For the prevention of injuries in handball it is essential to be familiar with some of the statistical data related to the frequency of injuries and most common causes of injuries. That’s why it is very important to present this publication about acute injuries in handball to as many coaches, players and goalkeepers as possible.

Therefore I decided to copy and post the most essential parts of the work “ACUTE INJURIES IN HANDBALL” by Patrick Luigi and Thomas Henke.

Spread the word, inform others, be the part of Positive Change and help to decrease frequency of injuries.

This is the extract from EHF Scientific Conference 2011, Science and Analytical Expertise in Handball (Scientific and practical approaches), held 18-19 November 2011 in Vienna, Austria.



Patrick LUIG & Thomas HENKE

Department of Sports Medicine, Ruhr-University Bochum, Germany

Despite injuries being an apparent problem in the handball community, injury prevention still seems far away from being a high-priority issue. The fact that a sports injury is mainly a consequence of definable risk factors is not common knowledge. Still a large share of the athletes, coaches and functionaries sees bad luck as main cause for getting injured.

Analysis of injury statistics and literature review indicates that the overall incidence of acute injuries in handball is around 2/1000h. Match incidences are ten time higher than training incidences. Lower extremities account for most injuries, followed by head injuries and injuries of the upper extremities. Sprains and contusions are leading injury types. Women are more vulnerable for non-contact lower extremity injuries whereas men have a higher share of contact head injuries.

It is roughly estimated that in Europe at least 320,000 handball injuries occur each year.

Injury topography / Anatomical location

The analysis of 8,520 handball injuries among 14 to 45 year old athletes revealed that handball injuries can essentially be attributed to four main body regions: Regarding the upper body head (male: 17.4%; female 13.2%) and hand/wrist (male: 19.8%, female 19.6%) are considerable core regions, whereas when talking about the lower extremities knee (male: 23.0%; female 31.7%) and ankle joints (male: 18.6%; female 22.1%) are mainly affected. In general female athletes have higher shares of knee and ankle injuries, whilst among male athletes the head is more frequently injured (cf. Fig. 1.)

Acute injuries in handball

Going more into details, younger athletes seem to be more prone to injuries of the upper body regions, especially finger injuries. With advancing age there is an increase in injuries of the lower extremities, in particular in knee injuries. Almost half of all injuries in the group of players under 14 years of age relate to hand/wrist or head. In contrast nearly one third of all injuries in adults relate to knee injuries. In female professionals even every second injury is a knee injury (cf. Tab. 4).

Localisation of match injuries

Recent studies show similar tendencies. There is a general consensus that regardless from age, gender and performance level the majority of all injuries affects the lower limbs.

Moreover, is obvious that young female athletes have a significantly higher risk to sustain a severe knee injuries.


Injury types

The most common acute injuries are sprains, with knee, ankle and fingers being the most affected body parts followed by contusions and strains11,17,18,20. Fractures and dislocations are quite rare. However, younger athletes are typically more vulnerable to fractures, in particular finger, wrist and forearm fractures, than older athletes. Strikingly, during important elite tournaments contusions become more frequent.


Injury situations & risk factors

Studies commonly differentiate between contact situations, whether legal contact or foul play, and non-contact situations, typically running with quick direction changes, cutting and pivoting, starts and stops as well as jumping and landing on one or both feet. On closer examination of 293 injuries in German professional handball contact situations, either with an opponent or a teammate, trigger injuries most frequently, followed by jumping, landing, and running with quick direction changes (feints), which are typical non-contact injury situations (cf. Fig. 2.). In the majority of all cases injuries occurring in contact situations affect the upper body, in particular head and fingers. In contrast, non-contact injuries mostly are related to the lower extremities.

Situations leading to injuries


Several studies have indicated that female particularly young female athletes are at greater risk for non-contact injuries. This is insofar of great significance as non-contact injuries are commonly more serious than contact injuries.

Almost 90% of ACL ruptures are reported to happen without the opponent’s or team-mate’s contribution. In general players in offensive actions are more at risk than defense players.

