Association of Cognitive Function and Water Polo Exposure with Sports Injuries in Youth Water Polo Players

Background: Water polo is a sport that combines substantial physical contact with high cognitive demands, exposing athletes to sports-related injuries, including head and orofacial trauma. This study investigated associations between cognitive performance, cumulative water polo exposure and injury history in youth water polo players. Methods: This cross-sectional study included 161 youth water polo players (103 males, 58 females; mean age 15.76 ± 1.53 years). Sports-related injury history was assessed using an online questionnaire. Cognitive performance was evaluated with the computerized Stroop test. Sport exposure time (years of official water polo participation) and number of games played were extracted from the official Croatian Water Polo Federation database. Logistic regression analyses were adjusted for age and sex; additional head injury models were adjusted for years of participation. Results: A history of overall sports-related, head and orofacial injury was reported by 93 (57.8%), 65 (40.4%) and 51 (31.7%) players, respectively. Participants with head injury history had lower Stroop OffTime (55.90 ± 6.46 s vs. 58.56 ± 8.72 s, p = 0.028) and OffTime + OnTime (118.63 ± 16.10 s vs. 125.10 ± 22.11 s, p = 0.033) in unadjusted comparisons. However, the Stroop test measure was not independently associated with head injury history after adjustment. Each additional year of water polo participation was associated with 34% higher odds of reporting head injury history (aOR = 1.34, 95%CI 1.08–1.65, p = 0.007), while number of games played was not independently associated with any injury history outcomes. Conclusions: Within the limits of the cross-sectional design, longer participation in water polo, used as an indirect measure for cumulative exposure, appears more strongly associated with head injury history than the cognitive measures assessed. Prospective longitudinal studies are needed to establish temporal relationships and evaluate future injury risk.