Injuries in men’s elite handball

A review of the literature

by
Einar Sand Koren

Veiledere:
Grethe Myklebust og Lars Engebretsen

Faculty of Medicine

University of OSLO
2010

1
2
Abstract
Background:

Several authors have analyzed the incidence of injuries in team handball, but there is a lack of
knowledge concerning professional handball and especially for men. The aim of this study is
to review the literature and analyze the incidence, circumstances and characteristics of
handball injuries in men’s elite handball.

Methods:

A systematic search in PubMed is used. In general only results from men’s elite handball are
included, but a few exceptions are made when it comes to studies where the results are not
separated between the different groups. When comparing studies one must be aware that the
definition of an injury might differ.

Results:

The highest incidence of injuries is reported in major international tournaments with 1.2-2.7
injuries/match and 89-129 injuries/1000 match hours. ACL injuries specifically have an
incidence of 0.24±0.09 injuries/1000 match hours. About 40% of all injuries that need
medical treatment are caused by overuse and the most common locations are the shoulder and
knee. Some studies have showed that up to 30% of all injuries were classified as major with a
time loss over 28 days.

Discussion:

There is a larger risk of sustaining an injury during matches than training and there are more
injuries as the performance level increases. However, more research is needed in elite male
handball and especially concerning overuse injuries and injuries to the head. With sufficient
information about the total burden, injury types and mechanisms, it has been shown that
prevention programs based on this information can reduce the injury incidence.

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Table of Contents
Abstract ...................................................................................................................................... 3  
Table of Contents ....................................................................................................................... 4  
Introduction ................................................................................................................................ 5  
Materials and Methods ............................................................................................................... 6  
Results ........................................................................................................................................ 7  
Who is affected by an injury? ................................................................................................ 7  
ACL injuries........................................................................................................................... 8  
Overuse injuries...................................................................................................................... 9  
Injury type ............................................................................................................................ 10  
Anatomical location ............................................................................................................. 10  
Lower Extremity .............................................................................................................. 10  
Upper Extremity............................................................................................................... 10  
Head and Neck ................................................................................................................. 10  
Time loss .............................................................................................................................. 11  
What are the inciting events? ............................................................................................... 11  
Osteoarthritis ........................................................................................................................ 12  
Protective Equipments.......................................................................................................... 12  
Discussion ................................................................................................................................ 13  
References ................................................................................................................................ 16  
Appendix .................................................................................................................................. 18  
Asembo & Wekesa, Langevoort et al................................................................................... 18  

4
Introduction
Team Handball is a popular sport in Europe and it has been an Olympic sport since the
Olympic Games in Münich in 1972. Today, handball is a sport played in 183 countries; there
are 19 million players worldwide and 795,000 teams (International Handball Federation
2009).

Handball has since the beginning been a game in continuous development. There has been an
increase in the players’ speed, strength and technique, and changes in the rules and tactics.
This along with excitement until the very end of each game have made handball into a sport
of great public interest. The Men’s EHF European Championship 2008 in Norway had about
1.2 billion television viewers and it was broadcasted in 85 nations (European Handball
Federation).

In elite handball it takes few seconds from a team has lost control of the ball till the opponent
makes a counterattack. Despite this, many teams substitute one or two players between attack
and defense. Some players are specialists in offense and others in defense. Handball is a game
with much contact between the players and it is common that teams play hard and destructive
to achieve advantages. If the use of a tackling can make the attacker a little reserved, the
defense player has won a small victory. The referee has an important task taking care of the
player’s health by keeping the game fair and sanction brutal play.

Earlier studies in the handball literature have reported that injuries caused by a contact
situation represent between 40% and 84% of the total number of injuries (Nielsen and Yde
1988; Fagerli et al.1990; Langevoort et al 2007).

Matches are played all year round when it comes to a professional level. The best players,
which have activity with a national team and participate in an international tournament with
their club, play between 70 and 100 matches a year. Each year there is either a World
Championship or an European Championship played and every fourth year there is also a
handball tournament in the Olympic Games. The burden at each player varies depending on
personal level and the total number of players in the teams, but it is in general high and there
is especially short time to rest during a championship where the best teams play 8 matches in
13 days (European Championship 2010).

