Research conducted on more than 200 men’s and women’s handball players (senior and youth categories) by our coaches Krešimir Pažin and Robert Papić
“I would rather know what sort of person has a disease
than what sort of disease a person has.”
– Hippocrates –
The hip joint is a spherical joint consisting of the head of the femur (caput femoris) and the cup of the pelvis. The bodies of the pubic, iliac, and sciatic bones form the acetabulum. Movements in the joint can be divided on the basis of 3 main axes: transverse axis – flexion movements (regular range of motion 130° – 140°) and extensions (10°), sagittal axis – abduction movements (30° – 45°) and adductions (20° – 30°) and vertical axis – internal rotations (36°) and external rotations (13°).
Internal and external rotation increase significantly with hip and knee flexion of 90°, when internal rotation is 40 to 50° and external rotation is 30 to 45°.
(Uršula Fabijanić, Treatment of Hip Dysplasia in Adulthood, Zagreb, 2017).
20 or 30 years ago, children and young handball players spent a few hours a day in free play, mostly outdoors, when they were growing up.
They were engaged in activities which were varied (climbing, jumping, crawling, falling, catching etc.) and mostly low or medium in intensity with an extremely high number of repetitions if we take into account the hours spent in the game through a period of growing up of about 15 years.
As what we do, in addition to genetic predispositions, shapes our body, such a wide range of different movements allows the body to adapt to different requirements and thus independently adjust the imbalances in the body.
Today, due to a sedentary lifestyle conditioned by cultural change,
most children do not have the opportunity to go through this type of adjustment.
If we add to this the fact that children are nowadays involved in organised sports 7-8 years earlier than 20 years ago (today at the age of 6, and sometimes at 13 or 14), the ratio of the total number of hours spent in free play and handball changes significantly on the handball side.
As a result, young athletes are more susceptible to morphological and functional changes due to specific handball requirements.
”Between stimulus and response, there is a space.
In that space lies our freedom and our power to choose our response.
In our response lies our growth and our happiness.”
– Viktor E. Frankl –
Handball is a game in which the movements performed by a player are very diverse, but it is predominantly a unilateral sport in which some movements are repeated much more than others (passing the ball and shooting if we observe the arms and torso, and stopping the maximum speed and changing direction if we observe the legs and torso) and is therefore ideal for creating imbalances in the body.
Since the right hand is dominant for most players,
the left foot is used as a foothold for most movements.
Jump shots, landings, changes in the direction of movement, penetration and feints make up the largest part of the movement in the attack, and in defensive actions defenders most often use the left diagonal position because they most often stop right-handers.
All of the above movements begin by stopping the body.
As this stopping is generally performed unilaterally on the left leg and the knee does not have the freedom of movement of rotation around the transverse axis, in order for the body to remain stable rotation in the ankle and internal rotation of the hip must be prevented.
Effective stopping requires the body to adapt to the ability to create large forces in the shortest possible time. With a long process of strengthening the muscles and shortening the tendons, the body becomes more efficient in shortening the movement of the internal hip rotation.
However, excessive use creates a physical imbalance that leads to an increased susceptibility of injuries, syndromes and impingement to the left hip.
”When you are young, you have the face your parents gave you.
After you are forty, you have the face you deserve.”
– Edwin M. Stanton –
We define imbalance as the ability of the body to disable its function in the middle of an unnatural position and use of one part of the system, therefore the other part of the same system adapts and takes on a role that is not its primary function.
Frequent repetition of this action increases the imbalance and impairs the function of the system as a whole. If the joint does not have natural freedom of movement, if the muscle is often in spasm or if the tendon has reduced elasticity, the body will compensate for these deficiencies by adjusting, but only in extremely rare cases these compensations will successfully compensate for the efficiency which the athlete would have had in natural balance.
”In addition to reducing system efficiency,
body imbalances increase the risk of injury.
M. L’Hermete et al. in their 2006 paper demonstrate an increased number of cases of hip osteoarthritis in retired professional handball players compared to the general population (control group).
In support of the above theses is an indicator that the incidence of osteoarthritis is higher on the left hip than on the right.
