Workload and Noncontact Musculoskeletal Injury in Collegiate Swimmers: A Prospective Cohort Study

Context: Swimmers are known for experiencing high training loads and a high incidence of overuse injuries, but few researchers have investigated the relationship between the two at the collegiate level. Objective: To determine the association between workload and noncontact musculoskeletal injury in collegiate swimmers. Design: Prospective cohort study. Setting: College natatorium. Patients or Other Participants: A total of 37 National Collegiate Athletic Association Division III swimmers, 26 uninjured (age = 19 years [interquartile range = 3 years], height = 175 +/- 11 cm, mass = 70.2 +/- 10 kg) and 11 injured (age = 19 years [interquartile range = 3 years], height = 173 +/- 9 cm, mass = 69.4 +/- 13.5 kg) individuals. Main Outcome Measure(s): Logistic regression using generalized estimating equations was conducted to calculate odds ratios (ORs) with 95% CIs for injury relative to high workloads and high acute:chronic workload ratio (ACWRs). Injury rates for several ranges of workloads and ACWRs were also calculated. Results: A total of 11 participants (29.7%) sustained 12 injuries, with 7 injuries occurring during the participants' winter training trip. Injury was associated with high acute workloads (OR = 27.1; 95% CI = 8.2, 89.8) and high ACWRs (OR = 25.1; 95% CI = 7.7, 81.4) but not high chronic (OR = 2.6; 95% CI = 0.3, 20.0) or overall (OR = 1.00; 95% CI = 0.99, 1.01) workloads. High acute workloads (>37.2 km/wk) and ACWRs (>1.56) increased the injury rate from <= 1% to 15% and 14%, respectively, compared with all lower acute workloads and ACWRs. Conclusions: Collegiate swimmers tolerated high workloads spread out during the season. However, caution should be used when prescribing high acute workloads and high ACWRs (eg, winter training trip) because of the increased odds of injury.