Prevention of injuries in young female players in European team handball. A prospective intervention study

Young female players in European handball have a very high injury incidence, up to 50 injuries per 1000 hours of game. More than half of these injuries happen without any external cause. The aim of the study was to investigate the effect of an intervention programme designed to reduce the number of injuries in young female players in European handball, with special emphasis on injuries in the lower extremities. The programme was created using elite athlete training programmes and those designed for rehabilitation of injured athletes with functional instability of their ankles and rupture of the anterior cruciate ligament. It included the use of an ankle disk for 10–15 min at all practice sessions, for one 10-month season (August 1995-May 1996). Twenty-two teams participated in the study, and were randomly assigned to the intervention or control group. Eleven teams with 111 players were randomised to the intervention group and 11 teams with 126 players to the control group. Data were analysed using a t -test for continuous variables, chi²-analysis and Fisher's exact test for dichotomous variables and multivariate methods to determine odds-ratios. The results indicated that using the intervention programme decreased the numbers of both traumatic and overuse injuries significantly. The differences in injuries between the groups were 80% during games and 71% during practice. In addition, the players in the control group had a 5.9 times higher risk of acquiring an injury than the players in the intervention group.     

Beach handball is safer than indoor team handball: injury rates during the 2017 European Beach Handball Championships

Purpose

Beach handball is a relatively new type of sports, which was derived from team handball. Medical issues such as frequency and severity of injury are yet unknown. The purpose of this study was to investigate the injury pattern and injury rates of this new type of sports.

Methods

This study investigated the injury incidence of 30 national teams (10 senior and 20 u-17 teams, 16 men’s and 14 women’s teams) participating in the 2017 European Beach Handball Championships. Reports on injuries sustained during the senior and u-17 youth tournaments were provided by the medical staff of each team. Injury incidence was differentiated between age and sex, and between the five field positions (goalkeeper, wing, central defender, pivot, and specialist).

Results

During the tournaments, 87 injuries were recorded yielding an overall injury incidence of 286.1 per 1000 match hours. Time-loss due to injury was 49.3 per 1000 match hours. Senior players had a higher overall injury incidence with 395.3 injuries than u-17 players with 205.7 injuries per 1000 h match hours (p?<?0.01). Comparison of the injury incidence between the two sexes showed 330.23 injuries per 1000 h handball exposure for male players and 234.9 injuries for female players (n.s.). The most frequent injury type was sprains (21 injuries, 24.1%) followed by contusions (19 injuries, 21.8%) and skin abrasions with (15 injuries, 17.2%). Central defenders and specialists had the highest injury incidence. Thighs, ankles, as well as foot and toes (altogether 12 injuries, all 13.8%) were the three most frequently injured anatomic sites.

Conclusions

Beach handball seems to have a lower incidence of time-loss injuries than that reported for indoor team handball. This study is an important basis for developing injury prevention strategies in this sports that should focus on thighs, ankles, feet and toes. Further research into this new type of sports is essential to identify risk factors and to develop adequate injury prevention measures.

Level of evidence

II.

     

An epidemiologic and traumatologic study of injuries in handball

To identify the risk factors of injuries in handball, 221 players were followed during one indoor season. The injury incidence was 4.6/1000 playing hours and 11.4/1000 game hours. The upper extremity was involved in 41% of the injuries including 21% finger sprains. Ankle sprains were the most common injury (33%), and overuse injuries accounted for 18%. The risk of reinjury was 32%. Contact with opponent players during running or shooting caused 31% of the injuries. Errors during grasping the ball were the reason for most of the finger injuries. Forty percent of the injuries was treated by the players themselves. After the injury 73% were absent from handball for more than 1 week. Forty-one percent of the injured players had complaints 6 months after the end of the season. The study shows that injuries in handball are serious and cause extensive consequences for the players. In most of the injuries both intrinsic and extrinsic factors were involved, and prophylactic intervention in these cases demands changes in more fields.     

