Neuromuscular fatigue and recovery in elite female handball players

The purpose of this study was to investigate the degree of neuromuscular fatigue and recovery from fatigue, following handball training and handball matches at elite level. The focus was specifically on changes in physical performance when playing three matches over the course of 3 days, which simulates a sequence in international championships. Female players from the Norwegian national handball team were tested during a 5-day training camp (seven players) and a 3-day international tournament (eight players). Testing was done before and after training sessions and matches. Neuromuscular fatigue was measured as changes in voluntary isokinetic knee extensions, jump height in counter-movement jumps, and 20 m sprint time. The results showed a significant reduction by 2-6% in all three performance tests during the training camp and by 4-7% during the tournament (sprint and jump test) (P<0.05). Slow recovery was indicated by incomplete restoration of performance between matches and training sessions. The paper discusses the insufficient recovery measured related to handball performance. Because of changes in the rules of the game and strategic tendencies towards higher speed in play, the physical demands in elite handball seems to be increasing. The results of the study indicate that coaches should consider physical loading and recovery time available when distributing playing time between individual players in international tournaments.     

Effects of hip and head position on ankle range of motion,ankle passive torque,and passive gastrocnemius tension

Ankle joint range of motion (ROM) is notably influenced by the position of the hip joint. However, this result remains unexplained. Thus, the aim of this study was to test if the ankle passive torque and gastrocnemius muscle tension are affected by the hip and the head positions. The torque and the muscle shear elastic modulus (measured by elastography to estimate muscle tension) were collected in nine participants during passive ankle dorsiflexions performed in four conditions (by combining hip flexion at 90 or 150°, and head flexed or neutral). Ankle maximum dorsiflexion angle significantly decreased by flexing the hip from 150 to 90° (P < 0.001; mean difference 17.7 ± 2.5°), but no effect of the head position was observed (P > 0.05). Maximal passive torque and shear elastic modulus were higher with the hip flexed at 90° (P < 0.001). During submaximal ROM, no effects of the head and hip positioning (P > 0.05) were found for both torque and shear elastic modulus at a given common ankle angle among conditions. Shifts in maximal ankle angle due to hip angle manipulation are not related neither to changes in passive torque nor tension of the gastrocnemius. Further studies should be addressed to better understand the functional role of peripheral nerves and fasciae in the ankle ROM limits.     

Hip joint range of motion restriction precedes athletic chronic groin injury

Although a restricted hip range of motion has been previously associated with chronic groin injury the temporal course of this association remains unclear. Accordingly the purpose of this prospective cohort study was to report preliminary findings examining whether hip joint range of motion restriction is associated with subsequent onset of athletic chronic groin injury. End-range internal and external hip joint range of motion was determined in 29 elite Australian football players, without previous history of groin injury. The players were followed for two subsequent playing seasons for the development of chronic groin injury. Four athletes developed chronic groin injury defined as at least 6 weeks of groin pain and missing match playing time. In athletes that developed chronic groin injury a lower body weight (p = 0.02) and reduced total hip joint range of motion (p = 0.03) were found to be associated. This study suggests that hip stiffness is associated with later development of chronic groin injury and as such may be a risk factor for this condition. This work should be viewed as preliminary and caution is advised in applying the conclusion to clinical practice as the numbers in this study were small.     

