Elbow Injuries in Handball Goalkeepers

Handball, a dynamic and physically very demanding sport, poses various injury risks, particularly when it comes to elbow injuries in handball goalkeepers. This is one of the less discussed but significant concerns among handball goalkeepers. This article explores the prevalence, causes, risk factors, and prevention strategies for elbow injuries among handball goalkeepers, drawing main insights from research studies that have already been done.

Understanding the Prevalence of Elbow Injuries in Handball Goalkeepers

Elbow injuries, while not the most common type of injury in handball, present a significant issue, especially for goalkeepers. A study conducted by Moller et al. (2022) sheds light on this, revealing that elbow injuries constitute approximately 10-15% of the injuries sustained by handball goalkeepers. These injuries vary in severity from minor strains to more serious conditions like ligament tears and fractures.

Further insights from Andersen et al. (2021), published in the “Journal of Sports Medicine”, emphasize that these injuries often stem from overuse and repetitive strain. The specific role of goalkeepers, involving constant arm and elbow use for blocking shots, contributes to this heightened risk.

Risk Factors

Several factors contribute to the risk of elbow injuries among handball goalkeepers:

Repetitive Motion: The repetitive nature of blocking / saving shots and of training drills puts continuous stress on the elbow joint, as highlighted in the studies by Moller et al. and Andersen et al.

Impact Forces: The high-velocity impact of the ball against the arm and elbow during save reactions can lead to acute injuries, a point underscored in research by Santos and Coelho (2024).

Lack of Proper Technique: Improper blocking techniques can exacerbate the risk of injury by placing undue stress on the elbow joint.

Inadequate Strength and Conditioning: Insufficient muscle strength around the elbow can increase vulnerability to injuries, as per the findings of Jensen (2023).

Inadequate Rest and Recovery: Overtraining without sufficient rest periods can lead to overuse injuries.

The prevalence of elbow injuries in handball goalkeepers is a significant concern, primarily driven by the repetitive and high-impact nature of their role in the game. Understanding these risk factors is crucial for developing effective prevention and training strategies to protect handball goalkeepers from these kinds of injuries. Future research should continue to focus on injury prevention methods, training modifications, and protective equipment innovations to further protection of handball goalkeepers from such injuries.

Prevention Strategies

Based on these findings, several prevention strategies emerge:

Focused Strength Training: Tailored muscle strengthening exercises can alleviate the risk and severity of elbow injuries.

Proper Technique: Emphasizing correct saving techniques to distribute impact evenly.

Awareness and Early Intervention: Educating goalkeepers about the signs of elbow injuries for prompt treatment.

Elbow injuries in handball goalkeepers, though challenging, can be managed and prevented with informed strategies. By integrating strength training, technique refinement, and awareness into their routines, goalkeepers can protect themselves against these career-impacting injuries.

More Detailed Insights From Some of The Studies About Goalkeeper Elbow Injuries

“Elbow Injury in Handball: Overuse Injuries” – Nebojsa Popovic (2018)

The study provides a detailed analysis of elbow overuse injuries in handball, focusing on both field players and goalkeepers. Here is a summary of the key points:

Epidemiology and Prevalence: The study cites two large studies indicating high prevalence of elbow problems among handball players, especially goalkeepers, with up to 51% of goalkeepers and 32% of field players reporting elbow issues. The pain is typically located on the medial side of the elbow in about half of the cases.

Mechanisms of Injury: Field players primarily experience injuries due to the mechanism of repeated overhead throwing. Goalkeepers, on the other hand, frequently incur injuries from repetitive hyperextension trauma while blocking shots. Most goalkeepers report bilateral problems, contrasting with field players who mainly have issues in their throwing arm.

Functional Anatomy and Injury Patterns: The study highlights the functional anatomy of the elbow, describing the joint’s components and how they contribute to stability. Different patterns of elbow injuries are identified in handball players, with the medial compartment being particularly vulnerable due to repetitive high valgus stress.

Imaging and Pathology: Imaging studies have shown typical overuse injuries of the elbow in handball players, including hypertrophic osteophytes, loose bodies, and periarticular calcification. Repetitive hyperextension trauma in goalkeepers can result in various pathological changes, confirmed by ultrasound and radiographic examinations.

Prevention and Treatment: The treatment for elbow overuse injuries in handball players is mainly conservative, including rest, physiotherapy, and a progressive return to activity. Prevention strategies involve proper conditioning and training, focusing on reducing repetitive stress and managing load during training and competition periods.

