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A Functional High-Load Exercise Intervention for the Patellar Tendon Reduces Tendon Pain Prevalence During a Competitive Season in Adolescent Handball Players.

ABSTRACT: Imbalances of muscle strength and tendon stiffness may increase the risk for patellar tendinopathy in growing athletes. The present study investigated if a functional high-load exercise intervention, designed to facilitate tendon adaptation and reduce muscle-tendon imbalances, may prevent patellar tendon pain in adolescent male handball players (12-14 years). Tendon pain prevalence (using VISA-P scores), knee extensor strength, vastus lateralis (VL) architecture and patellar tendon mechanical properties were measured at four measurement time points (M1-M4) over a season. The control group (CON; n = 18; age 13.1 ± 0.7 yrs, height 170 ± 8 cm, mass 58 ± 10 kg) followed the usual strength training plan, including muscular endurance and explosive strength components. In the experimental group (EXP; n = 16; 13.1 ± 0.6 yrs, 169 ± 11 cm, 58 ± 16 kg), two sessions per week with functional high-load exercises for the patellar tendon were integrated in the strength training schedule, aiming to provide repetitive high-intensity loading of at least 3 s loading duration per repetition. While in the control group 30% of the athletes reported a clinically significant aggravation of symptoms, all players in the experimental group remained or became pain-free at M2 until the end of the season. There was a similar increase of strength (normalized to body mass; CON: 3.1%, d = 0.22; EXP: 6.8%, d = 0.47; p = 0.04) and VL thickness (CON: 4.8%, d = 0.28; EXP: 5.7%, d = 0.32; p < 0.001) in both groups, but no significant changes of tendon stiffness or maximum tendon strain. Further, both groups demonstrated similar fluctuations of tendon strain over time. We conclude that functional high-load exercises can reduce the prevalence of patellar tendon pain in adolescent athletes even without a reduction of tendon strain.

SUBMITTER: Mersmann F

PROVIDER: S-EPMC7987778 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Talent development is integral to the policy and organizational practice of competitive sport, but has also been associated with excessive amounts of training and competition, and athlete injuries and illnesses. The lack of available prospective data on the training and match activities of youth athletes and their health problems is therefore of concern. The aim of this study was two-fold: (a) to examine the amount and frequency of training load, match activities, injury and illness incidence, and prevalence among Norwegian youth elite handball players over the course of the 2018-2019 competitive season; and (b) to explore whether the injury rates are related to the sex or competition level of players, or their membership of the youth international team. We recruited 205 handball players (64% female, 36% male), aged 15-18 years (17.2 years ± 0.9) from five different sport school programs in southeast Norway. Data were collected daily from September 2018 to May 2019, during the competitive handball season. The variables included types of athlete activities, the number of activities, the rating of perceived exertion (RPE), and the duration of training and matches. Injury and illness data were collected weekly using the Oslo Sports Trauma Research Center (OSTRC) questionnaire. The mean number of matches per week per player was 0.9 ± 1.29; the number of weekly training events was 6.1 ± 4.4; and the mean weekly session RPE was 986 ± 1 412 arbitrary units. The players reported a total of 472 injuries, and the mean number of injuries per player was 2.3 ± 2.9. The results demonstrated a 53% weekly injury prevalence, of which 38% were categorized as substantial injuries. Male players and players who participated at the highest level of senior competition and/or the youth international team reported significantly lower weekly incidences of health problems, compared to other players. Our findings showed that players enrolled in sport school programs are exposed to high training and competition loads, and that both general and substantial health problems are common. The potential implications for talent development and future research are discussed.

Project description:ContextWhen playing handball, the preservation of the subacromial space, which can be quantified by the acromiohumeral distance (AHD), plays a crucial role for shoulder health of handball players. Acute effects of handball-specific loading on the subacromial space with consideration of individual adaptions resulting from long-term handball-specific loading experience have yet to be determined in order to prevent injuries such as e. g. an impingement of the supraspinatus tendon.ObjectiveTo (1) assess the acute effects of handball-specific loading on the AHD in healthy experienced handball players (HB) and non-handball experienced athletes (CG) and (2) to assess the AHD behavior in relation to individual intrinsic factors to identify possible risk factors and the effect of handball-specific experience associated adaptations.Participants20 HB (10m; 10f) and 20 CG (10m; 10f); 24 ± 5 years.InterventionHandball-specific loading protocol.Main outcome measuresThe AHD was measured by ultrasonography at 0° and 60° abduction pre and post intervention. Isometric shoulder strength was measured with hand-held dynamometry. Shoulder range of motion (ROM) was measured with goniometry.ResultsHandball-specific loading led to significantly reduced AHD in the dominant shoulder in the 60° abducted position in both groups (HB: -1.7 ± 2.0 mm; p = 0.001, d = 0.69; CG: -1.1 ± 2.0 mm; p = 0.024, d = 0.37) and in the non-dominant shoulder in 0° (-0.7 ± 1.5 mm; p = 0.038, d = 0.35) and 60° abducted position (-1.3 ± 1.8 mm; p = 0.004, d = 0.69) in HB only. Handball-specific loading enhanced AHD reduction when elevating the shoulder from 0° to 60° in both groups and arms. Larger shoulder abduction strength affected the maintenance of the AHD positively. HB demonstrated less shoulder strength compared to CG, while ROM did not differ.ConclusionsHandball-specific loading can affect the ability to preserve the subacromial space which might put handball players at risk for shoulder injuries. Poor shoulder strength can aggravate this mechanism. Therefore, implementation of strengthening exercises of the external rotator and abductor muscles in the training schedule may improve shoulder health of handball players.

