Dr. Jim Hicks

For more than a decade I have followed the sport of water polo. All three of my sons played high

school polo, and my youngest also played club (SET, SoCal), and collegiate polo (UC Davis,

2009-2012). At its best, the sport is a beautiful game to watch. The sport has elements of its

land based cousins, hockey, soccer and basketball. In addition, its combination of power, speed,

tactics and strategy makes it, in my opinion, a great spectator sport.

In 2013, I became the Director of a new program at the University of California Irvine called, the

Exercise Medicine and Sports Sciences Initiative (EMSSI; http://emssi.uci.edu). It is a unique

multidisciplinary program that promotes scholarly activities and innovative discoveries in all fields

associated with movement, including sports medicine and rehabilitation.  The Initiative is

dedicated to enhancing human health and wellness through undergraduate and graduate

teaching, basic and translational research, development of innovative technologies, service to the

community, and clinical activities.

Latest posts by Dr. Jim Hicks (see all)

Concussion and Water Polo

Over the past several years there has been growing awareness of contact sports and the associated risks of concussions.  Based on my personal experience of watching water polo, combined with my curiosity as a physiologist and role as Director of EMSSI, I was motivated to ask what were the concussion risks in water polo.  Searching the medical literature became frustrating.  Although I found epidemiological studies about football, soccer, lacrosse, ice hockey, field hockey, basketball, softball, wrestling and cheerleading, there was no single study on water polo.   So last year, along with my colleagues, Drs. Steven Small, Chair, Department of Neurology and Robert Blumenfeld of the Brain Circuits Laboratory, we developed a questionnaire that asked players’ experiences with head injury in the sport.  With the help of USA Water Polo, a link to our survey was emailed to all members of USAWP.

A link to our published results (The epidemiology of sports-related head injury and concussion in Water Polo)  is here;


This paper is OPEN ACCESS and can be downloaded by anyone:

We found that 36% of respondents report sustaining a concussion while playing water polo, with an average of two concussions reported.  As might be expected, the prevalence and number of concussions reported varied across positions, levels, and gender. Most strikingly, we found that goalies are at significantly higher risk for concussion and report significantly more concussions. In addition, goalies received more head impacts from balls shot during practice as compared to games.   It is important to point out that during our analysis we were curious as to how our results compared to other sports.  Unfortunately, that comparison is not currently possible.  In our study we report lifetime prevalence, while in other contact sports, concussion risks are often reported as an incident rate (injury rate per hours of exposure).  So at this time we cannot make direct comparisons.  

As this is the first systematic survey of concussions in water polo, we note several important limitations of our study related to sample size, self-reporting bias, age and memory.  Our paper addresses each of these limitations in detail and we conclude that our results more likely reflect the specific risk factors of head injury in water polo, rather than survey bias.    

Finally, we make several recommendations regarding the sport.  Our results speak to the clear need for systematic concussion reporting in water polo. In particular, reporting for individuals at the college level, who have among the highest prevalence of concussion, is especially vital. The NCAA should require a systematic collection of all injury information in water polo (during practice and games), just as they require for other sports.  Such reporting systems will ultimately allow comparisons of incident rates to other sports. Second, our data strongly suggests that goalies are at a disproportionate risk for concussion and head injury compared to other positions. Given that goalies report that most of their head impacts occur during practice, we recommend that goalies wear head protection during practice, regardless of level (age group club, high school, NCAA).

Where do we go next?  In cooperation with UCI’s Department of Intercollegiate Athletics, we will begin using small 3D-accelerometers (https://www.triaxtec.com) to measure, in real time, head impact forces during actual game play in our UCI men’s and women’s team this coming year. Such data may be used to drive re-evaluations of rules or help design future equipment and can ultimately provide important information regarding player management.    In addition, we are partnering with UCI’s School of Medicine to develop cutting-edge diagnostic and assessment protocols for traumatic brain injury that can be used in all of our student-athletes.

Our team at UCI is comprised of scientists and physicians, and all of us are sports fans.  We understand that concussion can never be eliminated, as all activities have inherent risks. Our goal is simple; to learn as much as we can about the game, provide insights into risks, and to ultimately apply our knowledge to provide the best advances in sports neurology to athletes.