Contact - but not foul play - dominates injury mechanisms in men's professional handball: a video match analysis of 580 injuries

Prevalence and severity of injuries and illnesses among university handball players: A prospective cohort study

OBJECTIVES

To clarify the prevalence and severity of injuries and illnesses in university handball players.

DESIGN

Prospective cohort study.

SETTING

Survey-based online questionnaire.

PARTICIPANTS

231 university handball players (109 males and 122 females) over 38 weeks.

MAIN OUTCOME MEASURES

Each participant completed the Japanese version of the Oslo Sports Trauma Research Center Questionnaire on Health Problems every Sunday. The main outcome measures were the average weekly prevalence of injuries and illnesses, duration, average weekly severity scores rated on a scale of 0-100 based on answers to four key questions, and cumulative severity scores.

RESULTS

The average weekly prevalence was 27.4 % (95 % CI: 25.6-29.1 %) for injuries and 2.2 % (95 % CI: 1.6-2.8 %) for illnesses. Among injuries, traumatic injuries had higher average weekly severity scores (50.0 vs 32.0, p < 0.05) and cumulative severity scores per case (65.0 vs 42.0, p < 0.05) than overuse injuries. Conversely, overuse injuries lasted approximately 10 days longer than traumatic injuries (18 days vs 10 days, p < 0.05). Traumatic knee injuries and overuse shoulder injuries ranked the highest in prevalence, duration, and cumulative severity scores.

CONCLUSIONS

We found that, although overuse injuries were less severe than traumatic injuries, they interfered with handball activities for extended periods.

Time to Ring in the Body Checking, Head Contact, and Suspected Injury Rates in Youth Ringette: A Video-Analysis Study in Youth Ringette and Female Ice Hockey

OBJECTIVE

To compare physical contacts (PCs), including head contacts (HCs), suspected concussion, and nonconcussion injury incidence rates between youth ringette and female ice hockey.

DESIGN

Cross-sectional.

SETTING

Alberta ice arenas.

PARTICIPANTS

Players participating in 8 U16AA (ages 14-15 years) ringette and 8 U15AA (ages 13-14 years) female ice hockey games during the 2021 to 2022 season.

ASSESSMENT OF RISK FACTORS

Dartfish video-analysis software was used to analyze video recordings.

MAIN OUTCOME MEASURES

Univariate Poisson regression analyses (adjusted for cluster by team-game, offset by game minutes) were used to estimate PCs (including HCs) and suspected injury (concussion and nonconcussion) and concussion-specific IRs and incidence rate ratios (IRRs) to compare sports. Proportions of all PCs that were body checks (level 4-5 trunk PC) and direct HCs (HC 1 ) penalized were reported.

RESULTS

Ringette had a 2.6-fold higher rate of body checking compared with hockey (IRR = 2.63, 95% CI: 1.59-4.37). Ringette also had a 2-fold higher rate of HC 1 compared with hockey (IRR = 2.08, 95% CI: 1.37-3.16). A 3.4-fold higher rate of suspected injury was found in ringette (IRR = 3.37, 95% CI: 1.40-8.15). There was no significant difference in suspected concussion IRs in ringette compared with hockey (IRR = 1.93, 95% CI: 0.43-8.74). Despite being prohibited in both sports, only a small proportion of body checks (Ringette = 18%; Hockey = 17%) and HC 1 (Ringette = 6%; Hockey = 6%) were penalized.

CONCLUSIONS

Higher rates of body checking, HC 1 , and suspected injuries were found in ringette compared with female ice hockey. Body checking and HC 1 were rarely penalized, despite rules disallowing them in both sports. Future research should consider other youth age groups.

High incidence of anterior cruciate ligament injuries in professional men's handball: Analysis of the 'ACL registry in German Sports' over seven consecutive seasons

PURPOSE

The purpose of this study was to generate knowledge about the epidemiology and risk factors for anterior cruciate ligament (ACL) injuries in handball. It was hypothesised that the incidence of ACL injuries is high and comparable to other pivoting sports like football.

METHODS

This study is based on the prospective 'ACL registry in German Sports' implemented in the 2016-2017 season. Professional (first and second leagues) male handball players were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double-checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2016-2017 to the 2022-2023 season.

