Table 1

Epidemiological studies in water polo

ReferenceDesignParticipantsOutcomeKey findings
Annett et al23Retrospective cohort77 males from national team, mean 20 years old13-year retrospective chart analysis of documented injuriesIncidence of injuries 1.16/1000 hours;
24.1% shoulder, 15.5% face, 14.7% hand, 11.5% elbow;
73.4% acute, 26.6% overuse, 20.5% chronic (>6 weeks)
Black et al24Retrospective cohort28 males and 22 females from collegiate level3-year retrospective chart analysis of concussionsNo injuries recorded
Blumenfeld et al36Cross-sectional895 males and 602 females (and 22 undefined sex) from high school to master’s club levels, mean 30 years oldRetrospective survey of life-long concussion injuries36% overall lifetime prevalence with average 2.14±0.07 episodes;
30.8% males 2.2±0.12 episodes; 45.5% females 2.06±0.08 episodes; 47% goalies with 2.49±0.18 episodes;
Cunningham and Cunningham14Prospective cohort382 males and females from collegiate levelProspective injury surveillance during 1 weekPeriod prevalence 13.1%
De Castro-Maqueda and Amar-Cantos37Cross-sectional285 males and 202 females from club teams, mean 24±8 years oldRetrospective survey of injury over the last 10 years10-year prevalence 98.4% shoulder injury, 87% sunburn, 56% groin injury, 23.7% had fracture, 4.2% hypothermia, 2% no injury
Ellapen et al38Cross-sectional100 males of high school level, 15–17 years oldRetrospective survey of pain over the last
12 months		72% prevalence;
Incidence 2.49/1000 player×hours; shoulders 51%, vertebral column 18%, upper limb 6%, knee 24%, lower limb 1%
Elliott39Cross-sectional13 males from national team, mean 28 years old (no injury data for 12 controls)Retrospective survey of lifetime injuriesLifetime prevalence 85%;
62% shoulder, 50% hand and finger, 18% groin strain
Engebretsen et al7Prospective cohort156 males and 104 females from national teamsProspective injury surveillance during 17 daysPeriod prevalence 13.1% overall;
female prevalence 8.7%;
male prevalence 16%
Forrester25Retrospective cohort256 males and 158 females, 73.5% age 13–18 from high school and collegeRetrospective chart analysis of emergency department admissions 2000–2019Head and neck 53.6% of all injuries (56.9% male and 48.1% female), upper extremity 31.1% (29.7% male and 33.6% female), lower extremity 6.5% (6.1% male and 7.2% female);
laceration 19.4% (27.3% male and 6.6% female); strain or sprain 17.8% (14.1% male and 23.8% female); contusion or abrasion 17.6% (17.3% male and 18% female); fracture 13% (14% male and 11.3% female); internal organ 8.4% (4.8% male and 14.3% female but seems to cross-over with concussion); dislocation 5.5% (6.1% male and 4.6% female); concussion 4.8% (6.1% male and 4.6% female); others 13.4%
Galic et al40Cross-sectional59 males, mean 12.9±3.2 years oldRetrospective survey of lifetime injuriesOf all respondents, 28.8% had had orofacial injuries, 18.6% dental injuries, only 5.1% wear mouth guards
Goes et al41Cross-sectional36 males and 26 females, mean 23.4±5.1 years old and 11.5±6.1 years water polo experienceRetrospective survey of lifetime injuriesInjury counts joint injury 51, muscle injury 43 and tendinopathy 38; shoulders were 65.8% of tendinopathies, 46.5% of muscle injuries and 31.4% of joint injuries
Gradidge et al42Cross-sectional36 males from high school level, mean 17±1 years oldRetrospective survey of lifetime injuriesLifetime prevalence 55%;
period prevalence <1 month 13%; shoulders 25% previous versus 8.3% recent injuries; elbow 11% previous injuries; back 6% previous injuries
Hame et al26Retrospective cohort5900 multisport males and females from collegiate level15-year retrospective chart analysis of fracturesIncidence rate of fractures 0.04–0.05/athlete×year for males versus 0.01–0.02/athlete×year for females;
significant sex difference (p=0.03)
Hams et al27Retrospective and prospective cohorts90 males and 128 females from professional league, mean 20.6±3.7 and 19.3±2.9 years old respectivelyRetrospective chart review of self-report shoulder injuries in last 4 years AND 3-year prospective injury surveillanceIncidence 0.65/1000 athlete×exposure;
retrospective 4-year prevalence:
25% shoulder, 17% thoracic and lumbar spine, 15% hand/wrist/finger, 10% knee, 9.6% pelvis/hip, 9.2% elbow;
prospective 3-year prevalence:
16% shoulder, 10.5% lumbar, 10.5% hip/groin, 10.5% hand, 9% elbow, 8.3% knee
