The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) Performance in Elite Team Handball Players Playing with Shoulder Pain, Previous Pain, or No Pain

Background

Physical therapists use tests that could determine strength and weaknesses of the shoulder for overhead throwing athletes to enhance performance, prevent injury, and safely progress rehabilitation. The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) has been proposed to assess muscular capacity and dynamic shoulder stability in overhead athletes, which could provide information to determine a risk of injury.

Purpose

To investigate if the CKCUEST is an appropriate test to implement within team elite handball players to evaluate dynamic shoulder stability across sexes and in the screening of shoulder pain.

Study design

Cross-sectional study.

Methods

Elite team handball players were recruited and performed the CKCUEST from which three different scores (raw, touch, and power) were calculated and compared among handball players playing with shoulder pain, previous pain, and no pain.

Results

A total of 106 handball players were included: 49 females (1.74±0.03 m, 70.4±6.7 kg, and 22±4.9 years) and 57 males (1.90±0.08 m, 91.6±11.4 kg, and 22±5.4 years), A significant difference was found between the female and male handball players when comparing all three CKCUEST scores (p<0.01). No significant differences were found in the CKCUEST scores among the three different groups (F≤1.23, p≥0.30, η2≤0.03). Among the female participants, no significant differences were found between performing the CKCUEST and the modified test. A significant correlation was found between height and the power score for men (r=0.661, p≤0.001) and women (r=0.434, p=0.01).

Conclusion

A comparison of scores across sexes appears unsuitable, due to the possible positive influence of height on the final score. But within the female group, performances of the CKCUEST and the modified CKCUEST were comparable. Additionally, the CKCUEST was not able to differentiate among elite handball players who are playing with shoulder pain, previous shoulder pain, and no pain.

Level of evidence

3.

Adolescents' experiences with the food selection at the sports arena in the area of Oslo, Norway: a focus group study

OBJECTIVE

To investigate adolescents' experiences with the food selection at the sport arena.

DESIGN

Four focus group interviews were conducted with 4-6 participants each. Interviews were recorded and transcribed verbatim. The transcripts were coded in NVivo and the analysis was guided by thematic analysis.

SETTING

Adolescents from handball and football clubs in Oslo and Viken, Norway, participated in the study.

PARTICIPANTS

A total of nine boys (11-14 years old) and ten girls (11-14 years old) participated in the study.

RESULTS

We identified four main themes: interest for healthy food; experiences with the food selection at the sports arena; factors influencing participants' food choices at the sports arena and expectations related to a healthy food selection at the sports arena. Adolescents across the focus groups experienced the food selection at the sports arena as unhealthy. Price, marketing and availability of unhealthy food were important factors that influenced their food choices at the sports arena. The trainer appeared to motivate the participants to eat healthy.

CONCLUSIONS

Participants wished for a healthier food selection at the sports arena. Cost of food emerged as a factor that influenced their food choices. Our study also indicates that marketing of unhealthy food and beverages should be restricted, to influence adolescence food choice towards healthier alternatives.

Dietary habits in adolescent male and female handball players: the Swedish Handball Cohort

Objectives

This cross-sectional study aimed to describe dietary habits in Swedish adolescent handball players and differences with respect to sex and school grade.

Methods

Participants in the Swedish Handball Cohort answered a web-survey assessing adherence to sports nutrition recommendations for meal frequency and meal timing, and the Nordic Nutrition Recommendations (NNR) for fruits/vegetables and fish/seafood, food exclusions and use of dietary supplements. Differences with respect to sex and school grade were estimated with generalised linear models, generating prevalence ratios (PR) with 95% CIs.

Results

A total of 1040 participants (16.6±0.9 years, 51% males) were included. Overall, 70% and 90%, respectively, met recommendations for meal frequency and meal timing, whereas adherence to recommended carbohydrate intake during training/game was met by 17%. Adherence to the NNR for fruits/vegetables and fish/seafood was met by 16% and 37%, respectively. Twenty-eight per cent reported using dietary supplements. Females reported lower frequency of meals, especially morning snacks (-0.6 days/week (95% CI -0.3 to -0.9)) and evening snacks (-0.8 days/week (95% CI -0.5 to -1.1)), higher prevalence of exclusions due to intolerances (PR 1.66 (95% CI 1.31 to 2.01)) and other reasons (PR 1.36 (95% CI 1.08 to 1.64)), higher adherence to the NNR for fruits/vegetables (PR 2.30 (95% CI 1.98 to 2.62)) and use of micronutrient supplements (PR 1.72 (95% CI 1.43 to 2.00)) compared with males. Only small differences were observed between school grades.

Conclusions

Swedish adolescent handball players' dietary habits are fairly in accordance with sports nutrition recommendations but not the NNR. Females appear to display more restrictive habits than males.

Effectiveness of patient triage at the orthopedic hospital and the hygiene concept in a professional handball team in the first year of the SARS-CoV-2 pandemic

The first severe acute respiratory syndrome coronavirus type 2 (SARS-CoV‑2) pandemic wave in Germany in spring 2020 challenged the largely unprepared healthcare system. A prevention concept was implemented to protect the vulnerable patient group at our orthopedic department. The patient triage during the pre-admission process included screening for symptoms and obtaining information on travel, occupation, contact and cluster (TOCC) [16].In March 2020, all sporting events were also cancelled or postponed [12]. Mitigation strategies for sport activities were necessary to restart training and competition. For the professional handball team of the Sport Club Magdeburg (SCM), a hygiene concept including strict mitigation measures combined with a polymerase chain reaction (PCR) test regime was implemented.We reviewed 15,739 patient contacts in a 12-month period at orthopedic department during the SARS-CoV‑2 pandemic. This epidemiological, retrospective study presents the results of patient triage detecting cases with suspected SARS-CoV‑2 infections when entering the clinic. We also considered 2328 inpatient PCR test results and the infection rates among the medical staff. At the same period, professional athletes underwent 1428 PCR tests as a part of the hygiene concept.During the triage process, 333 cases (2.12%) with suspected SARS-CoV‑2 infections were detected at the orthopedic outpatient department. Three patients had a positive PCR test result after triage. Another four positive PCR tests were found among the inpatient group and one positive result among the medical staff. In the athletes' cohort, none of the 1428 PCR tests was positive.Patient triage as a part of the preadmission process is an effective tool to protect the maximum-care hospital from a SARS-CoV‑2 mass outbreak. A hygiene concept with a defined PCR test regime protects a professional athlete team from SARS-CoV‑2 infections during international competition and training.

The case of professional handball refereeing

In double refereeing, agreement between referees is fundamental for the achievement of a flawless and smooth refereeing activity. Nonetheless, the agreeement can be affected by several external and internal factors, with a negative impact on the consistency of the refereeing and the fluidity of the game. The referee's Decision Threshold (DT) is the limit above which the evidence of a foul results in the call of an infraction by the referee. It represents the individual refereeing style, and it is one of the factors that can contribute to low agreement between the referees. We present an application of a new Bayesian procedure to estimate referee's DT in a typical refereeing task. To this end, 56 italian professional handball (FIGH) referees were asked to evaluate 96 potential foul plays, belonging to four different infraction types: 7-m throw, passive play, offensive foul, disciplinary sanctions. The proposed method provides information about: (i) referee's individual DT; (ii) the agreement between pairs of referees (i.e., one-to-one); (iii) the agreement between each referee and all the other referees (i.e., one-to-total); (iv) the agreement between each referee and a reference referee (i.e., one-to-expert); (v) the proportion of agreement between the referees and a reference referee for each potential foul play. Sport federations would profit by this procedure in different ways: by using the information about the DT to train referees, by detecting referees with a low agreement with their colleagues or with the reference referee, by focusing training on specific plays to improve the arbitration class internal consistency.

Adherence to the Mediterranean diet, kinanthropometric characteristics and physical performance of young male handball players

Introduction

Handball is a team sport whose performance depends on a large number of factors. The objectives of the present study were to analyze the differences in physical performance, kinanthropometric variables, and adherence to the Mediterranean diet (MD), in handball players according to sports category, as well as the possible relationships between these variables.

Methods

One hundred and thirty-three male handball players (35 infant; 46 cadets; 26 juniors and 26 seniors players) underwent a kinanthropometric analysis following the ISAK protocol, self-completed the KIDMED questionnaire, and their physical condition was evaluated with different physical tests.