On 20 former handball players who made up the experimental group and 39 people of the same age who did not play any sport professionally, the author finds that as many as 60% of respondents from the experimental group have osteoarthritis on one or both hips.
Compared with the experimental group, in the control group in 13% of subjects found forms of osteoarthritis.
Also, the internal hip rotation in the experimental group is significantly lower: by 7 degrees,
The data we obtained by measuring the senior team in our club (2nd level of national competition) confirms the thesis of a significant reduction in the ability of internal rotation of the hips from the above research.
Vad, V., B., et al. in their 2003 work on 100 professional tennis players found that due to the large number of actions in which a tennis player dominantly pivots around one leg when performing elements (a movement that is almost the same as dominant handball movements: passing the ball, penetration and shooting), tennis players have a significantly lower internal rotation of the dominant hip compared to the non-dominant hip.
The author finds a difference of 7.2 degrees
between the internal rotation of the dominant hip
in favour of a group that has no lower back problems.
On a non-dominant hip, this difference is only 3 degrees. Looking within the group, the symptomatic group has a difference between the dominant and non-dominant hip as much as 15.5 degrees in favour of the non-dominant hip. While in the group that has no problems with the lower back, the difference is 7.5 degrees. Thus, the author concludes a correlation between reduced internal hip rotation and lower back problems.
Given the above, and a review of the sources and research indicating an association between lack of internal hip rotation and anterior cruciate ligament injuries, lower back problems (Vad, V., B., et al. Hip and shoulder internal rotation range of motion deficits in professional tennis players, 2003) occurrence of femoroacetabular impingement (Kapron L., A., et al., Internal Rotation Is Correlated to Radiographic Findings of Cam Femoroacetabular Impingement in Collegiate Football Players, 2012) and hip osteoarthritis (L’Hermette, M., Hip passive range of motion and frequency of radiographic hip osteoarthritis in former elite handball players, 2006)
is a necessary step to determine when and to what extent
playing handball begins to create imbalances in the body
and to what extent it is possible to protect players from injury.
Methods of work
Two groups of boys aged 12 to 14 who train 450 minutes of training in 5 training days (Monday to Friday).
The total number of subjects was 27, of which 13 boys in the experimental group and 14 in the control group. In the last 4 years, the experimental group has conducted an average of 30% of training (about 100 minutes per week) so-called corrective training contents in training, while the control group did not carry out corrective contents as planned for 4 years, but handball contents were dominant.
Data were collected using internal hip rotation measurements performed by the same meter for both groups.
The respondent lay on his stomach with his hands placed under his chin. The legs were stretched at the hip, while the measured leg was at a 90-degree knee flexion. At the surveyor’s signal, the subject let his foot descend with the help of gravity to the outside in relation to the body. In order to avoid compensatory rotation of the hips and lumbar back, the respondent’s buttocks were pressed against the ground.
The angle was measured using the My ROM application, Dr. Carlos Balsalobre-Fernandez, PhD, on an Apple iPad Air 3, California.
The device was placed on the outside of the lower leg and followed the leg to the end position (internal rotation of the hip).
Since the software automatically sets the left foot as the first to be tested, the test was conducted in this way. A T-test for independent samples was used to verify the statistical significance of the data of the two groups.
Results and Discussion
Descriptive statistics showed a statistically significant difference between the arithmetic means of the experimental and control groups (T = 2.26). As the t-value is in the positive sign, it is confirmed that the experimental group has a significantly higher value in the measurements compared to the control group.
Table 1 shows the measurement results of each player of the experimental and control groups for the left and right hips.
Comparing the results of both groups with the criteria stated in the introduction, we conclude that the control group does not have a sufficient range of movement in any hip, and this range of movement is significantly smaller compared to the experimental group. Previous research has been conducted on the adults and the results show around 35 degrees of internal hip rotation.
As children aged 14 and younger, especially in the male population, have not yet reached the plateau of growth and development of the body, and their muscle and connective tissues are more elastic and joint tissues more mobile, the expected range of motion in the hip in the respondents should be greater than in adults.
”If I’d known I was going to live this long,
I would have taken better care of myself.”
