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A review on volleyball injuries

Hans Eric Reitmayer
Timisoara Physical Education and Rehabilitation Journal

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 Timişoara Physical Education and Rehabilitation Journal

DOI:10.1515/tperj-2017-0040

A review on volleyball injuries

Hans-Eric REITMAYER1,2

Abstract

Introduction: Unlike other team sports on the court, volleyball lacks physical contact between players, the teams being
separated by the net. However, lower limb injuries take place during spiking and blocking trough unintentional and illegal
intrusion of a player in the opponent’s court. Due to the specificity of the game, the joints of the upper limbs are also subject
to overload.
The purpose of this study is to analyze the international literature on injury and trauma in performance volleyball.
Methods: We analysed several studies about injuries in performance volleyballwhich were identified using online databases:
Google Scholar, EBSCO, Springer, Elsevier, and Scopus.
Results: The injury patternshows the ankle sprain as being by far the most common injury in volleyball with a percentage of
31.9%. The knee is the second most injured anatomic site, 17.38% of injuries affecting this joint. Third most frequent injury
affects the fingers 13.44%, followed by lower back 12,38% andshoulder trauma 12.18%. The hand is injured in 6.97%, while
other injuries were found in 5.25% of cases.
Conclusions: The need for in depth analysis of volleyball injuries still persists. Analysing the literature we are comming to
understand the mechanisms that produce the injuries with the purpose of finding metods to avoid these unfortunate events
before they happen. It is no longer enough to recover from an injury, it must be prevented entirely if possible. Time spent by a
player recovering may negatively affect the team's performance.
Injury prevention measures must occupy an important place in training. Coaches should take into acount all the factors that
influence injury incidence and design the training plan accordingly.
Key words: injuries, volleyball, ankle sprain, shoulder, performance

Rezumat

Spre deosebire de celelalte jocuri sportive de pe parchet, putem spune că în volei lipşeste contactul dintre jucători, echipele
fiind separate de fileu în cele două jumătăţi ale terenului. Cu toate acestea, majoritatea accidentărilor membrelor inferioare
au loc în timpul acţiunilor de atac şi blocaj prin pătrunderea neintenţionată şi neregulamentară a jucătorului în terenul
advers. Datorită specificului jocului, articulațiile membrelor superioare sunt și ele supuse suprasolicitării.
Scopul acestui studiu este acela de a analiza literatura de specialitate internatională pe tema accidentarilor si traumatismelor
în voleiul de performanță.
Metode: Am analizat mai multe studii referitoare la leziunile întălnite în voleiul de performanță care au fost identificate
folosind bazele de date online: Google Scholar, EBSCO, Springer, Elsevier și Scopus.
Rezultate: Tiparul accidentarilor arată faptul că entorsa de gleznă este pe departe cel mai comun traumatism în voleiul de
performanță cu un procent de 31.9%. Genunchiul este al doilea, 17.38% din accidentări afectează aceasta atriculație. Al
treilea traumatism ca frecvență afectează degetele mâinii 13,44%, urmat de accidentările la nivelul coloanei lombare 12,38 %
si a umărului cu un procent de 12.18%. Încheietura mâinii este afectată în 6.97% din cazuri, in timp ce alte traumatisme au
fost raportate cu o fregvență de 5.25%.
Concluzii: Nevoia de analiză în profunzime a traumatismelor specifice în volei persistă. Analizând literatura ajungem să
înțelegem mecanismele ce produc accidentarile cu scopul de a găsi metode de evitare a evenimentelor neplacute înainte ca
ele să se întâmple. Nu mai este suficientă recuperarea după accidentare, aceasta trebuie prevenită în totalitate dacă se poate.
Timpul petrecut de un jucător ce se recuperează poate afecta negativ performanța echipei.

1Physical Education and Sport Faculty, West University of Timisoara, Romania, email: [email protected]
2PhD Student, Institute for Doctoral Studies, Babeș-Bolyai University, Cluj-Napoca, Romania

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Metodele de profilaxie a traumatismelor trebuie sa ocupe un loc important în antrenament. Este necesar ca antrenorii să ia în
calcul toți factorii ce influențează incidența accidentărilor și să conceapă planul de antrenament în consecință.
Cuvinte cheie: accidentari, volei, entorsă de gleznă, umăr, performanță

