The high incidence of ACL injuries in Norwegian female team handball is a considerable problem for the sport. Lots of the best players get injured and they get a long break off from handball if they ever come back. The ACL injury is expensive for both players and the community. There is a certain need for prevention of these injuries. New research has shown that the proprioceptive ability and the ability to protect a joint against sudden changes in position can be trained. An Italian study of the incidence of ACL injuries in soccer players showed promising results with their proprioceptive intervention. The players who trained the proprioceptive program reduced the risk of getting an ACL injury with almost 80% compared with the players who did not do this proprioceptive training. We want to try out a proprioceptive intervention in Norwegian female team handball. The aim of the study is to assess the ability of a proprioceptive training program, in combination with some technical changes, to reduce the incidence of ACL injuries in female team handball players. Methods: First we did a registration of new ACL injuries in the three upper divisions in Norwegian female team handball during the 1998-99 season (1000 players). Then we worked out a five phase training program, which consisted of different proprioceptive exercises on 1) the floor, 2) a wobble board and 3) a balance-mat. This intervention was carried out in the beginning of the season 1999-2000. Each player should carry out the exercises 2-3 times each week in a 5-7 weeks period. During the season they should perform the program once a week. In the instruction of the players we focused on the knee position in the plant and cut-movement and a two-foot landing after a jump shot, since these are the two main injury mechanisms. Complience with the exercise program was recorded during the season. On the backgroud of the feedback from this study we wanted to continue with a new intervention, with some changes of the program and a closer follow-up from physical therapists. About 60 physiotherapists have been on a seminar and they started the intervention in the clubs during august 2000, and finished the intervention in june 2001.
There were 29 ACL injuries during the control season compared with 23 injuries during the intervention season I (OR: 0.87; P=0.62), and 17 injuries during the intervention season II (OR: 0.64; P=0.15). In the elite division there were 13 injuries during the control season and six injuries during the intervention season I (OR: 0.51; P=0.17), and five injuries in intervention season II (OR: 0.37; P=0.06). Of the 23 players injured during the intervention period I, five of the players had performed the program as prescribed, while seven of 17 injured players in intervention period II had followed the program as prescribed. Among the elite players who had performed the ACL injury prevention program we found a significant reduction in the number of injuries (OR: 0.06; P=0.01). Conclusion: The study shows that ACL injuries among elite female team handball players can be prevented with specific balance training if they perform the program as prescribed. It seems to be a further potential for reduction of ACL injuries through better compliance with the training program.