ISSN: 2147-5652

Turkish Journal of Sport and Exercise

www.turksportexe.org
Year: 2013 - Volume: 15 - Issue: 3 - Pages: 27-34
Analysis of sports injuries in training and competition for
handball players
Muharrem KARANFILCI, Banu KABAK
The Ministry of Youth and Sports, Sports General Administration, Healt Affairs Department, Ankara, Turkey.
Address correspondence to Banu Kabak, [email protected].
Abstract
The aim of this study is to determine injury types and injured body parts of handball athletes in competition and training in
our country so that we will be able to find tangible data providing facility to prepare protector program for most injured body
parts. A total of 705 athletes (male, 492; female, 213), who are the ones at different ages participated in handball tournaments in
2011 in Turkey and young male and female national team players (22 male, 22 female) joined voluntarily to the study. A
questionnaire about the subject was asked to athletes. It is determined that the min-max age rage of sporters is 11-31 and the
average age of them is 17.044.6, 69.08% of sporters who participated in the study are male and 30.2% of them are female.
52.6% of the athletes reported that they got at least one injury in their sports life and 47.4% of them reported that they have had
no injury. The injury incidence in relation to exposure in competition and training was 65% and 35%, respectively. The most
popular incidence of injury in competition (37.8%) and training (45.8%) was sprain and it is determined that foot and ankle
were the most commonly injured body parts. The most injured body parts in handball caused by competition and training are
ankle, knee, and calf-thigh. It is evaluated that exercise programs for these body parts should be developed and added to
training programs to lessen incidence of injuries except ones caused by factors being particular to sports.
Keywords: Handball, sports injury, training, competition.
INTRODUCTION
Having millions of fanciers and players handball
is a sports branch which are becoming more
common and attractive internationally. In European
countries, handball becomes main factor of physical
education thanks to that attention (24).
It is emphasised that modern handball imposes
pretty much burden on musculoskeletal system of
players so it turns conditioning of all body and
extremity muscles into a precondition. Also it is
stressed that using forearm, arm, shoulder, knee and
ankle actively causes working muscles in an extreme
way in that area thus these areas used extremely and
they are open to strikes and injuries because of the
aspects of handball (23). According a study, 40-60 %
of handball accidents result from colliding with
competitor, 20-40 % of them result from wrong
throwing or dropping technique, hampering the arm
throwing the ball causes sudden handicap, wrong
shooting technique causes shoulder handicaps and
jumping and turning movements causes knee
handicaps (11).
Reasons of sport injuries may be collected
under many titles. Overloading, prior and partly
treated injuries, cold, muscle and joint strictness due
to extreme stress and infection, muscle weakness
due to previous injury or lack of education, power
imbalance between muscles, inability of sports
equipment, lacking physical preperation, the lack of
warming, not appropriate sports branch for sporter,
insufficient technique, not being ready mentally,
extreme competition, competetive sport and
illnesses can be shown among these reasons (21).
In additon to these, sporters can be exposed to
handicaps and injuries with different extents due to
striking, dropping, sudden and severe spasm and
some compulsion. Also factors as starting a hard
training without sufficient warm-up and stretching
exercises, focal infection, sleepless and tired sporter,
lack of condition can result in injuries (28).
Knowledge in athletes common injury types,
causes and regions can the base to develop different
strategies for preventive measures and to execute
studies called protective sports medicine.
The aim of this study is to determine the sports
injury types and injury zones occurring in training
and competitions for athletes who are interested
with handball sports branch in our country.
According to the results, it is aimed to put forward
data for the creation of training programs which
Karanfilci and Kabak 2013
Turk J Sport Exe 2013; 15(3): 2734
2013 Department of Physical Education and Sport, Selcuk University 28

