Injury incidence and injury patterns by category, player position, and maturation in elite male handball elite players

Ligament Injuries in Professional Male Handball Players: A 6-Year Longitudinal Study

Handball is a sport that involves high-intensity actions throughout the game, such as sprints, jumps, landings, and high-speed, repeated throws. This, along with competitive and tactical factors, congested schedules, and the need to maintain a high level of performance throughout the season, contributes to a high injury rate. This study aimed to analyse ligament injuries in a professional handball team over six consecutive seasons. A total of 68 elite male Spanish handball players participated, with 54 time-loss injuries (i.e., injuries involving at least one day of absence) observed during this study period. Ligament injury information was recorded following the International Olympic Committee consensus statement. The overall incidence was 0.89 ligament injuries per 1000 h of exposure. Additionally, a higher incidence and burden of ligament injuries was observed during match-play compared to training. Most ligament injuries were classified as minor or moderate (i.e., 79.63% of the total), and 46.29% were reinjuries. A significantly higher incidence of ligament injuries was suffered in the lower limbs compared to the upper limbs (0.81 vs. 0.08 ligament injuries per 1000 h; p < 0.001). Specifically, the highest incidence was observed in the anterior talofibular ligament of the ankle (0.57 injuries per 1000 h of exposure), while the greatest burden was related to the anterior cruciate ligament (24.08 absence days per 1000 h of exposure). This study provides an overview of ligament injuries among professional handball players, highlighting the need to implement strategies with positive effects during competition (e.g., specific activation strategies or training programmes based on strength and balance) and to reduce injury recurrences.

Epidemiology of Injuries in Men's Professional and Amateur Football (Part I)

Background (1): Football is the most popular sport among men, associated with a certain risk of injury, which leads to short- and long-term health consequences. While the injury profile of professional footballers is known, little is known about the injury profile of amateur footballers; amateur football is a major and diverse area, the development of which should be a priority for football associations around the world and UEFA. The aim of this study was to perform a systematic review of epidemiological literature data on injuries in professional and amateur football players belonging to certain leagues. Methods (2): A systematic review according to the PRISMA guidelines was performed until June 2023 in the databases PubMed, Web of Science, Google Academic, Google Scholar, and Diva portal. Forty-six studies reporting injury incidence in professional and amateur men's football were selected and analyzed. Two reviewers independently extracted data and assessed study quality using an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): The overall incidence of injuries in professional male football players was 7.75 ± 2.28, 95% confidence interval, injuries/1000 h of exposure and that of amateur football players was 7.98 ± 2.95, 95% confidence interval, injuries/1000 h of exposure. The incidence of match injuries (30.64 ± 10.28, 95% confidence interval, injuries/1000 exposure hours) was 7.71 times higher than the training injury incidence rate (3.97 ± 1.35, 95% confidence interval, injuries/1000 h) in professional football players and 5.45 times higher in amateurs (17.56 ± 6.15 vs. 3.22 ± 1.4, 95% confidence interval, injuries/1000 h). Aggregate lower extremity injuries had the highest prevalence in both categories of footballers, being 83.32 ± 4.85% in professional footballers and 80.4 ± 7.04% in amateur footballers: thigh, ankle, and knee injuries predominated. Conclusions (4): Professional and amateur football players are at substantial risk of injury, especially during matches that require the highest level of performance. Injury rates have implications for players, coaches, and sports medicine practitioners. Therefore, information on football injuries can help develop personalized injury risk mitigation strategies that could make football safer for both categories of football players. The current findings have implications for the management, monitoring, and design of training, competition, injury prevention, especially severe injury, and education programs for amateur football players.

The impact of sport-specific physical fitness change patterns on lower limb non-contact injury risk in youth female basketball players: a pilot study based on field testing and machine learning

