SHOULDER INJURIES IN HONG KONG
INTER-SCHOOL SWIMMING CHAMPIONS
(HONG KONG ISLAND AND KOWLOON)
DIVISION I SCHOOLS' STUDENTS
BY
LI KI YAN
10002731
AN HONOURS PROJECT SUBMITTED IN PARTIAL FUFILMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
BACHELOR OF ARTS
IN
PHYSICAL EDUCATION AND RECREATION MANAGEMENT (HONOURS)
HONG KONG BAPTIST UNIVERSITY
APRIL 2012
2
HONG KONG BAPTIST UNIVERSITY
30TH ARPIL, 2012
We hereby recommend that the Honours Project by Miss LI
KI YAN entitled “SHOULDER INJURIES IN HONG KONG INTERSCHOOL SWIMMING CHAMPIONS (HONG KONG ISLAND AND KOWLOON)
DIVISION I SCHOOLS' STUDENTS” be accepted in partial
fulfillment of the requirements for the Bachelor of Arts
Honours Degree in Physical Education and Recreation
Management.
_______________________
_______________________
Dr. LOBO LOUIE
DR. TOM TONG
Chief Adviser
Second Reader
3
DECLARATION
I hereby declare that this honours project ”SHOULDER
INJURIES IN HONG KONG INTER-SCHOOL SWIMMING CHAMPIONS (HONG
KONG
ISLAND
represents
submitted
AND
my
to
KOWLOON)
own
this
work
or
DIVISION
I
and
not
other
had
SCHOOLS'
institution
been
for
STUDENTS”
previously
a
degree,
diploma or other qualification. Citations from the other
authors were listed in the references.
____________________
Li Ki Yan
30th April, 2012
4
ACKNOWLEDGEMENTS
I would like to express my deepest gratitude to my chief
advisor, Dr. Lobo Louie for his professional advices and
valuable recommendations throughout the entire project
period.
I would also like to thank Dr. Tom Tong for being my
second reader. Appreciation was given to the cooperation of
the following secondary schools for participating in this
study.
Secondary Schools
Diocesan Boys' School
Diocesan Girls' School
Fukien Secondary School (Kwun Tong)
Heep Yunn School
Maryknoll Convent School
Marymount Secondary School
Queen's College
Raimondi College
Sacred Heart Canossian College
St. Joseph's College
5
St. Paul's College
St. Paul's Convent School (Secondary Section)
St. Stephen's Girls' College
Wa Ying College
Wah Yan College (Kowloon)
Finally, I would like to give special thanks to my
family for their supports, Hill Top Swimming Club, swimming
team members of Hong Kong Baptist University for their
advise, university swimming team coach, Mr. Wong Ka Ki for
his guidance and my friends, Lu Zhe, Carmen Tang, Kwok Fong
Pui, Chow Chit Ling and Lai Tsz Wing for their assistances
throughout the project.
______________________
Li Ki Yan
Department of Physical Education
Hong Kong Baptist University
Date: 30th April, 2012
6
Abstract
The results of the competitive swimming in Hong Kong
have been raised in the past years. Many Hong Kong Records
have been broken by the Hong Kong swimmers in international
events. In order to achieve outstanding results, swimmers
in Hong Kong received intense training and soon after years,
it is common to hear swimmers got injured due to
overtraining. The purpose of this study is to investigate
the injury patterns of swimming injuries of swimmers whom
were studied in schools that participated in the Hong Kong
Inter-school Swimming Championships (Hong Kong Island and
Kowloon) Division I 2010/2011 and 2011/2012.
There were 437 young swimmers participated in the study.
There result showed that 154 swimmers (59 males and 95
females) had suffered from injuries in the past one year.
There were a total of 437 injury incidents happened in the
past one year among all the swimmers and gave an incidence
rate of 0.28 per 1000 training hours. Swimmers from the
junior training squad had the highest incidence rate.
Sprain/strain at lumbar spine/low back (27 cases) and
strain at shoulder (26 cases) were the most frequent sites
at upper extremities and dorsal trunk while in the lower
7
extremities, muscle cramps at the thigh/lower legs (53
cases) and sprain at ankle (46 cases) were the most common
injuries. The demographical information of swimmers with
shoulder injuries was also investigated.
8
Table of Content
CHAPTER
Page
1. INTRODUCTION ......................................... 13
Statement of the Problem ............................. 14
Purpose of the Study ................................. 15
Definition of Terms .................................. 16
Delimitations ........................................ 20
Limitations .......................................... 20
Significance of the Study ............................ 21
2. REVIEW OF LITERATURE ................................. 22
Rate of Swimming Injuries ............................ 22
Rate of Shoulder Dislocation in Sports ............... 25
Summary ..............................................30
3. METHOD ............................................... 31
The Subjects ......................................... 31
Instrument ........................................... 32
9
Procedures ........................................... 33
Method of Analysis ................................... 34
4. ANALYSIS OF DATA ..................................... 35
Results .............................................. 37
Discussion ........................................... 73
5. SUMMARY AND CONCLUSIONS .............................. 79
Summary of Results ................................... 79
Conclusion ........................................... 85
Recommendation for Further Studies ................... 85
REFERENCE ............................................... 88
APPENDIX ................................................ 95
A. Letter to schools ................................. 95
B. 中學學界游泳比賽受傷比率調查 .......................... 96
10
LIST OF TABLES
TABLE
PAGE
1.
Demographic information of respondents (N=437)..... 38
2.
Performance Levels and Injury rates (N=437)........ 40
3.
One way ANOVA to analyze the performance levels of
swimmers and the injury occurrence (N=437)......... 40
4.
Main strokes and Injury rates (N=437).............. 42
5.
One way ANOVA to analyze the main stroke of
swimmers and the injury occurrence (N=437)......... 42
6.
Grade participation in Inter-school Swimming
Championship (Hong Kong Island & Kowloon) Division
I 2010/2011 and the injury rates (N=247)........... 44
7.
One way ANOVA of grade participation in Interschool Swimming Championship (Hong Kong Island &
Kowloon) Division I 2010/2011 and the injury rates
(N=247)............................................ 44
8.
Grade participation in Inter-school Swimming
Championship (Hong Kong Island & Kowloon) Division
I 2011/2012 and the injury rates (N=343)........... 46
9.
One way ANOVA of grade participation in Interschool Swimming Championship (Hong Kong Island &
11
Kowloon) Division I 2011/2012 and the injury rates
(N=343)............................................ 46
10. Independent t-test of injury rates of swimmers who
had participated in the Inter-school Swimming
Championship (Hong Kong Island & Kowloon) Division
I 2010/2011 and 2011/2012 (N=232).................. 48
11. Independent t-test of hours of swimming or land
training among Males and Females Swimmers (N=437).. 51
12. Independent t-test of hours of swimming or land
training and the injury occurrence of swimmers
(N=232)............................................ 51
13. The total training hours, total number of injury
cases and the incidence rates of injuries (per 1000
training hours) for each performance level group of
swimmers (N=437)................................... 53
14. Warm up time patterns of the swimmers in swimming
or land training (N=437)........................... 55
15. Warm up patterns in swimming and landing training
of swimmers (N=437)................................ 57
16. Cool down patterns of swimmers after swimming and
land training (N=437).............................. 59
17. Injury patterns and the incident rates of swimmers
12
of different performance levels (N=437)............ 62
18. Background information of swimmers with shoulder
injury of different performance level (N=43)....... 66
19. Types of shoulder injury and the type of main
strokes (N=43)..................................... 67
20. Recurrent rate and acute injury rate of shoulder of
different strokes (N=43)........................... 68
21. Treatments after first time and recurrent injury
(N=43)............................................. 69
22. The frequencies of the number of days staying in
hospital, number of days off from training and
sports completely (N=43)........................... 70
23. Self Rating (1-5) on muscle strength, range of
motion and swimming skills after treatment (N=43).. 71
LIST OF FIGURES
FIGURE
1.
Histogram of the Self Rating on muscle strength,
range of motion and swimming skills after treatment
PAGE
72
13
Chapter One
Introduction
Swimming is one of the elite sports in Hong Kong. This
is because the Hong Kong team has gained outstanding
results in numerous international events, especially in the
2009 East Asian Games and the 2010 Asian Games. For years,
the Hong Kong swimmers have broken the new Hong Kong
records in different competitions: in 2010, the Hong Kong
swimmers have broken 3 new Hong Kong records in Asian
Games-Guangzhou, China and 7 new Hong Kong records in 10th
FINA World Swimming Championships- Dubai, UAE (Chiu, 2011).
These tell us that their limits have not been reached.
There are still rooms of improvement can be made and Hong
Kong swimmers are stepping toward the bright stage of the
swimming world.
In the past, swimming is a survival or rescue skill.
People swim for bathing, cooling, fishing, recreation,
exercise and sport. The modern four swimming styles are
developed throughout years. Front crawl as an example, it
is deduced from the dog paddle, to breaststroke, sidestroke,
then trudgen (Colwin, 2002). Other than the front crawl,
14
the mechanism of breathing technique,as an example, among
the backstroke, breaststroke and butterfly are also changed
to the nowadays forms.
Every year, there are 12 boys’ schools and 12 girls’
schools participate in the Inter-school Swimming
Championships (Hong Kong Island & Kowloon) Division I. New
records are always created by young swimmers within this
division rather than division two or three. Thus, it is
believed that the training quantity is much tenser within
this group of swimmers. Since there are a significant
number of swimmers (either for recreational or competitive)
in Hong Kong, it is essential to understand the pattern of
the potential injuries so as to set up preventive measures
to prevent and reduce the chance of the swimming injuries
to occur.
Statement of the Problem
The aim of the study was to investigate the injury
patterns of Inter-school Swimming Championships (Hong Kong
Island & Kowloon) Division I swimmers in Hong Kong.
Included in the study was an attempt to identify the injury
15
patterns and the demography information of the shoulder
injuries of swimmers in Hong Kong.
