Handball load and shoulder injury rate: a 31-week cohort study of 679 elite youth handball players

Abstract

BackgroundKnowledge of injury patterns, an essential step towards injury prevention, is lacking in youth handball.AimTo investigate if an increase in handball load is associated with increased shoulder injury rates compared with a minor increase or decrease, and if an association is influenced by scapular control, isometric shoulder strength or glenohumeral range of motion (ROM).Methods679 players (14–18 years) provided weekly reports on shoulder injury and handball load (training and competition hours) over 31 weeks using the SMS, phone and medical examination system. Handball load in a given week was categorised into (1) <20% increase or decrease (reference), (2) increase between 20% and 60% and (3) increase >60% relative to the weekly average amount of handball load the preceding 4 weeks. Assessment of shoulder isometric rotational and abduction strength, ROM and scapular control was performed at baseline and midseason.ResultsAn increase in handball load by >60% was associated with greater shoulder injury rate (HR 1.91; 95% CI 1.00 to 3.70, p=0.05) compared with the reference group. The effect of an increase in handball load between 20% and 60% was exacerbated among players with reduced external rotational strength (HR 4.0; 95% CI 1.1 to 15.2, p=0.04) or scapular dyskinesis (HR 4.8; 95% CI 1.3 to 18.3, p=0.02). Reduced external rotational strength exacerbated the effect of an increase above 60% (HR 4.2; 95% CI 1.4 to 12.8, p=0.01).ConclusionsA large increase in weekly handball load increases the shoulder injury rate in elite youth handball players; particularly, in the presence of reduced external rotational strength or scapular dyskinesis.

Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis

“…There was limited evidence of greater humeral torsion among baseball players who developed a shoulder injury 47. Furthermore, there was limited evidence for an increased risk of shoulder injury when training and match load in youth handball players increased >60% in the week before injury compared with the average load of the preceding 4 weeks,50 or if youth baseball players participated in a high volume of training each week 49. Since change in training load is under the control of coaches, and the athletes themselves to some extent, training load may be an effective target for interventions that aiming at shoulder injury prevention in overhead sports.…”

“…However, such underestimation does not affect the risk estimates unless it differs between categories of the exposure. Other studies defined injury as a shoulder problem irrespective of the need for time loss or medical attention,50 or shoulder problems/pain that impaired participation or performance or required surgery 36 45…”

Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed

“…The opposite arm was placed resting on the hip. The handheld dynamometer was externally fixed to limit measurement error related to manual fixation from multiple examiners 21. Players were verbally and manually assisted to stabilise their scapula prior to testing.…”

Load, capacity and health: critical pieces of the holistic performance puzzle

“…Consequently, the various components must be considered together; adaptations in load alone will be insufficient to optimise performance while protecting athletes’ health. As an example, Møller et al 6 showed that handball players with reduced external rotational strength or scapular dyskinesis could withstand a lower increase in weekly handball load compared with players without such shoulder deficits. One could either adapt the load to the capacity of each player or improve the shoulder function of affected players, or preferably both.…”