The sport of volleyball is a very physically demanding sport, regardless of what position you play. Across all positions, there are 4 common injuries that volleyball players suffer from. They are lateral ankle sprains, muscle strains, patellar tendinopathy or “Jumper’s Knee”, and shoulder overuse injuries. The positions that are at the highest risk of injuries are outside hitter, followed by middle blocker, libero, setter, then opposite. Most injuries occur without contact from another person and overuse injuries.

Four of the most common injuries that volleyball players suffer from are:

Lateral ankle sprain (15.6%)
Muscle strain (quadriceps and abdomen) (7% combined)
Patellar tendinopathy (Jumper’s knee)
Shoulder overuse injury

Most common mechanism is acute non-contact (39.1%) then gradual/overuse mechanism (17.1) and then contact with a teammate (14%).

Lateral Ankle Sprain

Throughout the course of your volleyball career, you have most likely “rolled your ankle” at least once. Many times, during athletics, this injury happens when quickly cutting and changing directions or jumping and landing. Although this type of injury is common with volleyball players, there are exercises and steps that you can take to either prevent a first-time ankle sprain or to prevent recurrent ankle sprains.

Mechanism of injury – usually caused by a sudden twisting, turning, or rolling of ankle to one side resulting in an inversion and plantar flexion position. Many times, during athletics, it happens when quickly changing directions or jumping and landing.

Prevention – Neuromuscular training (proprioceptive training) is effective to prevent recurrent lateral ankle sprains. However, evidence for prevention of first-time ankle sprains is lacking. There are several risk factors, which can be targeted if classified as modifiable risk factors and used as preventative measures. These include decreased ankle mobility, reduced awareness of the position in movement of your foot and ankle and decreased postural control. In addition, other risk factors include decreased strength, coordination, and cardiorespiratory endurance.

Treatment – Supervised physical therapy results in improved ankle strength and proprioception, quicker return to work and sport than a home program. Manual joint mobilization to address ankle dorsiflexion range of motion is reported to decrease pain. Manual therapy combined with exercise results in even better outcomes.

Muscle Strain (quadriceps and abdomen)

Another common injury in volleyball is a muscle strain particularly in the quadriceps and abdomen muscles. A muscle strain occurs when the muscle is overstretched or torn. When this happens, it usually causes localized pain and generalized weakness of that muscle when you attempt to use that muscle.

Mechanism of injury – disruption of the muscle tendon unit typically occurring when the muscle is activated while being stretched (eccentric contraction). When a muscle strain occurs, it causes localized pain and generalized weakness of the muscle when activity using that muscle is attempted. Regarding a quadriceps strain, there are three common mechanisms of injury: sudden deceleration of the leg, violent contraction of the quadriceps (sprinting), or rapid deceleration of an overstretched muscle (quick change of direction)

Prevention – evidence shows that regarding hamstring strain injury prevention, eccentric hamstring exercises substantially reduce the incidence of these types of injuries. Another study revealed that a muscle imbalance between eccentric hamstring strength and concentric quadriceps strength resulted in a 4-fold increased risk of injury to the hamstring muscle. These concepts, in theory, can be applied to the prevention of other muscle strain injuries. Prevention of quadriceps strain includes increasing flexibility and strength of the quadriceps, particularly eccentric strength. Eccentric control of the quads is important for that muscle to be able to control the forces experienced during landing from a jump.

Treatment/Exercises –

Patellar Tendinopathy (Jumper’s Knee)

Many volleyball players experience pain in the front of their knee every time they jump and when they run. This pain can be signs of patellar tendinopathy, or more commonly called Jumper’s Knee. This injury is very common in athletes that perform an excessive amount of running and jumping. Common signs of Jumper’s knee are pain beneath your kneecap when moving, pain when bending at the knee, stiffness in the knee while jumping, kneeling, or squatting, and pain with jumping.

Mechanism of injury – Jumper’s knee is caused by irritation of the patellar tendon due to excessive or repetitive overload on the tendon. It is very common in athletes that perform a lot of running and jumping, in sports such as volleyball and basketball, and more prevalent when jumping on harder surfaces.