Purpose of the Study
The purpose of the study was to investigate the injury
patterns among swimmers in Hong Kong Inter-school Swimming
Championships (Hong Kong Island & Kowloon) Division I and
would be providing information for coaches and swimmers of
common injuries in swimming. This would help the coaches
and schools to develop a better plan for training so as to
reduce the risk of injury and improve their training
quality. Also, it can raise the awareness of sports
injuries among recreational swimmers. To understand the
injury patterns of swimmers, the following research
questions were asked:
1. What would the injury patterns of swimmers in Interschool Swimming Championships (Hong Kong Island &
Kowloon) Division I be?
2. Are there any association between the performance
levels of swimmers and their injury patterns?
16
3. Are there any association between the main stroke of
swimmers and their injury patterns?
4. Are there any association between training intensity
of swimmers and the injury patterns?
5. Are there any association between different main
strokes of swimmers and the shoulder injury patterns?
Definition of Terms
The operational definitions of the terms in this study
were defined as follows:
Sport Injuries
It refers to any injuries that happened when playing
sports or exercising. Some are from accidents. Others can
result from poor training practices or improper gear. Some
people get injured when they are not in proper condition.
Not warming up or stretching enough before playing or
exercising can also lead to injuries (U.S. Department of
Health and Human Services, 2009).
17
Performance Level
It refers to the highest swimming ability of the
subjects including Hong Kong Team, Regional Training Squad,
Junior Training Squad, swimming clubs swimmers and school
team only swimmers.
Swimming Strokes
There are four swimming strokes as stated in the FINA
(Federation International De Association). They are
freestyle, backstroke, breaststroke and butterfly.
Freestyle
It means that in an event so designated the swimmer
may swim any style and some part of the swimmer must break
the surface of the water throughout the race except that in
individual medley or medley relay events, freestyle means
any style other than backstroke, breaststroke or butterfly
(FINA, SW 5 Freestyle, 2010).
Backstroke
Prior to the starting signal, the swimmers shall line
up in the water facing the starting end, with both hands
holding the starting grips. The swimmer shall push off and
18
swim upon his back throughout the race except when
executing a turn (FINA, SW 6 Backstroke, 2010).
Breaststroke
From the beginning of the first arm stroke after the
start and after each turn, the body shall be on the breast.
It is not permitted to roll onto the back at any time. From
the start and throughout the race, the stroke cycle must be
one arm stroke and one leg kick in that order. All
movements of the arms shall be simultaneous and on the same
horizontal plane without alternating movement (FINA, SW 7
Breaststroke, 2010).
Butterfly
Both arms shall be brought forward together over the
water and brought backward simultaneously through-out the
race. All up and down movements of the legs must be
simultaneous. The legs or the feet need not be on the same
level, but they shall not alternate in relation to each
other. A breaststroke kicking movement is not permitted
(FINA, SW 8 Butterfly, 2010).
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Individual Medley
Swimmer covers the four swimming strokes in the
following order: Butterfly, Backstroke, Breaststroke and
Freestyle. Each of the strokes must cover one quarter (1/4)
of the distance (FINA, SW 9 Medley Swimming, 2010).
Additional Land Training
It refers to the any types of extra training on dryland which aims to enhance the muscular strength and
endurance of swimmers so as to improve their performance.
Warm Up
It refers to the exercise conducted prior to
performance, whether or not muscle or body temperature is
elevated (Powers & Howley, 2004).
Cool Down
It refers to activities including slow walking and
stretching exercises that gradually return heart rate and
blood pressure back to normal(Powers & Howley, 2004).
20
Delimitations
The delimitations of the present study were list as
follows:
1. The subjects were delimited to be the school swimming
team members whom schools had participated
consecutively in the Inter-school Swimming
Championships (Hong Kong Island & Kowloon) Division
One for the academic years of 2010/2011 and 2011/2012.
2. The subjects were assumed to have regular swimming or
dry-land training at least once per week.
3. Incidence of injuries was delimited to the past one
year.
Limitations
The following limitations should be considered when
interpreting the results of this study:
1. It was assumed that the injury items of the
questionnaire are enough to measure the common types
of injury.
2. It was assumed that all subjects would answer the
questionnaires honestly.
21
3. It was assumed that all subjects were able to identify
their injuries.
Significance of the Study
The significance of study was to investigate the
potential injuries in swimming. It examined associations
between gender, age, performance levels, the main strokes
and the years of participation in the Championships of the
swimmers with the injuries. It also provided information to
compare the injury patterns from the Hong Kong team
swimmers to the school team swimmers.
The study was specifically focused on the injuries
that are related to the shoulder. According to the
Federation Internationale de Natation (FINA) (Mountjoy et
al, 2010), it was reported that in the World Championships
2009, the upper extremity especially shoulder was the most
frequently injured region. Finding out the patterns of
injuries could help the coaches and schools to plan and
develop their training programs so as to enhance swimmers’
performance and improve their skills and technique
effectively.
22
Chapter Two
Review of Literature
It is likely to have injuries when you play basketball,
rugby, and soccer. It is always heard that people who are
injured shall swim for rehabilitation but it is rare to get
injured because of swimming.
The rate of swimming injuries and the rate of shoulder
dislocation in sports will be included in this chapter.
Rate of Swimming Injuries
Some researchers had conducted a study about the injury
patterns in National Collegiate Athletic Association (NCAA)
Division I-A level (Wolf, Ebinger, Lawler & Britton,2009).
They followed one men and women swimming team over 5
seasons (2002-2007). Out of 44 male and 50 female athletes,
90 injuries were sustained by 32 males (72.7%) and 35
female swimmers got 76 injuries (70.0%).
There was no
significant gender different in the risk of being injured.
The common injuries included in the report were
shoulder/upper arm (23 cases out of 55 swimmers), neck/back
23
(12 cases out of 38 swimmers) and elbow/wrist/hand/finger
(6 out of 18 male swimmers) or knee/leg (5 cases out of 13
female swimmers). In the study, there were 30% and 28% of
male and female swimmers injury cases reported in their
strength training that back/neck injury happened the most.
Moreover, there was no relationship between the injury to
different body parts and the stroke specialty.
Although Wolf et al. (2009)indicated that there was no
correlation between the body part injured and the stroke
specialty, Grote, Lincoln & Gamble (2004) pointed out that
breaststroke swimmers had a greater chance to have groin
pain (6.92%) than the individual medley swimmers who did
not take part in the breaststroke events (0, P = 0.015).
From the survey collected from the 296 competitive swimmers,
it was found that the pain at hip adductors (groin injury)
has been affecting or inhibiting the trainings and
competitions of these breaststroke swimmers.
Furthermore, 341 elite swimmers conditions were followed
by Knobloch, Yoon, Kraemer & Vogt (2008). It is found that
the overall injury rate of these swimmers was 0.39/1000h.
In details, the rate of overuse injuries was greater than
the acute injuries (0.22/1000h and 0.17/1000h respectively).
24
It is likely to see that the injuries of upper limbs was
much more than the trunk or lower limbs (0.11, 0.067 and
0.085 per 1000h correspondingly) while ahead by the knee
pain at the rate of 0.17/1000h. The study also made
contrast with the previous research of Wolf et al.(2009)
that 200-400m breaststroke swimmers had a higher risk of
knee pain (relative risk, RR 5.1, p = 0.001). Shoulder
overuse syndromes and acute shoulder injury were indicated
as in freestyle and butterfly swimmers respectively. It was
noted that athletes who trained for 4 times a week or above
were under a higher risk of knee injuries (RR2.1) and
shoulder injuries (RR4.0).
On the other hand, a case study was reported that a
female butterfly swimmer suffered from the bilateral
subluxation of sternoclavicular joints which initially
associated with pain and discomfort at the shoulder girdle
(Echlin & Michaelson, 2006).
Another case of swimming
injury was that a 31-year-old male recreational triathlete
reported that he had headaches and temporomandibular joint
pain while attempting to incorporate bilateral breathing
into his free-style swimming training regime (Yuill & Howit,
2009). Besides, an unusual case of injury that happened to
25
competitive swimmers was the chronic costochondritis. In
this case, a 14 years old female competitive swimmer
reported that the pain occurred during dry-land training,
including push-ups, seated rows, medicine ball toss and
relieved with rest. Due to the numerous consecutive pushups performance during swimming practice, the pain was then
developed (Cubos, Cubos & Stefano,2010).
Rate of Shoulder Dislocation in Sports
There were many kinds of injuries over the shoulder
complex, including the sternoclavicular joint injury,
clavicle fracture, acrominoclavicular joint injury,
osteolysis of the distal clavicle, little league shoulder,
proximal humerus fracture, glenohumeral instability and
rotator cuff injury. The level of injury and the patterns
were related to the kinds of sport, the intensity involved
and the level of participation (Kocher, Waters & Micheli,
2000).
When the arm was forcefully abducted (e.g. when making an
arm tackle in football) or having an excessive shoulder
external rotation and extension, i.e., arm in the overhead
26
position (Anderson, Hall & Martin, 2000). A study of
“Injuries to the Shoulder in the Throwing Athlete” by Keith
Meister (2000) gave a clear explanation of how the throwing
mechanism affected the shoulder complex. It is mentioned
that the improper mechanics and poor conditioning
contribute to the injuries of throwing shoulder the most.
Meister (2000) had the following elaboration about part of
the throwing phase that may lead to injury:
Hyperextension of the knee while planting the striding
leg and landing on the heel cause a sudden deceleration of
the body, which results in undue counterforce on the
throwing arm. Such a maneuver is often seen in pitchers who
are “overthrowing” and trying to get more velocity on their
fastballs.
The planted foot should always point toward home plate.
Placing the striding foot outside the target (toward the
first-base side for a right-handed pitcher) and wide to the
torso results in “opening up too soon”. In this instance,
pelvic rotation occurs too early, creating increased stress
across the anterior shoulder and elbow. Planting the foot
toward the third-base side of home plate slows down
27
rotation of the torso, taking from the body’s momentum and
forcing the throw to be delivered entirely by the arm.
