Throwing Biomechanics: Aspects
of Throwing Performance
and Shoulder Injury Risk
Jesper Bencke, Roland van den Tillaar,
Merete Møller, and Herbert Wagner
6.1 Introduction
Biomechanics is the scientific discipline of describ-
ing movements and loading of joints and soft tissue.
Biomechanics typically utilises motion analysis to
obtain the kinematics and kinetics in order to quan-
tify human movement. Kinematics quantifies the
motion of a system (i.e., position/velocity/accel-
eration), whereas kinetics quantifies the forces and
torques that cause these motions. As such, it may
provide insight into the technique of sports per-
formance and information about mechanisms of
injury. In team handball, being able to throw with
high quality is crucial for performance, and inves-
tigating the biomechanics of throwing will eluci-
date the specific timing and segmental coordination
(i.e., technique) characterising the optimal throw.
At the same time, in combination with knowledge
of functional anatomy, biomechanical investiga-
tions may also reveal loading patterns or nonop-
timal coordination which may increase the risk of
injury. Information about both optimal throwing
technique and injury risk factors is important for
the athlete, coach and health-care personnel.
J. Bencke (*)
Human Movement Analysis Laboratory,
Copenhagen University Hospital,
Amager-Hvidovre, Denmark
e-mail: jesper.bencke@regionh.dk
R. van den Tillaar
Department of Sport Science and Physical Education,
Nord University,
Levanger, Norway
© ESSKA 2018
L. Laver et al. (eds.), Handball Sports Medicine, https://doi.org/10.1007/978-3-662-55892-8_6
6
6.2 Biomechanical Aspects
of Throwing Performance
In team handball competition, the throwing
movement finalises the offensive action. To suc-
ceed in an attempt to score a goal, a team hand-
ball player must maximise the precision of the
throw as well as ball velocity. It is well known
that team handball players use different throwing
techniques based on their playing position and it
is dictated by the movements of the opposing
defensive players. In competition, 73–75% of all
throws during the game constitute jump throws,
followed by the standing throw with run-up
(14–18%), penalty throw (6–9%), diving throw
(2–4%) and direct free throw (0–1%) [1]. These
different throwing techniques are used to increase
the horizontal velocity (run-up), making it diffi-
cult for the defensive player to tackle and poten-
tially enabling a higher ball velocity.
In general, all sports that involve overarm
movements with a high endpoint speed, an optimal
performance (maximal ball velocity) is obtained
through a specific progression (timing) of accel-
eration and deceleration of segmental movements,
M. Møller
Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark
H. Wagner
IFFB Sport Science and Kinesiology,
University of Salzburg,
Salzburg, Austria
69
 70
as suggested by Herring and Chapman [2]. The
progression of segmental motion displays initial
forward motion of a proximal segment, while
more distal segments rotate backwards (i.e., like
the upper arm extends and “lags behind,” when the
trunk begins the forward rotation). The distal seg-
ments will be decelerated by eccentric contraction
of the agonist muscles and subsequently acceler-
ated forwards by concentric contraction of the
same muscles [3], with the muscles thus perform-
ing a stretch-shortening cycle. If this progression
of segmental movements occurs in a proximal-to-
distal order, it facilitates a transfer of momentum
from the pelvis (or lower limb) through the trunk
to the throwing arm, thereby enabling higher
velocities in throwing movements [3].
In team handball throwing, a proximal-to-­distal
sequence was also found in elite and experienced
players (Fig. 6.1), however not fully complying to
this segmental rotation order in the final part of the
throw [4–8]. It was shown that maximal pelvis rota-
tion angular velocity occurred before trunk rotation
and trunk flexion angular velocity followed by the
elbow extension and shoulder internal rotation
angular velocity. The observation that the maximal
elbow extension occurred before the maximal
shoulder rotation angular velocity ­ facilitates a
COCKING P
6000
Angular velocity [˚/s]
5000 Elbow extension
Pelvis rotation
Trunk rotation
2000 Shoulder rotation
1000
-1000
-0.20 -0.15
Fig. 6.1 Pelvis and trunk rotation, shoulder internal rotation and elbow extension angular velocity in the team handball
jump throw
J. Bencke et al.
higher ball velocity, as the earlier extension of the
elbow reduces the moment arm for the shoulder
internal rotation allowing a higher internal rotation
angular velocity and thereby leading to a higher ball
velocity [9]. As shown in Fig. 6.2 this characteristic
movement coordination was found at all experience
levels; however, less experienced players were not
able to produce a proximal-to-distal sequencing
from the pelvis rotation to the shoulder flexion com-
pared to experienced and elite players. Not only in
timing (Fig. 6.2) but also in the maximal trunk flex-
ion and rotation angular velocity significant differ-
ences were found between elite and low-level
players [10]. Furthermore, to optimise throwing
velocity, it was found that the elbow extension and
shoulder internal rotation velocity starting from a
maximal external rotation angle are the two main
parameters related to overarm throwing velocity in
team handball [5, 11]. These results have shown
that the movement of the trunk and an optimal tim-
ing of segmental accelerations are essential in team
handball throwing.