Background: In recent years, identifying players with injury risk through physical fitness assessment has become a hot topic in sports science research. Although practitioners have conducted many studies on the relationship between physical fitness and the likelihood of injury, the relationship between the two remains indeterminate. Consequently, this study utilized machine learning to preliminary investigate the relationship between individual physical fitness tests and injury risk, aiming to identify whether patterns of physical fitness change have an impact on injury risk. Methods: This study conducted a retrospective analysis by extracting the records of 17 young female basketball players from the sport-specific physical fitness monitoring and injury registration database in Fujian Province. Sports-specific physical fitness tests included physical performance, physiological, biochemical, and subjective perceived responses. The data for each player was standardized individually using Z-scores. Synthetic minority over-sampling techniques and edited nearest neighbor algorithms were used to sample the training set to address the negative impact of class imbalance on model performance. Feature extraction was performed on the dataset using linear discriminant analysis, and the prediction model was constructed using the cost-sensitive neural network. Results: The 10 replicate 5-fold stratified cross-validation showed that the lower limb non-contact injury prediction model based on the cost-sensitive neural network had achieved good discrimination and calibration (average Precision: 0.6360; average Recall: 0.8700; average F2-Score: 0.7980; average AUC: 0.8590; average Brier-score: 0.1020), which could be well applied in training practice. According to the attribution analysis, agility and speed were important physical attributes that affect youth female basketball players' non-contact lower limb injury risk. Specifically, there was enhance in the performance of the 1-min double under, accompanied by an increase in urinary ketone and urinary blood levels following the agility test. The 3/4 basketball court sprint performance improved, while urinary protein and RPE levels decreased after the speed test. Conclusion: The sport-specific physical fitness change pattern can impact the lower limb non-contact injury risk of young female basketball players in Fujian Province, specifically in terms of agility and speed. These findings will provide valuable insights for planning athletes' physical training programs, managing fatigue, and preventing injuries.

The Association Between Chronological Age and Maturity Status on Lower Body Clinical Measurements and Asymmetries in Elite Youth Tennis Players

BACKGROUND

Tennis is one of the most popular sports among youths. At elite levels, a notable increase in injury incidence and a temporary decline in performance may occur when children progress through puberty. However, limited research has explored maturity-associated variations in clinical measurements suggested as predictors of injury and tennis performance in elite youth players. Therefore, the main purpose of this study was to analyze the association between chronological age and maturity status on several measures of neuromuscular capability and physical performance as well as bilateral (interlimb) asymmetries in elite youth tennis players.

HYPOTHESIS

Youth tennis players around peak height velocity (PHV) will show higher growth-related impairments or deficits in measures of neuromuscular capability and physical performance than their less (pre-PHV) and more (post-PHV) mature counterparts irrespective of sex.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 68 male (age, 13.7 ± 1.1 years; height, 162.4 ± 9.4 cm; body mass, 51.4 ± 10.3 kg [Mean values ± SD]) and 60 female (age, 13.6 ± 1.1 years; height, 162.8 ± 7.2 cm; body mass, 52.7 ± 7.5 kg [Mean values ± SD]) elite youth tennis players from 2 different age groups (under 13 [U13] and under 15 [U15]) and maturity status (pre-PHV, around PHV, and post-PHV), were tested during national training camps. Tests included the Y Balance Test, isometric hip abduction and adduction strength, hip ranges of motion (ROMs), and countermovement jump (CMJ) height. Bayesian analysis was used to establish any significant between-group differences.

RESULTS

Only dynamic balance (in boys; Bayesian factor [BF₁₀] = 88.2) and jump height (in both boys and girls; BF₁₀ >100) were significatively associated with chronological age, whereby the U15 group showed lower Y Balance Test reach distances (-6%; standardized effect size δ = 0.62) but higher CMJ height scores (+18%; δ = 0.73) than the U13 group. Although boys jump higher (+11%; δ = 0.62) and were stronger in isometric hip adduction strength (+14%; δ = 0.92) than girls, the latter had greater hip internal ROM values (+15%; δ = 0.75). Furthermore, relevant maturity-associated effects (BF₁₀ = 34.6) were solely observed for the CMJ test in boys, with the most mature players demonstrating higher jump height scores (+12%; δ = 0.93). Finally, a significant percentage (>25%) of tennis players, independent of sex, demonstrated bilateral asymmetries in hip ROM, hip strength, and jump height values.

CONCLUSION

The findings of this study show that in U13 and U15 male and female tennis players, there were neither positive nor negative maturity-associated variations in the clinical measurements analyzed (with the exception of jump height in male players). The high proportion of tennis players showing bilateral asymmetries in dynamic balance, hip ROM, and strength and jump performance highlight the need of future studies to analyze these factors in relation to unilateral tennis-specific adaptations in the musculoskeletal and sensorimotor systems.

CLINICAL RELEVANCE

These results may help to better understand how different clinical measurements are associated with the process of growth and maturation in elite youth tennis players and may aid in the design of specific training interventions during these stages of development.

