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Water polo - not just sport for tough men

Dear Sirs and Madames,
In midsummer temperatures, we all like to jump into the pool, lake or sea to cool off. The athletes that the July newsletter is about, however, work up a sweat in the water. Our author Dr. med. Ralf Schauer from Würzburg has been accompanying professional water polo players for a long time. In his contribution he guides you through the world of water polo, from the rules of the game to the injury patterns. And if you think you can't get injured in the water, you're really wrong. From eye injuries to cheekbones, concussions to shoulder impingement, everything that needs medical care is the order of the day in this sport. Despite all of this, water polo is an interesting, athletically demanding sport riddled with duels that is worth taking a closer look at. With this in mind, have fun reading it.

Sincerely,
Your Kathrin Reisinger, GOTS press officer ([email protected])

Water polo - not just sport for tough men

© Pixabay

Historical

Water polo was invented in England around 1870 to make swimming events more attractive. In 1885 it was recognized as an independent sport by the English Swimming Association. In Germany, water polo was first played in Berlin in 1894 and the first German championship was held in 1912. Water polo is the oldest Olympic team sport and was first featured in the Olympic program in St. Louis USA in 1904.

definition

Water polo is a ball game in water in which the players of two teams try to hit the ball into the opponent's goal by skillfully playing and swimming free.

regulate

A team consists of 13 players, of which 7 players (1 goalkeeper, 6 field players) are in the water. The playing time is 4 x 8 minutes of pure playing time. There is a two-minute break between the first and second quarters and between the third and fourth quarters, and a five-minute break between the second and third quarters. During this break, the page change takes place.

The host plays in white caps, the guest in blue caps.

The playing field is 30 x 20 meters, for women, young people and senior citizens 25 x 20 meters. The goals are 3m wide and 90cm high.

The water depth should be two meters throughout. A penalty throw is taken from the five meter line. The game is directed by two referees. The ball weighs 450g and is the size of a soccer ball, slightly smaller for women and up to D-youth. It is made of plastic (used to be made of leather).

Water polo can be played by the E-youth U11 and younger up to old age, health and physical fitness are a prerequisite. Masters AK start at 30 and end at 70 years of age.

Injuries in water polo

In the course of time the rules have been changed again and again, whereby water polo has developed from a swimming game to a swimming and body-focused game. Athletics have increased over the years. As a result, the injury pattern has shifted from lacerations caused by elbow checks and punches to overuse injuries with tendon and joint injuries. The game between Hungary and Russia at the 1958 Olympics, where political interests were fought out in the water, was legendary. (see picture)


© RS Sportfoto (2)

Which body parts or joints are in the foreground of the injury pattern?

In the first place you have to name the shoulder. She is the focal point of both swimming and throwing. If you compare water polo with other overhead sports such as handball, volleyball, baseball and swimming, the same pattern of injuries and overloads is found.

The Shoulder dislocation or Shoulder dislocation occurs with water polo when the arm is grasped in 90 ° abduction and external rotation during the acceleration phase of the throw or the throwing arm is blocked directly from the front.

Reaching into the arm leads to an anterior dislocation, and blocking leads to a posterior dislocation.


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This can also result in an injury to the rotator cuff and a Bankart lesion (a bony tear in the labrum.

SLAP lesion: This leads to an anterior, posterior or basket-handle-like avulsion of the supraglenoid labrum. The injury occurs in an acutely traumatic manner when the limb is grasped.


© RS Sportfoto (2)

The more common version is continuous micro-injuries when the shoulder is continuously overloaded by throwing loads.

The Rotator cuff injury has the same injury pattern as described above. It can also be an accompanying injury in the context of a shoulder dislocation and occur in isolated traumatic situations when strong forces are exerted on the shoulder. The most frequent cause, however, are degenerative changes in the context of micro-injuries in the case of overload damage to the shoulder through years of training or incorrect throwing technique and muscular imbalances.

Biceps tendon lesion: Due to its anatomical situation, the biceps tendon is a very vulnerable structure in overhead sports.

The long biceps tendon runs through the joint and acts as a depressor for the head of the humerus.

When throwing - especially in the final phase - the biceps tendon hits the acromion, causing chronic irritation. The so-called pulley (a sinewy sheath) for the tendon is increasingly damaged and tears over time. There is now an unstable situation of the tendon with dislocations from the sulcus, which lead to chronic irritation and mechanical inflammation of the tendon with accompanying inflammation of the subacromial bursa.

This narrows the space under the roof of the shoulders and leads to trapping, the so-called impingement. This leads to a painful restriction of movement of the shoulder and, in the case of recurring inflammation, can in the worst case lead to a tear in the tendon.

