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 45,8
Handball 15,3
Volleyball 6,5
Fitness Training 4,3
Basketball 3,5
Gymnastics 3,1
Judo 2,2
Horse-Riding 1,9
Ball games 1,7
Tennis 1,5
Badminton 1,5
Athletics 1,4
Cycling 1,1
Hockey 0,9

0 10 20 30 40 % 50
 Injury rates* in sports
(own database)

Professional
Icehockey 280
Football 125
Handball 187
Basketball 54
Competitive
Football 15,3
Basketball 14,9
Handball 14,1
Volleyball 9,5

0 50 100 150 200 250 300

*Injuries / 100 Athletes / Year
Time–loss injury incidences* in handball
Training Competition
Study Male Female Male Female
Wedderkopp et al. 1997 3,4 40,7
Wedderkopp et al. 1999 1,2 23,4
Seil et al. 1998 0,6 14,3
Petersen et al. 2002 2,6 12,1
Olsen et al. 2006 0,6 1 8,3 10,4

Junge et al. 2005 40 36

Langevoort et al. 2007 34 19
Holdhaus et al. 2008 33,3
Holdhaus et al. 2009 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
contact 34,6
24,2
jumping/landing
25,0
12,6
running/feints 15,4
9,9 Men
falls 11,5 Women
16,3
others 13,3
0 10 20 30 % 40
Position-specific backcourt

analysis

pivot players

defense

wing players
goalkeeper
 Main
Situation Injured body part
Wing Players
Jumping/landing Ankle, knee and
+ contact/foul hand injuries

Video analysis shows that

even modest contacts can
be sufficient to make the
players lose body-control.
 Main
Situation

Running/feints,
Injured body part
Backcourt players
Knee and ankle
jumping/landing
injuries
+ contact/foul
 Main
Situation Injured body part
Head injuries
Pivot players
Contact/foul
Falls + twisting Knee injuries
 Main
Situation Injured body part

Head + finger Defense players

Contact
injuries
Jumping/landing Ankle injuries
 Main
Situation

Landing after
Injured body part

Knee + ankle
Goalkeeper
saves injuries
 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

Technical +
Training political
(programmes)
strategies
Multi-
faceted
approach
Medical +
(protective)
nonmedical
equipment +
support +
facilities
treatment
 Database / Literature Research "Handball Inventory"
(protective) Medical + Non-
Technical + Political Multi-faceted
Training (Programmes) Equipment + medical Support +
Strategies Approaches
Facilities Treatment
Ardila 2007 Pieper 2007 Holdhaus 2008 Badel 2007 Luck 1996 Aaltonen 2007
Kolodziej 2009 Pokorný 2008 Junge 2005 Kececi 2005 Luck 1991 Abernethy 2007
Oslo Sports Trauma ARAG Sports
Bencke 2000 N / N Langevoort 2007 Knapik 2007 Oxizoglou 2005 2003
Research Centre Insurance
ARAG Sports
Buchheit 2008 Svenska Handbollförbundet 2007 Moegling 2003 Aaltonen 2007 Platen 2007 2003
Insurance
Suva Accident Insurance Schnurrer-Luke
Buholzer 2003 Wedderkopp 1999 N / N Abernethy 2007 2007 bfu 2004
Company Vrbanic
ARAG Sports
Christensen 2007 Wedderkopp 2003 Abernethy 2007 2003 Zebis 2009 Buholzer 2000
Insurance
ARAG Sports
Curdt 2003 Zebis 2008 ARAG Sports Insurance 2003 2003 Dittert 2006
Insurance
Dansk Handbold Forbund 2006 Renstrom 2008 bfu 2004 bfu 2004 Hübner 2002
Dansk Handbold Forbund 2006 Silvers 2007 Buholzer 2000 Buholzer 2000 Kreische 2007
Dansk Handbold Forbund 2006 Hrysomallis 2007 Hübner 2002 Dittert 2006 Lieger 2006
Dansk Handbold Forbund 2006 Yoo 2009 Lieger 2006 Hübner 2002 Luck 1996
Dansk Handbold Forbund N/N Rivilla 2008 Luck 1996 Kreische 2007 Luck 1991
Fayolle 1993 Aaltonen 2007 Oehlert 2004 Lieger 2006 Mayer 2003
Flack 2007 Abernethy 2007 Olsen 2003 Luck 1996 Oehlert 2004
Gollhofer 2006 ARAG Sports Insurance 2003 Oxizoglou 2005 Luck 1991 Olsen 2003
Hatzimanouil 2007 ARAG Sports Insurance 2003 Parkkari 2001 Mayer 2003 Oxizoglou 2005
Henke 2005 bfu 2004 Schott 2008 Olsen 2003 Parkkari 2001
Hewett 2006 Buholzer 2000 Seil 1997 Oxizoglou 2005 Platen 2007
Schnurrer-Luke
Holm 2004 Dittert 2006 Parkkari 2001 2007
Vrbanic
Junsten 2008 Hübner 2002 Seil 1997 Schott 2008
Knobloch 2005 Kreische 2007 Seil 1997
Knobloch 2007 Luck 1996 Zebis 2009
Kvorning 2007 Luck 1991
Mayer 1999 Mayer 2003
Muschol 2007 Oehlert 2004
Myklebust 2003 Oxizoglou 2005
Olsen 2003 Parkkari 2001
Olsen 2004 Platen 2007
Olsen 2005 Schnurrer-Luke Vrbanic 2007
Pánics 2008 Schott 2008
Petersen 2003 Seil 1997
Petersen 2005 Zebis 2009
Petersen 2005
 Surveys among Top Coaches

EHF(Skopje) : Norway: EHF(Györ) : Norway:

International Top Norwegian Top International Elite Norwegian Regions
Level Coaches Coaches Youth Coaches
n = 45 n = 45 n = 51 n = 125
Age 39 37 40 35

Gender Male: 86% Male: 78% Male: 81% Male: 56%

Female: 14% Female: 22% Female: 19% Female: 44%
Coaching National team: 26% None: 0% None: 30%
Education 1st league: 64% Level 1: 5% Level 1: 25%
2nd league: 8% Level 2: 14% Level 2: 37%
Level 3: 47% Level 3: 6%
Level 4: 33% Level 4: 1%
Level 5: 2% Level 5: 1%
 Surveys among Top Coaches
International Top Level
Coaches
Awareness Yes: 67%
(Injuries as a No: 33%
problem?)
Causes Poor physical preparation (36%)
Collisions / body contact (18%)
Fouls / unfair play (18%)
Lack of regeneration (6%)
Insufficient warm-up (15%)
Reduction Better athletic preparation (54%)
Modification of rules (32%)
Norwegian Top Coaches
Very important issue (12%)
Important issue (44%)
Medium (35%)
Less important (9%)
Not important (0%)
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%)
Better athletic preparation (84%)
Longer regeneration (69%)
Reduction of matches (40%)
Modification of rules (4%)
Protective equipment (13%)
Prevention programmes (80%)
International Elite Youth
Coaches
Very important issue (38%)
Important issue (53%)
Medium (9%)
Less important (0%)
Not important (0%)
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%)
Better athletic preparation (83%)
Longer regeneration (49%)
Reduction of matches (28%)
Modification of rules (17%)
Protective equipment (19%)
Prevention programmes (64%)
Norwegian Regional Coaches
Very important issue (7%)
Important issue (43%)
Medium (43%)
Less important (3%)
Not important (3%)
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%)
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 single-
leg 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. Myrrick et al. Myklebust et al.

Rivilla et al. Danish Handball Federation 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