Physical Demands during Official Competitions in Elite Handball: A Systematic Review

An understanding of physical demands during official competitions is essential to achieving the highest performance in handball. The aim of this systematic review was to summarise the available scientific evidence associated with physical demands during official competitions in elite handball according to playing positions, competition level and gender. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 17 studies were selected after a systematic search and selection process of three digital databases: PubMed, Web of Science and Sport Discus. The quality of the selected studies was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology checklist; the average score was 18.47 points. The sample consisted of 1175 handball players, of whom 1042 were men (88.68%) and 133 were women (11.32%). The results show that an elite handball player covered on average 3664.4 ± 1121.6 m during a match. The average running pace was 84.8 ± 17.2 m∙min-1. The total distance covered was largely greater in national competitions (4506.7 ± 647.9 m) compared with international competitions (2190.3 ± 1950.5 m) (effect size (ES) = 1.2); however, the running pace did not present any significant difference between the international or national level (ES = 0.06). In regard to gender, the total distance covered was moderately greater in female competitions (4549.1 ± 758.6 m) compared with male competitions (3332.6 ± 1257.7 m) (ES = 0.9), and the running pace was largely greater in female competitions (110.5 ± 7.2 m∙min-1) compared with male competitions (78.4 ± 19.7 m∙min-1) (ES = 1.6). In relation to playing position, backs and wings covered a moderately greater total distance (ES = 0.7 and 0.6) and slightly more meters per minute (ES = 0.4 and 0.2) than pivots. Moreover, the technical activity profile differed between playing positions. Backs performed moderately more throws than pivots and wings (ES = 1.2 and 0.9), pivots exhibited largely more body contact than backs and wings, and wings performed moderately more fast breaks (6.7 ± 3.0) than backs (2.2 ± 2.3) (ES = 1.8). Therefore, this research study provides practical applications for handball coaches and strength and conditioning professionals with respect to designing and implementing more individualised training programmes to maximise performance and reduce injury risk.

The Effect of Shoulder and Knee Exercise Programmes on the Risk of Shoulder and Knee Injuries in Adolescent Elite Handball Players: A Three-Armed Cluster Randomised Controlled Trial

Background

The risk of injury in adolescent handball is high, and shoulder and knee injuries are among the most frequent and burdensome. The Swedish Knee Control programme reduced the risk of anterior cruciate ligament injuries in female youth football players and traumatic knee injuries in male and female youth floorball players. However, to date, Knee Control has not been evaluated in an elite youth sport setting. The literature on the prevention of shoulder injuries in sport is scarce, and there are to our knowledge no previous studies evaluating the preventative efficacy of injury prevention exercise programmes (IPEPs) on shoulder injuries in adolescent handball players.

Objectives

To study the preventive efficacy of IPEPs on shoulder and knee injuries in adolescent elite handball players.

Methods

Eighteen Swedish handball-profiled secondary schools (clusters) with players aged 15–19 years, 54% males were randomised into either the Shoulder Group or Knee Group (interventions) or a Control Group. Players in the Shoulder Group were instructed to perform the Shoulder Control programme, and  players in the Knee Group to perform the Knee Control programme, three times per week during May 2018 to May 2019. Control Group players continued their usual training. Outcomes were shoulder and knee injuries defined by the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Intention-to-treat analyses were performed using Cox regression models with hazard rate ratios (HRRs) with corresponding 95% confidence intervals (CI).

Results

Six clusters (199 players) in the Shoulder Group, six clusters (216 players) in the Knee Group and six clusters (212 players) in the Control Group were included. There were 100 shoulder injuries and 156 knee injuries. The Shoulder Group had a 56% lower shoulder injury rate, HRR 0.44 (95% CI 0.29 to 0.68), and the Knee Group had a 31% lower knee injury rate, HRR 0.69 (95% CI 0.49 to 0.97) than the Control Group. The absolute risk reduction was 11% and 8%, and the number needed to treat was 9 and 13, respectively.

Conclusions

Adolescent elite handball players who performed the Shoulder Control and the Knee Control programmes had a lower risk of shoulder and knee injuries, respectively, than players who continued their usual training. Further research on how these two programmes can be combined to reduce knee and shoulder injuries in a time effective way is warranted.

Trial registration ISRCTN15946352.

