Off-season beach handball participation lowers injury incidence among handball players—A cross-sectional survey on 641 athletes

Purpose: To assess the effect of beach handball training during the indoor handball off-season on the incidence of indoor handball injuries over three seasons. It was hypothesised that off-season beach handball training would be associated with a lower injury incidence in indoor handball season. Methods: An online survey of indoor handball athletes was distributed between 04-06/2023. Athletes' demographics, activity level, beach handball training during indoor handball off-season, indoor handball injuries in the previous three years, injury mechanisms and time to return to sport were collected. Results: A total of 641 athletes (22 years [interquartile range [IQR]: 19–26]; 62.1% female) from 36 different countries were included. 50.1% (n = 321) played beach handball in the off-season. The majority of athletes (92.7%, n = 594) played at a competitive (70.0%, n = 449) or a semi-professional (22.6%, n = 145) level. During the three-year period, 374 athletes (58.4%) reported a total of 501 injuries during indoor handball (incidence rate: 260.5 per 1000 athletes and year). The lower (66.1%) and upper extremity (26.3%) were the most frequently injured body parts. Overall, 87.0% (n = 436) of all athletes returned to indoor handball after injury. If participated in beach handball, a lower incidence of indoor handball injuries (odds ratio 0.60; [95% CI 0.42–0.87]; p = 0.006) and a lower injury rate in beach-and-indoor handball athletes was observed (225.3 vs. 295.8 injuries per 1000 athletes and year, p < 0.001). Conclusion: Participation in beach handball during indoor handball off-season was associated with a significantly lower injury incidence during indoor handball. Beach handball may serve as a preventative training method to reduce injuries during breaks between indoor handball seasons. Level of Evidence: Level III, retrospective comparative study.