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Diving and High-Diving Evidence Summary: Diving and High-Diving Clodagh Toomey, PT, PhD Version 1 February 2018 The British Columbia Injury Research and Prevention Unit (BCIRPU) was established by the Ministry of Health and the Minister’s Injury Prevention Advisory Committee in August 1997. BCIRPU is housed within the Evidence to Innovation research theme at BC Children’s Hospital (BCCH) and supported by the Provincial Health Services Authority (PHSA) and the University of British Columbia (UBC). BCIRPU’s vision is to be a leader in the production and transfer of injury prevention knowledge and the integration of evidence-based injury prevention practices into the daily lives of those at risk, those who care for them, and those with a mandate for public health and safety in British Columbia. Author: Clodagh Toomey Editors: Sarah A Richmond, Amanda Black Reproduction, in its original form, is permitted for background use for private study, education instruction and research, provided appropriate credit is given to the BC Injury Research and Prevention Unit. Citation in editorial copy, for newsprint, radio and television is permitted. The material may not be reproduced for commercial use or profit, promotion, resale, or publication in whole or in part without written permission from the BC Injury Research and Prevention Unit. For any questions regarding this report, contact: BC Injury Research and Prevention Unit F508 – 4480 Oak Street Vancouver, BC V6H 3V4 Email: [email protected] Phone: (604) 875-3776 Fax: (604) 875-3569 Website: www.injuryresearch.bc.ca Suggested Citation: Toomey C, Black A, Richmond SA, Pike I, Babul S. Evidence Summary: Diving and High-Diving. Active & Safe Central. BC Injury Research and Prevention Unit: Vancouver, BC; 2018. Available at http://activesafe.ca/. Evidence synthesis tool Competitive (high schools and club-level to elite professionals) and recreational SPORT: Diving and High-Diving (not scuba) Target Group: divers Injury Mechanisms: All Injury: Musculoskeletal or concussion injury sustained during diving training, competition or recreation Incidence/Prevalence Risk/Protective Factors Interventions Implementation/ Evaluation Resources Competitive Diving Competitive Diving Recreational Diving Recreational Diving Recommendations for The injury rate during professional In elite junior male divers, Few prevention programs for In an assessment and interventions based on games (competition and practice) is Shoulder flexibility (O= 0.919; diving-related injury or spinal evaluation of primary evidence-based risk factors reported as 8.1% (female 5.9%, male 95% CI 0.851 to 0.992) and age cord injury have evaluated or prevention in spinal cord for DSCI have been published 7.4%; 2012 Olympics)1 and ranges (OR=0.441; 95% CI 0.239 to published their outcome injury,14 it was found that a by Barss et al 2008 (personal, from 114 to 134 injuries per 1000 0.814) are recognized as risk effectiveness. school-distributed educational environmental and athletes in diving and is 48 injuries per factors related to lower back video, Sudden Impact (Think equipment interventions).17 1000 athletes in the high dive event pain. Only age (OR=0.536; 95% A systematic review10 in 2008 First), was only viewed by an (FINA World Championships 2009 and CI 0.335 to 0.856) was a factor descriptively evaluated average of 16% of students in ThinkFirst – US National Injury 2013).2,3 in female-elite junior divers.5 interventions for the prevention each school.15 Little change in Prevention Foundation – of spinal cord injury in diving. attitude and no consistent education for kids, youth and In elite varsity NCAA teams, the diving Recreational Diving change in knowledge or teens. injury rate in males is 1.94 (1.18 to In all divers, risk factors for The American Red Cross behaviours were seen as a http://www.thinkfirst.org/ 2.69) and in females is 2.49 (1.69 to cervical spinal cord injury were Swimming and Diving guidelines result of Think First in high 3.29). Shoulder injuries are common in assessed in two systematic in 1992 required a minimum school students. Dive Smart (Parachute males (32%); trunk injuries are most reviews (2005 and 2008). Risk depth of water below the tip of Canada) injury prevention common in females (37.8%). Most factors included consumption the diving board in a standard Underuse of materials is an programs injuries are classified as overuse of alcohol (3.4% of all SCIs in public pool of 9 ft. No incidences implementation barrier for http://www.parachutecanada (males 24%; females 21.6%).4 Japan were sport-related under have been reported of SCI in many prevention programs .org/injury- the influence of alcohol, while Olympic sized public pools that that do not own the topics/item/diving-and-injury- Lower back pain is the most 30% of sport-related SCIs were meet these criteria. Most diving distribution channels for prevention-dive-smart-and- commonly reported injury in elite under the