Nov. 10, 2005

The athletic demands of volleyball can place an athlete at high risk for injury. My experience with volleyball here at the University of Miami, has led me to evaluate a multitude of injuries and the majority of them have been associated with blocking and spiking. The shoulder is susceptible to these injuries because volleyball, like swimming, tennis, baseball and other sports that involve overhead arm movement, subjects the shoulder to repetitive abduction and external rotation followed by extension, and internal rotation, In addition, contact with the ball when spiking occurs at the point of maximal arm abduction, which may increase impingement forces. The mechanics of the shoulder during overhead motion helps explain why overuse injuries are very common in volleyball. Familiar upper extremity overuse injuries include biceps tendonitis, impingement, suprascapular nerve entrapment and rotator cuff tendonitis. Glenoid labral pathology, such as SLAP tears, and rotator cuff strains are other injuries that overhead athletes are at high risk to encounter.

Based on the high risk for injuries during collegiate volleyball, I follow a philosophy of pre-habilitation. Pre-habilitation is an umbrella term for the shoulder strengthening, core stabilization, and proprioceptive work, I have my student athletes do even though they are "healthy" and able to practice and compete without restrictions. Here at the University of Miami, all outsides must engage in a shoulder strengthening program. Usually volleyball athletes have some degree of shoulder instability even if they may be pain free. However, athletes who are required to generate speed and strength overhead should do scapular stabilizing and rotator cuff strengthening for both performance and injury prevention. Also, all volleyball athletes at UM must ice their dominant shoulder after lifting and/or practice/matches.

Below is an example of a shoulder program that is used at UM. The pre-habilitation exercises listed stress the rotator cuff and scapular stabilizers as many complex lifts performed in the weight room already target the pecs, lats, deltoids, biceps and triceps. It is important that one use proper lifting form during these strengthening exercises. One will note that the individual is asked to lift a relatively light weight over a larger number of reps and sets so that one can build endurance of stabilizing muscles (We don't want a dead shoulder when it comes to game 5!) Furthermore, I incorporate the use of medicine balls, theraband tubing, the bodyblade, physioballs and exercises requiring deceleration of small balls because sport specific strengthening has an increased carry over effect for performance enhancement. It is also important to work all ranges of motion in strengthening, not just one plane of motion.

Volleyball Shoulder Strengthening Program
Circuit A: Heavy Shoulder day
Circuit B: Moderate Shoulder day
Circuit C: Light Shoulder day
Circuit D: Misc, partner exercises

In addition to shoulder strengthening, it is important to have core strength. A strong core helps in maintaining correct posture, prevention of lowback pain and in the generation of power in jumping activities. Core exercises can be done alone or in unison with other pre-habilitation. For example, we have athletes do walk out push ups on the physioball which requires a strong core and shoulder in order to keep your body on the physioball. Having stability of the pelvis and a strong balance between the abdominals and lowback, hip flexors and hip extensors, internal and external rotators of the hip and last but not least the hamstrings and quadriceps is key to a stable pelvis and injury prevention. There are a variety of ways to strengthen the core and aim for muscular symmetry and balance. The following is an example of a few core exercises I use with the athletes I work with (Supermans, Pelvic tilts with feet on a physioball, Physioball single leg squats, Physioball reverse crunches, Hovers, Physioball back hyperextensions, V-ups, Medball toe touches, Quadruped lifting opposite arm with the opposite leg, Fire hydrants with arms and legs on foam rollers, and Hip extension while feet are on the physioball).

Volleyball requires quick changes in directions, agility and explosive movements. Therefore, it is not surprising that injury incidence can also be related to the court surface. For example, patellar tendonitis, a very widespread injury in volleyball players, is more frequent in those who play on concrete or linoleum than in those who play on softer wood courts. Likewise, ankle sprains are also likely because of the sports demands. Most players injure their ankles when they land after blocking or spiking in the front court or when changing direction laterally. It is very common for a player to land on a teammate's foot resulting in a lateral ankle sprain. Due to the frequency of jumping and landing in volleyball, all of our UM volleyball athletes must be either taped or braced for every practice/game. Moreover, due to the volume of jumping in volleyball, a goal of both the athletic training staff and our strength and conditioning staff is to encompass balance and proprioception into the pre-habilitation program. When athletes are in the weight room, they perform dumbbell lateral raises and bicep curls standing on one leg. When using the bodyblade, the athletes stand on one leg on an unstable surface such as a foam pad. The proprioception progression includes balance training with the athlete's eyes open then closed, and then standing first on stable surfaces and progressing to unstable surfaces such as BOSU balls, and airex pads.

As once can see, pre-habilitation has been a vital component to both the successful prevention and management of injuries to the University of Miami Volleyball team. In my opinion, our student athletes receive the very best in state of the art professional medical care. Our athletic training staff works hand-in hand with a wide variety of specialists including our team nutritionist, sports psychologist, internists, orthopedic surgeons, dentists, optometrists, cardiologists and strength and conditioning coaches. A sports medicine team works together to evaluate and treat both acute and chronic injuries, design sport specific rehabilitation and programs to help reduce the risk of re-injury, enhance physical parameters such as strength, speed, power, and flexibility, develop nutrition plans for optimal performance and provide athletes the tools necessary to reach their maximum potential as both a student and athlete.