Results

Significant differences (p < 0.001-0.007) were found between the sports categories in most of the physical condition variables and anthropometric characteristics, but not in the degree of adherence to the MD. The predominant level of adherence to the MD was medium (47.4%), followed by good (42.1%), and correlated with the body mass, the height, the BMI, the muscle mass and the ∑3-girths sum corrected, but not with physical test results. A multiple linear regression analysis showed that the fat mass and muscle mass variables had a more specific weight in the results of the physical fitness tests.

Conclusions

There are differences according to sports category in kinanthropometric characteristics and physical fitness tests in adolescent handball players. The predominant degrees of adherence to the MD were medium and good. A relationship was found between anthropometric characteristics and physical performance in handball players.

Establishing Normative Dynamic Postural Control Values in Elite Female Handball Players

Background

Lower extremity injuries among young female handball players are very common. The modified Star Excursion Balance Test (mSEBT) is a valid clinical tool to assess dynamic postural control and identify athletes with higher risk of injury. However, its interpretation is difficult since performance on this test is highly sport dependent. No normative values on the mSEBT exist in handball.

Purpose

The aim of this investigation was to establish normative ranges of mSEBT performance in young, healthy female handball players to help practitioners when interpreting risk estimates.

Study design

Cross-Sectional Study.

Methods

Athletes from 14 elite teams were recruited during a national tournament and performed 3 trials in the anterior (ANT), posteromedial (PM), posterolateral (PL) directions of the mSEBT. Means, standard deviations and 95% confidence intervals (95%CI) of normalized reached distances were calculated for each direction and the composite score (COMP). Level of asymmetry between dominant and non-dominant limbs were calculated for each direction using Bland Altman analyses. Group differences were weighed against the established mSEBT minimum detectable differences (MDD) to compare scores between limbs and across different player positions.

Results

One-hundred and eighty-eight females (16.8±0.9 years) were tested. Mean reach distances were 65.2±5% (64.7-65.7), 110.0±6.2% (109.3-110.6), 107.1±6.2% (106.5-107.8) and 94.1±4.9% (93.6-94.6) for the ANT, PM, PL directions and COMP score respectively. Bias and limits of agreement for limb asymmetry were -0.23% (-5.85%, 5.38%) for ANT, -0.83% (-8.80%, 7.14%) for PM, 0.33% (-8.51%, 9.17%) for PL and -0.27% (-4.88%, 4.33%) for COMP score. No meaningful differences were observed between limbs or across player positions since the values did not exceed the MDD and all 95%CIs overlapped.

Conclusion

This study provides normative performance values for dynamic postural control as measured by the mSEBT among young, healthy, elite female handball players. Considering the high incidence of injury in this population, these values can be used for injury risk reduction and return to sport decisions. Further prospective studies are needed to established specific cut-off scores in this population.

Level of evidence

2c.

Risk factors and prevention strategies for shoulder injuries in overhead sports: an updated systematic review

PURPOSE

The aim of this systematic review was to update the knowledge on risk factors and prevention strategies for shoulder injuries in overhead sports with special emphasis on methodological quality.

METHODS

All methodological procedures were performed in line with a previous systematic review by Asker et al. (2018). The literature search was conducted in the PubMed, Google Scholar, Cochrane, and SPORT-Discuss databases. Due to the risk of bias assessment, only studies with at least an acceptable methodological quality were included. A best-evidence synthesis was performed to clarify the evidence and direction of the risk factors and prevention strategies.

RESULTS

A total of nine studies were included in the data extraction process. One study had a high and eight studies had an acceptable methodological quality. Seven cohort studies investigated risk factors and two randomised controlled trails evaluated prevention strategies. Moderate evidence was found for two non-modifiable (playing position, gender) and three modifiable factors (shoulder rotational strength, scapular dyskinesia, shoulder prevention programme) that were associated with the shoulder injury risk. All further risk factors had moderate and no association with risk (shoulder rotational ROM, joint position sense) or limited (history of shoulder/elbow pain, age, training experience, training volume, school grade, playing level), and conflicting evidence (setting).

CONCLUSIONS

There is moderate evidence for two non-modifiable (playing position, gender) and three modifiable factors (shoulder rotational strength, scapular dyskinesia, shoulder prevention programme) being associated with the shoulder injury risk in overhead sports.

Cocreating injury prevention training for youth team handball: bridging theory and practice

Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants’ contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.

First-time anterior cruciate ligament injury in adolescent female elite athletes: a prospective cohort study to identify modifiable risk factors

PURPOSE

To identify modifiable biomechanical and neuromuscular anterior cruciate ligament (ACL) injury risk factors for first-time ACL injury in adolescent female elite football and team handball players.

METHODS

Adolescent female elite football and handball players with no previous ACL injury participated in the present study. At baseline, players were tested during side-cutting manoeuvres performed in a 3-dimensional motion analysis laboratory with concomitant electromyography (EMG) measurements. Maximal isometric lower limb muscle strength was assessed by handheld dynamometry. Players were prospectively followed for 2 years after baseline testing, and all magnetic resonance imaging (MRI) verified ACL injuries were registered. The effect of 16 risk factor candidates on the relative risk (RR) of ACL injury was estimated using Poisson regression analysis.

RESULTS

Ninety players (age 16.9 ± 1.2 years) were included in the analyses. Nine first-time ACL injuries (injury incidence 10.0% (95% confidence interval (CI) 5.4-18.6%)) were registered during the 2-year follow-up period. Four risk factor candidates were significantly associated with the risk of ACL injury: (1) hip flexion angle at initial contact (IC) [RR 0.56, 95% confidence interval (CI) 0.34-0.92], (2) internal knee rotation angle at IC [RR 1.13, 95% CI 1.08-1.19], (3) semitendinosus EMG activity 50 ms prior to IC [RR: 0.62, 95% CI 0.43-0.89], and (4) external hip rotator strength [RR: 0.77, 95% CI 0.66-0.89].

CONCLUSION

Four distinct ACL injury risk factors related to the side-cutting manoeuvre were identified in a population of adolescent female elite football and team handball players with no previous ACL injury. As ACL injury typically occur during side-cutting, intervention programmes to modify these risk factors pose a promising strategy for ACL injury prevention in adolescent female elite football and team handball.

LEVEL OF EVIDENCE

II.

Exploring the Effect of Long Naps on Handball Performance and Heart Rate Variability

This study explored the effect of long naps on handball-related performance and assessed the role of the cardiac autonomic nervous system in this process. Eleven male collegiate handball players performed a repeated sequential trial consisting of a 20-m consecutive turnaround run, 10-m run with a load, and shooting the ball into a target. Participants were allocated randomly and sequentially to have a short (20 minutes) nap, long (60 minutes) nap, or no nap. The Pittsburgh Sleep Quality Index was used to assess regular sleep quality. Subjective sleepiness before and after napping was measured using the Karolinska Sleepiness Scale. Heart rate variability was recorded to assess cardiac autonomic nervous function during napping. The Pittsburgh Sleep Quality Index score was correlated with shot accuracy only after long naps (ρ=0.636, r=0.048). A negative correlation was observed between the root mean square of successive differences and average load run time (ρ=−0.929, p<0.001). Long napping was associated with a significant benefit on performance in athletes with poor sleep quality, implying a role of the autonomic nervous system in this regard. Our findings indicate the effect of sleep quality on the endurance and resistance of handball players.

Monitoring external load in elite male handball players depending on playing positions

Monitoring workload is critical for elite training and competition, as well as preventing potential sports injuries. The assessment of external load in team sports has been provided with new technologies that help coaches to individualize training and optimize their team's playing system. In this study we characterized the physical demands of an elite handball team during an entire sports season. Novel data are reported for each playing position of this highly strenuous body-contact team sport. Sixteen world top players (5 wings, 2 centre backs, 6 backs, 3 line players) were equipped with a local positioning system (WIMU PRO) during fourteen official Spanish first league matches. Playing time, total distance covered at different running speeds, and acceleration variables were monitored. During a handball match, wings cover the greater distance by high-speed running (> 5.0 m·s-1): 410.3 ± 193.2 m, and by sprint (> 6.7 m·s-1): 98.0 ± 75.4 m. Centre backs perform the following playing position that supports the highest speed intensities during the matches: high-speed running: 243.2 ± 130.2 m; sprint: 62.0 ± 54.2 m. Centre backs also register the largest number of high-intensity decelerations (n = 142.7 ± 59.5) compared to wings (n = 112.9 ± 56.0), backs (n = 105.2 ± 49.2) and line players: 99.6 ± 28.9). This study provides helpful information for professional coaches and their technical staff to optimize training load and individualize the physical demands of their elite male handball players depending on each playing position.