Prevention

The shoulder is the most commonly affected joint in water polo. This is because water polo is a very physical sport, so most of the throwing movement takes place under the interference of an opponent. This means that a technically correct execution of the throw is usually not possible. If the disturbance takes place in the acceleration phase, the forces on the muscles and the tendon tissue increase. This is where most of the shoulder lesions develop. As early as 1993, Bettin was able to show in a study that the pain in movement in the shoulder mainly occurs with high external rotation at the end of the recovery phase and in flexion and internal rotation at the end of the throw.

To minimize the risk of injury, the player needs good shoulder mobility and good muscle strength and balance to keep the humerus head centered during the throwing movement.

Furthermore, a good core and leg strength is necessary to stabilize the body in the water and to get strength behind the ball.

Other injuries that do not occur that often are hip problems caused by congenital malpositions and technically incorrect treading water. Ultimately, this can cause early osteoarthritis of the hip joint.

During the game itself, finger injuries with tendon and ligament ruptures or broken finger bones occur due to holding hands.

Lacerations, nasal bones and cheekbones, as well as injuries to the bony eyeball (orbital floor) usually occur through fist and elbow checks. Likewise, retinal and corneal injuries to the eye. Injuries to the eardrum have decreased significantly due to the introduction of the earmuffs, but still occur when the ear is hit or kicked when this is done underwater.

The medium of water requires good trunk stability and core strength so that the player can perform both throwing movements and attack and defense games
can move as stable as possible in the water. In the basic training of the young players, great importance should be attached to coordination and agility exercises. The strength when throwing should come from the legs, the hip and body rotation with the necessary strength and not exclusively from the shoulder.

In our own studies, we were able to show that players with good body rotation and stability have fewer shoulder problems than players who have significant deficits here.

Center players are particularly susceptible here, as they are usually not able, due to the opponent's influence, to shape the throw from the entire body, but mainly from the shoulder.

Concussion has recently also been discussed in water polo. This serves to sensitize the players to this syndrome. The goalkeepers must be trained to face the opponent and to have a basic tension in defending the ball.

Rule change: an aimed shot at the head must result in a significant penalty.

Concussions shouldn't be underestimated, even without loss of consciousness.

Trainers and supervisors have a duty of care. A player should be removed from the game if they have symptoms for their own protection. In this case, post-traumatic recommendations are rest, rest, no use of multimedia devices, no reading, no mental or physical overexertion, analgesia.

Slowly introducing or building up stress in school and training. The training approval should be given by the team doctor.

Prevention: wearing a protective cap under the goalkeeper's cap.

Summary

Water polo is a very physical and strenuous sport that places high demands on the player's strength, flexibility and coordination.

The player is doubly burdened in the shoulder by swimming and throwing himself, as well as by the action of the opponent.

When swimming, the player has a different position in the water than the competitive swimmer. Due to the high position of the upper body, a rotation in the thoracic spine area is not easy to carry out and requires greater shoulder mobility, which in turn can lead to microtraumas due to overload.

Throwing itself, and here with an opponent, places even greater demands on coordination and agility in order to perform the throw in a technically correct and powerful manner.

What is so fascinating about water polo?

It's an action-packed sport that requires a lot of training. Water polo players have some of the best medical performance results. Water polo is an endurance sport with a high strength character. It is a combat sport that can be played both indoors and outdoors. It demands intelligence and playfulness. And: water polo has developed from a purely swimming game to a fast and athletic game.


© RS Sportfoto

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The author

Dr. med. Ralf Schauer, FA for general surgery, orthopedics and trauma surgery, spec. Trauma surgery, sports medicine and emergency medicine, works at the Orthopedic University Clinic Würzburg König-Ludwig-Haus. He is the association doctor of the German Swimming Association for Water Polo, is responsible for the team medical care of SV05 Würzburg from E-Youth to Masters and 1st Bundesliga, looks after the Bundesliga team of SSV Esslingen, the U17 and U19 male junior teams. He was an active second division water polo player at SV Heilbronn and was still an active player in the German Masters until 3 years ago.


Congress review: GOTS sports doctor of the year

Dr. med. univ.Gerhard Oberthaler is Sports Doctor of the Year 2019

Dr. med. univ. Gerhard Oberthaler has just been elected Sports Doctor of the Year at the 34th Annual GOTS Congress. The 59 year old trauma surgeon and sports doctor from Salzburg accepted the award beaming with joy and a little confused: "I'm totally surprised because I really didn't know anything."
Oberthaler was born in Linz, spent his school years in Steyr and completed his medical studies in Innsbruck. "In addition to his studies, he was a ski instructor, taxi driver and model in Innsbruck," revealed laudator Dr. Klaus Then. And further: “He is a very critical zeitgeist, took care of the next generation of medical professionals and helped organize the GOTS sports doctor certificates. His passion is ice hockey - there he is primarily committed to the prevention of sports injuries. Gerhard Oberthaler stands for straightforward, honest, rocking and perseverance ”, so the emotional laudation. Friends and family came to the Salzburg Congress Center for the ceremony. Gerhard Oberthaler himself wishes: "... that many more young doctors today will find a fire for sport and the care of young athletes."


