Volleyball Injury


Disclaimer

I'm not a qualified physician. The information on this page comes from books, journals, web sites, conversations with medics and a couple of decades in the sport.

As I find more time I'll add to this page. Until then the following parts marked with a will be in note form.

 

Introduction

Compared to many other sports, volleyball is fairly safe - helped by the fact there there is a high net separating the teams and no sticks are involved. However, as with any competitive sport, players push their bodies to the edge and sometimes just a bit over the edge.

 

Injury Prevention

The best way to clear injuries is not to get them in the 1st place. OK, obviously, this is a somewhat glib statement, but hey, few things get less sympathy than bravado on crutches. There are plenty of things that can be done to help prevent injuries.

  • Good playing surface: Sand is the safest, followed by wooden sprung gym floor - never play on bare concrete. Gym floors should be dry and clean - both sweat and dust allow feet to slide which causes sprains.
  • Safe Posts: Padding is available to cover metal posts. If anchor ropes are used to hold the post make sure everyone understands that the area around them is out of bounds.
  • Good volleyball: for their first few sessions low sting balls are available for the beginners that need them. Unless you're trying to put them off for life, don't use soccer balls.
  • Personal safety equipment: Shoes with good grip and not built up too high, knee pads, and for the girls: a sports bra and hip pads if you dive around a lot. Beginners that bruise easily may also benefit from elasticated support bandage on the wrists or long sleeves.
  • Jewellery: Snagging an earring (or any other piercings) in the net does not happen often, but it's impressive when it does. Angular rings and watches can cause nasty scratches, and watches will bruise the wrists during digs (forearm pass)
  • Glasses: Sports goggles, shatter resistant lenses and contact lenses all provide better protection than regular glasses.
  • Fit:. Be fit enough to play / train at your level. As well as providing strength, muscles are also shock absorbers and help stabilise joints
  • Tiredness: general illness (eg colds), insufficient sleep and lack of fitness are examples of states where you're unlikely to be sufficiently lucid to be safe on court. Not only unsafe for yourself but even worse - unsafe for the other players there.
  • Light warm-up and stretching: cold, stiff muscles tend to get pulled, warm muscles are faster. Warming up stimulates the production of synovial fluid, which helps lubricate and cushion joints. Note: the warm-up prepares the body before more intense exercise, if the warm-up starts off too vigorously, you'll be damaging un-prepared, cold muscles and joints during the warm-up itself. Doh! If you want to do fitness training in the session then do it some time after the warm up but not instead of the warm up
  • Ground control: Make sure that bags, clothes etc don't spread from the edges of the gym into the playing area, and that unattended balls don't drift behind players.
  • Safe drills: Some exercises, drills and 'plays' result in many injuries, there's always an adequate, safer alternative.
  • Understand the sport:, if you know the likely trajectories of the ball and the players you're less likely to end up in unsafe positions.
  • Avoid the net line: The rule that allows you to put most of your foot over the centre line should have been removed years ago. An ankle sprained by landing on someone else's foot often takes longer to heal than a broken bone. (One week on crutches and a 8-12 week recovery is typical) Train yourself not to get so close to the net when you hit. Start a bit further back and to reach forward more when you block. Campaign for a 'no foot on the line rule'. Beware the randomly flailing feet of beginners and basketball players!

Sports Injury Prevention References:



 

General

Muscles aches starting the day following a session
AKA Delayed onset muscle soreness (DOMS)

This effects people who have used their muscles at a level significantly above their regular level. Particularly beginners, infrequent players, seasonal players, or players that are returning to the game after not playing for a while.

Cause (Etiology): Overuse

This seems to be on overexertion beyond what your body is used to.

Muscle tissue is damaged at a very fine level, The repair mechanism involves pushing more blood into the area which causes inflammation and heat, both of these activate pain signals in the nerves. The new tissue takes time to become elastic which leads to a few days of muscle stiffness.

Myths:

Lactic acid build up does not seem to play any role in this as it usually returns to normal levels an hour or so after exercise.
Warm ups, stretching, ultrasound and massage do not appear to help much with prevention or recovery.

Treatment: Rehabilitation

None - it'll clear on its own - but do yourself a favour and give it time to clear before returning to training.

Prevention:

With regular exercise and a gradual increase of training intensity, DOMS reduces and eventually stops.

Delayed Onset Muscle Soreness References:

General

General References:

  • Volleyball Injuries From ChiroWeb
  • Volleyball Injuries From 'the physician and sportsmedicine'
  • Sports Medicine Problems and Practical Management, ed E Sherry D Bokor, ISBN 1 900151 553, 1997


 

Foot & Ankle

Burning or Shooting pain in the foot
AKA Morton's Neuroma, plantar neuroma, intermetatarsal neuroma

Symptoms:

This is can present itself as a shooting pain or a burning sensation from the front of the foot. Sometimes there is also numbness. The pain may happen when the foot is made to bear weight and sometimes during the removal of a shoe. The pain may not stop after removing the shoe.