influence of alcohol related SCI (DSCI) occur in their work. sudden-impact 7 competitive divers with prevalence in the US) , presence of a pool residential pools where the Implementation facilitator 5,6 rates of 38.4-49% reported. party, water depth <1.2m, maximum depth is less than 9 ft. - In general, prevention Sudden Impact leader’s guide absence of a lifeguard on duty, programs (from non diving- http://www.parachutecanada Recreational Diving non-competitive standard, A number of education programs related sources) with .org/downloads/injurytopics/ In a systematic review of all sport reduced risk perception, poor (see resources) on diving safety multimodal (including social Think_First__Sudden_Impact_ participants, the proportion of spinal lighting, hidden objects, lack of have been implemented in North media) components that LG_Eng_v3.2_2007_07_27.pdf cord injury (SCI) in diving related to depth markings or warnings, America but not evaluated for include long-term follow-up all-sport SCI was 35.3% (range 7.7- lack of adequate effectiveness in reducing DSCI. and “booster” interventions 64.9%). This was the highest reported design/legislation.8,10 One educational video to appear to be more effective of all sports. The most common schoolchildren in Slovenia noted than one-dimensional, one- groups to experience high cervical SCI Protective factors for spinal a decrease from seven DSCI per time programs.14 are adolescent and young adult cord injury include diving with year to two DSCI per year after 3 experienced male divers. Almost all maximized flight distance and a years of education. In structured interviews with SCI related to diving (87%) occur in low entry angle with steering 120 children (age 7-10y) that private or residential swimming pools. technique appear to be safest. A 60-min audio-visual (ThinkFirst) evaluated “no diving” warning Non-competitive standard diving Head and neck injury is reduced lecture on brain and spinal cord signs for shallow water, accounts for 70% of SCI cases. 7,8 with hands held together, injury prevention significantly children understood that thumbs locked and arms changed students' opinions about breaking your neck results in In a representative sample of US extended beyond the head.10 checking the depth of swimming limitations in mobility and can Emergency Department records, there pool 5 months later. This was the occur from diving, but they did was an average yearly rate of 8.4 only attitude that changed after not anticipate that such an diving-related injuries seen per the educational intervention.11 injury is likely to occur.16 100,000 US residents under age 20 years. 9 In public diving facilities, more Implementation Barrier restrictive regulation of dive Younger children were less forms was not associated with a likely to interpret text decrease in injuries in the information. Having diving previous 12 months (p = 0.93). Risk was perceived to be lower experience biased children for those with experience, and toward assuming less these people favoured less likelihood of injury. 12 regulation. Implementation Facilitator An intervention (7 10-minute “Danger” should be the sessions) to improve diving skill in signal word of choice for inexperienced divers was warning signs targeting successful in significantly children. Explicitly saying on reducing diving depth (with lesser No Diving signs that one can entry angles, improved hand/arm “break your neck” may placement, greater flight distance maximize effectiveness of and steering-up manoeuvre) in the warning. In addition, different dive types 20 months providing active supervision 13 later. by adults has been shown to reduce children’s risk behaviours.16 Works Cited: Works Cited: Works Cited: Works Cited: Works Cited: 1. Engebretsen L, Steffen K, Alonso 5. Narita T, Kaneoka K, 10. Cusimano MD, Mascarenhas 14. Sandin KJ, Klaas SJ. 17. Barss P, Djerrari H, Leduc JM, et al. Sports injuries and illnesses Takemura M, Sakata Y, Nomura AM, Manoranjan B. Spinal cord Assessment and evaluation of BE, Lepage Y, Dionne CE. Risk during the London Summer Olympic T, Miyakawa S. Critical factors injuries due to diving: a primary prevention in spinal factors and prevention for Games 2012. (2013). British Journal of for the prevention of low back framework and call for cord injury. (2013). Topics in spinal cord injury from diving Sports Medicine, 44(11), 772-780. pain in elite junior divers. prevention. (2008). Journal of Spinal Cord Injury in swimming pools and (2014). British Journal of Sports Trauma, 65(5), 1180-1185. Rehabilitation, 19(1), 9-14. natural sites in Quebec, 2. Mountjoy M, Junge A, Alonso JM, et Medicine, 48, 919-923. Canada: A 44-year study. al. (2010). Sports injuries and illnesses 11. Falavigna A, Teles AR, Velho 15. Bhide VM, Edmonds VE, (2008). Accident Analysis and in the 2009 FINA World 7. Chan CWL, Eng JJ, Tator CH, MC, et al. Impact of an injury Tator CH. Prevention of spinal Prevention, 40(2), 787-797.
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