What are the most common ankle injuries in volleyball?
The most common ankle injury in volleyball is a lateral ankle sprain, also known as an inversion ankle sprain, and in the most severe cases, may occur in combination with an ankle fracture. Other common ankle injuries in volleyball include medial ankle sprains, Achilles tendinopathy, and Achilles rupture.
What causes ankle sprains in volleyball?
Lateral ankle sprains, also known as inversion ankle sprains, occur when the ankle is forced into an inverted position beyond the limits that its ligaments can handle. In other words, the typical mechanism of injury for a lateral ankle sprain is the movement of “rolling the ankle”.
Why are lateral ankle sprains so common in volleyball? The reason that lateral ankle sprains, also known as inversion ankle sprains, are so common in volleyball is multi-factorial and is a combination of the dynamic nature of the sport, the amount of maximal jumping involved, and potential for contact with opponents. Let’s break this down a little further.
When we refer to the dynamic nature of volleyball, what we really mean is the rapid change of direction in a confined space. Plant + cut maneuvers, lateral shuffling, and/or rapid change of direction in response to an opponent’s move place a high level of demand on the ankles, and as such, an unstable ankle will be more prone to injury.
Jumping itself is very safe when controlled, but again, jumping in response to an opponent’s move, especially should there be any sort of displacement occurring in the air (i.e. jumping up and to the side to move into a blocking position) can make it even more important for the ankle to quickly react to both the push-off and the landing phase of the jump. Landing is typically where the ankle will be more prone to excessive inversion.
While many people may think of volleyball as a non-contact sport, it can definitely still happen, particularly in the conflict zone (Verhagen et al, 2004), which is the area directly below the net. The most common mechanism of injury for an ankle sprain in this area is landing on an opponents foot, which will make rolling the ankle almost unavoidable in some cases.
Medial ankle sprains, also known as eversion ankle sprains, can also occur, whereby the mechanism of injury is the opposite of a lateral ankle sprain. In this case, forced eversion of the ankle joint stresses the deltoid ligament on the inside of the ankle.
Landing on an opponent’s foot is the most common way to sustain a medial ankle sprain in volleyball, but can also occur from awkward plant + cut movements or awkward falls.
What can put volleyball players at higher risk of an ankle sprain?
Aside from the nature of the sport itself as described above, the biggest intrinsic risk factor for sustaining a sprained ankle while playing volleyball is ankle instability, which can result from having a history of recurrent ankle sprains, especially if the previous ankle sprains were not specifically rehabilitated. A history of ankle sprains will lead to an inherently unstable ankle, which increases the risk of future sprains.
Interestingly, some research shows that volleyball players with higher plantarflexion strength (i.e. calf muscle strength) combined with reduced ankle dorsiflexion range of motion (i.e. calf flexibility and/or ankle joint mobility) is a significant risk factors for sustaining an ankle sprain in volleyball (Hadzic et al, 2009).
Overall, a history of recurrent ankle sprains, as well as imbalances in ankle strength and mobility, can all be significant risk factors for ankle sprains in volleyball.
How can volleyball players prevent and treat ankle sprains?
Given that underlying ankle instability is a big risk factor for sustaining an ankle sprain while playing volleyball, one of the best ways to prevent ankle sprains is to seek guidance from a physical therapist regarding injury prevention exercises for the ankle.
A physical therapist will be able to identify specific limitations in ankle strength or mobility and can provide specific guidance on how to build in addressing these limitations without distracting from training. This will may take the form of isolated strengthening of specific muscles that need to “catch up”, mobility exercises, global dynamic sport-specific strengthening, as well as ankle proprioception exercises.
When it comes to the general treatment for ankle sprains, it is quite similar to prevention strategies, but usually takes more focus and patience while allowing the injured ligaments to heal. Additionally, there may be more precautions in place, especially in the early stages of recovery, and as such, the physical therapy becomes an even more crucial element in ensuring proper recovery and reduced risk of re-injury.
Will an ankle brace help prevent ankle sprains in volleyball?
Yes, a properly worn lace-up ankle, or a double upright ankle brace, can absolutely reduce the risk of ankle sprains in volleyball (Pedowitz et al, 2008). While these bracing techniques can offer additional ankle stability, they should not be used as a complete substitute for ankle strength and proprioception, which is why physical therapy is still very important.
Achilles tendinopathy refers to chronic degeneration and possibly disorganization of the collagen fibers that make up the tendon. Achilles tendinopathy usually doesn’t have an inflammatory component unless flared up, but it can occasionally be inflamed as well, especially int he case of insertional Achilles tendinopathy, or if retrocalcaneal bursitis is also involved.
What causes Achilles tendinopathy in volleyball?
Achilles tendinopathy usually develops in volleyball players as a result of constant jumping, which repesents a very high rate of significant loading on the tendon, combined with a lack of recovery and/or lack of strength of the calf muscle and tendon itself. It can also result from a sudden increase in activity, such as resting in the off-season and then hitting training hard all of a sudden.
What can put volleyball players at higher risk of Achilles tendinopathy?
Previous calf injuries, or Achilles tendinopathy itself, especially if not comprehensively rehabilitated, will put any jumping athlete at a higher risk of developing the condition again. Additionally, a combination of calf weakness and stiffness will create a more vulnerable tendon, especially when a high rate of loading is involved, such as jumping, but especially landing from a jump.
