1. No category

08-04-2014
Forskning i idrætsmedicin
Korsbåndsskader i håndbold –
hvor galt står det til?
Jesper Bencke, cand.scient, PhD
Laboratorieleder
Ganganalyse-Laboratoriet
Ortopædkirurgisk Afdeling
Hvidovre Hospital
[email protected]
Van Mechelen et al, 1992
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Tidligere elitefodboldspiller; alder 32 ÅR
• År 1994: ‘Delvis’ ACL overrivning,
menisk læsion, MCL læsion => MCL
rekonstruktion => genopstarter fodbold
• År 1996: Arthroskopi pga. smerter
og knæløshed
Cathrine Paaske
15 procent invalid
45
• År 1997: Arthroskopi pga. smerter
og knæløshed => stopper fodbold
aktivitet
• År 2000: Arthroskopi => ACL
overrivning og menisk læsion
• År 2002: Arthroskopi => ACL
rekonstruktion, delvis resektion af
lateral menisk, reinsertion af medial
menisk
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Nationalt ACL register (20052007)
CMJ (cm)
• År 1999: Arthroskopi => ACL
rekonstruktion
40
35
30
25
Efter
Slut
styrkeefterår træning
1999
29 cm
31 cm
Slut
forår
2000
36 cm
TD test
2005
40 cm
20
5
0
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Long term consequences
Ewa Roos (2005)
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
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08-04-2014
Korsbåndsskadens empiri
Kvindelige idrætsudøvere har en 4-8 gang
større sandsynlighed for at pådrage sig en ACL
skade sammenlignet med deres mandlige
kollegaer indenfor samme idrætsgren.
(Malinzak et al. 2001, Ostenberg & Roos 2000, Myklebust et al. 1997)
Incidens raten for ACL skade => 0.14-0.31 ACL
skader/1000 time for kvindelige elitehåndboldspillere =>1-2 spiller/hold/spilsæson
(Myklebust et al. 1998, Myklebust et al. 2003)
Incidens raten for ACL skade => 0.12 ACL
skader/1000 time for kvindelige
elitefodboldspillere =>1 spiller/hold/spilsæson.
Lind et al. 2008
(Le Gall et al. 2008)
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Korsbåndsskadens empiri
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Korsbåndsskadens empiri
• I håndbold er retningsskiftet
(fodfinten) den mest risikable
bevægelse i forh.t. risiko for
korsbåndsskade. Strand et al, 1990.
• Mange forskellige skadesmekanismer – nogle veldefinerede
og andre stadig hypotetiske.
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Korsbåndsskadens empiri
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Skal disse piger fortsætte
med håndbold?
• 75 – 90 % af alle korsbåndsskader
sker uden kontakt med
modstanderen.
Strand et al, 1990.
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
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08-04-2014
Projekt formål – ACL screening
Primary investigator: Mette Zebis, Jesper Bencke
Korsbåndsskader i håndbold biomekaniske årsager og
forebyggelse
Jesper Bencke, cand.scient, PhD
Laboratorieleder
Ganganalyse-Laboratoriet
Ortopædkirurgisk Afdeling
Hvidovre Hospital
[email protected]
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Forskning i idrætsmedicin
• Vi håber, at have et redskab til mere præcis vurdering
af skadesrisiko for unge håndboldpiger.
– Det giver potentiale til individuel forebyggelse
– Det giver mulighed for bedre rådgivning ved
’return-to-sport’ tidspunktet.
• Vi håber at vide mere om langtidskonsekvenserne af
ACL-skader – give bedre rådgivning.
• Vi håber at vide meget mere om hvilke kvaliteter en
øvelse skal indeholde for at virke skadesforebyggende.
• Måske potentiale for individualiseret træning mhp
præstationsforbedring.
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Forskning i idrætsmedicin
Van Mechelen et al, 1992
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Faktorer af betydning
• Anatomiske og fysiologiske
• Biomekaniske belastninger
Van Mechelen et al, 1992
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Anatomiske og fysiologiske
Genetiske (køns)forskelle?
– In vitro
• Kadaverstudier
– In vivo
• Biomekaniske bevægelsesanalyser
• Neuromuskulær kontrol
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
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08-04-2014
Kønsforskelle:
Intercondylær notch
Kønsforskelle:
Intercondylær notch
Kvinder<mænd ?
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Kønsforskelle:
Q-angle
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Kønsforskelle:
Hormonelle faktorer
• Menstruationscyklus??
• Foreløbige studier: P-piller
nedsætter tilsyneladende risikoen
Risikofaktor?