Injury pattern in youth team handball: a comparison of two prospective registration methods

The purpose of this study was to examine the injury incidence and pattern of injuries in youth female and male team handball players using two different prospective registration methods; match reports (90 teams, 1080 players) and coach reports (34 teams, 428 players). A total of 118 injuries were recorded by the coach report, of which 93 (79%) were acute injuries (incidence training: 0.9+/-0.16 injuries/1000 player hours; matches: 9.9+/-1.26; rate ratio vs training: 10.8 [95% confidence interval (CI) 7.0-16.6]; P<0.0001) and 25 (21%) were overuse injuries. Knee (26%) and ankle (24%) injuries accounted for half of the acute injuries (training: 0.5+/-0.12 injuries/1000/h; matches: 4.4+/-0.84; rate ratio vs training: 8.0 (95% CI 4.5-14.5); P<0.0001). No gender difference was found in the injury rate (rate ratio female vs male: 1.3 (95% CI 0.8-2.1); P=0.40). Most of the injuries occurred in the attacking phase by back or wing players doing a plant-and-cut, landing or turning movement, and more than half in contact situations with the opponent. Similar results were observed for acute match injuries in the match report. These results indicate that the rate of injuries in youth team handball is as high as at the senior level, and prevention should focus on knee and ankle injuries. The coach report seems to be the best method to register injuries in youth team handball to provide a full spectrum of injuries according to their type, incidence and severity.     

UEFA Champions League study: a prospective study of injuries in professional football during the 2001-2002 season

Background: No previous study on adult football involving several different countries has investigated the incidence and pattern of injuries at the highest club competitive level. Objective: To investigate the risk exposure, risk of injury, and injury pattern of footballers involved in UEFA Champions League and international matches during a full football season. Method: Eleven top clubs (266 players) in five European countries were followed prospectively throughout the season of 2001–2002. Time-lost injuries and individual exposure times were recorded during all club and national team training sessions and matches. Results: A total of 658 injuries were recorded. The mean (SD) injury incidence was 9.4 (3.2) injuries per 1000 hours (30.5 (11.0) injuries per 1000 match hours and 5.8 (2.1) injuries per 1000 training hours). The risk of match injury was significantly higher in the English and Dutch teams than in the teams from France, Italy, and Spain (41.8 (3.3) v 24.0 (7.9) injuries per 1000 hours; p = 0.008). Major injuries (absence >4 weeks) constituted 15% of all injuries, and the risk of major injury was also significantly higher among the English and Dutch teams (p = 0.04). National team players had a higher match exposure, with a tendency towards a lower training injury incidence than the rest of the players (p = 0.051). Thigh strain was the most common injury (16%), with posterior strains being significantly more common than anterior ones (67 v 36; p<0.0001). Conclusions: The risk of injury in European professional football is high. The most common injury is the thigh strain typically involving the hamstrings. The results suggest that regional differences may influence injury epidemiology and traumatology, but the factors involved are unclear. National team players have a higher match exposure, but no higher risk of injury than other top level players.     

Neuromuscular exercises prevent severe knee injury in adolescent team handball players

Purpose

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players.

Methods

Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury.

Results

Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01–0.90), p?=?0.019. Other injuries to the lower extremities showed no significant difference between the two groups.

Conclusions

Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

     

Handball injuries during major international tournaments

BACKGROUND: Several authors have analyzed the incidence of handball injuries in amateur players but information of handball injury in top-level players is very limited. The aim of the study was to analyze the incidence, circumstances and characteristics of handball injuries during major international tournaments. METHODS: Injuries during six international handball tournaments were analyzed, using an established injury report system. The physicians of all participating teams were asked to report all injuries after each match on a standardized injury report form. The response rate was on average 87%. RESULTS: The incidence of injury was on average 108 injuries/1000 player hours (95% confidence interval (CI): 98-117) or 1.5 injuries/match (95% CI: 1.4-1.6). The injuries affected most frequently the lower extremity (42%), followed by injuries of the head (23%), upper extremity (18%) and trunk (14%). The most frequent diagnosis was contusion of head (14%) or ankle sprain (8%). The majority of injuries were caused by contact with another player. The incidence of time loss injuries was on average 27/1000 player hours (95% CI: 22-32), and significantly higher in men than in women. CONCLUSION: Preventive program proven effective should be implemented. Fair Play is an essential aspect of injury prevention. Therefore, close cooperation with the referees is also necessary to make handball a safer sport.     

