Video analysis of acute injuries and referee decisions during the 24th Men's Handball World Championship 2015 in Qatar

Although handball is a contact sport with a high risk of acute match injuries, their mechanisms have not yet been investigated. We aimed to describe the mechanisms of acute match injuries in elite male handball and evaluate referee performance in injury situations. Based on injury surveillance from the 24th Men′s Handball World Championship 2015 in Qatar, injury situations and the referee decisions were identified on video footage. A total of 55 injury situations and 37 referee decisions were included for analysis. The injury situations were analyzed individually by five handball experts, followed by a consensus meeting. An expert referee panel performed individual blinded evaluation of the referee decisions, followed by an online consensus meeting. Injuries were evenly distributed among attackers (n = 29) and defenders (n = 26). The most frequent injury cause was contact trauma due to a tackle (n = 27). At the time of injury, attackers were most frequently performing a jump shot (n = 9), while defenders were completing a tackle (n = 10). Defenders most commonly tackled the throwing arm (n = 7) or toward the head/face region (n = 6) of injured attackers, while attackers most frequently hit injured defenders with the knee during jump shots (n = 5). Agreement between the referees and the expert panel was weak (kappa: 0.22, 95% CI 0.07 to 0.36), with substantially more lenient rule interpretation by the referees. Our results suggest that stricter refereeing and rule amendments should be considered to prevent acute match injuries in elite handball, especially in relation to tackling episodes when an attacker is performing a jump shot.     

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.     

Epidemiology of injuries during the Wheelchair Basketball World Championships 2018: A prospective cohort study

Several international sports federations have implemented a standardized injury reporting system during their championships. However, very few studies have investigated athletes with disabilities during major championships apart from the Paralympic Games. Therefore, the aim of this study was to assess the rate and characteristics of injuries during the Wheelchair Basketball World Championships 2018 (WBWC). This prospective cohort study was conducted during the WBWC held in Hamburg, Germany, from August 16 to August 26, 2018. Physicians or physiotherapists of all 28 participating teams (total 336 players) were asked to report all newly incurred injuries (with location, diagnosis, cause, and estimated duration of absence) daily on a standardized injury report form. Prevalence and incidence rates were calculated. Medical staff of 11 teams (132 players) reported 100 injuries, equivalent to 75.8 per 100 players (95% CI: 60.9-90.7) or 68.9 per 1000 player-days (55.4-82.4). Eight time-loss injuries were reported (6.1 injuries per 100 players [95% CI: 1.9-10.3] or 5.5 injuries per 1000 player-days [1.7-9.3]). More injuries were incurred during matches (n = 68) than during training. Most injuries affected the neck/cervical spine (16%), thoracic spine/upper back (15%), and shoulder (14%). The most frequent diagnosis was muscle spasms (25%), the most frequent cause was overuse (52%). A high rate of non–time-loss injuries compared to Paralympic Games was reported. Future studies should focus on the etiology of muscle spasms and further identify injury mechanisms of traumatic and overuse injuries in wheelchair basketball players to develop adequate preventive measures.     

Epidemiology of physical activity‐related injuries in Chinese university students

Knowledge gaps of the physical activity‐related injury (PARI) problem among general undergraduates exist. We conducted a study in four universities, where 1421 students graded 1‐3 were interviewed face‐to‐face during April and May after their completion of the baseline survey in March and April 2017, aiming to describe the incidence and characteristics of PARI. PARI experience and physical activity (PA) participation in the past 12 months were collected. Injury incidence density (IID) and risk, and injury characteristics were evaluated for the overall sample and by gender. Pearson chi‐square or Fisher's exact tests and independent‐sample t tests were used to test between‐group differences. We found that 486 PARIs were reported totally by 289 participants , with an overall IID of 0.57 per 1000 hours of exposure (males: 1.07, females: 0.45) and an injury risk of 0.34 injuries/student/y (males: 0.52; females: 0.28) . Higher IIDs were found in roller skating, football, and basketball. The majority of injuries occurred outdoors and involved the lower extremities, with sprain and strain being the primary injury types. Moreover, most injuries were new, acute, and happened in non‐contact situations. Of all injuries, 52.1% required medical attention and 64.6% resulted in inactivity of one or more days. Some significant differences were observed between males and females. Our study indicates that PARI is a public health concern among Chinese university students, which can provide direction for targeted prophylactic interventions to underpin the sex‐specific injury mechanism to reduce PARI.     