RESULTS

A total of 84 ACL injuries were registered. 46.3% of ACL injuries were re-ruptures. This represents a total incidence of 0.044 ACL injuries per 1000 h of exposure in training and matches per player over the study period. An increased incidence rate of 0.064/1000 h in the first league compared to 0.031/1000 h in the second league was reported (p ˂ 0.001). The mean number of injuries in the first division was 8.3, and in the second division, 6.6 ACL ruptures per season. Risk factors for ACL injury include previous knee injury and increased match exposure.

CONCLUSION

The incidence of ACL injuries in professional handball is high and comparable to football with an increased risk in the first league compared to the second league in Germany. There was a high incidence of re-injury. Other risk factors for ACL injuries include previous injuries to the affected knee in general as well as increased match exposure.

LEVEL OF EVIDENCE

Level II prospective cohort study.

Systematic video analysis of shoulder dislocations in professional male football (soccer): Injury mechanisms, situational and kinematic patterns

Purpose

Shoulder dislocations in professional football are severe injuries with an increasing incidence and considerable layoff times. Unlike other football injuries, the mechanisms leading to shoulder dislocations are not well understood, which limits the development of targeted preventive measures. Thus, the aims of this study were: (1) to analyse injury mechanisms of shoulder dislocations in professional football, (2) to evaluate situational and (3) to assess kinematic patterns by performing a systematic video analysis.

Methods

The study included all shoulder dislocations occurring in official matches within Germany's top two professional male football (soccer) leagues (1. and 2. Bundesliga) from the 2012/2013 to the 2022/2023 seasons. A systematic video analysis was performed using the official Bundesliga video database. Two independent reviewers assessed injury-related, situational and kinematic parameters.

Results

A total of 37 shoulder dislocations in 36 players (mean age 25 years) were analysed. Two primary injury mechanisms were identified: Type 1 mechanisms, caused by direct contact to the upper extremity (n = 14), and Type 2 mechanisms, caused by catching a fall (n = 22). Only one case did not fit these categories. Median layoff times were 94 days for Type 1 and 56 days for Type 2, but this difference was not statistically significant. Statistically significant differences between the two types were found in player action (p < 0.001) and type of contact (p = 0.005), while factors like player's speed, movement direction, football-specific actions, ball possession and pitch location showed no statistically significant differences. On-field treatment methods varied, but there were no statistically significant differences in repositioning attempts or reduction techniques (n.s.). Trunk position, shoulder joint version, shoulder elevation, and rotation, as well as elbow and wrist joint positions at the moment of dislocation, were similar between the two types (n.s.).

Conclusion

Shoulder dislocations in professional football typically occur through direct contact or catching a fall, indicating a potential role for specific preventive measures.

Level of Evidence

Level III.

Four distinct patterns of anterior cruciate ligament injury in women's professional football (soccer): a systematic video analysis of 37 match injuries

BACKGROUND

To identify mechanisms and patterns of anterior cruciate ligament (ACL) injury in adult women's professional football by means of video match analysis.

METHODS

ACL match injuries sustained in Germany's first women's league during the 2016-2017 to 2022-2023 seasons were prospectively analysed by three expert raters using a standardised observation form. Epidemiological and injury data, as well as the medical history of ACL tears, were obtained from media reports and the statutory accident insurance for professional athletes.

RESULTS

Thirty-seven ACL injuries sustained in official football matches were included in the video analysis, of which 24 (65%) had associated knee injuries, mainly meniscus and collateral ligament injuries. According to the categorised contact mechanisms, 17 (46%) were non-contact injuries, 14 indirect contact injuries (38%) and six direct contact injuries (16%). Of the 17 non-contact injuries, seven (41%) occurred during the first 15 min of the match. Contact mechanisms did not differ between primary and secondary ACL injuries to the same or the contralateral side. Most injuries (80%) of field players occurred during horizontal movements such as sprinting (n=9, 26%), change-of-direction manoeuvres (n=7, 19%), stopping (n=5, 14%) and lunging (n=5, 14%). Four distinct repetitive patterns of ACL match injuries were identified: (1) non-contact 'pressing ACL injury' (n=9), (2) indirect contact 'parallel sprinting and tackling ACL injury' (n=7), (3) direct contact 'knee-to-knee ACL injury' (n=6) and (4) non-contact 'landing ACL injury' (n=4).

CONCLUSION

Most of the identified patterns of ACL injuries in women's professional football have great potential for prevention.