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Introduction Methods
There are very few studies that cover volleyball We performed the search in Google Scholar, EBSCO,
injuries, and the international literature includes Springer, Elsevier, and Scopus data bases. The
papers with such various design and methodology criteria for inclusion were information regarding
that is quite difficult to compare them to each other. injuries and incidence of injuries in performance
Studies on volleyball incidence during match play volleyball players. The terms used for the search
and training are mainly retrospective and reliable were "volleyball injuries".
information on season long prospective studies is We have found 29 high impact studies covering
rare [1]. injury incidence, general volleyball injuries and
In contrary to popular belief the subject of injuries particular volleyball injuries.
in elite volleyball is quite a serious one and The publications ranged from the year 1984 [5] to
overlooking it would be a mistake. 2015 [6].
Unlike the other team sports on the court, volleyball
lacks physical contact between players, the teams Results
being separated by the net. However, lower limb Out of the 29 papers found, 8 mentioned the
injuries take place during spiking and blocking incidence rate of injuries. The measuring unit for
trough unintentional and illegal intrusion of a injury incidence is player injuries per 1000 hours of
player in the opponent’s court, the ankle sprain play or training.
being the most common. Repetitive jumping and Injury incidence rate varied from 2.4 [7] to 4.2 [5]
unbalanced landings take their toll on the knees and player injuries per 1000 h. We also found a
can cause overuse and acute injuries. A notable fact particular study from 2011 that aimed to determine
is that female players are more susceptible to knee relationship between prevalence and types of
ligament injuries than males probably due to the injuries and anthropometric properties of 91 male
more pronounced valgus of the lower limbs [2,3,4]. elite volleyball players from Iran having a incidence
Volleyball is an overhead type sport in wich, of 0.9 player injuries per 1000 h. This value is
excepting the bump pass, all contact with the ball considered very low compared to the results from
takes place above the player. This repeated process other papers. One reason for this contradiction
subjects the shoulder and the adjacent muscle could be the difference between the technical and
groups to a great mechanical stress, leading finally tactical level of training in Iran compared to other
to injuries like impingement syndrome and rotator countries [9].
cuff tendinitis and even rotator cuff tears. A The average injury incidence found was 3.05 player
determinant factor for rotator cuff injuries is injuries per 1000 hours(Table I).
strenght inbalance between internal and external
rotators of the shoulder [3]. Table I. Player injury incidence per 1000 hours
Overuse of the lumbar spine as a result of extension Ref. Year Players Injuries Player Inj./1000h
coupled with torsion during the spike is also
[8] 1996 277 286 4.2
common among taller players[1].
[10] 1996 137 177 3.8
Another type of injury that takes place during the
game involves the hands and fingers. Ball speed [11] 1997 272 89 3.5
during spikes and jump serves commonly exceeds [1] 2004 486 100 2.6
100 km/h. Misplacing the hand during the block or [12] 2006 114 363 3.2
overhead reception leads to finger sprains. [7] 2009 407 248 2.4
[9] 2011 91 0.9
Aim
[6] 2015 3.8
The purpose of this study is to analyze the
mean inj. incidence 3.05
international literature on injury and trauma in
performance volleyball SD 1.06

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Table II. Injury location (%) to that of other contact sports like handball or
Injury location (%) basketball [2, 18]. This type of injury mainly occurs
Ref. Players Injuries
Shoulder Hand Fingers Spine Knee Ankle at the net, during spiking or blocking by landing on
[13] 522 124 36.5 an opponent or a teammate's foot. A previous ankle
[1] 486 100 9 7 10 12 41 sprain is another serious risk factor. There is an
[12] 114 363 18 5.5 12.4 18.2 51 increased chance for the player to sustain a re-
[7] 407 248 12.7 10 14 24.4 38.9 injury in 6 to 12 months after the initial sprain [18].
[8] 277 286 16 18 17 23
[11] 272 89 8 7 11 8 54 Knee
[10] 137 177 15 21 16 18 The knee was the next most common injury site.
[14] 86 46 22 17 30 26
Volleyball players are exposed to two different
[15] 269 278 6 31
types of knee injuries. The first one is an overuse
[16] 144 178 11.8 3.9 6.17 10.7 21.9 23
injury known as patellar tendinopathy or jumper's
[9] 91 14.28 22.61 21.86 22.37
knee. This overuse syndrome originates from the
[17] 158 12 8 15 18 23
repetitive loads the quadriceps patellar tendon is
[18]* 106 9* 59* 24*
[6] 5 10.7 8.9 15.2 26.9 exposed to during the jump landing sequence.
mean 12.18 6.97 13.44 12.38 17.38 31.90 Degenerative changes to the tendon can take place
SD 3.95 3.05 7.33 2.76 6.76 11.51 after cumulative micro-trauma. There are factors
* Acute injuries related to patellar tendinopathy such as training
volume, floor type and gender. Harder surfaces lead
to a higher risk of jumper's knee [14]. Also males
31.9
are twice more susceptible than female players due
35
to the higher power generated during a jump [20].
30
25 The right knee is affected more often than the left
Percent

20 17.38 among volleyball players. One explanation could be

13.44 12.38 12.18
15 the dynamic biomechanical factors acting upon the
10 6.97 5.25 leg extensor apparatus during a spike jump with the
5 right-left take off. This is expected to cause a higher
0 eccentric-concentric loading of the right knee
compared to the left [21] (Fig. 2).