Cause: Overuse

This is caused by the thickening of the soft tissue around where a nerve splits into separate channels for the toes. The most common location is just forward of the ball of the foot and between the 3rd and 4th toes. Sometimes the thickening is a reaction to this area being compressed from the sides by over-tight shoes, but there are many reasons why this nerve can be repeatedly 'pinched', not all of which have yet been identified. Normally this junction is the size of a grain of rice, but once thickening starts this area can become the size of the little finger nail.

Diagnosis:

The symptoms can often be made to reappear by squeezing the spot where the nerves split. But diagnosis is difficult and may need a MRI scan although this is not always conclusive.

Treatment: Rehabilitation

Rest and wear shoes that are wide fitting around the ball of the foot, loosen the shoe laces around the bottom few holes. Pads in the shoe can move the pressure away from the painful spot. Anti-inflammatory drugs may also help but if the pain is severe or persistent you will need to see a doctor. The earlier this condition is diagnosed and treatment starts the less drastic the treatment.

Prevention:

Remove the cause or irritation to this area, which may be as simple as wearing less tight shoes. It may be possible to stop it re-occurring by changing the forces on this area of the foot using pads and tapes.

Morton's Neuroma References:



Pain at the back of the heel
aka Retro-Calcaneal Bursitis

Symptoms:

Back of the heel has some very tender swelling.

Diagnosis:

Swelling at the back of the heel this may be warm, red, tough and tender. You may need to exclude bone fractures Achilles tendonitis and rupture of the Achilles tendon.

Cause: Overuse

The Achilles tendon comes down over the back of the leg, over the heel bone (aka the Calcaneus) and connects almost underneath it. Where the tendon passes over the bone is a small fluid filled 'pad' (called a bursa) that prevents the tendon rubbing against the bone. When over-stressed the bursa becomes inflamed - a condition called bursitis. And once inflamed then pressure or movement are painful. The bursa may inflate over night and be very painful for half an hour after rising.

Treatment: Rehabilitation

Start with a couple of weeks rest, ice packs (if the area is warm) and NSAIDs. Special pads added to the shoe can also help. Continue with the treatment until the condition improves, if it does not improve or only partially improves then consult a doctor.

Prevention:

Poor footwear and overuse are contributory factors as is age. In some cases the inflammation may be caused arthritis or even a bacterial infection. Prevention is depends on being able to identify the cause.

Calcaneal Bursitis References:



Ankle Sprain

This is one of the least popular volleyball injuries.

Cause: Trauma

There are varying degrees of sprain. How far the ankle turned over and how much force was behind it, determines which ligaments and tendons got torn and how much they got torn.

In my experience of volleyball I've not seen the most serious ankle sprain, where the ligament has snapped and the ankle is almost floppy. So I'll just cover a light and medium sprain.

In a light sprain there is minor or no swelling, mild pain, the joint is stable but it's uncomfortable to put weight on the foot.

This is usually the result of: slippery floor, loose fitting shoes, over reach etc.

In a medium sprain, there may be a lot of swelling (though not always), a lot of pain, the joint is fairly unstable and the player does not react joyfully to the joint being tested for stability. As painful as it is, it may become even more painful after a few hours or the following day. (I've been able to limp off court with a medium sprain, get half an hour of RICE and a couple of hours later to be unable to put any load on it such that I spent the next 2 days hopping.)

The medium sprain is almost always due to one person lading on another persons foot near the net. And most of the time (but not ALL of the time) it's because the set is closer to the net than normal. The spiker runs in and gets closer to the net than normal such that their foot is over the central line. The blocker, who's motion does not require running towards the net, is the one to get injured, landing on the spiker's foot.

Treatment: First Aid

Treatment: Rehabilitation

Myths:

Not taking off the shoe. This may be a good idea in an uncontrolled environment, where it would be a serious problem if the ankle swells and the shoe/boot can not be put back. In an environment like a gym, leaving the shoe on, prevents proper diagnosis and prevents the ability to apply ice. Only leave the shoe on if the patient needs to continue walking on the foot before reaching treatment.

Twisted Ankle References:



 

Leg & Knee

Jumpers Knee
aka Patellar Tendinitis

Cause: Overuse

Treatment: First Aid

Treatment: Rehabilitation

Jumpers Knee References:



Jumpers Knee
aka Patella tendinopathy

Cause:

Treatment: First Aid

Treatment: Rehabilitation

Jumpers Knee References:




Iliotibial Band Tendinitis

Cause: Overuse

Treatment: First Aid

Treatment: Rehabilitation




Knee Ligaments MCL/ACL

Cause: Overuse

Treatment: First Aid

Treatment: Rehabilitation

References:




Tendon Abnormality (TA)

Cause: Overuse

Treatment: First Aid

Treatment: Rehabilitation

Tendon Abnormality References:



Shin Splints

Cause: Overuse

Treatment: First Aid

Treatment: Rehabilitation

Shin splints References:



Calf Cramp

Cause: Overuse

Treatment: First Aid

Treatment: Rehabilitation

Calf Cramp References:



Leg Cramp

Cause: Overuse

Treatment: First Aid

Treatment: Rehabilitation

Leg Cramp References:



Hip
Sacroiliac Pain

Cause: Overuse

Treatment: First Aid

Treatment: Rehabilitation



Groin strain
Rupture of the adductor muscles

Cause: Trauma

Treatment: First Aid

Treatment: Rehabilitation

Groin strain References:



 

Hand

Hand
Mallet finger

Cause: Trauma

Treatment: First Aid

Treatment: Rehabilitation



Finger Joint Dislocation

Cause: Trauma

Treatment: First Aid

Treatment: Rehabilitation

Finger Joint Dislocation References:



 

Shoulder

Shoulder Ache
aka Rotator Cuff Tendonitis

Cause: Overuse

Treatment: First Aid

Treatment: Rehabilitation

Rotator Cuff References:



Shoulder Ache
aka SLAP lesion

Cause:

Treatment: First Aid

Treatment: Rehabilitation

Rotator Cuff References:



Shoulder Ache
aka Suprascapular Neuropathy

Damage to the nerve that goes through the shoulder to join the spine in the neck. Infrequent

Cause:

Treatment: First Aid

Treatment: Rehabilitation

Suprascapular Neuropathy References:



General Shoulder Injury References:



 

Knock to the head

Cause: Trauma

This does not come about often, but I've seen: 2 players both moving for the same ball and banging their heads together, One player get hit by the elbow of a team mate while blocking and players getting hit in the head from a spike or a serve.

Treatment: First Aid

Treatment: Rehabilitation



Eye: Minor Scratch
aka Corneal Abrasion

This does not happen often in volleyball.

Symptoms:

If feels like there is a piece of grit in the eye but the irritation is not stopped by the usual methods to get rid of grit. The location of the pain does not move around the eye as it would with loose grit, and no grit can be seen when looking in a mirror or getting someone else to check.

Diagnosis:

Diagnosis is best done at the hospital where the extent of the damage can be assessed and the eye checked for embedded shards.

Cause:

Some pieces of grit can be hard or angular/sharp especially sand. Rubbing the eye to get rid of it can cause a slight scratch or scrape.

Treatment: First Aid

Don't rub the eye any more, doing so could widen the scratch. If the piece of grit is still in the eye, tilt the head back and flood the eye with clean water to wash it out. Alternatively dunk the face in a sink or large bowl of water and try to blink the grit out. Only do this if someone has visually verified that the grit is still in the eye. Even if the grit has gone the scratch will give the same painful sensation as though the grit was still there. If getting to hospital will take some time then a few drops of fully dissolved salt water will act as an antibiotic. If the grit has become embedded leave it for a medic to remove.

Treatment: Hospital

Part of verifying that the scratch is not too deep or in a dangerous place is the use of local anesthetic. This will ease the pain of the scratch. They would sometimes use antiseptic eye drops to help prevent infection getting a hold in the wound.

Treatment: Rehabilitation

This usually heals itself in a couple of days, however resting the eye for a couple of days will reduce the discomfort and, if needed, so will over-the-counter pain killers.

Prevention:

By the time you realise that the irritation is not going away, the grit that caused the problem is usually long gone so it it not often possible to identify the source of the grit.

Grit from the floor can be transferred directly to the hands when diving or indirectly by the ball so making sure that the floor is free of dust, grit and sand would help, as would banning footwear that is used outdoors. Whilst these measures would help reduce the incidence they would not eliminate this injury as the grit may have been brought in on the sports kit or have been on the hands for several hours.



Eye: Knock to the Eye

Cause: Blunt Trauma

This does not come about often.

Treatment: First Aid

Treatment: Rehabilitation

Prevention:

When blocking make sure that the elbows are tight to the trunk and do not protrude outwards. Some enthusiastic beginners, especially if they also play basketball, will attempt a 'flying block' crashing in to everyone in their path so make sure there is no lateral movement during the block.

Making sure that players are clear which territory each of them is expected to be defending would help prevent a clash. As would early calling when you are going for the ball.

If this is caused by being hit by a ball then it occurs even more often during drills when there are so many more balls in use than in games. In drills, avoid placing queues where other players are going to be hitting at. Encourage, 'power hitters' to work on precision placement rather than mindless power if there is a queue on the other side of the net. People chatting during drills often turn off their 'radar'. If yours is a 'social club' encourage them to keep on scanning for 'wild' balls. Take extra care when placing beginners with undisciplined strong players. The beginners will be unaware of the variety of high speed attacks and may not have enough time to move out of the way or even protect their face with their forearms.



 

Treatments
NSAID & RICE

NSAID Non-Steroidal Anti-Inflammatory Drugs

RICE Rest Ice Compression Elevation