The purpose of this study is to review the literature of elite handball for men, presenting
injury incidences, prevalence, injury types and locations and to see what kind of studies that
are needed in the future.

5
Materials and Methods
This article is based on a systematic search in PubMed.

Key words: handball, handball injuries, elite handball, jumpers knee, ACL injuries, shoulder
injures and goalies elbow.

The literature consists of many studies on handball, but there is a lack of knowledge
concerning men’s handball and especially in the elite level.

Some research have been performed looking at injuries at the top international level for men
in the Olympic Games in Athens 2004 (Junge et al. 2006) and the World Championships in
2001 and 2003 (Langevoort et al. 2007).

Gundersen and Myklebust have done a prospective study examining Norwegian elite handball
during the season 2008/2009. This is not published yet, but the abstract is available.
Furthermore Asembo and Wekesa did a study under East and Central Africa Senior Clubs
Championship in Kenya in 1995 and Oehlert et al made a video analysis of injuries during the
Olympic games in Barcelona 1992.

In the already mentioned literature, these studies are at the highest performance level,
however, there are published more studies in handball. Some of these studies include both
genders while other includes both elite and amateur teams. A challenge here is that the
authors not always present the data separated, which makes it difficult to analyze for this
purpose. (Jørgensen 1983 and 1984, Leidinger 1990).

Since the numbers of studies in elite handball for men are limited, parts of other studies are
included in this paper. (Tyrdal & Bahr 1996, Seil et al 1998)

One methodological problem in the handball literature is that the definition of an injury
differs. Most studies in elite handball define an injury as “any physical complaint incurred
during the match that received medical attention from the team physician regardless of the
consequences with respect to absence from the match or training” (Langevoort, Junge,
Gundersen). Another common definition is where an injury is causing time loss from match
or practice session (Tyrdal & Bahr, Nielsen & Yde). A third definition is “all injuries which
led either to a temporary stoppage of the game or to substitution of the injured player”
(Asembo & Wekesa and Oehlert).

Similar to the challenges in the injury definition, there are differences in the definition of the
injury’s severity. The most used classification in the handball literature is: minor injury (1-7
days absence), moderate injury (8-21 days absence) and major injury (>21 days), but these
studies do not include injuries without time loss. At the same time there is a weakness in some
studies (i.e. Langevoort et al and Junge et al), where the duration of absence is estimated at
time of injury and not by following the player in the rehabilitation phase to give the exact
time frame.

6
Results

Who is affected by an injury?

Langevoort et al have done a study (1) analyzing injuries in major international tournaments,
including the men’s World Championships in 2001 and 2003. In the World Cup 2001 in
France 80 matches were played and Langevoort et al found an incidence of 110 injuries/ 1000
match hours and 1.5 injuries / match. If we just look on the time loss injuries it gives an
incidence of 31 injuries/1000 match hours and 0.4 injuries/match.

At the following World Cup in Portugal the incidence was 129 injuries /1000 match hours and
1.8 injuries/match. Injuries that led to time loss were 34 injuries/ 1000 match hours and 0.5
injuries/match.

Junge et al did a similar study (2) at the Olympic Games 2004 in Athens. In the men’s
tournament the results were 89 injuries/1000 match hours and 1.2 injuries/match. The
numbers of time loss injuries were 40 injuries/1000 match hours and 0.6 injuries/match.

Asembo and Wekesa found in their study (4) from Kenya in 1995 under East and Central
Africa Senior Clubs Championship, an average incidence of 2.74 injuries/match. They also
found an incidence of 0.9 injuries/player during the 19 matches the championship lasted.

Tournament WC 2001 WC 2003 OG 2004 Kenya 1995

No. of matches 80 80 44 19

Respons rate 125 (78%) 122 (76%) 79 (90%)

No.of injuries 96 110 49 52

Injuries/1000 h 110 129 89

Injuries per match 1.5 1.8 1.2 2.74

Time loss injuries 27 29 22

Injuries/1000h 31 34 40

Injuries per match 0.4 0.5 0.6

7
Gundersen and Myklebust have in a prospective study (3) in Norwegian elite handball
registered injuries in the season 2008/2009. All acute and overuse injuries that needed
medical attention and/or led to absence from match or training were registered. In total they
found an incidence of 3.9 injuries/1000 match hours. Acute injuries were 1 injury /1000
training hours and 15.2 injuries/1000 match hours. There are in other words a 15 times higher
risk of getting injured during match than training.