provide prevention or reduction of injuries not
caused by the structure of sport.
MATERIALS AND METHODS
The study was conducted on male and female
handball players who participated in national
tournaments at the categories of stars, young and
adult during the year 2011and young male and
female national team players. The list of clubs which
will participate in Championships in Turkey was
created by the help of the federation before the
study, clubs` accommodation were visited one by
one to have athletes fill out questionnaires before
competitions. In this way, athletes from seven
regions had been reached. National team camps
were visited for the national team players. The
research was completed in a period of 6 months
between the months of January-June and 705 (492
male, 213 female) athletes whose average age is
17.04 participated in the study on a voluntary basis.
Athletes were informed in accordance with
"Declaration of Helsinki" and they declared their
voluntary participation.
A questionnaire of 20 questions which was
previously prepared on the subject by us was
distributed to handball players and they were asked
to fill out. The questionnaire has been created in two
parts. The decisive questions such as age, gender,
education level, age to start competitive sports,
demographic characteristics as the province in
which the license was given take place in the first
part. In the second part, "sports Injury" was defined
and questions as having or not having sports injury
throughout their lives according to this definition,
name given to their injury, injured body parts,
having injury in training or competition, the
personal opinion for the cause of injury and other
questions related with athletes` sport life were
asked. The activity in which pain or discomfort felt
was based for injuries that may occur due to
overuse. As a result of the possibility that athletes
have injury more than one, statistical studies were
done depending on the number of injuries not the
number of athletes.
The data collected by questionnaires were
brought into tables in package program, SPSS 16.0
according to the purpose of the study. The
percentage (%), standard deviation (SD), min-max
values and average values were calculated.
Significance levels were assessed according to the
level, p <0.05, by using X test in the comparison of
data in cross tables.
RESULTS
Rate of ages in handball players participated in
the study shows a wide distribution. Min-max age is
11 - 31 and the mean age is 17.04. It is determined
that age of 42.1% of athletes is in 11-14, 25.1% in 15-
18, 21% in 18-23, 11.8% of them is at 24 and above
(sd = 4, 67). A significant relationship was found
between sports injury and age in the statistical study
(p = 0.00).
As shown in Table 1, the ratio of the answers as
"yes" for the question, Have you ever had sports
Injuries? is max in the range of 24 to 31 years of
age.

Table 1. Distribution of sports injuries according to age.

Sports Injury
Total
Yes No
Age
11-14
Count 121 175 296
% within Age 40.90% 59.10% 100.00%
% of Total 17.20% 24.80% 42.00%
15-18
Count 59 119 178
% within Age 33.10% 66.90% 100.00%
% of Total 8.40% 16.90% 25.20%
19-23
Count 121 30 151
% within Age 80.10% 19.90% 100.00%
% of Total 17.20% 4.30% 21.40%
24-31
Count 70 10 80
% within Age 87.50% 12.50% 100.00%
% of Total 9.90% 1.40% 11.30%
Total
Count 371 334 705
% within Age 52.60% 47.40% 100.00%
% of Total 52.60% 47.40% 100.00%
Pearson Chi-Square Asymp. Sig. (2-sided) ,00
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2013 Department of Physical Education and Sport, Selcuk University 29

According to gender distribution of the athletes
participating in the study, 69.8% were male (492)
and 30.2% were female (213). A significant
correlation wasn`t found between gender and sports
injury (p = 0.553) in the statistical study (Table 2).
Age to begin sports for handball players was
identified as 11.2% is under the age of eight, 51.6%
between 9-11, 26.1% in 12-14, 9.7% 15-17, % 1.4 at 18
and above. A significant relationship was found
between sports injury and age to begin sports in the
study (p = 0.003). Search for the level of statistical
significance of sports injuries with age to begin
sports is another study (Table 3).
When handball players` sports injury cases
throughout their active sports lives are searched,
52.6% of 705 athletes participated in the study stated
that they had a sports injury, 47.4% said that they
have not undergone the sports injury.
In the study, the question, "What do you think
about the most important reason to have sports
injury in training?" is asked to athletes; %34,1of
them said that insufficient warming cause injury.
17.6% said unconscious action and 16.3% declared
overload as a major cause of injury (Table 4).
When the causes for having injury in
competition was asked to athletes; 37.6% of athletes
showed illegal behavior of the opponents, 19.8%
insufficient warming before competitions, and 12.3%
inadequate training in preparation for the
competition as a cause of injury (Table 5).

Table 2. Distribution of sports injuries according to sex.