The throwing motion should be a smooth acceleration and
deceleration of the center of gravity toward the target.
(p.269)
The excessive stress on the upper arm would then give
impact on the structure of the shoulder girdle.
A survey on the shoulder injury patterns of high school
athletes was conducted in 2005-2006 and 2006-2007 school
years (Bonza, Fields & Yard, 2009). A total of nine sports
were investigated. They were: football, soccer, basketball,
baseball, and wrestling for boys and soccer, volleyball,
basketball, and softball for girls. In the result, 805
shoulder injuries were reported out of 3,550,141 athleteexposures (AEs). It is more likely to have shoulder
injuries occur during competition than practice (rate ratio
= 3.01, 95% confidence interval = 2.62, 3.46). Nevertheless,
Thomas and Swanik (2009) measured glenohumeral internal
rotation (IR) and external rotation (ER) with the scapular
stabilized of 10 swimmers, 16 tennis players and 10 tennis
players. All of them were female athletes. Results showed
that the internal rotation decreased from preseason to
28
postseason (P=.012) and swimmers had less IR than both
volleyball and tennis players (P = .001). External rotation
also decreased in the swimmers (P= .001). In the overall,
from the preseason to postseason, the total motion
decreased for athletes participating in swimming (P =.001)
and tennis (P = .019). It is then suggested that close
monitoring should be given to the athletes throughout the
competitive seasons.
In swimming, during the hand entry and exit of the
freestyle stroke (most swimmers would choose front crawl),
the following muscular co-ordinations were involved to
perform the motion: the upper trapezius, rhomboids,
supraspinatus, middle deltoid and anterior deltoid position
the scapula and the humerus. The serratus anterior and
subscapularis also performed to position the scapular and
the internal rotation of the humerus respectively (Pink &
Tibone, 2000).
Similar study on the measurement on the glenohumeral
internal and external rotation was also conducted on 54
healthy males (Torres & Gomes, 2009). Subjects were divided
into 3 groups (tennis players, swimmers, control group).
From the result, the mean glenohumeral internal rotation
29
deficit (GIRD) in tennis players, swimmers and control
group were 23.9° ± 8.4° (P <.001), 12° ± 6.8° (P <.001) and
4.9° ± 7.4° (P =.035)
respectively. It showed that
significant difference of dominant shoulder between all
groups, and the difference in internal rotation of the
dominant shoulder between the group of tennis players in
comparison with the control group (27.6°, P < .001) was
greater than the difference in internal rotation of the
dominant shoulder found in the group of swimmers compared
with the control group (17.9°, P <.001). Between tennis
players and swimmers, the difference in internal rotation
of the dominant shoulder was 9.7° (P =.002).
A research had been done on the bony defect of the
glenoid rim (Saito et al., 2005). The hypothesis was that
the bony defect was anterior rather than anteroinferior to
the glenoid and the result confirmed this that the mean
orientation of the defect was pointing toward 3:01 on the
clock face of the glenoid, at a mean angle of 90.5° ± 10.4°
from the 12-o’clock direction.
A study on the injury in rugby (Headey, Brooks & Kemp,
2007) had the following findings: The most common match
injury was acromioclavicular joint injury (32%); the most
30
severe was shoulder dislocation and instability (mean
severity, 81 days absent), which also caused the greatest
proportion of absence (42%) and had the highest rate of
recurrence (62%). The majority of match shoulder injuries
were sustained in the tackle (65%), and outside backs were
the most likely to sustain an injury from tackling
(2.4/1000 player-tackles). It is then suggested that: the
potential to reduce this injury burden by modifying
training activities and implementing “prehabilitation”
strategies in an effort to minimize the risk of shoulder
dislocation/instability.
Summary
In summary, differ from other sports, swimming
requires relatively more strength and power of the upper
limbs and trunk and the coordinations between the breathing
and stroke motions is also a necessity.
Common injured body sites in swimming include the
shoulder region, spine and knee. Proper treatment should be
taken and consultations from professional are encouraged in
returning to trainings and participating in competitions.
31
Chapter Three
Method
The method of this study was presented in the
following sections: 1) The subjects, 2) Instruments, 3)
Procedures and 4) Method of analysis.
The Subjects
The subjects were both male and female swimmers. They
were from the school swimming teams whom schools had been
consecutively participated in the Inter-school Swimming
Championships Division I in the academic years of 2010/2011
and 2011/2012. A total of 19 secondary schools fulfilled
this requirement while only 15 schools participated in the
study with 8 girls’ schools and 7 boys’ schools. The total
number of subjects was 437 with 266 (60.9%) girls and 171
(39.1%) boys, aged 13 to 19.
The performance level included Hong Kong team swimmers
(4.1%), regional training squads (5.5%), junior training
squads (2.3%), swimming clubs swimmers (67.7%) and swimmers
who only train in school swimming team (19.9%).
32
Instrument
A self-designed questionnaire was used as the method
of collecting data (see Appendix B). The procedures for
developing the self-designed questionnaires are based on
reviewing the journals that were related to the research
topic. The development of the questionnaire and translation
were supervised by the advisor. The questionnaire was
divided into three parts.
In the first part, the demographic information of the
respondents such as gender, performance level, stroke
majored in, training hours on swimming and fitness, warm up
and cool down exercise habits were investigated. They were
not required to provide their names.
In the second part, it focused on injuries happened
within one year time. Common injuries in swimming were
investigated, sorted by injury sites with types of injuries.
Other injuries out of the list would also be asked to
specify by the subjects.
In the third part, only subjects who had been suffered
in shoulder injuries were required to answer. The
background information such as the dominate side and
injured side, the period of suffering in the injury (acute
33
or chronic), the occasion when injury happened, the motion
that caused the injury, the time for recovery, medical help
from hospitals and a self rating on the muscle strength,
rang of motion and swimming skills have also been asked.
Procedures
A pilot test was conducted with the swimmers from Hong
Kong Baptist University swimming team and Hill Top Swimming
Club to assess the suitability of the questionnaire before
the formal survey.
The purposes of this conduction were to see whether
the Chinese translation matches the English terms and to
test if the wordings used were understandable and
acceptable. In this pilot study, 40 swimmers were asked to
complete the questionnaire and stated out the problems of
understanding the questions after completing the
questionnaires.
In the actual study, questionnaires were administered
to subjects by school teachers and swimming team captains.
The purpose of the study has been explained to the subjects
by the administrator. The respondents were asked to recall
34
their past experience in swimming in the past years and
also within the past one year. Each questionnaire took
approximately 3 minutes to complete.
Method of Analysis
All the responses of the questionnaires will be coded
for further data analysis and inputted into Statistic
Package of Social Science 16.0 for windows” (SPSS 16.0) and
Microsoft Excel. All statistical procedures were tested at
the 0.05 level of significance. Descriptive statistics such
as frequency, mean, standard deviation and percentage will
be used to describe the social demographic information such
as the personal data, exercise and warm up habit, the main
stroke and injury patterns of the subjects.
In comparing the means difference between male and
female swimmers in hours of swimming, additional fitness
training and the main stroke, the independent group t-test
and One way ANOVA were used.
35
Chapter 4
Analysis of Data
The purpose of this study was to investigate the injury
patterns of the swimming players who have participated in
the 2010/2011 and 2011/2012 Inter-school Swimming
Championships (Hong Kong Island & Kowloon) Division I.
The descriptive statistics, ONEWAY ANOVA, Chi square and
independent t-test were used to analyze the data. The
analyses of the data were presented in the following
results:
1. Demographic information of respondents
2. Distribution of grade participation with percentage of
injuries
3. Years of participation with percentage of injuries
4. Hours of swimming and land training of the swimmers and
the incidence rates of injuries
5. Warm up patterns of the swimmers
6. Cool down patterns of swimmers
7. Details of injuries among injured body sites and injury
types
8. Background information of swimmers with shoulder injury
36
9. Types of shoulder injury
10.Recurrent rate and acute injury rate of shoulder of
different strokes
11.Treatments after first time and recurrent injury
12.The frequencies of the number of days staying in
hospital, number of days off from training and sports
completely
13.Self rating on muscle strength, range of motion and
swimming skills after treatment
37
Results
Demographic information of respondents
In this study, there were 437 swimmers involved, with
171 were males (39.1%) and 266 were females (60.9%). The
mean age of the subjects was 15 (SD±1.5), ranged from 13-19.
The average weight and height of the subjects were 51.96kg
(SD±9.8) and 162.83cm (SD±8.5).
Within the 437 swimmers, there were 95 males and 152
females participated in the 2010/2011 Championship while
138 males and 205 females had participated in the 2011/2012
Championship. The average of age, weight and height,
participation rates in the inter-school swimming
championships of 2010/2011 and 2011/2012 and the injury
rates were summarized in Table 1.
38
Table 1 Demographic information of respondents (N=437)
Gender
Age
Weight Height
Mean
Mean
Mean
Male
15.25
57
Female
15.06
49
Participated in
2010/2011
Championship
Yes
No
Participated in
2011/2012
Championship
Injury Occurrence
Yes
No
Yes
No
168
95
76
138
(21.7%) (17.4%) (31.6%)
33
(7.6%)
59
(13.5%)
112
(25.6%)
160
152
114
205
(34.7%) (26.1%) (46.9%)
61
(13.9%)
95
(21.7%)
171
(39.1%)
39
The D1 swimmers were categorized into five performance
levels. As illustrated in Table 2, the rates of injury of
the Hong Kong team (8 swimmers), Regional training squad
(10 swimmers), the junior training squad (3 swimmers) and
those who only trained in the school swimming teams (21
swimmers) were 1.8%, 2.3%, 0.7% and 4.8% respectively. For
those who trained in the swimming clubs (112 swimmers), the
injury rate was relatively much higher than the rest of the
performance groups which was 25.6%.
