Dr. Chris Koutures: 6 common volleyball injuries and how to prevent them

Working with Olympic-level male and female volleyball players has allowed me a unique appreciation for common volleyball injuries. Since there are six players on the court, I will identify six common volleyball injuries with a focus on key prevention tips for players of all ages.

1) Concussions
Many of the concussions I see in volleyball players are from direct ball to head impact or collisions with other players or objects (poles, chairs on courtside) when diving for a ball. I see a fair amount of concussions due to poor ball control including too many free balls going in various directions with hitting and serving drills. 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. A player should not return until evaluated and cleared by a sports medicine specialist who is familiar with concussion care.

(We have our own information on sports-related concussion and there are a variety of resources in the VolleyballMag.com section about concussions.

Prevention tips for the volleyball player include:

• Calling for balls before starting a dive or passing
• Ensuring defensive players are aware of incoming balls during hitting/serving drills
• Reducing the number of free balls in air and hitting/serving in only one direction during drills or warm-ups
• Never turn away from the court when balls are in play (this also includes coaches, spectators and officials)
• Limiting older and stronger players from hitting into younger players
• 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, it should be no surprise that shoulder problems are among the most common volleyball injuries. 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
• Reduced function of the rotator cuff muscles, leading to pain and decreased hitting and serving accuracy and speed
• Limited follow through on hitting or serving can put more pressure on the shoulder and also 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 be hit long and 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 established at this time.

3) Finger/Hand Injuries
I 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 downward ball placement in the opponent court, but also reduce chances for injuries.

The widespread finger position places unique stress on the skin between the fingers leading to breaks in the skin that are extremely difficult to heal, even with 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 (passing or following through on a serve/hit) or leaning back (setting or initiating a serve/hit).

• Pain that is more with leaning forward could cause issues with the discs between the bones of the lower spine
• Pain leaning back could lead to stress injuries of the bones 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 this 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 increase forces on the lower back. Setters should attempt to make contact with balls right above their head – avoid reaching too far forward for front sets or backwards on back sets.

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. 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 volleyball injury. Very few things spark intense debate more than the question about using ankle braces for prevention of ankle sprains.

• The majority of ankle sprains are when the ankle inverts (rolls in)
• This most often occurs with play at the net where athletes make contact with another players foot when landing from a jump
• 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. Some fear that depending on bracing might make lower leg supporting muscles weaker and maybe even increase the risk of knee injuries.

After an ankle sprain, there is little doubt that combining braces and appropriate rehabilitation exercises can reduce future injury risk.

When in doubt, never hesitate to seek the opinion of a sports medicine specialist when it comes to volleyball injures or to learn additional prevention tips.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on Facebook (https://www.facebook.com/activekidmd/), Instagram (https://www.instagram.com/activekidmd/), or Twitter (@dockoutures).

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