The study concludes that there are two distinct patterns of elbow injury in handball players, both leading to overuse injuries. The term ‘handball elbow’ is suggested to describe these injuries. In essence, Nebojsa Popovic’s study provides an extensive overview of elbow injuries in handball, highlighting the need for focused preventive and treatment strategies tailored to the specific demands and injury mechanisms in the sport.

“Direction of the load on the elbow of the ball blocking handball goalie” – Umut Akgun, Mustafa Karahan, Cetin Tiryaki, Bulent Erol, Lars Engebretsen (2007)

This study focused on the elbow problems commonly experienced by handball goalkeepers, often referred to as “handball goalie’s elbow.” The primary cause of these injuries was believed to be hyperextension of the elbow. The study involved fifteen handball goalies, both male and female, with an average of 6.5 years of playing experience. Using video analysis, the researchers observed the elbow position at the moment of ball impact during shots. They found that 78 out of 101 shots (77%) resulted in valgus or mostly valgus load on the elbow, while the remaining 23 shots (23%) caused hyperextension or mostly hyperextension loads. This indicates that valgus loads are more common than previously thought during the blocking action in handball goalies​.

The study “Direction of the load on the elbow of the ball blocking handball goalie” provided several detailed insights:

Participant Profile: The study involved 15 handball goalkeepers from four different teams, with a mean playing experience of 6.8 years. These players, comprising ten females and five males, were all playing in the national handball league and were considered healthy by their coaches​​.

Experimental Setup: A single striker, a 23-year-old male national team member with 11 years of handball experience, was used to perform shots towards the right side of each goalkeeper. The goalkeepers were instructed not to move their feet to stay within the camera frames. All actions were captured using three digital cameras for different views​​.

Video Analysis: The videos were digitized and enhanced for detailed analysis. This task was performed by three experts: an orthopedic surgeon specialized in sports trauma, a general orthopedic surgeon with significant clinical and research experience, and a former national women’s handball team coach​​.

Shot Analysis: Out of 218 shots, 67 did not hit the goalies’ hands, and 50 of the remaining 151 shots were of unacceptable image quality. The study eventually analyzed 101 shots, which were categorized based on the impact location and elbow position during impact​​.

Results: The analysis showed that 78 of the 101 shots (77%) resulted in valgus or mostly valgus load on the goalies’ elbows. The remaining 23 shots (23%) caused hyperextension or mostly hyperextension loads. Notably, when the ball was blocked in the coronal area, the elbow was more likely to experience valgus loads than hyperextension loads, with a statistically significant difference (Pearson Chi-Square Test, P < 0.01)​​​​.

This study highlights the predominance of valgus load on goalkeepers’ elbows during ball blocking, providing a basis for developing preventive and treatment strategies for the common “handball goalie’s elbow” condition​.

“Hyperextension trauma to the elbow: radiological and ultrasonographic evaluation in handball goalkeepers”  – N Popovic, R Lemaire (2002)

The study provides significant insights into the impact of handball on goalkeepers’ elbows. The key findings and conclusions of the study are:

Study Objective and Method: The main goal was to detect elbow lesions produced by hyperextension in 30 elite handball goalkeepers. The study employed conventional radiographs, stress radiographs, and ultrasound examination of both elbows. For comparison, 30 male volunteers from the general population within the same age group with no history of elbow injury were used as a control group​​​​.

Participant Profile: The goalkeepers in the study had a mean age of 26.7 years and an average athletic experience of 15 years. Most of them (25 out of 30) complained of chronic elbow pain, which varied in intensity and location around the elbow​​​​.

Radiographic Findings: A significant number of goalkeepers showed osteophyte formation (67%), with these osteophytes usually located at the olecranon process. Additionally, loose bodies and periarticular calcifications were observed in 5.5% of the players​​.

Ultrasonographic Findings: There was thickening of the medial collateral ligament (MCL) in 50% of the goalkeepers, thickening of the tricipital tendon in 11%, and signs of ulnar neuritis in 22%. Also, intra-articular effusion was found in 66% of the players, and small loose bodies in 33%​​.

Injury Mechanism: The study confirms that pain in the elbow is a common problem for handball goalkeepers at all levels. The mechanism of injury is believed to be repetitive hyperextension trauma caused by the ball hitting a fully extended forearm with considerable energy​​.