Injuries in Japanese university handball: a study among 1017 players

The aim of this study was to examine the injury profile of Japanese university handball players. In this cross-sectional study, a total of 1017 participants who played in the 2018 Japanese National University Handball Championship were followed. The incidence within the previous year was 0.59 [95% CI, confidence interval: 0.56-0.62] per player per year. The ankle (33.3%), knee (23.6%), and shoulder/clavicle (12.6%) were the body regions most affected by traumatic mechanisms, while the lumbar spine/lower back (26.0%), knee (15.7%), and shoulder (15.0%) were the body regions most affected by overuse mechanisms. Sprain (30.7%), ligamentous rupture (23.2%), and fracture (11.8%) were the main types of traumatic injuries, and stress fracture (25.0%) and lesion of meniscus or cartilage (25.0%) were the main types of overuse injuries. Female players were 1.5 times more likely (OR, odds ratio: 1.55 [95% CI: 1.20-2.01]) to experience an injury than their male counterparts, and line players were also 1.5 times more likely (OR: 1.49 [95% CI: 1.00-2.21]) to experience an injury than their wing counterparts. This study showed that there is a need for increased injury prevention efforts in Japanese handball, especially among female players.

Injury pattern according to player position in Japanese youth handball: A cross-sectional study among 2377 players

OBJECTIVE

Although the incidence and pattern of injuries in youth handball have widely been investigated, it is unclear whether the characteristics of injuries differ on the basis of player position. This study aimed at revealing the player position-based injury profile in Japanese youth handball players.

DESIGN

Cross-sectional.

SETTING

Injury questionnaire.

PARTICIPANTS

Overall, 2377 participants who played in the 2018 and 2019 Japanese National High School Handball Championships were included.

MAIN OUTCOME MEASURES

Prevalence, body region, type, severity, and mechanism of injuries were collected through a questionnaire.

RESULTS

The overall prevalence of injury within the previous year was 46.7%, and the proportion of back players (52.8%) who sustained at least one injury was higher than that of players in other positions (p < 0.001). Differences in player positions were found among overuse injuries by body region, with a higher proportion of the lower leg and knee in wings and backs, respectively (p = 0.047). Among traumatic injuries, a higher proportion of ligamentous rupture in backs and fracture in lines were seen (p = 0.011).

CONCLUSION

There were significant differences in the prevalence and patterns of injuries between player positions. Therefore, injury prevention programmes should consider the characteristics of player positions.

Automatic detection of peripheral stimuli in shooters and handball players: an event-related potential study

This study examined the practice-related sensitivity of automatic change detection. The visual mismatch negativity (vMMN) component of event-related potentials was compared in handball players and in sport shooters. Whereas effective performance in handball requires processing of a wide visual field, effective performance in shooting requires concentration to a narrow field. Thus, we hypothesized larger sensitivity to peripheral stimuli violating the regularity of sequential stimulation in handball players. Participants performed a tracking task, while task-irrelevant checkerboard patterns (a frequent and an infrequent type) were presented in the lateral parts of the visual field. We analyzed the vMMN, a signature of automatic detection of violating sequential regularity, and sensory components (P1, N1, and P2). We obtained larger vMMN in the handball players' group indicating larger sensitivity to peripheral stimuli. These results suggest the plasticity of the automatic visual processing, i.e., it can adapt to sport-specific demands, and this can be captured even in a short experimental session in the laboratory.

Exercise-induced downregulation of serum interleukin-6 and tumor necrosis factor-alpha in Egyptian handball players

Muscles of candidates work at various grades of intensity during handball exercises according to the pace of exercise. The movement pattern involves large number of contractions, feints, dodges and numerous changes in movements, all of which are highly responsible for changes in trainer's organs, including the immune system. In this study, inflammatory mediators involving interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in serum of 18 Egyptian male handball players, selected from Tanta club handball under 21 year’s old team, were analyzed. The analysis was established on samples collected just before and immediately after intermediate reasonable exercise via enzyme linked immunosorbent assay (ELISA). Moreover, white blood cells (WBCs) count and other hematological markers including hemoglobin %, hematocrit value, and platelet count were assessed. Our results demonstrated a significant decrease in the levels of IL-6 and TNF-α after exercise compared to those before exercise. This was coupled with an increase in WBCs and platelets count. It is also noteworthy that there was a significant positive correlation between serum levels of IL-6 and TNF-α in the study subjects coupled with a significant negative correlation between IL-6 and WBCs after the exercise. Therefore, it is concluded that intermediate reasonable exercises result in decreased levels of IL-6 and TNF-α, which result in decreasing of the inflammation and help in healing and rapid recovery of muscles of the candidates.

Brain activation patterns during visuomotor adaptation in motor experts and novices: An FDG PET study with unrestricted movements

BACKGROUND

Speed of performance improvements and the strength of memory consolidation in humans vary with movement expertise. Underlying neural mechanisms of behavioural differences between levels of movement expertise are so far unknown.

NEW METHOD

In this study, PET with [¹⁸F]fluorodeoxyglucose (FDG) was proposed as a powerful novel methodology to assess learning-related brain activity patterns during large non-restricted movements (ball throwing with a right hand). 24 male handball players ('Experts') and 24 male participants without handball experience ('Novices') performed visuomotor adaptations to prismatic glasses with or without strategic manoeuvres (i.e., explicit or implicit adaptation).

RESULTS

Regional changes in FDG uptake as a marker of neuronal activity, relative to a control condition, were assessed. Prismatic adaptation, in general, was associated with decreased occipital neuronal activity as a possible response to misleading visual information. In 'Experts', the adaptation was associated with altered neuronal activity in a network comprising the right parietal cortex and the left cerebellum. In 'Novices', implicit adaptation resulted in an activation of the middle frontal and inferior temporal gyrus.

COMPARISON WITH EXISTING METHODS

This study demonstrates the versatility of FDG PET for studying brain activations patterns in experimental settings with unrestricted movements that are not accessible by other techniques (e.g., fMRI or EEG).

CONCLUSIONS

Observed results are consistent with the involvement of different functional networks related to strategic manoeuvres and expertise levels. This strengthens the assumption of different mechanisms underlying behavioural changes associated with movement expertise. Furthermore, the present study underscores the value of FDG PET for studying brain activation patterns during unrestricted movements.

Facilitators and barriers to healthy food selection at children's sports arenas in Norway: a qualitative study among club managers and parents

Objective:

To investigate club managers’ and parents’ experiences with food selection at handball halls in order to identify facilitators and barriers to the availability of healthy food.

Design:

Individual interviews with club managers (n 6) and focus groups (n 5) with parents (n 21) were conducted. Interviews were recorded and transcribed verbatim, transcripts were coded in NVivo and the analysis was guided by thematic analysis.

Setting:

Interviews were conducted at five handball clubs with varying socio-economic user populations and sizes in the area of Oslo, Norway.

Participants:

The club managers were responsible for food selection at the handball clubs. The participating parents had one or two active children between the ages of 6 and 12 years who took part in the clubs.

Results:

The club managers and parents generally described food selection at the handball halls as unhealthy and wanted a healthier selection of food. The club managers’ primary barriers to providing a healthier food selection included the potential to lose profits, limited facilities and time to prepare these foods. The parents often valued unhealthy food, as they believed that it supported the social environment and served as a reward for the children. Trainers were perceived as important role models for the promotion of healthy eating. The participants thought that national guidelines could facilitate healthy food environments in sports arenas.

Conclusion:

Healthier food options in sports settings could be facilitated through national guidelines that describe healthy foods and establish who is responsible for providing healthy food selections.

Development of a short and effective shoulder external rotation strength program in handball: A delphi study

BACKGROUND

Weakness of the shoulder external rotators (ER) is one of the main risk factors for shoulder pain in handball. Short, effective shoulder ER strength programs the players will adhere to are lacking.

OBJECTIVES

to develop a short and effective shoulder ER strength program, handball players will adhere to.

