Background Although high injury prevalences and incidences for professional handball were reported, longitudinal analysis of injury burden remain rare.

Objective Analysis of the injury data of the national statutory accident insurance (VBG) for the two highest divisions in German professional male handball over three consecutive seasons regarding interseason, inter-division and inter-team differences of injury burden.

Design Prospective observational open cohort study over the seasons 2014/2015, 2015/2016 and 2016/2017.

Setting German professional male handball (Handball Bundesliga=HB, 2. Handball Bundesliga=HB2).

Patients (or Participants) All first and second division handball players who played at least one competitive club match within the seasons 2014/15 (n=808), 15/16 (n=757) and 16/17 (n=758) were included.

Interventions (or Assessment of Risk Factors) Analysis of all injuries that were registered by clubs or physicians with the German statutory accident insurance for professional athletes (VBG) as part of occupational accident reporting and that led to time loss and/or to medical attention.

Main Outcome Measurements Inter-team comparisons were calculated using the following formula: ‘Cumulative injury burden resulting from mandatory reportable injuries (≥4 days) per team-season/number of competitive matches per team-season’.

Results Every German professional handball player missed on average (cumulative) 28.7 days per season due to injuries. The total burden equalled 66,597 days of absence (HB: 31,247, HB2: 35,350). The mean injury burden per competitive match over the three observed seasons for all HB teams ranged from 12.5 to 14.2 days of absence with individual rates ranging from 4.3 to 28.8 (2014/2015), 2.1 to 27.5 (2015/2016) and 2.3 to 33.6 (2016/2017). For HB2 teams the mean burden ranged from 13.3 to 14.6 days of absence per competitive match, with individual rates ranging from 3.0 to 25.1 (2014/2015), 2.5 to 30.0 (2015/2016) and 0.9 to 35.7 (2016/17).

Conclusions These wide ranges indicate that a reduction in the injury burden seems generally possible and that some teams and coaching staffs are more successful concerning their preventive (coach, medical and therapeutic specific) player support.