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water polo injuries

Water Polo is a sport that many don’t really think about until the Olympics are on. For some, however, it’s an intense way of life. Water polo is a hard-hitting sport riddled with injuries, blood, and loads of excitement.

Similar to hockey, once you catch the water polo bug, you can’t shake it. Don’t believe me? Go watch a Masters Water Polo match, they love every minute of it and you have to kick them out of the pool just to get them to leave! If you are a high school, college, or Masters water polo player, here are the most common water polo injuries and how to prevent, care for, and recover from them.

Water Polo and the Body

Water polo is like rugby for the pool. Its players experience more than rugby-type injuries, but swimming injuries and throwing injuries too. Water polo injuries are caused by the sudden bursts of activity that the sport demands in just seconds.

To better understand the injuries, let’s first take a look at how a water polo game is played. Teams play water polo in deep pools. Players keep themselves afloat by treading water for the four quarters that make up the game. In a water polo game, swimmers are treading, throwing, catching, and swimming to get their ball into the goal.

Swimmers tread water while waiting to receive the ball. This requires a great deal of stamina and energy to stay afloat. The feet cannot touch the bottom of the pool. Players cannot use the bottom of the pool as an advantage, and if they are caught doing so, can be pulled or ejected. Players pass the ball among each other, trying to shoot the ball into their goal.

The  most strenuous actions in water polo are both throwing and catching. The sudden bursts of energy combined with the force to throw the ball across the pool – with one arm – cause severe trauma to the swimmer’s shoulders. Trauma can be impingement, tears, instability, and pain – Swimmer’s Shoulder.

Additional areas of concern for water polo swimmers are facial and head injuries, dental, arm, leg and back injuries, too.

Signs and Symptoms of Water Polo Injuries

Water polo is a contact sport, so some signs and symptoms are obvious. That is not true for other injuries that can’t be seen. Signs and symptoms of water polo injuries are:

  • Inflammation and pain
  • Tears and lacerations in the skin
  • Swelling and bruising in a specific area
  • Pain when performing an action or stroke
  • Instability in the joints
  • Pain that is not relieved with rest, ice, elevation, and compression
  • Limited flexibility and range of motion
  • Pain that goes away after leaving the pool

Shoulder Injury is the Most Common of Water Polo Injuries

When you consider the position of the body and the shoulder demands, it is no surprise that shoulder injuries are the most common water polo injuries among athletes. To understand why, take a look at the phases of throwing in water polo:

  1. Wind-up
  2. Early and late cocking
  3. Acceleration and deceleration


While the water polo player prepares to throw, they stabilize the body with one arm in the water. In the wind-up phase, the athlete extends the shoulder back. The shoulder is externally rotated and abducted, with the elbow positioned at a 45-degree angle. In this phase the muscles are mostly inactive, but they are extended and rotated.

The musculoskeleton of the head and neck
The musculoskeleton of the head and neck

Early and Late Cocking

Early cocking is when the water polo athlete prepares to throw the ball by attempting to stabilize. In the pool, as I said before, they don’t have the ground to do so. They also have to do it quickly and with little regard to form. The muscles are at peak activation, with most of the activity coming from the deltoid.

The late cocking phase involves more muscle activity. The primary muscles used in this phase are the infraspinatus, teres minor, and the supraspinatus. This phase is the peak muscle activity phase, and it is the phase of maximum shoulder rotation and torque.

Acceleration and Deceleration

This is the phase where the power and force are required to pass the ball or to make a goal. All the force comes from the upper body. The shoulder reaches a 90-degree abduction when the ball leaves the hand. In the beginning of acceleration, the triceps are activated. In the latter phase of acceleration, dominate muscle activity involves latissimus dorsi, pectoralis major, and serratus anterior.

In the deceleration, or follow-through, phase, the shoulder experiences maximum internal rotation and eccentric contraction of the muscles. This is to slow down and stop the arm. At the same time, the arm continues to experience maximum torque before and when the arm crashes into the water. The extensive muscle demand in this final phase makes the deceleration phase on the most injurious.

Common Water Polo Shoulder Injuries

Combine the number of muscles used, pressure of the water, sheer and explosive force, position manipulation, and lack of stability, and it’s not hard to see why shoulder injuries are the most common water polo injuries. Take a look at the most common shoulder water polo injuries, and in which phases they are most likely to occur.

