Injuries in elite volleyball

Ball-To-Hand Contact Forces Increase Modeled Shoulder Torques during a Volleyball Spike

The volleyball spike is repeated many times in practices and games, presenting a high risk of overuse injury. Previous biomechanical analyses estimating forces on the shoulder during spiking have not included the force exerted on the arm by the ball, because no practical method exists to estimate the contact force between the ball and the hand. The objective of the study was to model the internal shoulder joint reactions while including the measured ball contact force. Ten adolescent female volleyball players performed spikes while we recorded 3D motion capture data for both ball and player. Using an impulse-momentum analysis, we estimated the ball contact force, then included the force in a computational simulation model to estimate the torques produced by the shoulder. The study found that post-contact ball velocities range from 8.6 m/s - 18.2 m/s with net forces between 238 N - 672 N. Most notably, when the ball contact force was included, the average modeled internal shoulder torque to internally rotate the arm increased from -26 N-m to +44 N-m (p < 0.001). These data suggest that neglecting the contact force may risk misinterpreting connections between biomechanics and injury due to spiking. More accurate joint mechanics models will lead to better injury prevention recommendations for volleyball players of all ages.

Efficacy of semi-customized exercises in preventing low back pain in high school volleyball players: A randomized controlled trial

BACKGROUND

Low back pain (LBP) is a common injury in high school volleyball players. We hypothesized that a prevention program could decrease the incidence of LBP in high school volleyball players. This study was an in-season cluster-randomized controlled trial.

METHODS

We block-randomized 8 high school volleyball teams comprising 70 players aged 15 to 17 years into the intervention (4 teams, 34 players) and control (4 teams, 36 players) groups. The intervention program consisted of 9 physical function tests as well as 1 or 2 self-selected preventive exercises, including dynamic thoracic mobility, trunk stabilization exercises, and static stretching, performed during warm-up. Both groups were followed up for 4 weeks, during which the incidence of LBP was recorded. Physical function tests (back endurance; spinal and back flexibility; active or passive shoulder and trunk range of motion; ankle joint mobility; and iliopsoas, quadriceps, and hamstrings flexibility) were conducted before and after the intervention.

RESULTS

The intervention group had a significantly lower incidence of LBP (8.8%) than the control group (33.3%) (relative risk, 3.78; 95% confidence interval, 1.17-12.23; P = .017, 1 - β = 0.99). Lumbar extension accounted for nearly 70% of LBP incidences. Most players in the intervention group demonstrated improved physical function associated with the exercises.

CONCLUSION

The semi-customized prevention program decreased the incidence of LBP and enhanced the physical function parameter in high school volleyball players.

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

OBJECTIVE

To determine the prevalence and risk factors associated with musculoskeletal injuries sustained in female adolescent volleyball players.

METHODS

Volleyball players (n = 276; 13-18 years), with any level of volleyball experience, were recruited. Participants completed a study-specific survey about their overall sport(s) involvement, training modalities, volleyball experience (beginner, intermediate, advanced), annual volume of volleyball play, injuries accrued during volleyball, and care received for injury.

RESULTS

Annual volume of volleyball play was higher in advanced than beginner/intermediate players (490.0 hr/yr versus 302.3 hr/yr; p < 0.0001). Nearly 67% (188/276) of participants incurred one or more volleyball-related injuries over the last year. The ankle (40.6%), fingers (36.6%), knee (21.2%), and shoulder (15.5%) were the most frequently reported injury. Injury prevalence was higher in advanced than beginner/intermediate players (73.5% versus 62.0%; p = 0.04). Beginner/intermediate players have significantly higher odds ratio (OR) of sustaining an elbow injury than advanced players (OR 5.88; p = 0.025). 21.5% of injured players missed more than one month of play.

CONCLUSION

More competitive and experienced adolescent female players may incur injuries due to progressively higher volumes of play as experience and competition level increase. Players who have committed to only playing volleyball participated in greater volumes of volleyball play, which increases the odds of sustaining an injury.

CLINICAL RELEVANCE

Understanding injury risk factors may improve clinical management and injury prevention.

Physical function characteristics in Japanese high school volleyball players with low back pain: A case-controlled study

Low back pain (LBP) is a typical symptom in volleyball players, yet associated physical function factors have not been identified. This study purpose is to determine the relationship between LBP and physical function factors in order to identify potential factors for the management of LBP.Participants were 123 male and female volleyball players of 15- to 17-year-olds who, completed a questionnaire regarding demographic details, presence of LBP, and years of volleyball experience. Participants were divided into 2 groups based on the presence of current LBP and evaluated on physical function tests. The results of the questionnaire response and physical function test were compared between the 2 groups. Data were analyzed using a multivariate logistic regression analysis with presence and absence of current LBP as the explanatory variable.11.4% of all participants reported current LBP. Physical function factors associated with current LBP were a positive modified Thomas test, years of volleyball experience and reduced range of motion of shoulder horizontal abduction on the dominant hand side.The associations between physical function factors and LBP found in this survey suggest that attention should be given to more experienced players with decreased flexibility of hip and shoulder flexors on the dominant side in order to manage LBP in high school volleyball players.

Shoulder complaints more likely in volleyball players with a thickened bursa or supraspinatus tendon neovessels

Shoulder problems are common in volleyball and greatly impede both training and player performance. Subacromial bursa (SAB) thickening and tendon neovascularity have shown relevance in other populations, but their relationship with the development of shoulder complaints has not been investigated in volleyball players or overhead-throwing athletes. The study aim was to examine the role of SAB thickness, neovascularization of the supraspinatus tendon, shoulder strength, range of motion (ROM), player position, and age in the development of shoulder complaints in professional volleyball players. Players underwent preseason baseline testing (n = 86) and reported shoulder complaints during the subsequent 12-week period. Generalized estimating equations were used to model for probabilities of complaints after adjusting for player position, SAB side-to-side difference, neovessel presence, shoulder external rotation (ER) ROM, and age. Outside hitters and opposites were 12.2-fold more likely to develop complaints, and greater shoulder ER ROM increased risk by 8% for each additional degree. A side-to-side difference in SAB thickness ≥0.3 mm in the dominant compared with the non-dominant arm was associated with a 10.2-fold increased risk. Those with neovessels were 6.5 times more likely to develop complaints. Players without neovessels and with normal SAB thickness were very unlikely to develop complaints. This stark contrast to players with neovessels or increased SAB thickness, where nearly half of the players developed complaints, is of interest. Players with current complaints at baseline presented with greater IR:ER strength ratios; however, neither strength nor IR ROM at baseline was associated with an increased risk of developing complaints.

