INJURIES IN (PROFESSIONAL) HANDBALL

EPIDEMIOLOGY, MECHANISMS & PREVENTION

PATRICK LUIG Sports Scientist Handball Coach DHB Lecturer

EHF Top Coaches Seminar 2010, Vienna

„Injury Career“ Daniel Stephan (World Handball Player 1998) • • • • • • • • • •

1999: metacarpus fracture 1999: torn ligament in the foot 2000: thumb operation 2000: rupture of capsule at ankle joint 2000: splintering of the bone at the thumb of the operated hand (missed world championship 2001) 2002: Achilles tendon irritation 2003: Achilles tendon rupture (missed world championship 2003) 2004: ellbow injury (missed world championship 2005) 2006: tendon rupture in the right shoulder 2008: end of career

Injury statistics in German club sports (own database, N=170.000)

Football Handball Volleyball Fitness Training Basketball Gymnastics Judo Horse-Riding Ball games Tennis Badminton Athletics Cycling Hockey

45,8 15,3 6,5 4,3 3,5 3,1 2,2 1,9 1,7 1,5 1,5 1,4 1,1 0,9 0

10

20

30

40

%

50

Injury rates* in sports (own database) Professional Icehockey Football Handball Basketball

280 125 187 54

Competitive Football Basketball Handball Volleyball

15,3 14,9 14,1 9,5

0

50

100

150

200

*Injuries / 100 Athletes / Year

250

300

Time–loss injury incidences* in handball Training Male Female

Study

Wedderkopp et al. Wedderkopp et al. Seil et al. Petersen et al. Olsen et al.

1997 1999 1998 2002 2006

Junge et al. Langevoort et al. Holdhaus et al. Holdhaus et al.

2005 2007 2008 2009

Competition Male Female

3,4

40,7

1,2

23,4

0,6

14,3

2,6

12,1

0,6

1

8,3

10,4

40

36

34

19

33,3 31,9

*Injuries /1000 playing hours

Please note that: ¾ min. 10x higher risk in games (vs. training)2,7,11,12 ¾ min. 2-3x higher risk for pros (vs. amateurs) ¾ independent from gender ¾ 20-40 serious injuries* per international tournament (EC, WC, OG) / 0.5-1 per game!3,4,5 * time-loss injuries

Injuries among adults (>16 years; N=2700, own database)

Head 18%

Head 15%

Hand 20%

Hand 18%

Knee 36% Knee 27%

Ankle 13%

Ankle 18%

Please note that: ¾ 50% (men) to 60% (women) of injuries affect lower extremities ¾ up to 8x higher risk for females to suffer ACL ruptures2,6 ¾ shoulder injuries (field players) and elbow injuries (goalkeeper) mainly overuse injuries due to repetitive impacts

Situations leading to injuries (own database)

36,8 34,6

contact 24,2 25,0

jumping/landing 12,6 15,4

running/feints

Men Women

9,9 11,5

falls

16,3 13,3

others 0

10

20

30

%

40

Position-specific analysis

backcourt

pivot players defense

wing players

goalkeeper

Main Situation

Injured body part

Jumping/landing Ankle, knee and + contact/foul hand injuries

Wing Players

Video analysis shows that even modest contacts can be sufficient to make the players lose body-control.

Main Situation

Injured body part

Running/feints, Knee and ankle jumping/landing injuries + contact/foul

Backcourt players

Main Situation

Injured body part

Contact/foul Falls + twisting

Head injuries Knee injuries

Pivot players

Main Situation

Contact Jumping/landing

Injured body part

Head + finger injuries Ankle injuries

Defense players

Main Situation

Injured body part

Landing after saves

Knee + ankle injuries

Goalkeeper

Please note that: ¾ lower extremities injuries derive mainly from non-contact situations ¾ upper extremities and head injuries mainly due to contact situations and unfair play ¾ previous injuries are the main risk factor for new injuries (regeneration and rehabiltation tasks)2