Key points

The Most Common Handball Injuries: A Systematic Review

Handball is a team sport involving a great physical demand from its practitioners in which a high number of injuries occur, affecting individual and collective performance. Knowledge of the injuries is of great importance for their prevention. The objective of the present study was to identify, locate and compare the most frequent injuries and injury mechanisms in handball practice. It was carried out following the Preferred Informed Item for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The source of data collection was direct consultation of the PubMed and Medline databases. Several keywords were used for the documentary retrieval, and the quality of the studies that were selected was evaluated. Of the 707 studies retrieved, only 27 were considered appropriate for the review, and quality scores were obtained that ranged from 10 to 26 points, out of a maximum of 28. The most frequent injuries in handball players are located in the lower limbs (thigh, knee and ankle), and in the shoulder in the upper limbs. Regarding the playing position, the players who play over the 6-m line are the most affected by injuries, while the women players have a higher probability of injury. Most injuries occur during competition.

Relationship of Vertical Jump Performance and Ankle Joint Range of Motion: Effect of Knee Joint Angle and Handedness in Young Adult Handball Players

The purpose of the study is to examine the effect of the ankle joint range of motion (ROM) on the vertical jump (VJ) performance of adult handball players. The active (ACT) and passive (PAS) ankle joint ROM of 12 male members of the U21 National Handball Team with the knee joint at 0°, 40°, and 90° flexion (0° = fully extended knee) was evaluated using a video analysis measuring method. Participants also performed maximum VJ with (CMJ) and without (SQJ) countermovement, as well as with (AS) and without (NAS) an arm swing. Statistical analyses included 2 × 2 × 3 MANOVA, 2 × 2 repeated measures ANOVA, and Pearson’s correlation. Results reveal that PAS-ROM was larger (p < 0.05) in all knee joint flexion angles. ROM was smaller (p < 0.05) by approximately 10° at 0° compared to 90° knee flexion. No lateral effects on ROM due to the handedness of the players were observed. AS and CM resulted in increased jump height (p < 0.05). Finally, ACT-ROM when the knee joint was flexed at 40° was highly correlated (r ≥ 0.66, p < 0.05) with VJ performance except for CMJ-AS. In conclusion, the differences in the bi-articular gastrocnemius muscle flexibility due to the alteration of the angular position of the examined joints affected the ability to generate impulse during the VJ tests.

Epidemiology of injuries in elite male and female futsal: a systematic review and meta-analysis

The main purpose of this study was to conduct a systematic review and meta-analysis quantifying the incidence of injuries in futsal players. A systematic search was conducted using MEDLINE, PubMed, Web of Science and Scopus databases and subsequently, six studies (14 cohorts) were selected. Separate meta-analyses for male and female players were conducted using a Poisson random-effect regression model approach. The overall and match incidence rates in elite male futsal players were 6.8 (95% CI = 0.0-15.2) and 44.9 (95% CI = 17.2-72.6) injuries/1000 hours of exposure. Pooled training injury rate in male players was not calculated due to the lack of studies reporting training injuries in this cohort. For females, an overall, training and match incidence rates of 5.3 (95% CI = 3.5-7), 5.1 (95% CI = 2.7-7.6) and 10.3 (95% CI = 0.6-20.1) injuries/1000 hours of exposure were reported. In males, match incidence rate in International tournaments was 8.5 times higher than in national leagues (77.2 [95% CI = 60.0-94.5] vs 9.1 [95% CI = 0.0-19.3] for international tournaments and national leagues, respectively). Elite male and female futsal players are exposed to a substantial risk of sustaining injuries, especially during matches.

Injury Prevalence of the Lower Limbs in Handball Players: A Systematic Review

Lower limb injuries are frequent in handball and a serious hindrance to athletic performance. The aim of this systematic review was to synthesize the available research on the prevalence of lower limb injuries in handball players according to sex and competitive level. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, 19 studies were selected after a systematic search and selection process of three digital databases: Scopus, PubMed, and Web of Science. Furthermore, a study quality analysis using an ‘Extension for Sports Injury and Illness Surveillance of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE-SIIS)’ was carried out. The sample consisted of 7110 male and female handball players registering 4483 injuries in their lower limbs. The results showed a high incidence of knee injuries (30.23%) and ankle injuries (24.80%), especially in the ligaments, such as the talofibular and the anterior cruciate ligaments. Considering sex and competitive level, knee injuries accounted for 47.02% of injuries among women, while among men, ankle injuries were most prevalent (34.22%) in international competitions. Additionally, the most common cause of injuries was trauma (85.61%). The findings highlighted that the prevalence of lower limb injuries varies greatly according to the characteristics of the sample and injury. Therefore, the study underlines the importance that sports practitioners (physical trainers, readapters, and physiotherapists) adapt training protocols to reduce injury incidence in the most affected body areas or tissues.