Congress gleanings: summary

Largest European sports medicine congress (orthopedics / traumatology) ended in Salzburg

The 34th international congress of the Society for Orthopedic-Traumatological Sports Medicine was a complete success. More than 500 guests from 10 countries came to Salzburg to exchange ideas across countries and disciplines about the latest therapy methods, operations and prevention and to promote developments in modern sports medicine.

Participants even came from countries as far away as Canada, Brazil and Japan. The topics dealt with the entirety of all illnesses, accident risks, and chronic overload of recreational and competitive athletes. It was about football, handball, ice hockey, tennis as well as water sports, alpine and climbing sports, dancing, jogging, yoga and Pilates.

Injuries and their avoidance in children and adolescents, school sport and preventive sport examinations were just as much a focus as sport in old age and what “is still possible”.

“No sports - and the consequences” were highlighted, but also ailments that only arise from - incorrectly performed - sports. Key words were: sport for osteoarthritis, sport with artificial joints, prevention in sport. It involved damage to the knees, ankles, hips, elbows and shoulders. There was also a completely separate session on the subject of the spine.

In workshops, symposia and multimedia lectures, doctors, therapists and students learned the latest from the world of sports medicine.

The presentations and case studies from team support in all the leagues, championships and at the Olympics were also exciting. The subsequent election of Dr. Gerhard Oberthaler (Austria) for sports doctor of the year brought long-lasting, thunderous applause in the hall.

The live demonstrations of mountain and alpine rescue were almost spectacular. The audience learned how long people who have had an accident survive in the mountains / in the snow and ice, what modern rescue, including emergency medicine, looks like by helicopter today.

The "GOTS expert meeting" on shoulder instability, ACL, cartilage and muscle / tendon injuries, the symposium "Physio- & Sports Physiotherapy" with lively discussion, the main topic "Sports medicine in children" with over 150 listeners, the symposium " Elbow in Sport “with a very young audience. The symposium “Spine & Sport - is it okay?” And at the highlight lecture “Sport in old age - what's still possible?” Was bursting with people.

The new format “Orthoses on the test stand” on the “action field” - the stage in the industrial exhibition - brought power to the congress. Moderated by GOTS and industry experts, it showed the collaboration that is so important for sports patients.

Doctors, therapists, athletes and patients alike benefited from this congress. Regardless of the topic: it is always about maintaining health with the maximum amount of individually possible sport.

Last but not least, the unique solidarity among the GOTS people could be felt again: at the gala evening in the Gwandhaus, at GOTS rocks - with its own band and at the “Wings4Life” charity run.
Not only do colleagues and like-minded people come together here - but also friends!


GOTS Spine Committee

The GOTS Spine Committee under the direction of Dr. M. Knöringer is currently in the process of recruiting new members. After the extremely successful WS symposium at the GOTS annual congress in Salzburg, many other activities are planned, including:

  • WS session at the DGOU congress in Berlin 2019
  • WS session at the GOTS annual congress in Berlin 2020
  • WS part of the GOTS certificate course
  • WS part of the master’s degree at Danube University
  • Article in the prevention booklet (SOT)
  • Aiming for a separate SOT booklet
  • Collaboration on guidelines for scoliosis (with H. Schmitt)

GOTS Prevention Committee

From 19 to 22 September the GOTS expert meeting 2019 "Primary prevention of sports injuries" instead of. The recommendations and results developed there are published in a joint publication after each meeting. The meeting of experts this year is under the direction of Prof. Romain Seil (Luxembourg) and Prof. Thomas Tischer (Rostock).

The topic of prevention was omnipresent at the congress as well. For the Young Academy there was a prevention workshop with lots of practical examples, group work and discussions. At the meeting on Friday, different projects were presented, e.g. how you can create your own prevention programs in cooperation with the health insurance companies.


Lost & Found

Nothing is lost at GOTS - not even sunglasses at the congress gala evening.This one remained lying around and was taken into custody by our office. So if you miss these sunglasses, just send a short email to [email protected] and our nice staff will send them to you by post.


GOTS call

Have you been to well-known sporting events as the attending physician, do you have news from your symposia, workshops, events, from your commissions or are there new important publications from you? Then we look forward to sending you texts and photos or just bullet points / links so that we can market everything using multimedia.

The address: [email protected]