DOWNLOAD – Pdf article: Statistical epidemiological trends of injuries in European Handball. Retrospective analysis.pdf
Tamburrino P.1 D’Onofrio R.2 Martella M.3 Tucciarone A.4
Handball is classified as a team sport, alternating aerobic-anaerobic, with a metabolic activity dependent mainly on the anaerobic-alactacid system. During a match the athlete makes numerous changes of direction and pace, vertical jump shots or standing shots and shots while falling. We can see that: a) 73-75% of all shots in a match are made during a jump, b) 14-18% standing shooting while running (c) 6-9% penalty d) 2-4% shots while falling e) 0-1% direct free shots (40). Recent studies have analyzed the gestural pattern of shots in handball teams, highlighting different expressive gestural techniques related to different ball velocity (41). Bayios and Boudolos (42) studied the differences in ball velocity and throwing accuracy among handball players in the Greek Elite Championship. The author showed how a different ball velocity is also linked to specific gestures: a) shoot while running without jump (speed 26.3 ± 3.2 m • s-1) b) shot without run nor jump (speed 23.5 ± 2.2 m • s-1) c) jump shot (speed 22.7 ± 2 m • s-1). A complete kinematic analysis of the shot in a handball team (40, 41) showed that angular velocity of shoulder internal rotation to ball release, and maximum elbow extension are important contributors to ball velocity. Contacts-contrasts occur with very high frequency in throwing. Hence it is clear that the risk of traumatic events affecting the osteomyoarticular system is high and unavoidable. The aim of this work is to fathom the existing literature on handball injuries and give an overview of the most important international works, in order to identify the risk factors and the most frequent injuries during agonistic sport activity.
Epidemiological investigation in European Handball
Already in 1988 handball was subject to a study by Nielsen AB, Yde J., (2). The incidence of lesions found on 221 handball players, was 4.6/1000 training hours and 11.4/1000 hours game. Upper limb injuries were 41% of the total, among these 21% were linked to lesions of metacarpophalangeal. Conversely Wedderkopp et al (43) in 1977 completed a retrospective study on Danish handball, and found that young female players had a much higher injury incidence, up to 41 injuries per 1000 hours game. Injury rates among senior players are similar to those found in young players, 12 to 14 lesions per 1000 hours game (44). Ankle sprain is the most common injury (17, 40, 43) 44, 45) with a percentage of 33%, while overuse injuries were around 18%. Re-injury risk remained very high, as in other sports with jumping; it was found around a percentage of 32%. According to the authors, the main injury mechanism is the contact/contrast (Figure 1), and this is a game situation occurring mainly during the shot, which is known as overhead gesture (31% of lesions). Injury risk in handball is substantial, this was confirmed by the International Olympic Committee (IOC) during the latest Summer Olympic Games. In their study Engebretsen et al (7) reported that 22% handball players got injured during the 2012 London Games (45). Compared to other Olympic team sports, injuries appear to be much lower than soccer (35% of players injured in the Olympic tournament) but significantly higher than basketball (11%) and volleyball (6.9%). Hand-distorting events are mainly related to poor ball reception, falls on the court while performing acrobatics, or arm block by defenders in the throwing / passing phase. Technical errors in ball catching are the primary injury mechanism for the majority of harmful events to metacarpophalangeal and interphalangeal joints. After harmful events 73% of injured players are absent from training and matches for more than 2 weeks. 41% of handball players do not reach a satisfactory clinical and sports recovery, and have “complications” till the end of the season and beyond. 40% of the athletes use unprofessional cares and treatments. A chronic damage of lumbosacral hinge was especially found in athletes over 28 years. D’Onofrio R. et al 2010 (17), in an unpublished statistical work on the 2008/2009 championship in A1 Men Handball Division, studied a sample of 90 players, belonging to 6 teams….
From this review on European handball, we can conclude that handball goalie’s elbow is the valgusforce repetitive stress injury characterizing the role of handball goalkeeper, and it is the most disabling injury as far as sport performance is concerned. Handball is an overhead sport that gives supra-physiological stress, therefore a prominent place in the injury pyramid have overuse injuries and tendinitis or tendinosis of Achilles tendon, patellar tendon, supraspinatus, long head of the biceps brachii. We do not have to forget the repetition of technical movements, which concur in increasing risk factors, as do mistakes in the training programme and early resumption of sports activity after a rehabilitation phase.
- A.Dal Monte, M. Faina Valutazione dell’atleta Utet ed.