Prevalence and Factors Associated With Injuries in Elite Spanish Volleyball

CONTEXT

Prevalence studies have been carried out widely on elite volleyball players. However, the extent to which specific prevention strategies are used and the influence of the sport equipment on the occurrence of injuries have been sparsely investigated.

OBJECTIVE

To describe the prevalence of injuries sustained during 1 season in elite Spanish volleyball leagues and to investigate the association of injuries with factors such as player court position, injury mechanism, type of shoes used when playing, or participation in prevention activities.

DESIGN

Descriptive cross-sectional epidemiology study: observational study.

SETTING

European elite professional volleyball.

PARTICIPANTS

Professional volleyball players from the elite Spanish volleyball league.

MAIN OUTCOME MEASURES

A self-report questionnaire assessed the presence of injury during a volleyball season. Questions included the type of injury, its anatomic location, participation in prevention strategies, shoe type, the injury mechanism, the season period, the period of leave, and the treatment received.

RESULTS

In total, 490 players (71.2% response rate) completed and returned the questionnaire. The injury prevalence was 66.9%, and the average of injuries per player was 0.94 (0.85) (range: 0-4). Most Spanish elite volleyball players participated in prevention programs during the season (90.3%) and played volleyball with low-top shoes (83.6%), but these factors were not associated with the prevalence of injuries (P > .05). The anatomic regions with the most injuries were the ankle, knee, and shoulder; the most common types of injury were sprains, tendinopathies, and strains, usually occurring during blocking and attack actions during the in-season period.

CONCLUSIONS

Despite most elite volleyball players participating in prevention programs, the results reveal a high injury prevalence. Further prospective research on the effectiveness of prevention strategies in elite volleyball is needed.

Anticipatory effects on lower extremity kinetics during a land and cross step maneuver in female volleyball players

BACKGROUND

Anticipation has been previously shown to affect lower extremity mechanics during both landing and cutting maneuvers. However, little research has been conducted looking at the effects of anticipation on lower body kinetics and kinematics during a land and cross step maneuver, which due to similar kinematics, may elicit injury. The purpose of this study was to investigate competitive female volleyball players and the effect of anticipation on lower extremity mechanics during a landing and subsequent cross stepping maneuver.

METHODS

Twelve female, college-level volleyball players performed right and left cross step maneuvers following a landing under anticipated and unanticipated conditions. Kinetics were measured for the ankle, knee and hip of the dominant limb during the landing phase of the land and cross step anticipatory conditions.

RESULTS

An interaction effect (anticipation x direction; P=0.001) was observed for vertical ground reaction force (VGRF), in which greater VGRF was found during unanticipated pivoting maneuvers. Additional interaction effects were determined for ankle (P=0.004) and hip (P=0.037) power absorption, in which greater absorption was found during anticipated, push off conditions. Frontal plant knee kinetics revealed a higher-order interaction, as a larger knee adduction moment was shown during anticipated, push off trials (P=0.001).

CONCLUSIONS

High risk cross step maneuvers were found during unanticipated and anticipated conditions, as athletes demonstrated movement mechanics that may increase the risk of knee injury when performing movements away from the dominant limb. Consideration should be given to drills familiarizing volleyball players with unanticipated and anticipated changes of direction, as well as improving strength of the lower extremity muscles required to effectively decelerate the body, as both training modalities may minimize injury risk during cross step maneuvers.

Spiking Kinematics in Volleyball Players With Shoulder Pain

CONTEXT

Spiking is one of the most frequently used scoring techniques in volleyball games, and around 80% of shoulder pain in volleyball players is linked with the spiking movement.

OBJECTIVE

To investigate the differences in glenohumeral joint, scapular, and trunk movements during the spiking motion between volleyball players with and those without shoulder pain.

DESIGN

Cross-sectional study.

SETTING

University laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty amateur volleyball players with shoulder pain (age = 21.8 ± 1.79 years, with an average of 4.0 ± 0.92 years of volleyball experience and 6.0 ± 3.51 months of shoulder pain) and 20 sex-, age-, and experience-matched control participants.

MAIN OUTCOME MEASURE(S)

The 3-dimensional kinematics of the shoulder joint, scapula, and trunk during spiking were assessed using an electromagnetic tracking system.

RESULTS

Compared with the control group, individuals with shoulder pain demonstrated less scapular posterior tilt ( P = .041) and more glenohumeral horizontal abduction ( P = .008) and scapular internal rotation ( P = .02) at ball contact when performing the cross-body spike.

CONCLUSIONS

The decrease in scapular posterior tilt, along with increased glenohumeral horizontal abduction and scapular internal rotation, was associated with shoulder pain in university volleyball players. These changes should be addressed in the training and treatment of young volleyball players.

Landing-related ankle injuries do not occur in plantarflexion as once thought: a systematic video analysis of ankle injuries in world-class volleyball

Background

Ankle injuries are prevalent in elite volleyball and suggested to result from player contact at the net. Traditionally, ankle sprains are thought to happen in a plantarflexed position, but case studies suggest plantarflexion may not be involved.

Aim

Describe the injury situations and mechanisms of ankle injuries in world-class volleyball based on systematic video analysis of injuries reported through the Fédération Internationale de Volleyball (FIVB) Injury Surveillance System.