Ingen koncensus
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Strength
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Bevægelser der belaster forreste korsbånd
• For girls, strength-to-weight ratio
↓ or → after puberty, especially
compared to boys.
ACL
• Sagittal:
Anteriore translationer
af tibia.
• Transversal:
Rotationer af tibia.
• Frontal:
Valgusbevægelse
Ahmad et al, 2006
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
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08-04-2014
Biomekaniske belastninger
Biomekaniske belastninger
- Sagittal plan: Anterior translation af tibia
• Ved 90° flekteret knæled virker m.
quadriceps femoris komprimerende på
knæleddet.
• Ved mere ekstenderet stilling optræder
tillige translation af tibia.
• Kraftige rotationer?
• Kraftig valgusbevægelse?
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Video analyser
Biomekaniske belastninger
• Injuries to the anterior cruciate
ligament (ACL) has previously
been reported to occur early (<40
ms) in the eccentric part of a
handball sidecut manoeuvre with:
• Kraftige rotationer
• Kraftig valgusbevægelse
– the knee near full extension,
– in outward or internal rotation, and
– with increased valgus movement.
(Olsen et al., 2004)
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Bevægelseslaboratorium
Biomechanical movement analyses
• Kinematics
Jan Chrisensen©
– Joint angles in 3D
• Kinetics
– Net joint moments in
3D
– Power
• Electromyography
(EMG)
– Neuromuscular
coordination
8 infrarøde kameraer
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
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08-04-2014
Bevægelseslaboratorium
Biomekanisk metode
2 kraftplatforme
Calculation of a 3D coordinate for a marker needs
a minimum of 2 cameras to ’see’ the marker
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Biomekanisk metode
Sagittal plan
Antropometri
Ledvinkler
Kraftdata
Moment udvikling
Simonsen et al, 2000
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Frontal plan
Sagittal plan
Hewett et al., 2005; The American
Journal of Sports Medicine, Vol.33, No
4
n=205
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
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08-04-2014
The handball side step cut
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
The handball side step cut
Local
maximum
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
The handball side step cut
The handball side step cut
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
The handball side step cut
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
The handball side step cut
NB! Hofteled
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
7
08-04-2014
The handball side step cut
Hip joint kinematics may
influence knee joint moments
• Significant relation between hip joint
internal rotation and knee valgus
moments during sidecutting.
(Bencke, Zebis et al. BJSM, 2014)
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
External knee valgus
moments
Biomekanisk profil
External knee joint moment (Nm/kg BM)
Teknik 2
Teknik 2
0
-1
-2
Valgus
Teknik 1
Varus
1
Teknik 1
-3
0.0
0.1
0.2
0.3
0.4
0.5
Time (sec)
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
45
Why do so many ACL-injuries
occur during sidecutting?
Neuromuskulære faktorer
One-legged landing demanding high
muscle strength.
A frontal plane and transverse plane
movement!
(Different from stopping or dropjump)
Players should learn:
To land on flexed knees
With hips less internally rotated
With CoM more above the knee
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Pause
External moments trying to rotate
knee or bring it in valgus straining the ACL. Higher values
than other movements.
The Biomechanical Gait Analysis Laboratory
Copenhagen University Hospital at Hvidovre
47
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
8
08-04-2014
Vigtige muskelgrupper
Explosive muscle strength
•
•
•
•
Undgå strakt knæ
stærk quad
Modvirke valgus
Mediale
haser+vas.med.
• Modvirke
udadrotation
• mediale haser
Rate of force development (RFD)
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Explosive muscle strength
Zebis et al, 2011
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Kønsforskelle
IC
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Neuromuskulær koordination under
håndboldfodfinte
Bencke & Zebis, JEK 2011
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Kønsforskelle
Toe-off
Bencke & Zebis, JEK 2011
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Bencke & Zebis, JEK 2011
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
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08-04-2014
HIGH RISK ZONE?
Neuromuskulær koordination under
håndboldfodfinte
X : ACL cases (n=5)
VL - ST
NEUROMUSCULAR ACTIVATION DIFFERENCE
O: Non-injured (n=50)
NEUROMUSCULAR ACTIVITY OF ST
(10 ms pre-landing)
%
100
P = 0.0002
EMG ACTIVITY (% OF MAX)
EMG ACTIVITY (% OF MAX)
100
80
60
40
20
0
NEUROMUSCULAR ACTIVITY OF VL
(10 ms pre-landing)
case
%
P = 0.009
80
60
40
PRE-ACTIVATION DIFFERENCE
80
%
60
40
MEAN + SD
20
0
-20
MEAN - SD
-40
-60
20
CASE
0
case
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Zebis et al. AJSM
2009
Why are young female players
more at risk?