Swimmer’s Shoulder

Swimmer’s Shoulder is an epidemic among swimmers. Swimmer’s Shoulder is caused by overuse. All of the concerns with throwing, swimming, and contact in water polo are risk factors for swimmer’s shoulder.

Read more: 18 Common Risk Factors for Swimmer’s Shoulder Pain and Injury

Internal and external shoulder impingement

Shoulder impingement is likely to occur on the bursal side of the rotator cuff, or on the articular side of the rotator cuff. The bursal side, often called the subacromial, is the most common.

Glenohumeral internal rotation defect (GIRD)

It is not a digestive issue, but a serious injury that can occur in the cocking phase of throwing. GIRD affects the glenohumeral joint, causing an alteration of the humeral head. GIRD often presents itself with excessive external rotation, decreased internal rotation, decreased throwing performance, and shoulder pain.

SLAP lesions

In many cases, athletes with GIRD often have SLAP lesions. SLAP lesions and injuries affect the labrum of the shoulder. The labrum is the cartilage in the shoulder joint socket. The labrum is located between the humerus, clavicle, and the scapula. SLAP injuries often occur in the cocking and acceleration phase.

Dislocated shoulder

Dislocated shoulder is often confused with a separated shoulder. Dislocated shoulder occurs when the bone in the top of the shoulder pop out of socket. In some cases, the injury can damage nerves and joints, which perpetuates chronic weakness, future injury, and instability.   Dislocations are often caused by direct blows and falls.

Thrower’s Elbow

Thrower’s elbow doesn’t only affect baseball and football players. In fact, water polo players suffer the same fate because of the position, pitch, and speed at which they throw the water polo ball. Thrower’s elbow injuries can cause severe stress on the shoulder because it forces the arm to overcompensate or to adjust its position to avoid pain in the elbow.

Rotator cuff tears and Rotator Cuff Syndrome

Rotator cuff injuries can be as minor as inflammation or as severe as tears, to something more severe as impingement and tears. While most rotator cuff injuries can be remedied with physical therapy exercises for the rotator cuff, some injuries may require surgery.

Mayo Clinic
Mayo Clinic

Additional Water Polo Injuries

We know that the shoulder takes the brunt of the pain and suffers the most injuries, but other areas of the body experience pain, too. Water polo is an all-body sport, which means more areas are prone to pain. Other common areas of the body that experience injuries are the face, back and spine, and the lower extremities. Here is a list of more water polo injuries.

Facial and head injuries

Water polo players face rubber balls hurling in their direction at speeds up to 30 to 35 mph. They also dodge flying elbows and hands. As a result, players can experience a number of facial and head injuries.

  • Black eyes
  • Broken bones
  • Lacerations
  • Concussions
  • Eye injury and hemorrhage
  • Ear drum ruptures

While not associated with a blow to the head, swimmer’s ear is just as concerning.

Neck, back, and spine injuries

The neck, back, and spine suffer from injury because of many factors, such as hyper-extension, blunt force, and acceleration to name a few. Injuries on the list include:

  • Lower back pain
  • Neck pain
  • Disc and vertebrae injuries
  • Nerve compression
  • Bulging discs and degenerative discs
  • Side strain

To avoid and remedy spine, neck and back problems, a water polo player’s best defense is physical therapy. In severe cases, swimmers may be removed from the pool or have to undergo surgery; however, after surgery, a water polo player requires extensive physical therapy to return back to the pool and to avoid further injury or future injury.

Injuries to the upper and lower extremities

I addressed shoulder and elbow injuries, but the extremities face other injury as well. Common water polo injuries to the extremities include:

  • Sprained or broken wrist and fingers
  • Knee injuries
    • Menisiscus tears
    • MCL strains and tears
  • Tendonitis and tendinopathy
  • Adductor tears and pain (injury and pain to the groin)
  • Osteitis pubis
  • Ankle impingement
  • Thigh strain
  • Muscle cramps and cork thigh

Conclusion: Advice from Dr. John

Water polo injuries are more severe than you may have initially thought. That is why it is critical for athletes, coaches, parents, and other players to identify the signs of injury. In water polo, oftentimes it is up to the others to point out an injury, especially if the athlete doesn’t notice him/herself.

Attention to water polo injuries requires strengthening, lengthening, stability, self-myofascial release techniques, mobility, and biomechanical analyses for safe, elite performance. All of these are offered only by elite physical therapist and elite personal training. The only defense against and treatment for to prevent water polo injuries are with skilled care and attention from a professional, such as a physical therapist.

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