Essential screenings of the upper and lower extremities
High-intensity actions such as throws, duels, sprints, changes of direction and jumps put extreme strain on both the upper and lower body in handball. Sports scientist and athletics trainer at SC Magdeburg, Daniel Müller, explains essential screening procedures on a functional level and provides training and therapy recommendations for both biomechanical and neuro-centered methods.
The advantage of functional screening procedures
In the world of sport and fitness, there has been a trend in recent decades for trainers and therapists to work across disciplines. For example, athletic trainers may carry out movement analyses that were once the sole preserve of physiotherapists. On the other hand, physiotherapy has long since ceased to be synonymous with “only” passive treatments. The modern physiotherapist is more familiar with training theory than in days gone by.
Regardless of the clear separation for certain competences, such as the manipulation of joints, which is only reserved for physiotherapists, coaches can make their work much more efficient if they use targeted functional assessments or screenings to target training management according to deficits that are relevant for the respective athletes.
Relevance to the sport is the key point here. Functional screening is only helpful if the following two factors apply:
the screening or assessment provides information about a functional issue that is required directly or indirectly within the sport/discipline
the user of the screening procedure can take measures in the event of deficits that lead directly to an improvement in the quality of movement
In addition to other, more objective tests such as strength tests on machines, mobility tests or vertical jump tests, this article will present test methods and screenings that provide information on the athlete’s movement quality and can be easily carried out by any trainer or therapist. The screening procedures and tests are by no means a complete picture, they are merely an essence. At professional level, more tests should be added in order to get as accurate a picture as possible of the athletes.
The requirements profile in handball
Handball is one of the most complex sports in the world. The demands on physical fitness are characterized by diverse elements at the highest level of fitness and coordination (1,4). Due to the countless number of movement variations that handball players perform on the field, the quality of movement control is crucial for all joints.
In the following, I will show you essential tests and screenings of the lower extremities. The legs and feet of handball players must have precise coordination throughout the entire course of the game, which is why coordinative tests are of great importance. Furthermore, the ankles (14.6%) and knees (12.8%) are by far the most frequently injured structures in professional handball (2.3). Both the sensory system of the feet and ankles and the quality of movement of the leg axes are therefore also in focus.
Testing the sensors for the feet and ankles
The perception of the feet should be as accurate as possible so that the athlete has a good internal image, as this also improves motor skills. If you can’t feel it well, you can’t move it well – so the sensory system should be checked.
Fig. 1: Test for vibration (using a Z-vibe or massager) – especially on the inside and outside of the ankle joints, perception must be equal on both sides (always compare left and right!), otherwise there is a sensory deficit.
If, for example, one ankle is easy to feel (10/10 on a subjective scale) but the other is only 7/10, then the latter should be worked up with the vibration tool, approx. 60-90s before the warm-up, 5-10 times a day. Taping can also be used to improve perception. From a neuro-centered training perspective, the following drills are also recommended:
- Stimulation of the reciprocal parietal lobe (e.g. through right pursuits for the right cortex in the case of sensory deficits of the left ankle joint)
- reciprocal cerebellar drills (e.g. foot figure-eight circles in a closed chain)
- Nerve mobilization techniques for the equilateral leg, especially the sural nerve, tibial nerve and saphenous nerve
REMARK: especially if your athletes have scars, you should include them in the sensory testing, because they are usually sensory disturbed and need to be worked on accordingly. If you don’t have a Z-Vibe or electronic massager, you can also use an electric toothbrush.
Tapping test
Test the pulling and stretching of the foot from the upper ankle joint (dorsiflexion and plantar flexion) at maximum speed from a standing position for 10s. Check the error rate, speed differences and sense of rhythm. If one foot is less coordinated, hopefully it is not the ankle!
Fig. 2: Testing coordination using the toe tapping test
Poorer coordination after 10s means that this leg will be even worse after 45-55min on the pitch due to fatigue. Coordination can be trained with the following drills:
- Complex, non-linear movements on the same side (figure-eight foot circles, figure-eight knee circles, figure-eight hip circles) with precision and tempo specifications (with target points, with metronome/beat generator)
- Precision movements with the foot (e.g. repeated one-legged jumps onto different floor markings)
- Breathing drills when endurance is the limiting element (e.g. air hunger drills)
- Trainers from the neuro-centered field can also stimulate the reciprocal frontal brain and the same-sided vestibular organ
Side-hop test
The side-hop test is also a coordinative test that provides information on ankle stability and can also record the precise movement control of the leg axes under higher loads. The side-hop test requires repeated, controlled execution of quick one-legged sideways jumps. Two strips of tape are stuck parallel to each other at a distance of 30 cm. The player stands in the starting position with one leg on the leg to be tested. The hands are on the back. From this position, the player should jump over the two tape strips with their standing leg on a start command. The aim is to complete ten jumps as quickly as possible. If the tape is touched during a landing, this jump is invalid and is not counted. The same test is then carried out with the other leg
Fig. 3: Starting position of the side-hop test. Differences in leg axis stability, precision and endurance are often already apparent during the first test run.
It is advisable to record the test on video using a smartphone in order to be able to better observe any inaccuracies in the test performance and movement abnormalities. This also makes it easier to evaluate the test with the player afterwards.
