1. Injury Patterns in Elite Canadian Divers Kate Milhausen, MD Dept of Orthopedic Surgery University of British Columbia Vancouver, BC, Canada Kristin Wingfield, MD,CCFP Center for Sports Medicine San Francisco, CA, USA

2. Canadian springboard and platform divers rank top in the world despite always being Injured  Incidence of injuries in competitive diving 92-100%  No studies to link factors like training practices, MD visits, treatment methods to injury patterns Introduction

3. Objectives 1) To determine:  Injury patterns  Mechanisms, diagnosis and treatment methods  characteristics and training patterns of athletes with the most injuries  factors associated with unresolved or chronic injuries 2) To recommend injury prevention and treatment strategies

4. Design  Retrospective survey, convenience sample  Participants: divers qualified for Senior National Summer Championships, Victoria, BC 2002  Self-reported injury details and outcomes  Training, competition profiles of athletes

5. Main Outcome Measures  Injury defined: training missed > 1week  Injury types, body parts, mechanisms, duration, resolution and #/diver  Training practices & techniques, training & competitions missed due to injuries  MD visits, imaging, treatment modalities used  All results reported here have significant p values <0.05

6. Demographics  64% response rate (44/69)  Mean age: 17.8 +/- 3.8 yrs  Average # hours training/week: 36 (min 13, max 66)  Average # years at Senior Nationals: 3.7 (min 1, max 12)  Med Hx: 5/42 asthma, 1 below elbow amputation  14/44 athletes participated in other sports, eg ballet, skiing

7. Results  44 divers, mean age 17.8 yrs, reported 93 injuries  Sprains, strains, fractures, tendonitis, tympanic membrane perforations most common  Lumbar spine, shoulder, wrist, hand, head  Divers with 3 or more injuries each: 34% (male, older, higher DD)  Chronic injuries > 6months duration: 39%  Unresolved injuries: 47%  Male-female differences Identified

8. Injury Diagnoses

9. Mechanisms of Injury

10. Overuse injuries:  Caused 24% of injuries  Shoulder, lumbar spine  tendinopathies, mechanical back pain, strains  64% reported by females Platform entry:  Caused 38% of injuries  sprains, strains, fractures, subluxations, tympanic membrane perforations  Wrist, lumbar spine, hand, shoulder, head  72% of injuries resolved in LESS than 6 months, p=0.017

11. Males vs. Females MALES: (41%) divers  52% of the 93 injuries  10/18 (56%) injured males had 3+ injuries each  Platform entry injuries: 69% are in males FEMALES: (59%) divers  48% of the 93 injuries  21/29 (72%) injured females had 2 or fewer injuries each  Overuse injuries: 64% in females, p=0.014

12. Injury Duration  Chronic injuries (6 months or longer): 39%, 36/93  Unresolved injuries: 47%, 44/93 19 provincial, 18 national, 12 international competitions affected by injuries (49/93 injuries)

13. Chronic Injuries  39% of all injuries reported  44% from overuse, 28% from platform entry, p=0.017  Tendonitis, sprains, fractures, strains, mechanical back pain, dislocations, spondy’s  Treatments: PT 75%, massage 53%, chiropractor 39%, acupuncture 33%, NSAIDs used in 87% (n=30)

14. Unresolved Injuries  47% of injuries unresolved  Wrist, lumbar spine, shoulder  Strains, tendinopathies, mech back, dislocations, spondy’s, disc injuries, stress fractures, patello- femoral pain  NSAIDs used in 94% of unresolved injuries treated with medication, p=0.015

15. Injury Duration vs. Number of Injuries Resolved

16. Injury Interventions

17. CONCLUSIONS 1. Unresolved Injuries  Almost ½ of all injuries reported by Canadian elite divers unresolved

18. 2. Chronic Injuries  40% of Canadian athletes’ injuries  Occur more commonly in FEMALES, due to OVERUSE  Treatments (physio, NSAIDs, massage) largely unsuccessful

19. 3. Divers with multiple injuries: Males Older Performing difficult dive lists Platform divers

20. RECOMMENDATIONS  Male platform divers must be monitored closely & their injuries treated early & followed aggressively  Female athletes may benefit from specific kinetic chain, core and eccentric strengthening to treat and prevent chronic, overuse injuries  Divers need to be educated on the proper use of NSAID’s

21. ACKNOWLEDGEMENTS  Dr. C.W. Reilly, Dept of Orthopedic Surgery, UBC; Dr. C. Loock Dept of Pediatrics, UBC, Vancouver, Canada - coauthors  Jonathan Berkowitz - statistical analysis  Dr. Benjamin Rubin (USA diving) - questionnaire format  CADA – support, coaches & administrators at 2002 Senior Nationals in Victoria, BC