Comparing different throwing techniques in
team handball, it was found that ball velocity was
significantly impacted by the run-up and the pel-
vis and trunk movements. Depending on floor
contact (standing vs. jump throws), team handball
ACCELERATION PHASE FOLLOW TP
-0.10 -0.05 0.00 0.05
Time [s]
6 Throwing Biomechanics: Aspects of Throwing Performance and Shoulder Injury Risk 71

ACCELERATION PHASE FOLLOW THROUGH PHASE

shoulder flexion

less experienced
wrist flexion
experienced
Joint movement

elite p<.01**
forearm pronation

shoulder rotation

elbow extension

trunk flexion p<.01**

trunk rotation p<.05*

pelvis rotation

–0,15 –0,10 –0,05 0,00 0,05 0,10

Time [S]

Fig. 6.2 Mean timing of occurrence of maximal joint players. Significant differences between two joints and
angular velocities in the standing throw with run-up in skill groups: *P < 0.05, **P < 0.001 and **P < 0.001
less experienced, experienced and elite team handball

players used two different strategies (lead leg
brakes the body vs. opposed leg movements dur-
ing flight) to accelerate the pelvis and trunk to
yield differences in ball velocity [12]. Comparing
different arm positions (overarm vs. sidearm), it
was found that the different position of the hand
at ball release was primarily caused by different
trunk flexion and tilt angles [10]. However, in all
different throwing techniques (standing vs. jump-
ing and/or run-up, overarm vs. sidearm), elite and
experienced players were able to adapt their
throwing movement to the different conditions to
perform an optimal proximal-to-distal sequenc-
ing and similar throwing arm movements [8, 12–
15]. These optimal proximal-to-distal sequencing
and similar arm movements were also found in
overarm movements in other sports like tennis,
volleyball, and baseball [3, 4].
When examining differences between male and
female players, several studies have shown that
male players are able to throw faster, although the
ball in male team handball is 0.1 kg heavier [16–
18]. These differences in throwing velocity were
mainly caused by the height of male compared
with female players. Male players are on average
0.1 m taller, the distance between the shoulder and
finger at ball release is 0.06 m longer, and the seg-
mental length of the forearm with hand is 0.04 m
longer [19]. Another variable that could explain
sex differences in throwing velocity was the fat-
free mass. Male elite handball players have gener-
ally more fat-free mass than female players and
were therefore able to throw faster because of the
subsequent higher muscle mass [18].
Besides dividing the different throws based on
arm position or after run-up or jumping, it is pos-
sible to identify all types of handball throws by
their wind-up: a circular or whip-like wind-up
and that these different wind-up have different
biomechanical characteristics [20]. Higher ball
72
velocities were found with the circular wind-up
than with the whip-like wind-up. These were
mainly caused by a significantly higher maximal
joint movement velocity of the pelvis and pelvic
tilt using the circular wind-up than with the whip-­
like wind-up. Since the rest of the joint move-
ments showed no significant differences between
the two wind-up techniques, the pelvis and pelvic
tilt resulted in a higher maximal velocity of the
endpoints of the hip and shoulder segments of
around 0.5 m/s each and a higher ball velocity of
1 m/s. However, timing sequence of initiation
and maximal angular velocity between the two
wind-ups was very similar [20] (Fig. 6.3).
The main difference in the wind-up techniques
was how the arm was moved backwards in the
cocking phase, and naturally the kinematics in
this phase was expected to be different. Minimal
shoulder abduction angle was higher with the
whip-like wind-up, because the elbow is raised to
the side from the two-hand phase to the one-hand
phase and not downwards backwards like in the
Fig. 6.3 (a) An example of an overarm throw with a circular wind-up throwing movement. (b) An example of an
overarm throw with a whip-like wind-up throwing movement in team handball (adapted with permission [20])