METHODS

We conducted a modified Delphi study, including experts in the field of shoulder, strength training and handball. In the first round, the experts were asked to rate eight pre-defined shoulder ER exercises on efficacy and adherence and to suggest other preferred exercises. In round two, they were asked to rate the new exercises from round one. In round three, they received a statistical summary of the panels scores, their own score and a summary of the suggestions. Based on the feedback, the experts were asked to revise their response.

RESULTS

Sixteen experts completed three rounds with 100% response rate. Twenty-eight exercises were rated. We reached consensus for both efficacy and adherence for two exercises, ER in 90° abduction in a bent-over squat position and ER in 90° abduction combined with horizontal abduction and trunk rotation in a push-up position.

CONCLUSION

We reached consensus for both efficacy and adherence for two exercises.

Influence of typical handball characteristics on upper body posture and postural control in male handball players

Background

Well defined constitutional parameters support the physical fatigue resistance in handball to maintain the performance level for the majority of actions. Ideal constitutional conditions are necessary to achieve these physiological advantages in handball. But limited knowledge exists about the upper body posture or the postural control in correlation to the Body Mass Index (BMI), playing years, playing position and throwing arm in professional male handball.

Methods

Ninety-one male handball players participate (24.1 ± 5.9 years; playing experience 16.6 ± 5.7 years). A three-dimensional back scanner and a pressure measuring plate were used.

Results

Correlations between BMI and upper body posture and postural control were not significant. Same counts for the comparison between the left and right throwing arm according to upper body posture and postural control (p ≥ 0.05). Correlations between the years of playing can be found at pelvis height (p ≤ 0.04) and for the length of the Center of Pressure (CoP) (p ≤ 0.01). Wing players are 6.5-8.5 cm smaller. The playing position is independently of BMI, age or upper body posture (p ≥ 0.05). Backcourt players have a higher load of the left and a lower load of the right foot compared to wing players (p ≤ 0.001). Left-right comparison (p ≤ 0.001/ 0.01) can be seen in pivot player (covered area), backcourt player (weight distribution left/right [rear] foot), wing player (weight and force distribution left/right foot, covered area).

Conclusion

Goalkeeper, Backcourt and pivot players are taller and heavier than wing players. These physiological demands are not detectable in the upper body posture and slightly in postural control. Wing players have the most asymmetric load distribution and the longest length of CoP. Since goalkeepers do not differ from pivot or backcourt players, this can be lead back to the same training.

The rapid recovery of vertical force propulsion production and postural sway after a specific fatigue protocol in female handball athletes

BACKGROUND

Muscle fatigue is characterized by a decrease in muscle performance, accompanied by an increase in perceived exertion to produce a desired amount of force. The duration of the fatigue effects is not completely clear regarding postural sway and force production in athletes.

RESEARCH QUESTION

What is the effect of a specific fatigue protocol in postural sway and force production in female handball athletes and the recovery time necessary for these variables?

METHODS

Twenty female handball athletes participated in this study. Specific handball actions composed the fatigue protocol in the format of a circuit with the gradual increment of laps. They stood upright in one-leg posture on a force plate. For the maximum propulsion force (F_MAX), they performed a countermovement jump on the force plate. The center of pressure (COP) and the F_MAX were obtained at baseline, immediately after the exhaustion due to the fatigue protocol and every minute during the first 10 min of the recovery phase.

RESULTS

The F_MAX decreased ∼9.5% after the fatigue protocol, whereas de COP area increased 224%. During the recovery phase, the F_MAX and the COP area returned to baseline values after five minutes.

SIGNIFICANCE

The first five minutes immediately after the fatigue protocol represent the time interval where the fatigue effects are still present. Future studies willing to investigate the effects of fatigue in athletes should perform the analysis within this short time-window.

[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.

Elite athletes as research model: vitamin D insufficiency associates with elevated central blood pressure in professional handball athletes

PURPOSE

Low vitamin D levels have been associated with elevated blood pressure in the general population. Prospective studies, however, have produced conflicting evidence about the blood pressure-lowering effects of vitamin D supplementation. Cardiorespiratory fitness may modulate the vitamin D-blood pressure association. We therefore examined this association in professional athletes, whose high training load serves as a biological control for physical fitness.

METHODS

50 male professional handball players (age 26 ± 5 years) were examined. We assessed the central aortic pressure parameters using transfer function-based analysis of oscillometrically obtained peripheral arterial waveforms. Serum 25-OH vitamin D concentrations were determined by chemiluminescent immunoassay. The threshold for insufficiency was set at values of < 30 ng/mL.

RESULTS

Central blood pressure (cBP) was 98 ± 7/60 ± 10 mmHg. The aortic pulse wave velocity (PWV) was 6.3 ± 1.0 m/s. Nine athletes (18%) displayed insufficient 25-OH vitamin D levels and had a significantly (p < 0.01) higher cBP compared with the 41 (82%) athletes with sufficient 25-OH vitamin D levels (106 ± 5/68 ± 8 vs. 97 ± 7/58 ± 9 mmHg). Central systolic blood pressure (cSBP) in vitamin D-sufficient athletes was significantly lower in comparison to the healthy reference population (97 mmHg vs. 103 mmHg, p < 0.001). This significance of difference was lost in vitamin D-insufficient athletes (106 mmHg vs. 103 mmHg, p = 0.12).

CONCLUSION

Significantly raised central systolic and diastolic blood pressure in vitamin D-insufficient elite athletes implicates vitamin D as a potential modifier of vascular functional health.

Current Approaches to the Use of Artificial Intelligence for Injury Risk Assessment and Performance Prediction in Team Sports: a Systematic Review

Background

The application of artificial intelligence (AI) opens an interesting perspective for predicting injury risk and performance in team sports. A better understanding of the techniques of AI employed and of the sports that are using AI is clearly warranted. The purpose of this study is to identify which AI approaches have been applied to investigate sport performance and injury risk and to find out which AI techniques each sport has been using.

Methods

Systematic searches through the PubMed, Scopus, and Web of Science online databases were conducted for articles reporting AI techniques or methods applied to team sports athletes.

Results

Fifty-eight studies were included in the review with 11 AI techniques or methods being applied in 12 team sports. Pooled sample consisted of 6456 participants (97% male, 25 ± 8 years old; 3% female, 21 ± 10 years old) with 76% of them being professional athletes. The AI techniques or methods most frequently used were artificial neural networks, decision tree classifier, support vector machine, and Markov process with good performance metrics for all of them. Soccer, basketball, handball, and volleyball were the team sports with more applications of AI.

Conclusions

The results of this review suggest a prevalent application of AI methods in team sports based on the number of published studies. The current state of development in the area proposes a promising future with regard to AI use in team sports. Further evaluation research based on prospective methods is warranted to establish the predictive performance of specific AI techniques and methods.

Electronic supplementary material

The online version of this article (10.1186/s40798-019-0202-3) contains supplementary material, which is available to authorized users.

Shoulder kinematics and kinetics of team handball throwing: A scoping review

In recent years a number of studies have investigated shoulder biomechanics in handball throwing. The purpose of this scoping review is to summarize the current handball research in terms of shoulder joint kinematics and kinetics and identify gaps in the current research. Nineteen articles relevant to this topic were identified and included. The handball throw is characterized by large external shoulder rotation followed by a rapid internal rotation with minor changes in shoulder flexion and abduction. Generally timing sequence, joint angles and joint velocities were not affected by different conditions such as throwing type, arm position, ball weight and gender. However, large differences in shoulder angles and angular velocities were found between studies, which most likely are explained by methodological differences. Unfortunately, the information provided in the articles did not make it possible to transform measurements from one study to another and thereby eliminate the methodological differences. Only one study reported shoulder kinetics and found that kinetics were not affected by fatigue. This scoping review highlights the need for better descriptions of the methods used to obtain shoulder kinematics and for studies investigating shoulder kinetics in handball throwing.

High prevalence of vitamin D insufficiency in professional handball athletes

OBJECTIVES

Vitamin D affects multiple body functions through the regulation of gene expression. In sports medicine, its influence on musculoskeletal health and performance is of particular interest. Vitamin D insufficiency might decrease athletic performance and increase the risk of musculoskeletal injuries. Several studies have demonstrated vitamin D deficiency in professional athletes; however, the prevalence of vitamin D insufficiency in professional handball players is yet unknown.