Methods

Videos of 24 injuries from major FIVB tournaments were included for analysis (14 men, 10 women). Five analysts reviewed the videos to determine specific situations and mechanisms leading to injuries.

Results

The majority of injuries occurred during two volleyball situations, blocking (n=15) and attacking (n=6). Injuries to blockers were the result of landing on an opponent (n=11) or teammate (n=4). Attacking injuries most frequently occurred when a back-row player landed on a front-row teammate (n=4 of 6). When landing on an opponent under the net, the attacker landed into the opponent’s court in 11 of 12 situations but without violating the centre line rule. Injuries mostly resulted from rapid inversion without any substantial plantarflexion.

Conclusions

The majority of injuries occur while blocking, often landing on an opponent. The attacker is overwhelmingly to blame for injuries at the net secondary to crossing the centre line. Injuries while attacking often result from a back-row player landing on a front-row teammate. Landing-related injuries mostly result from rapid inversion with the absence of plantarflexion.

Assessment of isokinetic muscle function in Korea male volleyball athletes

Volleyball players performed numerous repetitions of spike actions, which uses and requires strong and explosive force, and control of the muscles of the shoulder, lower back, and legs. Muscle imbalance is one of the main causes of sport injuries. The purpose of this study was to assess isokinetic muscle functions in male volleyball players. We thus aim to accurately evaluate their muscle functions, and identify the best training strategy to achieve optimal muscle strength balance in future training programs. The participants in this study consisted of 14 male volleyball players. Muscle strength was measured using the isokinetic dynamometer. Muscle strength was evaluated in terms of peak torque and average power, calculated from five repeated measurements at an angular speed of 60°/sec. Three players who were left attackers showed shoulder imbalance, four players showed trunk joint imbalance, nine players had knee joint of extension/flexion imbalance and four players showed left/right imbalance. The results showed that the number of volleyball players with differences between the strength of the bilateral knee muscles, and between the strength of the hamstrings and quadriceps muscles was higher than the number of players with differences between the strength of the shoulder internal and external rotation muscles, and higher than the number of players with differences between the strength of the lower back extension and flexion muscles.

Shoulder-Rotator Strength, Range of Motion, and Acromiohumeral Distance in Asymptomatic Adolescent Volleyball Attackers

CONTEXT

Sport-specific adaptations at the glenohumeral joint could occur in adolescent athletes because they start participating in high-performance sports in early childhood.

OBJECTIVE

To investigate shoulder-rotator strength, internal-rotation (IR) and external-rotation (ER) range of motion (ROM), and acromiohumeral distance (AHD) in asymptomatic adolescent volleyball attackers to determine if they have risk factors for injury.

DESIGN

Cross-sectional study.

SETTING

University laboratory.

PARTICIPANTS

Thirty-nine adolescent high school-aged volleyball attackers (22 boys, 17 girls; age = 16.0 ± 1.4 years, height = 179.2 ± 9.0 cm, mass = 67.1 ± 10.9 kg, body mass index = 20.7 ± 2.6 kg/m²).

MAIN OUTCOME MEASURE(S)

Shoulder IR and ER ROM, total-rotation ROM, glenohumeral IR deficit, AHD, and concentric and eccentric strength of the shoulder internal and external rotators were tested bilaterally.

RESULTS

External-rotation ROM was greater (t₃₈ = 4.92, P < .001), but IR ROM (t₃₈ = -8.61, P < .001) and total ROM (t₃₈ = -3.55, P = .01) were less in the dominant shoulder, and 15 athletes had a glenohumeral IR deficit (IR ROM loss > 18°). We observed greater concentric internal-rotator (t₃₈ = 2.89, P = .006) and eccentric external-rotator (t₃₈ = 2.65, P = .01) strength in the dominant than in the nondominant shoulder. The AHD was less in the dominant shoulder (t₃₈ = -3.60, P < .001).

CONCLUSIONS

Adolescent volleyball attackers demonstrated decreased IR ROM, total ROM, and AHD and increased ER ROM in their dominant shoulder. Therefore, routine screening of adolescent athletes and designing training programs for hazardous adaptive changes could be important in preventing shoulder injuries.

Y-balance normative data for female collegiate volleyball players

OBJECTIVE

The Lower Quarter Y Balance (YBT-LQ) Test performance varies depending on competitive level, sport, gender, and age; therefore, determining normative scores specific to a population may be helpful in identifying injury-risk thresholds and return-to-play criteria following an injury. The purpose of this study was to determine normative YBT-LQ scores by assessing a subset of female, Division I volleyball players.

DESIGN

A descriptive analysis cohort study.

PARTICIPANTS

Ninety healthy (19.6 ± 1.2 y/o), collegiate female volleyball players.

MAIN OUTCOME MEASURES

YBT-LQ was measured in 3 distinct directions of anterior (ANT), posteromedial (PM) and posterolateral (PL) on both the dominant and non-dominant limbs. In addition, a one way ANOVA was performed to determine mean group differences of YBT-LQ dominant and non-dominant limb composite score across position.

RESULTS

Baseline values for this population were 94.1 ± 6.6% on the dominant limb and 93.9 ± 6.2% on the non-dominant limb. There were no significant differences for YBT-LQ composite scores on dominant (P = 0.867) and non-dominant (P = 0.989) limbs between position.

CONCLUSIONS

This study identified normative YBT-LQ composite scores for healthy, female, collegiate volleyball players. Participants performed similarly despite their position.

Reliability and Validity of EN-TreeM Dynamometer for Measurement of Shoulder Rotator Strength in Volleyball Players

INTRODUCTION

Volleyball involves repeated forceful arm actions that produce a high incidence of shoulder injury. Shoulder rotator strength ratio is an important predictor of the likelihood of shoulder injury, especially, secondary shoulder impingement and instability. Therefore, assessment of muscle strength of external and internal rotators of shoulder is imperative to establish the profiles of shoulder rotator performance, strength ratios, and shoulder mobility of volleyball players.

