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

Context: Shoulder pain is pervasive in swimmers of all ages. Yet due to a limited number of prospective studies, risk factors for injury 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 non-contact musculoskeletal injury in college swimmers. We hypothesized each risk factor would be associated with increased odds of injury. Design: Prospective cohort study. Setting: College natatorium. Patients or Other Participants: Thirty-seven Division III college swimmers. Main Outcome Measures: Participants completed preseason questionnaires on previous injuries and perceived susceptibility to sport injury. At the beginning of the season, they completed the Movement System Screening Tool and Freestyle Swimming Technique Assessment. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals for the association between each risk factor and injury. Results: Eleven of the 37 participants (29.7%) sustained an injury. Univariate analyses identified two risk factors: previous injury (OR = 8.89 [95% CI = 1.78, 44.48]) and cross-over hand positions during the freestyle entry phase (OR = 8.50 [95% CI = 1.50, 48.05]). After adjusting for previous injury, higher perceived percentage chance of injury (one item from the perceived susceptibility to sport injury questionnaire) decreased injury odds (adjusted OR = 0.11 [95% CI = 0.02, 0.82). Poor movement competency was not associated with injury (P > 0.05). Conclusions: Previous injury, a cross-over hand entry position in freestyle, and low perceived percentage chance of injury were associated with increased injury odds. Ascertaining injury histories and assessing for cross-over may help identify swimmers with elevated injury risk and inform injury prevention strategies.