Table 3 showed that there was no significant difference
between the performance levels and the injury occurrence
(p<0.05).
40
Table 2 Performance Levels and Injury rates (N=437)
Injury Occurrence
Performance Levels
Total
Yes
No
Hong Kong Team
8
(1.8%)
10
(2.3%)
18
Regional Training
Squad
10
(2.3%)
14
(3.2%)
24
Junior Training Squad
3
(0.7%)
7
(1.6%)
10
112
(25.6%)
186
(42.6%)
298
21
(4.8%)
66
(15.1%)
87
154
(35.2%)
283
(64.8%)
437
Swimming Clubs
School Swimming Team
only
Total
Table 3 One way ANOVA to analyze the performance levels of
swimmers and the injury occurrence (N=437)
df
Mean
Square
F
p
1.515
4
.379
1.666
.157
Within Groups
98.215
432
.227
Total
99.730
436
Between
Groups
Sum of
Squares
41
The main stroke of the subjects was identified. The
front crawl was the main stroke of 147 swimmers (33.6%)
while 112 swimmers (25.7%) chose breaststroke as their main
stroke. Backstroke and butterfly were the main strokes of
86 (19.7%) and 63 (14.4%) swimmers. The individual medley
had the fewest swimmers with 29 out of 437 (6.6%) swimmers.
Table 4 had shown the main strokes and the injury rates of
the swimmers.
One way ANOVA was used and the results were shown in
Table 5. The results indicated that there was no
significant difference (p<0.05) between the main stroke of
swimmers and the injury rates.
42
Table 4 Main strokes and Injury rates (N=437)
Injury Occurrence
Types of Stroke
Yes
44
(10.1%)
43
(9.8%)
30
(6.9%)
24
(5.5%)
13
(3.0%)
154
(35.2%)
Front Crawl
Breaststroke
Backstroke
Butterfly
Individual Medley
Total
No
103
(23.6%)
69
(15.8%)
56
(12.8%)
39
(8.9%)
16
(3.7%)
283
(64.8%)
Total
147
(33.6%)
112
(25.7%)
86
(19.7%)
63
(14.4%)
29
(6.6%)
437
Table 5 One way ANOVA to analyze the main stroke of swimmers
and the injury occurrence (N=437)
Sum of
Squares
df
Mean
Square
F
p
.845
4
.211
.922
.451
Within Groups
98.885
432
.229
Total
99.730
436
Between Groups
43
Distribution of grade participation with percentage of
injuries
Table 6 showed the grade participation of swimmers who
had participated in the Inter-school Swimming Championship
(Hong Kong Island & Kowloon) Division I 2010/2011 and the
injury rates of which there were 18 swimmers (7.3%), 40
swimmers (16.2%) and 46 swimmers (18.6%) from A grade, B
grade and C grade reported that they were injured in the
past one year. The One way ANOVA test showed there was
significant difference (p<0.05) between the swimmers who
had participated in the Championship 2010/2011 and the
injury rates.
44
Table 6 Grade participation in Inter-school Swimming
Championship (Hong Kong Island & Kowloon) Division I
2010/2011 and the injury rates (N=247)
Grade Participation
Injury Occurrence
in Championships
2010/2011
Yes
No
Total
A Grade
18
(7.3%)
32
(13.0%)
50
(20.2%)
B Grade
40
(16.2%)
70
(28.3%)
110
(44.5%)
C Grade
46
(18.6%)
41
(16.6%)
87
(35.2%)
Total
100
(42.1%)
143
(57.9%)
247
Table 7 One way ANOVA of grade participation in Interschool Swimming Championship (Hong Kong Island & Kowloon)
Division I 2010/2011 and the injury rates (N=247)
Sum of
Squares
df
Mean
Square
Between
Groups
1.607
2
.804
Within
Groups
58.780
245
.240
Total
60.387
247
*p<.05, two-tailed.
F
3.350
p
*.041
45
In the study, there were a total of 344 swimmers have
been participated in the Inter-school Swimming Championship
(Hong Kong Island & Kowloon) Division I 2011/2012, Out of
the 344 swimmers, there were 132 swimmers got injured in
the past one year with 29 swimmers (8.5%) were from A grade,
60 swimmers (17.5%) were from B grade and 43 swimmers
(12.5%) were from C grade. Table 5.1 showed the grade
participation and the injury rates while Table 8 showed
that there was no significant difference (p>0.05) between
the grade participation in the championships 2011/2012 and
the injury rates.
46
Table 8 Grade participation in Inter-school Swimming
Championship (Hong Kong Island & Kowloon) Division I
2011/2012 and the injury rates (N=343)
Grade Participation
Injury Occurrence
in Championships
Total
2011/2012
Yes
No
A Grade
29
(8.5%)
55
(16.0 %)
84
(24.5%)
B Grade
60
(17.5%)
84
(24.5%)
144
(42.0%)
C Grade
43
(12.5%)
72
(21.0%)
115
(33.5%)
Total
132
(38.5%)
211
(61.5%)
343
Table 9 One way ANOVA of grade participation in Interschool Swimming Championship (Hong Kong Island & Kowloon)
Division I 2011/2012 and the injury rates (N=343)
Sum of
Squares
df
Mean
Square
.291
2
.146
Within
Groups
80.910
340
.238
Total
81.201
342
Between
Groups
F
.612
p
.543
47
Years of participation with percentage of injuries
For those who had participated in the championships
2010/2011 and 2011/2012, the injured rates of swimmers were
summarized in Table 10. There were 232 out of 437 swimmers
had participated in the Championships consecutive for two
years (2010/2011 and 2011/2012). Among the 232 swimmers,
there were 100 swimmers (39 male swimmers, 16.8% and 61
female swimmers, 26.2%) got injured on different bodies in
the past one year. The independent t-test has shown that
there is no significant difference (p>0.05) between the
injury rates and the 2-year of participation in the Interschool Swimming Championship (Hong Kong Island & Kowloon)
Division I.
48
Table 10 Independent t-test of injury rates of swimmers who
had participated in the Inter-school Swimming Championship
(Hong Kong Island & Kowloon) Division I 2010/2011 and
2011/2012 (N=232)
Injury
Occurrence
Yes
No
Total
Gender
Total t (df=230)
Male
Female
39
(16.8%)
61
(26.3%)
50
(21.6%)
82
(35.3%)
89
(38.4%)
143
(61.6%)
100
(43.1%)
132
(56.9%)
232
0.173
p
0.863
49
Hours of swimming and land training of the swimmers and the
incidence rates of injuries
The average hours of training in swimming and land
training were illustrated in Table 11. The mean hours of
swimming training per week for males and females were 7.65
(SD±5.05) and 6.20 (SD±4.69) hours respectively and the
mean hours of land training per week for males and females
were 1.35 (SD±1.70) and 1.08 (SD±1.22) hours respectively.
The mean hours of the swimming and land training were 6.77
(SD±4.88) and 1.18 (SD±1.43) hours. Both of the groups
showed significant mean differences, (t=3.058, p= .002) in
the number of hours of swimming training between males and
females; and (t=1.962, p=.050) in the number of hours of
land training between males and females. Males spent more
time in both swimming training and land training than
females.
Table 12 summarized the results of independent t-test
of the hours of swimming or land training and the injury
occurrence of swimmers and showed there were no significant
mean differences, (t=2.147, p=0.33) in the number of hours
of swimming training between the injured and non-injured
50
swimmers, and (t=1.988, p=0.48) in the number of hours of
land training between the injured and non-injured swimmers.
51
Table 11 Independent t-test of hours of swimming or land
training among Males and Females Swimmers (N=437)
Standard
Hours of
swimming
Training
Hours of
land
training
Mean
Total N Difference t (df=435)
Mean
Deviation
Male
7.65
5.05
171
Female
6.20
4.69
266
Total
6.77
4.88
437
Male
1.35
1.70
171
Female
1.08
1.22
266
Total
1.18
1.43
437
p
1.45
3.058
*0.002
0.27
1.96
*0.050
*p<.05, two-tailed.
Table 12 Independent t-test of hours of swimming or land
training and the injury occurrence of swimmers (N=232)
Injury
Occurrence
Hours of
Standard
Mean
Mean
Deviation
Total N
Yes
8.6317
4.78409
100
No
7.2389
4.97303
132
Yes
1.4883
1.23876
100
No
1.1184
1.51615
132
swimming
Training
Hours of
land
training
difference t (df=230)
p
1.39
2.147
0.33
0.37
1.988
0.48
52
The total numbers of training hours of each
performance group were shown in Table 13. The mean training
hours including the swimming part and land training part
were 9.00 (SD±5.84) and 7.28 (SD±5.36) hours for male and
female swimmers. The total training hours of the
respondents were 3476.57 hours per week, approximately
180782 training hours per year. In the past one year, the
total number of injured swimmers was 154 out of 437
swimmers and the total number of injury cases was 427 among
the 154 swimmers.
The incident rates of injuries (per 1000 training
hours) of the five performance groups ranked were, in
descending order, the junior training squad (6.04),
regional training squad (1.91), Hong Kong team (1.75),
school swimming team (1.42) and swimming club swimmers
(0.50).
53
Table 13 The total training hours, total number of injury
cases and the incidence rates of injuries (per 1000 training
hours) for each performance level group of swimmers (N=437)
Performance
level
Total
Training
Hours(per
week)
Total
number of
swimmers
injured
Incidence
Total
rates of
number of
injuries (per
injury
1000 training
cases
hours)
Hong Kong
Team
(N=18)
349.08
8
(5.2%)
11.00
1.75
Regional
Training
Squad
(N=24)
305.75
10
(6.5%)
14.00
1.91
Junior
Training
Squad
(N=10)
115.92
3
(1.9%)
7.00
6.04
Swimming Club
swimmers
(N=298)
2301.49
112
(72.7%)
345.00
0.50
School Team
only swimmers
(N=87)
404.33
21
(13.6%)
50.00
1.42
3476.57
154
(100%)
427.00
0.28
Total
(N=437)
54
Warm up patterns of the swimmers
The warm up time patterns of swimmers were illustrated
in Table 14. In both swimming and land training, swimmers
used less than five minutes for their warm up sections (198
swimmers in swimming training and 204 swimmers in land
training. In swimming training, there were 182 and 57
swimmers used five to 10 minutes and more than ten minutes
to warm up before starting swimming training whilst there
were 185 and 48 swimmers spent five to 10 minutes and more
than ten minutes for the warm up session in the land
training.
