Common Injuries in Volleyball: Recognize Them and Reduce the Risks

Common Injuries in Volleyball: Recognize Them and Reduce the Risks

by | Jan 28, 2021 | Sports Medicine

Sports medicine physician Jane S. Chung, M.D., has a special interest in caring for young female athletes. She worked to let coaches and parents of young volleyball players know about injury risk and prevention in the sport.

Download the Volleyball Safety Sheet to share with parents of teammates and coaches.

Like many sports, volleyball comes with some inherent risks. This popular, fast-paced, explosive-natured sport requires players to react quickly, swiftly generate power from the legs and arms and perform movements repeatedly. Year-round, intense competition adds to the challenges for preventing overuse injuries and burnout. However, strategic rest periods and following appropriate safety recommendations can help decrease injury risk and help keep these athletes on the court.

COMMON PROBLEMS FOR VOLLEYBALL PLAYERS

Knee Pain and Injuries
Pain in the front of the knee is a common complaint from growing, active females. A proper strength and conditioning program can help prevent this discomfort and improve the alignment of both hips and knees for more power in squatting and jumping. Activity-related pain should not be ignored. Landing awkwardly from a jump can cause sprains and tears to ligaments and other soft tissue in the knee. A swollen knee after an injury warrants removal from play and an evaluation.

Finger Injuries
Blocking high-speed hits and setting the ball can put the fingers at risk of being jammed, fractured or dislocated. While jammed fingers typically heal with rest and ice, they can sometimes cause injury to ligaments and cartilage, which may require closer evaluation. If you are unsure or if pain and swelling do not subside with rest, it is best to have a medical evaluation.

Ankle Injuries
Ankle injuries are common in many sports, including volleyball, and typically occur while changing direction or landing on another player’s foot after a jump. Mild ankle sprains are often treated with RICE (Rest, Ice, Compression and Elevation). Repeated sprains, more severe sprains or an inability to bear weight may require an X-ray, evaluation and rehabilitation.

Shoulder Pain
The repetitive overhead motion of serving and hitting the ball can lead to pain in and around an athlete’s shoulder. Without ample recovery time, the tissue cannot adapt to the stress, and the muscle, tendon, bone or cartilage can be damaged. If pain persists after resting the injury for a couple of days, it is best to have a medical evaluation. For further information on shoulder pain, please visit Sports Medicine

Concussions
Liberos seem to be at the greatest risk of concussions in volleyball, but a hit or fall can happen to any player. An athlete with any symptoms or change in behavior, thinking, or physical functioning after a blow to the head or body should be suspected of having a concussion. This athlete should be removed from play immediately, even if there was not a loss of consciousness. The athlete should not return to play the same day as the injury and should have a medical evaluation.

Groin Injuries
Defensive moves require rapid changes in direction and speed, which can cause the adductor muscle group (inner thigh) to become overstretched. Pain from a muscle strain to this group may occur suddenly or over time. A medical evaluation is appropriate if the condition persists or occurs repeatedly.

Low Back Pain
Back pain that persists or does not get better with rest should not be ignored. Promptly addressing it can keep it from worsening. Overuse injuries such as a stress fracture (spondylolysis) in the lower back can develop from repeated hyperextension common in volleyball. Studies have found that volleyball players with a history of ankle sprains may be at a higher risk of low back pain. Strength and conditioning programs that include core training will help to prevent back pain.

TIPS TO HELP PREVENT INJURIES IN VOLLEYBALL

Play Smart and Be Aware of the Environment 

All coaches want their players to hustle, but it is equally important to make smart plays.

Communicate
Volleyball is truly a team sport where one athlete cannot shine without the others.

Pre-Participation Evaluation (PPE) 
A PPE is an essential first step in injury prevention.

Dynamic Warm-Up
A dynamic warm-up involves continuous movement in preparation for competition or practice.

Stay Hydrated
Whether, indoors and outdoors, an athlete’s performance can be impacted by even mild dehydration.

Rest
Take a day or two off from volleyball each week to let the shoulder rest even if there are no symptoms.

Wear Appropriate Gear
Athletes should wear properly sized shoes that are tied correctly and are appropriate for the playing surface.

Learn more about pediatric sports medicine.

Why is a Sports Registered Dietitian Valuable to Your Young Athlete?

Why is a Sports Registered Dietitian Valuable to Your Young Athlete?

by | Jan 25, 2021 | Sports Medicine

Is your athlete struggling to get the upper edge in his or her sport or trying to recover from a recent or recurring injury? Maybe your athlete is competitive in school and club sports while also trying to manage a chronic illness like diabetes, gastrointestinal (GI) issues or food allergies. These situations can all be overwhelming for an athlete and family. However, working with a registered dietitian can help ease the burden and help you and your athlete navigate food in a way that will help him or her recover and excel in their sport.

As part of our multidisciplinary approach to care, we have a certified sports dietitian on our team to support the wellness of our young athletes. We understand that every athlete is different, making it even more important that they understand the proper ways to fuel and take care of their bodies.

