Volleyball-related injuries in adolescent female players: an initial report

Prevalence and associated factors of non-traumatic knee pain in high school volleyball players: a cross-sectional study

OBJECTIVES

This study aimed to determine the prevalence of knee pain among high school volleyball attackers, identify associated factors, and explore the relationship between knee pain and lower back pain (LBP).

METHODS

A cross-sectional study involving 82 high school volleyball attackers (15-17 years) used questionnaires, interviews, and field-based assessments to collect data on demographics, volleyball-specific factors, flexibility, and jumping ability. Logistic regression analysis was used to identify factors associated with knee pain.

RESULTS

The prevalence of knee pain was 19.5%. Factors significantly associated with knee pain were a history of LBP (OR, 4.64; 95% CI, 1.28 to 16.8; p = 0.019) and flexibility determined by the absolute difference in heel-buttock distance (OR, 1.37; 95% CI, 1.02 to 1.83; p = 0.037). Participants with knee pain had more volleyball experience and a higher proportion of players who competed as starters in the previous year. Both groups reported approximately 18 hours of practice per week during the school year and around 27 hours during school holidays, with no significant difference observed.

CONCLUSION

Factors associated with knee pain include a history of LBP and reduced flexibility on the heel-buttock distance test. The study highlights the need for a comprehensive approach, considering the coexistence of LBP and focusing on improving anterior thigh flexibility.

Damage for gain: The useful damage of the Pitcher's paradox

Introduction

Sport-specific adaptations of the glenohumeral joint may arise in adolescent overhead athletes who begin high-performance sports early in life. Research mainly addresses overuse injuries, leaving gaps in prevention, with adults studied more than youths.

Objective

This study aims to investigate sport-adaptations of the glenohumeral joint in asymptomatic adolescent volleyball players to identify potential shoulder injury risk factors.

Design

Observational study.

Setting

Clinical screening campaign conducted at the Physical Medicine and Rehabilitation Unit of Policlinic Hospital in Catania, Italy.

Participants

Forty asymptomatic under-16 athletes were evaluated.

Interventions

Shoulder internal rotation (IR) and external rotation (ER), range of motion (ROM), total-rotation ROM, glenohumeral IR deficit (GIRD), general joint laxity using Beighton score, apprehension, relocation, O'Brian tests, and ultrasound (US) glenohumeral distance were tested bilaterally. Variables such as the player's position, the age they began the sport, limb dominance, weight, and height were also considered.

Results

The median US glenohumeral distance was at 0.42 ± 0.26 cm, which is consistent with the range found in non-dislocated shoulders of a healthy non-athletic population. The ER ROM was significantly greater in the dominant shoulder than the contralateral one (P = 0.0001), and there was a significant correlation between the ER ROM of attackers and their US glenohumeral distance (P = 0.0413). Furthermore, shoulder IR ROM and US glenohumeral distance were not significantly different between the dominant and contralateral limbs (P = 0.05). None of the athletes presented GIRD. Other tests, including the Beighton score, apprehension, and relocation tests, yielded no significant differences between the dominant and contralateral limbs.

Conclusions

Despite an increased shoulder ER in the dominant limb, the glenohumeral joint remains stable, suggesting that greater ROM in ER does not equate to instability in overhead athletes without hyperlaxity. Nevertheless, increased ER impacts glenohumeral distance in attacker volleyball players. This finding suggests that the shoulder morphological adaptation process starts early in attackers.

The Finger, Wrist, and Shoulder are the Most Commonly Injured Areas in Youth Volleyball Players but the Incidence of Injuries Decreased Overall Between 2012 and 2022

Purpose

To analyze epidemiology, mechanisms, and diagnoses of upper extremity volleyball injuries in youth who present to United States emergency departments.

Methods

Data from the National Electronic Injury Surveillance System were analyzed for upper extremity volleyball injuries in patients ≤18 years old from January 1, 2012, to December 31, 2022. Data were collected for body part, diagnosis, mechanism of injury, and disposition. Weighted national estimates were calculated using the hospitals' corresponding statistical sample weights. Linear regressions were used to analyze annual trends. χ2 tests were used to analyze categorical variables.

Results

A weighted national estimate of 131,624 upper extremity volleyball-related injuries occurred in the study period. Average age was 13.9 ± 2.3 years. Female patients constituted 77.6% of patients; 99.3% of patients did not require admission. The most common body parts injured were fingers (43.0%), wrists (22.8%), and shoulders (12.2%). The most common identifiable mechanisms of injury were impacts with the floor (19.4%), impacts with the ball (14.7%), and spikes/serves (5.7%). Most common diagnoses were strains/sprains (42.6%) and fractures (19.5%). Most common locations of fracture were fingers (57.4% of all fractures), wrists (16.6%), and lower arms (12.4%). There was a decrease of 544 overall injuries per year (P = .03, 95% confidence interval [CI] -1031 to -58). Female players experienced more contusions/abrasions (16.0% vs 9.9%, P < .001) and strains/sprains (46.1% vs 30.4%, P < .001) compared with male players. Female patients had decreases of 513 overall injuries (P = .01, 95% CI -881 to -144), 349 strains/sprains (P = .002, 95% CI -530 to -168), 102 contusions/abrasions (P = .008, 95% CI 170 to -34), and 92 fractures per year (P = .03, 95% CI -175 to -10).