- Nielsen AB, Yde J. An epidemiologic and traumatologic study of injuries in handball. Int J Sports Med 1988 Oct;9(5):341-4
- Leidinger A, Gast W, Pforringer W. Traumatology in indoor handball sports. A sports medicine analysis of the incidence of injuries and accident epidemiology of indoor handball sports in senior players in the Federal Republic of Germany after 1981] Sportverletz Sportschaden 1990 Jun;4(2):65-
- Fagerli UM, Lereim I, Sahlin Y Injuries in handball players] Tidsskr Nor Laegeforen 1990 Feb 10;110(4):475-8
- Yde J, Nielsen AB. Sports injuries in adolescents’ ball games: soccer, handball and basketball Br J Sports Med 1990 Mar;24(1):51-4
- Lindblad È, Hoy K, Terkelsen CJ Helleland Lui, Terkelsen CJ Handball injuries. An epidemiologic and socioeconomic study. Am J Sports Med 1992 Jul-Aug;20(4):441-4
- Lund-Hanssen H, Gannon J, Engebretsen L, Holen K, Hammer S. Isokinetic muscle performance in healthy female handball players and players with a unilateral anterior cruciate ligament reconstruction. Scand J Med Sci Sports 1996 Jun;6(3):172-5
- Seil R, Rupp S, Tempelhof S, Kohn D. Injuries during handball. A comparative, retrospective study between regional and upper league teams Sportverletz Sportschaden 1997 Jun;11(2):58- 62
- Tyrdal S, Olsen BS. Hyperextension of the elbow joint: pathoanatomy and kinematics of ligament injuries. Shoulder Elbow Surg 1998 May-Jun;7(3):272-83
- Tyrdal S, Pettersen OJ. The effect of strength training on ‘handball goalie’s elbow’–a prospective uncontrolled clinical trial. Scand J Med Sci Sports 1998 Feb;8(1):33-41
- Popovic N, Ferrara MA, Daenen B, Georis P, Lemaire R. Imaging overuse injury of the elbow in professional team handball players: a bilateral comparison using plain films, stress radiography, ultrasound, and magnetic resonance imaging. Int J Sports Med 2001 Jan;22(1):60-7
- Myklebust G, Maehlum S, Holm I, Bahr R. A prospective cohort study of anterior cruciate ligament injuries in elite Norwegian team handball. Scand J Med Sci Sports 1998 Jun;8(3):149- 53
- Asembo JM, Wekesa M. Injury pattern during team handball competition in east Africa. East Afr Med J 1998 Feb;75(2):113-6
- Tyrdal S, Bahr R. High prevalence of elbow problems among goalkeepers in European team handball — ‘handball goalie’s elbow’. Scand J Med Sci Sports 1996 Oct;6(5):297-302
- Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. Prevention of injuries in young female players in European team handball. A prospective intervention study. Scand J Med Sci Sports 1999 Feb;9(1):41-7
- Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K Injuries in young female players in European team handball. Scand J Med Sci Sports 1997 Dec;7(6):342-7
- D’Onofrio R Tamburrino P. Indagine epidemiologica nel handball/pallamano Relazione personale – Relazione personale -. CPO CONI – formia 10 marzo 2010 –
- Kaalund S, Lass P, Le Fevre S, Sinkjær Clinical significance of altered gastrocnemius muscle coordination in anterior cruciate ligament-deficient knees. Scand J Med Sci Sports 1992: 2: 79– 83.
- M. Osborne , T Rizzo Prevention and Treatment of ankle sprain in athletes Sport med 2003,33,15,1145 – 1150
- Sear J.A. Ericson J.C. T.W. Worrell EMG analysis of lower extremity muscle recruitment patterns during an unloaded squat Med sci sports exercise 29: 532-539 1997
- Escalilla, R.F. , GS Fleisig, N. Zheng Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises Med. Sci sports Exerc. 30:556-569 1998
- Zakas A, Vergou A, Grammatikopoulou MG, Zakas N, Sentelidis T, Vamvakoudis S. The effect of stretching during warming-up on the flexibility of junior handball players. J Sports Med Phys Fitness. 2003 Jun;43(2):145-9.
- Petersen W, Zantop T, Steensen M, Hypa A, Wessolowski T, Hassenpflug J. Prevention of lower extremity injuries in handball: initial results of the handball injuries prevention programme Sportverletz Sportschaden. 2002 Sep;16(3):122-6.
