Injuries and preventive actions in elite Swedish volleyball

The effects of fatigue on the relationship between ankle angle at initial contact and the knee and hip joints in landing: Assessing the risk of ACL injury

BACKGROUND

Anterior cruciate ligament (ACL) injuries may correlate with lower limb angles and biomechanical factors in both dominant and non-dominant legs at initial contact (IC) post-landing. This study aims to investigate the correlation between ankle angles in three axes at IC and knee and hip joint angles during post-spike landings in professional volleyball players, both pre- and post-fatigue induction.

RESEARCH QUESTION

To what extent does fatigue influence lower limb joint angles, and what is the relationship between ankle joint angles and hip and knee angles at IC during the landing phase following a volleyball spike?

METHODS

Under conditions involving the peripheral fatiguing protocol, the lower limb joint angles at IC following post-spike landings were measured in 28 professional male volleyball players aged between 19 and 28 years, who executed the Bosco fatigue protocol both before and after inducing fatigue. A paired t-test was utilized to compare the joint angles pre- and post-fatigue in both dominant and non-dominant legs. Furthermore, Pearson's correlation test was conducted to explore the relationship between ankle angles at IC and the corresponding knee and hip joint angles.

RESULTS

The findings of the study revealed that fatigue significantly increased hip external rotation and decreased knee joint flexion and external rotation in both the dominant and non-dominant legs (p < 0.05). Additionally, correlation analysis demonstrated that the ankle joint's positioning in the frontal and horizontal planes was significantly associated with hip flexion and external rotation at the IC, as well as with knee flexion and rotation (0.40 < r < 0.80).

CONCLUSION

Fatigue increased hip external rotation and ankle internal rotation, weakening the correlation between these joints while strengthening the ankle-knee relationship, indicating a reduced hip control in jumps. This suggests a heightened ACL injury risk in the dominant leg due to the weakened ankle-hip connection, contrasting with the non-dominant leg.

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.

Prognostic Power of Foot Mobility in Identifying the Risk of Musculoskeletal Injuries: A Cross-Sectional Study of Male Volleyball Players at Different Competitive Levels

(1) Background: The arch structure and mobility of the foot are considered injury risk factors in volleyball. However, there are limited studies presenting differences in injury prevalence and the risk of lower limb injuries in relation to the competitive level in male volleyball. Therefore, the main aim of the current study was to evaluate foot mobility (through navicular drop test) as an injury risk factor in volleyball players from different competitive levels. (2) Methods: The reliability and usefulness of navicular drop testing were initially assessed in test-retest procedures (based on a sample of eight participants and 16 feet measurements), with primary analyses conducted using foot measurements of the twelve top-level volleyball players (24 feet) and eighteen academic-level volleyball players (36 feet). The modified navicular drop test was conducted, and the feet were classified based on arch height, and injury prevalence was retrospectively assessed with a previously validated questionnaire. Chi-squared tests, receiver operating curves, and logistic regression were used as statistical methods. The navicular drop test was verified as a reliable tool by intraclass correlation coefficient (ICC) (3.1) analysis. (3) Results: There were no significant differences in injury prevalence between academic- and top-level volleyball players, though there was a significant relationship between pronated foot and injury risk independent of competitive level. Generally, for both groups, thresholds above 10 mm of the navicular drop were predictors of lower limb injuries. The risk of injury if the foot was pronated ranged from 70% (academic level) to over 90% (top-level players). However, no statistically significant effect of competitive level on the chance of injury was observed. (4) Conclusions: Our study found a high prevalence of foot injuries independently of competitive level. There was a relationship between pronation of the foot and the risk of injury. However, the risk of lower limb injury was higher in pronated top-level players. Also, a navicular drop greater than 10 mm was an excellent predictor of injuries at both competitive levels.

Prevalence of lower limb pain and disability in football, hockey, and floorball players

BACKGROUND

Currently there are not enough studies that compared frequent types of collective sports with regard to the prevalence of pain and disability of the lower limb.

OBJECTIVE

To determine the prevalence of lower limb pain and disability in team sports players.

METHODS

388 athletes with average age 27.26 ± 4.69, from sports clubs at the national level were included in the study. The Oxford Hip Score was used to determine the prevalence of hip pain. The International Knee Documentation Committee was used to determine the prevalence of knee pain. The Foot and Ankle Disability Index was used to determine the prevalence of ankle pain.

