Injury prevention programmes should incorporate interventions aimed at improving glenohumeral rotational range of motion, external rotation strength and scapular control.

Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på bjsm.bmj.com: http://dx.doi. org/10.1136/bjsports-2016-096226 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. Design Stratified cluster-randomised controlled trial with teams as the unit of randomisation.Setting 45 handball teams (22 female, 23 male) from the two upper divisions in Norway (22 in the intervention group, 23 in the control group) were followed for one competitive season (7 months).Participants 660 players aged 16-47 (331 in the intervention group, 329 in the control group).Intervention Ten-minute comprehensive exercise program to increase glenohumeral internal rotation, external rotation strength and scapular control, as well as improve kinetic chain and thoracic mobility, to be delivered by coaches and team captains three times per week as a part of the handball warm-up throughout the season. Main outcome measuresPrevalence of shoulder problems and substantial shoulder problems. ResultsThe average prevalence of shoulder problems during the season was 17% (95% CI: 16% to 19%) in the intervention group and 23% (95% CI: 21% to 26%) in the control group (mean difference: 6%). The average prevalence of substantial shoulder problems was 5% (95% CI: 4% to 6%) in the intervention group and 8% (95% CI: 7% to 9%) in the control group (mean difference: 3%). Using generalized estimating equation models, a 28% lower risk of shoulder problems (OR 0.72, 95% CI: 0.52 to 0.98, p=0.038) and 22% lower risk of substantial shoulder problems (OR 0.78, 95% CI: 0.53 to 1.16, p=0.23) was observed in the intervention group compared to the control group.Conclusion A comprehensive exercise program reduced the prevalence of shoulder problems in elite handball.

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses—The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data.

None of the previously identified risk factors were associated with overuse shoulder injuries in a mixed-sex cohort of elite handball players.

AimTo record overuse injuries among male junior handball players throughout a handball season.DesignProspective cohort study.MethodsTen Norwegian junior male handball teams (145 players aged 16–18 years) were followed for one 10-month season. All players were sent the Oslo Sports Trauma Research Center Overuse Injury Questionaire every second week to record overuse injuries located in the shoulder, elbow, lower back and knee. The relative burden of overuse injuries was calculated in each anatomical area represented, defined as the proportion of the total cumulative severity score.ResultsThe average prevalence of all overuse injury problems was 39% (95% CI 29% to 49%) across all anatomical areas. The average prevalence of substantial overuse injury problems, defined as those leading to moderate or large reductions in training volume or sports performance, or to complete inability to participate, was 15% (95% CI 13% to 17%). Over the duration of the study, the cumulative incidence of overuse injury problems was 91% (133 players). Shoulder problems were the most prevalent (average prevalence 17%, 95% CI 16% to 19%), whereas knee problems had the greatest relative burden.ConclusionOveruse injuries, particularly in the shoulder and knee, have a substantial impact on junior handball players’ training participation and performance. Interventions to prevent overuse injuries among male junior handball players should focus on these areas.

We aimed to examine attitudes, beliefs, and current behavior toward risk factors and prevention of shoulder injuries, and to investigate the application of an exercise program during a cluster‐randomized controlled trial aiming to prevent shoulder injuries in elite handball. All captains and coaches of 44 elite handball teams (22 male and 22 female) constituting the intervention (21 teams) and control arm (n = 23 teams) in the trial were invited to take part in a survey. A questionnaire, based on the Reach, Efficacy, Adoption, Implementation, and Maintenance framework, addressing the end user perspective on risk factors and prevention of shoulder injuries, as well as key issues related to the application of the Oslo Sports Trauma Research Center (OSTRC) Shoulder Injury Prevention Programme, was distributed using electronic survey software. The response rate was 100%. Overall, the majority of coaches (84%) and captains (89%) believed that handball players are at high risk for shoulder injuries. All delivery agents in the trial reported to be familiar with the exercise program and the majority believed in a preventative effect (coaches 90% and captains 81%). Only a minority reported full compliance with the recommended frequency (coaches 29%, captains 14%), with program being too time‐consuming (coaches 67%, captains 81%) and lack of player motivation (coaches 76%, captains 62%) as the main barriers. Our results suggest that there is fertile ground for implementation of the OSTRC Shoulder Injury Prevention Programme in elite handball, with program length and lack of player motivation as the main barriers to overcome.

Professional and amateur athletes alike are burdened by shoulder injuries. 7,44,48,49,78,88 Shoulder pain affects athlete performance, training, and daily life. 61,64 More than half of elite collegiate American football players sustain at least 1 shoulder injury during their career. 48 Shoulder injuries are a problem for athletes in sports as diverse as rugby, 54 baseball, 34 handball, 20 diving, 73 water polo, 73 and kayaking. 41 Yet, there is a lack of quality evidence to guide clinicians, athletes, and coaches in managing shoulder injury risk or return to sport (RTS) post injury. The absence of quality evidence hinders those who wish to produce clinical practice guidelines. Previous consensus statements have targeted specific shoulder pathologies 4,31,60,89 and the scapula. 50 However, questions remain: • Which exercises are most appropriate for supporting primary prevention of shoulder injury in athletes? • Does screening for muscle weakness, such as a loss of rotational strength in the shoulder, hold value for athletes? • Which load management measures are relevant for the athlete with shoulder injury?U SYNOPSIS: There is an absence of high-quality evidence to support rehabilitation and return-tosport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future.

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.