- J Yde and AB Nielsen Sports injuries in adolescents’ ball games: soccer, handball and basketball British Journal of Sports Medicine, Vol 24, Issue 1 51-54, 1990
- Wedderkopp N, Kaltoft M, Holm R, Froberg K. Comparison of two intervention programmes in young female players in European handball–with and without ankle disc. Scand J Med Sci Sports. 2003 Dec;13(6):371-5.
- E OIsen & L Engebretsen Injury Mechanisms for ACL Injuries in Team Handball – A Video Analysis Norvegian Sport science 2004
- Myklebust G, Engebretsen L, Braekken IH, Skjolberg A, Olsen OE, Bahr R. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons Clin J Sport Med. 2003 Mar;13(2):71-8.
- Reckling C, Zantop T, Petersen W. Epidemiology of injuries in juvenile handball players Sportverletz Sportschaden. 2003 Sep;17(3):112-7.
- Henry JC, Kaeding C. Neuromuscular differences between male and female athletes. Curr Womens Health Rep. 2001 Dec;1(3):241-4.
- Wojtys EM, Huston LJ, Boynton MD, Spindler KP, The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. Am J Sports Med. 2002 Mar-Apr;30(2):182-8.
- D’Onofrio R. Manzi V.,Colli R.,D’Ottavio S. Riflessi delle modificazioni ormonali sull’incidenza delle lesioni del legamento crociato anteriore e sulla performance fisica nel basket femminile. Teknosport 2004 (30) 27,34
- M.Cardinale,R.Colli,V.Manzi Allenare la specificità Sport &medicina 2,marzo aprile 2000 – 35-39
- D’Onofrio R. Manzi V.,Colli R.,D’Ottavio S. Pintus A. Un legamento da proteggere Analisi dei rischi connessi alle manovre di crossover e sidestep cutting e proposta di un protocollo di esercizi propriocettivi nella prevenzione delle lesioni del lca nella pallacanestro femminile sulla base della letteratura internazionale Sport&medicina ;21,2, 37 –46, 2004
- Genevois C. Effects of 6-Week Sling-Based Training of the External Rotator Muscles on the Shoulder Profile in High-School Elite Female Handball Players J: Sport Rehabil 2014 Jul 23. [Epub ahead of print]
- Edouard P. Shoulder strength imbalances as injury risk in handball In J Sports Med 2013 Jul;34(7):654-60
- Clarsen B. Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study Br. J Sports Med 2014 Sep;48(17):1327-33.
- Clarsen B. The prevalence and impact of overuse injuries in five Norwegian sports: Application of a new surveillance method Scan J: Med Sci Sport 2014 Mar 30 [Epub ahead of print]
- Michaelidis M et al Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: a systematic review. Phys Ther Sport 2014 Aug;15(3):200-10
- Zebis MK Acute fatigue impairs neuromuscular activity of anterior cruciate ligament-agonist muscles in female team handball players. J Med Sci Sports 011 Dec;21(6):833-40.
- Wagner, H., Tilp, M., von Duvillard, S. and Müller, E. (2009) Kinematic analysis of volleyball spike jump. International Journal of Sport Medicine 30, 760-765.
- Wagner, H., Kainrath, S. and Müller, E. (2008) Coordinative and tactical parameters of teamhandball jump throw. The correlation of level of performance, throwing quality and selected techniquetactical parameters. Leistungssport 38, 35-41. (In German).
- Bayios, I. and Boudolos, K. (1998) Accuracy and throwing velocity in handball. In: XVI International Symposium on Biomechanics in Sports, Konstanz, Germany, July 21 – 25, 1998
- Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. Injuries in young female players in European team handball. Scand J Med Sci Sports 1997; 7:342-347.
- Seil R, Rupp S, Tempelhof S, Kohn D. Sports injuries in team handball. A one-year prospective study of sixteen men’s senior teams of a superior nonprofessional level. Am J Sports Med 1998; 26:681-687.
- Engebretsen L, Soligard T, Steffen K, Alonso JM, Aubry M, Budgett R et al. Sports injuries and illnesses during the London Summer Olympic Games 2012. Br J Sports Med 2013; 47:407-414.
- Strand T, Tvedte R, Engebretsen L, Tegnander A. [Anterior cruciate ligament injuries in handball playing. Mechanisms and incidence of injuries]. Tidsskr Nor Laegeforen 1990; 110:2222-2225.
- Myklebust G,Engebretsen L, Braekken IH, Skjolberg A, Olsen OE, Bahr R. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 2003; 13:71-78.
- Langevoort G, Myklebust G, Dvorak J, Junge A. Handball injuries during major international tournaments. Scand J Med Sci Sports 2007; 17:400-407.