Effect of isokinetic eccentric training on the human shoulder strength, flexibility, and muscle architecture in physically active men: A preliminary study

Strengthening the rotator cuff muscles is important for injury prevention and rehabilitation. Since muscle fascicle length improves motor performance and is suggested to reduce the risk of injury for the hamstring, it may be an important variable to promote multidirectional changes in the function and macroscopic structure for the shoulder. Recent literature reviews overwhelmingly suggest that eccentric exercises improve fascicle length and functional measures for the lower limb. However, there is a research gap for the shoulder. Since ultrasound imaging is the most commonly used imaging technique to quantify muscle structure, but has yielded heterogeneous results in different studies, there is another issue and a research gap for the imaging method. Based on the research gaps, the purpose of this study was to evaluate the effects of standardized eccentric strength training on the function and structure of the external rotator cuff muscles using an isokinetic dynamometer and MRI. Therefore, a preliminary pre-post intervention study was conducted and 16 physically active men were recruited in October 2021. For the right shoulder, an eccentric isokinetic training was performed twice a week for almost six weeks. The primary outcome measures (external rotators) were active and passive range of motion, eccentric and concentric torque at 30, 60, and 180°/s isokinetic speed, and fascicle length and fascicle volume for the supraspinatus and infraspinatus muscles. The findings show a training effect for the absolute mean values of eccentric strength (+24%, p = .008). The torque-angle relationship increased, especially in the final phase of range of motion, although a 4% (p = .002) decrease in passive range of motion was found in the stretch test. Positive changes in muscle structure were shown for the supraspinatus muscle fascicle length (+16%, p = .003) and fascicle volume (+19%, p = .002). Based on the study results, we can conclude that eccentric isokinetic training has a significant positive effect on the shoulder. To our knowledge, this is the first eccentric training study using both isokinetic dynamometer and muscle diffusion tensor imaging to access functional and structural changes in the human shoulder rotator cuff muscles. The methods were shown to be applicable for interventional studies. Based on these results, populations such as high-performance handball players with highly trained shoulders should be included in future studies.

Analyses of actions which cause anterior cruciate ligament injuries in the national basketball association players: YouTube-based video analyses

BACKGROUND

Anterior cruciate ligament (ACL) injuries are among the most common injuries in the National Basketball Association (NBA), and it is important to investigate the actual nature of the injury because it can impair a player's performance after returning to the game. Although the moment of injury has been investigated, the details of the movements and circumstances leading to injury in basketball games are unknown. This study aimed to clarify the actions leading to ACL injuries and to investigate their characteristics, based on YouTube video analyses of the NBA players.

METHODS

Players with ACL injuries in the NBA were identified through web-based research over 10 seasons (2011/2012-2021/2022, through October 2021), with 29 recorded videos of ACL injuries in the NBA. Actions were categorized based on basketball-specific gestures, and determined whether the player was in contact with an opponent or not and, if so, the location of the contact was analyzed focusing on two time points: at the injury frame (IF) and one step before the injury frame (IF-1). The "injury leg" timing was counted for each of the first and second steps after ball possession.

RESULTS

The majority (68.2%) of ACL injury occurred during the 2 steps phase (only two steps can proceed after ball retention in basketball, so we defined them as two steps) in the offense action, and most notably during the first step (80.0%). 73.3% of players who were injured during the 2 steps phase got contact to an area other than the knee (Indirect contact) at the IF-1, with 81.8% of contact being located in the upper body contralateral to the respective knee injury. The probability of players with ACL injuries during the 2 steps at the IF-1 who got Indirect contact was statistically significantly greater than those who got no contact with other players (p = 0.042).

CONCLUSIONS

We argue that including pre-injury play and contact falls into the novelty category. Through YouTube-based video analyses, this study revealed that ACL injuries tend to be characterized by specific types of actions, the timing of contact, and the location of contact in NBA players.

Associations between upper quarter Y-balance test performance and sport-related injuries in adolescent handball players

