Intrinsic Risk Factors for Noncontact Musculoskeletal Injury in Collegiate Swimmers: A Prospective Cohort Study

Abstract

Context: Shoulder pain is pervasive in swimmers of all ages. However, given the limited number of prospective studies, injury risk factors in swimmers remain uncertain. Objective: To determine the extent to which the risk factors of previous injury, poor movement competency, erroneous freestyle swimming technique, and low perceived susceptibility to sport injury were associated with noncontact musculoskeletal injury in collegiate swimmers. Design: Prospective cohort study. Setting: College natatorium. Patients or Other Participants: Thirty-seven National College Athletic Association Division III swimmers (21 females, 16 males; median age = 19 years [interquartile range = 3 years], height = 175 ± 10 cm; mass = 70.0 ± 10.9 kg). Main Outcome Measure(s): Participants completed preseason questionnaires on their previous injuries and perceived susceptibility to sport injury. At the beginning of the season, they completed the Movement System Screening Tool and the Freestyle Swimming Technique Assessment. Logistic regression was used to calculate odds ratios (ORs) with 95% CIs for the association between each risk factor and injury. Results: Eleven of the 37 participants (29.7%) sustained an injury. Univariate analyses identified 2 risk factors: previous injury (OR = 8.89 [95% CI = 1.78, 44.48]) and crossover hand positions during the freestyle entry phase (OR = 8.50 [95% CI = 1.50, 48.05]). After adjusting for previous injury, we found that a higher perceived percentage chance of injury (1 item from the Perceived Susceptibility to Sport Injury) decreased the injury odds (adjusted OR = 0.11 [95% CI = 0.02, 0.82]). Poor movement competency was not associated with injury (P > .05). Conclusions: Previous injury, a crossover hand-entry position in freestyle, and a low perceived percentage chance of injury were associated with increased injury odds. Ascertaining injury histories and assessing for crossover positions may help identify swimmers with an elevated injury risk and inform injury-prevention strategies.