METHODS

The study was planned as a prospective, non-interventional study. We examined 70 male elite handball athletes (first league) in a pre-competition medical assessment in July. Age, height, weight, body mass index, 25-OH vitamin D, calcium, and parathyroid hormone were evaluated, and a sun exposure score was calculated. Players were then divided into two groups of vitamin D levels: insufficient (<30 ng/mL) and sufficient (≥30 ng/mL).

RESULTS

The mean 25-OH vitamin D level of the 70 players was 33.5 ± 10.9 ng/mL (median 32.2, IQR 26.5-38.9 ng/mL). Thirty-nine (55.7%) had sufficient and 31 (44.3%) insufficient levels. Athletes with sufficient vitamin D levels had significantly lower parathyroid hormone levels than athletes with insufficiency (24.9 ± 12.1 vs. 33.5 ± 15.1 ng/mL, p = 0.02). All other parameters evaluated demonstrated no significant difference between the two groups.

CONCLUSION

Vitamin D insufficiency is a common finding in professional handball athletes even in summer, which might negatively affect physical performance. Furthermore, it might lead to an increased risk of musculoskeletal injuries and infections. This should be evaluated in further studies.

Are the functional movement analysis scores of handball players related to athletic parameters?

Handball is a popular sport in many countries. There is lack of knowledge about handball athlete’s functional movement capacity. The aim of this study is to investigate the Functional Movement Screen (FMS) scores, to evaluate the injury risks of handball athletes and to determine its relationship with athletic performance. A total of 51 professional handball players were included in this study. The sport-specific features and demographic data were recorded. The functional movement analysis was performed, agility and balance and force were evaluated. 37 were females and 14 were males. The mean age 21.00±4.50 years (range, 16–35 years). The mean FMS scores of handball athletes were 12.86±2.57. In addition, asymmetries were found between the left and right side FMS scores. There was a statistically significant poor correlation between the FMS and agility (r=0.292, P=0.038) and balance (right: r=0.224, P=0.024; left: r=0.228, P=0.022). Handball is a risky sport for injuries; therefore, athletes, coaches, and medical staff should recognize about the removal of functional deficiency before performance training. The FMS is a useful and cost-effective approach to identify these deficiencies. It is necessary not only to prevent injuries, but also to improve performance. These tests must be done before every season and, then, corrective, medical, or conservative approaches may be applied to athletes before performance training. (Clinical Trial ID: NCT03468569)

National injury prevention measures in team sports should focus on knee, head, and severe upper limb injuries

PURPOSE

To examine acute injuries in licensed floorball, football, handball, and ice hockey players in all ages nationwide in Sweden, and to identify the most common and severe injuries in each body location and recommend injury prevention measures.

METHODS

Using national sport insurance data from years 2006-2015 was the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), calculated in the four team sports. The most common injury type and injured body part was identified, with a particular focus of the severe injuries. Comparison between sexes was made.

RESULTS

In total, there were 92,162 registered injuries in all sports together. Knee injuries were most common, and also had the highest incidence of PMI, in all ball sports and in female ice hockey players. In male ice hockey, the most common injury was a dental and face injury, and PMI injuries were mostly in the shoulder. The most severe PMI injuries were rare and most often a face/eye injury in male floorball and ice hockey, a concussion in female ice hockey, and a knee injury in female floorball, and in both sexes in football and handball.

CONCLUSIONS

To achieve the greatest impact in reducing the adverse effects of acute sport injuries nationwide in Sweden, preventive measures should focus on knee injuries in all the investigated team sports. The severe head/face and upper limb injuries also need attention. Protective equipment, neuromuscular training programs, rules enforcements, and fair-play interventions may reduce the incidence of injuries.

Beach handball is safer than indoor team handball: injury rates during the 2017 European Beach Handball Championships

PURPOSE

Beach handball is a relatively new type of sports, which was derived from team handball. Medical issues such as frequency and severity of injury are yet unknown. The purpose of this study was to investigate the injury pattern and injury rates of this new type of sports.

METHODS

This study investigated the injury incidence of 30 national teams (10 senior and 20 u-17 teams, 16 men's and 14 women's teams) participating in the 2017 European Beach Handball Championships. Reports on injuries sustained during the senior and u-17 youth tournaments were provided by the medical staff of each team. Injury incidence was differentiated between age and sex, and between the five field positions (goalkeeper, wing, central defender, pivot, and specialist).

RESULTS

During the tournaments, 87 injuries were recorded yielding an overall injury incidence of 286.1 per 1000 match hours. Time-loss due to injury was 49.3 per 1000 match hours. Senior players had a higher overall injury incidence with 395.3 injuries than u-17 players with 205.7 injuries per 1000 h match hours (p < 0.01). Comparison of the injury incidence between the two sexes showed 330.23 injuries per 1000 h handball exposure for male players and 234.9 injuries for female players (n.s.). The most frequent injury type was sprains (21 injuries, 24.1%) followed by contusions (19 injuries, 21.8%) and skin abrasions with (15 injuries, 17.2%). Central defenders and specialists had the highest injury incidence. Thighs, ankles, as well as foot and toes (altogether 12 injuries, all 13.8%) were the three most frequently injured anatomic sites.

CONCLUSIONS

Beach handball seems to have a lower incidence of time-loss injuries than that reported for indoor team handball. This study is an important basis for developing injury prevention strategies in this sports that should focus on thighs, ankles, feet and toes. Further research into this new type of sports is essential to identify risk factors and to develop adequate injury prevention measures.

LEVEL OF EVIDENCE

II.

Increased injury rates after the restructure of Germany's national second league of team handball

PURPOSE

Scientific injury data in men's professional team handball injuries are rare and even less scientific information exists on injury prevention. In 2011, Germany's national second team handball league was restructured by merging the existing two regional leagues into one league. This study evaluates the injury patterns in professional team handball and compares the injury rates between the first and second league before and after the restructure.

METHODS

All players of Germany's national first and second men's team handball leagues have mandatory trauma insurance with the same insurance company. This retrospective cohort study analysed the injury data of three consecutive seasons 2010-2013 using standardized injury definitions.

RESULTS

1194 professional team handball players were included in this study. The majority of severe injuries affected the lower extremities, shoulders, and hands. The average injury incidence significantly differed between the first (4.9 injuries per 1000 h) and the second league (3.9 per 1000 h, p < 0.01). The injury incidence in the restructured second league had increased from 3.7 to 4.1 per 1000 h (p < 0.01) and prevalence from 67.1 to 79.3% (p < 0.001), thus almost to the same levels of the first league. The second league showed more time-loss injuries at all severity levels.

CONCLUSION

This study yielded a high injury incidence after the restructure of the national second team handball league and presents details on prevalence, incidence, and patterns of injury in professional men's team handball. This study is an important basis for developing injury prevention strategies that should focus on the shoulders, hands, and lower extremities and on reducing the number of matches and travel burden.

LEVEL OF EVIDENCE

III.

Neuromuscular exercises prevent severe knee injury in adolescent team handball players

PURPOSE

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players.

METHODS

Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury.

RESULTS

Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01-0.90), p = 0.019. Other injuries to the lower extremities showed no significant difference between the two groups.

CONCLUSIONS

Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

The inter- and intrarater reliability and agreement for field-based assessment of scapular control, shoulder range of motion, and shoulder isometric strength in elite adolescent athletes

OBJECTIVES

To investigate the intra- and interrater reliability and agreement for field-based assessment of scapular control, shoulder range of motion (ROM), and shoulder isometric strength in elite youth athletes.

DESIGN

Test-retest reliability and agreement study.

SETTING

Eight blinded raters (two for each assessment) assessed players on field during two testing sessions separated by one week.

PARTICIPANTS

162 elite youth handball players with or without a history of previous shoulder pain within the preceding six months.

MAIN OUTCOME MEASURES

Kappa (κ) and prevalence-adjusted bias-adjusted kappa (PABAK) coefficients for scapular control reliability, and 95% limits of agreement (LOA) for ROM and strength agreement.

RESULTS

Scapular control demonstrated substantial to almost perfect reliability (κ 0.67 to 0.84, PABAK from 0.68 to 0.88). Mean strength values ranged from 0.9 N/kg to 1.6 N/kg, and LOAs ranged from -0.7 N/kg to 0.8 N/kg. Rotational strength revealed additionally systematic bias between and within rater. No or acceptable systematic bias were evident for ROM and abduction strength measures. Mean values and LOAs for ROM ranged between 39.9° to 52.3°, and from -12.6° to 9.9°, respectively.

