Subscribe to RSS
DOI: 10.1055/s-0045-1808279
Aquatic Sports Injuries: Biomechanics, Injury Patterns, and Imaging in Swimming, Water Polo, and Diving

Abstract
Aquatic sports, such as swimming, water polo, diving, and artistic swimming, combine endurance, strength, and flexibility with unique biomechanical demands, often leading to sport-specific injuries. Although water is a low-impact environment, the repetitive and high-intensity movements required in these disciplines increase the risk of both acute and overuse injuries. Swimmers frequently encounter shoulder overuse syndromes, water polo players face injuries from throwing and physical contact, and divers are at risk for spinal and wrist injuries during entry impacts. Imaging modalities, particularly magnetic resonance imaging, play a vital role in diagnosing and managing these conditions by providing detailed insights into soft tissue and bone pathologies. Radiographs, ultrasound, and computed tomography also complement the evaluation of specific injuries. This review explores the biomechanics of aquatic sports, the common patterns of injury, and the application of imaging in diagnosis and management for optimal recovery and performance.
Publication History
Article published online:
16 July 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 FINA Communication Department - 2019 FINA General Survey. FINA Magazine. June 2019. Available at: https://www.wpdworld.com/wp-content/uploads/2019/12/fina-survey-ricerca-2019-PARTE-I.pdf . Accessed April 28, 2025
- 2 Pollard H, Fernandez M. Spinal musculoskeletal injuries associated with swimming: a discussion of technique. Australas Chiropr Osteopathy 2004; 12 (02) 72-80
- 3 Wanivenhaus F, Fox AJ, Chaudhury S, Rodeo SA. Epidemiology of injuries and prevention strategies in competitive swimmers. Sports Health 2012; 4 (03) 246-251
- 4 Bom HH, Jeong YH, Cho S. Injuries and illness during the 2019 Gwangju FINA and Masters World Championships in elite and amateur athletes. Chonnam Med J 2023; 59 (01) 83-86
- 5 Minelli M, Longo UG, Ranieri R. et al. The epidemiology of shoulder injuries in water polo players: a monocentric descriptive study on clinical and radiological presentation. J Clin Med 2024; 13 (07) 1951
- 6 Franić M, Ivković A, Rudić R. Injuries in water polo. Croat Med J 2007; 48 (03) 281-288
- 7 Feuerriegel GC, Kronthaler S, Weiss K. et al. Assessment of glenoid bone loss and other osseous shoulder pathologies comparing MR-based CT-like images with conventional CT. Eur Radiol 2023; 33 (12) 8617-8626
- 8 Olympics. Sports. 2024. Available at: https://olympics.com/en/sports/ . Accessed December 8, 2024
- 9 Borges-Hernández PJ, Argudo FM, García-Marín P, Ruiz-Lara E. Origin, evolution and influence on the game of water polo rules. Cultura, Ciencia y Deporte 2022;17(51):
- 10 De Martino I, Rodeo SA. The swimmer's shoulder: multi-directional instability. Curr Rev Musculoskelet Med 2018; 11 (02) 167-171
- 11 Toussaint HM, Hollander AP, van den Berg C, Vorontsov AR. Biomechanics of swimming. In: Garrett WE, Kirkendall DT. eds Exercise and sport science. Philadelphia, PA: Lippincott Williams & Wilkins; 2000: 639-660
- 12 Boltz AJ, Robison HJ, Morris SN, D'Alonzo BA, Collins CL, Chandran A. Epidemiology of injuries in National Collegiate Athletic Association men's swimming and diving: 2014–2015 through 2018–2019. J Athl Train 2021; 56 (07) 719-726
- 13 Matsuura Y, Matsunaga N, Akuzawa H, Oshikawa T, Kaneoka K. Comparison of muscle coordination during front crawl and backstroke with and without swimmer's shoulder pain. Sports Health 2024; 16 (01) 89-96
- 14 Tavares N, Dias G, Carvalho P, Vilas-Boas JP, Castro MA. Effectiveness of therapeutic exercise in musculoskeletal risk factors related to swimmer's shoulder. Eur J Investig Health Psychol Educ 2022; 12 (06) 601-615
- 15 Ejnismann B, Lopes AD. Aquatic sports. In: Cohen M, Abdalla RJ. eds. Sports injuries: diagnosis, prevention, and treatment [in Portuguese]. Rio de Janeiro: Revinter; 2003. ;60: 819-828
- 16 Kennedy JC, Hawkins R, Krissoff WB. Orthopaedic manifestations of swimming. Am J Sports Med 1978; 6 (06) 309-322