Soccer injuries among elite female players

Injuries occurring in two female elite soccer teams were recorded during 1 year. Of 41 players, 33 (80%) sustained 78 injuries. The incidence of injury during games was 24/1000 hours, while the incidence during training was 7/1000 hours. The majority (88%) of injuries were localized to the lower extremities, with equal occurrence in the left and right legs. Forty-nine percent of the injuries occurred in the knee or ankle. Most of the injuries were minor (49%), while 36% were moderate and 15% were major. Of the major injuries (N = 12), 10 were due to trauma and 7 (58%) were knee ligament or meniscal tears. Overuse injuries constituted 28% of all injuries and occurred mainly during preseason training and at the beginning and end of the competitive season. Traumatic injuries (72%) occurred mainly during games with a predominance at the beginning of the competitive season. Almost 80% of the traumatic injuries occurred during physical contact with an opponent. Extrinsic factors such as weather, playing surface, temperature, or the position of the player within the team did not influence the injury rate. We conclude that female elite soccer players sustain a high incidence of injury. Few injuries were major, but 17% of the players sustained a major knee injury during the year.     

Incidence and risk factors of injuries in Brazilian elite handball players: A prospective cohort study

The aim of this study was to investigate the incidence and risk factors for handball injuries in Brazilian elite handball players. Overall, 339 athletes from 21 handball teams who participated in the two main Brazilian championships were followed up during a season. In total, 312 injuries were reported by 201 athletes. The injury incidence rate during training was 3.7/1000 h, and during matches was 20.3/1000 matches. Ankle (19.4%, n = 46) and knee (13.5%, n = 32) were the body regions most affected by traumatic injuries. Shoulders (44.0%, n = 33) and knee (26.7%, n = 20) were the body regions most affected by overuse injuries. Muscle injuries (27.1%, n = 68) was the traumatic injury type most reported. Tendinopathy (91.8%, n = 56) was the overuse injury type most observed. Previous injury (OR: 2.42, CI 95%: 1.51–3.89) and an additional match per week (OR: 1.31, CI 95%: 1.05–1.62) were associated with a higher risk of overuse injury. Female athletes (OR: 1.56, CI 95%: 1.08–2.25) and an additional hour of training per week (OR: 1.09, CI 95%: 1.02–1.15) were associated with a higher risk of traumatic injury. This study showed that athletes with previous injury have shown a high risk of developing an overuse injury.     

Injury risk in female floorball: a prospective one-season follow-up

The purpose of this prospective study was to examine the incidence, nature, causes, and severity of injuries in female floorball. Three hundred and seventy-four licensed female floorball players from Finnish top leagues were observed prospectively for one season (6 months). The practice and game hours of floorball were recorded on an exercise diary. All injuries were registered with a structured questionnaire and verified by a physician. During the study period, 133 out of the 374 (35%) players sustained 172 injuries. The injury incidence was 1.8 per 1000 practice hours and 40.3 per 1000 game hours. Of all injuries, 70% were traumatic and 30% were from overuse. The most common injury type was joint sprain (27%). The most commonly injured sites were the knee (27%) and ankle (22%). Twenty-one of the knee injuries (46%) were serious including 10 anterior cruciate ligament (ACL) ruptures. Eight of ACL ruptures occurred during floorball games, giving an ACL rupture incidence of 3.6 per 1000 game hours. Eleven injuries (6%) needed hospital admission. The study attested that injury rate in floorball game is very high. Injury prevention strategies in female floorball should be targeted at injuries occurring at the knee and ankle.     

