Shoulders bear brunt of water polo's demands

2004 08 11 16 11 37 706

Water polo is for the athlete not satisfied with mere sport. There may be no crying in baseball, but there’s no stopping in water polo. A match is 28 minutes of constant motion that is torture on players’ shoulders.

"There’s probably no sport with a higher risk of shoulder injuries," said Dr. Robert Sallis, director of the sports medicine fellowship at the Kaiser Permanente Medical Center in Fontana, CA. "The athletes with the most risk for shoulder problems are throwers and swimmers. In water polo, you’re combining both with one sport."

It could be worse. According to the USA Water Polo Web site, early games were generally "exhibitions of brute strength and aquatic wrestling." Passing and dribbling were not in vogue; playing "hide the ball" was a popular scoring trick. But that was in the 1870s. Water polo became an Olympic sport in 1900 and modernized in due time.

Although the U.S. is thought to be the second country, after England, to play the sport, it’s far from an American pastime. Dr. Larry Drum, physician to the U.S. Olympic teams in Athens, says that’s why there’s not very much written in the U.S. about the game.

"It’s one of those left-out sports," Drum said in an interview with "There’s not a whole lot of literature on water polo, but it parallels the swimming literature. What’s been learned over the past couple of decades is that cutting down yardage (in training) will cut down on overuse injury. You don’t usually see acute shoulder injuries."

One study, co-authored by Sallis, concluded that conservative training was the best way to prevent shoulder injuries. Comparing injuries in men and women across several sports, including swimming and water polo, the study determined that the sole example of disparate injury rates was attributable to overaggressive coaching (Scandinavian Journal of Medicine and Science in Sports, June 2001, Vol. 11:3, pp. 149-155).

But water polo players can’t use the smooth, efficient strokes of swimmers.

"The stroke that water polo players use is harmful to the shoulder," Drum said. "Swimming with your head down, with a pinkie-first entry, favors the shoulder capsule. Swimming with your head up, with a short, choppy stroke, can injure the shoulder. If you have a shoulder problem, it’s not just from shooting. It could be because of the stroke."

For that reason, out-of-the-pool training -- known as dry-land techniques -- is as vital as pool work in protecting the shoulder. Water polo players spend a lot of time working with stretch cords and maintaining a careful weight-training balance in the front and back of the shoulder capsule. It’s essential that the rhomboid and trapezius muscles be as well developed as the biceps and triceps.

Overtraining is exacerbated when athletes don't heed the early warning signs of trouble. When they don't, a case of tendinitis can progress to impingement syndrome, a condition in which the rotator cuff is pinched between the humeral head and the under surface of the acromion. Untreated, the rotator cuff will eventually tear.

The signs of impingement syndrome are generally so tell-tale that a simple physical exam is often enough for a diagnosis, but imaging can help clarify and confirm shoulder problems. Radiographs may reveal bone spurs that can lead to pinching of the tendon in the subacromial space, and later result in a rotator cuff tear.

MRI exams can confirm tears and help determine treatment, typically involving physical therapy with strengthening regimens. Injuries that fail to respond may be treated with cortisone injections to calm inflammation. Surgical treatment is the last resort.

Ultimately, the best treatment begins only when the tough water polo athletes admit they’re in pain. "If you can’t raise your arm above your head to comb your hair and you ignore it," Sallis said, "you put yourself at risk."

By Matt King contributing writer
August 20, 2004

Related Reading

Ultrasound of muscles adds vital information on rotator cuff condition, August 16, 2004

MRI shoulders burden of skiers' rotator cuff tears, February 23, 2002

Intervention can help or harm in athletic injuries, February 17, 2002

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