Relationship between Anthropometric, Physical and Hormonal Parameters among Pre-Pubertal Handball Players

Background: The aims of our study were to investigate the changes in anthropometric and physical parameters and fasting hormonal levels among pre-pubertal female handball players (n = 14, age: 11.53 ± 0.58 yrs, height: 153.36 ± 5.12 cm, body mass: 43.59 ± 6.14 kg) in the pre-season period following 8 weeks of handball training, and to analyze the contribution of hormones, physical performance and anthropometric parameters. Methods: Prior to and immediately following the training period, several anthropometric, strength, and cardiorespiratory variables, including fasting hormonal concentrations (plasma cortisol, estradiol, testosterone and growth hormones) were measured. Athletes performed concurrent resistance and aerobic exercises, including game-based trainings during the 8-week training period. Results: Significant elevations were found in all strength parameters (maximal handgrip strength dominant (D): 16.40%, p < 0.01; non-dominant (ND): 25.15%, p < 0.05; maximal concentric (MVC) torque of quadriceps D: 13.82%, p < 0.05; ND: 12.61%, p < 0.05; MVC torque of hamstring D: 12.14%, p < 0.01; ND: 12.44%, p < 0.01), including plasma cortisol levels (C, 34.30%, p < 0.05) and peak respiratory quotient (5.24%, p < 0.05). Body composition and maximal oxygen uptake (VO_2max) remained unchanged. Percentage changes in thigh (r = 0.316, p < 0.05), hand (r = 0.361, p < 0.05), and hip circumference (r = 0.297, p < 0.05) correlated with C changes. Percentage changes in plasma growth hormone levels (GH) contributed to the magnitude of gains in handgrip strength (r = 0.553, p < 0.05). Percentage changes in maximal exercise pulmonary ventilation (MVE) correlated with elevated C (r = −0.592, p < 0.05). Discussion: Changes in anthropometric variables and fasting hormone levels (estradiol, testosterone and cortisol) were poor indicators of developing VO_2max and strength during pre-pubertal years. Physical adaptation may not be explained in consideration of the athletes’ hormonal or anthropometric characteristics. Conclusion: Gradually increased training volume followed by a summer break should be applied to youth handball, considering the anti-hypertrophic responses and the inhibitory effect of elevating C on pre-pubertal maturation.

Incidence of injury and pain in referees in German national handball leagues: a cohort study

Background

Handball referees play an important role during a handball match. Surprisingly, not much is known about their sports-related injuries and resulting pain, therefore the purpose of our study was to focus on injuries and sports-related pain in referees in German handball leagues.

Methods

During the 2018/19 national German handball season, referees of the German Federation of Handball (DHB) were contacted and asked to complete an injury and pain questionnaire on the penultimate matchday of the first and the second round of the season.

Results

Seventy referees participated in the study. One in three referees reported an injury during the last year and perceived some form of pain. Of those suffering from pain, 16.7% referees reported chronic pain disorders. During the season, 31.4% of referees incurred an injury and the majority of the 70 referees officiated despite pain (n = 43). Prospectively-enrolled data suggested an incidence of 11.6 (95% CI: 10.3 to 13.0) injuries per 1000 match hours, and 19.0 (95% CI: 16.8 to 21.3) sports-related pain events per 1000 match hours. The most common injuries were foot and knee injuries and a substantial number of the referees (n = 25) reported taking analgesics for the pain.

Conclusion

German handball referees are at risk of sports-related injuries with subsequent pain. Considering the injury profile, the incidence of sports-related pain events, and the high physiological demands of refereeing, it appears that prevention programs should be developed and integrated into the routine of the referee.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00320-1.

Injury Profile in Professional Handball Players During 4 Consecutive Seasons According to Playing Positions: A Longitudinal Study

BACKGROUND

The injury profile of each playing position in handball is a key factor in being able to improve the injury risk management process. Therefore, the aim of this study was to longitudinally analyze the differences in professional handball players' injury profile according to their playing position (ie, goalkeeper, back, wing, and line).

HYPOTHESIS

Injury incidence and burden would be higher in back players compared with the other playing positions, while ligament and knee would be the most common injury type and location.

STUDY DESIGN

Prospective cohort design.