Zebis et al. AJSM 2009
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Optimal development of
talent!
• Unfortunate technique during
sidecutting, thus increasing
external moments.
• Lower activation of hamstring
muscles prior to ground
contact during sidecutting
• Lack of adequate explosive
muscle strength may also be a
factor, especially in the
hamstrings, and more
pronounced in younger players.
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Kan korsbåndsskader
forebygges?
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Forskning i idrætsmedicin
JA!
Van Mechelen et al, 1992
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
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08-04-2014
Forebyggelse af korsbåndsskader?
Injury prevention
JA:
• Caraffa 1996: Fodbold.
• Hewett 1999: Basketball og fodbold.
• Wedderkopp 1999: Håndbold.
• Heidt 2000. Fodbold.
• Junge 2002: Fodbold.
• Myklebust 2003: Håndbold.
• Olsen 2005: Håndbold.
NEJ:
• Söderman 2000: Fodbold.
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
www.klokavskade.no
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
OLSEN et al. 2005 => Exercises to prevent lower
limb injuries in youth sports: cluster randomized
controlled trial
(BMJ 2005; 330;449330;449-;)
Myklebust et al. 2003 => ikke-kontakt ACL skader ↓ 38%
EFFEKT AF FOREBYGGELSE => Antal af akutte knæ- eller ankelskader i
kamp
INTERVENTIONSGRUPPE: 28 >< KONTROLGRUPPE: 57
(p<0.001)
Video from: www.skadefri.no
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
ALDER: 15-17 ÅR
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Forebyggelse af korsbåndsskader?
• Øge eksplosiv
muskelstyrke –
specielt for
hasemusklerne?
• Ændre intermuskulær koordination?
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
66
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08-04-2014
Myklebust et al., 2003
Risk movement in the lab
uVolt
800
400
0
s e m i te n d
-4 0 0
-8 0 0
uVolt
1000
500
0
b ic f e m c l
-5 0 0
-100 0
uVolt
800
400
0
re c t fe m
-4 0 0
-8 0 0
uVolt
800
400
0
va st m ed
-4 0 0
-8 0 0
uVolt
1600
800
0
-8 0 0
v a s t la t
Newton
-160 0
2000
F z F o rc e
1000
0
-3 0 0
-2 0 0
-100
0
T im e
Fotograf: Geert Mørch
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Effekt af neuromuskulær
træning
1 00
2 00
30 0
40 0
50 0
( m i li s e c o n d s )
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
68
Effekt af neuromuskulær
træning
• Effekt på neuromuskulær aktivitet
af glut.med under fodfinte: nedsat
pre-aktivitet.
Zebis et al, CJSM 2008
Zebis et al, CJSM 2008
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Springstyrke før og efter skadesforebyggende neuromuskulær
træning
SPRINGSTYRKE
35
30
25
20
PRE
POST
Forebyggelse af korsbåndsskader?
• Øge eksplosiv
muskelstyrke –
specielt for
hasemusklerne?
• Ændre intermuskulær koordination? • Træningsøvelser?
*
0
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Photo: Jan Christensen
Zebis et al., CJSM 2008
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
12
08-04-2014
Identifying Exercises with high ST activity?
120
ST
BF
Hip joint angle
100
EMG amplitude (V)
1,0
80
0,5
60
0,0
40
-0,5
20
-1,0
-1,5
0
-2,0
-20
0
500
1000
1500
2000
TIME (ms)
Andersen et al. Phys Ther. 2006 86
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
• Hasetræning???
• ”Øhhhh….jeg laver den der, hvor
jeg ligger og sparker bagud.”
Specific exercise evaluation
ST dominant
30
EMG ACTIVITY DIFFERENCE
STYRKETRÆNING
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
BFcl dominant
*
30
20
20
10
10
0
0
-10
-10
-20
-20
*
-30
K S R D SP
EMG ACTIVITY DIFFERENCE
1,5
Hip joint angle ( o )
2,0
Specific Strength exercises
-30
L LU JU JU LC FJ H B S J LC E LC
H u
N HE
F D P
Se
S
Zebis et al. Br. J. Sports Med. 2012
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Nordic hamstring
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Leg Curl
ST 80% (±20)
BF 90% (±20)
ST 91% (23)
BF 106% (58)
ST 83% (40)
BF 92% (36)
Zebis et al. Br. J. Sports Med. 2012
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Zebis et al. Br. J. Sports Med. 2012
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
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08-04-2014
6 weeks of Kettlebell training
ST Dominant
Week 1: 3 x 2 min
Monday - Easy swings: 50-60% of what you could do in the allotted time if you went all-out.