Our data show that attacking back-court players are mostly affected by injuries, followed by attacking pivot players and central defenders. Strikingly, pivot players have the highest share of head injuries.

Among female athletes Froböse et al.(1996) state a 30% higher injury risk for pivot and back-court players compared to other playing positions. Some other studies also demonstrated that back-court players have the highest overall incidences, in particular with regard to non-contact injuries of the lower extremities. Our data and recent research states that previous injuries increase the risk for recurring injuries, in particular with regard to injuries of the lower extremities. Among these ankle injuries are most common to reoccur. Moreover, Olsen et al. (2003) indicated a correlation between playing surface and injury risk. According to them artificial floors have a higher friction compared to wooden floors and thus can increase the ACL injury risk for women.




Handball is a physical and dynamic contact sport with a noticeable injury risk, in particular during matches. Even though the highest share of injuries is due to contact, in particular those severe non-contact injuries seem to be a key area for targeted injury prevention.

Contact injuries are most commonly less severe (i.e. minor contusions) compared to non-contact injuries. It has to be discussed if contact injuries, especially those that cannot be attributed to unfair play, are somehow evitable. Passive protection such as mouth guards and prophylactic finger tapes can probably assist to reduce the incidences of minor contact injuries such as finger sprains and soft tissue injuries. Certainly, in case of previous injuries, the wearing of protective devices, for example the application of external ankle stabilization such as tape and ankle braces, is explicitly recommended.

However, research and practice have revealed good opportunities to tackle the more serious non-contact injuries. Generally speaking, the various facets of training and physical preparation such as functional strengthening, core stabilization, agility training, neuromuscular and proprioceptive training can contribute to the reduction of injuries, if applied regularly and correctly. This includes technique training for crucial handball movement patterns that typically lead to match injuries e.g. jump shots, single-leg landings and feints.

Despite increasing efforts to propel this issue, the handball community is still not fully aware of the potential of smart injury prevention, which as a positive side-effect can also improve the individual performance of athletes – a win-win-situation for all.

This work in its entirety can be found here.


This whole topic initiates one of the most important questions about goalkeeper risk of head injuries caused by shots in the head.


At least I know many goalkeepers who have had brain concussions (milder or more severe) several times in their career.

“Smaller brain concussion” is like “I broke my nail” in handball goalkeeper vocabulary, unfortunately. It seems that no one recognizes the seriousness of this problem.


What are the consequences of repetitive head injuries?
What are the ways to prevent the head injuries?




Here you can read my whole post about concussions in handball.

4 Responses

  1. Hi, I’m a goalkeeper and i’m 18 years old. To me a shot in the head is like you said “I broke my nail” i got last year 6 balls in the head and 3 of them hit my nose. I’m beginning to worry what will happen next time? becuse every time a ball hits my nose its coming more and more blood. I’m lucky its still straight butt will I be as lucky as before on next training/game? I don’t know what should be done butt i’m hoping someone does.

    • This is for sure serious matter! And I am worried because it seems that nobody is giving it enough attention. Before we get more knowledge, and information about this whole subject – try to be safe, and at least visit a doctor if the shots in head are really strong, or if the bleeding was long.
      Have you had any other problems after those head shots? Such as: headache or a feeling of pressure in the head; temporary loss of consciousness; dizziness; ringing in the ears; nausea; sensitivity to light or noise???

  2. Good morning. Sorry, but what about shoulder and elbow? Did you forget these two major joins which have a determinant role in the sport?

    • Hello Rod, thank you for your comment. As it’s stated in the text: “This is the extract from EHF Scientific Conference 2011, Science and Analytical Expertise in Handball (Scientific and practical approaches), held 18-19 November 2011 in Vienna, Austria. ACUTE INJURIES IN HANDBALL, by Patrick LUIG & Thomas HENKE”. The work they have done is about acute injuries, and it’s based on the analysis of 8,520 handball injuries among 14 to 45 year old athletes.
      So the work is not mine. And besides, in the table in the middle of the text you have also % of elbow and shoulder injuries in different age groups. 🙂

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