Prevention – eccentric loading of the quadriceps muscle, lumbo-pelvic stabilization, and hamstring stretching can be utilized to prevent patellar tendinopathy. There is evidence stating that a prophylactic training regime of eccentric knee extensor training can effectively prevent sports-related anterior knee pain. Evidence also points towards core weakness as contributing to anterior knee pain.

Treatment/Exercises –

Staged progression of loading the patellar tendon.

Stage 1: isometric loading (if you have at least a 3/10 pain during exercises moving the knee). Aim for 5 repetitions of 45 seconds
- Seated knee extension isometric holds
  - Perform at 30°-60° of knee flexion
- Wall squat
Stage 2: isotonic loading (keeping a load on a muscle while it is moving). If you have < 3/10 pain
- Goblet squat
- Spanish squat
Stage 3: energy storage loading
- Squat jumps
- Lunge jumps
- Volleyball block or spike approach
Stage 4: return to sport

Shoulder Overuse

Regardless of the position that you play, volleyball players use their shoulders constantly. Whether you’re serving or swinging, every athlete (from liberos to outsides) needs to make sure their shoulders stay healthy and strong. The shoulder is loaded and challenged greatly during overhead motions. This leads to the most common type of shoulder injury with volleyball players: overuse of the shoulder joint.

Mechanism of injury – The exact cause of overuse shoulder pain in volleyball players is not completely understood, mainly because every player is drastically different, and every body moves in a different way. However, there have been several factors that have been identified in elite volleyball players that are present in those athletes that suffer from chronic overuse of their dominant shoulder. These factors include decreased shoulder range of motion, and decreased rotator cuff strength or imbalance. The rotator cuff is a group of muscles that surrounds the shoulder joint and keeps your shoulder stabilized. (It is not clear as to the extent to which biomechanical factors play a role in shoulder pain. However, several factors have been identified in the dominant shoulder of elite volleyball players that serve as risk factors for shoulder pain. These include shoulder range of motion, rotator cuff strength or imbalance.)

Prevention – Addressing the risk factors for developing shoulder pain can help in preventing the onset of shoulder pain. Improving shoulder range of motion, and strengthening the muscles surrounding the shoulder. During overhead serving and hitting, the shoulder is highly loaded and challenged in an eccentric manner of the shoulder external rotators. Strengthening and training these muscles, in the same way, they will be required to work during volleyball can help prevent future injuries. It is also noted that deficits in internal rotation range of motion have been linked to an increased risk of shoulder injuries.

Treatment/Exercises –

Closing Thoughts:

Although aches and pains and injuries are common in athletics, hopefully this post helps you to see that there are various ways to not only treat an injury, should you unfortunately suffer from one, but there are also many ways that you can prevent injuries from occurring. Seeing a physical therapist for preventative measures can help set you up for a longer, healthier career in volleyball. A PT will be able to conduct an appropriate examination to determine whether or not you have any risk factors for injury and will be able to prescribe you the appropriate exercise plan that sets you on the right path to perform your best and stay healthy all season long!

By Dr. Rachel Miller

References:

https://www.ncaa.org/sites/default/files/NCAA_W_Volleyball_Injuries_WEB.pdf

Chen, E. T., McInnis, K. C., & Borg-Stein, J. (2019). Ankle sprains: evaluation, rehabilitation, and prevention. Current sports medicine reports, 18(6), 217-223.

Cools, A. M., Johansson, F. R., Borms, D., & Maenhout, A. (2015). Prevention of shoulder injuries in overhead athletes: a science-based approach. Brazilian journal of physical therapy, 19(5), 331–339. https://doi.org/10.1590/bjpt-rbf.2014.0109

Heiderscheit, B. C., Sherry, M. A., Silder, A., Chumanov, E. S., & Thelen, D. G. (2010). Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention. journal of orthopaedic & sports physical therapy, 40(2), 67-81.

Kirkendall, D. T., & Garrett Jr, W. E. (2002). Clinical perspectives regarding eccentric muscle injury. Clinical Orthopaedics and Related Research®, 403, S81-S89.)

Malliaras, P., Cook, J., Purdam, C., & Rio, E. (2015). Patellar tendinopathy: clinical diagnosis, load management, and advice for challenging case presentations. journal of orthopaedic & sports physical therapy, 45(11), 887-898.

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