Pathological Changes: Hypertrophic osteophytes and traction spurs observed in goalkeepers are the result of repetitive excessive extension forces generated in the elbow during shot blocking. These repetitive impacts lead to chondromalacia and subsequent hypertrophic spur and osteophyte formation​​.

Stress Radiographs Findings: Stress radiographs revealed medial joint opening in some players, likely reflecting some MCL laxity due to repetitive hyperextension trauma of the elbow joint​​.

Ultrasound Examination Findings: Ultrasound examination confirmed joint effusion in 67% of the goalkeepers, with the precise location of the effusion usually being in the olecranon fossa, followed by the coronoid fossa and annular recess​​.

Effects on Tendons: Ultrasonographic examination showed thickening of the MCL, flexor-pronator tendon, and triceps tendon of both elbows in goalkeepers. This is attributed to micro ruptures of the soft tissue around the elbow with an imperfect healing process​​.

Comparative Findings and Implications: The study suggests that repetitive hyperextension stress of the elbow in handball goalkeepers leads to various pathologic changes and increased medial laxity of the elbow. This can result in chronic repetitive injuries of the elbow, especially in goalkeepers with poor dynamic muscular stabilization of the elbow​​.

Relevance to Other Athletes: The findings are not only relevant to handball goalkeepers but also to athletes in other sports involving similar impact injuries of the elbow, such as soccer goalkeepers and volleyball players​​.

Difference with Field Players: In contrast to goalkeepers, the main injury mechanism in field players was repetitive throwing, leading to high valgus stress on the medial aspect of the elbow joint​​.

In summary, this study highlights the significant impact of repetitive hyperextension trauma on the elbows of handball goalkeepers, leading to various pathological changes and injuries. The findings are critical for developing preventive and treatment strategies for these athletes.

“Handball Goalie’s Elbow Syndrome: A Systematic Review” – Matheus Oliveira de Almeida, Aline Carla Araújo Carvalho, Augusto Luis Boschi Riboldi, Jose Vélez Uribe (2014)

The study provides a comprehensive analysis of elbow injuries specific to handball goalkeepers. This study highlights the unique mechanism of injury in goalkeepers, primarily due to repetitive trauma in elbow hyperextension caused by ball impact. The review emphasizes that while elbow injuries are less common compared to other injuries in handball, their impact on goalkeepers is significant. The study also notes a lack of research on treatment and prevention specific to this syndrome, suggesting the need for more focused studies in this area. The study aimed to compile and analyze existing research on elbow injuries among handball goalkeepers. Here’s a summary along with the key findings and conclusions:

Objective: The review focused on understanding the epidemiology, etiology, and clinical symptoms of elbow injuries in handball goalkeepers.

Methodology: A comprehensive database search was conducted, identifying 623 papers, of which only ten met the criteria for inclusion in the review.

Findings: The results showed that elbow injuries in handball goalkeepers are predominantly caused by repetitive trauma in hyperextension due to ball contact on the forearm.

Epidemiology: Elbow injuries, though less common compared to other joint injuries, significantly affect goalkeepers due to the nature of their role in the sport. About 40% of goalkeepers reported elbow pain, and 34% had prior pain in the same location.

Injury Mechanism: Experimental studies with cadaveric elbows revealed that the injury mechanism is forced and repetitive hyperextension from ball impact, leading to joint laxity, articular capsule lesions, and partial rupture of collateral ligaments.

Clinical Manifestation: The most common symptom is pain in the elbow region, frequently in the medial part but also affecting other areas.

Diagnostic Tools: Radiography and ultrasonography have been used, with ultrasonography appearing more effective in detecting soft tissue lesions.

Prevalence: Despite being less common overall, elbow injuries are prevalent among goalkeepers due to their specific role and actions in handball.

Injury Rates: Studies show varying rates of elbow injuries among goalkeepers, with the incidence being significant due to the high-velocity impacts experienced during save reactions.

Mechanism of Injury: The typical injury involves repetitive hyperextension trauma, primarily due to the impact of a fast-moving ball on the forearm in an extended position.

Clinical Findings: Injuries often result in pain and sometimes in structural damage, such as ligament tears and articular cartilage damage.

Diagnostic Approaches: The use of radiography and ultrasonography has shown varied effectiveness, with ultrasonography being more beneficial for soft tissue injuries.

Lack of Treatment and Prevention Studies: The review highlights the absence of research on treatment and prevention strategies for this specific injury, underscoring the need for further studies in these areas.

The review concludes that while handball goalie’s elbow syndrome is a significant issue, there is a need for more research, particularly in the areas of treatment and prevention, to better address and manage these injuries​​​​.