Epidemiology and traumatology of injuries in track athletes

During one year 4398 injured athletes were treated at the casualty wards of Aarhus, Denmark; 156 were practicing track and field disciplines. In the same period 54 track athletes of a Danish sport club were followed in order to register any lesion incurred during sports activity. Thirty-one athletes (57%) had 35 injuries, giving an injury incidence of 1.8 per 1000 hours of practice. At follow-up after 1 year, 13% of all athletes still had complaints, and none of them had returned to former sports activity. Jumpers had overuse symptoms correlated to take-off, and sprains or fractures related to downstrokes. Runners had a higher risk of overuse injuries than jumpers, especially involving the Achilles tendon and the plantar aponeurosis. Young athletes had a higher injury incidence per time than older participants; and women had higher injury risk than men.     

Beweglichkeit der Wurfarmschulter sowie isometrische Kraftentwicklung und ihre Veränderungen unter Trainings- und Saisonbedingungen beim semi- /professionellen Handballsportler Teil I: Veränderungen in der Saisonvorbereitungsphase

The rotational capacity of the throwing shoulder and their changes during the pre-season and season in semi- and professional team handball athletes is not very much investigated yet. There are no data on changes in isometric strength as well, but correlations between the overhead- and throwing athlete shoulder, their changes in the rotational capacity and a risk of structural joint damages and symptoms.Materials and MethodsIn a longitudinal intra-individual investigation 27 semi- and professional male, third league team handball athletes underwent a specific clinical shoulder examination and were examined at the beginning (MZP 1) and end (MZP 2) of the pre-seasonal training (VP) at the dominant (throwing) and non dominant (non throwing) shoulder according to rotational strength (isometric) and range of motion.ResultsThe internal rotation (IR) at the dominant throwing shoulder (WA) was significantly reduced in comparison to the non throwing shoulder (NWA) at both days of determinations (baseline, after 6 weeks). The external rotation (ER) at the WA was significantly greater than the ER at the NWA at both times. The total range of motion (tROM) and the GIRD was slightly, but not significantly reduced at the WA at the end of the VP. The external rotational gain (ERG) was significantly reduced during the VP. The isometric strength in IR and ER at the WA was larger in comparison to the NWA at baseline. During the VP a significant reduction in internal rotational (IR) and isometric strength was seen at the WA. The external rotational isometric strength (ER) significantly reduced as well over the period of time at the WA.ConclusionsOver the period of 6 weeks the pre-seasonal training in team handball did not lead to significant pathological changes of the rotational capacities in shoulder joints, even not in a glenohumeral internal rotation deficit. The external rotation gain did significantly reduce after the period of the pre-seasonal training. The isometric strength in internal and external rotational movement also decreased significantly. Our data more likely show adaptive processes at the throwing shoulder joint according to the workload during training.Level of EvidenceLevel III.     

Completion rates and injuries in alpine races during the 1994 Olympic Winter Games

The starting lists for the alpine disciplines during the 1994 Olympic Winter Games in Lillehammer totalled 555 racers, but only 354 of them (64%) completed the different races. The race completion rate was 43% in the slalom, 51% in the giant slalom, 75% in the super giant slalom and 91% in the downhill. In combined downhill/slalom the race completion rate was 60%, but 96% in the downhill and 68% in the slalom part of the combination, respectively. Only three injuries were recorded, all in females. Including the training competitions a total of 1541 runs through the different alpine courses was recorded during the games. This means an injury rate of 1.9 injuries per 1000 runs. For downhill the injury rate was only 1.1 per 1000 runs. If the injury rate is related to the number of skiers who did not finish the race because of falls or skiing errors, the rate was 21.1 injuries per 1000 falls (skiing errors) for all alpine races. In conclusion, the race completion rate was twice as high in downhill as in slalom, and the injury rate was low.     