AIM

To establish reliability and validity of EN-TreeM dynamometer for the measurement of shoulder rotators strength in volleyball players.

MATERIALS AND METHODS

Thirty male volleyball players aged 18-24 years, mean height 1.7m, weight 69.8 Kg and BMI 23.1 participated in the study. They performed 1RM (one repetition maximum) estimation protocols using EN-TreeM dynamometer and free weights for shoulder rotators, to investigate its concurrent validity. A retest using the same protocol was performed 48 hours later to assess test-retest reliability of the EN-TreeM dynamometer.

RESULTS

The results yielded excellent test-retest reliability (ICC0.96) and internal consistency (Cronbach's alpha0.98) for both internal and external rotators. The concurrent validity was established using Pearson correlation coefficient (internal rotator r=0.45, p=0.01;External rotator r=0.38, p=0.03).

CONCLUSION

The findings establish the reliability and concurrent validity of EN-TreeM dynamometer for the quantification of shoulder rotators strength. Based on these findings in volleyball players, EN-TreeM dynamometer can be used with confidence as an instrument for assessing muscle performance (strength). Additionally, it may also be used for monitoring changes due to rehabilitation interventions in shoulder injuries.

Injury risk management plan for volleyball athletes

Volleyball is an increasingly popular team sport. As with any competitive sport, there is an inherent risk of injury that must be recognized and collaboratively managed. This article provides a practical approach to the management of volleyball injuries within a team or organization. A brief review of the epidemiological data is presented which establishes (i) ankle sprain, (ii) shoulder overuse injury, (iii) patella tendinopathy, and (iv) anterior cruciate ligament injury as the primary injuries to address amongst these athletes. The interaction of modifiable and non-modifiable risk factors for these injuries are used to classify athletes into high-, medium- and low-risk groups. Targeted training interventions are suggested, based upon the risk level of the athlete, to minimize the occurrence of these injuries. Practical methods for integrating these activities into a training plan are also discussed.

Injury risk is low among world-class volleyball players: 4-year data from the FIVB Injury Surveillance System

Background

Little is known about the rate and pattern of injuries in international volleyball competition.

Objective

To describe the risk and pattern of injuries among world-class players based on data from the The International Volleyball Federation (FIVB) Injury Surveillance System (ISS) (junior and senior, male and female).

Methods

The FIVB ISS is based on prospective registration of injuries by team medical staff during all major FIVB tournaments (World Championships, World Cup, World Grand Prix, World League, Olympic Games). This paper is based on 4-year data (September 2010 to November 2014) obtained through the FIVB ISS during 32 major FIVB events (23 senior and 9 junior).

Results

The incidence of time-loss injuries during match play was 3.8/1000 player hours (95% CI 3.0 to 4.5); this was greater for senior players than for junior players (relative risk: 2.04, 1.29 to 3.21), while there was no difference between males and females (1.04, 0.70 to 1.55). Across all age and sex groups, the ankle was the most commonly injured body part (25.9%), followed by the knee (15.2%), fingers/thumb (10.7%) and lower back (8.9%). Injury incidence was greater for centre players and lower for liberos than for other player functions; injury patterns also differed between player functions.

Conclusions

Volleyball is a very safe sport, even at the highest levels of play. Preventive measures should focus on acute ankle and finger sprains, and overuse injuries in the knee, lower back and shoulder.

Shoulder 3D range of motion and humerus rotation in two volleyball spike techniques: injury prevention and performance

Repetitive stresses and movements on the shoulder in the volleyball spike expose this joint to overuse injuries, bringing athletes to a career threatening injury. Assuming that specific spike techniques play an important role in injury risk, we compared the kinematic of the traditional (TT) and the alternative (AT) techniques in 21 elite athletes, evaluating their safety with respect to performance. Glenohumeral joint was set as the centre of an imaginary sphere, intersected by the distal end of the humerus at different angles. Shoulder range of motion and angular velocities were calculated and compared to the joint limits. Ball speed and jump height were also assessed. Results indicated the trajectory of the humerus to be different for the TT, with maximal flexion of the shoulder reduced by 10 degrees, and horizontal abduction 15 degrees higher. No difference was found for external rotation angles, while axial rotation velocities were significantly higher in AT, with a 5% higher ball speed. Results suggest AT as a potential preventive solution to shoulder chronic pathologies, reducing shoulder flexion during spiking. The proposed method allows visualisation of risks associated with different overhead manoeuvres, by depicting humerus angles and velocities with respect to joint limits in the same 3D space.

Evaluation of knee joint proprioception and balance of young female volleyball players: a pilot study

[Purpose] The main purpose of our study was the evaluation of the effects of long-term volleyball practice on knee joint proprioception and balance of young female athletes. [Subjects and Methods] An observational case-control study was performed. The study enrolled 19 female volleyball players in the experimental group and 19 sedentary counterparts as controls. A Biodex balance system and dynamometer were used for the evaluations. The paired t-test was used to determine the significance of differences between the performance of athletes and controls. [Results] The knee proprioception analysis showed a significant difference at 60° joint position in active and passive tests. A similar trend, but without significance, was found for the 20° joint position. In the postural stability tests both groups showed similar results with no significant differences between them. [Conclusion] In conclusion, the results indicate a significant influence on joint proprioception is elicited by long-term exposure to a team sport like volleyball. However, the postural stability indexes showed similar trends in both groups, highlighting the analogous ontogenesis of the subjects investigated and the low influence of volleyball practice on postural stability.

Chronic ankle instability in sporting populations

BACKGROUND

Chronic ankle instability (CAI) is a term used to identify certain insufficiencies of the ankle joint complex following an acute ankle injury. Acute ankle injuries are often associated with sporting mishaps; however, this review was the first to identify the aspects of CAI (perceived instability, mechanical instability and recurrent sprain), and persisting symptoms following an ankle sprain, that have been reported within sporting cohorts.

OBJECTIVE

To determine the presence of common aspects of CAI within individual sports.