CONCLUSIONS

Scapular control and ROM can be assessed on the field with acceptable reliability. The threshold for reliable measurements of isometric strength using handheld-dynamometers is high.

Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players

PURPOSE

Glenohumeral range of motion adaptations may affect throwing athletes and contribute to shoulder injury. The purpose of this study was to evaluate shoulder rotation deficits among elite professional handball players and its correlation to the presence of shoulder pain and morphological changes.

METHODS

Eighty-seven elite professional handball players and 41 healthy non-athlete volunteers participated in the study. Evaluations included measurement of range of internal and external rotation, total arch of motion, identification of shoulder pain and ultrasound scan for diagnosis of rotator cuff tears and internal impingement.

RESULTS

Glenohumeral rotational deficits (>20-25°) were found among 11 players group (13%). The throwing shoulders in the players group showed a decrease in internal rotation and an increase in external rotation with significantly larger ranges among players compared to the non-athlete group. Internal rotation deficit >20° was associated with higher incidence of shoulder pain among players. Both internal rotation deficits (>25°) and total arch of motion deficit (>20°) co-existed with higher incidence of internal impingement. Shoulder pain was common (36/97-41%) and was associated with decreased external rotation and total arch of motion. Internal impingement (found in 13/87-15%) correlated with decreased rotation ranges and a greater deficit in total arch of motion, whereas higher gain in external rotation correlated with a partial rotator cuff tear (found in 12/87-14%).

CONCLUSIONS

Shoulder pathologies and problems commonly affected the group of handball players. Greater glenohumeral rotational deficits in throwing shoulders of handball players correlate with shoulder pain and internal impingement, while increased external rotation with partial rotator cuff tears. Such deficits affect 13% of the athlete population. Major clinical relevance of the study is to monitor handball players' shoulders both clinically and by proper imaging. Evaluation of range of rotation seems to identify shoulders at risk of the pathology.

LEVEL OF EVIDENCE

Cross-Sectional study with control group, Level II.

A prospective cohort study identifying risk factors for shoulder injuries in adolescent elite handball players: the Karolinska Handball Study (KHAST) study protocol

Background

Handball is a physical contact sport that includes frequent overhead throwing, and this combination leads to a high rate of shoulder injuries. Several factors have been associated with shoulder injuries in overhead athletes, but strong scientific evidence is lacking for most suggested risk factors. We therefore designed the Karolinska Handball Study (KHAST) with the aim to identify risk factors for shoulder injuries in adolescent male and female elite handball players studying at handball-profiled secondary schools in Sweden. Secondary objectives are to investigate whether shoulder function changes during the competition season and whether the physical profile of the players changes during their time in secondary school.

Methods

Players aged 15 to 19 years were included during the pre-season period of the 2014–2015 and the 2015–2016 seasons. At inclusion, players signed informed consent and filled in a questionnaire regarding playing position, playing level, previous handball experience, history of shoulder problems and athletic identity. Players also completed a detailed test battery at baseline evaluating the shoulder, neck and trunk. Players were then prospectively monitored weekly during the 2014–2015 and/or 2015–2016 competitive seasons regarding injuries and training/match workload. Results from the annual routine physical tests in the secondary school curriculum including bench press, deep squat, hand grip strength, clean lifts, squat jumps, counter movement jumps, <30 m sprints, chins, dips and Cooper’s test will be collected until the end of the competitive season 2017–2018. The primary outcome is the incidence of shoulder injuries and shoulder problems. The secondary outcome is the prevalence of shoulder injuries and shoulder problems.

Discussion

Shoulder problems are frequent among handball players and a reduction of these injuries is therefore warranted. However, in order to introduce appropriate preventive measures, a detailed understanding of the underlying risk factors is needed. Our study has a high potential to identify important risk factors for shoulder injuries in adolescent elite handball players owing to a large study sample, a high response rate, data collection during consecutive seasons, and recording of potential confounding factors.

Electronic supplementary material

The online version of this article (10.1186/s12891-017-1852-2) contains supplementary material, which is available to authorized users.

Performance analysis of male handball goalkeepers at the World Handball championship 2015

Goalkeepers have a very important role in handball. In coaching communities it is well recognized that goalkeepers’ performances can predict team ranking in major tournaments. Despite this, few studies have been conducted on elite goalkeepers participating in World Championships. Therefore, the purpose of this study was to analyse goalkeepers’ save performance during the 88 matches of the 2015 men’s World Championships tournament. Goalkeepers from 24 national teams were analysed using a tracking camera system and bespoke software (Prozone Handball V.1.2, Prozone, Leeds, UK). The purpose of this study was to examine time-motion performance parameters and to evaluate the save rates for each goalkeeper. The mean total distance covered in a game by the goalkeepers was 1634±999 m. Goalkeepers spent most of the time walking or standing. The total amount of shots to the goal was 6893, with a mean save percentage of 30% (2088 saves). A significant relationship was identified between the goalkeepers’ save statistics and the final team rankings. The save rate is important for teams to achieve a higher ranking, and therefore the selection and training of goalkeepers requires more than just assessing physical abilities. The throwing distribution and success/save rate during the Qatar 2015 Men Handball World Championships suggest strong and weak parts of the goal area, and coaches can use this information to adjust their training approaches for both goalkeepers and shooters.

Maximal power training induced different improvement in throwing velocity and muscle strength according to playing positions in elite male handball players

This study was designed to assess the effect of strength and power training on throwing velocity and muscle strength in handball players according to their playing positions. Twenty-two male handball players were assigned to either an experimental group (n=11) or a control group (n=11) (age: 22.1 ± 3.0 years). They were asked to complete (i) the ball throwing velocity test and (ii) the one-repetition maximum (1-RM) tests for the half-back squat, the pull-over, the bench press, the developed neck, and the print exercises before and after 12 weeks of maximal power training. The training was designed to improve strength and power with an intensity of 85-95% of the 1RM. In addition to their usual routine handball training sessions, participants performed two sessions per week. During each session, they performed 3-5 sets of 3-8 repetitions with 3 min of rest in between. Then, they performed specific shots (i.e., 12 to 40). Ball-throwing velocity (p<0.001) was higher after the training period in rear line players (RL). The training programme resulted in an improvement of 1RM bench press (p<0.001), 1RM developed neck (p<0.001) and 1RM print (p<0.001) in both front line (FL) and RL. The control group showed a significant improvement only in ball-throwing velocity (p<0.01) and 1RM bench press (p<0.01) in RL. A significantly greater improvement was found in ball-throwing velocity (p<0.001), 1RM bench press (p<0.001), and 1RM half-back squat exercises in players of the central axis (CA) compared to the lateral axis (LA) (p<0.01). The power training programme induced significantly greater increases in ball-throwing velocity and muscle strength in FL than RL and in CA than LA axis players.

Effect of fatigue caused by a simulated handball game on ball throwing velocity, shoulder muscle strength and balance ratio: a prospective study

BACKGROUND

Arm throwing represents a deciding element in handball. Ball velocity, aim accuracy, and dynamic stability of the shoulder are factors that influence throwing effectiveness. The purpose of this study was to examine the influence of muscle fatigue caused by simulated game activities (SGA) on shoulder rotational isokinetic muscle strength, muscle balance and throwing performance, and to examine the relationship between muscle strength and throwing performance.

METHODS

Ten national elite adult handball athletes were evaluated. Isokinetic internal (IR), external (ER) rotators peak torque, and balance ratio were measured before and after SGA. Ball throwing velocity was assessed by radar gun.

RESULTS

Both internal (IR) and external (ER) rotators peak torque were significantly lower after SGA (p = 0.0003 and p = 0.02, respectively). However, the deleterious effect was more evident for IR than ER muscles (effect size r = 0.39 and r = 0.18, respectively). Balance ratio before and after SGA did not differ (p = 0.06). Ball throwing velocity was not impaired by SGA. Moreover, isokinetic variables correlated positively with ball velocity (r ≥ 0.67).

CONCLUSIONS

SGA affected the muscle strength of IR more than ER, predisposing the shoulder joint to muscular imbalance. The muscular impairment after SGA was insufficient to impair ball throwing velocity.