Additionally, any other ankle or lower body injuries can promote the development of Achilles tendininopathy if not treated properly. For example, those with a history of ankle sprains or calf strains will be more susceptible to developing this condition, but it can still be avoided.
What can volleyball players do to prevent or treat Achilles tendinopathy?
There are two general, but very important, factors to consider when attempting to prevent or treat Achilles tendinopathy: 1) Avoiding sudden increases in activity that places a high demand on the tendon, and 2) progressive loading of the tendon working towards eccentric strengthening.
First, tendons don’t like surprises. As such, a sudden uptick in activity that places a high demand on the Achilles tendon may promote the development of tendinopathy or other associated overuse injuries. Therefore, keeping up with general lower body strength in the offseason, and then gradually building up the demand on the tendon leading into training camp or preseason can really help prevent any issues during the season itself.
Second, the main way to treat Achilles tendinopathy if it does occur is through strengthening of the calf muscles to properly load the tendon in a therapeutic manner, but this strengthening should be strategically guided by a physical therapist or sports medicine physician.
When it comes to a strengthening program for Achilles tendinopathy, it should be progressive, but comprehensive, as is the case with many overuse injuries. This means it may look like a basic calf raise program to begin with, but with a therapist guiding how much pain to push into and how often to perform the exercises. Typically, a moderate amount of pain can be expected, and the exercises are usually performed most days of the week.
While stretching may feel nice in the moment, it is not a solution for resolving Achilles tendinopathy, and in fact, aggressive stretching should be avoided. This is the case with many overuse injuries. However, eccentric exercises, whereby the muscle is contracting while it is being lengthened, can help with flexibility.
Achilles Tendon Rupture
An Achilles tendon rupture is an acute injury refers to the full tearing of the Achilles tendon, which happens acutely when too tensile or torsional stress is suddenly placed on the Achilles tendon.
Achilles tendon ruptures are not very common, but in general, they are more common in explosive sports, especially those that involve jumping or planting hard on the back foot, such as volleyball and basketball, so they do happen.
What causes an Achilles tendon rupture in volleyball?
Achilles tendon ruptures most often occur in volleyball during the push-off phase of a jump, or when landing with a lot of force on the ankle and the tendon is in a stretched position. It can also happen when an athlete steps back to plant the back foot in a dorsiflexed position (see Kevin Durant’s Achilles tendon rupture as an example of the latter).
What can put a volleyball player at higher risk of Achilles tendon rupture?
Stiffness of the calf muscles and Achilles tendon combined with weakness of the calf muscles can make an athlete more prone to Achilles tendon rupture. If combined with other muscular imbalances in the lower body, the risk may be further increased.
Additionally, as with other injuries described in this article, having a history of injury to the calf muscles or Achilles tendon that wasn’t fully rehabilitated will also make the tendon more prone to injury, possibly even rupture.
What can volleyball players do to prevent or treat Achilles tendon rupture?
By working on calf muscle strength, particularly eccentric strengthening, any athlete can minimize their risk of sustain an Achilles tendon rupture. Eccentric strengthening refers to the type of strengthening whereby a muscle is being lengthened, but is also try to contract at the same time. In the case of the Achilles tendon and calf muscles, this would be the lowering part of a calf raise.
Strengthening should also be progressive in nature. Once an athlete has demonstrated solid eccentric strength of the calf muscles, they can progressive to increasing the rate of loading, for example, jumping exercises that emphasize triple flexion of the lower body. Triple flexion refers to bending at the hip, knee, and ankle to properly absorb a landing, allowing the muscles to react appropriately and decrease the undue stress on their tendons.
In this case, a physical therapist or strength and conditioning coach is likely your best bet in terms of receiving safe and effective guidance to avoid these Achilles issues. In the case of jumping athletes like volleyball players, this can make the difference between being on the court and off the court, so it’s usually a very worthwhile investment.
In terms of treatment for rupture, some cases are surgical (repairing the tendon), while other cases can be treated conservatively. The timeline for recovery for an Achilles tendon rupture is usually fairly long, with about 50% of athletes returning to their baseline form/performance after about 1 year of rehab.
In any case, rehab will focus on protecting the repair or healing of the injured ankle, for example, non-weight bearing immobilization in a walking boot followed by very progressive return to strengthening and improving mobility. It is extremely important to seek formal guidance via physical therapy when treating an Achilles tendon rupture, whether it is post-surgical or not, as there are a lot of things to consider when it comes to avoiding re-injury while still progressing through recovery.
Many different ankle injuries can happen in volleyball, but ankle sprains are definitely the most common. Additionally, Achilles tendon injuries are also common given the jumping nature of the sport. These injuries can often be prevented through strategic strength and mobility programs, and items like ankle braces can also help reduce the risk of injury while playing.
Pedowitz, D. I., Reddy, S., Parekh, S. G., Huffman, G. R., & Sennett, B. J. (2008). Prophylactic bracing decreases ankle injuries in collegiate female volleyball players. The American journal of sports medicine, 36(2), 324-327.
Hadzic, V., Sattler, T., Topole, E., Jarnovic, Z., Burger, H., & Dervisevic, E. (2009). Risk factors for ankle sprain in volleyball players: a preliminary analysis. Isokinetics and Exercise Science, 17(3), 155-160.
Verhagen, E. A. L. M., Van der Beek, A. J., Bouter, L. M., Bahr, R. M., & Van Mechelen, W. (2004). A one season prospective cohort study of volleyball injuries. British journal of sports medicine, 38(4), 477-481.
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