– Billy Noonan –
By analysing the data, we conclude that the consequences of a large volume of handball training on handball players appear at an early age if additional training facilities are not carried out as planned.
Since we cannot influence the sedentary lifestyle of young handball players, nor the specific requirements of sports, it is necessary to design the work plan so that it contains enough corrective content that is an incentive to reduce imbalances caused by handball training.
The test results of the experimental group
show that the planned implementation of these contents
can reduce the negative impact of specialised handball training
to the extent that young handball players grow up with normal hip mobility.
It is necessary to start implementing these contents from the youngest age, because the long-term repetition of handball movements creates and determines motor patterns that, by increasing strength to senior age, significantly increase the imbalances created through childhood.
“Don’t bend. Don’t water it down. Don’t try to make it logical. Don’t edit your own soul according to the fashion.
Rather, follow your most intense obsessions mercilessly.”
– Anne Rice –
Following the methods of Handball Education based on the idea that the human body is an integral system, in the work with the experimental group we did not use corrective exercises aimed at local improvement of the ability of internal hip rotation.
The additional contents we conducted were aimed at the development of as many different abilities as possible (coordination, proprioception, explosive power, flexibility, stability etc), the intensity of work was low or medium, and the volume was large.
The exercises we used are performed using the whole body with the simultaneous stimulation of the development of several abilities:
gymnastics exercises (forward reel, backward reel, flying reel, judo forward fall, cartwheel on the side, one-handed cartwheel, standing on shoulder blades, standing on head, standing on hands, standing on hands + reel forward, rondat, reel back + standing on hands, height on hoops, somersault forward, backward reverse, etc.),
basics of athletic school (low skip, high skip, Indian, lower leg throw, throwing lower leg, step-step, lateral step-step movement, grabbing step, step, skipping screws, frontal and lateral crossings over the groin at hip height, different combinations of foot and leg jumps through coordination ladders “kidgrid”, learning the technique of landing and reflection on both and one leg in a straight line and with rotation etc),
strength exercises, performing push-ups, reverse push-ups, squats without external load, technique and strength falls forward, on trail and side, learning joints and isometric strength in endurance in the fold position etc),
and various exercises of climbing (on a rope, on a bar),
swinging (on arms, bars and hoops),
crawling, walking on all fours, etc.
The test results show that with the development of targeted abilities that we wanted to influence by using these exercises, the “accidental” consequence of such training is better internal rotation of the hips, although we did not deal with it specifically.
”Statistics are no substitute for judgement.”
– Henry Clay –
The hip joint, along with the shoulder, is the most mobile joint on the human body. If we take into account the nature of handball and its requirements, the hip is important for the successful performance of many elements of the game (movement in attack and defence, performance of throwing elements, reflections, landings, slowdowns, stops, changes of direction etc).
Reduced mobility of the joint, which is very mobile by nature, leads to limitations in movements, i.e. sports performance, which creates imbalances in the body that often lead to injuries.
The aforementioned measurements show that playing handball is associated with reduced hip mobility, and the implementation of an additional program to develop a wider range of abilities contributes to a more harmonious development of the body.
Such a body will enable the handball player to maximise the manifestation of forces in all movements, stopping and control over them, which will lead to better performance of handball elements, longer sports career and higher life quality after a sports career.
The experimental group of non-handball-type training in childhood (gymnastics, athletics, power, strength, coordination etc) successfully maintains the level of internal hip rotation in a non-invasive manner (hip mobility exercises were not performed).
Further longitudinal research is needed to determine at what age limitation of the amplitude of movement in the hips begins to form, and what is the long-term impact of corrective programs on this ability.
The lack of research is the small number of scientific papers on the impact of sports on hip mobility in young athletes.
Simultaneously with the research on men, the measurement of all age categories was carried out in the women’s professional club RK “LOKOMOTIVA” and the measurement results are in the following table.
Hips were expected to be more mobile in women than in men, as measurements show.
What is interesting is the almost equal internal hip rotation in all age categories, and the fact that this mobility is higher than average, which in some resources is associated with knee injuries.
Table no. 2 shows the ratio of internal hip rotation for all groups listed in the study:
and the prevention program was made in collaboration with ”Prirodan Pokret”