- 17 Rovere GD, Nichols AW. Frequency, associated factors, and treatment of breaststroker's knee in competitive swimmers. Am J Sports Med 1985; 13 (02) 99-104
- 18 Cheng KY, Chambers H, Dwek JR. Magnetic resonance imaging appearance of breaststroker's knee. Pediatr Radiol 2022; 52 (13) 2645-2647
- 19 Soder RB, Mizerkowski MD, Petkowicz R, Baldisserotto M. MRI of the knee in asymptomatic adolescent swimmers: a controlled study. Br J Sports Med 2012; 46 (04) 268-272
- 20 Frank RM, Ukwuani G, Chahla J, Batko B, Bush-Joseph CA, Nho SJ. High rate of return to swimming after hip arthroscopy for femoroacetabular impingement. Arthroscopy 2018; 34 (05) 1471-1477
- 21 Bampouras TM, Wilson AJ, Papadopoulos K. Upper limb muscle strength and knee frontal plane projection angle asymmetries in female water-polo players. Sports Biomech 2024; 23 (10) 1398-1409
- 22 Panero E, Agostini VLG. Biomechanical assessment of throwing gesture and performance in female water-polo players. Appl Sci (Basel) 2022; 12 (15) 7856
- 23 Kawai E, Tsunokawa T, Sakaue H, Takagi H. Propulsive forces on water polo players' feet from eggbeater kicking estimated by pressure distribution analysis. Sports Biomech 2023; 22 (10) 1319-1333
- 24 Smith HK. Applied physiology of water polo. Sports Med 1998; 26 (05) 317-334
- 25 Schroeder GG, McClintick DJ, Trikha R, Kremen Jr TJ. Injuries affecting intercollegiate water polo athletes: a descriptive epidemiologic study. Orthop J Sports Med 2022; 10 (07) 23 259671221110208
- 26 Miller AH, Evans K, Adams R, Waddington G, Witchalls J. Shoulder injury in water polo: a systematic review of incidence and intrinsic risk factors. J Sci Med Sport 2018; 21 (04) 368-377
- 27 Bucknor MD, Stevens KJ, Steinbach LS. Elbow imaging in sport: sports imaging series. Radiology 2016; 280 (01) 328
- 28 Karantanas AH. Imaging of water sports injuries. In: Guermazi A, Roemer F, Crema M. eds Imaging in sports-specific musculoskeletal injuries. Cham: Springer; 2016. . p. 403-448 . https://doi.org/10.1007/978-3-319-14307-1_16
- 29 Avery III DM, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res 2016; 11 (01) 99
- 30 Currie BM, Drew MK, Hetherington M, Waddington G, Brown NAT, Toohey LA. Diving into the health problems of competitive divers: a systematic review of injuries and illnesses in pre-elite and elite diving athletes. Sports Health. 2024. Available at: https://journals.sagepub.com/doi/10.1177/19417381241255329 . Accessed April 11, 2025
- 31 Miller DI. Springboard and platform diving. In: Zatsiorsky VM. ed. Biomechanics in Sport: Performance Enhancement and Injury Prevention. Hoboken, NJ: John Wiley & Sons; 2000: 326-348
- 32 Demestre L, Grange S, Dubois C. et al. Characterization of the dynamic behavior of a diving board using motion capture data. Sports Eng 2022
- 33 Sinclair P, Walker C, Rickards T. Kinematic determinants of dive height in springboard diving. MSS-SM 2012; 75: 107-112
- 34 Jones NS. Competitive diving principles and injuries. Curr Sports Med Rep 2017; 16 (05) 351-356
- 35 Korres DS, Benetos IS, Themistocleous GS, Mavrogenis AF, Nikolakakos L, Liantis PT. Diving injuries of the cervical spine in amateur divers. Spine J 2006; 6 (01) 44-49
- 36 Aito S, D'Andrea M, Werhagen L. Spinal cord injuries due to diving accidents. Spinal Cord 2005; 43 (02) 109-116
- 37 Badman BL, Rechtine GR. Spinal injury considerations in the competitive diver: a case report and review of the literature. Spine J 2004; 4 (05) 584-590
- 38 Baranto A, Hellström M, Nyman R, Lundin O, Swärd L. Back pain and degenerative abnormalities in the spine of young elite divers: a 5-year follow-up magnetic resonance imaging study. Knee Surg Sports Traumatol Arthrosc 2006; 14 (09) 907-914
- 39 Haase SC. Management of upper extremity injury in divers. Hand Clin 2017; 33 (01) 73-80
- 40 Berkoff D, Boggess B. Carpal contusions in an elite platform diver. BMJ Case Rep 2011; 2011: bcr0120113691
- 41 Rietberg NT, Brown MS, Haase SC. Pisotriquetral pain treated with bilateral pisiform excision in a collegiate diver. J Wrist Surg 2018; 7 (05) 415-418
- 42 Rubin BD. The basics of competitive diving and its injuries. Clin Sports Med 1999; 18 (02) 293-303