RESULTS

Hockey players had a prevalence of hip pain of 97.2% and a 14.3 times higher risk of developing hip pain compared with football and floorball players. Floorball players had a 81.9% prevalence of knee pain, with a 3.8 times higher the risk of knee pain compared with football and hockey. Floorball players had a 62.3% prevalence of ankle pain and a 1.8 times higher the risk of developing ankle pain compared with football and hockey players.

CONCLUSIONS

The highest percentage of knee 81.9% and ankle 62.3% pain, as well as the greatest risk of pain, was found among floorball players. Hockey players had the highest prevalence (97.2%) and risk of developing hip pain.

Knee, Low Back, and Shoulder Problems Among University and Professional Volleyball Players: Playing With Pain

CONTEXT

The knee, low back, and shoulder account for most overuse injuries in volleyball. Previous researchers have used methodology that did not examine the extent of injury burden and effect on performance.

OBJECTIVE

To develop a more accurate and complete understanding regarding the weekly prevalence and burden of knee, low back, and shoulder problems within the highest levels of men's volleyball, including the role that preseason complaints, match participation, player position, team, and age have on complaints.

DESIGN

Descriptive epidemiology study.

SETTING

Professional volleyball clubs and the National Collegiate Athletic Association Division I program.

PATIENTS OR OTHER PARTICIPANTS

A total of 75 male volleyball players, representing 4 teams playing in their country's respective premier league (Japan, Qatar, Turkey, and the United States), participated over a 3-season period.

MAIN OUTCOME MEASURE(S)

Players completed a weekly questionnaire (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire) reporting pain related to their sport and the extent to which knee, low back, and shoulder problems affected participation, training volume, and performance. Problems leading to moderate or severe reductions in training volume or performance or the inability to participate were considered substantial problems.

RESULTS

The mean weekly prevalence of knee, low back, and shoulder problems based on 102 player-seasons was 31% (95% CI = 28%, 34%), 21% (95% CI = 18%, 23%), and 19% (95% CI = 18%, 21%), respectively. Most players (93%, 95/102 player-seasons) reported some level of knee (79%, n = 81/102 player-seasons), low back (71%, n = 72/102 player-seasons), or shoulder (67%, n = 68/102 player-seasons) complaints during the season. Most players (58%, n = 59/102 player-seasons) experienced at least 1 episode of substantial problems affecting the knee (33%, n = 34/102 player-seasons), low back (27%, n = 28/102 player-seasons), or shoulder (27%, n = 28/102 player-seasons). Players with preseason complaints had more in-season complaints than teammates without preseason problems (mean weekly prevalence: knee, 42% versus 8%, t49 = -18.726, P < .001; low back, 34% versus 6%, t32 = -12.025, P < .001; shoulder, 38% versus 8%, t30 = -10.650, P < .001).

CONCLUSION

Nearly all included elite male volleyball players experienced knee, low back, or shoulder problems, and most had at least 1 bout that substantially reduced training participation or sport performance. These findings suggest that knee, low back, and shoulder problems result in greater injury burden than previously reported.

Injuries and complaints in the Brazilian national volleyball male team: a case study

BACKGROUND

The literature reports a vast amount of epidemiological information on injuries in volleyball athletes. However, little is known about the incidence of injuries in elite athletes of international level participating in major competitions, such as world championships and Olympic games. The objective of the study was to analyse the incidence of injuries in elite professional volleyball athletes, and the prevalence of complaints reported by athletes.

METHODS

This is a case study in which data were collected between April 2018 and August 2021. All the athletes called to play for the Brazilian national male volleyball team during the analysis period participated. From the athletes' medical records, the occurrence of injuries (injurious events that lead to a time off from activities) and complaints (discomforts that did not lead to a time off from activities) were analysed. Frequency data were used to calculate incidence, prevalence and ratios.

RESULTS

From 41 athletes who played for the team during the analysed period, 12 athletes had 28 injuries and 38 athletes reported 402 complaints. For injuries, an incidence of seven injuries/1,000 h of competition and two injuries/1,000 h of training was observed. The average recovery time of the athletes was 10 days. The regions with the highest prevalence of injuries were the knee (111/1,000 athletes) and ankle (69/1,000 athletes). For complaints, 402 complaints required 1,085 treatment sessions, with the regions with the highest prevalence of complaints being the knee (261/1,000 complaints) followed by the shoulders (236/1,000 complaints). Athletes aged above 23 years and those playing as middle blockers and outside hitters presented a higher prevalence of injuries and complaints.

