Water Sanitation Health

Water-related Diseases

Spinal injury

The most important water-related cause of spinal injury is associated with recreational use, such as diving into water. Deformities of the spine may also occur when water has to be fetched and carried long distances over a considerable period of time.

The injury and how it affects people

The spine (vertebral column) - composed of blocks of bone (vertebrae) separated by soft-centred fibrous discs (intervertebral discs), which are bound together by ligaments and muscles - protects the spinal cord of the nervous system. Injuries range from damage to the vertebrae, ligaments and discs, to damage to the spinal cord itself. The effects depend on the severity and site of the injury; for instance, minor injuries may fracture one or more vertebrae without damaging the nerves or spinal cord. Hyperextension of the spine may occur in diving accidents, car crashes, or falls from a height, with particular risks to the cervical spine in the neck. Falls may dislodge one or more vertebrae, with consequent damage to the nerves. Severe damage to the cord and nerves emerging from the vertebral column will cause paralysis. The severity of disability depends on the level of the spinal cord where the damage is.

Damage in the lower or upper part of the back may cause some loss of trunk movement and complete or partial loss of leg movement. This is called paraplegia. Paraplegics also suffer loss of sensation (pain, temperature, vibration and position sense) and sometimes loss of bowel and bladder control. Damage to the spinal cord in the neck will cause some loss of arm movement and complete loss of trunk and leg movement. This is called quadriplegia. Some quadriplegics need mechanical ventilation for breathing because of paralysis of the chest muscles. The effects of spinal injury also include degeneration of the spine, deformity and severe pain.

The cause

Injury during recreational use of water, such as diving, is the main water-related cause of spinal injury. In the USA, the most common cause of spinal injuries in pools is from diving into the upslope of the pool bottom or into shallow water (WHO, 2000). In some developing countries where long journeys on foot are necessary to fetch water, women and children may suffer chronic damage or deformities of the spine due to the heavy weight of the water being carried or to falls on unsafe paths or in poor light when the journey to collect the water is made in the night or early hours of the morning. There are also many non-water-related causes of spinal injury, such as motor vehicle accidents, gun shots and stabbing.

Scope of the Problem

In a comparison of studies, diving-related injuries accounted for some 4-14% of spinal cord injuries in various countries (Minaire, et al., 1983). Diving-related injuries typically occur high in the spine and are frequently associated with quadriplegia. Those affected are commonly young adult males. However, there is at present insufficient information on the incidence and prevalence of spinal injury (WHO, 2000).


Diving injuries may be prevented by:

  • Education about diving hazards and safe behaviour
  • Supervision by life guards
  • Diving instruction
  • Access to emergency services for rapid first aid and treatment.

Where appropriate, the provision of safe access to water supplies in rural areas will help reduce injuries and damage to the spine due to carrying water.


Minaire P, Demolin P, Bourret J, Girard R, Berard E, Deider C, Eyssette M, Biron A. Life expectancy following spinal cord injury: a ten-years survey in the Rhone-Alpes Region, France, 1969-80. Paraplegia, 1983, 21(1): 11-15.

Promoting independence following a spinal cord injury: A manual for mid-Level rehabilitation workers (Unpublished WHO document, WHO/RHB/96.4).

WHO. Guidelines for Safe Recreational-Water Environments: Swimming pools, spas and similar recreational-water environments. Draft. Geneva, 2000.

WaterAid - Research on water, sanitation and hygiene education

Prepared for World Water Day 2001. Reviewed by staff and experts from the Disability and Rehabilitation Team (DAR), the Injuries and Violence Programme (VIP), and the Water, Sanitation and Health Unit (WSH), World Health Organization (WHO).