Leidinger et al did a study (5) among German senior players where they analyzed injuries that
needed medical attention and occurred during a five years period in 1981-86. They found that
96% of the players at the highest performance level (Bundesliga) got injured each year.

ACL injuries
Several studies have reported the incidence of ACL injuries in team handball.

Strand et al (1990) did a retrospective study (6) in a specific part of Norway covering ten
seasons from 1979-89 and found an incidence at the top three divisions in Hordaland handball
area to be 0.31 ACL injuries/1000 match hours.

Myklebust et al 1997 (7) registered all cruciate ligament injuries during the seasons 1989-90
and 1990-91 in Norwegian elite handball. At the highest performance level for men the
incidence was 0.54 injuries/1000 match hours and 2.2% of the players suffered an ACL injury
per season. On the second highest level there was 0.84 injuries/1000 match hours and 2.0% of
the players suffered an ACL

Myklebust et al. 1998 did a prospective study (8) of ACL injuries in Norwegian elite team
handball covering the seasons 93/94, 94/95 and 95/96. In this period a total of 5 ACL injuries
occurred among men and the incidence was calculated to be 0.06±0.03 injuries /1000 hour.
During competition the incidence was 0.23±0.13 injuries/1000 match hours. In this study
there was a 5 fold higher risk among woman than men.

The reason for the marked gender difference is unknown, but several hypotheses have been
suggested, both intrinsic (anatomic, strength, coordination, hormonal, level of skill and
conditioning) and extrinsic (shoe and surface type).

Olsen et al (2003) based their study (9) on injury data collected as part of three previous
studies (Myklebust et al., 1997, 1998, 2003). ACL injuries have prospectively been registered
for 7 seasons in the period 1989-00. During this time 9 ACL injuries occurred during regular
league matches for men. This gives an incidence of 0.24±0.09 injuries/1000 match hours.

8
Overuse injuries
Knowledge of overuse injuries in elite handball is sparse, but a study by Gundersen and
Myklebust (3) showed that 41% of all injuries that needed treatment were caused by overuse.
The most common location to have an overuse injury, according to this study, was the
shoulder (n=50, 22%). This study does not divide the overuse injuries by gender.

This high number of overuse injuries in the shoulder are also found in a German study (10) by
Gohlke, which reported that 40% of 25 male handball players had been debilitated during
handball activity in the last 6 months caused by shoulder pain.

The high prevalence of overuse injuries in the shoulders are also confirmed by Nielsen and
Yde (11) where 8 out of 12 injuries located to shoulder and elbow were overuse injuries
incurred during practice. The same study reported that 27% of all injuries were overuse
injuries.

In the study by Leidinger et al (5), 68.5% of the handball players complained about injuries.
The most common locations were knee (26.9) and ankle (20.3%), but handball specific
injuries like “throwing shoulder” and “throwing elbow” accounted for 17.1% and 11.9% of
the overuse injuries.

A study by Tyrdal and Bahr (12) looked at the prevalence of elbow problems among
goalkeepers, 41% of 729 goalkeepers in the top 4 divisions for both gender experienced
elbow problems. This condition is called goalies elbow because of the repeating
hyperextensions causing the injuries. Only 63% of the clubs responded the invitation to the
study and this is a weakness of the study.

These numbers are matching what Seil et al 1998 found in their study (13) at a superior
nonprofessional level, where one out of three goalkeepers suffered from overuse symptoms
from the elbow. In addition 17% of the players with overuse symptoms were complaining
about symptoms from the low back.

There has been research on other specific injuries as well. Lian et al (14) researched jumpers
knee among elite athletes from different sports. The total prevalence among male players was
30% and out of them did 13.5% have current symptoms.

