USA Volleyball Sports Medicine Experts Present at CHOC Children's Sports Cardiology Conference

The 2017 CHOC Children's Sports Cardiology Conference asks the question "What is the Role of the Cardiologist in the Sports Medicine Team?"

Our USA Volleyball Sports Medicine Team will be there to share our experience and provide our expert answers.

Sports Cardiology & Sudden Cardiac Arrest in Young - @chocchildrens Jan 20-21, 2017 @Disneyland Grand Californian https://t.co/xuV2OjzILZ

— Chris Koutures, MD (@dockoutures) October 27, 2016

Several years ago, expert pediatric cardiologist Paul Grossfeld offered his services to USA Volleyball.

The results have been eye-opening and intriguing.

Focused elite athlete screening evaluations have not just provided insights for our players, but for all volleyball athletes and even other taller athletes participating in high level sport.

• Read about the Clinical Journal of Sports Medicine article on USA Volleyball Screening Results

The process has not been without challenges.

Informing athletes of higher risk conditions  and making decisions about career status and potential termination is never easy.

However, thanks to our on-going study, we have been able to contribute necessary data and experience to the conversation about screening and risk stratification in elite, taller athletes.

Our team looks forward to sharing this knowledge and extending our collaboration with important colleagues.

Six Common Indoor Volleyball Injuries

Working with Olympic level male and female volleyball players has allowed a unique appreciation for common injuries patterns seen in this wonderful yet demanding sport. Since there are six players on the court, I will identify six  frequently seen injuries and will also focus on key prevention tips for players at all ages.

1) Concussions

Most of the concussions I encounter are seen in liberos or defensive specialists, usually from direct impact either from attempted passes of hits at the net or collisions with other players or objects (poles, chairs on courtside) when diving for a ball. I have also seen a fair amount of concussions resulting from mis-matches on the court, namely defensive players trying to return serves or hits from much stronger and older players.

Any new sign of concern (such as dizziness, headache, blurred vision) or behavior change after head trauma should mandate removing the player from all activity and not returning until appropriate clearance from a sports medicine specialist who is familiar with concussion care. 

For more information about dealing with sports-related concussions, click here.

Prevention tips for the volleyball player include calling  for balls before starting a dive, ensuring defensive players are aware of incoming balls during hitting/serving drills, limiting older and stronger players from hitting into younger players, and protecting the boundaries of the court to limit impact with chairs or other objects.

2) Shoulder injuries

Between serving, setting, passing, hitting, blocking and diving, the shoulders receive an amazing array of demands, so it should be no surprise that shoulder injuries are among the most common volleyball-related concerns.

Most shoulder injuries are due to repetitive use and overload stress  leading to common abnormalities. Tightness in the front of the chest leading to a more forward position of the dominant shoulder can reduce normal function of the rotator cuff muscles, leading to pain and decreased hitting and serving accuracy and speed.  Tightness in the back of the shoulder glenohumeral joint can decrease the follow-through phase of hitting or serving and lead to problems with the labrum (soft tissue past between the ball and socket), the inside of the elbow, and even the lower back.

Appropriate stretching exercises combined with strengthening exercises of the scapula (wingbone) can reduce the risk of shoulder overuse injuries. Avoid hitting and serving with signs of fatigue (balls tend to go long with reduced speed) or any form of shoulder pain. Reducing the overall number of hits/serves can help, but more formal hit or serve count recommendations have not been studied at this time.

3) Finger/Hand Injuries

Tend to see finger joint sprains and dislocations mostly with blocking at the net. Rigid wrists with widespread  and relaxed fingers not only allow better ball placement down in the opponents court, but also reduce the chance for acute injuries.

The widespread finger position does place unique stress on the skin web spaces between the fingers that can lead to lacerations or breaks in the skin that are extremely difficult to heal, even with the placement of sutures. Better to prevent these lacerations in the first place by moisturizing the skin between the fingers on a daily basis. 

4) Low Back Pain

Volleyball-related back pain can come either from leaning forward such as with passing or following through on a serve/hit or more with leaning back such as in setting or initiating a serve or hit. Pain that is more with leaning forward could cause issues with the discs between the bones of the lower spine, while pain leaning back could lead to stress injuries of the posterior spine or joints.

It is amazing how much shoulder dysfunction (discussed above) can lead to back problems in volleyball players. If you haven't already, take the time to review post linking shoulder issues to back problems.

Learning how to initiate movements with the gluteal muscles in the buttock area can reduce stress on the lower back, especially with jumping. Single leg gluteal strengthening activities are particularly recommended. Certain technical errors, such as reaching too far for passing or hitting, can also increased forces on the lower back. Setters should attempt to make contact with balls right above their head- reaching too far forward for front sets or backwards on back sets is not the best for long-term back health.

5) Knee Pain

If you are a volleyball player who doesn't have knee pain, then either you are extremely fortunate or perhaps in a bit of denial. 

The repetitive jumping in volleyball often leads to pain in the front of the knee, especially in the patellar tendon connecting the kneecap to the shin bone. Throw in frequent knee contact with the hard wood court surface and you have a recipe for knee problems.

For healthier volleyball knees, pay attention to the following recommendations:

• Avoid landing on straight knees. Always land and move "softly" with hips, knees and ankles in a bent position.

• Try to land in good alignment, with the hips and kneecaps lined up with the second toe. Don't let your knees collapse in or rotate.

• Initiate jumps with the gluteal muscles in the buttock region. This will improve knee and also lower back function.

• The best time to stretch the muscles that support knee function is after practice or after a match when the muscles are warm. Focus on hamstrings, quadriceps, hip adductors/abductors and calf muscles.

• Knee pads help reduce bruises and pounding, especially with repetitive diving drills. 

6) Ankle Sprains

Ankle sprains are the most common acute injury in indoor volleyball, and very few things spark intense debate in the volleyball community more than the question about using ankle braces to prevent these type of injuries. 

The majority of ankle sprains are when the ankle inverts (rolls in) and this most often occurs with play at the net where athletes make contact with another players foot when landing from a jump during hitting or blocking. More chaotic play such as with bad passes or plays out of system can also put ankles at risk.

The theory behind bracing is to reduce abnormal ankle motion, but some fear that depending on bracing might make lower leg supporting muscles weaker and maybe even increase the risk of knee injuries.

Click here to review the debate on ankle braces.

Once an ankle sprain has happened, little doubt that the combination of bracing and appropriate rehabilitation exercises can reduce the risk of future injuries.

Never hesitate to seek the opinion of a sports medicine specialist with any volleyball injury or to learn additional tips to prevent these problems.