Injury prevention in elite handball

Abstract

Handball is a team throwing sport characterised by frequent and rapid changes of movement, high intensity running efforts, cutting and jumping, frequent physical contact between opponents and repeated overhead throwing at high velocity. Considering injury risk, the shoulder region has been highlighted as an area warranting preventative efforts, especially in regard to overuse injuries, with reduced glenohumeral rotation, external rotation weakness and obvious scapular dyskinesis suggested as modifiable risk factors. Furthermore, players have been reported to be at high risk of acute injuries, especially during matches, with a lack of knowledge on their mechanisms. The main aim of this dissertation was to inform injury prevention efforts in elite handball, with an emphasis on overuse shoulder injuries specifically and acute injury mechanisms in general. Methods: This dissertation is based on two separate research projects. In the first project (Paper I, II and III), we evaluated the effect of an exercise programme developed to prevent overuse shoulder injuries in a cluster-randomised controlled trial including elite handball players (Paper I) and assessed whether previously identified risk factors could be confirmed in a prospective risk factor study including the players in the control group (Paper II). The exercise programme was designed to increase glenohumeral internal rotation, external rotation strength and scapular muscle strength, as well as improve kinetic chain and thoracic mobility. Towards the end of the intervention period, we also examined the end-user perspective on prevention of shoulder injuries, as well as key issues related to the application of the exercise programme (Paper III). In the second project (Paper IV), we described acute injury mechanisms and evaluated referee performance based on prospective video analysis of acute injury situations during the 24th Men´s Handball Wold Championship in 2015.

Paper I: Andersson SH, Bahr R, Clarsen B, Myklebust G. Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players. Br J Sports Med 2017;51:1073-1080

Paper II: Andersson SH, Bahr R, Clarsen B, Myklebust G. Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed. Br J Sports Med. Published Online First: 07 August 2017. doi:10.1136/bjsports-2017-097648

Paper III: Andersson SH, Bahr R, Olsen MJ, Myklebust G. Attitudes, beliefs and behaviour towards shoulder injury prevention in elite handball: fertile ground for implementation. Submitted Br J Sports Med, 27 February 2018.

Paper IV: Andersson SH, Cardinale M, Whiteley R, Popovic N, Hansen C, Sanz Lopez F, Bere T, Bahr R, Myklebust G. Video analysis of acute injuries and referee decisions during the 24th Men´s handball world championship 2015 in Qatar. Submitted Scand J Med Sci Sports, 16 June 2017. Revision submitted, 01 December 2017. Second revision submitted, 19 February 2018.