Oslo Sports Trauma Research Center

Intoduction

Why are female handball players so prone to ACL tears? Is there anything we can do to avoid these injuries? PhD-candidate and medical student Eirik Kristianslund is searching for an answer.

More than 700 elite players participate 

The anterior cruciate ligament (ACL) tears very suddenly - and without any warning.

Generally, the injury occurs in the absence of physical contact with an opponent, often during cut and plant movements, which are typical movement patterns in both handball and soccer; movements the player has made on innumerous occasions before. 

Females have a 3-5 times higher risk to tear an ACL compared to males competing in the same sport.

Approximately 4% of all players in the elite female handball league will tear their ACL each year.

PhD-candidate and medical student Eirik Kristianslund (picture) from the Oslo Sports Trauma Research Center and the University of Oslo is searching for an answer why we see these gender differences.  

Together with his colleagues, Eirik has tested all Norwegian female elite handball players since 2007. This unique research project, which also includes the best Norwegian female soccer players, draws a lot of attention worldwide.

Half of the ACL injuries during cut & plant

... typical for team sports.

Kristianslund explains the gender difference in ACL risk with the way male athletes perform:

- Men's natural movement performance put less strain on the cruciate ligament. Women have poorer ability to control their knees, and have therefore more difficulties to keep their knees over their toes during these movements.

In many cut and plants or one-leg landings, knees of female players collapse and fall inwards, putting a lot of strain to the ACL, and in worst case, the cruciate ligament ruptures.

Find the secret

... of loading the ACL without risk

As the ACL mostly tears in a cut and plant, it is of major interest to find that motion pattern that loads the ACL less.

All players have therefore been asked to replicate their match typical cut and plant motion patterns in a sophisticated biomechanical lab at the Norwegian School of Sport Sciences.

Players´ knee kinematics (angles) and moments (loads) were registered. In addition, all players performed a drop-jump from 30cm hight.

An ACL injury prevents a player from return to sport for 6-12 months. A long and tough rehabilitation period should be a reason alone to put more focus on injury prevention!

- We test how a player is jumping and cutting to determine her risk for incurring an injury. As many injuries occur in a cut & plant, and we are therefore interested in the relationship between jumps and cuts", explains Kristianslund.

- By identifying the techniques that load the knee as little as possible, we can give advices on exercises and technique training that we believe will reduce the risk for injury", he adds.

Effektive prevention

In this project, players are measured for anatomical, strength, balance, motion, and other neuromuscular risk factors, aimed to identify those players with the highest risk for an ACL injury.

... and research is easy to translate to the sports field.

– This is what we like best with our research. Our findings can easily be incorporated into sports performance and training, Kristianslund comments.

ACL injuries can be prevented!

Balance, strength and other functional plyometric training can reduce ACL injury risk by half - regardless of sport. This is well documented in the scientific literature, but prevention training has to be done!

It is of importance - also for the acceptance of such training - that the exercises are adjusted to the sport specific movement patterns.

– Incorporate familiar exercises into regular warm-up will make a big difference for the athlete, Kristianslund says.

Read more about prevention training on SKADEFRI.NO (in Norwegian, but watch out for all videos).

These pictures show you all the varied test stations the female handball and soccer players have to go through.