9
Injury type
In international championships (Langevoort et al and Asembo & Wekesa) contusions are the
most common injury type with between 44-60%, followed by sprains with 7-27% of all
injuries. In other studies like Seil et al 1998 and Nielsen & Yde sprains are the most common
injury type with 46-68%. This might be a result of different injury definitions in the studies.
In the last two studies in contrast to the first, it was necessary with a time loss for an injury to
be included.

Anatomical location

Lower Extremity
Injuries to the lower extremities are common. Merging the numbers from the three
championships for men that Langevoort et al studied, the percentage is 43%. 14 % are injuries
to the knee, while 11 % are affecting the ankle. Leidinger et al report similar numbers where
46% of all injuries were seated in the lower extremities, and 21% and 12% were located to the
ankle and knee. The studies of Jørgensen 1984 and Nielsen and Yde 1988 also confirm these
numbers while Gundersen and Myklebust found that there were most injuries to the knee
(22%). The last study does not separate between genders when presenting the most common
location of injury.

Upper Extremity
Injuries to the upper extremity represent 20% of all injuries according to the studies of
Langevoort et al. A percentage at 35 was reported in Leidinger et al, while it was 38% at the
regional league in Seil et al 1998 and 41% in Nielsen and Yde. Finger and shoulder injuries
are the most common injuries according to these studies.

Head and Neck

A high number of injuries to the head and neck are observed in international championships.
The highest rate is reported in the study of Asembo and Wekesa from Africa where 29 out of
52 injuries affected the head. This gives us a percentage of 56.

In Langevoort et al the numbers from the World Cup 2003 and the Olympic games in 2004
(28% and 32%) are similar to what Asembo and Wekesa found. Also the study (15) by
Oehlert et al (2004) confirms these percentages (34%). It is interesting like Myklebust discuss
in her chapter about team handball epidemiology (16), that there seems to be few concussions
among these injuries and that most of these injuries might be blows to the face, nose or
possible damage to the teeth. Only 2 out of 52 injuries in the study by Asembo & Wekesa

10
were concussions while 31 were contusions. This may be influenced by the definition of an
injury where events leading to stoppage of the game are included and where a requirement of
time loss does not exist. A study by Lieger and von Arx (17) about orofacial/cerebral injuries
among professional athletes in Switzerland reported that 4 out of 73 handball players used
mouth guards, and the most common injuries were a soft tissue lesion (40%) and a tooth
fracture (35%). Cerebral concussions represent 8% of the injuries among handball players
without mouth guard.

Time loss
Gundersen reported in the Norwegian prospective study that 30% of injuries were major with
a time loss over 28 days. This high number of major injuries is also found in the study by
Nielsen & Yde (20% of the injuries). Both these rates are not specific for male athletes.

In the studies by Langevoort et al the estimated duration of absence over 4 weeks where
between 1-6 %, but as mentioned previously, injured players in this study were not followed
in the rehabilitation. The same study had an estimated duration of absence at 0 days in 50%
and 72%. Langevoort et al also found that significantly more non-contact injuries than contact
injuries were expected to result in absence from play, and ankle sprain was the most frequent
diagnosis of a time loss injury.

What are the inciting events?

Most injuries in elite handball occur in a contact situation. Studies at the highest competition
level (Langevoort et al, Oehlert et al and Asembo & Wekesa) found contact injuries to
represent between 80% and 92%. About 50% of the injuries during major international
tournaments were caused by a foul and sanctioned.

These high numbers are not the case when we examine ACL injuries. They mostly occur in a
non-contact situation when the player is doing a plant and cut or a landing after a jump shot
(Myklebust et al 1997,1998,2003)

When we take a look at where on the court an injury happen, between 52% and 86% of
injuries occur in offense (Leidinger, Seil et al 1997 (18), Asembo & Wekesa and Oehlert).

11
Osteoarthritis
Osteoarthritis (OA) is a possible consequence both after an injury and long-term elite
handball. A study by L’Hermette et al. (19) showed that 60% of retired elite male handball
players were diagnosed with premature hip OA in at least one of the hip, compared with 13%
of the control suspects.

