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Handball load and shoulder injury rate: a 31-week cohort study of 679 elite youth handball players
  1. M Møller1,
  2. R O Nielsen1,
  3. J Attermann2,
  4. N Wedderkopp3,
  5. M Lind4,
  6. H Sørensen1,
  7. G Myklebust5
  1. 1Section for Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
  2. 2Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
  3. 3Sports medicine clinic, Orthopedic dep., Hospital of Lillebaelt Vejle-Middelfart, Institute of Regional Health Research and Center for Research in Childhood Health, University of Southern Denmark, Odense, Denmark
  4. 4Division of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark
  5. 5Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences, Oslo, Norway
  1. Correspondence to M Møller, Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C 8000, Denmark; memo{at}


Background Knowledge of injury patterns, an essential step towards injury prevention, is lacking in youth handball.

Aim To 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).

Methods 679 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) <20% increase or decrease (reference), (2) increase between 20% and 60% and (3) increase >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.

Results An 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).

Conclusions A 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.

  • Load
  • Scapula
  • Risk factor
  • Adolescent
  • Epidemiology

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  • Twitter Follow Merete Møller @Merete_Moller and Rasmus Ø Nielsen @RUNSAFE_Rasmus

  • Contributors MM and RON formulated the initial concept of the manuscript. All authors contributed to the manuscript preparation. MM was responsible for data collection, data analysis and the overall content.

  • Funding The Danish Rheumatism Association (grant number R114-A2678), Team Danmark.

  • Competing interests None declared.

  • Ethics approval According to the Act on Research Ethics Review of Health Research Projects, The Ethics Committee of Central Denmark Region deemed the study to be exempt from full ethical review (request 89/2013) due to the study design (observational study). Permission for the study was granted by the Danish Data Protection Agency (File no 2013-41-2137).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are available on request. All personally identifiable information will be deleted or anonymised before data transfer.