J. Bencke et al.
circular movement. Furthermore, in the circular
wind-up the maximal angle of the shoulder flex-
ion and the trunk tilt forwards were higher than
with the whip-like wind-up during the cocking
phase. These increased angles may stretch the
arm, shoulder and abdominal muscles more
extensively and can build up more tension early
in the movement, i.e., an enhanced counter move-
ment between trunk and upper extremity occurs
[11]. This was also shown by the significantly
higher pelvis and upper torso rotation with the
circular wind-up. In the whip-like wind-up the
ball was directly moved upwards and backwards,
and this resulted in a significantly higher peak
external rotation angle of the shoulder. These
increased angles during the arm-cocking phase
may cause increased forces around the elbow and
shoulder joint. Furthermore, total throwing time
was longer with the circular wind-up. This
resulted in a longer cocking phase since the tim-
ing of the maximal external rotation of the shoul-
der with the circular wind-up was significantly
6 Throwing Biomechanics: Aspects of Throwing Performance and Shoulder Injury Risk
closer to ball release. Also the initiation and max-
imal ball acceleration occurred closer to ball
release with the circular wind-up. As the maxi-
mal acceleration was closer to ball release, this
resulted in a higher ball release velocity with the
circular wind-up. As discussed above, handball
throwing is a very technical and forceful skill.
The nature of the game constantly challenges the
ability of the player to vary the way of throwing
either hard or soft, with run-up or jumping and
with different arm positions or wind-up, which
inherently also challenges the technical skills and
strength of the individual player. Training to opti-
mise technique in a variety of throwing types
seems essential for the top-level player.
Fact Box
Biomechanical Aspects of Throwing
Performance:
Ball velocity in team handball is strongly
influenced by an optimal proximal-to-­
distal sequencing, optimal trunk move-
ment, maximal arm rotation and an op-
timal adaptation to different conditions
(standing vs. jumping with or without
run-up, different arm positions, tackling
from the opposing defensive player).
Consequently, coaches should focus on
trunk stabilisation and an optimal throw-
ing technique before strength training to
improve performance.
6.3  iomechanical Injury Risk
B must also be considered when performing varia-
Factors of the Shoulder
The described biomechanics of performing an
optimal hard throw also imposes a risk of overload
injury. When looking at the potential injury risk
elements of a throw, two main phases are evident
as the instants involving the highest muscle forces
and then potentially the highest risk of injury: (1)
The cocking phase, where the initial backward
rotation of the trunk and shoulder horizontal exten-
sion and external rotation is decelerated and
immediately succeeded by a forceful trunk for-
ward rotation, shoulder horizontal flexion and
73
internal rotation, and (2) the deceleration phase
after ball release, where the forceful forward trunk
rotation, humeral flexion and internal rotation
must be decelerated quickly. These elements of the
throwing technique depend heavily on muscle
strength of all involved muscle groups, optimal
neuromuscular coordination, adequate range of
motion and stability of the proximal segments [3].
Reduced capacity or internal imbalance in any of
these parameters may increase injury risk.
The biomechanical foundation for exerting
high forces around the glenohumeral joint in order
to accelerate the ball is a solid proximal base of the
muscle attachments to accelerate the distal seg-
ment. That is, a stable scapula is necessary for the
glenohumeral rotators to internally and externally
rotate the upper arm with adequate force, and if
descending through the kinematic sequence of
rotation described above, the thorax needs to be
stable to adequately allow the scapula-­stabilising
muscles to control the scapula, etc. This exempli-
fies a kinetic chain where the transfer of momen-
tum from the proximal segment to the distal
segment is very dependent on the strength and
optimal neuromuscular control of the proximal
segment, starting with a good core stability as also
described by Kibler et al. [21] and having the opti-
mal coordination of segmental rotations in order to
reduce excessive loads in the shoulder. Studies in
baseball pitchers have shown that nonoptimal
coordination of pelvic and trunk rotation influ-
ences the shoulder joint loading [22, 23] underlin-
ing the importance of the correct kinematic
intersegmental coordination to reduce the stressful
loading of the shoulder. The same mechanism
tions of the standard throw. In handball, a very
diverse range of throwing techniques is displayed,
and the whip-like wind-up technique discussed in
the previous section is typical of the frequently
used, fast-performed throw with the ipsilateral
foot in front. Performing these alternative, quickly
performed, throws may increase the chance of get-
ting the ball past the defender due to the element of
surprise, but it may also increase the injury risk by
placing more stress on the shoulder joint as this
technique involves less rotation of the proximal
segments to initiate the acceleration and shorter
time for acceleration of the distal segments and
74
thus increasing the force needed to reach the same
approximate ball velocity [20].
As mentioned above, adequate muscular
strength and optimal neuromuscular activation is
also important, both for performance and injury
prevention. By creating a solid foundation for
optimal control of the distal segments, increased
core and pelvic strength and stability may reduce
shoulder injury risk [24], and in handball it is
shown that performance may be improved by
training core stability [25, 26]. Around the gleno-
humeral joint, reduced muscular strength of the
external rotators has been found to increase the
risk of shoulder injury in baseball [27]. This
association was also found in adult male handball
players [28, 29]; however, it could not be
­confirmed in a recent study in mixed-sex hand-
ball players [30]. Biomechanically, the shoulder
external rotators may play a role as stabilisers
during the cocking phase, but during throwing
the forceful deceleration of the internal rotation
after ball release depends largely on the shoulder
external rotator muscles. Lack of strength may
result on greater stress on other soft tissue on the
posterior side of the shoulder due to a lesser abil-
ity to dynamically break the internal rotation
movement.
