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- Asker, Martin, et al.
(author)
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A prospective cohort study identifying risk factors for shoulder injuries in adolescent elite handball players: the Karolinska Handball Study (KHAST) study protocol
- 2017
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In: BMC Musculoskeletal Disorders. - : BIOMED CENTRAL LTD. - 1471-2474. ; 18
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Journal article (peer-reviewed)abstract
- Background: Handball is a physical contact sport that includes frequent overhead throwing, and this combination leads to a high rate of shoulder injuries. Several factors have been associated with shoulder injuries in overhead athletes, but strong scientific evidence is lacking for most suggested risk factors. We therefore designed the Karolinska Handball Study (KHAST) with the aim to identify risk factors for shoulder injuries in adolescent male and female elite handball players studying at handball-profiled secondary schools in Sweden. Secondary objectives are to investigate whether shoulder function changes during the competition season and whether the physical profile of the players changes during their time in secondary school. Methods: Players aged 15 to 19 years were included during the pre-season period of the 2014-2015 and the 2015-2016 seasons. At inclusion, players signed informed consent and filled in a questionnaire regarding playing position, playing level, previous handball experience, history of shoulder problems and athletic identity. Players also completed a detailed test battery at baseline evaluating the shoulder, neck and trunk. Players were then prospectively monitored weekly during the 2014-2015 and/or 2015-2016 competitive seasons regarding injuries and training/match workload. Results from the annual routine physical tests in the secondary school curriculum including bench press, deep squat, hand grip strength, clean lifts, squat jumps, counter movement jumps, amp;lt;30 m sprints, chins, dips and Coopers test will be collected until the end of the competitive season 2017-2018. The primary outcome is the incidence of shoulder injuries and shoulder problems. The secondary outcome is the prevalence of shoulder injuries and shoulder problems. Discussion: Shoulder problems are frequent among handball players and a reduction of these injuries is therefore warranted. However, in order to introduce appropriate preventive measures, a detailed understanding of the underlying risk factors is needed. Our study has a high potential to identify important risk factors for shoulder injuries in adolescent elite handball players owing to a large study sample, a high response rate, data collection during consecutive seasons, and recording of potential confounding factors.
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| 2. |
- Asker, Martin, et al.
(author)
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Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts
- 2018
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : SPRINGER. - 0942-2056 .- 1433-7347. ; 26:7, s. 1892-1900
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Journal article (peer-reviewed)abstract
- Shoulder problems are frequent among senior elite handball players. The objective of this study was to assess the prevalence of shoulder problems among adolescent elite handball players and to investigate potential differences in gender, school grade, playing position and playing level. During the 2014 and 2015 pre-season periods, 471 players (age 15-18 years, 54% female) completed a comprehensive baseline questionnaire regarding history of any shoulder pain and shoulder problems experienced during the past season. The players were monitored weekly for one competition season (September-April) regarding shoulder problems and the amount of match and training. Generalised linear models with a binomial link function were used to calculate a prevalence ratio (PR) with 95% confidence interval (CI) to compare the subgroups of players. In total, 110 players (23%) reported having substantial shoulder problems (defined as moderate/severe reduction in training volume, or moderate/severe reduction in performance, or complete inability to participate) at some point during the follow-up season, of which almost half reported complete inability to participate. Of those players reporting substantial problems, 43% (95% CI 39-48) did so for at least 3 consecutive weeks during the season. The prevalence was significantly higher in female players (PR 1.46, 95% 1.04-2.06) and in backcourt players (PR 1.58, 95% CI 1.08-2.32), but no differences were found for school grade (PR 1.21 95% CI 0.88-1.67) or playing level (PR 1.09 95% CI 0.76-1.56). The prevalence of substantial shoulder problems in adolescent elite handball players is high, especially among females, and this warrants further studies on risk factors for shoulder injury and the development of prevention strategies in handball players already before the age of 15. These findings also highlight the importance of introducing a clinical monitoring programme on a routine basis and improving the medical support, taking gender-related aspects into consideration, at handball-profiled secondary schools. II.
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| 3. |
- Asker, Martin, et al.
(author)
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Risk factors for, and prevention of, shoulder injuries in overhead sports : a systematic review with best-evidence synthesis.
- 2018
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In: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 52:20, s. 312-1319
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Research review (peer-reviewed)abstract
- OBJECTIVE: To assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports.DESIGN: Systematic review with best-evidence synthesis.DATA SOURCES: Medline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017.ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria.RESULTS: Of 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n=13). The risk factors examined included participation level (competition vs training) (n=10), sex (n=4), biomechanics (n=2) and external workload (n=2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power.CONCLUSIONS: All investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports.PROSPERO TRIAL REGISTRATION NUMBER: CRD42015026850.
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| 4. |
- Asker, Martin
(author)
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Shoulder injuries in adolescent elite handball players
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Background: Handball is a physically demanding sport that includes jumping, running, side-cutting movements and frequent throwing. A high prevalence of shoulder problems and pain has been reported in adult handball players but the research on adolescent elite players is scarce. Several factors have been associated with shoulder injuries in handball players, but strong scientific evidence is lacking for most of the suggested risk factors. Objectives: The objectives of this thesis were to determine the prevalence of shoulder problems in adolescent elite handball players, to present reference values of shoulder strength in adolescent elite handball players and to investigate if adolescent elite hand- ball players with pre-season shoulder weakness, decreased shoulder range of motion (ROM), scapular dyskinesia or deceased joint position sense (JPS) have higher shoulder injury rates compared to players without these characteristics. Methods: The thesis is based on data from the Karolinska Handball Study, a prospective cohort study with, in total, 471 Swedish adolescent elite handball players (622 player seasons) from 10 handball-profiled secondary schools. At baseline the players filled in a questionnaire and then shoulder strength, JPS, ROM and scapula dyskinesia were measured. Thereafter, the players were monitored on a weekly basis regarding injuries and amount of handball training and matches. Prevalence ratios (PR) and hazard rate ratios (HRR) were calculated and any differences in shoulder strength between sex, playing position, school grade and playing level as well as side-to-side differences in shoulder strength were evaluated using t-tests. Results: In total, 110 players (23%) reported substantial shoulder problems during the competitive season. The prevalence was higher among females (PR 1.46, 95% 1.04-2.06) and backcourt players compared to 6-metre players (PR 1.58, 95% CI 1.08-2.32). Male players were stronger in all measures, regardless of normalisation to bodyweight or not (p<0.0001). Both male and female players were stronger in the dominant arm (p<0.001). In general, wing players and backcourt players were stronger than line players and goalkeepers. In females, the HRR for new shoulder injuries in players with lower isometric external rotational strength (IER) was 2.37 (95% CI 1.03-5.44), lower isometric internal rotational strength (IIR) 2.44 (95% CI 1.06-5.61), and in those with scapular dyskinesia 1.53 (95% CI 0.36-6.52). In males, the HRR for weaker IER was 1.02 (95% CI 0.44-2.36), for lower IIR 0.74 (95% CI 0.31-1.75), and for scapular dyskinesia 3.43 (95% CI 1.49-7.92). There were no associations between new shoulder injuries and deficits in ROM or JPS. Conclusions: The prevalence of substantial shoulder problems in adolescent elite hand- ball players is higher among females and backcourt players. Male players are stronger than female players in terms of both absolute strength and when normalised by body-weight. In both male and female players, wing players and backcourt players are, in general, stronger than line players and goalkeepers when normalised by bodyweight. Male players with pre-season scapula dyskinesia, and female players with pre-season internal or external rotation shoulder weakness, had an increased shoulder injury rate.
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