The epidemiology of injuries in competitive adolescent swimmers attending a Johannesburg swim squad

Master Thesis


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University of Cape Town

Background: Swimming is a popular competitive and recreational sport performed worldwide by all generations. Although swimming is associated with many positive health benefits, swimmers are at risk of developing musculoskeletal injuries. In particular, competitive swimmers may be at increased risk of injury, due to regular participation in demanding training regimes. Adolescent swimmers may be at increased risk of injury due to physiological and biological vulnerability associated with growth and development. However, there is a lack of evidence regarding the epidemiology of injuries in competitive adolescent swimmers. Aim: The aim of this study was to determine the relationship between injury incidence and potential risk factors in adolescent swimmers over a 24 - week period. Specific Objectives: (a) To describe the demographic and training characteristics of competitive adolescent swimmers; (b) to establish the incidence and nature of self - reported swimming - related injuries in competitive adolescent swimmers; (c) to determine if any specific intrinsic factors and extrinsic factors were associated with increased risk of injury in competitive adolescent swimmers. Methods: Twenty three competitive adolescent swimmers aged 12 to 18 years were recruited for the study. Swimmers attended a study information session and parents/legal guardians were emailed information sheets and informed consent forms. All participants brought signed informed consent forms from parents/legal guardians to the baseline data collection session. At baseline testing participants signed their own informed assent forms and completed the baseline questionnaire, anthropometry measurements, glenohumeral range of movement measurements, the Beighton score and glenohumeral and knee muscle strength measurements. Participants were advised on how to complete the electronic injury report and training questionnaire. A familiarisation trial - run of the survey was completed in the week following baseline testing. Formal data collection commenced two weeks after baseline testing. Participants were required to submit the injury report and training questionnaire on a weekly basis for the 24 - week study period. Results: The mean age for commencement of swimming training in both the injured and uninjured groups was approximately 7.5 years. The injured group had significantly decreased subscapularis muscle strength (p = 0.02) and significantly higher average training session distances (p = 0.04), compared to the uninjured group. Fourteen participants (60%) sustained injuries during the 24 - week study period. The injury rate was 22.4 per 1 000 athletic exposures (AE's). Sixty injuries were sustained in total; 16 were index, and 44 were recurrent injuries. The most common injury location was the knee joint (n = 20). The only factors associated with increased injury risk in this study were previous injury history (OR: 7.50; 95% CIs 1.02 - 55.00) and reduced percentage of time in breaststroke training (OR: 12.83; 95% C I s: 1.69 - 97.19). Few swimming training sessions were modified or changed due to injury, and the majority of injurie s did not receive any treatment. Conclusion The injury incidence of adolescent competitive swimmers attending a Johannesburg - based swim squad is high. In addition, the high number of recurrent injuries, the minimal adaptation of training loads in response to injury, and the low access to appropriate treatment suggest a lack of knowledge or poor practices regarding swimming - related injuries. Pre - season screening, specific to swimming, could assist in identifying weakness and potential risk factors for injury in this vulnerable age - group. Improving health literacy with education in swimmers, coaches and parents could reduce future injury incidence rates. Therefore, further research is needed regarding injury incidence, risk factors and training profiles of this population. Moreover, consensus regarding injury definitions and training loads in adolescent swimmers is needed to standardise reporting and to facilitate further research in this field.