Oslo Sports Trauma Research Center

Description

Previous studies have shown that the injury risk in volleyball is lower than that seen in other team sports such as handball, soccer or ice hockey.
Presumably, this difference can be attributed to the non-contact nature of the game of volleyball, since players from opposing teams are separated by the net.
However, the rate of ankle sprains, which account for about half of all acute volleyball injuries, is comparable to that found in contact sports, i.e. basketball, soccer or handball. We also have some evidence that these injuries mainly occur at the net when landing after blocking or attacking, but less is known about individual risk factors, although many injured players have a history of at least one previous ankle injury during their career.

The main purposes of this three-year study were: 1) During the first season to investigate the effects of previous ankle injury as a risk factor and to study the mechanisms for ankle injuries in volleyball and 2) during the following two seasons to introduce and test the effects of an intervention program developed based on this information.

Method: Four main intervention strategies were formulated based on the evidence we collected on injury mechanisms and risk factors during the first season: (1) rule changes to reduce the conflict zone under the net where an attacker may land on a blockers foot or vice versa; (2) use of tape or ankle braces as external ankle protection; (3) specific technical training on take-off and landing technique during attack and two-man blocks; and (4) proprioceptive training after previous ankle injury. The final two strategies (3 & 4) technical training and balance training, as well as general injury awareness information formed the basis for a specific and inexpensive prevention program that can be implemented without the use of medically trained personnel. Thus, this prospective study was carried out in the Norwegian Volleyball Federation league during the 1992-93, 1993-94 and 1994-95 indoor seasons. Base-line data on risk factors and mechanisms of injuries was collected during the 1992-93 season. The injury prevention program was introduced in the clubs during the 1993-94 season. Data collected during the 1994-95 season was used to determine any effects the injury prevention program may have on injury incidence and mechanisms.

Results: During the first season we found a baseline injury incidence of 1.7 ± 0.2 per 1000 h of play, 1.5 ± 0.2 during training and 3.5 ± 0.8 during games. The ankle (54%) was the most commonly injured region, followed by the lower back (11%), knee (8%), shoulder (8%) and fingers (7%). Of the ankle injuries, 79% were recurrences, and the relative risk of injury was 3.8 (p<0.0001) for previously injured ankles (38 of 232) vs. non-injured ankles (10 of the 234). Moreover, a reinjury was observed in 21 of the 50 ankles which had suffered an ankle sprain within the last 6 months (42.0 ± 7.0%; risk ratio: 9.8 vs. uninjured ankles; p<0.0001).
The data indicate that the risk of ankle sprains is extremely high during the first 6-12 months after an ankle sprain in this player population. The intervention program was introduced during the 1993-94 season, and the results from the 1994-95 season was used to evaluate the effects of the prevention program. The incidence of ankle injuries was reduced from 0.9 ± 0.1 per 1000 player hours during the 1992-93 season (48 injuries) to 0.7 ± 0.1 during the 1993-94 season (38 injuries; n.s. vs. 1992-93) and to 0.5 ± 0.1 during the 1994-95 season (24 injuries, p<0.01 vs. 1992-93).
In other words, there was a twofold reduction in the incidence of ankle sprains after the injury prevention program had been introduced.