmers swam 500 km in the Warta River (in 5-km intervals). Each swimmer swam seven intervals, each within 44:46 to 60:02 min. Objective difficulties included low water temperatures, strong winds, rain, and night conditions. Methods: Transthoracic echocardiography (TTE) was performed three times: at baseline (the day before exertion), at peak effort, and during recovery (48 h after the event). The heart rate (HR) of each swimmer was monitored. Results: Swimmers completed the ultramarathon relay within approximately 91 h. The average HR value at the end of each interval was 91% HRmax. TTE test results showed no significant changes indicative of deterioration of myocardial function at peak effort or after 48 h. Significant increases in left ventricular (LV) ejection fraction, LV fractional shortening (LVFS), LV myocardial systolic velocity, and right ventricular (RV) fractional area changes observed on day 2 after swimming were compared to baseline values and peak effort values. No significant changes in diastolic heart function were observed. Conclusion: Echocardiography assessment indicated that prolonged intense swimming does not affect LV or RV function. Supercompensation of the post-event RV function and increased global LV systolic function demonstrated ventricular interaction after prolonged intense swimming.