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Common handball injuries – Prevention and Treatment
Handball is an extremely dynamic sport with frequent direct contact between players, as well as a wide range of movements, including fast sprints, sudden stops, breaks, powerful throws and frequent jumps, landings and falls. If these movements are performed several times a day, over an extended period, the biological structures involved (joints, ligaments, nerve tissue and myofascia) will change to adapt to the loads and pressures to which they are subjected. These adaptations allow the quality of the specific movements to be maximized, leading to the improvement of the individual’s performance in sport. However, these adaptations are often the cause of changes in muscle tension patterns within the sport, and can in some circumstances lead to abnormal loading or overloading of the structures involved.
In order to prevent and rehabilitate handball injuries, it is important to understand how the body and fascia mechanically adapt and rebuild to meet the physical demands of the sport. It is also important to introduce early training and recovery methods that allow the fascia network to be rebuilt and strengthened multidimensionally.
Common types of injuries in handball
In handball, injuries often affect the lower limbs, but the upper body can also be at risk of injury, although it is not as common. Some examples are:
Knee injuries– In handball, the knee joints are often prone to injury. Structures such as the anterior cruciate ligament (ACL) and internal meniscus, along with the internal collateral ligament, are the most commonly injured.
Muscle ruptures in thighs – Muscle ruptures in handball often affect the different muscle groups of the thigh, such as the hamstrings and adductors. Ruptures can be partial or total.
Shoulder injuries – Repetitive throwing and catching motion, frequent falls, as well as the use of the upper limb in defensive actions, expose the shoulder to high risk of injury and overload.
Ankle injuries and sprains – Rapid turning associated with impaired proprioception of the plantar fascia can lead to injury.
Finger, hand and wrist Injuries to the wrist, hand and fingers are common. Goalkeepers are particularly vulnerable. To catch balls, which can be thrown at over 140 km/h, the thumb and little finger play an important role in stabilizing and locking the ball. Acute injuries are often due to direct impact, contact with other players or falls.
Ankle sprains
Knee injuries (ACL and meniscus injuries)
The anterior cruciate ligament of the knee is the most frequently injured ligament in handball. Women are affected to a greater extent than men. The ACL is most often injured when landing a jump or moving sideways, causing the knee joint to collapse inwards (valgus collapse). The force causes the knee joint to rotate inwards, taking it outside its normal range of motion. The mechanism of injury of menisci is usually very similar to that of an ACL injury where a violent inward rotation of the knee joint occurs. Most often it is the inner meniscus that is injured as it has a smaller range of motion than the outer one.
Symptoms of knee injuries (ACL and meniscus injuries)
Sudden pain and swelling in the knee at the time of injury.
Any audible snapping or twisting sensation in the knee.
Difficult to stretch the knee.
Sharp pain when squatting or twisting the knee.
Pain in the knee joint with mechanical symptoms such as locking and popping.
It hurts when you touch the area where the injury is.
Feeling of weakness and the knee “buckling and giving way” under load.
Muscle ruptures in thighs
In handball, it is often the connection between muscle and tendon, known as the myotendinous junction, that is affected. These areas play a key role by being the structure where the muscle fibers and their endomysium interact with the tendon. This area is the most fragile part of a muscle as the collagen there is not very resistant. In handball, rupture of any muscle in the hamstrings and quadriceps is most common, but injuries to adductors also occur. A common cause of muscle rupture in handball is through sudden changes in speed, jumping, landing and contact with other players such as collisions and tackles.
Symptoms of muscle ruptures in thighs
At the time of injury, you may experience a “popping” sensation in the muscle. A snapping sound may also be experienced
Severe pain at the junction of the muscle and tendon.
Redness and swelling
Muscle weakness
Impaired mobility of the muscle
Bruising in the injured area
Pain on exertion
Shoulder injuries (overloading and shoulder dislocations)
Shoulder injuries are one of the most common injuries in handball. The overhead throwing motion is a complex movement involving the whole body. Repetitive throwing and catching movements, frequent falls, as well as the use of the upper limb in defensive actions, put the shoulder at high risk of acute and overuse injuries. Basically, the whole spectrum of traumatic shoulder injuries can occur, from fractures, dislocations of the acromioclavicular or glenohumeral joints to acute injuries of the intra- or periarticular soft tissues. Handball players make up to 48,000 throws per year, at speeds of around 130 km/h, putting significant stresses on the shoulder in different directions. Over time, these overhead throws and repetitive micro-injuries can lead to functional changes in shoulder function, including altered glenohumeral mobility, shoulder girdle imbalances or dysfunctions, increasing the risk of injury in these athletes.
Symptoms of shoulder injuries
Pain at rest and or with strain, especially with overhead movements
Shoulder weakness
Reduced range of motion
Snapping, crackling sounds and sensations in the shoulder area when moving.
Ankle injuries and sprains
Ankle injuries are the most common injury reported in handball. Most often, overexertion is the cause of an ankle injury, and sprains are the most common ankle injury. Sprains involve the ankle being extended for a short period of time beyond its normal range of motion without the head of the joint moving out of the socket. In handball, sprains most often occur during rapid changes of direction, single-leg landing or the push-off phase of a jump throw.
Common symptoms of ankle injuries and sprains
Pain, swelling and stiffness of the ankle
Heat increase in the damaged area
Difficulties in putting weight on the foot
Bruising at the site of injury
Hand, wrist and finger injuries (finger dislocations and fractures)
Injuries to the wrist, hand, fingers and thumb are common and mainly affect center backs and goalkeepers. Goalkeepers are particularly vulnerable as they may have to catch balls thrown at over 140 km/h, where the thumb and little finger play an important role in stabilizing and locking the ball. Other common causes of injury are falls, bumps and collisions with other players.