Conclusions

Youth volleyball players are at risk of upper extremity injury, particularly involving the fingers, wrist, and shoulder. Despite increasing national participation in youth volleyball, there is a decreasing incidence of upper extremity injuries.

Level of Evidence

Level IV, prognostic case series.

Epidemiology of injuries in young volleyball athletes: a systematic review

BACKGROUND

Volleyball is among the five most popular sports in the world. Regardless of level and age, volleyball athletes perform fast high-impact movements such as jumps, landings, and changes in direction, demanding motor and sensory skills to avoid injuries. The available scientific literature provides information regarding the incidence of injuries in volleyball, but the evidence of injuries in young volleyball athletes (12-18 years old) is not well defined. Therefore, a systematic review was conducted to investigate the incidence and prevalence of injuries in young volleyball players.

METHODS

This systematic review was conducted according to the PRISMA recommendations and prospectively registered in PROSPERO (ID: CRD42022344623). An electronic search was conducted in the following databases: Web of Science, PubMed, and SportDiscuss via EBSCO in August 2022 and March 2023. Inclusion criteria followed the PICOS acronym: (P) youth volleyball players; (I) volleyball; (C) none; (O) incidence and/or prevalence of injury; and (S) cohort studies. The risk of bias was analysed using the adapted STROBE instrument.

RESULTS

Five studies were included in the qualitative analysis. They had a mean methodological quality of 6 (range 4-8) on the modified STROBE scale. Injury incidence was presented in varying ways, ranging from 1.51 injuries/1000 player hours to 12.4 injuries/10,000 athlete exposures (AEs). The prevalence was 1.6 ± 1.7 per 100 AEs. A total sample of 3698 youth volleyball athletes predominantly females was found. The body sites with the highest rate of injuries were the ankle, the distal portion of the upper limbs (wrist/hand/fingers) and the knee, respectively.

CONCLUSION

There was remarkable variability in the rate of injuries and the form of presentation between the studies. In addition, junior volleyball athletes had lower injury rates compared to other sports practised in high school, and older athletes had higher injury rates.

Efficacy of Proprioceptive Training on Plantar Pressure and Jump Performance in Volleyball Players: A Proof-of-Principle Study

Volleyball players are often subject to micro-traumatisms of the heel fat pad and ankle injuries. Recently, mat-based proprioceptive training has assumed a key role in recovery from these disorders. Therefore, this proof-of-principle study aimed to assess the efficacy of proprioceptive mat training on plantar pressures and athletic performance in volleyball players. The participants included adult semi-professional volleyball players allocated into two groups: an experimental group, with mat-based proprioceptive and balance training, and a control group, with a sham protocol. For the outcome, we evaluated the barefoot plantar pressure, performing an analysis on a baropodometric resistive platform. The countermovement jump and squat jump were measured using an inertial measurement unit. Nineteen subjects were included in the two groups: the active proprioceptive group (n = 10) or the control group (n = 9). The results show a more uniform redistribution of loads with pressure hindfoot relief in the experimental group compared to the control group (p = 0.021, RBC = 0.67). Moreover, we observed a significant increase in peak landing force and high concentric power development in the experimental group compared to the controls. Focused proprioceptive management provided hindfoot load attenuation by stimulating higher peaks of concentric force in the experimental group compared to the sham group. Even though the study included a small sample, the results obtained in this proof-of-principle study suggest a positive role of proprioceptive stimulation in the inter-seasonal scenario for volleyball players to improve their jump performance and reduce the micro-traumatisms of the heel fat pad and the ankle injury rate. However, further studies performed on larger samples are needed to confirm these preliminary results.

Prevalence of Glenohumeral Internal Rotation Deficit and Sex Differences in Range of Motion of Adolescent Volleyball Players: A Case-Control Study

Shoulder range of motion (ROM) adaptation is common observed among volleyball players, but studies on the shoulder joint function of adolescent athletes are lacking. This study aimed to clarify the prevalence of glenohumeral internal rotation deficit (GIRD) among adolescent players and differences in ROM based on sex. A questionnaire survey and ROM measurements of the shoulder joint and trunk using a plastic goniometer were conducted on 123 volleyball players (63 males and 60 females; mean age, 15.8 years). The prevalence of GIRD was investigated for internal rotation differences of >10° and total rotation motion of <5°. Questionnaire items and ROM were compared between GIRD and non-GIRD patients, and sex differences in ROM were also presented. Of the participants, 38.2% (n = 47/123) had GIRD. The GIRD group showed a decrease in external rotation on the dominant side (p = 0.003, 1 − beta = 0.84), but this was not associated with a history of shoulder injury. Sex differences in shoulder ROM showed hypomobility in males and hypermobility in females. However, there was no association between shoulder injury and GIRD among adolescent players. There are sex differences in ROM, which should be considered in future studies.