Fields of injury prevention

Training

Technical + political

(programmes)

strategies Multifaceted approach (protective)

equipment + facilities

Medical + nonmedical support + treatment

Training (Programmes) Ardila Kolodziej

Database / Literature Research "Handball Inventory" (protective) Technical + Political Equipment + Strategies Facilities 2007 Holdhaus 2008 Junge

2008 Badel 2005 Kececi

2007 Luck 2005 Luck

N / N Langevoort

2007 Knapik

2007 Oxizoglou

2008 Svenska Handbollförbundet

2007 Moegling

2003 Aaltonen

2007 Platen

Buholzer

2003 Wedderkopp

Suva Accident Insurance 1999 Company

N / N Abernethy

Christensen

2007 Wedderkopp

2003 Abernethy

2007

Curdt

2003 Zebis

2008 ARAG Sports Insurance

2003

Dansk Handbold Forbund Dansk Handbold Forbund Dansk Handbold Forbund Dansk Handbold Forbund Dansk Handbold Forbund Fayolle Flack Gollhofer Hatzimanouil Henke Hewett

2006 2006 2006 2006 N/N 1993 2007 2006 2007 2005 2006

2008 2007 2007 2009 2008 2007 2007 2003 2003 2004 2000

2004 2000 2002 2006 1996 2004 2003 2005 2001 2008 1997

Bencke Buchheit

2007 Pieper 2009 Pokorný Oslo Sports Trauma 2000 Research Centre

Medical + Nonmedical Support + Treatment

Renstrom Silvers Hrysomallis Yoo Rivilla Aaltonen Abernethy ARAG Sports Insurance ARAG Sports Insurance bfu Buholzer

bfu Buholzer Hübner Lieger Luck Oehlert Olsen Oxizoglou Parkkari Schott Seil

Multi-faceted Approaches

1996 Aaltonen 1991 Abernethy ARAG Sports 2005 Insurance ARAG Sports 2007 Insurance

2007 2007 2003

Schnurrer-Luke 2007 Vrbanic

2007 bfu

2004

2003 Zebis

2009 Buholzer

2000

2003

ARAG Sports Insurance ARAG Sports Insurance bfu Buholzer Dittert Hübner Kreische Lieger Luck Luck Mayer Olsen Oxizoglou

2003

Dittert

2006

2004 2000 2006 2002 2007 2006 1996 1991 2003 2003 2005

Hübner Kreische Lieger Luck Luck Mayer Oehlert Olsen Oxizoglou Parkkari Platen Schnurrer-Luke Vrbanic Schott Seil Zebis

2002 2007 2006 1996 1991 2003 2004 2003 2005 2001 2007

Holm

2004 Dittert

2006

Parkkari

2001

Junsten Knobloch Knobloch Kvorning

2008 2005 2007 2007

Hübner Kreische Luck Luck

2002 2007 1996 1991

Seil

1997

Mayer Muschol Myklebust Olsen Olsen Olsen Pánics Petersen Petersen Petersen

1999 2007 2003 2003 2004 2005 2008 2003 2005 2005

Mayer Oehlert Oxizoglou Parkkari Platen Schnurrer-Luke Vrbanic Schott Seil Zebis

2003 2004 2005 2001 2007 2007 2008 1997 2009

2007 2008 1997 2009

Surveys among Top Coaches EHF(Skopje) : International Top Level Coaches n = 45

Norway: Norwegian Top Coaches n = 45

39

37

Age Gender

Male: Female:

86% 14%

Male: 78% Female: 22%

Coaching National team: 26% Education 1st league: 64% 2nd league: 8%

None: 0% Level 1: 5% Level 2: 14% Level 3: 47% Level 4: 33% Level 5: 2%

EHF(Györ) : Norway: International Elite Norwegian Regions Youth Coaches n = 51 n = 125 40 Male: Female:

35 81% 19%

Male: 56% Female: 44% None: 30% Level 1: 25% Level 2: 37% Level 3: 6% Level 4: 1% Level 5: 1%

Surveys among Top Coaches International Top Level Coaches

Norwegian Top Coaches

International Elite Youth Coaches

Norwegian Regional Coaches

Awareness Yes: 67% (Injuries as a No: 33% problem?)