Sports Injury
Total
Yes No
Sex
Male
Count 256 236 492
% within Gender 52.00% 48.00% 100.00%
% of Total 36.30% 33.50% 69.80%
Female
Count 116 97 213
% within Gender 54.50% 45.50% 100.00%
% of Total 16.50% 13.80% 30.20%
Total
Count 372 333 705
% within Gender 52.80% 47.20% 100.00%
% of Total 52.80% 47.20% 100.00%
Pearson Chi-Square Asymp. Sig. (2-sided) .553

Table 3. Distribution of sports njuries according to age to begin sports.
Age to Begin Sports
Total
8 and under 9-11 12-14 15-17 18 and higher
Injury
Yes
Count 39 199 107 20 5 370
% within Injury 10,50% 53,80% 28,90% 5,40% 1,40% 100,00%
% of Total 5,50% 28,30% 15,20% 2,80% 0,70% 52,60%
No
Count 39 165 79 46 5 334
% within Injury 11,70% 49,40% 23,70% 13,80% 1,50% 100,00%
% of Total 5,50% 23,40% 11,20% 6,50% 0,70% 47,40%
Total
Count 78 364 186 66 10 704
% within Injury 11,10% 51,70% 26,40% 9,40% 1,40% 100,00%
% of Total 11,10% 51,70% 26,40% 9,40% 1,40% 100,00%
Pearson Chi-Square Asymp. Sig. (2-sided) ,003

Table 4. Causes of injuries in training.
Frequency Percent Valid Percent Cumulative Percent
Unconscious Movement 123 13.7 17.6 17.6
Protective Equipment Disuse 21 2.3 3 20.6
Insufficient Material 23 2.6 3.3 23.9
Insufficient warm-up 239 26.7 34.1 58
Overload 114 12.7 16.3 74.3
Irregular Practice 60 6.7 8.6 82.9
Lack of exercise area 27 3 3.9 86.7
Others 89 9.9 12.7 99.4
Multiple Reason 4 0.4 0.6 99.7
Total 700 78.2 100
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2013 Department of Physical Education and Sport, Selcuk University 30

Related with 705 handball players participating
in the study, the number of injuries in competition
was found as 505 and the number in training was
264. The most common sports injury exposed in
match for handball players is sprain with 34.7%.
This injury type was followed by contusion with
18.2%, strain 12.3%, tear 12.5%, fracture 8.9%,
rupture (bond breakage) 5.7%, dislocation 4.2%,
hernia-paravertebral spasm 1%, tendinitis 0.8% and
other types of injuries 1.8% (Table 6).
When the athletes body parts which are
affected by sports injuries in competition were
examined, they were found to be foot and ankle
with 37.8%, knee with 20.6%, the calf-thigh with
14.7%, hand and wrist with 7.9%, the shoulder 7.9%,
elbow region with 3%, the hip region with 3.6%, the
head region with 2.2%, low back with 1.6%, chest
area with 0.8% (Table 7).
An examination of sports injuries in training,
705 athletes got the total amount of 264 personal
injuries throughout their sports lives. Rick is in first
place with 41.3% at training again. This is the type of
injury is followed by, contusion with 22%, strain
with 17%, tear with 8.3%, fracture with 4.2%,
dislocation with 3.4%, rupture with 1.5%, tendinitis
with 1.1%, hernia- paravertebral spasm with 0.8%
and impingement syndrome with 0.4% (Table 8).

Table 5. Causes of injuries in competition.
Frequency Percent Valid Percent Cumulative Percent
Illegal Behavior of Opponent 262 29.3 37.6 37.6
Inadequate Exercise in Training Period 86 9.6 12.3 49.9
Insufficient Warm-up Before Competition 138 15.4 19.8 69.7
Late Stops by the Referees for Positions 46 5.1 6.6 76.3
Overload in the Preparation Period 41 4.6 5.9 82.2
Unsuitable Ground for Competition 32 3.6 4.6 86.8
Trainer`s Wrong Tactic 7 0.8 1 87.8
Others 78 8.7 11.2 99
Multiple Reason 7 0.8 1 99.3
Total 697 77.9 100 100

Table 6. Injury rates in competition (%)
Frequency Percent Valid Percent Cumulative Percent
Contusion 92 10,3 18,2 18,2
Sprain 175 19,6 34,7 52,9
Fracture 45 5 8,9 61,8
Dislocation 21 2,3 4,2 65,9
Rupture 29 3,2 5,7 71,7
Strain 62 6,9 12,3 84
Tear 63 7 12,5 96,4
Tendinitis 4 0,4 0,8 97,2
Hernia-Paravertreval Spasm 5 0,6 1 98,2
Other Injuries 9 1 1,8 100
Total 505 56,4 100