Epidemiology of injuries in typical Scandinavian team sports

An investigation by questionnaire was undertaken in a group of 480 football players and 288 handball players (768 players). Of these 803 were injured, giving a player incidence of 4.1 injury/1000 football hours and 8.3 injury/1000 handball hours. The lower extremities were involved in 82% of the football injuries, whereas handball injuries were evenly distributed on both upper and lower extremities. The football injury prevalence was 0.36 per player, the handball injury prevalence 0.71 per player. Medical attention was given to 62% of the injured footballers and 47% of the injured handballers. Based on the injury pattern, some modifications to the rules and equipment in the two sports is suggested: The "boot-type" footwear should be tried out, and the soles in both games should correspond to the different playing surfaces that may be encountered. Stricter enforcement of the rules, and the use of a maximum size playing ground in both sports. Last, but not least a modification of the football rules concerning substitution is a must.     

Registration of cruciate ligament injuries in Norwegian top level team handball. A prospective study covering two seasons

All cruciate ligament injuries in the three upper divisions for men and women (3392 players) in Norwegian team handball in the 1989-90 and 1990–91 seasons were registered. A questionnaire was mailed to all injured players. Ninety-three cruciate ligament injuries were registered; 87 in the anterior cruciate ligament (ACL), and six in the posterior cruciate ligament (PCL). Among women, 1.8% were injured compared with 1.0% of the men. In the first division, the risk of being injured was considerably higher: 4.5% of the players had a cruciate ligament injury. There were 0.97 cruciate ligament injuries per 1000 playing hours in the three divisions taken together. Seventy-five per cent of the injuries occurred during games. Ninety-five per cent involved no contact between players. Activities in which the friction between shoe and floor was significant caused 55% of the injuries. Injuries caused by running into another player contributed to only 5% of the injuries. No significant differences were observed in injury incidence during matches between different types of floors (parquet, Pulastic and other synthetic sufaces).     

Comparison of two intervention programmes in young female players in European handball--with and without ankle disc

INTRODUCTION: The prevention of injuries in all sports calls for a structured plan. The plan consists, as earlier described, of four steps. We have previously presented studies incorporating all four steps. The studies have shown that it is possible to prevent most injuries in young female players in European handball by applying a training programme combining the use of an ankle disc with functional strength training. In the previous studies we were not able to discriminate whether the preventive effect was due to the functional strength training or the training with the ankle disc. The aim of this study was to compare a programme with ankle disc and functional strength training with a programme with functional strength training only. METHODS: Twenty handball teams were asked to participate, and 16 of 20 handball teams agreed to participate. The teams were cluster randomised to either the programme with or without an ankle disc. RESULTS: The group using the programme without the ankle disc had a significantly higher number of traumatic injuries (16 vs. 6). The incidences of traumatic injuries in the ankle disc group were 2.4 (95% CI 0.7; 6.2) injuries per 1000 h of match and 0.2 (95% CI 0.02; 0.7) injuries per 1000 h of practice. In the group without ankle disc the incidences were 6.9 (95% CI 3.3; 12.7) injuries per 1000 h of match and 0.6 (95% CI 0.2; 1.3) injuries per 1000 h of practice. A significantly higher multivariate odds ratio (4.8) was found in the group not using the ankle disc. In addition the group using the ankle disc had significantly fewer moderate and major injuries. CONCLUSION: By adding ankle disc training to a training programme with functional strength training, it is possible to reduce the number of injuries significantly, especially the number of moderate and major injuries.     