LEVEL OF EVIDENCE

Level 4.

METHODS

Sixty-eight male handball players belonging to the same professional team participated in this study over 4 consecutive seasons. Injury incidence and injury burden were recorded as well as the severity, type, and location following the International Olympic Committee consensus statement.

RESULTS

Although nonsignificant differences in injury incidence were found according to playing position (rate ratios [RRs] from 0.43 to 2.47; P > 0.05), back players reported the highest burden (60.65 absence days/1000 h; RR from 0.12 to 7.75;P < 0.05), with wing players showing a greater burden (54.29 absence days/1000 h; RR from 0.09 to 4.91; P < 0.05) in comparison with goalkeepers (12.19 absence days/1000 h) and line players (13.10 absence days/1000 h). Muscle/tendon injuries and sprains presented higher incidence and burden than other type of injuries, and a greater incidence and burden was reported for knee injuries in all playing positions.

CONCLUSION

The highest injury incidence and injury burden is in back players in professional handball.

CLINICAL RELEVANCE

This study provides comprehensive information on the injury profile of professional handball players, which can be useful for strength and conditioning coaches when developing specific injury risk management programs.

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.

Epidemiology of injuries in female and male senior Slovenian handball leagues

BACKGROUND

Handball is associated with a high frequency of injuries due to unexpected situations, external disturbances of movement and extreme positions of body segments. The purpose of this study was to identify and analyze injuries among female and male players from all five senior Slovenian handball leagues in the season 2010/2011.

METHODS

We conducted a retrospective epidemiological study using a questionnaire. Data were collected between February and May 2012. Descriptive analysis is provided.

RESULTS

Forty-five percent of all the players were injured, reporting 92 injuries. 0.58 injuries/player occurred, 57 (62%) in females and 35 (38%) in males. Injury incidence in females (27.7 injuries/1000 hours match, 0.97 injuries/1000 hours training) was higher than in men (10.6 injuries/1000 hours match, 0.5 injuries/1000 hours training), respectively. The left- and right-back players were injured most often (41%). Sprain was the most common injury type (55%). Most injuries were severe (29%). The lower limb was injured most frequently (62%). Ankle was injured the most commonly (35%), but ankle injuries were in most cases moderate (38%). More than 70% of knee injuries and 50% of shoulder injuries were severe. In 33%, cause of injury was contact with an opponent/teammate. Thirty-six percent of players reported shoulder and 36% ankle overuse syndromes.

CONCLUSIONS

Present findings showed a higher incidence of injuries in female than in male senior Slovenian handball players in the 2010/2011 season. Preventive programs should focus not only on the acute ankle and knee injuries, but also on overuse syndromes of the shoulder and ankle.

Epidemiology of injuries in professional ice hockey: a prospective study over seven years

Background

Ice hockey injuries epidemiology is still poorly understood and very few studies are focused on it, especially about professional players.

Methods

Our prospective study collected all injuries occurring on ice during practice and games over 7 years (2006–2013) in a professional hockey team playing in the 1st division championship in Switzerland.

Results

During the 7 seasons, we recorded a total of 525 injuries and 190 injuries with time loss (TL).

Mean injuries incidence was 5.93 (95% CI 5.28 to 6.27) injuries/1000 h/player and with time loss 2.14 (95% CI 1.79 to 2.39) injuries/1000 h/player.

The lower limb was the most affected part of the body, with a total of 40.4% of all injuries, mostly knee Medial Collateral Ligament tear and muscle adductors/abdominal sprain. For the upper limb, shoulder was the most affected joint with mostly acromioclavicular sprain and shoulder dislocation.

Forwards had a significant (p < 0.05) higher risk than defensemen for knee Medial Collateral Ligament (MCL) tear. There was no significant difference in the concussion risk between forwards and defensemen, but defensemen had a significant higher risk (p < 0.05) to have a more severe concussion.

Conclusion

This study provides a better understanding about professional ice hockey epidemiology, which is still insufficiently researched and understood. We also found some significant risk factors, being a forward for knee MCL tear, being a defensemen for concussion severity.

Concussion program prevention seems to be effective but it is crucial to continue the follow up of concussion on long term and expand the surveillance system to all the League.