Handball players are at a high risk of suffering a sport-related injury. Recent studies in various adult populations (e.g., US Army soldiers/warrior athletes, and military members) showed that poor scores in the upper quarter Y-balance test (YBT-UQ) are related to an increased risk of injury. Yet, it is unclear whether this also applies to adolescent handball players. Thus, the present study aims to determine if pre-season YBT-UQ performance is associated with sport-related injuries during the competitive season in adolescent handball players. One hundred and thirty-three adolescent handball players (age: 15.4 ± 1.7 years; m = 99, f = 42) who competed in the second highest league in the Rhine-Ruhr region, Germany, during the 2021/2022 season participated in the study. Before the competitive season, the players performed the YBT-UQ to assess upper extremity mobility and stability of the throwing and non-throwing arm. Over the 8-month competitive season, the coaches monitored the occurrence of sports-related injuries once a week, using an injury report form from the legal accident insurance. Fifty-seven players (43%) incurred a sport-related injury during the competitive season, of which 27 (47%) had upper body injuries, and 30 (53%) were lower body injuries. The YBT-UQ performance of the throwing and non-throwing arm did not significantly differ between injured and non-injured players. Further, Cox proportional hazard survival regression model analyses revealed that only the presence of an inferolateral reach asymmetry score ≥7.75% arm length was associated with a moderate increase in the risk (hazard ratio = 2.18, 95% confidence interval = 1.02–4.68, p = 0.045) of lower but not upper or whole-body injuries. Our findings suggest that the YBT-UQ has limited value as a field-based screening tool to assess the risk of sport-related injuries in adolescent handball players.

A lateral ankle sprain during a lateral backward step in badminton: A case report of a televised injury incident

BACKGROUND

This study presents a kinematic analysis of an acute lateral ankle sprain incurred during a televised badminton match. The kinematics of this injury were compared to those of 19 previously reported cases in the published literature.

METHODS

Four camera views of an acute lateral ankle sprain incurred during a televised badminton match were synchronized and rendered in 3-dimensional animation software. A badminton court with known dimensions was built in a virtual environment, and a skeletal model scaled to the injured athlete's height was used for skeletal matching. The ankle joint angle and angular velocity profiles of this acute injury were compared to the summarized findings from 19 previously reported cases in the published literature.

RESULTS

At foot strike, the ankle joint was 2° everted, 33° plantarflexed, and 18° internally rotated. Maximum inversion of 114° and internal rotation of 69° was achieved at 0.24 s and 0.20 s after foot strike, respectively. After the foot strike, the ankle joint moved from an initial position of plantarflexion to dorsiflexion-from 33° plantarflexion to 53° dorsiflexion (range = 86°). Maximum inversion, dorsiflexion, and internal rotation angular velocity were 1262°/s, 961°/s, and 677°/s, respectively, at 0.12 s after foot strike.

CONCLUSION

A forefoot landing posture with a plantarflexed and internally rotated ankle joint configuration could incite an acute lateral ankle sprain injury in badminton. Prevention of lateral ankle sprains in badminton should focus on the control and stability of the ankle joint angle during forefoot landings, especially when the athletes perform a combined lateral and backward step.

Sports Injuries of a Portuguese Professional Football Team during Three Consecutive Seasons

Professional football players are exposed to high injury risk due to the physical demands of this sport. The purpose of this study was to characterize the injuries of a professional football team in the First Portuguese League over three consecutive sports seasons. Seventy-one male professional football players in the First Portuguese Football League were followed throughout the sports seasons of 2019/2020, 2020/2021, and 2021/2022. In total, 84 injuries were recorded. Each player missed an average of 16.6 days per injury. Lower limbs were massively affected by injuries across all three seasons, mainly with muscular injuries in the quadriceps and hamstrings and sprains in the tibiotarsal structure. Overall, the injury incidence was considerably higher in matches than in training. The two times of the season that proved most conducive to injuries were the months of July and January. Our results emphasize the importance of monitoring sports performance, including injury occurrence, and assisting in identifying risk factors in professional football. Designing individualized training programs and optimizing prevention and recovery protocols are crucial for maximizing this global process.

The Most Common Handball Injuries: A Systematic Review

Handball is a team sport involving a great physical demand from its practitioners in which a high number of injuries occur, affecting individual and collective performance. Knowledge of the injuries is of great importance for their prevention. The objective of the present study was to identify, locate and compare the most frequent injuries and injury mechanisms in handball practice. It was carried out following the Preferred Informed Item for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The source of data collection was direct consultation of the PubMed and Medline databases. Several keywords were used for the documentary retrieval, and the quality of the studies that were selected was evaluated. Of the 707 studies retrieved, only 27 were considered appropriate for the review, and quality scores were obtained that ranged from 10 to 26 points, out of a maximum of 28. The most frequent injuries in handball players are located in the lower limbs (thigh, knee and ankle), and in the shoulder in the upper limbs. Regarding the playing position, the players who play over the 6-m line are the most affected by injuries, while the women players have a higher probability of injury. Most injuries occur during competition.

