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

• Published in: British journal of sports medicine 2017-02, Vol.51 (4), p.231-237
• Main Authors: Møller, M, Nielsen, R O, Attermann, J, Wedderkopp, N, Lind, M, Sørensen, H, Myklebust, G
• Format: Article
• Language: English
• Subjects: Adolescent; Analysis; Athletes; Athletic Injuries - epidemiology; Cohort analysis; Cohort Studies; Communication; Dyskinesia; Female; Handball; Health aspects; Health risk assessment; Humans; Male; Medicine; Pain; Participation; Range of Motion, Articular; Risk factors; Rugby; Scapula - physiopathology; Shoulder; Shoulder Injuries - epidemiology; Shoulder Joint - physiopathology; Sports; Sports injuries; Sports medicine; Surveillance; Time Factors; Workloads
• ISSN: 0306-3674; 0303-7193; 1473-0480; 2230-4886
• DOI: 10.1136/bjsports-2016-096927

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