The One way ANOVA has shown that there was no
significant difference between the warm up time in both
swimming training (p=0.063) and land training (p=0.267) and
the injury rates.
55
Table 14 Warm up time patterns of the swimmers in swimming or land
training (N=437)
Swimming training
land training
Less
More
Less
More
Performance
5-10
5-10
than 5
than 10
than 5
than 10
level
minutes
minutes
minutes
minutes
minutes
minutes
Hong Kong
10
6
2
5
12
1
Team
(5.10%)
(3.30%)
(3.50%)
(2.50%)
(6.50%)
(2.10%)
Regional
7
14
3
6
15
3
Training
(3.50%)
(7.70%)
(5.30%)
(2.90%)
(8.10%)
(6.20%)
Squad
Junior
3
5
2
3
7
0
Training
(1.50%)
(2.70%)
(3.50%)
(1.50%)
(3.80%)
(0.00%)
Squad
Swimming
135
118
45
142
119
37
Club
(68.20%) (64.80%) (78.90%) (69.60%) (64.30%) (77.10%)
swimmers
School Team
43
39
5
48
32
7
only
(21.70%) (21.40%)
(8.80%) (23.50%) (17.30%) (14.60%)
swimmers
Total
198
182
57
204
185
48
56
Table 15 showed the type of warm up exercises that the
swimmers did before starting their training. It was more
likely for the swimmers to have stretching (382 swimmers,
87.41% before swimming training and 312 swimmers, 71.4%
before land training) for swimmers from every performance
level. Other than stretching, before swimming training
began, 123 swimmers (28.15%) had specific warm up and 76
swimmers (17.39%) jogged. There were 181 swimmers (41.42%)
jogged and 124 swimmers (28.38%) had specific warm up
before the land training.
57
Table 15 Warm up patterns in swimming and landing training of
swimmers (N=437)
Swimming training
Land training
Performance
Specific
Specific
level
Jogging
Stretching
Others
Jogging Stretching
warm up
Hong Kong
Team
Regional
Training Squad
Junior Training
Squad
Swimming Club
Swimmers
School Team
only swimmers
Total
warm up
Others
4
18
2
1
11
15
4
1
0.92%
4.12%
0.46%
0.23%
2.52%
3.43%
0.92%
0.23%
6
22
7
2
11
22
8
1
1.37%
5.03%
1.6%
0.46%
2.52%
5.03%
1.83%
0.23%
3
9
3
0
6
8
4
0
0.69%
2.06%
0.69%
0.00%
1.37%
1.83%
0.92%
0.00%
49
263
92
23
131
222
88
30
11.21%
60.18%
21.05%
5.26%
29.98%
50.8%
20.14%
6.86%
14
70
19
10
22
45
20
29
3.2%
16.02%
4.35%
2.29%
5.03%
10.3%
4.58%
6.64%
76
382
123
36
181
312
124
61
17.39%
87.41%
28.15%
8.24%
41.42%
71.4%
28.38%
13.96%
58
Cool down patterns of swimmers
After training, there were 288 (65.9%) and 282 (64.5%)
swimmers had cool down exercises after swimming and land
training whilst there were 149 (34.1%) and 155 (35.5%)
swimmers did not have cool down after training.
Table 16 illustrated the cool down patterns of swimmers
of different performance groups. The swimmers from swimming
clubs had the greatest percentage (69.4% for swimming and
71.3% for land training) to cool down after training.
Followed by that, the school team only swimmers had less
percentage in having cool down after both trainings. The
regional training squad, the Hong Kong team and the junior
training squad has a higher percentage of swimmers (7.6%
and 7.1%, 5.9% and 6.0%, 2.4% and 2.8%) to perform cool
down after training when compared with its own performance
group.
The independent t-test showed that there were
significant mean differences between the cool down sessions
in both swimming and land training (p=0.045 and p=0.015
respectively) and the injury rates.
59
Table 16 Cool down patterns of swimmers after swimming and land
training (N=437)
Cool down after
swimming training
Hong Kong Team
(N=18)
Regional Training
Squad (N=24)
Junior Training
Squad (N=10)
Swimming Club
swimmers (N=298)
School Team only
swimmers (N=87)
Total (N=437)
Injury
Yes
Occurrence No
Cool down after land
training
Yes
No
Yes
No
17
1
17
1
(5.9%)
(0.7%)
(6.0%)
(0.6%)
22
2
20
4
(7.6%)
(1.3%)
(7.1%)
(2.6%)
7
3
8
2
(2.4%)
(2.0%)
(2.8%)
(1.3%)
200
98
201
97
(69.4%)
(65.8%)
(71.3%)
(62.6%)
42
45
36
51
(14.6%)
(30.2%)
(12.8%)
(32.9%)
288
149
282
155
(65.9%)
(34.1%)
(64.5%)
(35.5%)
111
177
43
106
111
171
43
112
60
Details of injuries among injured body sites and injury
types
Table 17 illustrated the number of cases of each injured
body sites and the corresponding injury types with
different performance level groups. From the table, it is
showed that in the upper extremities and the dorsal of the
body, shoulder (59), lumbar spine/low back (39), cervical
spine/neck (27) and wrist/hand (27) were the top four
injured sites while in the lower extremities of the body,
thigh/lower leg (94), ankle/foot (82) and knee (37) were
the top three most common injured body sites.
For the detailed injury types over the injured body
sites, for the upper extremities and dorsal of the body,
sprain/strain at lumbar spine/low back (27), strain at
shoulder (26) and sprain/strain at cervical spine/neck (20)
were the top three injuries whereas cramps at the
thigh/lower legs (53), sprain at ankle (46) and strain at
the thigh/lower legs (40) were the top three injuries
occurred in the lower extremities.
Thigh/lower leg strain and knee contusion (both had
1.725 cases per 1000 training hours) had the highest
incident rate in the junior training squad. Among the
61
swimming club swimmers, cramps at thigh/lower leg was the
most frequent injury followed by strain at thigh/ lower leg
(0.048) and sprain at ankle (0.047). Shoulder strain and
sprain/strain at lumbar spine/low back had the same
incident rate of 0.034 (23 cases for both) and ranked
fourth.
62
Table 17 Injury patterns and the incident rates of swimmers
of different performance levels (N=437)
Body sites
Injury types
Head/
Face
Concussion
Cervical
spine/
Neck
Lumbar
spine/
Low back
Other
Trunk
Shoulder
Arm/
Elbow
Regional
Training
Squad
Hong Kong
Team
Junior
Training
Squad
Swimming
Clubs
School
swimming
Team only
Total
0
0
0
0
0
0.000
0.000
0.000
0.000
0.000
0
0
0
0
0
0.000
0.000
0.000
0.000
0.000
0
0
0
0
0
0.000
0.000
0.000
0.000
0.000
2
1
1
2
1
0.003
0.001
0.001
0.003
0.001
0
1
0
1
0
0.000
0.028
0.000
0.028
0.000
2
2
1
3
1
0
0.000
0
0.000
0 0.000
17
0.025
3
0.085
20
Muscle
Cramps
Others
Sprain/
Strain
Muscle
Cramps
Enthesopathy/
fasciitis
Other
0
0.000
0
0.000
0 0.000
6
0.009
1
0.028
7
0
0.000
0
0.000
0 0.000
0
0.000
0
0.000
0
1
0.159
1
0.136
0 0.000
23
0.034
2
0.057
27
0
0.000
1
0.136
0 0.000
6
0.009
3
0.085
10
0
0.000
0
0.000
0 0.000
1
0.001
0
0.000
1
0
0.000
0
0.000
0 0.000
1
0.001
0
Thoracic Spine
Sternum/ribs/
chest muscles
Abdomen
Other
Dislocation
Sprain
Strain
Contusion
Tendinitis
Inflammation/
bursitis
Impingement
Other
Sprain
Strain
Contusion
Tendinitis
Other
0
0.000
0
0.000
0 0.000
2
0.003
0.000
0 0.000
1
2
0
0.000
0
0.000
0 0.000
5
0.007
0
0.000
5
0
0
0
0
0
0
1
0.000
0.000
0.000
0.000
0.000
0.000
0.159
0
0
0
0
1
0
0
0.000
0.000
0.000
0.000
0.136
0.000
0.000
0
0
0
0
0
0
0
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1
0
3
5
23
4
6
0.001
0.000
0.004
0.007
0.034
0.006
0.009
0
0
1
1
2
0
0
0.000
0.000
0.028
0.028
0.057
0.000
0.000
1
0
4
6
26
4
7
0
0.000
0
0.000
0 0.000
5
0.007
0
0.000
5
0
0
0
1
0
0
0
0.000
0.000
0.000
0.159
0.000
0.000
0.000
0
0
0
2
0
0
0
0.000
0.000
0.000
0.273
0.000
0.000
0.000
0
0
0
1
0
0
0
7
0
3
17
1
0
1
0.010
0.000
0.004
0.025
0.001
0.000
0.001
0
0
1
1
1
0
0
0.000
0.000
0.028
0.028
0.028
0.000
0.000
7
0
4
22
2
0
1
Sprain
Contusion
Skin Lesion
Others
Sprain/
Strain
0.000
0.000
0.000
0.863
0.000
0.000
0.000
63
Table 17 Injury patterns and the incident rates of swimmers
of different performance levels (N=437)
Body sites
Wrist/
Hand
Hip/ Groin
Thigh/
Lower leg
Knee
Ankle/
Foot
OTHER
Injury types
Fracture
Tendon
Rupture
Sprain
Contusion
Skin Lesion
Other
Strain
Tendinitis
Impingement
Other
Strain
Contusion
Skin Lesion
Cramps
Other
Subluxation
Sprain
Contusion
Tendinosis
Skin Lesion
Other
Fracture
Sprain(ankle)
Sprain/Strain
(Foot)
Contusion
Skin Lesion
Other
Regional
Training
Squad
Hong Kong
Team
Junior
Training
Squad
Swimming
Clubs
School
swimming
Team only
Total
0
0.000
1
0.136
0 0.000
1
0.001
1
0.028
3
0
0.000
0
0.000
0 0.000
1
0.001
0
0.000
1
1
0
0
1
0
0
0
0
1
0
0
0
0
0
1
1
0
0
0
0
3
0.159
0.000
0.000
0.159
0.000
0.000
0.000
0.000
0.159
0.000
0.000
0.000
0.000
0.000
0.159
0.159
0.000
0.000
0.000
0.000
0.477
0
0
0
0
1
0
0
0
1
0
0
3
0
0
0
0
0
0
0
0
2
0.000
0.000
0.000
0.000
0.136
0.000
0.000
0.000
0.136
0.000
0.000
0.409
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.273
0
0
0
0
0
0
0
0
2
0
0
1
0
0
0
2
0
0
0
0
1
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
1.725
0.000
0.000
0.863
0.000
0.000
0.000
1.725
0.000
0.000
0.000
0.000
0.863
6
3
6
1
2
0
2
0
33
0
4
47
1
2
7
2
7
6
1
3
32
0.009
0.004
0.009
0.001
0.003
0.000
0.003
0.000
0.048
0.000
0.006
0.069
0.001
0.003
0.010
0.003
0.010
0.009
0.001
0.004
0.047
1
2
1
1
0
0
0
0
3
1
0
2
0
1
0
2
0
4
1
0
8
0.028
0.057
0.028
0.028
0.000
0.000
0.000
0.000
0.085
0.028
0.000
0.057
0.000
0.028
0.000
0.057
0.000
0.114
0.028
0.000
0.227
8
5
7
3
3
0
2
0
40
1
4
53
1
3
8
7
7
10
2
3
46
0
0.000
0
0.000
0 0.000
14
0.020
1
0.028
15
0
0
0
0
0.000
0.000
0.000
0.000
1
0
0
0
0.136
0.000
0.000
0.000
0
0
0
0
6
7
2
3
0.009
0.010
0.003
0.004
1
1
0
1
0.028
0.028
0.000
0.028
8
8
2
4
0.000
0.000
0.000
0.000
64
Background information of swimmers with shoulder injury
Table 18 has shown the background information of
swimmers who got the shoulder injuries. Items included the
subjects’ dominate side and injured side, the days for
recovery, the occasion when injury happened, the motion of
swimmers acquired during injury, the number of cases of
recurrent injury, the number of cases of acute shoulder
injury and the number of cases of participating in
competitions after recovery.
