Water polo athletes are modern-day gladiators. In part I of a series, Alicia Filley explains why stepping into the aquatic arena can be a dangerous proposition.
Water polo, while not played by the ancients, was the first team sport played in the Olympics, beginning at the 1900 games in Paris. The popularity of water polo grew, in part, due to the reckless, almost violent, style of play that delighted spectators. The pool or body of open water where it was played became a modern coliseum of sorts. This level of intense play still exists today. In a survey of injury incidence conducted by the Federation International de Natation Amateur (FINA) during the 2004 and 2008 Olympic Games, and the 2009 FINA World Championships, water polo was found to have the highest incidence of injuries, the most traumatic injuries, and the most time lost from play due to injuries1. A more recent analysis of the 2004-2018 Olympic Games and the 2009 – 2017 FINA World Championships found that 14.1 injuries occurred for every 100 players2.
Besides a swimsuit, the only required equipment worn by water polo player is a swim cap and a soft covering for the ears. The swim cap doesn’t provide protection, but rather allows players to identify their teammate. It’s no surprise then that most water polo injuries occur at the head. FINA reports that 56% of all traumas suffered by water polo athletes at the 2004 Olympic games were to the head3. Arms vie for a ball that can be thrown at speeds of up to 70 kilometers per hour by women, and faster than that by men, and the head is an easy target for both4.
Lacerations to the head can typically be tended to poolside unless they involve the cornea of the eye. Corneal abrasions can be painful and serious. Remove a player from the game, discourage him from rubbing the eye and refer to a physician if corneal abrasion is suspected. Medication to prevent infection, calm inflammation, and decrease pain may be prescribed.
Water polo athletes are also susceptible to eye irritation since they do not wear goggles. Recommend frequent use of artificial tears to prevent persistent conjunctivitis5. Chronic exposure to chlorine when wearing contact lenses can also lead to eye infections. Refer to an ocular specialist if athletes complain of irritation, light sensitivity, blurred vision, or feeling as though there is a foreign body in the eye. Advise athletes to dispose of or clean contact lenses after water sessions, or wear prescription sports lenses during play.
Blows to the head or face either from another player or from the ball itself can break delicate facial bones, affecting eyes and sinuses. In such cases, seek immediate medical attention for the athlete and evaluate for signs of concussion. If a player loses consciousness in the water, trainers must rely on other players to bring the injured player poolside. Therefore, all teams should periodically conduct life-saving drills so that players are prepared to rescue another, should the situation arise.
In a survey comparing team sports at the 2004 Olympic Games in Athens, water polo was found to have the highest number of head injuries3. In a study conducted by researchers at UC Irvine, 36% of USA Water Polo members surveyed reported suffering at least one concussion during play6. This percentage was somewhat higher for goalies5. Water polo teams, like all other sports teams, should have traumatic head injury protocols for baseline pre-season testing and return to play. Unfortunately, water polo usually falls under aquatics programming rather than field sports. Therefore, concussion protocols may be lacking. Returning to battle injured may seem heroic, but it is better to err on the side of caution and retreat until cleared by a physician.
The only protective gear a water polo athlete wears is over the ears (see figure 1). This covering lessens the trauma to the delicate ear tissue and protects the eardrum. Despite the protection, traumatic rupture of the eardrum is still prevalent and usually occurs when the ear is slapped or kicked while underwater. The resulting increased pressure in the ear canal tears a hole in the tympanic membrane. Most ruptured eardrums heal in about three months; however, they must be kept dry during the healing process. This means no pool time unless a physician approves of the use of a molded earplug and swim cap.
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