GIRD, TRROM, and humeral torsion-based classification of shoulder risk in throwing athletes are not in agreement and should not be used interchangeably

OBJECTIVES

Clinicians commonly interpret the findings of shoulder rotational ranges of motion using various approaches: an apparent reduction in dominant arm internal rotation ("GIRD"), a difference in total rotational range of motion-i.e. differences in the sum of internal and external rotational range (TRROM), and a combination of rotational ROM and torsional difference ("GIRD-torsion"). We have noticed that these approaches are being considered to provide equivalent estimates of shoulder rotational range. This investigation sought to document the extent of agreement of these three different approaches when classifying athletes' "at-risk" status.

DESIGN

Observational cohort study.

METHODS

162 professional male athletes participating in overhead sports (baseball, handball, and volleyball) had their GIRD, TRROM, and GIRD-torsion calculated, and classified as "at risk" using standard cut-points of 20°, 5°, and 10°, respectively.

RESULTS

25 (15.4%) athletes were classified as "at-risk" using GIRD, 55 (34%) with TRROM, and 30 (18.5%) using GIRD-torsion. Only 3/162 (1.9%) athletes were classified as "at-risk" by all 3 approaches, 4 athletes were concurrently classified as "at-risk" by GIRD and TRROM (Kappa=-0.142, poor agreement), 11 by GIRD and GIRD-torsion (Kappa=0.279, fair agreement), and 11 by TRROM and GIRD-torsion (Kappa=0.025, slight agreement).

RESULTS

25 (15.4%) athletes were classified as at risk using GIRD, 55 (34%) with TRROM, and 30 (18.5%) using GIRD-torsion. Only 3/162 (1.9%) athletes were classified as at risk by all 3 approaches, 4 athletes were concurrently classified as at risk by GIRD and TRROM (Kappa=-0.142, poor agreement), 11 by GIRD and GIRD-torsion (Kappa=0.279, fair agreement), and 11 by TRROM and GIRD-torsion (Kappa=0.025, slight agreement).

CONCLUSIONS

The three described approaches yield demonstrably different findings, and these approaches cannot be used interchangeably. Examples of clinical reasoning are provided to assist with the interpretation of these different measures.

Biomechanical characteristics of handballing maximally in Australian football

The handball pass is influential in Australian football, and achieving higher ball speeds in flight is an advantage in increasing distance and reducing the chance of interceptions. The purpose of this study was to provide descriptive kinematic data and identify key technical aspects of maximal handball performance. Three-dimensional full body kinematic data from 19 professional Australian football players performing handball pass for maximal speed were collected, and the hand speed at ball contact was used to determine performance. Sixty-four kinematic parameters initially obtained were reduced to 15, and then grouped into like components through a two-stage supervised principal components analysis procedure. These components were then entered into a multiple regression analysis, which indicated that greater hand speed was associated with greater shoulder angular velocity and separation angle between the shoulders and pelvis at ball contact, as well as an earlier time of maximum upper-trunk rotation velocity. These data suggested that in order to increase the speed of the handball pass in Australian football, strategies like increased shoulder angular velocity, increased separation angle at ball contact, and earlier achievement of upper-trunk rotation speed might be beneficial.

Action preferences and the anticipation of action outcomes

Skilled performers of time-constrained motor actions acquire information about the action preferences of their opponents in an effort to better anticipate the outcome of that opponent's actions. However, there is reason to doubt that knowledge of an opponent's action preferences would unequivocally influence anticipatory responses in a positive way. It is possible that overt information about an opponent's actions could distract skilled performers from using the advance kinematic information they would usually rely on to anticipate actions, particularly when the opponent performs an 'unexpected' action that is not in accordance with his or her previous behaviour. The aim of this study was to examine how the ability to anticipate the outcome of an opponent's actions can be influenced by exposure to the action preferences of that opponent. Two groups of skilled handball goalkeepers anticipated the direction of penalty throws performed by opponents before and after a training intervention that provided situational probability information in the form of action preferences (AP). During the training phase participants in an AP-training group anticipated the action outcomes of two throwers who had a strong preference to throw in one particular direction, whilst participants in a NP-training group viewed players who threw equally to all directions. Exposure to opponents who did have an action preference during the training phase resulted in improved anticipatory performance if the opponent continued to bias their throws towards their preferred direction, but decreased performance if the opponent did not. These findings highlight that skilled observers use information about action preferences to enhance their anticipatory ability, but that doing so can be disadvantageous when the outcomes are no longer consistent with their generated expectations.

Effect of Court Dimensions on Players' External and Internal Load during Small-Sided Handball Games

The aim of this study was to investigate the effect of three different court dimensions on the internal and external load during small-sided handball games. Six male amateur handball players took part in this study and participated in three different 8-min 3vs3 (plus goalkeepers) small-sided handball games (each repeated twice). The three court dimensions were 12×24m, 30×15m and 32×16m. Through Global Positioning System devices (SPI pro elite 15Hz, GPSports) and video analysis, the following parameters were recorded: cyclic and acyclic movements (distance covered and number of technical actions executed), heart rate, and rating of perceived exertion (RPE). Total distance travelled increased with court dimensions (885.2m ± 66.6m in 24×12m; 980.0m ± 73.4m in 30×15m; 1095.0m ± 112.9m in 32×16m, p < 0.05). The analysis of distance covered in the four speed zones (0-1.4 m·s(-1); 1.4-3.4 m·s(-1); 3.4-5.2 m·s(-1); >5.2 m·s(-1)) highlighted substantial differences: playing with the 30×15m court in comparison to the 24×12m, the players covered less distance in the first speed zone (p = 0.012; ES = 0.70) and more distance in the second (p = 0.049; ES = 0.73) and third (p = 0.012; ES = 0.51) speed zones. Statistical differences were also found between the 24×12m and 32×16m courts: the players covered more distance in the second and third speed zones (p = 0.013, ES = 0.76; p = 0.023 ES = 0.69) with the 32×16m court in comparison to the 24×12m. There was no significant effect of court dimensions on the technical parameters (number of team actions, passes, piston movements toward goal and defensive activities), the number of specific handball jumps and changes of direction, and the time spent in the different heart rate zones. Considering the average data of all the experimental conditions together (24×12m, 30×15m, 32×16m), a pronounced statistical difference was highlighted between the values in first two HR zones and the last two (p < 0.05; large ES). The rating of perceived exertion was significantly higher during the drill with the 32×16m court compared with the 24×12m one (p < 0.05; ES = 2.34). Our findings indicate that changing court dimensions during small-sided handball games can be used to manipulate both external and internal loads on the players. Key pointsTo cover the specific game demands, more specific training methodologies have been developed in many sport games.Specific game exercises may provide a useful conditioning stimulus, together with technical and tactical training components.Changing court dimensions during small-sided handball games can be used to manipulate both external and internal loads on the players.The high ratio of cyclic activity per minute and the high HR values recorded during SSHGs make this type of drills extremely useful for aerobic power training.

Anthropometry of World-Class Elite Handball Players According to the Playing Position: Reports From Men's Handball World Championship 2013

Identifying the anthropometric measures of successful and less successful handball players may be helpful in developing a talent identification and development model, allowing for the determination of key physical capacities required for elite performance. The purpose of the study was to describe the anthropometric characteristics, including age, standing stature, body mass and body mass index (BMI) in handball players who participated in the 2013 Men’s Handball World Championships. Secondly, the objective was to identify the possible differences in these parameters in terms of individual playing positions (goalkeeper, back, center back, wing, line player). Rosters with handball player’s age, standing stature, and body mass were obtained from the International Handball Federation website. The research material included 409 handball players (24 teams). National teams were organized by their ranks and sub-grouped using their continents and playing positions. The results of the analyses of variance demonstrated significant differences in age (F=2.30; p=0.044; Partial ŋ2=0.028), standing stature (F=14.02; p=0.0001; Partial ŋ2=0.148), and body mass (F=5.88; p=0.0001; Partial ŋ2=0.068) among the groups (G1–G6). Players in G1 had the highest standing stature and body mass, while players in G6 had the lowest age and body mass values. The backs and line players were the tallest. In addition, the measurement of body mass showed that the line players had the highest body mass and BMI values. In conclusion, this study presented anthropometric data that differentiated levels of success in male handball teams playing in the 2013 world championships. This information should serve as a reference for the average standing stature, body mass, and BMI of handball players for particular positions at the professional level.

Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: a systematic review

BACKGROUND

Anterior Cruciate Ligament (ACL) injury is frequently encountered in sports.

