Prevalence, incidence and burden of health problems across playing positions in elite male handball players: a 45-week prospective cohort study

Objectives To describe the prevalence, incidence and burden of injuries and illnesses, including their patterns (mechanisms, affected body parts/organ systems) across playing positions (wing, back, line and goalkeeper) in elite adult male handball players. Methods The Slovenian version of the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2-SLO) was used to record health problems (HP) weekly during the 45-week handball season 2022/23. Results The study included 189 athletes (age: 23.3±4.4 years). With a weekly response rate of 93%, the mean weekly prevalence of HP was 13.3% (95% CI: 12% to 15%). The overall incidence was 2.2 HP per player per year (95% CI: 1.9 to 2.4), with a cumulative 3318 days lost and a mean time loss of 10.7 days per problem. Acute injuries represented the highest prevalence, incidence and more than 4× greater burden than overuse injuries and illnesses. The knee was the most frequently injured site for both acute and overuse injuries. For acute injuries, the ankle was the second most affected site, while the pelvis/lower back and shoulder were common in overuse injuries. Respiratory illnesses comprised 48% of all illnesses. Wings had the highest prevalence (17%), while backs exhibited the highest incidence (0.99 HP per player per year 95% CI 0.84-1.17), and goalkeepers faced the longest time-loss per HP. Conclusion Our findings emphasise the need for position-specific medical care and prevention programmes, targeting knee, ankle, pelvis/lower back, shoulder and respiratory tract. Wings and backs require particular attention due to their high prevalence and burden, while goalkeepers need specialised rehabilitation protocols.