Injury Profile of Male and Female Senior and Youth Handball Players: A Systematic Review

Handball is a team sport in which players are exposed to high physical conditioning requirements and several contacts and collisions, so they must face various musculoskeletal injuries throughout their career. The aim of this study was to summarize the characteristics of handball injuries both in training and in competition contexts, differentiating by gender and age. A systematic review was conducted and a total of 15 studies (33 cohorts) met the inclusion criteria. Higher injury incidence was reported during matches compared to training sessions in all groups (i.e., male and female senior and youth players), with male senior players presenting the greatest values. Lower extremities were more frequently injured, being contusions and sprains the most common type of injuries. Females reported more serious injuries than males, who presented a higher percentage of acute injuries caused by direct contact, while in female players these injuries were not caused by direct contact actions. Wings and backs presented the highest injury incidence; additionally, players registered higher match incidence during international championships compared to national leagues. Due to the differences in the injury profile of handball players, specific preventive strategies should be implemented for each group to optimize the injury prevention process.

Musculoskeletal injuries in athletes from five modalities: a cross-sectional study

Background

Musculoskeletal injuries (MSK-I) are a serious problem in sports medicine. Modifiable and non-modifiable factors are associated with susceptibility to these injuries. Thus, the aim of this study was to describe the prevalence of and identify the factors associated with MSK-I, including tendinopathy and joint and muscle injuries, in athletes.

Methods

In this cross-sectional observational study, 627 athletes from rugby (n = 225), soccer (n = 172), combat sports (n = 86), handball (n = 82) and water polo (n = 62) were recruited at different sports training centres and competitions. Athlete profiles and the prevalence of MSK-I were assessed using a self-reported questionnaire. Only previous MSK-I with imaging confirmation and/or a positive physical exam by a specialized orthopaedist were considered. The association of the epidemiological, clinical and sports profiles of athletes with MSK-I was evaluated by a logistic regression model.

Results

The mean age was 25 ± 6 years, and 60% of the athletes were male. The epidemiological, clinical and sports profiles of the athletes were different for the five sport groups. The MSK-I prevalence among all athletes was 76%, with 55% of MSK-I occurring in a joint, 48% occurring in a muscle and 30% being tendinopathy, and 19% of athletes had three investigated injuries. The MSK-I prevalence and injury locations were significantly different among sport groups. There was a predominance of joint injury in combat sports athletes (77%), muscle injury in handball athletes (67%) and tendinopathy in water polo athletes (52%). Age (≥30 years) was positively associated with joint (OR = 5.2 and 95% CI = 2.6–10.7) and muscle (OR = 4.9 and 95% CI = 2.4–10.1) injuries and tendinopathy (OR = 4.1 and 95% CI = 1.9–9.3).

Conclusion

There is a high prevalence of tendinopathy and joint and muscle injuries among rugby, soccer, combat sports, handball and water polo athletes. The analysis of associated factors (epidemiological, clinical and sports profiles) and the presence of MSK-I in athletes suggests an approximately 4–5-fold increased risk for athletes ≥30 years of age. The identification of modifiable and non-modifiable factors can contribute to implementing surveillance programmes for MSK-I prevention.

Skeletal maturation and growth rates are related to bone and growth plate injuries in adolescent athletics

Injuries are common in elite adolescent athletics, but few studies have addressed risk factors for injury. Growth and maturation are potential risk factors in this population; however, the current body of literature is both inconclusive and considered at high risk of bias. The aim of this study was therefore to examine whether growth rate, maturity status, and maturity tempo are associated with injury risk in an elite sports academy. Anthropometric, skeletal maturity and injury data collected prospectively over four seasons (117 athlete-seasons) were included in the analyses. Growth rate for stature was associated with greater risk of bone (incidence rate ratio (IRR): 1.5 per one standard deviation increase above the mean; 95% CI: 1.1-1.9) and growth plate injuries (IRR: 2.1; 1.5-3.1). Growth rate for leg length was associated with greater overall injury risk (IRR: 1.3; 1.0-1.7) as well as the risk of bone (IRR: 1.4; 1.0-1.9) and growth plate injuries (IRR: 2.1; 1.4-3.0). Athletes with greater skeletal maturity, expressed as skeletal age (IRR: 0.6 per year; 0.5-0.9) and percentage of predicted mature height (IRR: 0.8 per percent increase; 0.7-1.0), were less prone to growth plate injuries. Rate of change in skeletal age was associated with an increased risk of bone injuries (IRR: 1.5; 1.0-2.3). The results of this study suggest that rapid growth in stature and leg length, skeletal maturity status, and maturity tempo represent risk factors for certain injury types in adolescent athletics.