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.     

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).     

Relationship between floor type and risk of ACL injury in team handball

The purpose of this study was to compare the ACL injury rate between two different floor types - wooden floors (parquet, generally having lower friction) and artificial floors (generally having higher friction). ACL injuries have been recorded prospectively from the three top divisions for men and women in Norwegian team handball during seven seasons (1989-2000). A total of 174 ACL injuries have been recorded, and of these 53 occurred in regular league games. The floor types for all regular games from the same seasons have been determined retrospectively based on match schedules. The matches were divided into two groups: those played on wooden floors and those played on artificial floors. A total of nine injuries occurred among men (incidence: 0.24+/-0.09 injuries per 1000 player hours) and 44 among women (0.77+/-0.04 injuries 1000 h(-1); OR vs. men: 3.21 (1.56-6.58); P=0.001). Among men, four injuries occurred on wooden floors (0.32+/-0.13 injuries 1000 h(-1)) and five injuries occurred on artificial floors (0.20+/-0.12 injuries 1000 h(-1); OR vs. wooden floors: 0.63 (0.17-2.37); ns). Among women, eight injuries occurred on wooden floors (0.41+/-0.09 injuries 1000 h(-1); OR vs. men: 1.29 (0.39-4.28); ns) and 36 on artificial floors (0.96+/-0.04 injuries 1000 h(-1); OR vs. wooden floors: 2.35 (1.09-5.07); P=0.03; OR vs. men: 4.77 (1.87-12.18); P=0.001). These results indicate that the risk of ACL injury for women is higher on artificial floors than on wooden floors.     

Incidence, nature and causes of floorball injuries

During 1990 and 1991, 9% of all sports injuries that required emergency care at the University Hospital of Umeå were caused by floorball. Seventy-eight per cent of the injuries were minor (AIS 1) and 21% were moderate (AIS 2). Sprains of the ankle and knee joints were most frequent, constituting 30% and 11% of all injuries, respectively. Licensed players were affected in 14% of all floorball injuries, and 61% of these injuries occurred during a game. We found no difference in severity or type of injuries between licensed players and recreational players. Our data show that the number of floorball injuries is increasing and that the majority of these injuries are of minor severity.     

Kompartment-Syndrom am Femur nach Kontusionstrauma beim Team-Handball

In September 2012, a 35-year-old semi-professional team handball player (right wing, 3rd national team handball league) injured his left lateral femur during a game in an offense action, when his opposing player hit him directly with his knee. After on-site inspection and local ice application, the athlete was transferred into a hospital, where a clinical and an ultrasound examination were performed; a hematoma was diagnosed and the patient was released. Two days later, the athlete was urgently admitted to a hospital after clinical examination by a general practitioner to undergo surgery with facial release and dissection as well removal of a hematoma caused by an increasing compartment syndrome. Owing to a progressive situation and ongoing bleeding, the patient was treated in a total of nine surgical revisions including skin transplantation for defect reconstruction and endovascular intervention with vascular clipping (coiling). The surgical procedures were completed without any further complication apart from a muscular herniation at the left lateral femur (Vastus lateralis muscle), which was technically treated with compression trousers. The athlete did recover completely but was unable to take up team handball sports again.ConclusionsIn contact sports such as team handball, athletes should be examined and checked in short periods after direct soft tissue contusion; sport activity should preferably be discontinued. Ultrasound examinations should be performed as soon and often as possible to exclude and follow any structural damages and hematoma. This allows compartment syndromes to be determined and diagnosed at an earlier stage and, if necessary, to be surgically treated with a high degree of success.     

