Measures of Knee Capability in Handball Players Differ by Age: A Cross Sectional Study

The return to sport after knee injury is challenging. This is burdensome for sports with a high incidence of injuries, such as team handball. Various tests guide decision making, but often the athlete's preinjury performance of these measures remains unknown. Moreover, objective return-to-sport criteria of a matching population are missing. The purpose of this study was to evaluate objective measures of knee capability in handball depending on players' age. Two hundred sixty-one handball players performed a functional test battery designed to evaluate knee capability after an anterior cruciate ligament injury: two- and one-legged stability analysis, jumps, speed tests, and agility assessments. For age-specific evaluation, athletes were divided into three age groups (16-19; 20-29;≥30 years). Male players showed differences in two and one-legged jumping height (p<0.02) as well as power per body weight (p<0.01) between age groups. Young female players reached better results in two-and one-legged stability. Besides the quick feet test, results of females did not differ between age groups. Functional knee stability in healthy handball players is partly influenced by age, and females show better results in stability and male athletes in power measurements. This aspect should be considered for return to sports testing and underlines the importance of performance measures in athletic testing.

A Novel Multiple-Cue Observational Clinical Scale for Functional Evaluation of Gait After Stroke - The Stroke Mobility Score (SMS)

Background

For future development of machine learning tools for gait impairment assessment after stroke, simple observational whole-body clinical scales are required. Current observational scales regard either only leg movement or discrete overall parameters, neglecting dysfunctions in the trunk and arms. The purpose of this study was to introduce a new multiple-cue observational scale, called the stroke mobility score (SMS).

Material/Methods

In a group of 131 patients, we developed a 1-page manual involving 6 subscores by Delphi method using the video-based SMS: trunk posture, leg movement of the most affected side, arm movement of the most affected side, walking speed, gait fluency and stability/risk of falling. Six medical raters then validated the SMS on a sample of 60 additional stroke patients. Conventional scales (NIHSS, Timed-Up-And-Go-Test, 10-Meter-Walk-Test, Berg Balance Scale, FIM-Item L, Barthel Index) were also applied.

Results

(1) High consistency and excellent inter-rater reliability of the SMS were verified (Cronbach’s alpha >0.9). (2) The SMS subscores are non-redundant and reveal much more nuanced whole-body dysfunction details than conventional scores, although evident correlations as e.g. between 10-Meter-Walk-Test and subscore “gait speed” are verified. (3) The analysis of cross-correlations between SMS subscores unveils new functional interrelationships for stroke profiling.

Conclusions

The SMS proves to be an easy-to-use, tele-applicable, robust, consistent, reliable, and nuanced functional scale of gait impairments after stroke. Due to its sensitivity to whole-body motion criteria, it is ideally suited for machine learning algorithms and for development of new therapy strategies based on instrumented gait analysis.

Functional Knee Performance Differences in Handball are Depending on Playing Class

Handball is one of the most traumatic sports. The knee is the most commonly injured joint. To prevent knee injuries, optimal functional knee stability is of great importance. Nevertheless, there is still no consensus about objective criteria for knee function. Depending on playing class, injury rates seem to differ. The purpose of this study was to evaluate knee function in handball depending on playing class and to establish reference data for functional knee stability. 261 handball players (25.1±5.8 years) performed a functional test including two- and one-legged stability assessments, jump tests, speed and agility analysis. Except for balance, differences between playing classes were detected in all tests with superior performance of high-class players (Germany’s 1st (“Oberliga”) and 2nd (“Verbandsliga”) non-elite playing class). High-class players achieved significant better results in jumping height (p≤0.011–0.029), relative power per body weight in the two-legged counter movement jump (p≤0.023) and speed and agility tests (p≤0.001). This study illustrates the relevance of playing class specific screening. Sports and playing class-specific databases will help to identify individual deficits and strengths in order to prevent injury and increase performance. Moreover, objective criteria for return to sports can be established.

Functional knee stability in non-elite handball: balance and jump performance differ based on players' position

PURPOSE

Despite the great evolvement of sports medicine, there is still a lack of consensus among sports physicians regarding the decision of return to sports after knee injury, especially in non-elite sports. Currently, no sport-specific reference data for an objective reliable evaluation of functional knee stability exist. The purpose of this study was to assess objective measures on knee joint stability from an established test battery in non-elite handball. It was assumed that players' knee stability differs depending on their field position.

METHODS

One-hundred and sixty-five non-elite handball players with a mean age of 24.3 ± 5.5 years underwent a test battery including two-legged and one-legged stability tests, two-legged and one-legged counter movement jumps, two-legged plyometric jumps, one-legged speedy jumps, and a quick feed test.

RESULTS

Athletes' physical performance differs in terms of field position. Significant differences between handball players of different positions were found in regard to two-legged stability (p < 0.036) and one-legged stability in the dominant leg (p < 0.009). Players of different positions differed in ground contact time of the plyometric jumps (p < 0.017), whereas the other functional tests did not show significant differences.

CONCLUSION

This study is first to report differences in functional knee stability of non-elite handball players on the basis of objective data. Significant differences of functional performance were noted, which were in congruence with position-specific demands. These findings demonstrate the importance of position-specific screening and training to prevent injuries.

LEVEL OF EVIDENCE

II.

[Handball injuries and their prevention]

BACKGROUND

Handball is one of the most popular team sports in Germany, as well as one of the most dangerous ones. Injury rates in Germany are higher amongst handball professionals than in soccer, with the knee being the most commonly injured joint. To prevent injuries, a functional inert stability is necessary, but definitions and objective measures are lacking.

OBJECTIVES

Establishing valid reference data of functional knee stability in amateur handball players with use of an established test battery giving objective measures METHODS: 261 athletes (f:130; m:131), mean age 25.1 ± 5.8 y were screened during the preseason. The test battery consisted of double and single-leg counter movement jumps, balance tests, agility, parkour, quick feet test and plyometric jumps.

RESULTS

Significant differences between males and females were noted in regard to balance scores (favour for females p ≤ 0.001), as well as jump height, agility and speed tests (favour for males [p ≤ 0.002-0.001]).

CONCLUSION

The noted differences once again bring focus to the interindividual presence of risk factors, because female and male handball athletes have gender-specific ground levels. These attributes have to be considered in further screening and prevention programs, as well as in the context of the return-to-sports decision after injury. The given data may serve as objective reference measures.

[Functional Knee Stability in Handball: An Indispensable Criterion For Safe Sport]

Various studies in recent years have shown that, within ball sports, handball players have a high risk of accidents and injuries. The knee joint is the most frequently injured body region, and ruptures of the anterior cruciate ligament the most common injury to the knee. To prevent consequential damage or recurrent knee injury, good functional stability of the knee is of high importance. Stability not only prevents injuries, but is also crucial for optimising handball-specific movements. Although there are numerous studies on injuries in handball - mostly performed on professional athletes - the field of research focusing on functional knee stability is deficient. This article provides an overview of the current state of research and discusses existing prevention approaches.