Shoulder Injury Prevention in Adolescent Handball Players Based on Scandinavian Protocols

NCT07146243 | Completed

• 1 other identifier: HBSP-HU-CRCT25
• Study Type: interventional
• Target: 137
• Locations: 1 country
• Sites: 1

Brief Summary

This cluster-randomised controlled trial will evaluate the effects of two internationally recognised shoulder injury prevention programmes - the Swedish Shoulder Control programme and the Norwegian Oslo Sports Trauma Research Center Shoulder Injury Prevention programme - on shoulder function, scapular control, and injury incidence in Hungarian adolescent handball players (U16-U20). Six elite-level teams (3 male, 3 female) from a single handball academy will be randomised by cluster into two intervention arms for an 18-week intervention period. Primary outcomes are changes in objective shoulder function tests; secondary outcomes include self-reported function and weekly injury monitoring.

Conditions

Injury Prevention; Shoulder Injuries

Keywords

overhead sport; handball; shoulder prevention; injury prevention

Outcome Measures

Primary Outcomes (4)

• Scapular Dyskinesis Test (SDT) - classification during flexion and abduction

  Description: Standard Kibler/McClure SDT with five consecutive repetitions of active shoulder flexion and abduction at a metronome cadence. Participants hold hand weights scaled to body mass: 1.5 kg if body mass \<68.1 kg, and 2.5 kg if ≥68.1 kg. Testing is video-recorded. Two trained assessors, rate each shoulder from the videos as none / subtle / obvious dyskinesis for each plane. Primary outcome: proportion with any dyskinesis (subtle+obvious) by plane; secondary: shift in severity category from baseline. Lower prevalence/severity indicates improvement. Rater reliability plan: Inter-rater agreement will be quantified using weighted Cohen's kappa per plane.

  Baseline and 18 weeks

• Change in Y Balance Test - Upper Quarter (composite reach, % limb length)

  Description: YBT-UQ performed for each arm in three directions (medial, inferolateral, superolateral), three valid trials per direction. Composite reach score = (sum of the 3 maximal reaches / limb length) × 100. Limb length = C7 to tip of middle finger. Primary score is the composite % per arm; higher is better.

  Baseline and 18 weeks

• Shoulder proprioception error in external and internal rotation (absolute error, degrees)

  Joint position sense was assessed in supine position using a wrist-mounted digital angle gauge. For external rotation testing, the participant actively moved the arm to their individual full external rotation in 90° abduction. The target angle was then calculated using the formula: (Full ER in degrees-90)/2+90 This yields a mid-range position between neutral and the individual's maximal external rotation. First, with eyes open, then vision was occluded using a towel, and the procedure was repeated three times per limb: the assessor passively positioned the arm at the target, returned it to vertical, and the participant attempted to reposition it to the same angle without visual feedback. The absolute repositioning error (in degrees) between the target and reproduced positions was recorded for each trial, then averaged across the three trials per limb. Internal rotation target angle calculated as: 90-(90-Full IR in degrees)/2 Lower error values indicate better proprioceptive acuity

  Baseline and 18 weeks

• OSTRC-O Shoulder Module severity score (0-100)

  Weekly Oslo Sports Trauma Research Center Overuse Injury Questionnaire (4 items). Composite 0-100 severity (higher = worse). Report mean weekly severity, prevalence of any problem (non-minimum response on any item), and prevalence of substantial problem (moderate/severe reduction in training/performance or complete inability to participate), as per standard methodology.

  Weekly for 18 Weeks

Secondary Outcomes (9)

• Change in CKCUEST performance (touch count)

  Baseline and 18 weeks

• Lateral Scapular Slide Test (LSST) total asymmetry score (3 positions)

  Baseline and 18 weeks

• Modified LSST (mLSST; 2 kg and 4 kg)

  Baseline and 18 weeks

• Change in isometric shoulder strength - external and internal rotation

  Baseline and 18 weeks

• Training/match exposure (minutes per week)

  Weekly for 18 Weeks

Study Arms (2)

Swedish Shoulder Control Programme

EXPERIMENTAL

Female U18, Male U16 and Male U20 perform the physiotherapy component of the Swedish Shoulder Control Programme, excluding the throwing block, as it is designed for the off-season and the programme is implemented during the competitive season. Sessions are supervised by two physiotherapists, performed twice per week for a total of 18 weeks, before training sessions, and last approximately 15 minutes each.

Behavioral: Swedish Shoulder Control Programme

Norwegian OSTRC Shoulder Injury Prevention Programme

EXPERIMENTAL

Female U16, Female U20 and Male U18 perform the Norwegian Shoulder Injury Prevention Programme (OSTRC). This evidence-based programme includes warm-up and strengthening exercises targeting the shoulder complex, designed to reduce the risk of shoulder injuries. Sessions are supervised by two physiotherapists, performed twice per week for a total of 18 weeks, before training sessions, and last approximately 15 minutes each.