CONCLUSIONS

Almost one-third of the athletes had injuries and almost all athletes reported complaints during the study period. Injuries and complaints were more prevalent in the knees. Complaints caused a high demand for the healthcare team. To manage risk of injuries for overload, specific injury prevention strategies are needed and should be included as an essential component of the training plan for elite volleyball players.

A test battery for evaluation of muscle strength, balance and functional performance in subjects with chronic ankle instability: a cross-sectional study

BACKGROUND

Studies investigating ankle condition in subjects with chronic ankle instability (CAI) using an on-the-field test battery are scarce. Understanding which tests that are most challenging for these subjects has the potential to set realistic goals in rehabilitation and return-to-sports criteria. Thus, the primary aim of this study was to investigate CAI subjects regarding strength, balance and functional performance with an easily used test battery that required minimal equipment.

METHODS

This study was conducted with a cross-sectional design. A total of 20 CAI subjects, engaged in sports, and 15 healthy subjects serving as a control group, were tested for assessment of strength, balance and functional performance. A test battery was developed accordingly; isometric strength in inversion and eversion, the single leg stance test (SLS), single leg hop for distance (SLHD) and side hop test. The limb symmetry index was calculated to determine whether a side-to-side lower limb difference could be classified as normal or abnormal. The sensitivity of the test battery was also calculated.

RESULTS

The subjects were 20% weaker on the injured side compared with the non-injured side in eversion (p < 0.01) and 16% weaker in inversion (p < 0.01) (Table 2). For the SLS test, the mean score of the injured side was 8 points (67%) higher (more foot lifts) compared to the non-injured side (p < 0.01). The mean distance of the SLHD was 10 cm (9%) shorter for the injured side compare to the non-injured side (p = 0.03). The mean number of side hop was 11 repetitions (29%) fewer for the injured side compare to the non-injured side (p < 0.01). Six of the 20 subjects obtained abnormal LSI values in all five tests whereas none obtained normal values in all tests. The sensitivity of the test battery was 100%.

CONCLUSION

Deficits in muscle strength, balance and functional performance appear to be present in CAI subjects with the largest impairments in balance and side hop performance, which stresses the need for return to sport criteria for this group of subjects.

TRIAL REGISTRATION

Registered retrospectively on 24/01/2023. NCT05732168.

Comparison of landing kinematics and kinetics between experienced and novice volleyball players during block and spike jumps

BACKGROUND

The practice of volleyball requires many jumps. During landing, anterior cruciate ligament injuries may occur with high-risk lower limb kinematics and kinetics. Differences in landing strategies between experienced and novice volleyball players have not been fully explored. The purpose of the study was to compare lower limb kinematics and kinetics in experienced and novice volleyball players when performing volleyball specific jumps.

METHODS

A total of 30 healthy males, 15 experienced and 15 novice volleyball players, participated in the study. Participants performed block and spike jumps at a controlled jump height. Hip, knee and ankle joints angles at initial ground contact and ranges of motion in the sagittal plane, knee joint angles and moments in the frontal plane, vertical ground reaction force peak and loading rate were analyzed to investigate the expertise effect.

RESULTS

Experienced volleyball players landed with larger ankle dorsiflexion range of motion compared to novices. For the spike jump, experienced players landed with larger ankle plantarflexion angles at initial contact and larger ankle dorsiflexion ranges of motion, and for the block jump, they landed with larger knee flexion ranges of motion. Experienced players jumped significantly higher than novices. No difference was found in vertical ground reaction force peaks and loading rates.

CONCLUSIONS

Although the experienced group jumped higher than the novice group, no difference was found in ground reaction force parameters. These findings highlight that the experience of volleyball players acquired during regular trainings and competitions may play an important role in landing kinematics and kinetics to reduce the injury risk.

Association of markers of patellofemoral maltracking to cartilage damage and bone marrow lesions on MRI: Data from the 2016 Olympic Games of Rio De Janeiro

Background

Patellofemoral joint (PFJ) disease is a common ailment in elite athletes. Our aim is to report the frequency of superolateral Hoffa’s fat pad (SHFP) edema, and PFJ cartilage damage and bone marrow lesions (BML), among Olympian athletes, and to study the association between measurements of trochlear morphology and vertical patellar position and a) PFJ cartilage damage or BML, and b) SHFP edema.