Humeral torsion and passive shoulder range in elite volleyball players

ObjectivesTo evaluate variations in humeral torsion in elite male volleyball players and determine whether these changes are related to training history, retrospective injury history and volleyball performance.Design and settingCross sectional design.ParticipantsTwenty-four elite male volleyball players.Main outcome measuresHumeral torsion, passive gleno-humeral rotation ranges and the available internal and external rotation from the humeral torsion neutral position of the dominant and non-dominant arm were measured. Training history and retrospective injury status were ascertained from a questionnaire. Performance was assessed by coach perceived spiking ability and peak serve velocity measures.ResultsHumeral torsion angles demonstrated the dominant arm to be on average 9.6° more retroverted than the non-dominant arm (p = 0.00). In the comparison of volleyball players with and without a history of overuse upper limb injury the most significant finding is on the non-dominant side, those with a history of injury had significantly decreased available external rotation from the humeral torsion neutral position (mean difference = ?15.1, p = 0.04). There was an unexpected negative weak relationship between age commenced and decreased humeral retroversion (r = ?0.413, p = 0.045). There did not appear to be any relationship between humeral torsion and performance measures.ConclusionThe dominant arm of elite male volleyball athletes is more retroverted. There was a tendency for stronger findings in the non-dominant arm in volleyball players with retrospective injury history. We were unable to find any significant correlation between humeral torsion angle and performance measures.     

High prevalence of shoulder pain among elite Norwegian female handball players

Clinical experience indicates that a substantial number of handball players may suffer from shoulder pain, but they continue to play despite having shoulder pain problems. The aim of this study was to evaluate the prevalence and consequences of shoulder pain problems among Norwegian female elite handball players. In the preseason of the 2007–2008 season, 179 players from all 12 teams of the Norwegian elite league went through the following tests: internal and external shoulder range of motion, apprehension, relocation test, and shooting velocity. All players completed the Fahlström questionnaire and, for players with current pain, the Western Ontario shoulder instability index questionnaire. Sixty‐five (36%) players reported shoulder pain on the test day, and 40 (22%) players reported previous shoulder pain. Two thirds of the players with pain reported a gradual onset. For players with current or previous pain, 22 (36%) and 14 (36%) had missed match play, and 43 (68%) and 28 (76%) reported changing their training habits. A positive apprehension and relocation test was found among 51 (29%) of the players. In conclusion, a high proportion of female elite handball players experience shoulder pain and problems and have an unstable shoulder.     

The prevalence of hand and wrist osteoarthritis in elite former cricket and rugby union players

ObjectivesThis study aimed to determine the prevalence of hand and wrist osteoarthritis in former elite cricket and rugby union players, by sport and playing position, and to define the prevalence of severe hand injury, and its association with hand osteoarthritis.DesignCross-sectional.MethodsData from cross-sectional studies of former elite male cricket and rugby players were used to determine the prevalence of hand pain, physician-diagnosed osteoarthritis, and previous severe injury. Multivariable logistic regression was used to determine the association of previous injury with pain and osteoarthritis.ResultsData from 200 cricketers and 229 rugby players were available. Complete case analysis resulted in 127 cricketers and 140 rugby players. Hand pain was more prevalent amongst cricketers (19.7%) than rugby players (10.0%). The prevalence did not differ between cricket and rugby players for hand osteoarthritis (2.4% and 3.6%), wrist osteoarthritis (1.6% and 2.1%), or previous severe hand injury (36.2% and 31.4%). No significant association between previous hand injury and pain or osteoarthritis was identified in either sport.ConclusionsFormer elite cricketers reported more hand pain than rugby players. No significant association was found between self-reported severe injury and hand osteoarthritis in either cohort, potentially indicating that risk factors aside from injury may be more prominent in the development of hand osteoarthritis.     

A new clinical test for measurement of lower limb specific range of motion in football players: Design,reliability and reference findings in non-injured players and those with long-standing adductor-related groin pain