Another biomechanical aspect of shoulder
injury risk is the range of motion of the gleno-
humeral joint. Rotational range of motion is an
important factor for throwing performance, and
increased maximal external rotation is often
observed in the throwing arm of handball play-
ers, as well as other overhead athletes, com-
pared to the non-throwing arm. It is argued that
increased maximal external rotation angle in the
overhead athletes allowing increased arm cock-
ing might have a positive effect on ball veloc-
ity, as it allows a larger internal rotation motion
to accelerate the ball [13]; however, a recent
study could not correlate clinically measured
external rotation RoM with either ball release
velocity or measured maximal external rotation
during throwing in handball [31]. Some of the
observed increased maximal external rotation
may be attributed to increased humeral retrover-
sion, probably due to the torsional stresses from
throwing on the growing bone [32, 33], thus
also displaying a glenohumeral internal rotation
J. Bencke et al.
deficit (GIRD), without any change in the total
rotational range of motion. However, studies in
baseball show that if GIRD is accompanied by a
reduced total rotation ROM, shoulder injury risk
is increased [34]. In the literature, consensus on
the importance of GIRD and total ROM as inde-
pendent risk factors for injury is not yet estab-
lished; however, in male elite handball players,
Clarsen et al. [28] found a slightly increased risk
of injury with reduced total rotational ROM, but
no significant association of GIRD and injury
risk, but on the other side, Andersson et al.
[30] could not confirm these risk factors in a
large group of mixed-sex handball players [30].
Besides the increased retroversion, a biome-
chanical explanation of a reduced total range of
motion may be a tightness of the posterior shoul-
der joint capsule and muscles [35, 36], probably
caused by the cumulative loads of the decelera-
tion phase in repetitive throwing [32].
Most studies on shoulder rotation have
reported the angles of humeral rotation in rela-
tion to the planes of the thorax with the scapula in
a fixed position, but in reality the humeral rota-
tion occurs with respect to the scapula, which in
turn moves with respect to the thorax [37].
Therefore, the positioning of the scapula is cru-
cial when discussing which degrees of rotation
that may be increasing the injury risk. For
instance, an external rotation of 140° in abduc-
tion with respect to the thorax may stretch the
joint capsule much more with an anterior tilted
scapula, than if the scapula has moved with the
external rotation by posterior tilting around a
transverse axis. The importance of the scapula
positioning has been shown in cadaver studies
during a simulated cocking phase, where maxi-
mal external rotation, in combination with less
scapula upward rotation and increased scapula
internal rotation, increases the risk of impinge-
ment [38]. These cadaveric observations direct
the attention to how optimal scapula kinematics
should be during the cocking phase of throwing,
i.e., optimise posterior tilting, and ensure ade-
quate upward rotation and sufficient external
rotation of the scapula. Adequate muscular
strength and neuromuscular activation of the
muscles securing this optimal positioning during
throwing is important, and later chapters will
6 Throwing Biomechanics: Aspects of Throwing Performance and Shoulder Injury Risk
discuss in detail which exercises are important
for the rehabilitation of nonoptimal scapula kine-
matics. But in order to investigate which factors
may influence the scapula positioning during the
injury situation, i.e., the throwing situation, bio-
mechanical measuring of the scapula may be a
means of investigation. However, measuring the
scapula kinematics during throwing is a chal-
lenge, because kinematic tracking of the scapula
is difficult due to the explosive nature of throw-
ing and the fact that most of the scapula move
under the skin and only the acromial plateau is
suitable for marker placement. Thus, relatively
few studies on the 3D biomechanics of the
­scapula during throwing have been performed.
Only two studies have investigated the scapula
kinematics during handball throwing showing
that at the instant of maximal arm cocking, i.e.,
the instant of great impingement risk [38], the
scapula was at the highest level of external rota-
tion, upward rotation and posterior tilting in order
to biomechanically accommodate the need for
stability (Bencke et al., unpublished; [39], which
corresponds well to the findings in baseball [40,
41]. During handball practice many throws of
different exertion are performed, and fatigue may
be a factor affecting the control of the scapula.
