Skip to main content
SpringerLink
Log in

Neuromuscular exercises prevent severe knee injury in adolescent team handball players

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players.

Methods

Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury.

Results

Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01–0.90), p = 0.019. Other injuries to the lower extremities showed no significant difference between the two groups.

Conclusions

Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Andersson SH, Bahr R, Clarsen B, Myklebust G (2017) Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players. Br J Sports Med 51(14):1073–1080

    Article  PubMed  Google Scholar 

  2. Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Haegglund M, McCrory P, Meeuwisse WH (2006) Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med 16(2):97–106

    Article  PubMed  Google Scholar 

  3. Gilchrist J, Mandelbaum BR, Melancon H, Ryan GW, Silvers HJ, Griffin LY, Watanabe DS, Randall WD, Dvorak J (2008) A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med 36(8):1476–1483

    Article  PubMed  Google Scholar 

  4. Giroto N, Hespanhol Junior LC, Gomes MR, Lopes AD (2017) Incidence and risk factors of injuries in Brazilian elite handball players: a prospective cohort study. Scand J Med Sci Sports 27(2):195–202

    Article  PubMed  CAS  Google Scholar 

  5. Hägglund M, Waldén M (2016) Risk factors for acute knee injury in female youth football. Knee Surg Sports Traumatol Arthrosc 24(3):737–746

    Article  PubMed  Google Scholar 

  6. Herman K, Barton C, Malliaras P, Morrissey D (2012) The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Med 10:75

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kiani A, Hellquist E, Ahlqvist K, Gedeborg R, Michaelsson K, Byberg L (2010) Prevention of soccer-related knee injuries in teenaged girls. Arch Intern Med 170(1):43–49

    Article  PubMed  Google Scholar 

  8. Klügl M, Shrier I, McBain K, Shultz R, Meeuwisse WH, Garza D, Matheson GO (2010) The prevention of sport injury: an analysis of 12.000 published manuscripts. Clin J Sports Med 20(6):407–412

    Article  Google Scholar 

  9. Krutsch W, Zeman F, Zellner J, Pfeifer C, Nerlich M, Angele P (2016) Increase in ACL and PCL injuries after implementation of a new professional football league. Knee Surg Sports Traumatol Arthrosc 24(7):2271–2279

    Article  PubMed  Google Scholar 

  10. LaBella CR, Huxford MR, Grissom J, Kim KY, Peng J, Christoffel KK (2011) Effect of neuromuscular warm-up on injuries in female soccer and basketball athletes in urban public high schools: cluster randomized controlled trial. Arch Pediatr Adolesc Med 165(11):1033–1040

    Article  PubMed  Google Scholar 

  11. Laver L, Myklebust G (2014) Handball injuries: epidemiology and injury characterization. In: Doral MN, Karlsson J (eds) Sports injuries: prevention, diagnosis, treatment and rehabilitation. Springer, Berlin, pp 1–27

    Google Scholar 

  12. Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35(10):1756–1769

    Article  PubMed  Google Scholar 

  13. Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garrett W Jr (2005) Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med 33(7):1003–1010

    Article  PubMed  Google Scholar 

  14. Moller M, Nielsen RO, Attermann J, Wedderkopp N, Lind M, Sorensen H, Myklebust G. Handball Load and Shoulder injury rate: a 31 week cohort study of 679 elite youth handball players. Br J Sports Med 51(4):231–237

  15. Moller M, Attermann J, Myklebust G, Wedderkopp N (2012) Injury risk in Danish youth and senior elite handball using a new SMS text messages approach. Br J Sports Med 46(7):531–537

    Article  PubMed  Google Scholar 

  16. Myklebust G, Maehlum S, Engebretsen L, Strand T, Solheim E (1997) Registration of cruciate ligament injuries in Norwegian top level team handball. A prospective study covering two seasons. Scand J Med Sci Sports 7(5):289–292

    Article  PubMed  CAS  Google Scholar 

  17. Myklebust G, Engebretsen L, Braekken IH, Skjolberg A, Olsen OE, Bahr R (2003) Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 13(2):71–78

    Article  PubMed  Google Scholar 

  18. Myklebust G, Skjølberg A, Bahr R (2013) ACL injury incidence in female handball 10 years after the Norwegian ACL prevention study: important lessons learned. Br J Sports Med 47(8):476–479

