DOES PLAYING HANDBALL REDUCE THE INTERNAL HIP ROTATION? CAUSES, CONSEQUENCES AND PREVENTION 1-6/12

Research conducted on more than 200 men’s and women’s handball players (senior and youth categories) by our coaches Krešimir Pažin and Robert Papić

“I would rather know what sort of person has a disease

than what sort of disease a person has.”

– Hippocrates –

Introduction

The hip joint is a spherical joint consisting of the head of the femur (caput femoris) and the cup of the pelvis. The bodies of the pubic, iliac, and sciatic bones form the acetabulum. Movements in the joint can be divided on the basis of 3 main axes: transverse axis – flexion movements (regular range of motion 130° – 140°) and extensions (10°), sagittal axis – abduction movements (30° – 45°) and adductions (20° – 30°) and vertical axis – internal rotations (36°) and external rotations (13°).

Internal and external rotation increase significantly with hip and knee flexion of 90°, when internal rotation is 40 to 50° and external rotation is 30 to 45°.

(Uršula Fabijanić, Treatment of Hip Dysplasia in Adulthood, Zagreb, 2017). 

20 or 30 years ago, children and young handball players spent a few hours a day in free play, mostly outdoors, when they were growing up.

They were engaged in activities which were varied (climbing, jumping, crawling, falling, catching etc.) and mostly low or medium in intensity with an extremely high number of repetitions if we take into account the hours spent in the game through a period of growing up of about 15 years.

As what we do, in addition to genetic predispositions, shapes our body, such a wide range of different movements allows the body to adapt to different requirements and thus independently adjust the imbalances in the body. 

Today, due to a sedentary lifestyle conditioned by cultural change,

most children do not have the opportunity to go through this type of adjustment.

If we add to this the fact that children are nowadays involved in organised sports 7-8 years earlier than 20 years ago (today at the age of 6, and sometimes at 13 or 14), the ratio of the total number of hours spent in free play and handball changes significantly on the handball side.

As a result, young athletes are more susceptible to morphological and functional changes due to specific handball requirements.

Between stimulus and response, there is a space.

In that space lies our freedom and our power to choose our response.

In our response lies our growth and our happiness.

– Viktor E. Frankl –

Handball is a game in which the movements performed by a player are very diverse, but it is predominantly a unilateral sport in which some movements are repeated much more than others (passing the ball and shooting if we observe the arms and torso, and stopping the maximum speed and changing direction if we observe the legs and torso) and is therefore ideal for creating imbalances in the body. 

Since the right hand is dominant for most players,

the left foot is used as a foothold for most movements.

Jump shots, landings, changes in the direction of movement, penetration and feints make up the largest part of the movement in the attack, and in defensive actions defenders most often use the left diagonal position because they most often stop right-handers. 

All of the above movements begin by stopping the body.

As this stopping is generally performed unilaterally on the left leg and the knee does not have the freedom of movement of rotation around the transverse axis, in order for the body to remain stable rotation in the ankle and internal rotation of the hip must be prevented.

Effective stopping requires the body to adapt to the ability to create large forces in the shortest possible time. With a long process of strengthening the muscles and shortening the tendons, the body becomes more efficient in shortening the movement of the internal hip rotation.

However, excessive use creates a physical imbalance that leads to an increased susceptibility of injuries, syndromes and impingement to the left hip.

When you are young, you have the face your parents gave you.

After you are forty, you have the face you deserve.”

– Edwin M. Stanton –

We define imbalance as the ability of the body to disable its function in the middle of an unnatural position and use of one part of the system, therefore the other part of the same system adapts and takes on a role that is not its primary function.

Frequent repetition of this action increases the imbalance and impairs the function of the system as a whole. If the joint does not have natural freedom of movement, if the muscle is often in spasm or if the tendon has reduced elasticity, the body will compensate for these deficiencies by adjusting, but only in extremely rare cases these compensations will successfully compensate for the efficiency which the athlete would have had in natural balance.

In addition to reducing system efficiency,

body imbalances increase the risk of injury.

M. L’Hermete et al. in their 2006 paper demonstrate an increased number of cases of hip osteoarthritis in retired professional handball players compared to the general population (control group).

In support of the above theses is an indicator that the incidence of osteoarthritis is higher on the left hip than on the right.