Several studies have observed abnormal scapula
kinematics as a result of fatigue during other,
more simple, upper limb motor tasks (e.g., [42]),
but Plummer and Oliver [39] find no change in
scapula kinematics in handball players after
localised fatigue induced by medicine ball throw-
ing. In contrast, new data suggests small signifi-
cant reductions in scapula upward rotation and
posterior tilting at the instant of maximal humeral
external rotation during throwing in handball
after a fatiguing protocol simulating handball
practice throwing (Bencke et al., unpublished
data). Although these data may only add some
suggestions for mechanical explanation of fac-
tors contributing to shoulder injury risk, a larger
prospective study in handball has also demon-
strated the scapula control as a risk factor for
overuse shoulder injuries. Clarsen et al. [28] have
shown prevalence of scapula dyskinesis among
players with shoulder injury in male elite hand-
ball players [28]; however, in a follow-­up study
in mixed-sex population of handball players,
75
these results could not be confirmed [30]. The
findings by Clarsen et al. [28] and Andersson
et al. [30] are limited by inclusion of both new
and existing shoulder problems at study start [28,
30]. As the authors recognise, causation cannot
be assumed without solely focusing on new
shoulder problems. The identified associations
between scapular control, decreased TROM,
reduced external strength and shoulder problems
in these studies might just as well have resulted
from the existing shoulder problems as they may
be a risk factor for development a new shoulder
problem. Based on the many chronic cases seen
in these studies, the former scenario is more
likely than the latter.
This is important in an injury preventive per-
spective, because for a modifiable biomechanical
risk factor to be preventable, it must be estab-
lished whether or not the association between the
risk factor and injury represents a causal relation-
ship [43].
Fact Box
Biomechanical Risk Factors in Throwing:
• The correct proximal-to-distal sequence
will reduce loading of the shoulder and
thus reduce the risk of overload
injuries.
• High dynamic core strength and stabil-
ity will reduce injury risk by facilitating
optimal rotation sequence.
• Optimal scapula control is crucial to
reduce risk of impingement and other
overload risk factors.
• Facilitating adequate posterior tilt, exter-
nal rotation and upward rotation through
sufficient ROM and optimal scapula
muscle strength and coordination is
recommendable.
• Strong external rotators and sufficient
total ROM will reduce injury risk related
to the deceleration phase of the throwing.
• Managing progression of throwing load
by close supervision throughout the sea-
son will reduce risk of injuries due to
overload.
76
6.4  etiology and Mechanisms
A inexperienced players or when a player returns to
of Shoulder Injury
To facilitate a better understanding of sports
injury aetiology, causal models, such as the origi-
nal multifactorial model [44] and its subsequent
revisions [45, 46], have been introduced as over-
all visual models to provide a broad conceptuali-
sation of aetiology for sports injury in general.
The model by Meeuwisse acknowledges that
exposure to injury results from a combination of
being subject to different risk factors and, through
preceding cycles, participating with these risk
factors being present [46]. Based on this premise,
handball participation must be considered as pri-
mary exposure for injury, while other factors, for
instance, biomechanical factors, influence the
level of handball participation a player can toler-
ate before injury occurs [47].
Risk factors related to participation, in the lit-
erature also described as external training load,
may represent step count, distance run, throws
and/or time spent practising sport in both training
and competition [48]. With regard to the associa-
tion between training load and shoulder injuries
in overhead sports, significant associations
between the absolute throwing workload defined
as the total number of self-reported throws or
pitches the week before injury have been reported
in baseball and cricket [49–52]. These findings
support the importance of training load in shoul-
der injury development and have already formed
the basis of preventive throwing regulations for
youth baseball pitchers [53].
A drawback to the use of absolute load
changes is that they do not take the players’
changing cycling of injury, participation and
other risk factors into account. For example, an
association between more than 75 throws and
risk of shoulder injury has been reported in the
literature [50, 51, 54]. However, there is a possi-
bility that the recommendations of the number of
throws might be different at the beginning of the
study (which could be the preseason or the start
of the season) than in the mid-season. In addition,
the number of throws tolerated is likely to be
different for experienced players compared to
J. Bencke et al.
sport after injury. To encompass these changing
factors, relative training load is likely to provide
a more applicable measure of the external load.
Sudden increase in training and competition
load relative to either the preceding week or 2–4
preceding weeks has been associated with injury
in various sports in the literature [55–57]. Only
one published study has undertaken research into
the relationship between relative training load
and injuries in youth handball players [29]. The
findings from this study demonstrated that the
shoulder injury rate was nearly twice as high in
the week following a 60% or greater increase in
handball load (hours of competition and training)
when compared with increase in handball load
<20%. Additionally, Møller and coworkers [29]
examined how athlete characteristics modified
the association between training and shoulder
injury rate. This analysis differed from previous
mentioned and traditional analyses, treating
handball load as the primary exposure and bio-
mechanical variables as effect measure modifi-
ers. The findings showed that an effect of a
moderate increase between 20% and 60% in
handball load was exacerbated by the presence of
reduced external rotational strength or scapular
dyskinesis and that reduced shoulder external
rotational strength also exacerbated the effect of
large increases in handball load above 60%.
