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Tamburrino P. D’Onofrio R.2 Martella M.3 Tucciarone A.

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.


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