Protective Equipments
Many athletes use protective equipments to avoid injuries and hard impact on the joints.
According to the study of Seil et al 1998 nearly 90% of high-level players wore some kind of
protective equipment. This is the use of tape, ankle support, mouth guard, knee/elbow pads
and other orthosis, and we understand that protective equipments are part of a handball
player’s day life.

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Discussion
Several problems are related to epidemiologic studies of sports related injuries. The definition
of an injury varies and to compare studies with different designs is difficult.

We know from the literature that there is a larger risk of injuries during matches than training
(Nielsen and Yde 1988; Seil et al 1998; Gundersen and Myklebust 2009) and a higher injury
incidence along with a higher performance level (Langevoort et al, Asembo & Wekesa,
Myklebust (16)).

The studies from the international championships for male players showed an incidence of
1.2-2.74 injuries / match. This is about the same as the incidence for women in the European
Championship 2002, World Cup 2003 and the Olympic in 2004 (Langevoort et al 2007) but
how is the incidence compared with football?

Ekstrand et al did a study (20) in professional football called the UEFA injury study. They
found an incidence of 27.5 injuries / 1000 match hour. This is less than Langevoort et al
reported (89-129 injuries / 1000 match hour) from international handball, but more than
Gundersen & Myklebust (15.2 injuries / 1000 match hour) found in Norwegian club handball.

The study by Junge et al examined not only handball during the Olympics in 2004, but also
sports like football, basketball and volleyball. The same study design was used for the various
sports making it easier to compare. The injury incidence during the 32 matches played in
men’s football was 2.4 injuries per match, 109 (85-133) injuries per 1000 player matches and
73 (57-89) per 1000 playing hours. This shows more injuries per match, but overall about the
same as in handball. The incidence from basketball and volleyball was lower than for
handball and football. However, when comparing the incidences it is difficult because the
actual playing time is hard to determine. Unlike football, the match clock stops when the ball
is out of bounds in basketball whereas the time of a match is not defined in volleyball. Despite
of this methodological dilemma we can still provide a certain impression.

The prevalence of jumpers knee in men’s elite handball was according to the study of Lian et
al 30% of which 13.5% had current symptoms. The overall prevalence of jumper’s knee in
this study was 14% across the sports included, with an additional 8% of the athletes reporting
previous symptoms. Volleyball- and basketball players were most affected with up to 45%
with current symptoms. The prevalence of current jumper’s knee was 5.6% in women’s
handball. The study suggests that jumper’s knee is twice as common among male athletes as it
is among female athletes.

The studies by Langevoort et al from major international male championships estimated the
duration of absence at 0 days to be between 50% and 72%. This might be a result of the injury
definition where even minor complaints that received medical attention were included or it
might tell us that players are pushing the limit and keep playing matches under a
championship in spite of an injury. This can lead to a longer absence after the tournament or a
longer time frame with complaints. The players are professionals and therefore have to be

13
paid by their clubs regardless of whether they play or not. Injuries sustained in national team
competitions and the resulting absence not only involve the players, but also give a financial
loss for the clubs of the players affected.

An international elite team has in average 6-10 hours of weekly training with just handball.
Other physical training and about two matches a week adds to this. Let us see what a team can
expect of injuries through a season with some of the numbers reported. Roughly there will be
about 300 hours of handball training and 80 matches a year. 80 matches gives 560 hour of
exposure per team and with the incidence of 0.54 ACL injuries/1000 match hours found at the
highest performance level in Myklebust et al 1997, it gives 0.3 ACL injuries in matches pr
team a year.

If we use an injury incidence about 100 injuries/1000 match hours like Langevoort et al., this
lead to 56 injuries in matches pr team a year. With a rate like Gundersen & Myklebust
reported, a team can expect 8.5 injuries per season.

The high incidence of acute injuries and prevalence of overuse injuries, combined with up to
one hundred matches per year for the best players, demands the teams to have a good medical
team. Since there is little time to rest it is important that the players get good and necessary
help from a physician and physical therapist so they can perform at a maximum level. With
activity all year round it is also important that there is a good collaboration between national
teams and club teams, so the health of the players are taken care of and not driven to
exhaustion. It is interesting to see if the increase from 14 to 16 players in each team in
international matches (a rule change introduced before the season 2009/10) will reduce the
incidence of injuries.