Methods

All knee MRI, performed in the Olympic Village and polyclinics, of participating athletes in the 2016 Olympic Games of Rio de Janeiro were included. MRI were scored for PFJ cartilage damage and BML, and SHFP edema. Trochlear morphology measurements included sulcus angle, trochlear angle, lateral trochlear inclination, and medial trochlear inclination. Insall-Salvati ratio was also assessed.

Results

One hundred twenty-one knee MRIs were included (62 female, 51.2 %). The highest frequencies of PFJ cartilage damage, combination of PFJ cartilage damage and BML, and SHFP edema were found among Beach Volleyball and Volleyball athletes. SHFP edema was more common among female compared to male Olympian athletes. We found no statistically significant associations between different measurements of trochlear morphology/vertical patellar position, and 1. SHFP edema, and 2. PFJ cartilage damage/BML.

Conclusion

SHFP edema and the combination of PFJ cartilage damage and BML are highly frequent among Olympic athletes especially those competing in Beach volleyball and Volleyball. SHFP edema is more common among female athletes. Further studies are needed to determine whether PFJ cartilage damage has a stronger association to sports disciplines rather than trochlear morphology.

Quadriceps strength asymmetry as predictor of ankle sprain in male volleyball players

BACKGROUND

Ankle sprain is the most common acute time-loss injury in volleyball and occurs mainly during landing from a jump. Therefore we have evaluated the role of quadriceps strength and countermovement jump height on ankle sprain occurrence, as these intrinsic modifiable risk factors were not yet evaluated. We have also hypothesised that presence of quadriceps strength asymmetry could be a possible risk factor for ankle sprains in male volleyball players.

METHODS

This was a prospective cohort study. Male volleyball players (N = 99) from Slovenian national league participated in the study. Before the start of the season, all participants completed a preseason questionnaire and underwent evaluation of vertical jump performance and bilateral isokinetic strength of the quadriceps (Q) and hamstrings (H). During the subsequent season the players reported acute time loss injuries because of ankle sprain through a weekly questionnaire.

RESULTS

We have registered 19 ankle sprains during the season. Overall ankle sprain incidence was 0.41±0.24 per 1000 h. Previous ankle sprain (odd ratio 0.86; 95% CI 0.25 - 2.89, p = 0.802) and jump height (1.05; 95% C.I. 0.94 - 1.19, p = 0.393) were not significant risk factors, while Q strength asymmetry was a significant predictor of an ankle sprain (odd ratio 0.956; 95% CI 0.919-0.995, p = 0.026). Compared with the uninjured players, the injured players had higher right concentric Q strength, higher Q strength asymmetry, and lower concentric right H-Q strength ratio (all p<0.03).

CONCLUSIONS

Our results suggest that excessive concentric strength of the right Q, which leads to low H-Q strength ratio, and high bilateral Q strength asymmetry in favor of the right side, could be associated with increased risk of ankle sprains in male volleyball.

Is There a Relationship Between Workload and Occurrence of Back Pain and Back Injuries in Athletes?

The back is subjected to a great deal of strain in many sports. Up to 20% of all sports injuries involve an injury to the lower back or neck. Repetitive or high impact loads (e.g., running, gymnastics, skiing) and weight loading (e.g., weightlifting) affect the lower back. Rotation of the torso (e.g., golf, tennis) causes damage to both, the lumbar and thoracic spine. The cervical spine is most commonly injured in contact sports (e.g., boxing, football). One of the factors that increases the odds of injuries in athletes is excessive and rapid increases in training loads. In spite of currently emerging evidence on this issue, little is known about the balance between physiological loading on the spine and athletic performance, versus overloading and back pain and/or injury in athletes. This scoping review aims (i) to map the literature that addresses the association between the training load and the occurrence of back pain and/or injury, especially between the Acute:Chronic Workload Ratio (ACWR) and back problems in athletes of individual and team sports, and (ii) to identify gaps in existing literature and propose future research on this topic. A literature search of six electronic databases (i.e., MEDLINE, PubMed, Web of Science, SCOPUS, SportDiscus, and CINAHL) was conducted. A total of 48 research articles met the inclusion criteria. Findings identified that fatigue of the trunk muscles induced by excessive loading of the spine is one of the sources of back problems in athletes. In particular, high training volume and repetitive motions are responsible for the high prevalence rates. The most influential are biomechanical and physiological variations underlying the spine, though stress-related psychological factors should also be considered. However, limited evidence exists on the relationship between the ACWR and back pain or non-contact back injuries in athletes from individual and team sports. This may be due to insufficiently specified the acute and chronic time window that varies according to sport-specific schedule of competition and training. More research is therefore warranted to elucidate whether ACWR, among other factors, is able to identify workloads that could increase the risk of back problems in athletes.