Concerted efforts should, therefore, be made to
avoid rapid increases in handball load. This is
particularly important for players with scapular
dyskinesis and reduced strength, because players
with these certain characteristics may be more
vulnerable to shoulder injury already at a moder-
ate increase in handball load [29].
In summary, this chapter has described that a
key element of good throwing performance is the
optimal proximal-to-distal rotation sequence
enabling the segments to build up ball velocity
efficiently without overloading specific joint
structures, typically around the shoulder; conse-
quently focus on improving throwing technique
is important for performance. Changing throwing
technique both in terms of different arm positions
and different wind-up techniques may give some
6 Throwing Biomechanics: Aspects of Throwing Performance and Shoulder Injury Risk 77

functional advantages in the game situation but
may also increase the loading of soft tissue
around the joints and thus injury risk.
Furthermore, the chapter has discussed the
importance of rotational strength and range of
motion around the shoulder, as well as distinct
biomechanical parameters important for optimal
kinematics of the scapula. Finally, we have dis-
cussed the association between these parameters
and shoulder injuries, as well as how some of
these factors influence the associations between
weekly increases in training load and shoulder
injury rates in handball. In short, throwing is the
key factor for injury, but optimal strength, range
of motion and scapula control will reduce the
injury risk.
References
1. Wagner H, Kainrath S, Müller E. Coordinative and tacti-
cal parameters in the handball throw and their influence
to the level of performance. In 13th Annual Congress of 17. Granados C, Izquierdo M, Ibanez J, Ruesta M,
the European College of Sports Science. 2008.
2. Herring RM, Chapman AE. Effects of changes in
segmental values and timing of both torque and
torque reversal in simulated throws. J Biomech. 18. van den Tillaar R, Ettema G. Effect of body size and
1992;25(10):1173–84.
3. Fleisig GS, Barrentine SW, Escamilla RF, Andrews
JR. Biomechanics of overhand throwing with implica- 19. van den Tillaar R, Cabri JM. Gender differences in
tions for injuries. Sports Med. 1996;21(6):421–37.
4. Wagner H, Pfusterschmied J, Tilp M, Landlinger J,
von Duvillard SP, Muller E. Upper-body kinematics
in team-handball throw, tennis serve, and volleyball 20. van den Tillaar R, Zondag A, Cabri J. Comparing per-
spike. Scand J Med Sci Sports. 2014;24(2):345–54.
5. Fradet L, Botcazou M, Durocher C, Cretual A, Multon
F, Prioux J, Delamarche P. Do handball throws always
exhibit a proximal-to-distal segmental sequence? J 21. Kibler WB, Press J, Sciascia A. The role of
Sports Sci. 2004;22(5):439–47.
6. van den Tillaar R, Ettema G. A force-velocity relation-
ship and coordination patterns in overarm throwing. J 22. Aguinaldo AL, Buttermore J, Chambers H. Effects of
Sports Sci Med. 2004;3(4):211–9.
7. van den Tillaar R, Ettema G. Is there a proximal-to-­
distal sequence in overarm throwing in team handball?
J Sports Sci. 2009;27(9):949–55.
8. Wagner H, Pfusterschmied J, von Duvillard SP,
Muller E. Skill-dependent proximal-to-distal
sequence in team-handball throwing. J Sports Sci.
2012;30(1):21–9.
9. Hong DA, Cheung TK, Roberts EM. A three-­
dimensional, six-segment chain analysis of force-
ful overarm throwing. J Electromyogr Kinesiol.
2001;11(2):95–112.
10. Wagner H, Buchecker M, von Duvillard SP, Muller
E. Kinematic comparison of team handball throwing
with two different arm positions. Int J Sports Physiol
Perform. 2010;5(4):469–83.
11. van den Tillaar R, Ettema G. A three-dimensional
analysis of overarm throwing in experienced handball
players. J Appl Biomech. 2007;23(1):12–9.
12. Wagner H, Pfusterschmied J, von Duvillard SP,
Muller E. Performance and kinematics of various
throwing techniques in team-handball. J Sports Sci
Med. 2011;10(1):73–80.
13. van den Tillaar R, Ettema G. A comparison between
novices and experts of the velocity-accuracy
trade-off in overarm throwing. Percept Mot Skills.
2006;103(2):503–14.
14. Wagner H, Buchecker M, von Duvillard SP, Muller
E. Kinematic description of elite vs. low level play-
ers in team-handball jump throw. J Sports Sci Med.
