ACL Injuries - Volleyball

Pain, devasting pain. And the realization that you are out for 6 months to a year. Welcome to the world of ACL injuries.

"A new study confirms what doctors working with young athletes already suspected: the number anterior cruciate ligament (ACL) tears among youths, particularly high school students, has risen during the past 20 years."

Watch the short video below to see what can happen and how it happens. Watch the biomechanics image at the end and watch how the knees, especially the left, buckle inward.

What we know:

1. Girls have a higher rate of injury than boys (Reference)

2. The most common injuries in volleyball are ankle sprain, shoulder overuse injury, patellar tendon injury (knee), and ACL injury (Reference)

3. There are multiple risk factors for ACL injury in females:

a. Knee anatomy

- Bone shape (Reference)

- Significant changes to the patellar tendon occur due to jumping (Reference)

- Knee recurvatum (Reference)

b. Hormonal

- Pre-ovulatory phase (day 1 through ovulation) - higher risk during this phase (Reference)

c. Prior injury - including fear of re-injury/lack of confidence to return to sports (Reference and Reference)

d. Biomechanics

- knee buckles inward on take off and landing (Reference)

- hip angle (Reference)

- gound contact angel (Reference)

- knee abduction angle (Reference)

e. Weak core (Reference)

4. Non-contact (player to player) is the most common mechanism of injury in general and in volleyball (Reference)

5. Osteoarthritis is likely post ACL surgery (Reference and Reference). Quality of life can be so bad, that there is even a post ACL injury quality of life medical questionnaire.

6. Patellar (kneecap) tendon injuries are common (Reference)

NCAA Women's Volleyball injuries Overview (Reference)

• The overall injury rate in NCAA women’s volleyball is 4.3 per 1,000 athlete exposures (games and practices combined)

• There were more than 26,000 injuries and 6.1 million athlete exposures from 2004 to 2009

• Volleyball players are just as likely to be injured in a game (4.2 injuries per 1,000 athlete exposures) as in practice (4.4 injuries per 1,000 athlete exposures). Injuries were evenly spread between warm-up (16.3 percent), set 1 (17.8 percent), set 2 (18.6 percent) and set 3 (15.8 percent) of competitions

• The majority of practicerelated injuries occurred during team drills (60.0 percent), followed by individual drills (10.0 percent) and conditioning (6.4 percent

• Preseason has the highest overall injury rate (6.5 per 1,000 athlete exposures), while the postseason has the lowest (2.4 per 1,000 athlete exposures) as compared to the in-season injury rate of 3.6 injuries per 1,000 athlete exposures

• Ligament sprains (28.2 percent), followed by muscle strains (21.7 percent), tendinosis (7.5 percent) and contusions (4.6 percent), are the most common types of injuries

• Ligament sprains of the lateral ankle (15.6 percent), concussions (4.1 percent), quadriceps (thigh) muscle strains (4.0 percent), and abdominal strains (3.0 percent) are the most common types of injury in women’s volleyball

• The outside hitter suffered the most injuries (38.7 percent) for all positions, followed by middle blocker (27.4 percent), libero (12.0 percent), setter (10.9 percent) and opposite/diagonal player (7.5 percent)

• The majority of injuries (35.3 percent) caused three to six days of time loss from participation, while injuries accounting for 21 or more days accounted for 12.1 percent of all injuries

• The most common activity at the time of injury during competition was general play (26.4 percent), followed by digging (19.9 percent), spiking (18.9 percent), blocking (18.8 percent) and passing (5.8 percent)

• The acute non-contact category was the most common mechanism (39.1 percent) for all injuries, followed by gradual/ overuse (17.1 percent) and contact with a teammate (14.0 percent)

There are ways to prevent ACL injuries. Studies (Reference, reference, reference) show that training which focuses on motor control (the ability of the body to do what you want it to do) can decrease the occurence of ACL injuries.

The British Journal of Sports Medicine says, "... the study provides a very clear message. If you have a daughter who is playing basketball, soccer, handball or floorball, then it is crazy if her team isn’t undertaking one of the evidence-based warm-ups targeting lower limb injury prevention." Of course, this includes volleyball! "There is now incontrovertible evidence that a series of warm-up programmes that encourage neuromuscular training and balance activities have more benefits than risks."

So, what does that look like? First, an assessment must be performed which looks at posture, movement patterns, strength, balance, mobility, and flexibility. The Functional Movement Screen is part of a series of evaluations I use to test athletes.

Next up are other tests, some more specific to females, that look more into possible hypermobility like Beighton's score. And then we can test for basic movement abilities like jumping/landing, hopping, and side stepping.

And based on these tests, a program is formulated specific to the needs of the player and the sport of volleyball. Most female athletes will need similar training, but the testing will help discover the specific deficiencies of your child. There are really no "bad' test results. The only "bad' is not being tested! If you don't know what you don't know, you are on a slippery slope.

And to emphasize how important a good sports performance coach is, watch this video of an female athlete performing cleans and jerks. Watch her right knee buckle in on EVERY clean and EVERY jerk. Ouch!