The most injured side was ambidextrous with 16 cases
(37.2%) followed by the right side (14 cases, 32.6%) and
left side (13 cases, 30.2%). The longest mean day of
recovery among the performance groups was 99 days which
equivalent to almost 3 months. Most shoulder injuries
happened during swimming training (20 cases, 46.5%). At the
moment of injury occurred, it was reported that the
subjects were under vigorous exercise (34 cases, 79.1%).
The recurrent rate was 41.9%, (18 cases) and there was
only 1 acute shoulder injury case that needed to send to
the hospital directly. The rate of participating in
65
competitions after recovery was high with 40 out of 43
cases (93.0%) with 3 swimmers had withdrawn.
There were 43 cases of shoulder injuries. Among the
five performance groups, there was no record of shoulder
injuries in the junior training squad level.
66
Table 18 Background information of swimmers with shoulder
injury of different performance level (N=43)
Hong
Kong
Team
(N=1)
1
0
Regional
Training
Squad
(N=1)
1
0
Junior
Training
Squad
(N=0)
0
0
Swimming
Club
swimmers
(N=38)
24
3
School
Swimming
Team only
(N=3)
1
2
0
0
0
11
0
0
1
1
0
0
0
11
11
2
1
0
0
0
16
0
18
20
0
99
50
1
1
0
16
2
0
0
0
8
1
0
0
0
6
0
0
0
0
5
0
0
0
0
3
0
0
0
0
1
0
1
0
0
5
0
0
0
0
31
3
Others (2)
0
1
0
1
0
Yes (18)
No (25)
1
0
1
0
0
0
16
22
0
3
Yes (1)
0
0
0
1
0
No (42)
Yes (40)
1
1
0
37
3
1
1
0
35
3
No (3)
0
0
0
3
0
Items
Dominate side Right (27)
Left (5)
Ambidextrous
(11)
Injured side
Right (14)
Left (13)
Ambidextrous
(16)
Days for
Mean
recovery
Occasion
During swimming
when injury training (20)
happened
After swimming
training (9)
During land/ land
training (6)
After land/ fitness
training (5)
During swimming
competition (3)
Motion
Static state (1)
acquire during Daily life work
injury
(6)
Vigorous exercise
(34)
Recurrent
Injury
Acute
shoulder
injury
Participate in
competition
after recovery
67
Types of shoulder injury
The types of shoulder injuries included in the study
were listed as follow (Table 19): overuse, strain,
dislocation, subluxation, sprain, inflammation and
arthritis. Sprain at shoulders was the most frequent type
among the five swimming styles (front crawl, butterfly,
breaststroke, backstroke and individual medley) with front
crawl swimmers acquired the most. Overuse was the second
one in front crawl and backstroke swimmers.
Table 19 Types of shoulder injury and the type of main
strokes (N=43)
Front
Individual
Type of Injuries
Butterfly
Breaststroke
Backstroke
Crawl
Medley
5
3
2
5
3
Overuse
9
4
4
4
2
Strain
0
2
1
0
0
Dislocation
0
1
0
0
0
Subluxation
1
2
0
1
1
Sprain
2
1
2
2
1
Inflammation
3
1
0
0
1
Arthritis
68
Recurrent rate and acute injury rate of shoulder of
different strokes
The recurrent rate of shoulder injuries at the same
position was 41.86% (18 cases). The rate of breaststroke
swimmers was high with 5 out of 18 cases (27.8%). Swimmers
of butterfly, individual medley, backstroke and front crawl
were ranked in a descending order.
Table 20 illustrated the recurrent rate and acute
injury rate of shoulder of different strokes. The acute
injury rate was low with only 1 butterfly swimmers had been
sent to the hospital directly due to the shoulder injury.
Table 20 Recurrent rate and acute injury rate of shoulder
of different strokes(N=43)
Recurrent
Injury
Yes
No
Total
Front
Crawl
2
11
13
Acute
shoulder
injury
Yes
No
Total
0
13
13
3
5
8
Individual
Medley
4
2
6
Percentage
(%)
41.86
58.14
100
0
8
8
0
6
6
2.33
97.67
100
Butterfly
Breaststroke
Backstroke
4
5
9
5
2
7
1
8
9
0
7
7
69
Treatments after first time and recurrent injury
Table 21 showed the types of treatment that subjects
had looked for after injury. When it was the first time to
have the injury, swimmers took rest (58.1%) or seek for
physiotherapists (27.9%) or the acupuncture treatment
(23.3%). Among the 18 recurrent cases, swimmers also chose
to take rest (11 cases), seek for physiotherapists (10
cases) or Chinese bone setters (5 cases)
Table 21 Treatments after first time and recurrent
injury (N=43)
First time
treatment
Recurrent
Types of treatment
(N=43)
treatment (N=18)
Rest
25
58.1
11
61.1
Emergency Treatment
5
11.6
1
5.6
(Hospital)
Orthopaedics Doctor
6
14
4
22.2
Family Doctor
Physiotherapist
Operations
Chinese Bone setter
Acupuncture
Others
N/A
4
12
2
9
10
3
/
9.3
27.9
4.7
20.9
23.3
7
/
3
10
0
5
4
2
23
16.7
55.6
0
27.8
22.2
11.1
/
70
The frequencies of the number of days staying in hospital,
number of days off from training and sports completely
The frequencies of the number of days staying in
hospital, number of days off from training and sports
completely were illustrated in Table 18. Five swimmers had
been stayed in the hospital for 1 to 2 weeks. The days off
from training and sports depended on the seriousness of the
injuries.
Table 22 The frequencies of the number of days staying in
hospital, number of days off from training and sports
completely (N=43)
0
1
2
3
1
2
3-4
Items
Days Week Weeks Weeks Month Months
Months
Hospital
38
4
1
/
/
/
/
Training
7
18
9
8
3
2
2
18
Sports
13
5
2
2
/
3
71
Self rating on muscle strength, range of motion and
swimming skills after treatment
The subjects were asked to compare and rate the
performance of the muscle strength, range of motion and the
swimming skills before and after injuries. The results were
listed in Table 23 and Figure 1. Most subjects rated the
three items as 3 (Neutral).
Table 23 Self rating (1-5)on muscle strength, range of motion
and swimming skills after treatment (N=43)
Items
Frequencies
Percentage
(%)
Mean
Median
Mode
Std.
Deviation
1
Muscle Strength
2
3
4
5
1
Range of Motion
2
3
4
2
6
22
10
3
5
5
20
4.7
14
51.2
23.3
7.0
11.6
11.6
46.5
Swimming skills
2
3
4
5
1
8
5
3
4
22
11
3
18.6
11.6
7.0
9.3
51.2
25.6
7.0
3.14
3.07
3.16
3
3
3
3
3
3
0.91
1.1
0.95
1-the performance is relatively better before injury;
5-the performance is relatively better after treatment
5
72
Figure 1 Histogram of the Self rating on muscle strength,
range of motion and swimming skills after treatment
73
Discussion
A total of 437 youth swimmers responded in this study.
