Polo

Polo and the Shoulder

Participation in polo is increasing and the HPA estimates that approximately 3000 people play in the UK.  It is a physically demanding mounted contact sport.  As such, players of all levels are at risk of sustaining sports injuries, and these injuries may force players to moderate their play or abstain altogether.  Of course, collisions and falls can also cause acute trauma, such as fractures and dislocations.  While no player wishes to dwell on injuries, most will nevertheless be interested to know more about the common injuries and, how they might be avoided and, if you have an injury, how it might be treated. 

 

There is scant data on sports injuries from polo in the published medical literature, so in 2016 Mr Granville-Chapman surveyed over 200 members of the Hurlingham Polo Association in order to gain a better understanding of the incidence and nature of both sports injuries and acute traumatic injuries from polo. This data forms one of the largest representative samples in polo. 

• 75% of players reported at least one sports injury from polo
• The upper limb dominated the breakdown of injuries: 
  • Over a third reported a shoulder injury
  • Almost 40% suffered an elbow problem 
  • A third had a wrist injury
• 60% of players required physiotherapy or chiropractor input 
• 22% required referral to a sports physician or orthopaedic surgeon
• 30% of those injured could not play chukkas for more than two weeks
• 7% were impacted for the rest of the season

 

The Shoulder in polo

In the shoulder, the commonest problems were related to the subacromial bursa and the rotator cuff tendons and these were reported in 30% of players who reported a sports injury. Problems with the proximal biceps tendon, the acromioclavicular joint and the glenoid labrum were reported in a few patients. 

It is no surprise that the upper limb suffers so frequently in polo.  There are several components of the game which place high demands on the region:

 

Swinging the mallet

The long mallet, although relatively light, hugely amplifies forces that pass through the shoulder. Many amateur players have inefficient swings that require more force to generate power

The full swing requires a complete range of motion in the shoulder, so poor control of the shoulder blade, a stiff back and/ or a weak core will predispose players to impingement and subacromial problems (bursitis or rotator cuff injury)

 

Checking / riding off 

This is a contact sport – the closing velocity of the two ponies and the upper body checking action of the players produces significant impacts – these may produce attritional damage to the shoulder, and may even cause acute trauma

 

Hooking 

A player may attempt to hook the mallet of an opposing player as they attempt to strike the ball.  This is often performed at full stretch with the and sometimes on the near side: the shoulder is therefore in a vulnerable position for overload injury to the biceps, labrum and rotator cuff 

As with most sports, repeated technical imperfections can produce issues such as tendinopathies 

• Most players reported undertaking between 4-8 hours of polo (including between 3 and 10 chukkas) per week in the season.  22% play for ten hours or more a week - this represents many repetitions of a high-load activity for the shoulder 
• 75% of players held handicaps of -2 or -1.  These relatively inexperienced players are likely to have more rudimentary and inefficient swings than the high goal players, so although they may play fewer hours of polo, they may well be exposing their shoulders to extra risk of injury
• 42% of players in the survey were aged between 35 and 55.  This age bracket is typical for the onset of most tendinopathies, so it is unsurprising that subacromial bursitis and rotator cuff disease were commonly reported
• Sport-specific training is employed in many sports to reduce injury rates
  • Only 11% of polo players reported undertaking any polo-specific pre-season training
  • The majority reported generally keeping fit and conditioned, but almost 30% stated that they simply turned up to play with no preparation
  • A focused polo-specific programme may reduce the incidence of polo sports injuries

  

 

Shoulder acute trauma in polo 

• The majority of these injuries will occur after a fall or a collision
• Landing on an outstretched arm, or directly onto the shoulder is common when falling in polo
• Over half of the players in the survey recorded at least one acute injury (fracture or dislocation) in the previous five years
• Again the upper limb dominated the injury breakdown:
  • 23% recorded a shoulder or collarbone fracture
  • 19% broke their arm or forearm
  • 14% sustained a break in the hand
• As you would expect, these injuries had a significant impact on work, driving, time off play  and return to pre-injury level