Descriptive epidemiology of injuries in Japanese collegiate men's basketball: 2013/2014 to 2019/2020

Background

Basketball is one of the most played sports in the world. However, only a few studies have examined the epidemiology of Japanese collegiate men’s basketball injuries. This study investigated the incidence of injury among Japanese collegiate men’s basketball from the 2013/2014 to the 2019/2020 seasons and identified unique patterns by comparing our data with the National Collegiate Athletic Association (NCAA) men’s basketball data.

Methods

Data from Japanese collegiate basketball teams of the Kanto Collegiate Basketball Federation Division I League during the 2013/2014 to 2019/2020 academic years (23 team-seasons) were used in this study. Injury rates per 1000 athlete exposures (AEs), injury proportions, and the injury rate ratio (IRR) were calculated according to the events, injury types, body parts, and common injury mechanisms. Injury rates were then compared with that from the time-loss injury data of the NCAA’s previous reports.

Results

In total, 480 injuries during 97,515 AEs were reported, leading to an injury rate of 4.92 per 1000 AEs (95% CI = 4.48–5.36). The overall injury rate was higher in Japan than in the NCAA ([2009/2010–2014/2015] IRR = 1.55, 95% CI = 1.39–1.73; [2014/2015–2018/2019] IRR = 1.64, 95% CI = 1.48–1.82). Lower extremity injuries occurred most frequently (73.5%). Ankle sprain was the most common injury in Japan, with higher injury rates than in the NCAA (IRR = 2.10; 95% CI = 1.72–2.57). The injury rate of concussion was lower in Japan than in the NCAA (IRR = 0.28; 95% CI = 0.14–0.55).

Conclusions

The rates of overall injury and ankle sprain were higher and that of concussion was lower in Japan than in the NCAA. These results suggested the existence of international differences in the pattern or features of injuries in basketball players.

Injury Prevalence of the Lower Limbs in Handball Players: A Systematic Review

Lower limb injuries are frequent in handball and a serious hindrance to athletic performance. The aim of this systematic review was to synthesize the available research on the prevalence of lower limb injuries in handball players according to sex and competitive level. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, 19 studies were selected after a systematic search and selection process of three digital databases: Scopus, PubMed, and Web of Science. Furthermore, a study quality analysis using an ‘Extension for Sports Injury and Illness Surveillance of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE-SIIS)’ was carried out. The sample consisted of 7110 male and female handball players registering 4483 injuries in their lower limbs. The results showed a high incidence of knee injuries (30.23%) and ankle injuries (24.80%), especially in the ligaments, such as the talofibular and the anterior cruciate ligaments. Considering sex and competitive level, knee injuries accounted for 47.02% of injuries among women, while among men, ankle injuries were most prevalent (34.22%) in international competitions. Additionally, the most common cause of injuries was trauma (85.61%). The findings highlighted that the prevalence of lower limb injuries varies greatly according to the characteristics of the sample and injury. Therefore, the study underlines the importance that sports practitioners (physical trainers, readapters, and physiotherapists) adapt training protocols to reduce injury incidence in the most affected body areas or tissues.

Diverging Playing Positions do not Lead to Differences in YBT-UQ Performance in Youth Handball Players

Handball playing positions can be differentiated between first line players who position themselves near the 6-m line and second line players who typically play outside the 9-m space. Handball is characterized by a high number of throwing actions that cause adaptations in the throwing shoulder. The objective of this cross-sectional study was to assess whether the specific physiological positional demands in handball lead to functional performance differences between the playing positions ( N =196; goalkeepers: n =25; backcourt: n =99; pivots: n =21; winger: n =51) in terms of shoulder mobility and stability in any reach direction as assessed through the Upper Quarter Y Balance Test (YBT-UQ). Contrary to our hypothesis, the results did not show significant differences between the playing positions in shoulder mobility and stability in youth handball players, irrespective of reach arm and reach direction. The obtained effect sizes ( η _p ² ) were solely small and ranged between 0.01 and 0.03. The adaptations following the demands of the diverging playing positions do not lead to significant differences in shoulder mobility and stability on the basis of the YBT-UQ. The overall training load of youth handball players may not be sufficient to lead to significant position-specific differences in shoulder mobility and stability.

Hamstring injury patterns in professional male football (soccer): a systematic video analysis of 52 cases

OBJECTIVE

To closely describe the injury inciting events of acute hamstring injuries in professional male football (soccer) using systematic video analysis.

METHODS

Video footage from four seasons (2014-2019) of the two highest divisions in German male football was searched for moderate and severe (ie, time loss of >7 days) acute non-contact and indirect contact match hamstring injuries. Two raters independently categorised inciting events using a standardised procedure to determine specific injury patterns and kinematics.