ObjectiveThe association between groin pain and range of motion is poorly understood. The aim of this study was to develop a test to measure sport specific range of motion (SSROM) of the lower limb, to evaluate its reliability and describe findings in non-injured (NI) and injured football players.DesignCase-controlled.Setting6 Dutch elite clubs, 6 amateur clubs and a sports medicine practice.Participants103 NI elite and 83 NI amateurs and 57 football players with unilateral adductor-related groin pain.Main outcome measuresSport specific hip extension, adduction, abduction, internal and external rotation of both legs were examined with inclinometers. Test-retest reliability (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Non-injured players were compared with the injured group.ResultsIntra and inter tester ICCs were acceptable and ranged from 0.90 to 0.98 and 0.50–0.88. SEM ranged from 1.3 to 9.2° and MDC from 3.7 to 25.6° for single directions and total SSROM. Both non-injured elite and amateur players had very similar total SSROM in non-dominant and dominant legs (188–190, SD ± 25). Injured players had significant (p < 0.05) total SSROM deficits with 187(SD ± 31)° on the healthy and 135(SD ± 29)° on the injured side.ConclusionThe SSROM test shows acceptable reliability. Loss of SSROM is found on the injured side in football players with unilateral adductor-related groin pain. Whether this is the cause or effect of groin pain cannot be stated due to the study design. Whether restoration of SSROM in injured players leads to improved outcomes should be investigated in new studies.     

Analysis of the presence and influence of Glenohumeral Internal Rotation Deficit on posterior stiffness and isometric shoulder rotators strength ratio in recreational and amateur handball players

ObjectiveTo determine whether recreational and amateur handball players exhibit Glenohumeral Internal Rotation Deficit (GIRD), and if it is accompanied by posterior stiffness and changes in shoulder rotators strength.DesignCross-Sectional Study;SettingResearch laboratory.ParticipantsIndoor and beach handball players, members of handball teams or engaged in some handball recreational group.Main outcome measuresRange of motion (ROM) of internal rotation (IR) and horizontal adduction (HA), and isometric internal and external rotators strength. Based on the ROM of internal rotation, they were allocated to groups with and without GIRD.ResultsThe dominant shoulder of GIRD group obtained a lower ROM of IR compared to the non-dominant shoulder of the same group (p < 0.01) and to the dominant (p = 0.02) and non-dominant (p = 0.01) shoulders of the group without GIRD. Less horizontal adduction was observed in both groups (p = 0.01), as well as greater external rotator strength (p = 0.01) and external/internal rotators strength ratio (p < 0.04) in the dominant shoulder. The rotators strength ratio was greater in GIRD group (p < 0.01).ConclusionsThe present study showed the dominant shoulder had greater posterior stiffness and external rotator strength, regardless of GIRD. Also the group with GIRD showed higher rotators strength ratio.     

Knee function among elite handball and football players 1‐6 years after anterior cruciate ligament injury

The aim of the study was to describe objective and self‐reported knee function for athletes who have returned to elite handball and football play after an ACL injury, comparing these to non‐injured players at the same level. A total of 414 handball and 444 football players completed baseline tests from 2007 through 2014, examining lower extremity strength, dynamic balance, knee laxity, and knee function (KOOS questionnaire). Measures were compared between injured and non‐injured legs and between injured legs and legs of controls. Eighty (9.3%) of the 858 players reported a previous ACL injury, 1‐6 years post‐injury (3.5±2.5 years), 49 handball (61.3%) and 31 football players (38.7%). We found no difference in strength or dynamic balance between previously ACL‐injured (N=80) and non‐injured players legs (N=1556). However, lower quadriceps (6.3%, 95% CI: 3.2‐9.2) and hamstrings muscle strength (6.1%, 95% CI: 3.3‐8.1) were observed in previously ACL‐injured legs compared to the non‐injured contralateral side (N=80). ACL‐injured knees displayed greater joint laxity than the contralateral knee (N=80, 17%, 95% CI: 8‐26) and healthy knees (N=1556, 23%, 95% CI: 14‐33). KOOS scores were significantly lower for injured knees compared to knees of non‐injured players. ACL‐injured players who have successfully returned to elite sport have comparable strength and balance measures as their non‐injured teammates. Subjective perception of knee function is strongly affected by injury history, with clinically relevant lower scores for the KOOS subscores Pain, Function, Sport, and Quality Of Life.     