On 20 former handball players who made up the experimental group and 39 people of the same age who did not play any sport professionally, the author finds that as many as 60% of respondents from the experimental group have osteoarthritis on one or both hips.

Compared with the experimental group, in the control group in 13% of subjects found forms of osteoarthritis.

Also, the internal hip rotation in the experimental group is significantly lower: by 7 degrees,

The data we obtained by measuring the senior team in our club (2nd level of national competition) confirms the thesis of a significant reduction in the ability of internal rotation of the hips from the above research.

Vad, V., B., et al. in their 2003 work on 100 professional tennis players found that due to the large number of actions in which a tennis player dominantly pivots around one leg when performing elements (a movement that is almost the same as dominant handball movements: passing the ball, penetration and shooting), tennis players have a significantly lower internal rotation of the dominant hip compared to the non-dominant hip.

The author finds a difference of 7.2 degrees

between the internal rotation of the dominant hip

in favour of a group that has no lower back problems.

On a non-dominant hip, this difference is only 3 degrees. Looking within the group, the symptomatic group has a difference between the dominant and non-dominant hip as much as 15.5 degrees in favour of the non-dominant hip. While in the group that has no problems with the lower back, the difference is 7.5 degrees. Thus, the author concludes a correlation between reduced internal hip rotation and lower back problems.

Given the above, and a review of the sources and research indicating an association between lack of internal hip rotation and anterior cruciate ligament injuries, lower back problems (Vad, V., B., et al. Hip and shoulder internal rotation range of motion deficits in professional tennis players, 2003) occurrence of  femoroacetabular impingement (Kapron L., A., et al., Internal Rotation Is Correlated to Radiographic Findings of Cam Femoroacetabular Impingement in Collegiate Football Players, 2012) and hip osteoarthritis (L’Hermette, M., Hip passive range of motion and frequency of radiographic hip osteoarthritis in former elite handball players, 2006)

is a necessary step to determine when and to what extent

playing handball begins to create imbalances in the body

and to what extent it is possible to protect players from injury.

Methods of work

Two groups of boys aged 12 to 14 who train 450 minutes of training in 5 training days (Monday to Friday).

The total number of subjects was 27, of which 13 boys in the experimental group and 14 in the control group. In the last 4 years, the experimental group has conducted an average of 30% of training (about 100 minutes per week) so-called corrective training contents in training, while the control group did not carry out corrective contents as planned for 4 years, but handball contents were dominant. 

Data were collected using internal hip rotation measurements performed by the same meter for both groups.

The respondent lay on his stomach with his hands placed under his chin. The legs were stretched at the hip, while the measured leg was at a 90-degree knee flexion. At the surveyor’s signal, the subject let his foot descend with the help of gravity to the outside in relation to the body. In order to avoid compensatory rotation of the hips and lumbar back, the respondent’s buttocks were pressed against the ground.

The angle was measured using the My ROM application, Dr. Carlos Balsalobre-Fernandez, PhD, on an Apple iPad Air 3, California.

The device was placed on the outside of the lower leg and followed the leg to the end position (internal rotation of the hip).

Since the software automatically sets the left foot as the first to be tested, the test was conducted in this way. A T-test for independent samples was used to verify the statistical significance of the data of the two groups.

Results and Discussion

Descriptive statistics showed a statistically significant difference between the arithmetic means of the experimental and control groups (T = 2.26). As the t-value is in the positive sign, it is confirmed that the experimental group has a significantly higher value in the measurements compared to the control group. 

Table 1 shows the measurement results of each player of the experimental and control groups for the left and right hips. 

Comparing the results of both groups with the criteria stated in the introduction, we conclude that the control group does not have a sufficient range of movement in any hip, and this range of movement is significantly smaller compared to the experimental group.  Previous research has been conducted on the adults and the results show around 35 degrees of internal hip rotation.

As children aged 14 and younger, especially in the male population, have not yet reached the plateau of growth and development of the body, and their muscle and connective tissues are more elastic and joint tissues more mobile, the expected range of motion in the hip in the respondents should be greater than in adults.

Clubs participated in conducting the research: RK ”Metalac”, RK ”Lokomotiva” and RK ”Maksimir”

and the prevention program was made in collaboration with ”Prirodan Pokret”