METHODS

A systematic search of the MEDLINE, Web of Science, CINAHL, SPORTDiscus and AMED databases up until 1 October, 2013 produced 88 studies appropriate for review. A calculated weighted percentage of the outcome data allowed the comparison of figures across a range of sports.

RESULTS

Soccer, basketball and volleyball were the most represented sports and recurrent ankle injury/sprain was the most reported aspect of CAI. Soccer had the highest percentage of participants with recurrent sprain (61%) and mechanical instability (38%), whilst track and field had the highest percentage of participants with perceived instability (41%). Gymnasts had the highest percentage of ankles with persisting symptoms following an initial ankle sprain.

CONCLUSION

This review was the first to assess aspects of CAI within sporting cohorts and has identified limitations to the research reporting these data. The problem of CAI across a range of sports remains unclear and thus advocates the need for further controlled research in the area to ascertain the true extent of CAI within sporting populations.

Scapular bracing and alteration of posture and muscle activity in overhead athletes with poor posture

CONTEXT

Overhead athletes commonly have poor posture. Commercial braces are used to improve posture and function, but few researchers have examined the effects of shoulder or scapular bracing on posture and scapular muscle activity.

OBJECTIVE

To examine whether a scapular stabilization brace acutely alters posture and scapular muscle activity in healthy overhead athletes with forward-head, rounded-shoulder posture (FHRSP).

DESIGN

Randomized controlled clinical trial.

SETTING

Applied biomechanics laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty-eight healthy overhead athletes with FHRSP.

INTERVENTION(S)

Participants were assigned randomly to 2 groups: compression shirt with no strap tension (S) and compression shirt with the straps fully tensioned (S + T). Posture was measured using lateral-view photography with retroreflective markers. Electromyography (EMG) of the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA) in the dominant upper extremity was measured during 4 exercises (scapular punches, W's, Y's, T's) and 2 glenohumeral motions (forward flexion, shoulder extension). Posture and exercise EMG measurements were taken with and without the brace applied.

MAIN OUTCOME MEASURE(S)

Head and shoulder angles were measured from lateral-view digital photographs. Normalized surface EMG was used to assess mean muscle activation of the UT, MT, LT, and SA.

RESULTS

Application of the brace decreased forward shoulder angle in the S + T condition. Brace application also caused a small increase in LT EMG during forward flexion and Y's and a small decrease in UT and MT EMG during shoulder extension. Brace application in the S + T group decreased UT EMG during W's, whereas UT EMG increased during W's in the S group.

CONCLUSIONS

Application of the scapular brace improved shoulder posture and scapular muscle activity, but EMG changes were highly variable. Use of a scapular brace might improve shoulder posture and muscle activity in overhead athletes with poor posture.

Characteristics and contributing factors related to sports injuries in young volleyball players

Background

The participation of young in volleyball is becoming increasingly common, and this increased involvement raises concerns about the risk of installation of sports injuries. Therefore, the objectives the study were identify the characteristics of sports injuries in young volleyball players and associate anthropometric and training variables with contributing factors for injuries.

Methods

A total of 522 volleyball players participating in the High School Olympic Games of the State of São Paulo (Brazil) were interviewed. A reported condition inquiry was used to gather information on injuries, such as anatomic site affected, mechanism and moment of injury, as well as personal and training data. The level of significance was set at 5%.

Results

A 19% frequency of injuries was found. Higher age, weight, height, body mass index and training duration values were associated with the occurrence of injuries. The most affected anatomic site was the ankle/foot complex (45 injuries, 36.3%). Direct contact and contactless mechanisms were the main causes of injuries (61 injuries; 49.2% and 48 injuries; 38.7%, respectively). Training was the moment in which most injuries occurred (93 injuries; 75%), independently of personal and training characteristics.

Conclusion

Injuries affected the ankle/foot complex with a greater frequency. Direct contact and contactless mechanisms were the most frequently reported and injuries occurred mainly during training sessions. Personal and training characteristics were contributing factors for the occurrence of injuries.

Overuse in volleyball training/practice: A review on shoulder and spine-related injuries

Overuse injuries are predominant in sports involving the repetition of similar movements patterns, such as in volleyball or beach volleyball, and they may represent as much a problem as do acute injuries. This review discusses the prevalence of two of the most common overuse-related injuries in volleyball: shoulder and back/spine injuries. Risk factors and the aetiology of these injuries are illustrated in order to make possible to initiate preventive programme or post-injuries solutions. Data collected from literature showed a moderately higher injury rate for overuse shoulder injuries compared to the back/spine (19.0 ± 11.2% and 16.8 ± 9.7%, respectively). These data could be underestimated, and future epidemiological studies should consider overuse injuries separately from the others, with new methodological approaches. In addition to age, biomechanical and anatomical features of a volleyball technique utilised in game and the amount of hours played are considered as the main risk factors for overuse upper limb injuries, both for professional and recreational athletes. Together with post-injuries solutions, great importance has to be placed on preventive programmes, such as preventive rehabilitation, stretching, adequate warm up, strength-power exercises, etc. Furthermore, it is particularly suggested that coaches and players work together in order to develop new game/training techniques that minimise stresses and range of motion of the principal anatomical structures involved, while maintaining athletes performance.