The result was used to give a better understanding of the
common injury patterns, the effect of demographic
backgrounds including the training time, performance level
and the type of stroke that may lead to high risk of injury.
Similar studies have been conducted but the target groups
and the design of content were different. Thus, some of the
viewpoints between studies are worth discussing.
Injury pattern of swimmers
The choices of different injured sites in the study
were basically referred to a similar study in the 2009 FINA
World Championships (Aquatics). The respondents of that
study were participants of the Championships and they were
asked if they had suffered in any injuries during
competitions and the results showed that, in the swimming
section, shoulder and wrist/hand injuries (9 cases for both)
were the most injured parts followed by head/face, lumbar
spine/low back and hip/groin (each was 5 cases) (Mountjoy,
et al., 2010). The researchers concluded at the end that
most of the injuries were not acute but caused by overuse.
74
Differ from the FINA study, this study recorded
swimmers injury patterns over the past one year which means
that the injuries may not happened during swimming
competitions but during or after trainings. One of the aims
of the current study was to investigate the injury patterns
among the youth swimmers over the past one year so as to
serve as a reference for further study in comparing the
probability of injury incidences during different occasions
for example, during and after training, injury patterns
between swimmers and other sports participants like field
athletes and volleyball players.
From the result of our study, it is obvious that in
the upper extremities and body trunk, sprain/strain at
lumbar spine/low back (27 cases) and strain at shoulder (26
cases) were remarkable injured sites. In 2008, XVIth FINA
(Federation Internationale De Natation) World Sports
Medicine Congress was held in Manchester, Great Britain. In
the Congress, the topic about injuries in aquatic athletes
was being discussed. Presentation topics included 1)
Tendinopathies in Sports, 2) Management of shoulder
problems in swimming and 3) Assessment and management of
lumbar spine problems (FINA, 2008). The presented topics
75
were chosen because of their eye-catching statistics on
swimmers which were consistent with the findings from our
study.
Shoulder injuries of swimmers
The shoulder injury rate of front crawl swimmers were
very high with 20 cases of different types of injury.
Several studies have been conducted on the biomechanical
analysis of front crawl. In the front crawl, the arm stroke
provided a backward pull and push in order to swim forward.
This motion involved lots of muscle groups, for examples,
trapezius,pectoralis major, latissimus dorsi, deltoid and
rotator cuff. There were several factors that affect the
injury incidence of the shoulder joint. These muscle groups
were attached around the shoulder joint (glenohumeral
joint). Overtraining or overreaching could bring harm to
these muscle groups.
According to the results, the mean training hours of
swimming training among the swimmers was 6.77(SD±4.88)
hours per week and there were significant mean difference
between the hours of training in both swimming sessions and
76
land training sessions among the male and female swimmers.
From the findings, the incidence rate of injuries is 0.28
per 1000 training hours which was closed to the result of
0.39/1000h in the study of Knobloch, Yoon, Kraemer & Vogt
(2008). The demand and intensity of the training and the
physiological status for example, muscle fibre type,
strength and power of the muscles of the swimmers would
greatly affect the chance of occurrence of the injury
incidence (Sortwell, 2012).
Pink and Tibone reported that among the 233
competitive swimmers, 44% of swimmers had anterior-superior
region, 26% had diffuse pain, 14% had anterior-inferior
region, 10% had posterior-superior region and 4% in
posterior-inferior region (Pink & Tibone, 2000). Compared
with the current result, it could not reflect the positions
of the shoulder injuries but the types only. Further
investigation could be made on this issue.
From the results of the current findings, there was no
significant difference between injury incident rates and
the main swimming style they had. These were consistent
with Wolf et al. findings (2009).
77
Treating injuries, Prevention and Promote Health
In the third part of the study, most respondents
mentioned that they took rest or seek help from
physiotherapists. In the 2008 Manchester Congress, Dr.
Gillett mentioned in the presentation about the diagnostic
methods in treating the lumbar spine pain while Dr.Rodeo
focused on the swimmer’s shoulder (FINA, 2008). The focus
of the injured body sites on the Congress had also matched
and reflected in the injury rates of the current study
(shoulder region).
Moreover, Shona Halson from the Australian Institute
of Sport did a review on the overreaching and the
overtraining syndrome in swimmers in varies aspects:
performance, lactate, endocrine system, immune system and
mood state (Halson, 2011). It is found that the mentioned
areas could be the potential indicatiors of the
overtraining syndrome whereas the ‘useful indicators
include the performance on standard exercise test and selfanalysis of well being. Halson also suggested some ways for
swimmers to recover from intense training like hydrotherapy,
78
hot/cold water immersion and sleep (in quantity and
quality).
It is important to teach swimmers and coaches to
understand the symptoms and differences in shoulder pain
and soreness so as to minimize the continuous demage to
swimmer’s shoulders and help the athletes to recover and
engage to the training again. Coaches should also set up
swimming conditioning program that involved muscular
endurance, resistance training, flexibility of muscular
muscles and joints, and strengthening exercises on shoulder
muscle groups, for example, rotator cuffs, external and
internal rotators, adductors and abductors. Although ,from
the study, it was shown that there was no significant mean
difference between the warm up patterns and the injury
rates, warm up exercise is essential to every athletes so
as to prepare the body to get into the status of ready to
participate in order to prevent from getting injuries. Cool
down stretching is also important in bring down the heart
rate muscle state back to normal and minimize the effects
of fatigue.
79
Chapter 5
Summary and Conclusions
This chapter consists of three main parts. They are (1)
Summary of Results (2) Conclusion and (3) Recommendations
for Future Study.
Summary of Results
The results of the study were summarized as follows:
1. Out of the 437 respondents, there were 154 of them
(35.2%) got injured in the past one year. The injury
rates of each performance group were 1.8% for the Hong
Kong Team, 2.3% for the Regional training squad, 0.7%
for the junior training squad, 25.6% for the swimming
clubs swimmers and 4.8% for those trained in school
swimming team only. The One way ANOVA has shown that
there was no significant difference between the
performance level of the swimmers and the injury rates.
2. The distribution of the main swimming stroke of swimmers
was identified. For choosing front crawl as the main
stroke, there were 147 swimmers; for breaststroke, there
were 112 swimmers; for backstroke, there were 86
80
swimmers; for butterfly, there were 63 swimmers. 29
swimmers who were good at the four swimming strokes
chose individual medley as their main swimming style.
One way ANOVA showed that there was no significant
difference (p=0.451) between the main strokes of
swimmers and their injury rates.
3. There were 247 swimmers had participated in the
2010/2011 Championships. The One way ANOVA showed there
was significant mean difference (p=0.041) between these
232 swimmers (categorized into A, B, C grades) and the
injury rates. In the 2011/2012 Championships, 344
swimmers had participated and the One way ANOVA showed
that there was no significant difference (p=0.543)
between these 344 swimmers and the injury rates. Within
the 437 swimmers, there were 232 swimmers who had
participated in both 2010/2011 and 2011/2012
Championships. The One way ANOVA has shown that there
was no significant difference (p=0.863) between these
swimmers and the injury rates.
4. The mean training hours per week in swimming and fitness
sessions were 6.77 (SD±4.88) and 1.18 (SD±1.43)
81
respectively. The independent t-test showed that there
was significant difference (p=o.33) between the training
hours (both swimming and fitness training) of and the
injury occurrence.
5. The total training hours of the 437 respondents
(including swimming and fitness training sessions) was
3476.57 hours per week. The total number of injury
incidents was 427 cases. The incidence rate of injuries
was 0.28 injuries per 1000 training hours.
6. The warm up time of training (both swimming and fitness
training) were divided into 3 categories: less than 5
minutes, 5 to 10 minutes and more than 10 minutes. There
were 198 and 204 swimmers had less than 5 minutes for
their warm up in swimming and fitness trainings
respectively;182 (swimming training) and 185 (land
training) swimmers used 5 to 10 minutes and 57 and 48
swimmers used more than 10 minutes for their warm up in
the swimming and land training sessions. The One way
ANOVA showed that there was no significant difference
between the warm up time in both swimming training
82
(p=0.063) and land training (p=0.267) and the injury
rates.
7. The warm up exercises were divided into four types:
jogging, stretching, specific warm up and others. The
percentages of swimmers’ choices in the types of warm up
were as follow: (during swimming training) 17.39%,
87.41%, 28.15% and 8.24% in jogging, stretching,
specific warm up and others like sit-up and push up;
(during land training) 41.42%, 71.4%, 28.38%, 13.96% in
jogging, stretching, specific warm up and others like
rope skipping.
8. The cool down patterns of swimmers were similar. 288
swimmers had cool down after swimming training while 282
swimmers had cool down after land training. The
independent t-test showed that there were significant
mean differences between the cool down sessions in both
swimming and land training (p=0.045 and p=0.015
respectively) and the injury rates.
9. The four most injured body sites in the upper
extremities and dorsal trunk were shoulder (59 cases),
lumbar spine/low back (39 cases), cervical spine/neck
83
(27 cases) and wrist/hand (27 cases); in the lower
extremities, thigh/lower leg (94 cases), ankle/foot (82
cases) and knee (37 cases) were the three most common
injured body sites. Among the swimming club swimmers,
muscle cramps at thigh/lower leg was the most frequent
injury followed by strain at thigh/ lower leg (0.048)
and sprain at ankle (0.047). Shoulder strain and
sprain/strain at lumbar spine/low back had the same
incident rate of 0.034 (23 cases for both) and ranked
fourth.
10.There were 43 cases of injuries among the 437
respondents. For those who suffered in the shoulder
injuries, the most injured side was ambidextrous with 16
cases (37.2%) followed by the right side (14 cases,
32.6%) and left side (13 cases, 30.2%). it was reported
that, at the moment of injury occurred, the subjects
were under vigorous exercise (34 cases, 79.1%). There
was no of shoulder injuries recorded in the junior
training squad level of swimmers.