RESULTS

52 cases of hamstring injuries were included for specific pattern analysis. The pattern analysis revealed 25 sprint-related (48%) and 27 stretch-related hamstring injuries (52%). All sprint-related hamstring injuries occured during linear acceleration or high-speed running. Stretch-related hamstring injuries were connected with closed chain movements like braking or stopping with a lunging or landing action and open chain movements like kicking. The kinematic analysis of stretch-related injuries revealed a change of movement involving knee flexion to knee extension and a knee angle of <45° at the assumed injury frame in all open and closed chain movements. Biceps femoris was the most affected muscle (79%) of all included cases.

CONCLUSION

Despite the variety of inciting events, rapid movements with high eccentric demands of the posterior thigh are likely the main hamstring injury mechanism. This study provides important data about how hamstring injuries occur in professional male football and supports the need for demand-specific multicomponent risk reduction programmes.

Injury pattern based on player positions in Japanese university handball: a cross-sectional study of 2056 players

BACKGROUND

Although it is evident that the risk of injury in handball varies according to player position, it is unclear whether the characteristics of these injuries also differ. The aim of this study was to characterise and compare the position-associated injury profiles of university handball players in Japan.

METHODS

A total of 2056 participants who played in the 2018 and 2019 Japanese National University Handball Championships were included in this cross-sectional study. A self-reported injury questionnaire regarding demographic and injury-related information was administered.

RESULTS

The overall prevalence of injury during the one-year period preceding the questionnaire was 44.1%, and back (47.9%) and line (49.2%) players exhibited a higher proportion of injuries than players in other positions (p < 0.001). The ankle, knee, and shoulder/clavicle were the most common body regions affected by traumatic injuries, and knee and shoulder/clavicle injuries differed based on player positions (p = 0.033). Conversely, overuse injuries predominantly affected the lumber spine/lower back, knee, and foot/toe, although there were no significant differences between player positions (p = 0.188). In terms of the injury mechanism, line players exhibited a higher proportion of contact injuries and goalkeepers had a higher proportion of non-contact injuries than that of other positions (p < 0.001).

CONCLUSIONS

Back and line players experienced more injuries than players in other positions. Depending on the player position, there were significant differences in the prevalence and patterns of injury. Therefore, injury prevention measures need to consider the characteristics of injuries based on player positions.

Collision with opponents-but not foul play-dominates injury mechanism in professional men's basketball

Background

To identify injury patterns and mechanisms in professional men’s basketball by means of video match analysis.

Methods

In Germany, injuries are registered with the statutory accident insurance for professional athletes (VBG) by clubs or club physicians as part of occupational accident reporting. Moderate and severe injuries (absence of > 7 days) sustained during basketball competition in one of four seasons (2014–2017 and 2018–2019) in the first or second national men’s league in Germany were prospectively analyzed using a newly developed standardized observation form. Season 2017–2018 was excluded because of missing video material.

Results

Video analysis included 175 (53%) of 329 moderate and severe match injuries. Contact patterns categorized according to the different body sites yielded eight groups of typical injury patterns: one each for the head, shoulders, and ankles, two for the thighs, and three for the knees. Injuries to the head (92%), ankles (76%), shoulders (70%), knees (47%), and thighs (32%) were mainly caused by direct contact. The injury proportion of foul play was 19%. Most injuries (61%) occurred in the central zone below the basket. More injuries occurred during the second (OR 1.8, p = 0.018) and fourth quarter (OR 1.8, p = 0.022) than during the first and third quarter of the match.

Conclusion

The eight identified injury patterns differed substantially in their mechanisms. Moderate and severe match injuries to the head, shoulders, knees, and ankles were mainly caused by collision with opponents and teammates. Thus, stricter rule enforcement is unlikely to facilitate safer match play.

Head injuries in professional football (soccer): Results of video analysis verified by an accident insurance registry

BACKGROUND

Video analysis is one of the most commonly applied methods for analysing football injuries.

PURPOSE

The objective of this study was to assess the accuracy of video analysis for recording head injuries in professional football from official matches in the four highest men's professional football leagues in Germany.

METHODS

In this cohort study, head injuries detected by means of video analysis of all official matches over one season (2017-18) were compared to head injuries registered with the German statutory accident insurance.

