The Importance of Illness Surveillance in Competitive Swimming
Injury prevention has been at the forefront of best practice for practitioners working in competitive sports for many years. Illness surveillance has not been commonplace, however. The impact of an injury can have wide-reaching implications for developing or elite athletes alike. From a performance perspective, lower injury incidence, lower injury burden, and higher match availability were associated with increased points per league match & a higher final league ranking over 11 soccer seasons (Hägglund et al. 2013). In rugby, clear negative associations were found between injury measures and team success over 7 seasons (Williams et al. 2016). Meanwhile, in athletics, the likelihood of achieving a performance goal increased by 7 times in those who completed greater than 80% of planned training weeks (across 5 seasons) (Raysmith and Drew 2016).
Injury Surveillance in Swimming
Similar research has not been conducted in the sport of swimming, however, research focusing on the prevention of injury is plentiful. The most recent review of the epidemiology of swimming injuries, highlighted the main location of injuries in swimmers are shoulder, back, and knee with muscle overuse and tendon injuries being the most common.
The majority of swimming-related injuries are non-time loss (Powell and Dompier 2004) and may have a gradual onset (repetitive) (Trinidad et al., 2021). This often leads to swimmers training and competing with symptoms of injury, as outlined by Mountjoy et al., (2015), who reported that 70% of athletes attending the 15th FINA World Championships had symptoms of injury in the weeks preceding and during the competition. Despite these swimmers being compromised, they participated in training and competition but stated their performance was affected (Mountjoy et al., 2015).
Despite this injury profile, the fact that swimming is a full-body sport allows for simple and specific modifications to be made. This allows the swimmer’s training programmes to be adapted, meaning a consistent training stimulus can be maintained despite the injury. In the event of non-time loss injury, many adaptations in the form of reduced training load, alteration of swimming biomechanics, and the use of kickboards or pull buoys can be introduced. The ability to manage a high proportion of injuries, while maintaining a full training program highlights how adept practitioners are in this arena.
Illness Surveillance in Swimming
More recently, a new challenge was faced by practitioners. The global landscape in sports health and well-being turned its focus to illness as COVID-19 and its rampant subsidiaries took hold. It didn’t take long to understand that while we had been focusing on the prevention and management of injuries we had neglected illness surveillance. Research has shown that the illness profile of a competitive swimmer is significantly less well-established than its injury profile.
A systematic review investigating the relationship between training load and pain, injury, and illness returned only one publication of a total of fifteen was centered on illness (Barry et al. 2021). This study showed that significant immune deficiencies are not commonplace in competitive swimmers (Hellard et al., 2015). However, minor deteriorations in health related to intensive periods of training can lead to minor illnesses such as upper respiratory tract infections (URTI) (Hellard et al., 2015). It has been found that URTI is not more common in swimmers than in the general population, but the infection has a greater impact on training and symptoms can be exacerbated by chlorine inhalation (Johnson 2003).
As part of my PhD research, we identified the need to include illness surveillance to tackle this deficiency in knowledge. This decision was vindicated after 104 weeks of injury and illness surveillance highlighted that illness (60 medical attention events) occurred more frequently than injury (58 medical attention events) in an Irish competitive swimming population.
A total of 84.4% of the participants registered at least one medical attention illness event during the data collection period. This is in comparison to 78.1% of the population who registered a medical attention injury. The majority (93.3%) of medical attention illnesses were categorised as time loss, which was far greater than injury (36.2%).
Illnesses were categorised as mild (53.6%) or moderate (46.4%), however, the majority of injuries were deemed to be mild (95.2%). Communicable medical attention illnesses were most prevalent (76.7%), while respiratory infections were the most common (70%) type of illness recorded. COVID-19 was the most common diagnosis (36.7%) with upper respiratory tract infection being the second most common (21.7%).
It is important to acknowledge the context of this data collection. The data collection took place from September 2020 to 2022, which was throughout the COVID-19 pandemic. During season one, a severe level of restrictions was in place enforcing significant athlete isolation from the general population and normal daily activities. These restrictions were largely removed in season two and a large portion of the athlete population returned to unrestricted activities.
A total of 122 illnesses (all categories) were recorded throughout the observation period; however, only 26.2% of them occurred in season one. The remainder occurred during season two showing an imbalance in the distribution. The government restrictions in season one followed by the easing of restrictions in season two potentially created an initial decrease and then a subsequent increase in illness in this population.
The higher incidence of time loss illness might also be related to government restrictions dictating athlete removal and a set isolation period at the earliest signs of illness and/or medical guidelines highlighting the need for a minimum graded return to play period after COVID-19 infection (Elliott et al., 2020). These findings add weight to the need for adequate illness surveillance and robust investigation into the risk factors associated with it.