2010;9(1):15–23.
15. Wagner H, Pfusterschmied J, Klous M, von Duvillard
SP, Muller E. Movement variability and skill level
of various throwing techniques. Hum Mov Sci.
2012;31(1):78–90.
16. Ettema G, Glosen T, van den Tillaar R. Effect of
specific resistance training on overarm throw-
ing performance. Int J Sports Physiol Perform.
2008;3(2):164–75.
Gorostiaga EM. Effects of an entire season on physi-
cal fitness in elite female handball players. Med Sci
Sports Exerc. 2008;40(2):351–61.
gender in overarm throwing performance. Eur J Appl
Physiol. 2004;91(4):413–8.
the kinematics and ball velocity of overarm throw-
ing in elite team handball players. J Sports Sci.
2012;30(8):807–13.
formance and kinematics of throwing with a circular
and whip-like wind up by experienced handball play-
ers. Scand J Med Sci Sports. 2013;23(6):e373–80.
core stability in athletic function. Sports Med.
2006;36(3):189–98.
upper trunk rotation on shoulder joint torque among
baseball pitchers of various levels. J Appl Biomech.
2007;23(1):42–51.
23. Chaudhari AM, McKenzie CS, Pan X, Onate
JA. Lumbopelvic control and days missed because of
injury in professional baseball pitchers. Am J Sports
Med. 2014;42(11):2734–40.
24. Chaudhari AM, McKenzie CS, Borchers JR, Best
TM. Lumbopelvic control and pitching performance
of professional baseball pitchers. J Strength Cond
Res. 2011;25(8):2127–32.
78
25. Manchado C, Garcia-Ruiz J, Cortell-Tormo JM,
Tortosa-Martinez J. Effect of core training on male
handball players’ throwing velocity. J Hum Kinet.
2017;56:177–85.
26. Saeterbakken AH, van den Tillaar R, Seiler S. Effect
of core stability training on throwing velocity in
female handball players. J Strength Cond Res.
2011;25(3):712–8.
27. Byram IR, Bushnell BD, Dugger K, Charron K,
Harrell FE, Noonan TJ. Preseason shoulder strength
measurements in professional baseball pitchers:
identifying players at risk for injury. Am J Sports
Med. 2010;38(7):1375–82.
28. Clarsen B, Bahr R, Andersson SH, Munk R,
Myklebust G. Reduced glenohumeral rotation, exter-
nal rotation weakness and scapular dyskinesis are risk
factors for shoulder injuries among elite male hand-
ball players: a prospective cohort study. Br J Sports
Med. 2014;48(17):1327–33.
29. Moller M, Nielsen RO, Attermann J, Wedderkopp N,
Lind M, Sorensen H, Myklebust G. Handball load
and shoulder injury rate: a 31-week cohort study of
679 elite youth handball players. Br J Sports Med.
2017;51(4):231–7.
30. Andersson SH, Bahr R, Clarsen B, Myklebust
G. Risk factors for overuse shoulder injuries in a
mixed-sex cohort of 329 elite handball players: pre-
vious findings could not be confirmed. Br J Sports
Med. 2017. https://doi.org/10.1136/bjsports-2017-
097648.
31. van den Tillaar R. Comparison of range of motion
tests with throwing kinematics in elite team handball
players. J Sports Sci. 2016;34(20):1976–82.
32. Borsa PA, Laudner KG, Sauers EL. Mobility and
stability adaptations in the shoulder of the overhead
athlete: a theoretical and evidence-based perspective.
Sports Med. 2008;38(1):17–36.
33. Pieper HG. Humeral torsion in the throw-
ing arm of handball players. Am J Sports Med.
1998;26(2):247–53.
34. Wilk KE, Macrina LC, Fleisig GS, Porterfield R,
Simpson CD, Harker P, Paparesta N, Andrews
JR. Correlation of glenohumeral internal rotation
deficit and total rotational motion to shoulder injuries
in professional baseball pitchers. Am J Sports Med.
2011;39(2):329–35.
35. Takenaga T, Sugimoto K, Goto H, Nozaki M,
Fukuyoshi M, Tsuchiya A, Murase A, Ono T, Otsuka
T. Posterior shoulder capsules are thicker and stiffer
in the throwing shoulders of healthy college base-
ball players: a quantitative assessment using shear-­
wave ultrasound elastography. Am J Sports Med.
2015;43(12):2935–42.
36. Thomas SJ, Swanik CB, Higginson JS, Kaminski
TW, Swanik KA, Bartolozzi AR, Abboud JA,
Nazarian LN. A bilateral comparison of posterior
capsule thickness and its correlation with glenohu-
J. Bencke et al.
meral range of motion and scapular upward rotation
in collegiate baseball players. J Shoulder Elb Surg.
