Secrets To Treating Lower Extremity Volleyball Injuries

Author(s): 
By Mark A. Caselli, DPM

How To Address And Prevent Patellar Tendinitis And Patellofemoral Syndrome

   The most common overuse injury reported in volleyball athletes is patellar tendinitis or “jumper’s knee.” Jumping to hit or block the ball requires a high rate of force development in extension and external tibial rotation, stressing the patellofemoral joint and tendon. Furthermore, eccentric loading of the quadriceps during landing can also compromise these tissues. Repetition of these mechanical stresses can cause microtears, irritation and inflammation, resulting in symptoms of pain and swelling localized to the lower pole of the patella, or less frequently, the upper pole of the patella or the tibial tuberosity.

   Patellofemoral syndrome is also a common, overuse, knee-related injury in volleyball. Abnormal tracking of the patella within the femoral groove can cause irritation of the articular surface of the patella and inflammation of the femoral groove. Repeated, forced extension of the knees, as one may see in hitters and blockers, or the demands placed on the knees of defensive specialists can stress the patellofemoral joint. This is especially the case if the patella is not aligned properly within the femoral groove. The etiology of patellar malalignment is often an increased Q angle, which results in lateral tracking of the patella.

   This situation is further complicated by anatomic variants such as genu valgum, genu recurvatum, patella alta, pronated feet, wide pelvis and external tibial torsion. Inflexibility of the iliotibial band or a weakness in the oblique portion of the vastus medialis can also result in lateral tracking of the patella. Give special attention to female athletes because they are more susceptible to these tracking abnormalities. Athletes who have patellofemoral symptoms experience pain with jumping and squatting. Stair climbing or sitting for long periods also increase knee pain. Crepitus and a patellar grind test are indicative of patellofemoral stress syndrome.

   Managing these overuse injuries begins with ice and antiinflammatory medication. Paying close attention to patellar tracking is necessary to rule out any anatomic abnormalities, especially in the female athlete. Emphasizing exercise techniques to strengthen and improve recruitment of the vastus medialis can improve medial patellar stability. Using patellar mobilization techniques, iliotibial band stretching and foot orthoses to correct hyperpronation can also help re-establish lateral patellar mobility. Be sure to initiate hamstring and quadriceps flexibility and strengthening exercises. Taping, patellar stabilizing braces and patellar straps can also help to reduce pain.

   To help prevent patellar tendinitis, identify players who are at increased risk. Those who generate the greatest power during jumping and have the highest vertical jumps have been found to be at the greatest risk. Decreasing their jump training may help prevent patellar tendinitis. Players who have increased external tibial torsion and deeper knee flexion at takeoff may also be at greater risk. Coaching these athletes in proper jumping technique may reduce the likelihood of these injuries.

What About Achilles Tendinitis, Peroneal Tendinitis And Plantar Fasciitis?

   Achilles tendinitis is another common overuse injury among volleyball athletes and occurs more frequently with indoor players. The repetitive eccentric loads of jumping, particularly on hard surfaces, can cause microtears within the tendon. Tight hamstrings, tibial varus, pes cavus and a tight gastrocnemius-soleus complex also predispose these athletes to tendinitis. Athletes will complain of pain while jumping or running that increases over time. Clinicians may detect tenderness, localized swelling, thickening, and crepitus upon palpation. Strength testing may reveal weakness in plantarflexion.

   When it comes to treating these injuries, one should ask athletes to reduce their jumping activities, properly stretch the gastrocnemius-soleus complex and use taping to reduce dorsiflexion. Clinicians can add a 1/4- inch to 1/2-inch heel lift to each shoe to reduce stress on the tendon. As symptoms subside and flexibility increases, one can allow a slow progression back to jumping activities. Leave the heel lifts in the shoes for the first seven to 14 days of practice to offer some shock absorption and protection to the Achilles tendon.

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