Cross-cultural adaptation, validity, and reliability of Turkish version of Identification of Functional Ankle Instability (IdFAI) scale

OBJECTIVE

This study aimed to develop the Turkish version of Identification of Functional Ankle Instability (TV_IdFAI) scale and evaluate its validity and reliability.

METHODS

A total of 100 participants (54 men and 46 women; 50 volleyball players and 50 sedentary individuals) between 18 and 38 years of age were included this study. The construct validity, reference validity, sensitivity, specificity, and test-retest reliability of TV_IdFAI were evaluated. For the test-retest reliability, the scale was applied to all participants again in 10-14 days. A correlation between the scale scores and test-retest results was examined with intraclass correlation coefficient. To evaluate the construct validity, a factor analysis method was used. For reference validity, a sports physician evaluated all participants and the clinical diagnoses were compared with total score of the scale. Sensitivity and specificity were calculated to evaluate the classification success of the scale with specified cutoff.

RESULTS

TV_IdFAI scale was grouped under two separate factors. It was determined that the variance for factor 1, factor 2 and for scale was 46.68%, 15.70%, and 62.38%, respectively. There was a statistically significant relationship 0.74 (95% CI 0.64-0.84; p<0.001) between the physician's diagnosis and TV_IdFAI in terms of reference validity. The sensitivity and specificity of TV_IdFAI was 0.61 and 0.80, respectively. The reliability of TV_IdFAI was 0.94 (95% CI 0.92-0.96; p<0.001).

CONCLUSION

This study shows that TV_IdFAI is a simple, easy to apply, reliable, and valid scale to define functional ankle instability in Turkish population.

LEVEL OF EVIDENCE

Level II, Diagnostic study.

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.

Factors associated with low back pain in elite high school volleyball players

[Purpose] To determine the relationship between low back pain and a range of demographic, environmental, and injury history factors to identify potential factors for the management of low back pain. [Participants and Methods] The participants were 123 elite high school male and female volleyball players. They answered an extensive questionnaire regarding demographic details, low back pain in the previous year, volleyball-specific movements, previous regional injuries, and years of volleyball experience. Questionnaire responses were analyzed. Data were analyzed using a multivariate logistic regression analysis using the presence and absence of low back pain within 1 year as the explanatory variable. [Results] Of the 123 volleyball players, 48.0% reported low back pain. The volleyball-specific movements that induced pain were diverse (e.g., spike, serve, and pass) with no common factor. The factors associated with low back pain were an ankle injury within the previous year and years of volleyball experience. [Conclusion] The associations found in this survey indicate that particular attention should be given to more experienced players with a history of ankle injury to manage low back pain in high school volleyball players.

Blocking landing techniques in volleyball and the possible association with anterior cruciate ligament injury

The number and type of landings performed after blocking during volleyball matches has been related to the potential risk of ACL injury. The aim of the present study was to determine whether gender affects the frequency of specific blocking landing techniques with potential risk of ACL injury from the perspective of foot contact and subsequent movement after the block used by volleyball players during competitive matches. Three matches involving four female volleyball teams (fourteen sets) and three matches involving four male volleyball teams (thirteen sets) in the Czech Republic were analyzed for this study. A Pearson chi-square test of independence was used to detect the relationship between gender and different blocking techniques. The results of the present study showed that gender affected single-leg landings with subsequent movement in lateral direction and double-leg landings. Although the total number of landings was lower for male athletes than for female athletes, a larger portion of male athletes demonstrated single leg landings with a subsequent movement than female athletes. Single leg landings with a subsequent movement have a higher potential risk of ACL injury.

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.