2011;20(5):708–16.
37. Ribeiro A, Pascoal AG. Scapular contribution for the
end-range of shoulder axial rotation in overhead ath-
letes. J Sports Sci Med. 2012;11(4):676–81.
38. Mihata T, Jun BJ, Bui CN, Hwang J, McGarry MH,
Kinoshita M, Lee TQ. Effect of scapular orientation
on shoulder internal impingement in a cadaveric
model of the cocking phase of throwing. J Bone Joint
Surg Am. 2012;94(17):1576–83.
39. Plummer HA, Oliver GD. The effects of local-
ised fatigue on upper extremity jump shot kine-
matics and kinetics in team handball. J Sports Sci.
2017;35(2):182–8.
40. Meyer KE, Saether EE, Soiney EK, Shebeck MS,
Paddock KL, Ludewig PM. Three-dimensional scap-
ular kinematics during the throwing motion. J Appl
Biomech. 2008;24(1):24–34.
41. Oliver GD, Weimar W. Hip range of motion and scap-
ula position in youth baseball pitching pre and post
simulated game. J Sports Sci. 2015;33(14):1447–53.
42. Pellegrini A, Tonino P, Paladini P, Cutti A, Ceccarelli
F, Porcellini G. Motion analysis assessment of altera-
tions in the scapulo-humeral rhythm after throwing in
baseball pitchers. Musculoskelet Surg. 2013;97(Suppl
1):9–13.
43. Shrier I. Understanding causal inference: the future
direction in sports injury prevention. Clin J Sport
Med. 2007;17(3):220–4.
44. Meeuwisse WH. Assessing causation in sport
injury: a multifactorial model. Clin J Sports Med.
1994;4(3):166–70.
45. Bahr R, Krosshaug T. Understanding injury mecha-
nisms: a key component of preventing injuries in
sport. Br J Sports Med. 2005;39(6):324–9.
46. Meeuwisse WH, Tyreman H, Hagel B, Emery C. A
dynamic model of etiology in sport injury: the
­recursive nature of risk and causation. Clin J Sport
Med. 2007;17(3):215–9.
47. Malisoux L, Nielsen RO, Urhausen A, Theisen D. A
step towards understanding the mechanisms of running-
related injuries. J Sci Med Sport. 2015;18(5):523–8.
48. Nielsen RO, Bertelsen ML, Moller M, Hulme A,
Windt J, Verhagen E, Mansournia MA, Casals M,
Parner ET. Training load and structure-specific load:
applications for sport injury causality and data analy-
ses. Br J Sports Med. 2017. https://doi.org/10.1136/
bjsports-2017-097838.
49. Fleisig GS, Andrews JR, Cutter GR, Weber A, Loftice
J, McMichael C, Hassell N, Lyman S. Risk of serious
injury for young baseball pitchers: a 10-year prospec-
tive study. Am J Sports Med. 2011;39(2):253–7.
50. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect
of pitch type, pitch count, and pitching mechanics on
risk of elbow and shoulder pain in youth baseball
pitchers. Am J Sports Med. 2002;30(4):463–8.
6 Throwing Biomechanics: Aspects of Throwing Performance and Shoulder Injury Risk
51. Lyman S, Fleisig GS, Waterbor JW, Funkhouser
EM, Pulley L, Andrews JR, Osinski ED, Roseman
JM. Longitudinal study of elbow and shoulder pain
in youth baseball pitchers. Med Sci Sports Exerc.
2001;33(11):1803–10.
52. Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews
JR. Risk factors for shoulder and elbow injuries
in adolescent baseball pitchers. Am J Sports Med.
2006;34(6):905–12.
53. ASMI. American Sports Medicine Institute. asmi.org.
2017.
54. Saw R, Dennis RJ, Bentley D, Farhart P. Throwing
workload and injury risk in elite cricketers. Br J
Sports Med. 2011;45(10):805–8.
79
55. Colby MJ, Dawson B, Heasman J, Rogalski B,
Gabbett TJ. Accelerometer and GPS-derived running
loads and injury risk in elite Australian footballers. J
Strength Cond Res. 2014;28(8):2244–52.
56. Ehrmann FE, Duncan CS, Sindhusake D, Franzsen
WN, Greene DA. GPS and injury prevention
in professional soccer. J Strength Cond Res.
2016;30(2):360–7.
57. Nielsen RO, Parner ET, Nohr EA, Sorensen H,
Lind M, Rasmussen S. Excessive progression
in weekly running distance and risk of running-
related injuries: an association which varies accord-
ing to type of injury. J Orthop Sports Phys Ther.
2014;44(10):739–47.