Project description:BackgroundFew studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims of this study were to investigate if accumulated external workload "spikes" in ACWR of tennis training, match play, and fitness training, and to see if high or low workload/age ratio were associated with the rate of shoulder complaints/injuries in competitive adolescent tennis players. Additional aims were to report the incidence of complaints/injuries stratified by sex and level of play and to describe shoulder injury characteristics.HypothesisRapid increases in external workload are associated with the incidence of shoulder complaints and injuries.Study designA cohort study.Level of evidenceLevel 3.MethodsAt baseline, 301 adolescent competitive tennis players, 13 to 19 years, were screened and followed weekly for 52 weeks with questionnaires, in the years 2018 to 2019. Information about time-varying accumulated external workload spikes (uncoupled ACWR >1.3), and workload/age ratio, in 252 uninjured players were used in Cox regression analyses with the outcomes shoulder complaints (≥20) and injuries (≥40) (Oslo Sports Trauma Research Center Overuse Injury Questionnaire).ResultsFor each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.26 (95% CI, 1.13-1.40) for a shoulder complaint and 1.26 (95% CI, 1.15-1.39) for a shoulder injury. The HRR for fitness training was 1.11 (95% CI, 1.02-1.20) for a shoulder complaint and 1.18 (95% CI, 1.09-1.27) for a shoulder injury. Workload/age ratio was not associated with the rate of shoulder complaints or injuries.ConclusionAccumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of shoulder complaints and shoulder injuries in competitive adolescent tennis players.Clinical relevanceConsistency in training load on a weekly basis is most likely more beneficial for adolescent tennis players regarding shoulder complaints/injuries than a training schedule comprising rapid increases (ie, spikes) in workload.

Project description:Sport does not automatically generate educational benefits for players. For a sports field to become a child-friendly educational environment, it is essential that all actors involved in the organization of youth sport take deliberate educational measures. Among these actors are referees, who should be taken into account during the research on the educational value of sport for the youngest. The subject of the present study was handball referees, who interact with the players during matches. Assuming that the referee is an important actor in sport education and that referee-players interactions are the basic mechanism of the referee's educational influence, this study aimed to assess the quality of his or her interactions with players during handball matches for children aged 9 to 12 years. The research was conducted in a group of 25 handball referees who refereed matches of children in the region of Mazowieckie Voivodeship in Poland. The referees surveyed had current licenses issued by the Warsaw-Mazovian Handball Association. To assess the quality of referee-players interactions, the authors' direct observation tool (Referee-Players' Interaction Assessment Scoring System) was used. The educational referee-players interaction was studied in six dimensions: Positive climate, Responsiveness, Behavior management, Proficiency, Instructing, and Communicating. Data were statistically analyzed using chi-squared test, Mann-Whitney U test and exploratory factor analysis (EFA). Cronbach's alpha values were higher than 0.90 in the factors, showing adequate levels of reliability. The results of the research demonstrated that the assessment of the quality of the referee's educational influence on players was neither affected by the referees' experience nor by the outcome of the match. The quality of educational referee-players interactions in five of the six dimensions studied was assessed as average, whereas positive climate was assessed as poor (three-step scale: poor, average, good). If referees are to support coaches and parents in achieving their educational goals, the results indicate areas where they can improve. The research provided empirical evidence that could be used as a basis for the modification of previous training programs for referees developed by local and national sports associations. The referees should be trained to build a positive climate on the sport field, which consists in creating emotional ties with players (physical proximity, social conversation), expressed in an enthusiastic attitude and joy of contacts (smiling, engagement, positive affect reaction, positive comments, respectful and inclusive language, using players first names, listening to players). In addition, referees must be taught to actively monitor players' emotional, cognitive, social, and health needs, as well as to respond to the players' needs and solve problems.

Project description:Background:Olympic handball is a sport mainly focused on executing throwing and passing techniques with the throwing arm. Functional specialization due to the unilateral characteristic and dominance of the throwing arm may lead to adapted control of shoulder stability and mobility. Thus, we examined side differences between the throwing and the non-throwing arm. Additionally, correlations between the Upper Quarter Y Balance Test (YBT-UQ) and handball-specific performance measures were investigated. Methods:All participants (F?=?13?yrs., n?=?14, training experience [te] 5.9?±?1.3?yrs.; M?=?14?yrs., n?=?24, te 6.5?±?2.5?yrs.; M?=?15?yrs., n?=?18, te 9.3?±?2.2?yrs) were Olympic handball players of a regional youth selection team. YBT-UQ was executed assessing performance in medial, inferolateral and superolateral reach direction normalized to the upper limb length together with a composite score of the mean of all reach directions. A radar gun and a target net were used for the assessment of throwing velocity and throwing accuracy. The paired t-test was used to detect side differences in YBT-UQ performance. Pearson's correlation analysis was calculated for associations between YBT-UQ and throwing velocity/accuracy. Results:Significant differences between the throwing and non-throwing arm were only detected for the superolateral reach direction in the 14-year-old males. Small correlations between YBT-UQ performance and throwing velocity/accuracy (13-year-old females: -?0.01???r???-?0.37 / 0.01???r???0.31; 14-year-old males: 0.10???r???0.45 / -0.01???r???.-0.51; 15-year-old males: 0.06???r???0.34 / 0.01???r???-?0.45) were observed, irrespective of age and sex category. Conclusions:There was only a minimal difference in performance of the YBT-UQ between the throwing and non-throwing arm and only weak if any relationships between throwing performance and stability/mobility of the upper extremities in adolescent Olympic handball players existed. Further research is needed to investigate whether the YBT-UQ is a useful tool to detect training-related improvements in measures of shoulder stability/mobility and functional performance.

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A Functional High-Load Exercise Intervention for the Patellar Tendon Reduces Tendon Pain Prevalence During a Competitive Season in Adolescent Handball Players.

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