“High Prevalence of Elbow Problems Among Goalkeepers in European Team Handball — ‘Handball Goalie’s Elbow'” – S Tyrdal, R Bahr (1996)

This study provides a comprehensive overview of elbow injuries specific to handball goalkeepers. The study is a systematic review aimed at understanding the epidemiology, etiology, and clinical symptoms of elbow injuries in handball goalkeepers.

It included various research designs, such as prospective, retrospective, case-control, and cross-sectional studies, with an emphasis on evaluating elbow injuries using diagnostic tests, clinical findings, and understanding injury mechanisms.

Prevalence and Epidemiology: Elbow injuries represent about 7% of all injuries in handball, predominantly among goalkeepers. The injuries are attributed to repetitive overloads in hyperextension due to ball impact, often reaching high velocities.

Mechanism of Injury: Goalkeepers typically block the ball with fully extended arms, exposing the elbow joint to repetitive overloads in hyperextension. This mechanism is distinct from elbow injuries in other sports, which are often related to throwing motions overloading the medial structures of the elbow.

Clinical Findings: Common clinical manifestations include pain in the elbow region, with a higher frequency of pain in the medial part of the elbow. Studies noted differences in the importance of radiography in diagnosing ‘handball goalie’s elbow.’ While some studies found significant osseous lesions, others did not find a correlation between symptoms and radiographic findings.

Lack of Comprehensive Research: The study points out a lack of systematic reviews and focused research on the treatment and prevention of elbow injuries in handball goalkeepers.

The review concludes that despite the low rates of elbow injuries compared to other injuries in handball, they significantly affect goalkeepers due to the unique mechanics of their role. There is a need for more focused studies and randomized clinical trials to evaluate interventions for treating and preventing ‘handball goalie’s elbow.’ This study offers valuable insights into the specific risks faced by handball goalkeepers and underscores the need for targeted prevention and treatment strategies.

“Subjective Perception of Pain Characteristics in Team Handball Players with ‘Goalie’s Elbow’: Effects of a Muscle Strengthening Protocol” – Mavropoulou Aggeliki, Hatzimanouil Dimitrios, Lazaridis Savvas, Iconomou Charalabos, Papadopoulos Konstantinos (2012).

The study investigated the impact of a muscle strengthening program on handball goalkeepers suffering from ‘goalie’s elbow’, a condition characterized by frequent elbow injuries often leading to an absence from the sport.

Objective: To evaluate the effects of a muscle strengthening program on symptoms of ‘handball goalie’s elbow’, particularly focusing on pain, subjective sense of elbow deterioration, and competitive consequences like training absence​​.

Participants: Sixteen top-level Greek male handball goalkeepers, all of whom had experienced elbow pain in the past​​.

Methodology: The goalkeepers were divided into an experimental group (n=8), which underwent a three-month strengthening program, and a control group (n=8). Measurements included subjective sense of injury deterioration, pain intensity, and goalkeepers’ absence from training. These were assessed at the beginning of the season, mid-season (after three months), and at the season’s end (after six months)​​.

Training Program – Design: The strengthening program aimed to develop maximal strength of upper arms, including exercises for elbow flexion and extension, wrist flexion and extension, and forearm pronation and supination. Training sessions were held three times a week, focusing on both eccentric and concentric muscle contractions​​.

Results – Pain Intensity: There was a significant decrease in pain intensity in the experimental group (p = .018), while no significant change was observed in the control group​​.

Subjective Sense of Elbow Deterioration: Although there was a tendency for decreased elbow deterioration in the experimental group and an increase in the control group, these changes were not statistically significant​​.

Absence from Training: The experimental group showed a significant decrease in absence from training and games (p = .001), indicating an improvement in their ability to participate in sport activities​​.

The study highlighted the importance of muscle strengthening in managing ‘goalie’s elbow’. While there was no significant change in the subjective sense of elbow deterioration, the decrease in pain intensity and absence from training suggests the effectiveness of the muscle strengthening program. The study recommends such programs as a preventive and management strategy for elbow injuries in handball goalkeepers. It also suggests that a longer duration of training might yield more significant results​​.

In summary, the study supports the implementation of a muscle strengthening regimen to alleviate pain and reduce training absences for handball goalkeepers suffering from ‘goalie’s elbow’.