Management of Sport Injuries with Korean Medicine: A Survey of Korean National Volleyball Team

The purpose of this study was to report the current state of Korean medicine (KM) treatment on sports injury by implementing survey with volleyball team medical doctors participating in 2013-2014 season. Six KM doctors completed a questionnaire that includes injury parameters: type, location, situation, and pain scores. We collected 166 injury cases from 94 Korean male and female national volleyball players. Knee (25.9%), low back (13.3%), elbow, and ankle (8.4%) injuries were most common. Joint (41.6%) and muscle (30.7%) were major injured tissues. KM team medical doctors utilized acupuncture (40.4%), chuna manual therapy (16.0%), physical therapy (15.2%), taping (9.0%), and cupping (7.8%) to treat volleyball injuries. Any types of medications were used infrequently. Additional physical and exercise therapy were preferred after receiving acupuncture (both 46.9%). This study presented the preliminary injury profile of Korean elite volleyball players. Injury and treatment parameters could be useful to build advanced KM model in sport medicine.

Injuries in Swedish floorball: a cost analysis

The epidemiology of sport injuries is well documented. However, the costs are rarely discussed. Previous studies have presented such costs in specific sports or localization. No study has investigated the costs related to injuries in elite floorball. Thus, the aim of this study was to estimate cost of injuries in Swedish elite floorball players. During 1 year, 346 floorball players were prospectively followed. All time-loss injures were recorded. The injured players were asked to complete a questionnaire regarding their costs tied to the injury. Mean costs were calculated by multiplying the total resource use with the collected unit costs and dividing these total costs with the number of injuries as well as players. The results showed that the average cost per injury increased with the level of severity and ranged from 332 to 2358 Euros. The mild and moderate overuse injuries were costlier than the corresponding traumatic injuries. However, the severe traumatic injuries were associated with higher costs than overuse injuries. Knee injuries were the costliest. Our results indicate that there are costs to be saved, if floorball injuries can be avoided. They should be of interest to decision makers deciding whether to invest in preventive interventions.

Physical therapists' role in prevention and management of patellar tendinopathy injuries in youth, collegiate, and middle-aged indoor volleyball athletes

Patellar tendinopathy is highly prevalent in all ages and skill levels of volleyball athletes. To illustrate this, we discuss the clinical, biomechanical, and ultrasound imaging presentation and the intervention strategies of three volleyball athletes at different stages of their athletic career: youth, middle-aged, and collegiate. We present our examination strategies and interpret the data collected, including visual movement analysis and dynamics, relating these findings to the probable causes of their pain and dysfunction. Using the framework of the EdUReP concept, incorporating Education, Unloading, Reloading, and Prevention, we propose intervention strategies that target each athlete's specific issues in terms of education, rehabilitation, training, and return to sport. This framework can be generalized to manage patellar tendinopathy in other sports requiring jumping, from youth to middle age, and from recreational to elite competitive levels.

Self-reported symptoms and risk factors for digital ischaemia among international world-class beach volleyball players

The prevalence of ischaemia-related symptoms is remarkably high among elite indoor volleyball players. Since the exposure to sport-specific demands may be higher in beach volleyball compared to indoor volleyball, the aim of this study was to assess the prevalence of ischaemia-related symptoms and associated risk factors among world-class beach volleyball players. Therefore, a questionnaire survey was performed among beach volleyball players active during the 2013 Grand Slam Beach Volleyball in the Netherlands. In total, 60 of the 128 beach volleyball players (47%) participated: 26 males and 34 females from 17 countries. The self-reported prevalence of cold or blue or pale digits in the dominant hand during or immediately after practice or competition was 38% (n = 23). Two risk factors were independently associated with symptoms of blue or pale digits: more than 14 years playing volleyball (odds ratio (OR) 4.42, 90% confidence interval (90% CI) 1.30-15.07) and sex (female) (OR 4.62, 90% CI 1.15-18.57). In conclusion, the prevalence of symptoms associated with digital ischaemia is high among international world-class beach volleyball players. Female sex and the length of the volleyball career were independently associated with an increased risk of ischaemia-related symptoms. The high prevalence of these seemingly innocuous symptoms and possible associated risk factors warrant regular monitoring since early detection can potentially prevent thromboembolic complications and irreversible tissue damage.

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.

