Secrets To Treating Lower Extremity Volleyball Injuries

By Mark A. Caselli, DPM

   Volleyball is the world’s most popular participation sport. The Federation Internationale de Volleyball (FIVB), volleyball’s international governing body, reports that over 800 million people worldwide play volleyball. Individuals of all ages and skill levels can enjoy the sport. Athletes in over 200 countries play volleyball and almost half of these countries compete at the international level.    According to USA Volleyball, the national governing body for the sport in the United States, there were 34.1 million players in the U.S. in 1998.    Volleyball players must combine vertical and horizontal motion. These athletes must utilize lateral, backward, forward and rotational motion complemented with jumps. The physical properties of the playing surface can further accentuate these demands. Given the growth of beach volleyball as well as court (indoor) volleyball, there are injuries that are distinct to each and common to both.    Given the popularity of the sport, the number of players and the potential rigors of the game, podiatrists can expect to see both acute and overuse injuries. Familiarity with injuries common to volleyball is necessary to facilitate appropriate diagnosis, treatment and rehabilitation as well as prevention.

When Injuries Are Caused By Jumps From Blocking Or Spiking

   Most volleyball injuries are related to blocking or spiking, both of which involve vertical jumps. The most common acute injuries in volleyball are ankle sprains. Common lower extremity overuse injuries include patellar, Achilles and peroneal tendonitis, patellofemoral syndrome and plantar fasciitis. Hyperextension and hyperflexion injuries of the toes also occur commonly.    Studies have shown that inversion or lateral ankle sprains account for 15 to 60 percent of recorded injuries in volleyball athletes. Most players injure their ankles when they land after blocking or spiking in the front court. The most common mechanism of injury is forced supination that occurs when the blocking player’s foot lands on an opposing spiker’s foot that has come underneath the net.    When this happens, the usual result is an inversion injury to the lateral collateral ligament complex of the blocker’s ankle. This injury occurs more often indoors because of the increased coefficient of friction between the floor and the athlete’s shoe. Furthermore, there are more players on the court with indoor volleyball (six players on each side) and they utilize side-to-side blocking techniques, which increase the risk of injury. In the beach player population, the combination of a more forgiving surface and the increased proprioception and tendon strength in a shoeless foot decreases the incidence of lateral ligamentous injury.    Grade 1 and 2 ankle injuries are more common than grade 3 injuries. One can treat the grade 1 and 2 injuries by emphasizing aggressive early weightbearing and range of motion, and progressing to strengthening and proprioceptive retraining exercises prior to a return to play.    As with all ankle sprains, the most important initial treatment is protection, rest, ice, compression and elevation. How long the athlete should use this regimen depends on the severity of the injury. Typically, the treatment lasts only a few days until edema subsides. The biomechanical ankle platform system (BAPS), tilt board or ankle discs can strengthen and restore balance. Functional exercises should begin with low-impact activities and advance to cutting and jumping activities. These athletes commonly use ankle braces, taping and high-topped shoes to provide stability to the ankle and prevent further injury.

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