Common symptoms of hand, wrist and finger injuries
Pain, swelling and stiffness in the affected body part
Heat increase in the damaged area
Difficulties in charging
Bruising at the site of injury
Cracking sound when moving the injured joint
Causes and risk factors of handball injuries
Optimizing sports performance involves increasing training loads and reducing rest periods, which drives a process of physiological adaptations associated with progressive and steady changes in muscles, muscle fascia and tendons.
After being exposed to frequent high-intensity loading, in addition to mechanical adaptation, a persistent low-grade inflammatory reaction of the fascia is included. Such micro-inflammations are associated with an increased secretion of pro-inflammatory and nociceptive substances. These substances can differentiate and profile the fibroblasts so collagen synthesis becomes excessive. Eventually, the subsequent remodeling can make the fascia network stiffer, impairing its viscoelasticity and our body movements. Reduced local elasticity prevents the fascia from being able to deform and absorb forces, which in turn increases the risk of injury to the musculoskeletal system. Tendons and muscles can withstand a certain amount of stress, but excessive repetitive work and increasing mechanical stimuli increase the risk of injury. The more fatigued a muscle or tendon is, the less force is required to damage them. In addition to factors such as muscle strength imbalances and neuromuscular inhibition, sufficient viscoelasticity of the soft tissues is also necessary to dissipate and absorb the energy required during eccentric movements.
Lack of warm-up can also increase the risk of injury for handball players, especially in the shoulder area. Warming up increases the body’s metabolic activity, increases body temperature which reduces fascia viscosity and optimizes neuromuscular control.
Prevention of handball injuries
There are several methods to prevent various handball injuries. Many advocate stretching the muscles of the back, shoulders, pelvis and legs. In particular, great emphasis should be placed on stretching the iliopsoas muscle. This muscle attaches to the diaphragm, which is important for our breathing and shoulder function. Stretching of the hamstring muscles is also important as they connect the pelvis with the lower extremities, surround the sciatic nerve and nerves to the lower leg.
Training the strength of the shoulder girdle is incredibly important in handball as this is often worn out in handball where a lot of throwing occurs. In women, it has been seen that injuries to the shoulder girdle are more common than in men.
Another way to prevent overload and injury is to use kinesiology/elastic tape before training and games to stabilize joints and relieve myofascial and myotendinous structures. In handball, taping of knees, ankles and shoulders can be beneficial.
Proper warm-up such as running at varying intensities increases metabolic activity, increases body temperature and optimizes neuromuscular control improving movement and balance.
Another important method to prepare the body for the stereotypical movements of handball is via dynamic stretches taking into account myofascial structures. Also, performing movement patterns inherent to handball, with progressive increase in complexity and intensity prepares the body. There can be sudden changes of direction, jumps, phases of acceleration and deceleration, both with or without the ball.
After a match, the recovery of the fascia system needs to be taken into account. It is important to replenish fluids and energy so that the body has the right building blocks to recover.
Promoting circulation can optimize physiological metabolic status. Activities such as low-intensity aerobic exercise that is not handball-specific, such as cycling, certain types of yoga and dancing, which do not put such high pressure on the joints are good examples.
Treatment of common handball injuries
Treatment methods for handball injuries are often based on the structure that has been injured such as muscle, ligament, tendon or bone. Common treatment methods can include short rest periods, light stretching and soft tissue therapy for minor injuries. Sometimes over-the-counter pain medication can be used. For more serious injuries, immobilization via orthoses or casts may be required. Sometimes physiotherapy may be required where the player follows a specially adapted program for the particular injury diagnosed. Physiotherapy allows the player to return to play in the best possible way without the risk of further injury, but also prevents the old injury from recurring. Surgery may also be needed to repair the injury, followed by a longer period of physiotherapy. If the pain is too severe, a doctor may prescribe stronger painkillers.
Rehabilitation and return to play
An important aspect of rehabilitation is to consider how the body’s musculoskeletal system adapts to handball. Rehabilitation and return to play often involves training programs based on progressive loading adapted to individual requirements. This can include various forms of eccentric training, core training, dynamic stabilization and muscle activation. Sports science researchers suggest that rehabilitation needs to be optimized as high-impact training is required to optimize sports performance.Although there is little data on how the fascia affects return to activity, a treatment is proposed that focuses on providing specific stimuli to the connective tissue that could speed up recovery.
One suggestion is to use manual techniques in rehabilitation to stimulate the extracellular matrix in the muscle to return it from a high tension state to a more low tension state. In the case of injuries, it is also important to consider the effect of arthrofibrosis (excessive scar tissue) if you choose to immobilize and protect the injury.
How our specialist team at Fascia Clinics can help you
At Fascia Clinics, we take a holistic approach to treating handball injuries. Our team of therapists use fascia therapy, a highly effective wellness treatment. The fascia is the network of connective tissue that binds and permeates everything in our body. All cells, tissues (even bone tissue), muscles and organs contain fascia.
Fascia treatment focuses on releasing tension and adhesions in the fascia and increasing its flow. In this way, we can balance the body to reduce pain, improve strength and increase mobility. Reducing pressure and increasing flow in the fascia also helps cell membranes to absorb nutrients and release waste products. The treatment provides a pleasant relaxation and does not hurt. Increased circulation with a more even load can promote the body’s own healing. A more even load also means that the body’s structures are not subjected to excessive wear and tear, reducing the risk of further injury.
During a visit, we analyze the whole body to see where compensations and imbalances are and how they have spread. If there is an imbalance in the body, there is a risk that it will spread and affect other structures such as muscles and joints. That’s why it’s very important to seek help quickly as soon as you notice any symptoms.
By combining traditional medical treatment with fascial therapy, we aim to optimize your recovery and minimize the risk of sustaining further injuries. Visit our website for more information and book a consultation today!