A prospective cohort study of anterior cruciate ligament injuries in elite Norwegian team handball

The purpose of this study was to examine gender differences in the incidence of anterior cruciate ligament (ACL) injuries in a population of highlevel team handball players. We also wanted to examine injury mechanisms and possible risk factors for ACL injuries, including menstrual status. The study was done prospectively during the 1993-94, 1994-95, and 1995–96 seasons. We found 28 ACL injuries, 23 among women (incidence: 0.31 ± 0.06 injuries per 1000 player hours) and 5 among men (0.06 ± 0.03 inj./1000 h; P < 0.001 vs women; risk ratio: 5.0). Of the 28 injuries, 24 occurred during competiton (0.91 ± 0.19 inj./1000 h; women: 1.60 ± 0.35 inj./1000 h; men: 0.23 ± 0.13 inj./1000 h; P ±0.001 vs. women; risk ratio: 7.0) and 4 during training (0.03 ± 0.02 inj./1000 h; P ±0.001 vs. competition; risk ratio: 29.9). Nearly all the injuries ( n = 25) occurred in noncontact situations when the players performed high-speed plant-and-cut movements which they were well accustomed to. A reliable menstrual history could be obtained in 17 of the 23 cases among females. Five of the injuries occurred in the menstrual phase, 2 in the follicular phase, 1 in the early luteal phase and 9 in the late luteal phase (chi-square_{3 d.f.}= 13.2; P ±0.01). The results suggest that there may be an increased risk of ACL injury during the week prior to or after the start of the menstrual period.     

Comparison of gluteus medius and minimus activity during gait in people with hip osteoarthritis and matched controls

The gluteal muscles act as stabilizers of the hip joint and are important for the maintenance of hip function. Atrophy and weakness of the gluteal muscles have been identified in people with hip OA, but it is not known whether these muscles also exhibit altered activity patterns. The aim of this study was to compare gluteal muscle activity in people with hip OA and healthy older adults. Fine‐wire intramuscular electrodes were inserted into the three segments of gluteus medius (GMed) and two segments of gluteus minimus (GMin) in 20 participants with unilateral hip OA and 20 age‐ and gender‐matched controls. Electromyographic activity of these muscle segments was examined during walking along a 10 m walkway. Peak amplitude, average amplitude, and time to peak were compared between groups during the stance phase of the gait cycle. During early stance, the OA group demonstrated a higher burst of activity in posterior GMin (P = 0.02) and trends toward a higher peak in anterior GMin. Both groups displayed peak activity in anterior GMin in the early stance phase in contrast to previous reports in young adults. This early burst of muscle activity was more pronounced with increasing severity of OA. No differences were identified in GMed activity. While altered GMin activity is associated with aging, these changes were more pronounced in participants with hip OA. To reduce disability associated with hip OA, future rehabilitation programs should consider targeted gait strategies and exercises for GMin.     

Normal values for hip muscle strength and range of motion in elite,sub-elite and amateur male field hockey players

ObjectivesTo determine normal values for hip strength and range of motion (ROM) of elite, sub-elite and amateur male field hockey players and to examine the effect of age, leg dominance, playing position, playing level and non-time-loss groin pain on hip strength and ROM.DesignCross-sectional study.SettingPhysical testing took place at field hockey clubs.ParticipantsMale field hockey players competing in the three highest Dutch field hockey leagues (n = 104).Main outcome measuresEccentric adduction, eccentric abduction, adductor squeeze strength, adduction/abduction ratio, internal rotation, external rotation and bent knee fall out (BKFO).ResultsStrength and ROM values (mean ± standard deviation) were: adduction = 2.8 ± 0.4 Nm/kg, abduction = 2.6 ± 0.4 Nm/kg, adduction/abduction ratio = 1.1 ± 0.2, squeeze test = 4.5 ± 0.8 N/kg, internal rotation = 34° ± 11°, external rotation = 47° ± 9°, BKFO = 15 ± 4 cm. Age, leg dominance, playing position, playing level and non-time-loss groin pain had no effect on these profiles.ConclusionsNormal values were established for hip strength and ROM of male field hockey players and showed to be independent of age, leg dominance, playing position, playing level and non-time-loss groin pain.     

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.