Very important issue (12%) Important issue (44%) Medium (35%) Less important (9%) Not important (0%)

Very important issue (38%) Important issue (53%) Medium (9%) Less important (0%) Not important (0%)

Very important issue (7%) Important issue (43%) Medium (43%) Less important (3%) Not important (3%)

Causes

Poor physical preparation (36%) Collisions / body contact (18%) Fouls / unfair play (18%) Lack of regeneration (6%) Insufficient warm-up (15%)

Poor physical preparation (71%) Fouls / unfair play (24%) Collisions / body contact (49%) Too many matches (58%) Lack of regeneration (64%) Insufficient warm-up (47%) Bad luck (36%)

Poor physical preparation (77%) Fouls / unfair play (46%) Collisions / body contact (38%) Too many matches (54%) Lack of regeneration (65%) Insufficient warm-up (50%) Bad luck (25%)

Poor physical preparation (68%) Fouls / unfair play (24%) Collisions / body contact (35%) Too many matches (15%) Lack of regeneration (35%) Insufficient warm-up (68%) Bad luck (36%)

Reduction

Better athletic preparation (54%) Modification of rules (32%)

Better athletic preparation (84%) Longer regeneration (69%) Reduction of matches (40%) Modification of rules (4%) Protective equipment (13%) Prevention programmes (80%)

Better athletic preparation (83%) Longer regeneration (49%) Reduction of matches (28%) Modification of rules (17%) Protective equipment (19%) Prevention programmes (64%)

Better athletic preparation (80%) Longer regeneration (32%) Reduction of matches (7%) Modification of rules (2%) Protective equipment (16%) Prevention programmes (86%)

Please note that: ¾ injuries are a major problem in handball ¾ coaches have a strong demand for prevention, in particular by means of training (programmes) ¾ BUT: To be sustainably executed these preventive training contents have to be performance enhancing

Consequences for training: ¾ better preparation for real game demands (due to min. 10x higher risk) 9

get players used to contact in all situations

9

increase jumping/ landing technique (two-leg and singleleg landings)

9

increase athletic condition of players (stabilisation, strengthening, agility, coordination, flexibility)

9

increase body control, body balance of players (proprioception, sensorimotor, neuromuscular training)

9

Sufficient regeneration, in particular after injuries

¾ adaptation considering etiology, age, gender and performance level

Examples from existing programmes

Henke et al.

Rivilla et al.

Myrrick et al.

Danish Handball Federation

Myklebust et al.

Tallay et al.

References 1 Dansk Håndbold Forbund (2006). "Skudklar Skulder." 2 Henke, T. (2005). Sportunfälle im Berufshandball – Epidemiologie und Prävention. 3 Holdhaus, H. (2008). "Summary of the Injury Study Conducted at the EHF Men’s Euro 2008 in Norway." 4 Junge, A. . (2005). "Injuries in Team Sport Tournaments during the 2004 Olympic Games." 5 Langevoort, G. (2007). "Handball Injuries during Major International Tournaments." 6 Myklebust, G. (2003). "Prevention of Anterior Cruciate Ligament Injuries in Female Team Handball Players: A Prospective Intervention Study Over Three Seasons." 7 Olsen, O.E. (2005). "Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial." 8 Pánics, G. (2008). "Effect of Proprioception Training on Knee Joint Position Sense in Female Team Handball Players." 9 Petersen, W. (2005). "Rupturen des vorderen Kreuzbandes bei weiblichen Athleten. Teil 1: Epidemiologie, Verletzungsmechanismen und Ursachen." 10 Seil, R. (1997). "Sports Injuries in Team Handball - A One-Year Prospective Study of Sixteen Men’s Senior Teams of a Superior Nonprofessional Level." 11 Wedderkopp, N. (2003). "Comparison of Two Intervention Programmes in Young Female Players in European Handball – with and without Ankle Disc." 12 Wedderkopp, N. (1999). "Prevention of Injuries in Young in European Team Handball. A Prospective Intervention Study Female Players

Thank you for your attention! PATRICK LUIG Sports Scientist Handball Coach DHB Lecturer

EHF Top Coaches Seminar 2010, Vienna