Análise da aptidão física, da antropometria e da prevalência de sintomas osteomusculares na categoria infanto-juvenil do voleibol

INTRODUÇÃO: O controle da ocorrência de lesões durante todo o processo de treinamento possui expressiva importância para o atleta, bem como o monitoramento das adaptações físicas decorrentes do programa de exercícios. OBJETIVOS: Descrever o perfil antropométrico e a aptidão física dos times de voleibol infanto-juvenil e determinar a prevalência de sintomas osteomusculares. Métodos: Estudo longitudinal. Participaram 38 atletas da categoria infanto-juvenil do voleibol monitorados por quatro meses através de testes de aptidão física, mensurações antropométricas e do questionário de sintomas osteomusculares. Foram utilizadas análises descritivas e comparativas através de médias e desvio padrão e teste t de Student. RESULTADOS: Os principais indicadores estatisticamente significativos observaram-se nas variáveis: estatura (p = 0,001 para o sexo masculino e 0,003 para o feminino) envergadura para os meninos (p < 0,001), arremesso (p = 0,003 para os meninos e p < 0,001 para as meninas), abdominal para as meninas (p = 0,001). A maioria dos sintomas prevaleceu nas costas (56,5%), ombros (52,2%), quadris/coxas (52,2%) e joelhos (52,2%). CONCLUSÃO: O perfil dos atletas apresentou como principais características: o aumento da estatura, envergadura e força explosiva de membros superiores, resistência abdominal e agilidade. A grande frequência de respostas afirmativas de queixas nas costas, parte inferior e superior, ombros, quadril/coxas, joelhos e tornozelos reforça a necessidade de um acompanhamento a longo prazo da reação dos jovens desportistas ao treinamento, bem como fomenta estratégias de prevenção.

Ultrasound assessment of asymmetric hypertrophy of the rectus abdominis muscle and prevalence of associated injury in professional tennis players

OBJECTIVE

To assess rectus abdominis (RA) thickness and injury prevalence using ultrasound in a group of professional tennis players. Observations with regard to muscle fiber repair is described. We likewise studied the potential link between RA volume asymmetry and the risk of muscle strain.

MATERIALS AND METHODS

The degree of asymmetry between the different RA slices was assessed using ultrasound in 61 professional tennis players. The history of RA injury in these tennis players was likewise studied, taking into account the following factors: dominant vs non-dominant arm, history of RA strains, duration thereof and number of recurrences. Ultrasound examination was performed with an 8- to 12-MHz linear multi-frequency transducer.

RESULTS

Ultrasound revealed the presence of fibrous scar tissue in the RA muscle in 18 cases (29.5%). In all instances, the lesion was located in the RA on the side of the nondominant arm. In 16 of the cases, the lesion was infra-umbilical and L2 was affected in two cases. The mean maximum width of the fibrous repair tissue was 9 mm (range 5-16). The mean distance between the umbilicus and the scar was 5.8 cm (range 2.9-11.4). Statistical study of the ultrasound measurements obtained for the different slices revealed statistically significant differences between the different depths and according to arm dominance.

CONCLUSIONS

In the series studied, the prevalence of RA muscle lesion in professional tennis players was 29.5%. Asymmetric hypertrophy of the RA muscle appears to constitute a risk factor for suffering an injury in this location.

Shoulder pain in Iranian elite athletes: the prevalence and risk factors

OBJECTIVE

Shoulder sports injuries are relatively common in athletes who perform highly repetitive motions. The purposes of this study were to determine the prevalence of and risk factors for shoulder injuries and to analyze how individual and other sport characteristics contribute to the risk of shoulder injuries among 6 overhead sports, those being swimming, rowing, wrestling, basketball, volleyball, and handball.

METHODS

A cross-sectional study was carried out on 613 Iranian overhead sports athletes in different collegiate sport fields. Data were collected using different questionnaires. A structured questionnaire including demographics, sport characteristics, and also prevalence and risk factors of shoulder pain was used. Visual analogue scale and Disability of the Arm, Shoulder, and Hand questionnaires were used to determine the pain intensity and functional disability, respectively.

RESULTS

Point, last 6-month, last year, and lifetime prevalences of shoulder pain were 21.4%, 29%, 38.8%, and 41.6%, respectively. The highest point prevalence was related to the rowing athletes with 31.9% and the lowest for swimming athletes (12.3%). Sex, body mass index, sport level, days of practice per week, and satisfaction with income were found to be significantly correlated with the prevalence of shoulder pain (P < .05 in all instances). For those with shoulder pain, the mean pain intensity and functional disability were 53.8 mm and 15.46%, respectively.

CONCLUSIONS

The prevalence of shoulder pain in athletes with highly repetitive overhead motions seems to be high.

Rectus abdominis muscle injuries in elite handball players: management and rehabilitation

Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball.

Low-back problems in recreational self-contained underwater breathing apparatus divers: prevalence and specific risk factors

Low-back problems (LBP) are one of the most common musculoskeletal disorders in the general population, with reported lifetime prevalences of 50% to 80%. Also, certain sports participants (e.g. gymnasts, alpine skiers, runners) are at risk of LBP and its repercussions. This epidemiological study was undertaken to examine the lifetime and 1-year prevalence of LBP among recreational Flemish self-contained breathing apparatus (scuba) divers and to identify general and sport-specific risk factors associated with the occurrence of LBP. A retrospective self-assessment questionnaire was developed and assessed for validity and reliability, to gather data concerning demographics, LBP prevalence and associated risk factors and injuries among active scuba divers. A total of 181 recreational scuba divers (men: n = 138, mean age 40.3 +/- 12.8 years; women: n = 43, mean age 35.0 +/- 10.9 years) from 10 randomly selected internationally recognised scuba diving clubs participated in the study. Lifetime and 1-year prevalence of LBP among recreational Flemish scuba divers were 55.8% and 50.3%, respectively. General risk factors for LBP were found to include prior history of LBP, structural abnormalities, heavy workload, pregnancy and parturition, general fatigue and bending forwards and backwards. Scuba divers suffering from LBP generally had a significantly higher dive certificate than those without LBP (p = 0.007). Symptomatic scuba divers also used significantly more weights on their weight belts during indoor training (p = 0.003) and during outdoor dives with a dry suit (p = 0.044) as compared to asymptomatic scuba divers. In scuba diving, reliable sport-specific risk factors for LBP were found to be scarce. Further biomechanical research is required to point out whether or not scuba diving characteristics actually contribute to LBP.

Isokinetic peak torque ratios and shoulder injury history in adolescent female volleyball athletes

CONTEXT

Few researchers have examined shoulder strength in adolescent volleyball athletes despite increasing levels of participation in this age group.