High ankle injury rate in adolescent basketball: A 3‐year prospective follow‐up study

This prospective study investigated the incidence and pattern of acute time‐loss injuries in young female and male basketball players. Eight basketball teams (n=201; mean age 14.85±1.5) participated in the follow‐up study (2011‐2014). The coaches recorded player participation in practices and games on a team diary. A study physician contacted the teams once a week to check new injuries and interviewed the injured players. In total, 158 injuries occurred. The overall rate of injury (per 1000 hours) was 2.64 (95% CI 2.23‐3.05). Injury rate was 34.47 (95% CI 26.59‐42.34) in basketball games and 1.51 (95% CI 1.19‐1.82) in team practices. Incidence rate ratio (IRR) between game and practice was 22.87 (95% CI 16.71‐31.29). Seventy‐eight percent of the injuries affected the lower limbs. The ankle (48%) and knee (15%) were the most commonly injured body sites. The majority of injuries involved joint or ligaments (67%). Twenty‐three percent of the injuries were severe causing more than 28 days absence from sports. Number of recurrent injuries was high (28% of all injuries), and most of them were ankle sprains (35 of 44, 79%). No significant differences were found in injury rates between females and males during games (IRR 0.88, 0.55, to 1.40) and practices (IRR 1.06, 0.69, to 1.62). In conclusion, ankle and knee ligament injuries were the most common injuries in this study. Moreover, the rate of recurrent ankle sprains was alarming.     

A 1‐year prospective analysis of injuries in amateur and elite fistball

The purpose of this study was to examine the incidence and mechanisms of acute injuries in the sport of fistball. No scientific studies on injury characteristics have yet been conducted in this traditional sport game. The study was conducted prospectively over the course of 12 months. During a total of 40.308 h of sport‐specific exposure, 240 players reported 492 injuries, representing an overall injury rate of 12.2 injuries/1000 h of exposure. Most injuries were classified as bagatelle injuries (67.8%). The majority of the injuries were located in the knee (23.5%) followed by the elbow (11.9%) and the hip (11.5%). Ankle injuries resulted in the longest impairment from sports participation. The most common types of injury were abrasions (38.2%), contusions (21.1%), distortions (7.5%) and muscle strains (6.9%). Wrong or insufficient equipment (15.0%) was the most commonly mentioned causes of injury. The data indicate that the injury risk in fistball is rather high; however, the sport should not be considered a high‐risk sport because most of the injuries are slight and do not prevent the players from training or competition. Injury prevention strategies should include the development of fistball‐specific protective equipment with focus on the knee and elbow joint.     

Soccer injuries in Iceland

We investigated the frequency, cause and location of injuries in Icelandic elite soccer in 1991. The incidence of injuries for the individual player was 34.8 ± 5.7 per 1000 game-hours and 5.9 ± 1.1 per 1000 practice-hours. The most common types of injuries were muscle strains (29%), ligament sprains (22%), contusions (20%), and other injuries (29%). The frequency of reinjury was markedly high, where 44% of the strains and 58% of the sprains were registered as reinjuries. Strains occurred mainly during sprinting, sprains by tackling, and contusion during other contact. Significantly more injuries occurred on artificial turf than on grass or gravel in correlation to number of hours in games and practices. Teams who had the longest pre-season preparation period obtained significantly fewer injuries during the season.     

Validity of the SMS,Phone, and medical staff Examination sports injury surveillance system for time‐loss and medical attention injuries in sports