RESULTS

Our video analysis yielded 359 head injuries of 287 players. The comparison of head injuries found in our video analysis to those registered with the accident insurance only yielded a match in 23.1% (n = 83), which presents a rather low verification rate. The verification rates varied between the leagues (7.0-30.8%). All injuries documented in the accident insurance registry were found in the video analysis (100%). The types of head injury most often verified by the accident insurance registry (n = 83) were contusion (43.4%), bone fractures (19.3%) and skin lacerations (18.1%). Only 66 of the 359 head injuries (18.4%) resulted in absence from at least one training session and involved a mean time loss of 18.5 days (1-87 days).

CONCLUSION

The mismatch between the number of head injuries found in the video analysis and head injuries registered with the accident insurance is an important methodological issue in scientific research. The low verification rate seems to be due to the unclear correlation between injury severity and clinical consequences of head injuries detected by means of video analysis and the failure of football clubs to register minor head injuries with the accident insurance.

Decision-making to stop or continue playing after football injuries - a systematic video analysis of 711 injury situations in amateur football

Scientific injury registration via video analysis is lacking in amateur football. The purpose of this study was to analyse match injury situations with a focus on the decisions made by players and referees after sustaining a football trauma. In a retrospective cohort study, traumatic injuries sustained in any of the 305 matches of the highest amateur level (4th league) in Germany in the 2015-16 season were assessed by means of video analysis and a standardised video protocol. In total, 711 traumatic incidents at 919 different body regions had been recorded. The three most frequently injured body regions were the ankles (34.1%), the head (17.5%) and the knees (17.0%). 90% (n = 156) of head injuries were direct contact injuries, this percentage was significantly higher than that of contact injuries on ankle (68.4%; p < 0.001) or knee (52.6%; p = 0.001). Referees decided on foul play significantly more often in case of knee injuries (57.1%; p = 0.002) or ankle injuries (64.5%; p < 0.001) than in head injuries (39.8%). Only 26.1% of players with a head injury opted for substitution, which was lower than after ankle (27.8%; p = 0.78) and knee injuries (34.0%; p = 0.13). In conclusion, amateur football is associated with a considerable number of injury situations that are followed by match interruptions and the substitution of players. Players and referees decided to continue playing more often after a head injury than after an injury to other body regions. An advanced education programme on the risks and management of head injuries in football is required to prevent long-term health consequences.

Prevalence of orofacial trauma and the attitude towards mouthguard use in handball players: A survey in Lorraine, France

BACKGROUND/AIMS

Contact sports such as handball may lead to orofacial injuries that can often be prevented by the use of a properly fitted mouthguard. Several studies have investigated orofacial injuries during contact sports in different countries, but there is a lack of data that is specific for French handball players. Therefore, the aims of this study were to determine the prevalence of orofacial injuries and the proportion of handball players using a mouthguard in Eastern France.

MATERIAL AND METHODS

Data were collected from handball players aged over 15 years old from five handball clubs in the Lorraine Region (Eastern France). A questionnaire containing 26 questions about the general characteristics of participants, orofacial injury experiences, emergency procedures following tooth avulsion, and use of mouthguards was self-administered.

RESULTS

Two hundred and sixty-three handball players, of which 76.8% (202) were males, aged 23 ± 8 years on average, with a mean playing experience of 11 ± 6 years, participated in the study. Among them, 24.7% (65) reported at least one orofacial injury. A total of 237 orofacial injuries was declared. The main types of orofacial injuries including lip, cheek and tongue injuries were reported by 18.6% of handball players (49); dental injuries were reported by 9.9% (26) and injuries to the temporomandibular joint were reported by 4.9% (13). Most participants knew about mouthguards (97.3%, 254) and considered them efficient for preventing dental injuries in handball (95.3%, 242/254), but only 3.0% (8) used them.

CONCLUSION

The prevalence of orofacial injuries among French handball players was high while mouthguards were very rarely used. Information should be provided to handball teams regarding mouthguard use and the management of dental injuries.

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.

Traumatic injuries to the hand and wrist in youth elite handball are most frequently localised to the thumb and proximal interphalangeal joints

INTRODUCTION

Hand and wrist injuries have been described as the second most common severe injuries in handball. However, no evidence exists regarding the specific characteristics of these injuries. The aim of this study was to determine the injury pattern of hand and wrist injuries in youth handball.

MATERIALS AND METHODS

Two-hundred and ninety-six adolescent elite handball players (mean age: 14.0 ± 0.8 years) completed a retrospective survey regarding their hand and wrist injuries during the previous season. The injury questionnaire was adapted from sports-specific questionnaires to the demands of hand and wrist injuries in handball and included injury location, type of injury and injury severity.