OBJECTIVE

To compare medial and lateral isokinetic peak torque of the rotator cuff among skill levels and between athletes with and without a history of shoulder injury.

DESIGN

Cross-sectional design.

SETTING

The Human Performance Lab and Athletic Training Lab.

PATIENTS OR OTHER PARTICIPANTS

Thirty-eight female adolescent club volleyball athletes from 10 to 15 years of age (mean = 13.02 +/- 1.60 years).

MAIN OUTCOME MEASURE(S)

We measured concentric and eccentric peak torque of the medial and lateral rotators of the shoulder and calculated resultant cocking and spiking ratios based on peak torque values.

RESULTS

Athletes at higher skill levels had higher peak torque measurements in concentric and eccentric medial and lateral rotation compared with the athletes at lower skill levels. No differences in peak torque existed between participants with or without an injury history 6 months before the study. Strength ratios did not differ across skill levels, but previously injured participants produced lower eccentric medial rotation to concentric lateral rotation ratios compared with participants without a history of injury (P = .02). At the highest skill level, previously injured participants produced lower eccentric lateral rotation to concentric medial rotation ratios compared with participants without an injury history (P = .04).

CONCLUSIONS

Differences in medial and lateral shoulder rotator strength ratios appear to be related more to injury prevalence than to absolute strength. Shoulder dysfunction related to strength ratio deficits also may exist in adolescent female volleyball athletes. Preventive shoulder strengthening programs focused on improving eccentric strength and correcting imbalances between medial and lateral rotators may be warranted for all female adolescent volleyball athletes.

Mudanças no padrão temporal da EMG de músculos do tornozelo e pé pré e pós-aterrissagem em jogadores de voleibol com instabilidade funcional

INTRODUÇÃO: A instabilidade funcional (IF) é a complicação mais comum após o entorse de tornozelo; acomete até 52% dos atletas com história de entorse. O entorse de tornozelo é uma das lesões esportivas mais comuns, inclusive no voleibol, em que 90% dos entorses de tornozelo ocorrem durante a aterrissagem, após o movimento de bloqueio. A IF é definida por queixas de falseios e entorses recorrentes, sem que haja evidências clínicas de lesão ligamentar, sendo extremamente prejudicial para a prática do voleibol, pois interfere na realização dos fundamentos envolvidos na modalidade. OBJETIVOS: Comparar os padrões temporais e de magnitude da atividade eletromiográfica dos músculos tibial anterior (TA), fibular longo (FL) e gastrocnêmio lateral (GL) durante a aterrissagem do salto vertical após a execução da habilidade do bloqueio do voleibol entre jogadores com e sem IF de tornozelo. MÉTODOS: Foi adquirida a atividade EMG do tibial anterior, do fibular longo e do gastrocnêmio lateral em 21 atletas com IF (GI) e em 19 atletas controle (GC) - idade média de 20 ± 4 anos. Os envoltórios lineares foram calculados para cada um dos grupos no período de tempo entre 200ms antes e 200ms após o instante do impacto, determinados por meio da componente vertical da FRS. A magnitude e o instante do pico máximo de cada um dos músculos também foram determinados matematicamente. Os grupos foram comparados por meio do teste t (α = 0,05). RESULTADOS: O grupo com instabilidade apresentou instante de pico do TA mais tardio ± (GC = -107,4 ± 29,6ms; GI = -134,0 ± 26,0ms) e FL (GC = -11,0 ± 55,9ms; GI = -41,7 ± 49,8ms) e menor pico de TA (GC = 68,5 ± 17,2%; GI = 81,2 ± 28,8%) e FL (GC = 72,9 ± 27,3%; GI = 59,1 ± 16,0%), CONCLUSÕES: Os resultados mostram um padrão de alteração mais tardio e com menor magnitude nos músculos de atletas com IF que podem predispô-los à condição de instabilidade, mesmo na ausência de lesão anatômica.

Quadriceps tendinosis and patellar tendinosis in professional beach volleyball players: sonographic findings in correlation with clinical symptoms

The purpose was to assess quadriceps and patellar tendinosis in professional beach volleyball players and to correlate ultrasound findings with clinical symptoms. During a grand-slam beach volleyball tournaments all 202 athletes (100 men and 102 women) were invited to participate at this study. Sixty-one athletes (38 male, mean age 29.6, 23 female, mean age 27.1) were included. The dominant leg was right in 51 (84%) and left in ten athletes (16%). Lysholm knee score and pain during the game was assessed using a visual analogue scale. Sonography of the quadriceps tendon and the patellar tendon was performed by a blinded sonographer. Sonographic findings were compared between both legs and correlated to clinical findings using a regression analysis. Quadriceps tendinosis was diagnosed in 13 (21%, dominant leg)/21 (34%, non-dominant leg), patellar tendinosis in 13(21%)/18(30%). Only sonographic findings at the quadriceps tendon were significantly associated with pain: thickness of the quadriceps tendon (mean diameter 6.9 mm/7.1 mm, significant for both legs P = 0.011/P = 0.030), abnormal echo texture (11/16; P = 0.001/P = 0.228), areas with positive power Doppler signals (mean number 0.3/0.4; P = 0.049/0.346), calcifications (mean number: 0.9/1.1; P = 0.021/0.864). A relationship between findings at patellar tendon was not found. Quadriceps tendinosis is as common as patellar tendinosis in professional beach volleyball players. Thickening and structure alteration of the quadriceps tendon is associated with anterior knee pain during beach volleyball.

A systematic review on ankle injury and ankle sprain in sports

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.

A systematic review on ankle injury and ankle sprain in sports

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.