    Article  PubMed  Google Scholar 

  19. Olsen OE, Myklebust G, Engebretsen L, Bahr R (2006) Injury pattern in youth team handball: a comparison of two prospective registration methods. Scand J Med Sci Sports 16(6):426–432

    Article  PubMed  Google Scholar 

  20. Olsen OE, Myklebust G, Engebretsen L, Holme I, Bahr R (2005) Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. BMJ 330(7489):449

    Article  PubMed  PubMed Central  Google Scholar 

  21. Petersen W, Braun C, Bock W, Schmidt K, Weimann A, Drescher W, Eiling E, Stange R, Fuchs T, Hedderich J, Zantop T (2005) A controlled prospective case-control study of a prevention program in female team handball players: the German experience. Arch Orthop Trauma Surg 125(9):614–621

    Article  PubMed  Google Scholar 

  22. Reckling C, Zantop T, Petersen W (2003) Epidemiology of injuries in juvenile handball players. Sportverletz Sportschaden 17(3):112–117

    Article  PubMed  CAS  Google Scholar 

  23. Seil R, Laver L, Landreau P, Myklebust G, Walden M (2017) ESSKA helps making a change: the example of handball medicine. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-017-4478-x

    Article  PubMed  PubMed Central  Google Scholar 

  24. Smith TO, Postle K, Penny F, McNamara I, Mann CJV (2014) Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. Knee 21(2):462–470

    Article  PubMed  CAS  Google Scholar 

  25. Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R, Andersen TE (2008) Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 337:a2469

    Article  PubMed  PubMed Central  Google Scholar 

  26. Soligard T, Nilstad A, Steffen K, Myklebust G, Holme I, Dvorak J, Bahr R, Andersen TE (2010) Compliance with a comprehensive warm-up programme to prevent injuries in youth football. Br J Sports Med 44(11):787–793

    Article  PubMed  Google Scholar 

  27. Steffen K, Myklebust G, Olsen OE, Holme I, Bahr R (2008) Preventing injuries in female youth football - a cluster-randomized controlled trial. Scand J Med Sci Sports 18(5):605–614

    Article  PubMed  CAS  Google Scholar 

  28. Wedderkopp N, Kaltoft M, Lundgarrd B, Rosendahl M, Froberg K (1997) Injuries in young female players in European handball. Scand J Med Sci Sports 7(6):342–347

    Article  PubMed  CAS  Google Scholar 

  29. Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K (1999) Prevention of injuries in young female players in European team handball. A prospective intervention study. Scand J Med Sci Sports 9(1):41–47

    Article  PubMed  CAS  Google Scholar 

  30. Zebis MK, Andersen LL, Brandt M, Myklebust G, Bencke J, Lauridsen HB, Bandholm T, Thorborg K, Hölmich P, Aagaard P (2016) Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial. Br J Sports Med 50(9):552–557

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Bavarian Handball Federation for supporting the study design. No further funding was received. All authors declare no conflict of interest for this study.

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany

    Leonard Achenbach, Johannes Weber, Michael Nerlich, Peter Angele & Werner Krutsch

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany

    Volker Krutsch

  3. Department of Sports Injury Prevention, VBG, German Statutory Accident Insurance for the Administrative Sector, Hamburg, Germany

    Patrick Luig

  4. Clinic of Paediatric Surgery, Clinic St. Hedwig, Regensburg, Germany

    Oliver Loose

Authors
  1. Leonard Achenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Volker Krutsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Johannes Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Nerlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick Luig
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Oliver Loose
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter Angele
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Werner Krutsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leonard Achenbach.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The authors received 300.00 € from the Bavarian Handball Federation.

Ethical approval

The study was approved by the Ethical committee of the University of Regensburg.

Informed consent

Players and parents were informed, and they consented to conduct the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Achenbach, L., Krutsch, V., Weber, J. et al. Neuromuscular exercises prevent severe knee injury in adolescent team handball players. Knee Surg Sports Traumatol Arthrosc 26, 1901–1908 (2018). https://doi.org/10.1007/s00167-017-4758-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4758-5

Keywords

Search

Navigation