Table 7. Rates for injured body parts in competition %
Frequency Percent Valid Percent Cumulative Percent
Foot-Ankle 191 21,3 37,8 37,8
Knee 104 11,6 20,6 58,4
Hand-Wrist 40 4,5 7,9 66,3
Elbow 15 1,7 3 69,3
Shoulder 40 4,5 7,9 77,2
Calf-Thigh 74 8,3 14,7 91,9
Low back 8 0,9 1,6 93,5
Hip 18 2 3,6 97
Chest 4 0,4 0, 8 97,8
Head 11 1,2 2,2 100
Total 505 56,4 100



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2013 Department of Physical Education and Sport, Selcuk University 31

Table 8. Injury rates in training (%).
Frequency Percent Valid Percent Cumulative Percent
Contusion 58 6,5 22 22
Sprain 109 12,2 41,3 63,3
Fracture 11 1,2 4,2 67,4
Dislocation 9 1 3,4 70,8
Rupture 4 0,4 1,5 72,3
Strain 45 5 17 89,4
Tear 22 2,5 8,3 97,7
Tendinitis 3 0,3 1,1 98,9
Impingement 1 0,1 0,4 99,2
Hernia-Paravertreval Spasm 2 0,2 0,8 100
Total 264 29,5 100

Table 9. Rates for injured body parts in training %.
Frequency Percent Valid Percent Cumulative Percent
Foot - Ankle 121 13,5 45,8 45,8
Knee 31 3,5 11,7 57,6
Hand-Wrist 23 2,6 8,7 66,3
Elbow 2 0,2 0,8 67
Shoulder 24 2,7 9,1 76,1
Calf-Thigh 50 5,6 18,9 95,1
Low back 6 0,7 2,3 97,3
Chest 7 0,8 2,7 100
Total 264 29,5 100


Graph 1. Comparison of injured body parts in training and competition.

When areas of the body affected by injuries in
training were examined, the foot and ankle with the
rate of 45.8% are at the first rank within entire
injuries in the study. This body part is followed by
the calf-thigh with 18.9% and knee injuries with
11.7%. The rate is 9.1% for shoulder injuries and
8.7% for hand and wrist injuries. In addition, the
rate was calculated as 2.3% of low back injuries,
0.8% of elbow injuries and 2.7% of chest injuries.
Head and hip injuries in training were not found in
the study (Table 9).
When parts of the body injured in the training
and competition are compared, similar results are
observed in the study (Figure 1).
DISCUSSION
Age interval of athletes in this study shows a
wide range. The mean age was determined as 17.04
4.6. In general, the age and experience may be
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Turk J Sport Exe 2013; 15(3): 2734
2013 Department of Physical Education and Sport, Selcuk University 32