The accurate measurement of sport exposure time and injury occurrence is key to effective injury prevention and management. Current measures are limited by their inability to identify all types of sport‐related injury, narrow scope of injury information, or lack the perspective of the injured athlete. The aims of the study were to evaluate the proportion of injuries and the agreement between sport exposures reported by the SMS messaging and follow‐up telephone part of the SMS , Phone, and medical staff Examination (SPE x) sports injury surveillance system when compared to measures obtained by trained on‐field observers and medical staff (comparison method). We followed 24 elite adolescent handball players over 12 consecutive weeks. Eighty‐six injury registrations were obtained by the SPE x and comparison methods. Of them, 35 injury registrations (41%) were captured by SPE x only, 10 injury registrations (12%) by the comparison method only, and 41 injury registrations (48%) by both methods. Weekly exposure time differences (95% limits of agreement) between SPE x and the comparison method ranged from −4.2 to 6.3 hours (training) and −1.5 to 1.0 hours (match) with systematic differences being 1.1 hours (95% CI 0.7 to 1.4) and −0.2 (95% CI −0.3 to −0.2), respectively. These results support the ability of the SPE x system to measure training and match exposures and injury occurrence among young athletes. High weekly response proportions (mean 83%) indicate that SMS messaging can be used for player measures of injury consequences beyond time‐loss from sport. However, this needs to be further evaluated in large‐scale studies.     

A comparison of pediatric freestyle and Greco-Roman wrestling injuries sustained during a 2006 US national tournament

The purpose of this study was to compare the epidemiology of freestyle and Greco-Roman wrestling injuries sustained during a 2006 United States (US) national tournament. A prospective injury surveillance study was conducted at the US 2006 ASICS/Vaughan Cadet and Junior National Championships. There were 83 freestyle- and 55 Greco-Roman-related injuries sustained, with the rate of injury per 1000 athlete-matches higher in freestyle (7.0) compared with Greco-Roman (4.6) wrestling [Rate ratio (RR)=1.51, 95% confidence interval (CI): 1.07–2.12]. Compared with Greco-Roman wrestling, there was a greater proportion of knee injuries in freestyle wrestling [injury proportion ratio (IPR)=4.17, 95% CI: 1.30–13.41]. In GrecoRoman wrestling, there were greater proportions of elbow (IPR=9.11, 95% CI: 1.13–73.59) and head/face/neck (IPR=1.72, 95% CI: 1.10–2.67) injuries and a greater proportion of concussions (IPR=1.95, 95% CI: 0.92–4.12), although the latter was statistically insignificant. Greco-Roman wrestlers sustained a greater proportion of injuries from being driven into the mat (IPR=2.97, 95% CI: 1.72–5.14). There were no statistically significant differences in injury outcome by wrestling style. The differing injury rates and patterns of injury between freestyle and Greco-Roman wrestling are likely due to the different rules between these styles that allow lower leg attacks in freestyle wrestling and encourage the use of throws in Greco-Roman wrestling.     

Altered hip control during a standing knee-lift test is associated with increased risk of knee injuries

A few prospective studies have investigated hip and pelvic control as a risk factor for lower extremity (LE) injuries. The purpose of this study was to investigate whether deficits in hip and lumbopelvic control during standing knee-lift test are associated with increased risk of acute knee and LE injuries in youth team sports. At baseline, 258 basketball and floorball players (aged 12-21 years) participated in a standing knee-lift test using 3-dimensional motion analysis. Two trials per leg were recorded from each participant. Peak sagittal plane pelvic tilt and frontal plane pelvic drop/hike were measured. Both continuous and categorical variables were analyzed. New non-contact LE injuries, and match and training exposure, were recorded for 12 months. Seventy acute LE injuries were registered. Of these, 17 were knee injuries (eight ACL ruptures) and 35 ankle injuries. Risk factor analyses showed that increased contralateral pelvic hike was significantly associated with knee injury risk when using categorical variable (HR for high vs low group 4.07; 95% CI 1.32-12.6). Furthermore, significant association was found between high lateral pelvic hike angles and ACL injury risk in female players (HR for high vs low group 9.10; 95% CI 1.10-75.2). Poor combined sensitivity and specificity of the test was observed. In conclusion, increased contralateral pelvic hike is associated with non-contact knee injury risk among young team sport players and non-contact ACL injuries among female players. More research to determine the role of pelvic control as a risk factor for knee injuries is needed.