There is a need of more studies in elite handball for men. Many of the studies in handball are
old, retrospective studies with self-report of injuries and when we think of the development of
the game, increase in training and number of matches; one might assume that things have
changed. These new studies should have a strict and well defined injury definition and
register all injuries during an entire season including the preseason.

Research regarding overuse injuries is especially limited. Overuse injuries are a problem for
the continuity of training and they reduce the performance. More knowledge on the injury
mechanisms is also needed so we can introduce the most effective prevention measures.

More studies are also needed to confirm the high incidence of head injuries and what the
consequences are. Is it necessary to have tougher sanctions from the referees when it comes to
dangerous play? About 50% of the injuries during major international tournaments were
caused by a foul and sanctioned. This stresses the importance of Fair Play as an essential
aspect in the prevention of injury.

And might it be an idea to reduce the frequency of international championships from today,
with a championship every year to be like it is in football with a championship just every
second year? Or is it possible to have more rest days at major events? This would give the
best players better time to recover and could reduce the number of injuries and improve the

14
performance on the court. Injuries are part of an athlete’s daily life and with help of sufficient
information about the total burden, injury types and mechanisms, we can make better seasonal
setup in terms of matches and championships and introduce effective preventive exercises for
the purpose of reducing the injuries to a minimum.

15
References
(1) Langevoort G, Myklebust G, Dvorak J, Junge A. Handball injuries during major
international tournaments. Scand J Med Sci Sports 2007:17:400-407

(2) Junge A, Langevoort G, Pipe A, Peytavin A, Wong F, Mountjoy M, Beltrami G, Terrell

R,Holzgraefe M, Charles R, Dvorak J. Injuries in team sport tournaments during the Olympic
games 2004. Am J Sports Med 2006:34:565-576

(3) Gundersen, Myklebust G, Skadeforekomst i norsk topphåndball en prospektiv

undersøkelse i sesongen 08/09.

(4) Asembo JM, Wekesa M. Injury pattern during team handball competition in East Africa.
East Afr Med J 1998:75:113-116

(5) Leidinger  A,  Gast  W,  Pforringer  W.  Traumatology  in  indoor  handball  sports.  A  sports  
medicine  analysis  of  the  incidence  of  injuries  and  accident  epidemiology  of  indoor  
handball  sports  in  senior  players  in  the  federal  republic  of  Germany  after  1981.  
Sportverletz  Sportschaden  1990:  4:  65–68

(6) Strand T, Tvedte R, Engebretsen L, Tegnander A. Anterior cruciate ligament injuries in

handball playing. Mechanisms and incidence of injuries. Tidsskr Nor Laegeforen
1990:110(17):2222-5.

(7)  Myklebust  G,  Maehlum  S,  Engebretsen  L,  Strand  T,  Solheim  E.  Registration  of  cruciate  
ligament  injuries  in  Norwegian  top  level  team  handball.  A  prospective  study  covering  
two  seasons.  Scand  J  Med  Sci  Sports  1997:  7:  289–292.  

(8) Myklebust  G,  Maehlum  S,  Holm  I,  Bahr  R.  A  prospective  cohort  study  of  anterior  
cruciate  ligament  injuries  in  Elite  Norwegian  team  handball.  Scand  J  Med  Sci  Sports  
1998:  8:  149–153.  

(9) Olsen  OE,  Myklebust  G,  Engebresten  L,  Holme  I,  Bahr  R.  Relationship  between  floor  
type  and  risk  of  ACL  injury  in  team  handball.  Scand  J  Med  Sci  Sports  2003:  13:  299–304  

(10) Gohlke Von F, Lippert M J, Keck O. Instabilität und impigement an der Schulter des
Leistungssportlers mit Überkopfbelastung. Sportverletz  Sportschaden  1993:  7:  115-­‐121

(11) Nielsen AB, Yde J. An epidemiologic and traumatologic study of Injuries in handball.
Int.J.Sports. Med.9 (1988) 341-344

(12) Tyrdal S , Bahr R. High Prevalence of elbow problems among goalkeepers in European
team handball- ”handball goalie’s elbow”. Scand  J  Med  Sci  Sports  1996:  6:  297-­‐302

(13) Seil  R,  Rupp  S,  Tempelhof  S,  Kohn  D.  Sports  injuries  in  team  handball.  A  one-­‐year  
prospective  study  of  sixteen  men’s  senior  teams  of  a  superior  nonprofessional  level.  

