Health behavior of the Icelandic youth
School of Health Sciences
It´s all in the hips

Handball has for a long time been one of the most popular sports in Iceland, often called the national sport of Iceland due to the success of the male national team in international tournaments. Shoulder injuries are common among handball players and can cause significant problems. The high prevalence of shoulder injuries among handball players underscores the importance of injury prevention methods and an increasing number of studies have therefore been attempting to identify possible risk factors for shoulder injuries.

Recent studies investigating the prevalence of shoulder injuries and possible risk factors have first and foremost looked at factors related to the shoulder itself. However, a large part of the forces required to use the shoulder in the most efficient way in throwing sports, influencing performance related factors like throwing velocity, is generated through the lower extremity and the trunk muscles.

No studies have, however, investigated to possible association between inefficient use of the lower extremities and the trunk during the throwing motion and shoulder injuries and whether lack of strength and force production in the lower extremities and the trunk is associated with an increase in reported shoulder injuries among handball players.

The aim of this research

This PhD project, titled “The relationship between strength and force development in the lower extremities and trunk and shoulder injuries in handball players – “It´s all in the hips” has been ongoing since August 2022. Kari Arnason, physiotherapist, is the PhD student leading the project and his supervisors are Dr.Kristin Briem, professor at the Department of physical therapy and Dr. Atli Agustsson, associate professor at the Department of physical therapy. Co-supervisors are Dr. Elís Thor Rafnsson physiotherapist at Sjúkraþjálfun Íslands and Dr. Hilde Fredriksson from Olympiatoppen in Oslo, Norway.

The aim of this project is to:

  1. Investigate the association between lower body and trunk efficiency during a throwing motion and shoulder injuries among Icelandic handball players and;
  2. To investigate whether players who test weaker on maximal strength and power tests for lower extremity and trunk muscles are more likely to deal with shoulder injuries. 

All data for this project has been collected. During the 2022-2023 handball season 42 male handball players participated in the first part of the study. Pre-season lower body and shoulder strength and trunk rotation power were measured, and a 3D motion analysis of a jump throw conducted. The players were followed through a whole regular season until April 2023, where they answered once a week a questionnaire specifically designed to document the prevalence and severity of shoulder problems.

During the 2023-2024 season, 31 female handball players participated in the second part of the study. The female players underwent the same pre-season strength and power measurements as conducted previously with the male players and were followed through a whole regular season until April 2024, answering once a week the same questionnaire documenting the prevalence and severity of shoulder problems. Data analysis is currently on-going. 

This project has been funded by the Doctoral grants of the University of Iceland and by the research fund of the Icelandic Physiotherapy association.

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Shoulder overuse injuries are common among handball players. Studies have shown that reduced strength and reduced range of motion can increase the risk of overuse injuries.

Principal investigator

Kári Árnason is a physiotherapist and PhD student at The University of Iceland. Alongside his research work and teaching, Kári is a clinical orthopedic physiotherapy specialist. In his clinical work, Kári focuses on treating shoulder problems and working with high-performance athletes and musicians, with organizations like the Iceland symphony orchestra and the U20 male national handball team.

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Kári Árnason, physiotherapist and PhD student.

Researchers

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