Shoulder pain among high-level volleyball players and preseason features

PURPOSE

The main goal of this prospective study was to identify the most significant intrinsic risk factors for shoulder pain by measuring strength developed by shoulder rotators and by carrying out various morphostatic assessments.

METHODS

Sixty-six players (mean ± SD age = 24 ± 5 yr) were recruited from nine volleyball teams from the first and second divisions (34 men and 32 women) to participate in the study. Before the start of the volleyball season, all the participants completed a preseason questionnaire and underwent both a bilateral isokinetic evaluation of the shoulders and morphostatic measurements. During the subsequent 6 months of the competition period, the players reported through a weekly questionnaire any shoulder pain experienced.

RESULTS

During the ongoing season, 23% (15 of 66 players) of the volleyball players experienced dominant shoulder pain. Interestingly, participants who reported a history of dominant shoulder pain were found to have nine times higher risk of suffering further pain in their dominant shoulder. The eccentric maximal strength developed by the internal and external rotators was found to represent a protective factor in the volleyball players (respective odds ratios = 0.946, P = 0.01 and 0.94, P = 0.05). No risk factors were found among the shoulder morphostatic measurements.

CONCLUSION

In our study, the evaluation of shoulder rotator muscle strength through isokinetic assessment, especially eccentric mode, appeared to be the most contributing parameter to identify risk factors for shoulder pain. This evaluation should allow to better identify players at risk.

Risk factors associated with self-reported symptoms of digital ischemia in elite male volleyball players in the Netherlands

One in every four elite male volleyball players in the Netherlands reported blue or pale digits in the dominant hand. Little is known about risk factors. To assess whether personal-, sports-, and work-related risk factors are associated with these symptoms in these volleyball players, a survey was performed among elite male volleyball players in the Dutch national top league and in the Dutch beach volleyball team. The questionnaire assessed the presence of symptoms and risk factors. Binary logistic regression was performed to calculate odds ratios (ORs). A total of 99 of the 107 athletes participated - a response rate of 93%. Two sports-related risk factors were associated with symptoms of blue or pale digits: 18-30 years playing volleyball [OR = 6.70; 95% confidence interval (CI) 1.12-29.54] and often/always performing weight training to increase dominant limb strength (OR = 2.70; 95% CI 1.05-6.92). No significant other sports-, personal-, or work-related risk factors were found. Playing volleyball for more than 17 years and often/always performing weight training to increase dominant limb strength were independently associated with an increased risk on ischemia-related complaints of the dominant hand in elite male volleyball players.

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.

Can pre-season fitness measures predict time to injury in varsity athletes?: a retrospective case control study

Background

The ability to determine athletic performance in varsity athletes using preseason measures has been established. The ability of pre-season performance measures and athlete’s exposure to predict the incidence of injuries is unclear. Thus our purpose was to determine the ability of pre-season measures of athletic performance to predict time to injury in varsity athletes.

Methods

Male and female varsity athletes competing in basketball, volleyball and ice hockey participated in this study. The main outcome measures were injury prevalence, time to injury (based on calculated exposure) and pre-season fitness measures as predictors of time to injury. Fitness measures were Apley’s range of motion, push-up, curl-ups, vertical jump, modified Illinois agility, and sit-and-reach. Cox regression models were used to identify which baseline fitness measures were predictors of time to injury.

Results

Seventy-six percent of the athletes reported 1 or more injuries. Mean times to initial injury were significantly different for females and males (40.6% and 66.1% of the total season (p < 0.05), respectively). A significant univariate correlation was observed between push-up performance and time to injury (Pearson’s r = 0.332, p < 0.01). No preseason fitness measure impacted the hazard of injury. Regardless of sport, female athletes had significantly shorter time to injury than males (Hazard Ratio = 2.2, p < 0.01). Athletes playing volleyball had significantly shorter time to injury (Hazard Ratio = 4.2, p < 0.01) compared to those playing hockey or basketball.

Conclusions

When accounting for exposure, gender, sport and fitness measures, prediction of time to injury was influenced most heavily by gender and sport.