A limited precision or speed of movement can usually be seen after a single test run in a side-by-side comparison. Coordination problems can be addressed with the following exercises, among others:
- Complex, non-linear movements on the same side (figure-eight foot circles, figure-eight knee circles, figure-eight hip circles) with precision and tempo specifications (with target points, with metronome/beat generator)
- Precision movements with the foot (e.g. repeated one-legged jumps on different floor markings)
- Trainers from the neuro-centered field can also stimulate the reciprocal frontal brain and the same-sided vestibular organ
Klatt test
The Klatt test offers a high level of informative value with little technical effort. It provides information about the dynamic stabilization of the leg axis during a one-legged landing.
Fig. 4: Starting and end position of the clap test to observe the leg axis dynamics during a one-legged landing.
The athlete stands on a 15-20 cm high step board in an upright position with their arms stretched out in front of their body and their hands clasped together. He jumps forward off the board with one leg and lands on the same leg. The test is then repeated with the opposite leg. In addition to the stabilization ability of the foot and ankle joints, the leg axis is also observed. The knee should not move into the valgus position, or only very minimally. If one side fails here, it is essential to counteract this, as the movement pattern of the landing has a negative effect.
with 31% by far the largest share of injury patterns in professional handball (2,3). I recommend the following methods for reconditioning:
- Strength training of the equilateral hip abductors and hip extensors in open and closed chain
- Training reflexive stability of the same side using vestibular reflexes
- Stimulation of cranial nerves 5-8 to improve reflexive stability of the same side
Tests and screenings for the upper extremities
Test of the sensory system for the hands
The perception of the hands is not only crucial for a good feel for the ball, but also has a direct influence on shoulder health. Mobility and strength deficits in the shoulder are often the direct result of impaired sensory perception in the hands.
Use a vibration tool (Z-vibe or massager) and light touches (light stroking with one finger) to test the perception of the palms, backs of the hands and fingers.
Fig. 5: Test of the vibratory sensors for the hands
If there is a difference in the sensation of selected areas of the fingers or hand, it should be worked on immediately, especially if it is the throwing arm. For this purpose, the underactive stimulus should be applied several times a day (e.g. 8x 1min vibration or light touching with a cloth).
Taping can also be used to improve perception. From a neuro-centered training perspective, the following drills are also recommended:
- Stimulation of the reciprocal parietal lobe (e.g. through right pursuits for the right cortex in case of problems in the left hand)
- equilateral cerebellar drills (e.g. foot figure-eight circles in a closed chain)
- Nerve mobilization techniques for the equilateral arm, especially the median nerve, ulnar nerve and radial nerve
Shoulder compression test
This test checks the neuro-muscular reaction of the brain to the positioning of the humerus. Muscle testing is used to check shoulder flexion (raising the arm) in two positions:
- with extended wrist and compressed shoulder
- with flexed wrist and decompressed shoulder
Fig. 6: The shoulder compression test examines whether the neuromuscular output of the shoulder, measured at the anterior deltoid muscle, is different in the compressed vs. decompressed position. Lower muscle strength in the decompressed position indicates a compressed shoulder joint.
If the reaction to the tester is worse in the decompressed position (less force, trembling or more compensation by e.g. holding your breath or tensing your trap
ezius), this indicates compression in the shoulder joint. The shoulder is not optimally stabilized in various positions with a “long arm”, as the joint triggers a protective reflex when traction is applied. Here are possible therapy and training considerations:
- Manual mobilization of the joint capsule
- Manual release of the compressing muscles, in particular the pectoralis minor and supraspinatus muscles
- Complex, non-linear movements of the equilateral shoulder joint (figure-of-eight circles) in a decompressed position
- Activation of the extensor muscles on the same side through activation of the cerebellum or brain stem (pons)
CONCLUSION
First and foremost, functional screenings should check things that also make a relevant contribution to the respective sport. Furthermore, coaches and therapists must also learn how to eliminate any deficits in order to process the results in a meaningful way. The screenings and tests presented in the article represent a selection for handball and can be used both pre-season and in-season. They can be implemented quickly with simple means, while providing great benefits.
Sources:
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Karcher, C. & Buchheit, M. (2014). On-Court Demands of Elite Handball, with Special Reference to Playing Positions. Journal of Sports Medicine (2014) 44:797-814.
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Klein, C., Bloch, H., Burkhardt, K., Kühn, N., Pietzonka, M. & Schäfer, M. (2020). VBG-Sportreport 2020 – Analysis of accidents in the two highest men’s leagues: basketball, ice hockey, soccer, handball. Hamburg: VBG.
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Luig, P., Krutsch, W., Henke, T., Klein, C., Bloch, H., Platen, P. & Achenbach, L. (2020). Contact – but not foul play – dominates injury mechanisms in men’s professional handball: a video match analysis of 580 injuries. British Journal of Sports Medicine, 54:984-990. https://doi.org/10.1136/bjsports-2018-100250
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Wagner, H.; Fuchs, P. & Duvillard, S. P. (2018). Specific physiological and biomechanical performance in elite, sub-elite and in non-elite male team handball players. Sports Med Phys Fitness, Jan-Feb 2018;58(1-2):73-81.
