Preseason Strength Assessment of the Rotator Muscles and Shoulder Injury in Handball Players.

CONTEXT: Few researchers have identified intrinsic risk factors for shoulder injury in team handball players by analyzing measurements of maximal isokinetic rotator muscle strength. OBJECTIVE: To identify possible intrinsic risk factors for shoulder injury by analyzing measurements of maximal isokinetic rotator muscle strength. DESIGN: Cross-sectional study. SETTING: Male team handball senior divisions (the highest level) in France and Belgium. PATIENTS OR OTHER PARTICIPANTS: A total of 108 male high-level handball players (age = 24 ± 4 years, height = 189 ± 6 cm, mass = 87 ± 11 kg) were enrolled. MAIN OUTCOME MEASURE(S): All players completed a preseason questionnaire and performed a bilateral isokinetic assessment of the shoulder rotator muscles. On a monthly questionnaire, players reported any shoulder injury that they sustained during the season. RESULTS: On the preseason questionnaire, 51 of 108 (47%) participants reported a history of dominant-shoulder injury. A total of 106 participants completed the in-season questionnaire, with 22% (n = 23) reporting a shoulder injury on their dominant side during the subsequent season. Fourteen percent (n = 15) sustained microtraumatic injuries, and 8% (n = 8) described a traumatic injury. Backcourt players had a 3.5-times increased risk of injury during the new season compared with players in other positions. Among the isokinetic results, no risk factor for further injury was identified in handball players with microtraumatic injuries. For traumatic injuries, the concentric maximal strength developed by the internal rotators at high speed (240°/s) in the dominant shoulder was a protective factor against the risk of further injury. CONCLUSIONS: These results can potentially identify intrinsic risk factors for shoulder injury and may be used to determine potential interventions for reducing this risk in handball players.

Prevalencia de lesiones en triatletas de una liga francesa / Prevalence of injuries in triathletes from a French league

Objetivo: Evaluar la prevalencia de traumatismos en triatletas y buscar los factores contribuyentes implicados. Método: Se envió por correo un cuestionario anónimo sobre los casos de traumatismos durante la temporada pasada a 788 triatletas de una liga francesa. Resultados: El 52,4% de los triatletas que respondieron notificaron que habían sufrido como mínimo una lesión durante la temporada pasada y el 17% varias lesiones. El 83,5% de las lesiones se produjeron durante el entrenamiento, sobre todo corriendo (72,5%). Los casos notificados con más frecuencia fueron tendinopatías (44,5%) y lesiones musculares (35%). Las zonas anatómicas notificadas con más frecuencia fueron el tobillo (20,6%), la rodilla (18,3%), el muslo (15%), la región lumbar (12,6%) y el hombro (8,3%). El 77% de los triatletas lesionados pudieron seguir entrenando, sobre todo haciendo natación (71%) y ciclismo (61,5%), mientras que en el 85,5% de los casos tuvieron que dejar de correr. Los triatletas que habían sufrido lesiones notificaron que dedican un tiempo significativamente menor al calentamiento que los triatletas ilesos (respectivamente, 13,7min frente a 18min) (p<0,01). El tiempo dedicado a los estiramientos también era inferior en los lesionados en comparación con los ilesos (respectivamente, 8,3min frente a 10,6min) (p<0,01). Se observó la misma asociación entre el tiempo empleado en el calentamiento y el estiramiento y la prevalencia de tendinopatías. La prevalencia de lesiones musculares se asoció de manera significativa con el número de horas de entrenamiento semanales (p<0,05) y con la distancia de entrenamiento semanal nadando, haciendo ciclismo y corriendo (p<0,05). Conclusión: Las lesiones observadas en triatletas amateurs son lesiones musculoesqueléticas por «abuso», producidas sobre todo durante el entrenamiento, principalmente al correr(AU)

Objective: To assess the prevalence of trauma injuries in triathletes and look for contributing factors involved. Method: An anonymous questionnaire about trauma history during the past season was sent by post to 788 triathletes from a French league. Results: 52.4% of triathletes responding reported having been injured at least once during the past season, for 17% of them several times. 83.5% of injuries occurred during training, mostly in running (72.5%). The tendinopathies (44.5%), and muscle injuries (35%), were the most frequently reported. The anatomical sites most frequently reported were the ankle (20.6%), knee (18.3%), thigh (15%), lumbar region (12.6%) and shoulder (8,3%). 77% of injured triathletes were able to keep training, mainly in swimming (71%) and cycling (61.5%), while running was stopped in 85.5% of cases. Injured triathletes reported devote significantly less time to warm-up than uninjured triathletes (respectively 13.7min vs. 18min) (p<0.01). Time devoted to stretching was also lower for injured vs. uninjured (respectively 8.3min vs. 10.6min) (p<0.01). The same association was also found between time spent warming up and stretching and the prevalence of tendinopathies. The prevalence of muscle injuries was significantly associated with number of training hours per week (p<0.05) and weekly training distance swimming, cycling and running (p<0.05). Conclusion: Injuries encountered in amateur triathletes are musculoskeletal injuries of «overuse», occurring mainly in training, especially running(AU)

Reliability of isokinetic assessment of shoulder-rotator strength: a systematic review of the effect of position.

CONTEXT: Isokinetic assessment of shoulder internal-(IR) and external-rotator (ER) strength is commonly used with many different postures (sitting, standing, or supine) and shoulder positions (frontal or scapular plane with 45° or 90° of abduction). OBJECTIVE: To conduct a systematic review to determine the influence of position on the intersession reliability of the assessment of IR and ER isokinetic strength, to identify the most reliable position, and to determine which isokinetic variable appears to be most stable in intersession reliability. EVIDENCE ACQUISITION: A systematic literature search through MEDLINE and Pascal Biomed databases was performed in October 2009. Criteria for inclusion were that studies be written in English or French, describe the isokinetic evaluation methods, and describe statistical analysis. EVIDENCE SYNTHESIS: Sixteen studies meeting the inclusion criteria were included. Variable reliability of ER and IR peak torque (PT) were generally reported for all assessment positions; intraclass correlation coefficients were .44-.98 in the seated position with 45° of shoulder abduction, .09-.77 in the seated position with 90° of shoulder abduction, .86-.99 (coefficient of variation: 7.5-29.8%) in the supine position with 90° of shoulder abduction, .82-.84 in the supine position with 45° of shoulder abduction, and .75-.94 in standing. The ER:IR ratio reliability was low for all positions. CONCLUSIONS: The seated position with 45° of shoulder abduction in the scapular plane seemed the most reliable for IR and ER strength assessment. The standing position or a shoulder posture with 90° of shoulder abduction or in the frontal plane must be used with caution given the low reliability for peak torque. Good reliability of ER and IR PT was generally reported, but ER:IR ratio reliability was low.