PURPOSE

To analyze the effects of ACL injury prevention programs on injury rates in female athletes between different sports.

METHODS

A comprehensive literature search was performed in September 2012 using Pubmed Central, Science Direct, CINAHL, PEDro, Cochrane Library, SCOPUS, SPORTDiscus. The key words used were: 'anterior cruciate ligament', 'ACL', 'knee joint', 'knee injuries', 'female', 'athletes', 'neuromuscular', 'training', 'prevention'. The inclusion criteria applied were: (1) ACL injury prevention training programs for female athletes; (2) Athlete-exposure data reporting; (3) Effect of training on ACL incidence rates for female athletes.

RESULTS

13 studies met the inclusion criteria. Three training programs in soccer and one in handball led to reduced ACL injury incidence. In basketball no effective training intervention was found. In season training was more effective than preseason in ACL injury prevention. A combination of strength training, plyometrics, balance training, technique monitoring with feedback, produced the most favorable results.

CONCLUSION

Comparing the main components of ACL injury prevention programs for female athletes, some sports-dependent training specificity issues may need addressing in future studies, related primarily to the individual biomechanics of each sport but also their most effective method of delivery.

Profiling the isokinetic shoulder rotator muscle strength in 13- to 36-year-old male and female handball players

OBJECTIVES

To evaluate the external (ER) and internal rotator (IR) muscles' isokinetic peak torque and conventional and functional strength ratios in handball players and controls of different ages.

DESIGN

Cross-sectional and descriptive analysis.

SETTING

Exercise Physiology Laboratory.

PARTICIPANTS

A total of 228 participants (108 athletes and 120 controls) were divided into five groups according to age, ranging from 13 to 36 years old.

MAIN OUTCOME MEASURES

Isokinetic tests were performed concentrically at 60 and 300 deg s(-1) and eccentrically at 300 deg s(-1).

RESULTS

The differences between the athletes and controls regarding the peak torque of the ER and IR muscles were significant in males older than 18 years. The peak torque of the IR and ER muscles increased significantly across age in male athletes, but not in female athletes, except in the case of ER peak torque, which differed significantly between 13 and 16 years old. The female athletes presented higher conventional ratios (0.81 ± 0.07) than males (0.66 ± 0.08). Values represent means and standard deviations. Athletes and controls showed mean functional strength ratios below 1.0.

CONCLUSIONS

Although there were no muscular ratio differences between the athletes and the controls, their ratio values were below the literature-recommended reference values to prevent shoulder injuries.

Game Analysis of Olympic, World and European Championships in Men's Handball

The development of men’s handball was analyzed using data from the Olympic, World and European Championships held within the last eight years. The most obvious change, especially within these last nine tournaments, was that men’s handball was played more dynamically and rapidly, both in attack and defense, especially by European teams. The first aim of this study was to conduct a technical analysis of current handball and to determine factors related to success in this sport discipline. The second aim was to compare the data of European Championships with other tournaments, considering the success of European teams in Men’s World Handball. The technical variables used to compare the tournaments included: the average number of attacks, the efficiency of attacks, the efficiency of goal throws, fast break goals per game, the efficiency of fast breaks, the efficiency of the goalkeeper, saves by the goalkeeper per game, number of turnovers per game, and the efficiency of position throws (wing, pivot, back court, break-through, fast break, and 7-meter). This technical analysis used cumulative statistics from the European Handball Federation and International Handball Federation. ANOVA revealed significant differences between the first eight teams in the European Championships and their counterparts in the other two tournaments (Olympics and World Championships) in terms of several technical variables. The results showed that the efficiency of fast break, pivot position and back court players affected the ranking in favor of the European teams in significant international tournaments.

Influence of morphological characteristics on physical and physiological performances of tunisian elite male handball players

Purpose

The purpose of this study was to describe the body structure and morphological characteristics of Tunisian elite handball players, and to determine the effect of these variables on functional and physical performance levels.

Methods

A sample of 42 male handball players (mean age 21.98±3.24 years; training duration 12 years) at international level was submitted to a test battery comprising morphological, physical and physiological assessments. Tests were yo-yo intermittent recovery test, squat jump test, countermovement jump test, vertical-jump test, and Repeated sprint Ability. Measures for assessment of anthropometric characteristics were age, size, weight, body mass index, body fat, fat mass and thin mass.

Results

Weight was negatively correlated to the squat jump and the countermovement jump performance. Age, weight, and body composition measures (fat and thin body mass) were additionally negatively related to the maximal oxygen uptake, and to the maximal velocity obtained in the Yo-Yo recovery test. No relationship was found between size, body mass index, body fat and the physical abilities considered. Concerning the effects of physical characteristics on the functional performances, we can note a positive relationship between squat jump, countermovement jump, and the yo-yo recovery test performance. No relationship was found between vertical jump, repeated sprint ability, and the physiological performances.

Conclusions

Study results point to the existence of strong correlation between morphological and physical characteristics with functional characteristics. In handball, it is possible to have a reliable estimate of anthropometric measurements, physical and physiological performances.

The effect of a combined high-intensity plyometric and speed training program on the running and jumping ability of male handball players

Purpose

The aim of this study was to investigate the effect of a combined program including sprint repetitions and drop jump training in the same session on male handball players.

Methods

Twenty-two male handball players aged more than 20 years were assigned into 2 groups: experimental group (n=11) and control group (n=11). Selection was based on variables “axis” and “lines”, goalkeepers were not included. The experimental group was subjected to 2 testing periods (test and retest) separated by 12 weeks of an additional combined plyometric and running speed training program. The control group performed the usual handball training. The testing period comprised, at the first day, a medical checking, anthropometric measurements and an incremental exercise test called yo-yo intermittent recovery test. 2 days later, participants performed the Repeated Sprint Ability test (RSA), and performed the Jumping Performance using 3 different events: Squat jump (SJ), Countermovement jump without (CMJ) and with arms (CMJA), and Drop jump (DJ). At the end of the training period, participants performed again the repeated sprint ability test, and the jumping performance.

Results

The conventional combined program improved the explosive force ability of handball players in CMJ (P=0.01), CMJA (P=0.01) and DJR (P=0.03). The change was 2.78, 2.42 and 2.62% respectively. No significant changes were noted in performances of the experimental group at the squat jump test and the drop jump with the left leg test. The training intervention also improved the running speed ability of the experimental group (P=0.003). No statistical differences were observed between lines or axes.

Conclusion

Additional combined training program between sprint repetition and vertical jump in the same training session positively influence the jumping ability and the sprint ability of handball players.

The offensive efficiency of the high-level handball players of the front and the rear lines

Purpose

The aim of this study was to investigat the offensive efficiency of the professional handball players forming the front and rear lines.

Methods

Our investigation was carried out on four matches (final, semi-finals and classifying match) at the 19^th male Handball World Championship “Tunisia 2005”. Finalist teams were Tunisia, France, Croatia, and Spain. Matches were recorded using 5 digital camcorders (SONY, DCL, and TRV 130E). Number of passes and the length of the attacks were determined by software “STUDIO 9”. Speed of the ball at the different shootings was calculated by REGAVI software, version 2.57, 2004. Work was dissociated according to 2 variables namely axes and lines.

Results

Players of lateral axes (A4) and front basis (L1) were shorter and thinner than those of the central axis (A3) and rear basis (L2). No differences were observed between lines and axes in age. The analysis of the total shootings to the goal shows that the players of lines and axes present very close values in each team, excepting the Croatian L2 compared to the Tunisian L2. Players of the rear Croatian basis present also a number of attacks concluded by a non-successfully cadred shooting greater than all other groups. In the Spanish group, a significant difference among number of passes concluded by a non-successfully cadred shooting between lines, and front basis vs central axis was noted. No significant difference was found between lines and axes in the Croatian team. Regarding the velocity of shooting, excepting the Croatian team, no differences were found between lines and axes of the other teams. No differences were also noted in the attack duration between lines and axes in Croatian and Tunisian teams. In the Spanish team, duration of attacks concluded by a cadred shooting was most important when finished by an L2 or an A3 player.

Conclusion

The present results demonstrate that finalist teams were found to be clearly characterized by L2 and A3 players taller and weightier than those of L1 and A4. Organized attack was generally concluded by shooting done by an L2 or an A4 player and the shooting velocity did not significantly determine the offensive efficiency.