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Am  J  Sports  Med  1998:  26:  681–687  

(14) Lian OB, Engebretsen L, Bahr R. Prevalence of jumper’s knee among elite athletes from
different sports: a cross-sectional study. Am J Sports Med. 2005 Apr; 33(4): 561-7.  

(15) Oehlert  K,  Drescher  W,  Petersen  W,  Zantop  T,  Gross  V,  Hassenpflug  J.  Injuries  in  
Olympic  handball  tournaments:  a  video  analysis.  Sportverletz  Sportschaden  2004:  
18:80–84.  

(16) Myklebust team handball chapter 20 in Epidemiology of injury in Olympic sports.

(17) Lieger O, von Arx T. Orofacial / cerebral injuries and the use of mouthguards by
professional athletes in Switzerland. Dent Traumatol. 2006 Feb;22(1):1-6.

(18) Seil  R,  Rupp  S,  Tempelhof  S,  Kohn  D.  Injuries  during  handball:  a  comparative,  
retrospective  study  between  regional  and  upper  league  teams.  Sportverletz  
Sportschaden  1997:  11:  58–62.

(19) L’Hermette M, Polle G, Tourny-Chollet C, Dujardin F. Hip passive range of motion and
frequency of radiographic hip osteoarthritis in former elite handball players. Br J Sports Med
2006: 40: 45-49

(20) Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional
football- the UEFA injury study. Br J Sports Med published online June 23, 2009.

17
Appendix

Asembo & Wekesa, Langevoort et al.

Asembo &
Langevoort et al.
Wekesa

East Africa World Cup World Olympics

Study 1995 01 Cup 03 Games 04 Merged

No.of injuries 52 96 110 49 255

Injuried body part

Head, neck 29 (56) 11(11) 30(28) 15(32) 56(22)

Trunk 13 (25) 16(17) 14(13) 5(11) 35(14)

Upper extremities 3(6) 21(22) 21(19) 10(21) 52(20)

Shoulder 4(4) 3(3) 4(9) 11(4)

Arm 2(2) 2(2) 2(4) 6(2)

Elbow 7(7) 6(6) 0 13(5)

Hand incl. Wrist,finger 8(8) 10(9) 4(9) 22(9)

Lower extremities 8(15) 48(50) 45(41) 22(45) 115(45)

Hip, groin 4(4) 3(3) 2(4) 9(4)

Thigh 7(7) 8(7) 2(4) 17(7)

Knee 15(16) 15(14) 5(11) 35(14)

Lower leg 13(14) 1(1) 3(6) 17(7)

Ankle 7(7) 14(13 7(15) 28(11)

Foot/toe 2(2) 3(3) 1(2) 6(2)

Missing 0 1 2 3

18
 Asembo &
Langevoort et al.
Wekesa

East Africa World Cup World Olympics

1995 01 Cup 03 Games 04 Merged

Type of injury

Concussion 2(4) 1(1) 4(4) 1(2) 6(2)

Fracture 1(1) 1(1) 2(4) 4(2)

Dislocation 3(3) 2(2) 2(4) 7(3)

Tendon/ligamentous,

rupture, meniscus lesion 4(4) 3(3) 5(11) 12(5)

Sprain 5(10) 10(11) 29(27) 3(7) 42(16)

Strain/mucle fiber rupture 7(8) 7(6) 2(4) 16(6)

Cuntusion 31(60) 57(60) 48(44) 25(54) 130(51)

Tendonitis/bursitis 2(2) 0 0 2(1)

Laceration/abrasion/blister 7(13) 1(1) 7(6) 1(2) 9(4)

Other 7(13) 5(6) 7(6) 5(11) 17(7)

Missing 5 2 3 10(4)

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