The importance of consistent and longitudinal injury and illness surveillance practices is highlighted by the findings of this research. This data collection only occurred over two seasons and while critical data was obtained it is not possible to compare it to a “typical” training season. Consistent and longitudinal injury and illness surveillance would allow for improved comparison between seasons and show the true nature of the impact of injury and illness on this population. Practitioners working in elite sports need to consider the impact of injuries and illness on their respective programmes and incorporating illness surveillance will be the first step in tackling these issues.
- Barry, L., Lyons, M., McCreesh, K., Powell, C., and Comyns, T. (2021) ‘The relationship between training load and pain, injury and illness in competitive swimming: a systematic review’, Physical Therapy in Sport, 48, 154–168, available: https://doi.org/10.1016/j.ptsp.2021.01.002.
- Elliott, N., Martin, R., Heron, N., Elliott, J., Grimstead, D., and Biswas, A. (2020) ‘Graduated return to play guidance following COVID-19 infection’, British Journal of Sports Medicine, 54(19), 1174–1175, available: https://doi.org/10.1136/bjsports-2020-102637.
- Hägglund, M., Waldén, M., Magnusson, H., Kristenson, K., Bengtsson, H., and Ekstrand, J. (2013) ‘Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study’, British Journal of Sports Medicine, 47(12), 738–742, available: https://doi.org/10.1136/bjsports-2013-092215.
- Hellard, P., Avalos, M., Guimaraes, F., Toussaint, J.-F., and Pyne, D.B. (2015) ‘Training-related risk of common illnesses in elite swimmers over a 4-yr period’, Medicine & Science in Sports and Exercise, 47(4), 698–707, available: https://doi.org/10.1249/MSS.0000000000000461.
- Johnson, J.N. (2003) ‘Competitive swimming illness and injury: common conditions limiting participation’, Current Sports Medicine Reports, 2(5), 267–271, available: https://doi.org/10.1249/00149619-200310000-00007.
- Mountjoy, M., Junge, A., Benjamen, S., Boyd, K., Diop, M., Gerrard, D., van den Hoogenband, C.-R., Marks, S., Martinez-Ruiz, E., Miller, J., Nanousis, K., Shahpar, F.M., Veloso, J., van Mechelen, W., and Verhagen, E. (2015) ‘Competing with injuries: injuries prior to and during the 15th FINA World Championships 2013 (aquatics)’, British Journal of Sports Medicine, 49(1), 37–43, available: https://doi.org/10.1136/bjsports-2014-093991.
- Powell, J.W. and Dompier, T.P. (2004) ‘Analysis of injury rates and treatment patterns for time-loss and non-time-loss injuries among collegiate student-athletes’, Journal of Athletic Training, 39(1), 56–70.
- Raysmith, B.P. and Drew, M.K. (2016) ‘Performance success or failure is influenced by weeks lost to injury and illness in elite Australian track and field athletes: a 5-year prospective study’, Journal of Science and Medicine in Sport, 19(10), 778–783, available: https://doi.org/10.1016/j.jsams.2015.12.515.
- Trinidad, A., González‐Garcia, H., and López‐Valenciano, A. (2021) ‘An updated review of the epidemiology of swimming injuries’, Journal of Injury, Function and Rehabilitation, 13(9), 1005–1020, available: https://doi.org/10.1002/pmrj.12503. Williams, S., Trewartha, G., Kemp, S.P.T., Brooks, J.H.M., Fuller, C.W., Taylor, A.E., Cross, M.J., and Stokes, K.A. (2016) ‘Time loss injuries compromise team success in Elite Rugby Union: a 7-year prospective study’, British Journal of Sports Medicine, 50(11), 651–656, available: https://doi.org/10.1136/bjsports-2015-094798.
About the author
Lorna Barry is a UKSCA accredited strength and conditioning coach (S&C) working with Swim Ireland while managing her role as a Ph.D. researcher in the Department of Physical Education and Sport Sciences at the University of Limerick. Lorna is also an S&C in the Limerick region for the IRFU high-performance referees and Women’s 15’s national squad. Previously, Lorna has worked as an S&C for several years, spending two seasons working with Rugby Canadas Men’s 15’s and 7’s programmes where she was S&C on their Sevens World Cup campaign in 2013 and the Commonwealth Games in 2014. More recently Lorna held a rehabilitation role with the Sports Surgery Clinic musculoskeletal team and was lead S&C with Munster Rugby’s Senior squad. Lorna has a Master of Science (MSc.) in Sports Performance (University of Limerick, 2012) and a BSc. in Sport and Exercise Sciences (University of Limerick, 2005-2009).
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