Behavioral: Norwegian OSTRC Shoulder Injury Prevention Programme

Interventions

Swedish Shoulder Control Programme BEHAVIORAL

An evidence-based warm-up and strengthening routine developed for handball players to reduce the risk of shoulder injuries. The physiotherapy component includes exercises for scapular control, rotator cuff strength, and shoulder mobility. The throwing block is excluded in this trial, as it is designed for the off-season and the programme is implemented during the competitive season. Exercises are performed twice per week before training sessions, last about 15 minutes, and are supervised by two physiotherapists.

Also known as: Swedish Shoulder Control

Swedish Shoulder Control Programme

Norwegian OSTRC Shoulder Injury Prevention Programme BEHAVIORAL

An evidence-based warm-up and strengthening routine developed for handball players to reduce the risk of shoulder injuries. The programme focuses on exercises for scapular control, rotator cuff strength, and functional shoulder stability. Exercises are performed twice per week before training sessions, last about 15 minutes, and are supervised by two physiotherapists.

Also known as: OSTRC Shoulder Injury Prevention Programme, Oslo Sports Trauma Research Centre Shoulder Programme

Norwegian OSTRC Shoulder Injury Prevention Programme

Eligibility Criteria

• Age: 13 Years - 19 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Registered competitive handball players from the participating academy team (U16, U18, U20; male and female).
• Age between 13 and 19 years at baseline assessment.
• Currently participating in regular handball training and matches (minimum 3 training sessions per week).
• Member of a team assigned to the intervention for the full study period.
• Provided written informed consent (and parental consent for participants under 18 years).

You may not qualify if:

• Acute shoulder injury at baseline preventing training
• Shoulder surgery in last 6 months
• Contraindication to resistance training
• Concurrent enrolment in another interventional study targeting the shoulder/upper limb.
• Refusal of informed consent (and parental consent for participants \<18 years).

Sponsors & Collaborators

• Semmelweis University: lead

Study Sites (1)

Handball Academy

Budapest, Hungary

Location

Related Publications (4)

• Asker M, Hagglund M, Walden M, Kallberg H, Skillgate E. The Effect of Shoulder and Knee Exercise Programmes on the Risk of Shoulder and Knee Injuries in Adolescent Elite Handball Players: A Three-Armed Cluster Randomised Controlled Trial. Sports Med Open. 2022 Jul 14;8(1):91. doi: 10.1186/s40798-022-00478-z.

  PMID: 35834139 BACKGROUND

• Tooth C, Gofflot A, Schwartz C, Croisier JL, Beaudart C, Bruyere O, Forthomme B. Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A Systematic Review. Sports Health. 2020 Sep/Oct;12(5):478-487. doi: 10.1177/1941738120931764. Epub 2020 Aug 6.

  PMID: 32758080 BACKGROUND

• Andersson SH, Bahr R, Clarsen B, Myklebust G. Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players. Br J Sports Med. 2017 Jul;51(14):1073-1080. doi: 10.1136/bjsports-2016-096226. Epub 2016 Jun 16.

  PMID: 27313171 BACKGROUND

• Clarsen B, Myklebust G, Bahr R. Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire. Br J Sports Med. 2013 May;47(8):495-502. doi: 10.1136/bjsports-2012-091524. Epub 2012 Oct 4.

  PMID: 23038786 BACKGROUND

MeSH Terms

Conditions

Shoulder Injuries

Condition Hierarchy (Ancestors)

Wounds and Injuries

Study Officials

• Attila Pavlik, MD, PhD

  Department of Sports Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Due to the team-based cluster randomization and the nature of the intervention, masking of participants, coaches, and outcome assessors is not feasible. Entire teams are assigned to either the Swedish or the Norwegian shoulder injury prevention programme, making the intervention easily identifiable. The physiotherapists conducting the physical performance tests are aware of team allocation because they are also involved in the organization and supervision of the intervention sessions. However, the primary outcomes are objective, performance-based measures (e.g., CKCUEST, Y Balance Test-Upper Quarter, LSST, SDT, shoulder proprioception testing), which substantially reduces the potential risk of measurement bias.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Two-armed Cluster-Randomised Controlled Trial

Study Record Dates

• First Submitted: August 13, 2025
• First Posted: August 28, 2025
• Study Start: August 1, 2025
• Primary Completion: December 22, 2025
• Study Completion: December 22, 2025
• Last Updated: January 6, 2026

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

HU (1)