considered to decrease sports injuries. However, in a
study of 642 athletes over the age of 12 in England,
%66 of handball players are over the age of 20, 34%
are under twenty. 49% of athletes over the age of
twenty said not having any injury, while the rate of
51% of athletes under the age of 20 are expressing
that they underwent injury. While considering that
experience and the rate of injury interact in the
opposite direction, they were found to be parallel
based on the study. Older age, more and more
experience is thought to risk further injury.
Relatively more severe disabilities (e.g., requires
stabilization with gypsum or splint) increased with
age of athlete noteworthy. The explanation for the
result is that physical fitness (strength, speed,
endurance, etc.) increases with age, and thus, game
is played with more speed and power (1). In this
study, a significant statistical relationship between
age and injury has been identified. Increase in the
number of injury with age is observed.
Looking at rates of injury based on sex
differences of athletes participating in the study,
they had a sports injury while expressing 52% for
male athletes, 54,5% of female athletes stated that
they had a sports injury.
According to the studies in the literature,
although rates of sports injury for young girls are
similar with young men`s ratio, mechanisms of
injury may be different. Pull-type injuries for
women and contusion injuries for men have been
mainly reported (9). In a study conducted in 2008;
knee injuries in different sports, especially the
incidence of anterior cruciate ligament and ankle
injuries for young women are more than young
men`s injury declared. The possible causes of this
situation were determined as the high arthro laxity,
lack of muscle strength, coordination and weak
proprioception (26).
In our country, the age of onset of handball for
men and women is stated as 7, and the minimum
age of license extraction is applied as 9 (20). Studies
in the literature reveals that sports trainings does
not affect the growth, especially in girls before
puberty, even postpone it, in the later period is up,
the optimal sports training does not negatively affect
the growth and increase the development of the
organism (functional ability-capacity). As a result,
sport exercises may not adversely affect the growth
of achieving levels, in addition it can be said that it
mainly contributes to development (22). The
majority of athletes in sport between the ages of 9-11
are observed in this study. Despite a statistically
significant relationship is seen between sports
injuries and age of onset in the study, assessment of
the severity of injuries by age of onset is a topic for
another study. In a study conducted with 302
athletes, injury rates of football players, basketball
players and handball players were compared, a total
of 119 injuries were identified. That the occurrence
of these injuries is 62, 36 and 21 in football, handball
and basketball, respectively is reported (27). In a
study conducted in Turkey, 100 football players, 50
basketball players, 50 handball players and 50
volleyball players, totally 250 professional athletes
were examined, 96% of the football players, 90% of
the basketball players, 80% of the handball players,
76% of volleyball players participating in the study
stated that they had a sports injury (13).
Sports injuries examined in the study shows
65% of injuries occurs in competitions and 35% in
training. Sport injury types` rates of handball in
training and match are similar and the most
common one is sprain. This type of injury is
followed by tears and strain. Fracture, dislocation,
fracture type injuries are more frequent in
competitions than training session. Contusion, a
common type of injury in training and competitions,
is noteworthy. Studies in literature shows that
handball players mostly have sprain, strain, and
contusion type injuries (1,19).
In a study of 130 handball players in the
Netherlands, type of injuries were examined,
according to the results of the study, 35,4% of
handball players are exposed to dislocations, 25,4%
to sprains, 12,3% to fractures, 13,8% to ligament
rupture, 5,4% to crushing and 7,7% to other injuries
have been reported (7). Depending on the
comparison of these studies with our study, the
sprain and contusion rates were higher, fracture,
dislocation and fracture rates were significantly
lower.
221 handball players were examined in another
study, 18% of sports injuries occurred due to
overuse, indicated (19). Rates of injuries such as
tendonitis and shoulder impingement syndrome
thought to be due to overuse were very low in the
study (1.4%, 0.5%).
Body parts exposed to injury in competition
and training are similar according to the study
results. Foot and ankle are first parts that injury is
seen in training and competition. Knee, hand and
Karanfilci and Kabak 2013
Turk J Sport Exe 2013; 15(3): 2734
2013 Department of Physical Education and Sport, Selcuk University 33

wrist, calf-thigh and shoulder are identified other
injured body parts in the study. Studies in the
literature reveal that the vast majority of injuries in
handball occurred in the lower extremities. The
study results in this regard are parallel with the
literature.
In a study of 108 handball players in
Switzerland, 42% of the total injuries occurred in
lower limb and 8% of these injuries are ankle sprain
indicated. The same study indicated that 18% of
injuries occurred in the upper extremities, 14% in
chest, and 14% in the head (18).
However the study is in compliance with
literature from this point of view, head and chest
injuries` rates were found lower in the study.
Investigating causes of injuries in the literature,
proprioception disorder in people with a history of
ankle sprain set out by Glencross and Thornton for
the first time. Later, correlation between the severity
of ankle injury and joint position sense disorders
was shown (17). In another study, reduction in
proprioception with individuals suffering from
chronic ankle instability and knee injury was
indicated (2). Disorders occurring in the sense of
balance and the perception of passive act which are
components of probrioception may cause an injury,
indicated (6).
Stretching exercises in the warm-up phase
preparing for athletic performance have become an
essential habit in many sports. Stretching exercises
are believed to be important in reducing the risk of
injury and performance enhancement (5.15), and
there are many studies that supports this idea in the
literature (8,14,15,25). In addition, studies in the
literature indicate that the acquisition of flexibility
prevents injuries and enhances athletic performance.
Loss of flexibility also leads to a decrease in joint
movement, disrupts the pattern of walking and
jogging, adversely effects sports performance and
the development of strength and speed (4,29). The
muscle strength`s effects for prevention of injuries
and support at rehabilitation were also determined
in the literature (4).
In conclusion; it is observed that the body parts
most injured in handball are foot and ankle, knee,
calf-thigh, shoulder and hand and wrist regions.
Exercise programs should be developed to
strengthen the muscles of these body parts which
frequently have injuries to minimize injuries such as
tears, strain, sprains, ligament ruptures and
tendonitis due to overuse except injuries such as
contusion caused by the binary struggle, the nature
of the sport. The probrioception, tendon and
ligament`s strengthening exercises for knee injury,
foot and ankle which are mostly injured body parts
must be added to the training program.
Development of warm-up, cool-down and stretching
exercises are necessary to prevent injuries caused by
inadequate warm-up.
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