RESULTS

One-hundred and twenty-three (42 %) players reported 156 injuries (0.53 injuries per season per player) to their hands or wrists in the past season. Injuries to the proximal interphalangeal joints were most frequently described (n = 74, 47 %). The thumb was involved in 46 (29 %) cases. Sprains (n = 113, 72 %) were the most common type of injury. Thirty-six percent of moderate and severe injuries (> 7 days time loss) had not been treated by a physician.

CONCLUSIONS

The rates of hand and wrist injuries are high in youth elite handball. Injury prevention strategies and return to competition criteria should focus on the thumb and the interphalangeal joints. Further research into these injuries is essential to identify risk factors and to develop adequate injury prevention measures.

Nine typical injury patterns in German professional male football (soccer): a systematic visual video analysis of 345 match injuries

AIM

We aimed to systematically analyse the videos of acute injuries in professional men's football and describe typical injury patterns.

METHODS

Injuries were registered with the German statutory accident insurance for professional athletes as part of occupational accident reporting. Following each season (2014-2017), video footage of the two highest divisions in German male football was searched for moderate and severe acute match injuries. Two raters then independently assessed the injuries for: game situation, player and opponent behaviour, referee decision, and injury mechanisms.

RESULTS

The total data set included 7493 acute injuries. Of these, 857 (11%) were moderate or severe match injuries. The video search yielded 345 (40%) clearly identifiable injuries and of those 170 (49%) were contact injuries. We describe nine typical injury patterns: one each for head and shoulder injuries, two for thigh and ankle, and three for knee injuries. The nine patterns are called: (1) Head-to-head injury. (2) Collision-and-fall shoulder injury. (3) Sprinter's thigh injury. (4) Perturbation-and-strain thigh injury. (5) Tackle knee injury. (6) Tackle-and-twist knee injury. (7) Non-contact knee injury. (8) Attacked ankle injury. (9) Collision-and-twist ankle injury. Thigh injuries occurred primarily in non-contact situations (44/81), mostly while the player was sprinting (23/44). Knee injuries were often caused by direct external impact (49/84)-mainly suffered by the tackler during a tackle (17/49).

CONCLUSION

The nine common injury patterns in football differed substantially in their mechanisms and causes.

[Epidemiology and injury prevention in handball]

Handball is characterised by a high rate of injuries. Recent epidemiologic studies, which take the characteristics of handball into account, demonstrate a clear picture of injury patterns and injury risks for handball athletes. While more than half of all athletes can continue playing handball after medical treatment, the other half of injuries is accompanied by loss of training and match time. Although the sustained injuries are associated with a contact mechanism, they are not related to a high rate of foul play in the league setting. This shows that there is a high potential for prevention. Handball medicine strongly aims to primarily reduce and thus prevent injuries in this sport. The existing evidence for the potential of prevention of severe knee injuries must now be implemented into daily training. Due to the high prevalence of overuse injuries to the throwing shoulder, here, too, the first insights have been implemented in a prevention programme. This is described in detail in this article.

["Handball shoulder" in the focus of diagnosis and treatment]

Handball is one of the most popular team sports in Germany. In the diagnosis and treatment of shoulder injuries and shoulder complaints, a distinction must be made between sports-specific adaptation over many years and supposed decompensation. In contrast to throwing sports such as baseball or javelin, intended movement sequences in handball are often disrupted suddenly and abruptly by simultaneous contact with an opponent. This can result in a potential for further injuries. There is usually a gradual transition from a physiologically adapted handball shoulder to a pathological throwing shoulder requiring therapy. A throwing shoulder is characterised by a limitation of performance caused by pain in the shoulder during repeated sports-specific stress. In addition to a thorough clinical examination, MRI is the preferred method of examination due to the fact that changes in a handball shoulder are reflected in muscular tissue, tendons and bone in the form of overstrain reactions (bone bruise). Patients should not only take a break from sports and receive adequate pain treatment, but also undergo a specific physiotherapy regimen. MRI results should always be interpreted in due consideration of symptoms and clinical examination results. Surgery is indicated if there is a lack of improvement after specific pain treatment and physiotherapy, or structural damage corresponding to the symptoms without a chance of recovery or with a higher probability of symptoms and function improving in response to surgery. After surgical treatment, the subsequent rehabilitation plays a major role. Depending on the injury, up to 90 % of the patients may be able to return to sports.