Hersberger et al43Cross-sectional355 males and 60 females from junior to national level, mean 30 years oldRetrospective survey of lifetime dental injuriesLifetime prevalence 103 arm and fingers, 72 lip injuries; 87 tooth injuries
Jerolimov and Jagger44Cross-sectional102 males from professional league, mean 22±4 years oldRetrospective survey of injuries during professional careerIncidence 0.57/player×year;
48% lips, 13% tongue, 9% cheek,
8% broken tooth
Junge et al9Prospective cohortMales and females from national teamsProspective injury surveillance during 1 monthPeriod prevalence 9.7%;
Incidence 23.8/1000 hours;
injury types fracture and dislocation
Junge et al8Prospective cohort259 males and females from national teamsProspective injury surveillance during 1 monthIncidence 21/1000 player×matches (95% CI, 11 to 31);
56% head, 28% upper extremity, 11% trunk, 6% lower extremity
Kim and Park28Prospective cohort73 males from national team programme, mean 24.4±3.4 years oldProspective injury surveillance during 8 yearsInjury rates 2.06/1000 hours (95% CI 1.77 to 2.34);
proportion of injuries to the shoulder (25.2%), lumbosacral (14.4%), elbow (10.9%) and neck (8.9%) most common;
injury types proportion were joint sprain (31.2%), muscle injury (28.3%) and tendinopathy (14.4%) most common
MacIntosh et al29Retrospective cohortMales from collegiate level17-year retrospective chart analysisProportion 11.9% of all injuries from 25 sports;
incidence=7/1000 player×years for recreational versus 141/1000 player×years competitive
McLain and Reynolds30Prospective cohort36 males and 16 females from high school levelProspective injury surveillance during 1 yearPeriod prevalence boys 5.6% versus girls 0%;
incidence 6.34/1000 hours
Mountjoy et al10Prospective cohort235 males and 226 females from national teamsProspective injury surveillance during 14 daysIncidence 89.4/1000 male players and 101.82/1000 female players;
9 head and face, 8 arm/elbow, 6 shoulder, 6 wrist/hand, etc
Mountjoy et al11Retrospective cross-sectional and prospective cohort208 males and 208 females from national teams, mean 25±5 years4-week retrospective survey and prospective injury surveillance during 14 days1-month prevalence 41.9% (36.6% male and 46.6% female); counts during event 65 injuries (33 males and 32 females); incidence 1.1/100 athlete×days
Mountjoy et al31Retrospective cohort1456 males and 1248 females from national teamsRepeated prospective injury surveillancePeriod prevalence 14.1%
Incidence 56.2±6.7/1000 hours; 25.6% head, 16.1% hand, 12.7% trunk, 11.3% shoulder
Prien et al12Retrospective cross-sectional and prospective cohort415 males and females from national teams, mean 22±5 years old4-week retrospective survey and prospective injury surveillance during 14 days1-month prevalence 19.9%; prevalence during event 23.1%
Rugg et al32Retrospective cohort40 males and 41 females from collegiate level7-year retrospective database analysis of upper extremity injuriesPeriod prevalence 35% upper extremity injuries for males versus 39% for female players; males 22.5% shoulder, 2.5% elbow and 10% wrist and hand; females 19.4% shoulder, 9.8% elbow and 9.8% wrist and hand
Sallis et al33Retrospective cohortMales and females from collegiate level, age 18–22 years old9-year retrospective database analysisIncidence 18.38/100 player×years (females) versus 7.10/100 player×years (males);
incidence/100 player×years by area: shoulders 8.09 (female) versus 3.4 (male), knee 2.94 (female) versus 0.93 (male)
Soligard et al13Prospective cohort154 males and 104 females from national teamsProspective injury surveillance during 17 daysPeriod prevalence 19%
Toohey et al34Prospective cohort6 males and 36 females from national team, mean male 19.9±3.4 and 20.8±4.1, respectivelyProspective injury surveillance over 8 monthsInjury counts 74 ;
23% shoulder, 16.2% elbow, 13.5% lumbar;
21.6% impingement, 18.2% sprain, 16.2% strain
Youn et al35Retrospective cohortMales and females from collegiate level, age 18–22 years oldRetrospective chart analysis of ocular injuriesIncidence 0.45/1000 male player×matches versus 0/1000 female player×matches
Zamora-Olave et al45Cross-sectional224 males and 123 females from club teams, 10 years old to seniorRetrospective survey of orofacial injuries over the last 12 monthsPeriod prevalence 57.9%