Injuries in Norwegian female elite soccer: a prospective one-season cohort study

Female soccer has become increasingly popular during the last two decades. According to the International Football Association (FIFA) there are approximately 40 million registered female soccer players in the world. Three studies in elite soccer have shown an injury incidence during games ranging from 12.6 to 23.3 injuries per 1,000 h. A very high incidence of ACL-injuries ranging from 0.31 to 2.2 per 1,000 game hours has also been shown. We followed the Norwegian female elite series during the 2001 season to estimate the incidence and characteristics of injuries. A total of 181 female soccer players on ten teams were followed during the 2001 elite season in Norway. We recorded baseline data, match and training exposure and injury data as type of injury, location and severity of injury. The mean age of the players was 23 years (range 17–34). A total of 189 injuries were recorded and 19 (10%) of these were overuse injuries; 89 (47%) occurred during games and 100 (53%) during training sessions. The incidence of acute injuries was 23.6 per 1,000 game hours and 3.1 per 1,000 training hours. The majority of the injuries occurred in the lower extremities (81%), but there were also a significant number of head injuries (6.3%). The most common injury type was ankle sprain (17.2%). Half of the injuries were minor, with training or game absence of less than 7 days. Midfielders sustained the most injuries (32.6%) with an incidence of 42.4 per 1,000 game hours. We recorded two ACL-injuries and two PCL-injuries during the season. They all occurred during games, and the incidence was therefore calculated to 0.6 per 1,000 game hours for both injury types. The incidences of injuries reported for female soccer varies considerably, with the highest numbers reported from Germany and the present study. These studies have also the highest incidence of minor injuries registered. The location of the injuries is quite similar compared to other reports, but the number of ankle sprains seems to be higher in our study, whereas the number of knee and thigh injuries is lower. There has been much attention to ACL injuries in team handball and hamstring injuries in soccer in Norway, and this could have influenced the team’s pre-season training, resulting in a reduction in the incidence of these injury types. The high number of ankle injuries has to be addressed to see whether this is a result of inadequate rehabilitation routines leading to re-injuries, or other factors. The high number of ACL-injuries in these reports is alarming and needs special attention in the future.     

Injuries in team sport tournaments during the 2004 Olympic Games

BACKGROUND: Several authors have analyzed the incidence of injuries in a given sport, but only a few have examined the exposure-related incidence of injuries in different types of sports using the same methodology. PURPOSE: Analysis of the incidence, circumstances, and characteristics of injuries in different team sports during the 2004 Olympic Games. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: During the 2004 Olympic Games, injuries in 14 team sport tournaments (men's and women's soccer, men's and women's handball, men's and women's basketball, men's and women's field hockey, baseball, softball, men's and women's water polo, and men's and women's volleyball) were analyzed. After each match, the physician of the participating teams or the official medical representative of the sport completed a standardized injury report form. The mean response rate was 93%. RESULTS: A total of 377 injuries were reported from 456 matches, an incidence of 0.8 injuries per match (95% confidence interval, 0.75-0.91) or 54 injuries per 1000 player matches (95% confidence interval, 49-60). Half of all injuries affected the lower extremity; 24% involved the head or neck. The most prevalent diagnoses were head contusion and ankle sprain. On average, 78% of injuries were caused by contact with another player. However, a significantly higher percentage of noncontact (57%) versus contact injuries (37%) was expected to prevent the player from participating in his or her sport. Significantly more injuries in male players (46%) versus female players (35%) were expected to result in absence from match or training. The incidence, diagnosis, and causes of injuries differed substantially between the team sports. CONCLUSION: The risk of injury in different team sports can be compared using standardized methodology. Even if the incidence and characteristics of injuries are not identical in all sports, prevention of injury and promotion of fair play are relevant topics for almost all team sports.     

Injuries in adolescent female players in European football: a prospective study over one outdoor soccer season

In this prospective study, injuries in 153 adolescent female soccer players were recorded during one outdoor season (April-October). The overall injury incidence rate was 6.8 per 1000 h soccer (games and practice) and the incidence rate of traumatic injury 9.1 and 1.5 per 1000 player-hours in games and practice, respectively. Sixty-three players (41%) sustained 79 injuries. Sixty-six percent of the injuries were traumatic and 34% were overuse injuries. Most of the traumatic injuries occurred during games. Eighty-nine percent of the injuries were located in the lower extremities and 42% occurred in the knee or ankle. The most frequent type of injury was ankle sprain (22.8%). Forty-one percent of the traumatic injuries and 56% of the ankle sprains were re-injuries. Most of the injuries were of moderate severity (52%), while 34% were minor and 14% were major. Most of the major injuries were traumatic such as knee ligament injuries and ankle sprains.     

