On this episode of the Healthy Wealthy and Smart Podcast, I welcome Martin Asker on the show to discuss a handball injury case study. Martin is a sports medicine therapist specialised in shoulders and biomechanics. He has worked with different elite European handball teams since 2000 and for the last 12 years with a special focus on youth and adolescent elite players. He works part time as clinical lead at a multidisciplinary sports medicine clinic in Stockholm, Sweden mainly seeing shoulder related problems and part time as a PhD-candidate at the Musculoskeletal & Sports injury Epidemiology Center (MUSIC) at Karolinska Institutet in Stockholm.
In this episode, we discuss:
-Teasing out subjective findings and when to refer for imaging
-How the acute:chronic workload ratio impacts young handball athletes risk for injury
-Essential and nonessential objective measurements that are relevant for return to sport
-The importance of strength and conditioning in end ranges of motion and return to throwing programming
-And so much more!
Understanding the motivation behind why a youth athlete seeks care can help guide your patient education because, “They don’t see you when they are in pain, they see you when they can’t perform anymore.”
The acute:chronic workload ratio is an important consideration for injury management as Martin stresses, “Being an on and off, on and off player, it won’t do anymore.”
Your clinical tests and measures need to be robust enough to translate to the sport setting because, “What we measure on the bench does not correlate to what happens when they are throwing.”
Framing your language surrounding a shoulder health maintenance program as being a performance enhancer will help improve compliance as Martin has found that, “They care, but they care more about the performance than injury prevention.”
For more information on Martin:
Martin is a sports medicine therapist specialised in shoulders and biomechanics. He has worked with different elite European handball teams since 2000 and for the last 12 years with a special focus on youth and adolescent elite players. He works part time as clinical lead at a multidisciplinary sports medicine clinic in Stockholm, Sweden mainly seeing shoulder related problems and part time as a PhD-candidate at the Musculoskeletal & Sports injury Epidemiology Center (MUSIC) at Karolinska Institutet in Stockholm. The overall aim of his PhD project is to deepen the knowledge in shoulder function in elite adolescent handball players and the specific aim is to investigate risk factors for, and prevention of shoulder injuries in such population. He also has a special interest throwing biomechanics and its relationship to throwing performance and injuries. Martin is also a board member of the Medical Committee of the Swedish Handball Federation and part of the medical team of the Swedish youth-16 national handball team.
Resources discussed on this show:
Measuring shoulder strength in overhead athletes and normative values:
Cools AM, Vanderstukken F, Vereecken F et al. Eccentric and isometric shoulder rotator cuff strength testing using a hand-held dynamometer: reference values for overhead athletes. Knee Surg Sports Traumatol Arthrosc 2015 Aug 21 [Epub ahead of print].
Risk factors for shoulder pain in young throwers:
Matsuura T, Iwame T, Suzue N, et al. Risk factors for shoulder and elbow pain in youth baseball players. Phys Sportsmed 2017;45(2):140-4.
Moller M, Nielsen RO, Attermann J, et al. Handball load and shoulder injury rate: a 31-week cohort study of 679 elite youth handball players. Br J Sports Med 2017;51(4):231-7.
Asker M, Brooke HL, Waldén M, et al. Risk factors for, and prevention of, shoulder injuries
in overhead sports: a systematic review with best evidence synthesis. Br J Sports Med Epub ahead of print: doi:10.1136/bjsports-2017-098254
Prevalence of shoulder problemes in adolescent throwers
Asker M, Holm L.W, Källberg H et al. Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts. Knee Surg Sports Traumatol Arthrosc. 2018;10. doi: 10.1007/s00167-018-4857-y. [Epub ahead of print]
Warm-up program for handball players:
Andersson SH, Bahr R, Clarsen B, et al. Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players. Br J Sports Med Published Online Frist: 16 June 2016. doi: 10.1136/bjsports-2016-096226.
Interpreating shoulder ROM:
Whiteley R, Ginn K, Nicholson L et al. Indirect ultrasound measurement of humeral torsion in adolescent baseball players and non-athletic adults: reli-ability and significance. J Sci Med Sport 2006;9:310–318.
Medicine ball training in throwers:
Effects of Six Weeks of Medicine Ball Training on Throwing Velocity, Throwing Precision, and Isokinetic Strength of Shoulder Rotators in Female Handball Players. J Strength Cond Res. 2015;29:1904-14.
Monitoring workload in throwers:
Black GM, Gabbett TJ, Cole MH, Naughton G. Monitoring Workload in Throwing-Dominant Sports: A Systematic Review. Sports Med. 2016;46:1503-16.
Shoulder examination – “specific” tests:
Hegedus EJ, Goode AP, Cook CE et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med 2012;46:964–78.
Normal findings during the inspection of an overhead athlete:
Ribeiro A, Pascoal AG. Resting scapular posture in healthy overhead throwing athletes. Man Ther. 2013;18:547-50.
Hosseinimehr SH, Anbarian M, Norasteh AA, Fardmal J, Khosravi MT. The comparison of scapular upward rotation and scapulohumeral rhythm between dominant and non-dominant shoulder in male overhead athletes and non-athletes. Man Ther. 2015;20:758-62.
Textbook in handball medicine
Laver, L., Landreau, P., Seil, R., Popovic, N. (Eds.) Handball Sports Medicine. Basic Science, Injury Management and Return to Sport. Springer 2018. https://www.springer.com/us/book/9783662558911
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