11.In the five swimming styles, front crawl swimmers
suffered the most (20 cases), followed by butterfly (14
84
cases), backstroke (12 cases), breaststroke (9 cases)
and individual medley swimmers (8 cases).
12.The recurrent rate of shoulder injuries at the same
position was 41.86% (18 cases). There was only one case
that swimmers needed to be sent to the hospital directly.
13.After suffered in the shoulder injuries for the first
time, swimmers took rest (58.1%) or seek for
physiotherapists (27.9%) or the acupuncture treatment
(23.3%). Among the 18 recurrent cases, swimmers also
chose to take rest (11 cases), seek for physiotherapists
(10 cases) or Chinese bone setters (5 cases)
14. Within the 43 swimmers who were suffered from shoulder
injuries, 5 of them have been stayed in the hospital; 7
of them did not stop training and 18 of them did not
stop involving in sports activities.
15.After recovered from the shoulder injuries, 22
respondents rated that their muscle strength and
swimming skills were in different (3, rating 1-5) as
before injury while 20 of them rated 3 (neutral) in the
range of motion of the shoulder joint.
85
Conclusion
This study gave a general injury patterns among the
competitive swimmers in Hong Kong. Although the injuries
incidents in swimming were not serious, it is essential to
reduce the injury rate to minimize the effect on swimmers’
performance and the chance of recurrent injuries. Therefore,
the training programs for swimmers should be well-planned
and revised regularly in order to enhance swimmers’
strength and abilities and to maximize their limits.
Recommendations for Further Studies
Base on the study, the following recommendations are
presented for further studies:
1. The items and choices of injuries were limited. It may
not be able to reflect all the problems.
2. Studies may focus on general group and other training
groups, e.g. the general public and high level
competitions.
3. Study may focus on general injury types or injured sites,
which may give the outline of the injury patterns, thus
move onto the correlation between the specific injured
sites of swimming and other sports.
86
4. Study may focus on the specific strokes and the
corresponding injured sites. Detailed result may provide
advice in setting up of preventive measure or specific
training program, e.g. different kind of swimming
strokes and the common injured sites in swimming.
5. Developmental research can be conducted in longitudinal
approach of the injured swimmers to follow up the
injured site status and swimmers’ participation in
swimming competitions after injury, e.g. the specific
treatments and the recovery periods.
6. Qualitative studies can be conducted to acquire in-depth
understanding of the mechanism of injury, which enable a
more meaningful conclusion, e.g. which specific skill or
action leading to a particular injury.
7. Research can include new and recurrent injuries of other
injured sites, to find out any relationship between them.
8. Research can include other injured sites about the
relationship between the dominant and non-dominant sides
of the swimmers and their injuries, to find out any
relationship between them.
9. Research can include the skeletal and muscular contents
of swimmers and other sports participants, to find out
87
the sports type that affects the particular bone and
muscle content which may lead to the common injuries,
e.g. the relationship between the bone density of
swimmers and basketball players and the rate of fracture.
10.Experimental studies can be conduct in the relationship
between the quantity of swimming training and the land
training in the skeletal muscular content or the
recovery of the injured sites.
11.Research can include the expense on medication for
injury.
12.Research can include psychological impact on swimmers
after injury.
13.Research can include what the swimmers will do to reduce
the risk of injuries.
88
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95
Appendix A
Letter to schools
96
Appendix B
中學學界游泳比賽受傷比率調查
本人是香港浸會大學體育系三年級學生。最近正進行一份關於中學校際游泳錦標賽(香港
及九龍) (第一組) 泳手受傷情況的研究。現誠邀閣下參與有關研究並回答本問卷以作收集
數據之用。
出生年份：__________
體重:_________公斤
性別：__________
身高:_________米
請圈出最適合您的答案。
甲部
1. a) 您有曾參加 2011/2012 年度(本年度)的中學校際游泳錦標賽？
a.
有 -> 請回答問題 1b
b.
沒有 -> 請回答問題 2
b) 請問您代表哪一個組別？
a.
甲組
b.
乙組
c.
丙組
2. a) 請問您有沒有參加 2010/2011 年度 (上年度) 的中學校際游泳錦標賽？
a.
有 -> 請回答問題 2b
b.
沒有 -> 請回答問題 3
b) 請問您代表哪一個組別？
a.
甲組
b.
乙組
c.
丙組
3. 請問您在過往一年內(2011 年 1 月至 12 月)，曾代表香港參加任何本地或海外的游
泳比賽嗎？
a.
有
b.
沒有
4. 請問您在哪裡接受訓練？
a.
香港代表隊
b.
地區游泳訓練隊
c.
青年軍
d.
游泳會
e.
只在學校校隊
97
5. 您的主項是？
a.
捷泳
b.
蝶泳
c.
胸泳
d.
背泳
e.
個人四式
6. 過去一年內，您平均每星期進行多少節游泳訓練?
平均每星期___ 節
7. 承上題，平均每節游泳訓練的時數是?
每節平均___分鐘
8. 進行游泳訓練前，您平均用多少時間作熱身運動?
a. 少於五分鐘
b. 五至十分鐘
c. 多於十分鐘
9. 進行游泳訓練前，您做的熱身運動包括? (可選多項)
□ 1 慢跑
□ 2 伸展(拉筋)
□ 3 針對性的熱身運動
□ 4 其他:____________
10. 運動後，您有沒有做緩和運動(cool down)?
a. 有
b. 沒有
11. 過去一年內，您平均每星期進行多少節輔助訓練(陸上訓練)?
平均每星期__ 節
12. 承上題，平均每節輔助訓練的時數是?
每節平均__分鐘
13. 進行輔助訓練前，您平均用多少時間作熱身運動?
a. 少於五分鐘
b. 五至十分鐘
c. 多於十分鐘
14. 進行輔助訓練前，您做的熱身運動包括? (可選多項)
□ 1 慢跑
□ 2 伸展(拉筋)
□ 3 針對性的熱身運動
□ 4 其他:____________
98
15. 在游泳或輔助訓練後，您有沒有做緩和運動(cool down)?
a. 有
b. 沒有
16. 過去一年內，您有沒有曾經受傷?
a. 有 (到乙部)
b. 沒有 (有關是次研究已經完成,謝謝)
乙部
過去一年內，您有否曾出現以下哪些受傷? (可選多項)
頭部/臉部
 腦震盪
 皮膚性損害
 扭傷
 其他_______
 挫傷
頸部/頸椎
 扭傷/拉傷
 肌肉抽筋
 其他_______
腰部/腰椎
 扭傷/拉傷
 其他_______
 肌肉抽筋
 筋膜炎
身軀其他位置
 胸椎受傷
 腹部受傷
 胸骨/肋骨/胸部肌肉 受傷
 其他_______
肩部
 脫臼
 挫傷
 受撞擊
 扭傷
 肌腱炎
 其他_______
 拉傷
 發炎, 黏液囊炎
手臂/手肘
 扭傷
 肌腱炎
 拉傷
 其他_______
 挫傷
手腕/手
 骨折
 挫傷
 肌腱炎
 皮膚性損害
 扭傷
 其他_______
臀部
 拉傷
 其他_______
 肌腱炎
 受撞擊
大腿/小腿
 拉傷
 抽筋
 挫傷
 其他_______
 皮膚性損害
膝部
 半脫臼
 肌腱炎
 扭傷
 皮膚性損害
 挫傷
 其他_______
足踝/足部
 骨折
 挫傷
 扭傷 (足踝)
 皮膚性損害
 扭傷/拉傷 (足部)
 其他_______
其他(請註明) :_____________________
如您的肩部曾有過任何受傷，請繼續回答丙部問題。
99
丙部
如您曾有過肩部受傷,請回答以下問題。
1. 慣用手：右 / 左 /兩手都善用的
2. 受傷部位：右 / 左 / 兩邊也曾受傷
3. 肩部第一次是在甚麼時候受傷?
_____/_____ (月月/年年年年)
4. 肩部是何時痊癒?
_____/_____ (月月/年年年年)
5. 肩部的第一次受傷是在什麼場合發生?
□ 1 游泳訓練過程中
□ 2 游泳訓練後
□ 3 輔助訓練過程中
□ 4 輔助訓練後
□ 5 游泳比賽中
6. 您如何受傷?
a. 靜止狀態
b. 日常生活活動
c. 激烈運動
d. 其他(請形容):_____________________________________
7. 受傷後，您如何處理患處及尋求協助? (可選多項)
□ 1 休息 □ 2 急症室 □ 3 骨科醫生 □ 4 家庭醫生 □ 5 物理治療
□ 6 進行手術 □ 7 中醫跌打 □ 8 針灸 □ 9 其他(請註明):_______________
8. 是次的肩部受傷類型為？
□１長期勞損 □２肌肉拉傷
□６肌肉發炎 □７關節發炎
□３脫臼 □４半脫臼 □５扭傷
□８其他(請註明):_______________
9. 受傷後，(在以下項目中) 您花了多少日子?
在醫院 ________天
停止訓練 ___________天
不接觸任何運動 ___________天
10. 肩部的同一位置有沒有再次受傷?
a. 有
b. 沒有
100
11. 您如何處理再次受傷患處及尋求協助?
□ 1 休息 □ 2 急症室 □ 3 骨科醫生 □ 4 家庭醫生 □ 5 物理治療
□ 6 進行手術 □ 7 中醫跌打 □ 8 針灸 □ 9 其他 (請註明):_______________
□ 10 不適用
12. 您有否因肩部受傷而緊急入院治療?
a. 有
b. 沒有
13. 康復後，您有否參加任何游泳比賽?
a. 有
b. 沒有
14. 請就以下的項目，比較您曾受傷的肩膀於受傷前及經過治療後的表現：
(1-代表受傷部位於受傷前的表現相對較好; 5-代表受傷部位於治療後表現相對較好)
評分
肌肉強度
1
2
3
4
5
動作幅度
1
2
3
4
5
游泳技術
1
2
3
4
5
是次問卷已經完成，謝謝您的參與。