A retrospective injury analysis of state representative female soccer players

Objectives: A 5-year retrospective injury survey was conducted with 45 female elite soccer players from the Queensland Academy of Sport (QAS), to record the anatomical distribution, diagnosis and incidence of injury and identify possible risk factors in elite female soccer players at the QAS from 1993–1998. Methods: Data were gathered from medical, physiological, coaches and team managers' records. Results: The study recorded 239 injuries. Incidence of injury was highest in 1994 (12·2 per 1000 h) and lowest in 1995 (5·0 per 1000 h). Athletic exposure almost doubled between 1994 and 1995. Incidence of injury per 1000 athletic exposure hours decreased from 12·2 to 5 between 1994 and 1995. The leg accounted for 81·5% of all injuries and 52% of injuries involved the foot, ankle and shin. Strains (35%) and sprains (31%) were the most common diagnoses. Most injuries were of a mild nature (61%), with major injuries accounting for 19% of total injuries over the period 1993–1998. The most common major injuries were stress fractures (29%), with tibial stress fractures being the most common type. Injuries to the ankle, shin or both these areas were sustained by 66% of players. Seventy-six percent of ankle injuries and 100% of shin injuries were recurrent. Twenty-two percent of players had both ankle and shin injuries, in 90% of cases ankle injury was sustained before the shin injury. Conclusions: Ankle and shin were the most common injury in this group of high performance female soccer players with high recurrence. Incidence of injury may be related to athletic exposure.     

Isokinetic muscle performance in healthy female handball players and players with a unilateral anterior cruciate ligament reconstruction

A total of 114 healthy female European team handball players in the elite to second division with no previous ACL injury, and the uninjured legs of 22 females with a unilaterally reconstructed ACL (the injury sustained while playing handball; mean time from reconstruction 15 months) were examined with a Biodex isokinetic testing device. Five extensions and flexions at lower speed (60°/s) and 15 repetitions at higher speed (240°/s) were performed. Gravity-corrected peak torque values for flexion and extension were obtained, and hamstrings-to-quadriceps ratios (H/Q) were calculated at both speeds. Compared with the control group, the uninjured legs of the injury group showed 8% weaker quadriceps muscles and 14% higher H/Q ratios at higher speed. The other between-group comparisons were not significant. These differences could have been developed by strength reduction after the injury in the noninjured limb due-to-insufficient rehabilitation, by a weaker musculature in the patient group already initially, or by both mechanisms. If the second option is true, the finding may indicate that weak quadriceps musculature is one of the risk factors for anterior cruciate ligament injuries. The study establishes additional normative data on hamstrings and quadriceps torque on high-level female handball players.     

Injuries in youth amateur soccer and rugby players--comparison of incidence and characteristics

OBJECTIVES: In reviewing the literature on sports injuries, few studies could be found in which exposure related incidences of injury in different types of sport were compared. These studies indicated that ice hockey, handball, basketball, soccer, and rugby are popular team sports with a relatively high risk of injury. The aim of the study was to compare the characteristics and incidence of injuries in male youth amateur soccer and rugby players. METHODS: This prospective cohort study comprised an initial baseline examination to ascertain the characteristics of the players and their level of performance, and a one season observation period during which a physician visited the team weekly and documented all occurring injuries. Twelve soccer and 10 rugby school teams with male amateur players aged 14-18 years were selected for the study. 145 soccer and 123 rugby players could be followed up over one season. RESULTS: Comparison of the incidence of soccer and rugby injuries indicated that rugby union football was associated with a significantly higher rate of injury than soccer. The differences were pronounced for contact injuries, injuries of the head, neck, shoulder, and upper extremity, as well as for concussion, fractures, dislocations, and strains. Rugby players incurred 1.5 times more overuse and training injuries in relation to exposure time, and 2.7 times more match injuries than soccer players. Three rugby players but no soccer players had to stop their participation in sport because of severe injury. CONCLUSION: The incidence of injury in New Zealand school teams playing soccer or rugby union is high, probably in part because of the low ratio of hours spent in training relative to hours spent playing matches. The development and implementation of preventive interventions to reduce the rate and severity of injury is recommended.