Purpose
The main aim of this dissertation was to inform injury prevention efforts in elite handball, with an emphasis on overuse shoulder injuries specifically and acute injury mechanisms in general.
Project description
This dissertation is based on two separate research projects. In the first project (Paper I, II and III), we evaluated the effect of an exercise programme developed to prevent overuse shoulder injuries in a cluster-randomised controlled trial including elite handball players (Paper I) and assessed whether previously identified risk factors could be confirmed in a prospective risk factor study including the players in the control group (Paper II). The exercise programme was designed to increase glenohumeral internal rotation, external rotation strength and scapular muscle strength, as well as improve kinetic chain and thoracic mobility. Towards the end of the intervention period, we also examined the end-user perspective on prevention of shoulder injuries, as well as key issues related to the application of the exercise programme (Paper III).
In the second project (Paper IV), we described acute injury mechanisms and evaluated referee performance based on prospective video analysis of acute injury situations during the 24th Men´s Handball Wold Championship in 2015.
Results
In Paper I, the exercise programme was found to reduce the risk of shoulder problems by 28% in the intervention group compared with the control group (OR 0.72, 95% CI 0.52 to 0.98). In Paper II, no significant associations were found between total rotation (OR 1.05 per 5° change, 95% CI 0.98 to 1.13), external rotation strength (OR 1.05 per 10 N change, 95% CI 0.92 to 1.20) or obvious scapular dyskinesis (OR 1.23, 95% CI 0.25 to 5.99) and overuse shoulder injury. A significant positive association was found between greater internal rotation (OR 1.16 per 5° change, 95% CI 1.00 to 1.34) and overuse shoulder injury. In Paper III, we found that the majority of coaches (84%) and captains (89%) believed that handball players are at high risk for shoulder injuries. All delivery agents in the trial were familiar with the exercise programme and the majority believed in a preventative effect (coaches 90%, captains 81%). Only a minority reported full compliance with the recommended frequency (coaches 29%, captains 14%), with the programme being too time consuming (coaches 67%, captains 81%) and lack of player motivation (coaches 76%, captains 62%) as the main barriers. In Paper IV, we found acute injuries (n=55) to be evenly distributed among attackers (n=29) and defenders (n=26). At the time of injury, attackers were most frequently performing a jump shot (n=9), while defenders were completing a tackle (n=10). Agreement between the referees and the expert panel was weak (kappa: 0.22, 95% CI 0.07 to 0.36), with substantially more lenient rule interpretation by the referees.