Figure 1. Injury distribution

The injury pattern(Fig. 1.) shows the ankle sprain as

being by far the most common injury in volleyball
with a percentage of 31.9%. The knee is the second
most injured anatomic site, 17.38% of injuries
affecting this joint. Third most frequent injury
affects the fingers 13.44%, followed by lower back
12.38% and shoulder trauma 12.18%. The hand is
injured in 6.97% of the cases with other injuries
found at 5.25%.
Figure 2. Spike jump with right-left take off
Ankle
Note the greater flexion angle of the right knee
The most common anatomic site of injury in
compared to the left. This may result in higher loads
volleyball is the ankle [13,1,12,,7, 8, 11,15,16,17,6].
on the right knee during eccentric phase of the
The rate of ankle sprains which account for about
jump[21]
half of the acute injuries in volleyball is comparable

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The second type of knee injury is the knee ligament at contact with the ball, sprains, strains and
injury. The large volumes of jumps involved in the sometimes fractures can occur at this level. Index
game with frequent body turns and loss of balance finger and thumb are the most exposed to injury
are particularly harmful for the knees. It has been being at the edge of the palm [24]. Even though it is
found that volleyball should be included among a frequent injury, it is not uncommon for volleyball
sports considered high risk to the knee joint. players to perform with sprained fingers. Taping is
Women are more at risk to this type of injury due to a solution for this kind of injury. Usually the injured
the more pronounced valgus of the lower limbs. finger is strapped to an adjacent, uninjured one. The
Acute knee injuries are more common during the thumb is immobilized separately (Fig. 3).
game than during training sessions [22].

Lower back
From our findings lower back trauma accounts for
12.38 % of volleyball injuries.
There is an increased risk of developing stress
fractures on the pars interarticularis of the
vertebral bodies of the lumbar spine [27]. This
condition is common among volleyball players,
especially spikers and jump servers due to
demanding repetitive lumbar hyperextension,
truncal rotation and axial loading, and is referred as
spondylolysis [21].
Figure 3. Finger taping [25]
Shoulder
A volleyball player's shoulders are also exposed to Discussions
overuse syndrome. Most of the skills used during There are different factors that can influence the
the game are performed with the upper limbs in an incidence of an injury. Intrinsic factors are age,
overhead position. As a result, the players gender, core instability, muscle imbalances whereas
experience shoulder dysfunction. Attackers and extrinsic factors are the position played and service
jump servers are especially at risk compared to style [23].
setters and defense specialists [23]. It has been Most injuries take place in the front row, at the net,
estimated that an elite volleyball player will during blocking and spiking [10].The middle
perform 40,000 spikes in one season of competition. blocker, being replaced in the back row by the
With this volume and load it is not surprising that defense specialist plays exclusively in the front row,
the most common shoulder injuries for volleyball thus he is more exposed to ankle sprains due to
players are overuse in character. Of these we name interference with the opponent during landing. On
the following: glenohumeral instability syndrome, the other hand, outside hitters and opposites, being
rotator cuff tendinopathy and suprascapular the main attacking force, tend to have a higher
neuropathy[21]. chance of shoulder dysfunction as a consequence of
Shoulder injuries area more serious problem in overuse [6].
females [10]. Male players have a higher chance of knee overuse
syndrome whereas women are more exposed to
Hand and fingers acute ligament injury at this level [20]. Also female
We have found that volleyball players sustain a high players are more prone to shoulder dysfunction
number of injuries to their hands. Finger trauma compared to men. The number of overuse injuries
accounts for about 14% of all volleyball injuries. in male volleyball has increased over the last
This does not come as a surprise as the ball speed decade. The rise by 50% in training activity may be
during a spike or jump serve exceeds 100 km/h. If to blame [10].
the hands and fingers are not in the correct position

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In volleyball ankle and finger injuries are typical 12. Zetou E., Malliou P., Lola A., Tsigganos G., Godolias G.
(2006). Factors related to the incidence of injuries
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Pastre C. (2013). Characteristics and contributing factors
Conclusions related tosports injuries in young volleyball players, BMC
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Jensen J. (1995).Volleyball injuries presenting in casualty: a
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