A training program to improve neuromuscular indices in female high school volleyball players

The purpose of this study was to determine if a sports-specific training program could improve neuromuscular indices in female high school volleyball players. We combined components from a previously published knee ligament injury prevention intervention program for jump and strength training with additional exercises and drills to improve speed, agility, overall strength, and aerobic conditioning. We hypothesized that this sports-specific training program would lead to significant improvements in neuromuscular indices in high school female volleyball players. Thirty-four athletes (age 14.5 years ± 1.0) participated in the supervised 6-week program, 3 d·wk(-1) for approximately 90-120 minutes per session. The program was conducted on the school's volleyball court and weight room facilities. The athletes underwent a video drop-jump test, multistage fitness test, vertical jump test, and sit-up test before and after training. A significant increase was found in the mean VO2max score (p < 0.001), where 73% of the athletes improved this score. A significant improvement was found in the sit-up test (p = 0.03) and in the vertical jump test (p = 0.05), where 68% of the athletes increased their scores. In the drop-jump video test, significant increases were found in both the mean absolute knee separation distance (p = 0.002) and in the mean normalized knee separation distance (p = 0.04), indicating improved lower limb alignment on landing. No athlete sustained an injury or developed an overuse syndrome during training. This program significantly improved lower limb alignment on a drop-jump test, abdominal strength, estimated maximal aerobic power, and vertical jump height and may be implemented in high school female volleyball programs.

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.

Landing techniques in volleyball

Knee injuries such as anterior cruciate ligament lesions and patellar tendonitis are very frequent in volleyball, and are often attributed to micro traumas that occur during the landing phase of airborne actions. The aim of the present study was to compare different jumping activities during official men's and women's volleyball games. Twelve top-level matches from the Italian men's and women's professional leagues were analysed. The jumps performed during the games were classified according to the landing technique used by the player (left or right foot or both feet together), court position, and ball trajectory. Chi-square analyses were performed to detect differences in landing techniques between the sexes, court positions, and trajectories when serving, attacking, blocking, and setting. Significant differences (P < 0.05) were found between the sexes for block, set, and spike but not for the jump serve. The frequency of landings on one foot was related to court position and the trajectory of the sets: when spiking faster sets, the players were more likely to use a one-footed landing. The present results should help coaches and physiotherapists to devise appropriate training and prevention programmes, and reveal the need for further detailed biomechanical investigations of the relationships between landings and knee injuries.

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.

Analysis of sex-specific injury patterns and risk factors in young high-level athletes

This study analyzed sex-specific injury patterns and risk factors in young athletes (n=256) from 12 sport disciplines practicing at the national or the international level in the Grand-Duchy of Luxembourg. Injury occurrence as a result of sport practice was analyzed retrospectively over the year 2006 using a standardized self-administered questionnaire. Overall incidence was not different between girls and boys (1.20 and 1.21 injuries/1000 athlete-hours, respectively), but in the context of team sport competition girls tended to be at a greater risk (rate ratio 2.05, P=0.053). Girls had a higher proportion of injuries in the ankle/foot region compared with boys (34.8% vs 16.8%). No sex-related differences were found regarding injury severity. Multivariate logistic regression (controlling for age and practice volume) revealed that girls' team sports were associated with a greater injury risk compared with individual sports [odds ratio (OR) of 4.76], while in boys this was observed for racket sports (OR=3.31). Furthermore, physical or emotional stress tended to be a specific risk factor in girls. There was a tendency for injury outside sports to be coupled to a higher injury risk in girls and boys. Consideration of sex-specific injury patterns and risk factors could be of importance for effective injury prevention.

Dynamic trunk stabilization: a conceptual back injury prevention program for volleyball athletes

The sport of volleyball creates considerable dynamic trunk stability demands. Back injury occurs all too frequently in volleyball, particularly among female athletes. The purpose of this clinical commentary is to review functional anatomy, muscle coactivation strategies, assessment of trunk muscle performance, and the characteristics of effective exercises for the trunk or core. From this information, a conceptual progressive 3-phase volleyball-specific training program is presented to improve dynamic trunk stability and to potentially reduce the incidence of back injury among volleyball athletes. Phase 1 addresses low-velocity motor control, kinesthetic awareness, and endurance, with the clinician providing cues to teach achievement of biomechanically neutral spine alignment. Phase 2 focuses on progressively higher velocity dynamic multiplanar endurance, coordination, and strength-power challenges integrating upper and lower extremity movements, while maintaining neutral spine alignment. Phase 3 integrates volleyball-specific skill simulations by breaking down composite movement patterns into their component parts, with differing dynamic trunk stability requirements, while maintaining neutral spine alignment. Prospective research is needed to validate the efficacy of this program.