How To Minimize Elbow Injuries in Handball Goalkeepers

Minimizing elbow injuries in handball goalkeepers is a crucial aspect of ensuring their longevity and effectiveness in the sport. Based on the available research, minimizing elbow injuries in handball goalkeepers involves:

Proper Warm-Up and Dynamic Stretching: Before training or a game, it’s essential to have a comprehensive warm-up routine. This should include dynamic stretches focusing on the arms, especially the elbows, to prepare them for the movements they’ll be performing.

Strength Training: Implementing specific strength training exercises for the muscles around the elbow to enhance stability and reduce injury risk. Exercises that target the forearm, biceps, triceps, and shoulder muscles are beneficial. Remember, the goal is to build balanced muscle strength to support the elbow joint.

Proper Technique Training: Teaching goalkeepers the correct arm positioning and movement to distribute impact evenly and reduce stress on the elbow joint is extremely important. Proper save techniques and arm reactions can significantly reduce the stress placed on the elbow. As a coach, you need to make sure that goalkeepers are trained in using their entire body effectively to minimize the load on their elbows.

Adequate Rest and Recovery: Ensuring goalkeepers get enough rest and follow a balanced training schedule to prevent overuse injuries.

Use of Protective Gear: Elbow sleeves, braces, pads or guards can offer additional support and protection for impact absorption, especially during intense training sessions or matches.

Flexibility and Mobility Training: Incorporating regular stretching and mobility exercises to maintain elbow joint health.

Education and Awareness: Educating goalkeepers and goalkeeper coaches about the risks and signs of elbow injuries for early detection and treatment is crucial.

Regular Physiotherapy and Massage: Regular sessions with a physiotherapist or masseuse can help maintain muscle health and joint flexibility, reducing the risk of elbow injuries in handball goalkeepers.

Adequate Rest and Recovery: Overuse injuries are very common in sports like handball. Ensure you’re your goalkeepers get enough rest between training sessions and games to allow their bodies, including their elbows (especially when they are already injured), to recover.

Hydration and Nutrition: Adequate hydration and a balanced diet play a significant role in muscle and joint health. Ensure that the goalkeeper’s nutrition supports their physical demands.

Prompt Attention to Pain or Discomfort: If a goalkeeper experiences elbow pain or discomfort, it’s important to address it immediately. Early intervention can prevent more serious injuries. But this is very often not the case, because somehow in handball we still believe in “being tough”, pushing through, and playing with pain.

Awareness and Emotional Well-Being: Encouraging goalkeepers to be mindful of their bodies and to communicate openly with their coaches about any discomfort can be as crucial as the physical training itself. Balancing the physical aspects of injury prevention with an awareness of the mental and emotional well-being of the goalkeepers can create a more comprehensive and effective training environment.

This article offers practical advice for coaches and goalkeepers, aiming to foster a safer playing environment and enhance handball goalkeeper career longevity. I hope that this article is helpful to you and that you will feel more empowered with the newfound knowledge about elbow injuries in handball goalkeeping.

Let me know in comments, or via email if you have any questions, doubts, recommendations, or additional tips about elbow injuries in handball goalkeepers?

Remember – sharing is caring! If we all share our knowledge and useful information – more goalkeeper coaches and goalkeepers will benefit! And for me, that is the main motivation for writing all articles here on my website!

Keep up the great work in your ever evolving coaching career!

References

• Hyperextension trauma to the elbow: radiological and ultrasonographic evaluation in handball goalkeepers – N Popovic, R Lemaire (2002).
• Is the ulnar nerve damaged in ‘handball goalie’s elbow’? – IR Rise, G Dhaenens, S Tyrdal (2001).
• Direction of the load on the elbow of the ball blocking handball goalie – Umut Akgun, Mustafa Karahan, Cetin Tiryaki, Bulent Erol, Lars Engebretsen (2007).
• Elbow Injury in Handball: Overuse Injuries – Nebojsa Popovic (2018).
• Subjective perception of pain characteristics in team handball players with “goalie”s elbow”: effects of a muscle strengthening protocol – Mavropoulou Aggeliki, Hatzimanouil Dimitrios, Lazaridis Savvas, Iconomou Charalabos, Papadopoulos Konstantinos (2012).
• Handball goalie’s elbow syndrome: A systematic review – Matheus Oliveira de Almeida, Aline Carla Araújo Carvalho, Augusto Luis Boschi Riboldi, Jose Vélez Uribe (2014)
• High prevalence of elbow problems among goalkeepers in European team handball – ‘handball goalie’s elbow’ – S Tyrdal, R Bahr (1996)

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