Injuries and preventive actions in elite Swedish volleyball

The purpose of this study was to examine the prevalence of injury and the extent of preventive actions in elite Swedish volleyball players. Injuries to players in the elite male and female Swedish division, during the 2002-2003 season, were registered by using a questionnaire. Of the 158 volleyball players (70% response rate), a total of 82 players (52%) reported 121 injuries, during a total exposure time of 24 632 h, representing an overall incidence of 0.77 injuries per player. The majority of the injuries were located in the ankle (23%), followed by the knee (18%) and the back (15%). Most injuries (62%) were classified as being of minor severity. Most injuries occurred during training (47%), and 41% of the injuries had a gradual onset. Fifty-four percent of the injuries that could be related to a specific court situation occurred during blocking, and 30% during spiking. Most players (96%) participated in injury prevention training of some kind, generally performed without supervision (58%). Although most players took part in some kind of preventive action, one out of two players incurred an injury during the season, which indicates that the risk of suffering an injury in elite volleyball is relatively high.

A one season prospective cohort study of volleyball injuries

OBJECTIVE

To estimate the overall incidence of acute and overuse volleyball injuries, and to describe factors associated with ankle sprains.

METHODS

486 players from the second and third Dutch national volleyball divisions participated in the study and were followed prospectively during a whole season. Three measurements were made during the season (baseline, follow up 1, and follow up 2), where all players completed a questionnaire on demographic variables (only at baseline), sports participation, use of preventive measures, and previous injuries. Volleyball exposure during training and matches was recorded for each individual player by the coach on a weekly exposure form. In case of injury the coach provided the injured player with an injury registration form, which had to be completed within one week after the onset of injury.

RESULTS

100 injuries were reported, resulting in an overall injury incidence of 2.6 injuries/1000 hours. The incidence of acute injuries was 2.0/1000 hours. Ankle sprains (n = 41) accounted for most of the acute injuries, and 31 (75%) of all players with an ankle sprain reported a previous ankle sprain. Twenty five overuse injuries were reported. The overall incidence of overuse injuries was 0.6/1000 hours; the back and the shoulder were the most common sites.

CONCLUSIONS

Ankle sprain is the most common injury in volleyball, accounting for 41% of all volleyball related injuries. Previous injury seems to be an important risk factor for an ankle sprain. Injury prevention programmes should focus on ankle sprains and concentrate on players with previous ankle sprains.

Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players

BACKGROUND

Ankle sprains are the most common form of acute injury in volleyball. A prevention programme consisting of technical training, proprioceptive training, and external support was previously designed to reduce the rate of ankle sprains in volleyball players.

OBJECTIVE

To investigate which of these three interventions is the most effective in preventing ankle sprain in female volleyball players.

METHODS

Participants were 52 players who suffered ankle sprains during the season 1998-1999. They were divided randomly into three preventive groups: group 1 (n = 18) followed the technical training programme; group 2 (n = 17) followed the proprioceptive programme; group 3 (n = 17) used orthosis. The players followed their respective programmes for the whole of the 1999-2000 season. Data were collected at the end of the season.

RESULTS

The three preventive strategies were all effective in preventive further ankle sprain. Technical training was slightly more effective than the other two methods. Orthosis was not effective in athletes who had suffered ankle sprains more than three times during their careers. Under those circumstances, technical training and proprioceptive training were equally effective at preventive further sprains.

CONCLUSIONS

Technical training and proprioceptive training are effective methods of preventing ankle sprain in volleyball players who have suffered this injury four or more times during their career. Orthosis appears effective only in players with fewer than four previous sprains.

Injuries among world-class professional beach volleyball players. The Fédération Internationale de Volleyball beach volleyball injury study

BACKGROUND

Very little is known about the injury characteristics of beach volleyball.

PURPOSE

To describe the incidence and pattern of injuries among professional male and female beach volleyball players.

STUDY DESIGN

Cohort study--retrospective injury recall and prospective registration.

METHODS

Injuries occurring over a 7.5-week interval of the summer season were retrospectively registered by interviewing 178 of the 188 participating players (95%) in the 2001 Beach Volleyball World Championships. Injuries were also cataloged prospectively during five of the tournaments held during this interval.

RESULTS

Fifty-four acute injuries was recorded, of which 23 (43%) resulted in 1 or more days of missed practice or competition. The incidence of acute time-loss injuries was estimated to be 3.1 per 1000 competition hours and 0.8 per 1000 training hours. Knee (30%), ankle (17%), and finger injuries (17%) accounted for more than half of all acute time-loss injuries. In addition, 67 players reported 79 overuse injuries for which they received medical attention during the study period. The three most common overuse conditions were low back pain (19%), knee pain (12%), and shoulder problems (10%). Similar results were observed in the prospective portion of the study.

CONCLUSIONS

The rate of acute time-loss injuries in beach volleyball is considerably lower than that in most other team sports, but overuse injuries affecting the low back, knees, and shoulder represent a significant source of disability and impaired performance for professional beach volleyball players.

Personal risk factors associated with injury among female recreational ice hockey players

INTRODUCTION

Women's ice hockey is a rapidly growing sport, however little is known about the injuries sustained by this group of athletes.

PURPOSE

The objective of this research was to identify risk factors associated with injury among female recreational ice hockey players.

METHODS

This prospective study followed players from two women's ice hockey leagues in Edmonton, Canada during the 1997-98 hockey season. The occurrence of injuries was monitored during the season through standardized telephone follow-up. Risk factors were determined using multiple logistic regression.

RESULTS

The initial study sample consisted of 314 players, however as the season progressed 19 (6%) were lost to follow-up. The results of the study are based on 295 (94%) participants. A total of 125 injuries were reported; the injury rate was 7.5 injuries/1,000 player-exposures. Risk factors found to be significantly related to the occurrence of injury were: injury in the past year (OR= 1.57), more than 5 years of hockey experience (OR=1.49), and high exposure level (OR=1.41).

CONCLUSION

This research is the first to quantify personal risk factors associated with injury among female recreational ice hockey players. A sports injury in the previous 12 months appears to be highly associated with injury and further research is required to more fully understand this relationship. The importance of controlling for level of exposure when investigating risk factors for sports injury was demonstrated.