Wednesday - Moderate swings: 70-80% of what you could do in the allotted time if you went all-out.
Friday - Hard swings: as many as you can do in the allotted time.
Week 2: 3 x 3 min
Monday - Easy swings: 50-60% of what you could do in the allotted time if you went all-out.
Wednesday - Moderate swings: 70-80% of what you could do in the allotted time if you went all-out.
Friday - Hard swings: as many as you can do in the allotted time.
ST 115% (55) *
Week 3: 5 x 2 min
BF 93% (33)
Monday - Easy swings: 50-60% of what you could do in the allotted time if you went all-out.
Wednesday - Moderate swings: 70-80% of what you could do in the allotted time if you went all-out.
Friday - Hard swings: as many as you can do in the allotted time.
Week 4: 4 x 3 min
ST 73% (32) *
BF 56% (20)
Monday - Easy swings: 50-60% of what you could do in the allotted time if you went all-out.
Wednesday - Moderate swings: 70-80% of what you could do in the allotted time if you went all-out.
Friday - Hard swings: as many as you can do in the allotted time.
Week 5: 3 x 4 min
Monday - Easy swings: 50-60% of what you could do in the allotted time if you went all-out.
Wednesday - Moderate swings: 70-80% of what you could do in the allotted time if you went all-out.
Friday - Hard swings: as many as you can do in the allotted time.
Week 6: 5 x 1 min + 5 x 2 min
Adjust pauses between intervals as it fits you. If you monitor your heart rate you can for example start each interval when the heart rate has
dropped 25-30 heart beats from the ’end heart rate’ from last working interval.
Zebis et al. Br. J. Sports Med. 2012
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Injury prevention program
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
15 selected Exercises
Balance mat
Young handball players (15-17 yrs)
Acute ankle and knee injuries ↓ 50%
Wobble board
Floor
Instep
OLSEN et al. 2005 => Exercises to prevent lower limb injuries in youth sports: cluster randomized
controlled trial (BMJ 2005; 330;449-;)
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Forskning i idrætsmedicin
http://www.klokavskade.no
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Er der færre skader nu?
Van Mechelen et al, 1992
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
14
08-04-2014
Screenings tests
• Drop jump
• Single leg hop
• Andre?
• ‘Måler’ vi det vi vil?
Single leg hop
• Sammenligner med et rask ben, som måske
har tabt styrke?
• Man springer med tre led; hofte og ankel kan
kompensere for knæled!
• Knæ ekstensorer er dominerende, ikke
fleksorer.
Gait Analysis Laboratory, Dept. of Orthopaedic surgery
Hvidovre University Hospital
Optimal screeningstest – fra
biomekanisk evidensbaseret synspunkt
• Måling af eksterne valgus momenter (og
rotationsmomenter?) under individuel spillignende situationer
• Måling af neuromuskulær aktivitet,
semitendinosus preaktivitet, i relation til
vastus lateralis preaktivitet under individuel
spil-lignende situationer.
• Måling af eksplosiv hasemuskelstyrke (RFD)
Opsummering og
perspektivering
The Biomechanical Gait Analysis Laboratory
Copenhagen University Hospital at Hvidovre
Why?
• High magnitude of knee injuries!
• Terrible physical and social short-term
consequences and long-term consequences.
88
Why?
• High magnitude of knee injuries!
• Terrible physical and social short-term
consequences and long-term consequences
• Disruption of talent development fewer
good players in handball.
15
08-04-2014
When?
Who?
• At what age should players commence specific
prohylactic training?
• Would special periods in the season be more
optimal?
– (Do we have the time to prioritise this element?)
• When in the training lesson?
– In the beginning, late in the training? How much?
• Who should do this training?
– Most important for girls…but boys also get
injured!
• Who is responsible?
– The players?
– The parents?
– The physiotherapist?
– The trainer?
– The club management?
How?
• How can this be implemented in the real life
of handball training?
– How do we choose the exercises?
– How should the attitude of the coach be? Of the
players?
– Allocation of time?
Tak for
opmærksomheden
• How could the national handball associations
act?
Jesper Bencke
[email protected]
Tlf: 38626932
The Biomechanical Gait Analysis Laboratory
Copenhagen University Hospital at Hvidovre
FJU
SPL
LU
KS
DJU
NH
FJ
The Biomechanical Gait Analysis Laboratory
Copenhagen University Hospital at Hvidovre
94
SuLC
SJ
95
16
08-04-2014
HE
HEB
RD
SeLC
PrLC
The Biomechanical Gait Analysis Laboratory
Copenhagen University Hospital at Hvidovre
97
17