Aquatic Concussions: Anecdotal Problem Or Widespread Issue?

No Diving Signs

No Diving Signs

The Brain Injury Association of America (BIAA) uses March as part of their awareness campaign to educate and expand the conversation around traumatic brain injuries, including helping the general public understand both the incidence rate of brain injuries, as well as how to support the brain community and their families.

Five to 10 percent of athletes will suffer from a concussion during any giving sporting season; the highest demographic being athletes between the ages of 15 and 17 years, according to the Southwest Athletic Trainers Association (SWATA). While many of these injuries will happen to the usual suspects (football, hockey and soccer players for high impact sports; cheerleaders and gymnasts for  high fall potential), one area in which head injuries occur that doesn’t get nearly enough attention is in and around swimming pools. Competitive swimming, synchronized swimming, and diving are sports where concussions and head injuries are understudied and often overlooked.

First, what is a concussion?

A concussion is considered a “mild” head injury by medical providers, in that (in the range of potential head injuries) it is usually not life-threatening. However, the effects of a concussion can be serious, long-lasting and invasive just as easily as they can be a temporary inconvenience.

A concussion is, according to the CDC “caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.” (x). Essentially the brain is normally protected by veins and fluid to stop it from jostling against the skull. However when the head, or body, are jostled too fast or sharply the “sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

Different parts of the brain can be affected depending on the specifics of the injury and how different people will recover. “Most people with a concussion recover well from symptoms experienced at the time of the injury. But for some people, symptoms can last for days, weeks, or longer.” (x)

Immediate symptoms include (severe symptoms requiring immediate emergency attention in bold):

  • Loss of consciousness (even brief loss of consciousness should be taken seriously)

  • One pupil larger than the other

  • Confusion (Unusual behavior, restlessness, agitation)

  • Headache (Which gets worse, or doesn’t go away.)

  • Slurred speech (Weakness, numbness or decreased coordination)

  • Dizziness

  • Ringing in the ears

  • Nausea (Vomiting, convulsions, seizures)

  • Amnesia

  • Tiredness (Inability to wake up or drowsiness)

Of these symptoms, the loss of consciousness in water presents the most immediate danger to swimmers and divers. The good news, though, is that 90% of concussions occur without loss of consciousness.  However, many swimmers who experience concussions in the pool often do not immediately notice their condition, continue the activity, and do not check in with a doctor because of the lack of awareness around concussions in swimming.

How widespread is the issue?

Today, facilities protect divers by regulating the depth of diving wells, posting ‘No Diving’ signs and Swimming Etiquette around commercial pools, and lifeguards monitoring the activity in and out of the pool. Swimmers, for the most part, however, have little to no safety equipment in and around the pool to protect against concussions, which is possibly why we are seeing 70% of pool injuries related to the head and neck.

In December 2016, Washington Post published an article titled ”Swimming is supposed to be low-impact, so why the concussions?” (x) in which writer Marlene Cimons details the experiences of two swimmers who had recently suffered concussive blows to the head from other swimmers. “We just don’t know what’s going on outside organized school sports, including among adults, although we believe the risk in swimming and diving to be fairly low,” says behavioral scientist Matt Breiding, who leads CDC’s traumatic brain injury team, part of its division of unintentional injury prevention. “We are trying to put together a national concussion surveillance system to get a better estimate.”

How are swimmers getting injured?

There are a few distinct situations where we see concussions taking place in swimming:

  • Diving into shallow water

  • Bumping against the pool wall during lane turns

  • Colliding with other swimmers (swimming the wrong direction, swimming too close in another lane, not following swimming etiquette)

  • Slipping on the pool deck

  • Dryland training (x)

While swimming has less occurrences of concussions than other sports, we see the added element of risk in a few places. For one, many injuries that happen to swimmers occur out of view and underwater so it can be difficult to isolate a moment of injury and swimmers can continue practicing or competing out of muscle memory, and by misattributing their symptoms. According to SwimmingWorldMagazine: “Swimmers are sometimes slow to recognize they have a concussion because many of the symptoms, like dizziness and blurred vision, can be caused by swimming upside down and holding their breath for long periods.”

What can we do?

As pointed out by the Washington Post article, a significant danger to swimmers is other swimmers. Swimmers pose a threat to each other when they do not follow proper lap swimming procedures, which is why posted signs detailing the proper lap swimming etiquette can prevent someone from significant injury (imagine a full-force kick to the head).  Facility staff can also monitor lane behavior, educate beginner swimmers, and enforce proper lap swimming procedures to prevent collisions.

As far as equipment and facility safety, helmets have been proposed for swimmers to absorb impact (such as with crashing into a wall, the force of water during a dive, a direct kick to the top of the head). While helmets reduce injuries and concussions in these situations, the NFL knows only too well that helmets are not concussion proof and do little to protect athlete’s brains from rotational or side impacts. (x)

To continue the NFL parallel, the association has created safety standards to prevent concussions that includes both personal padding and surfaces with Gmax impact absorption. One could argue that having impact surfacing on the walls of a pool as well as on the deck to reduce slip and falls (which are one of the leading causes of injury in most applications, not just aquatics) could prevent concussions in and out of the water. This doesn’t solve the problem of in-water collisions but does potentially address one piece of the puzzle.

As part of our company mission to help create safer aquatics facilities, we are writing about this issue to support the most universally helpful solution, awareness. Because we all know, there’s no such thing as risk elimination, but we can work together to provide risk mitigation. To learn more about awareness and concussion prevention, visit the BIAA website to see how you can get involved and bring awareness to your community and aquatics programs.