During the nine years I have been involved with the national tournament there has been a consistent pattern to the injuries sustained by the players. Fortunately, or perhaps unfortunately, a vast majority of the injuries sustained by handball players are avoidable. Does that surprise you?

It shouldn't. Think about the injuries you have sustained in your handball career. You'll be thinking about the same injuries your fellow handball players have sustained on a regular basis. Why do handball players continue to sustain the same injuries over and over.

If one looks at the factors that contribute to the occurrence of the injuries most frequently seen in handball, as I have been doing for the past nine years, it readily appears the majority of the injuries sustained are avoidable. They are avoidable since the contributing factors to the injuries can be eliminated. Let's look at the major factors I have noted as the main contributors to the injuries most frequently sustained by handball players. Let's also look at what can be done by a player to eliminate each possible cause or contributor to impending injury.

Factor No. 1

The lack of physical conditioning is a major cause for many injuries sustained on the handball court. In general, handball players do not physically train for the sport outside the court. Rather, they rely on their time in the court to adequately prepare them. Unfortunately, this is not sufficient. If it were, why would Naty Alvarado run and cycle while preparing himself for the rigors of handball?

As a player fatigues due to the lack of adequate physical conditioning during the course of a match, he becomes incapable of getting to the ball early enough to properly position the body to shoot. Thus, he is forced to compensate. This causes overstress, most commonly on the shoulder, elbow and back.

The solution to eliminating this major injury contributor is obvious. start a physical conditioning program outside the court to better prepare yourself for the demands placed on you in the court. Running, cycling and swimming are three great ways to improve your level of physical fitness. The sad part is they are not as much fun as handball, and many players don't participate in them on a regular basis - but they should.

As a spectator, I have also noted that many of the smarter players rely more on fist shots as they fatigue. Taking some time to develop a reliable fist shot will perhaps decrease the physical demands on your body, primarily the shoulder and elbow. however, this new shot alone should not be considered an alternative to improving your physical fitness status.

Factor No. 2

The lack of adequate flexibility is another major cause for injury among handballers. Although this factor appears to be of less significance for players under the age of 30, the majority of players at the nationals are over 30 and flexibility becomes a significant factor. At the last nine national tournaments we have spent countless hours showing players how to effectively stretch the muscles in the calf/Achilles tendon complex, hamstrings, groin, hip flexors, lower back, shoulders, and forearms. We haven't been doing this simply because it is one of the things we know best, but due to the large number of complaints we hear that are related to the lack of flexibility.

As I said of running, swimming, and cycling, a pre- and post-game stretching program is not a lot of fun and does take some time to perform. But, just as a good training program can enhance your game as well as decrease the likelihood of injury, so can the regular performance of a pre- and post-game stretching program.

Factor No. 3

The lack of adequate treatment and rehabilitation of injuries is a common cause for further injury. Players must recognize the majority of injuries sustained in handball are overstress injuries that require initial treatment as well as the completion of an adequate and appropriate rehabilitation program prior to returning to the court. Far too often players treat their injuries solely by resting. Then, upon returning to the court, they experience recurrent symptoms of the initial injury or develop a secondary problem due to compensating for it.

As a physician, I must apologize to the players who are told to rest by their doctors, and then experience recurrent problems upon returning to the court. Over the last nine years, the causes and treatment programs for the most common handball injuries have been discussed in this column.

Factor No. 4

Improper stroke technique or errors in the fundamentals of the sport can also be a major contributing factor to injuries sustained on the court. As is true of the player's hope that he can adequately condition himself by merely playing handball, a player's belief that he can improve his fundamentals or technique merely by playing is also a common fallacy. As Rod Gaspar of Mission Viejo, Calif., who starred with the N.Y. Mets before starting handball, will readily attest, practicing for any sport is not nearly as much fun as competing. But practice is necessary to improve your techniques and fundamentals.

Each issue of this magazine contains information on how to improve your game. But each player must take the time to practice in the court alone in order to benefit from the information. A simple example is: if you're curious how good a player's offhand is, just watch him throw with it as he warms up. If he can't throw with his offhand, he can't shoot with it either. Yet, if this player is typical, he will continue to try to improve his offhand by playing matches rather than taking the time to learn how to throw with it first.

Handball is a unique sport in many ways. And there are two important facts regarding injuries in the game: handball is not a serious injury producing sport, and the majority of injuries sustained and the recurrence of those symptoms can be avoided if players would follow the advice in this article and the articles which were featured in past issues of Handball.