Oslo Sports Trauma Research Center

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Information about project titled 'Association between difference floor types and the incidence of ACL injuries in team handball'

Association between difference floor types and the incidence of ACL injuries in team handball

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Project status: Published
Project manager: Odd-Egil Olsen
Supervisor(s): Roald Bahr, Lars Engebretsen
Coworker(s): Grethe Myklebust


Parquet and Pulastic are the two most commonly used floor materials in Norway. A previous retrospective study indicated association between these difference floor types and ACL injuries in team handball, but no prospective studies have found this association. Immediately, in Australian Football one prospective study have found association between differences ground conditions and the incidence of ACL injuries.


The purpose of this study is to examine association between difference floor types and the incidence of ACL injuries in team handball. ACL injuries (n=172) from previously prospective studies and the prevention study in Norwegian team handball are registered by one of the investigator (GM). These studies included the three upper divisions for men and women (212 teams, 3392 players) during the period 1989-91, elite for men and women (24 teams, 384 players) during 1993-96 and the three upper divisions for women (60 teams, 950 players) during the period 1998-2000. The players on these teams were either amateurs or semi-professionals. Information about injured players was gathered from team coaches, physiotherapists, physicians and the insurance company. An ACL injury was registered if it occurred during organized handball training or games. All the injured players consented to participate in a personal or telephone interview.


Method: Physiotherapists did the interviews based on a standardized questionnaire. Among the information from these registrations we have data about the time of injury, which floor types (Parquet and Pulastic) the injuries occur on and the competition exposure (player hours). Furthermore, we have collected data about where the matches in these periods (1989-91, 93-96 and 98-2000) were played from the Norwegian Handball Federation, and we are now collecting data about the floor types in the handball arenas were the teams were playing in these periods from the Norwegian Department of Culture and the Norwegian Building Research Institute.

Number of competition hours on differences floor types and the number of ACL injuries will be calculated. Based on these data a statistical analysis of which floor types that gives the highest incidence of ACL injuries in competition will be done. Data from this study are important for planning prevention attempt to influence/change one possible extrinsic risk factor, either its applied which floor type we should use in the handball arenas or restrictions against playing on one type of floor. Furthermore, data from this study could form the starting point for more research on difference floor types, shoes and the friction between the shoe and floor.


Results: A total of 41 injuries occurred during 4440 matches on artificial floors (0.66/1000 h) and 12 injuries occurred during 2284 matches on wooden floors (0.38/1000 h; OR: 1.76 (0.93-3.36, P=0.08). Among women 36 injuries occurred during 2682 matches on artificial floors (0.96/1000 h) and 8 injuries occurred during 1391 matches on wooden floors (0.41/1000 h; OR: 2.35 (1.09-5.07, P=0.03). Among women in the elite division 14 injuries occurred during 633 matches on artificial floors (1.58/1000 h) and 2 injuries occurred during 289 matches on wooden floors (0.49/1000 h; OR: 3.25 (0.76-14.38, ns).


Conclusion: The incidence of ACL injuries for women was 2-3-fold higher on artificial floor types than on wooden floors, whereas no such effect was observed for men. It is assumed that the increased risk results from the high friction on some artificial floors. But, there are some limitations that must be considered when interpreting the results. First, we had to use a model comparing artificial floors with wooden floors. These two groups of sports floors are not homogenous and the shoe-surface friction within each group differs considerably. In the artificial floor group, some of the older floor covering materials have very high friction, whereas newer artificial floors with polyurethane coverings have a low friction coefficient in the same range as wooden floors. Also, freshly lacquered/painted wooden floors can have very high friction. Nevertheless, the trend among the floor types tested was for the artificial floors to have higher friction and wooden floors lower friction. There are also other factors that are important for the friction, including the age of the floor, the cleaning and maintenance routines, the use of stick' em/hand glue and shoe types.

To prevent non-contact ACL injuries in team handball and other ball games the data available seem to indicate that floor types, either wooden or artificial, with as low shoe-surface traction as possible should be selected. Hence, shoe and surface designs that result in a safer environment, yet provide sufficient friction to allow optimal performance, must be sought. The information about the friction, cleaning, limitations the use of hand glue etc., and use of different types of shoes - to match the floors - should be made available to the athletes and the coaches.