While anyone can claim to specialize in nutrition, it is best for athletes to work with a registered dietitian (RD), specifically one that is a certified specialist in sports dietetics (CSSD). They have special training and are qualified to help manage health or illness, prepare for or recover from surgery and fuel for sport.

A Registered Certified Sports Dietitian is uniquely educated and credentialed to:

  • Provide medical nutrition therapy (MNT).
    • MNT includes a nutrition diagnosis as well as therapeutic and counseling services to help manage conditions such as diabetes, kidney disease, eating disorders and more.
  • Evaluate the quality of supplements, making sure they are safe and effective.
  • Assist an athlete in achieving weight management and body composition goals in a safe and realistic way that acknowledges and avoids body image issues and eating disorders.
  • Teach athletes helpful skills through cooking demonstrations, meal planning and grocery store tours.

Find all resources from our sports dietitian on the sports nutrition page.

Dietitians are qualified to provide the above care because of the education they receive and the 1,200 hours of supervised practice they complete. Learn more about a registered dietitian here.

Body, Mind, Sport: The Role of Wellness in Recovery and Injury Prevention

Body, Mind, Sport: The Role of Wellness in Recovery and Injury Prevention

by | Dec 15, 2020 | Sports Medicine

This is a summary of a presentation made as a part of the 2020 Coffee, Kids and Sports Medicine education series.

Watch the full lecture here.
Print the PDF

Young athletes are under a lot of pressure to perform. No matter where the pressure comes from, a coach, a parent or himself, an athlete needs support to balance the demands of the sport with the needs of the developing body and mind. Chung and Morrison teamed up to help medical professionals like you address this challenge for young athletes.

Finding the Right Balance

Effective training requires a balance of load and recovery. Here are some definitions that will help with this discussion:

Load is an inevitable result of athletic conditioning, training and competition. If safely managed, load may result in improved athletic capacity and performance as well as reduce risk of injury and illness.

  • External load is work completed by the athlete during training and competition. The load creates physical, physiological and psychosocial demands. For example, number of pitches thrown, distance run, hours training or amount of weight lifted.
  • Internal load is the individual physical, physiological and psychosocial characteristics that respond to an external load. For example, aerobic capacity, mood and muscle strength.

Overload is a load that is excessive or not well managed. This can result in anatomical, physiological and/or psychosocial conditions that will manifest as altered performance, injury and illness. It is important to identify and modify load to minimize overload. This helps with improving performance and contributes to injury and illness prevention.
Recovery is the process and period during which body responds to load.

  • Adequate Recovery = positive adaptations for athletic capacity, performance and injury/illness risk.
  • Inadequate Recovery = negative adaptations for athletic capacity, performance and injury/illness risk.

Balance is achieved when the load is enough to create progress and allow adequate recovery. When overload occurs with intensity or a sudden increase in training, there are consequences seen as a plateau or decline performance and medical issues.

Systems and Functions with Medical Issues Related to Overload

  • Sleep
  • Immune system
  • Cardiovascular
  • Respiratory
  • Hormonal, specifically in female athletes
  • Nutrition

Musculoskeletal Issues Related to Overload or Sudden Increases in Load

  • Bone stress injuries (stress reaction, stress fractures)
  • Physeal injury (skeletally immature athletes)
  • Muscle injury
  • Tendinopathy
  • Youth elbow and shoulder injuries

How Do We Support Young Athletes?

Medical professionals including team physicians, pediatricians, physical therapists, school nurses and athletic trainers, all have a responsibility to support young athletes as they progress through their sport and training. Here is a look at several categories to help with performance and injury prevention.

What is the Role of Nutrition in Recovery and Injury Prevention?

Optimal nutrition supports an athlete managing appropriate training load AND growth. Anything less can leave the athlete short, increasing risk of these and other conditions:

  • Hormone changes
  • Altered menstrual cycle
  • Increased injury and risk of injury
  • Decreased response to training
  • Delayed healing
  • Increased illness
  • Mood changes
  • Fatigue
  • Disordered eating

What is Optimal Nutrition?

  • ADEQUATE ENERGY AVAILABILITY provides enough calories to support training and growth.
  • VARIETY OF FOODS AND FOOD GROUPS ensures macronutrient and micronutrient balance to meet physiological demands of growth and performance.
  • OPTIMAL MEAL AND SNACK TIMING AND FREQUENCY supports training needs depending on each athlete’s schedule.
  • INDIVIDUALIZED HYDRATION PLAN is an important component to nutrition plan and supports the unique needs of each athlete.
  • POSITIVE “FOOD TALK” affects an overall healthy attitude toward food, especially for athletes in “aesthetic” or lean-focused sports.

Find and download sports nutrition resources for your patients here.

A Consequence of Suboptimal Nutrition: Female Athlete Triad

This occurs when energy intake does not adequately compensate for exercise related energy expenditure (under-fueling). Each component of triad exists on a spectrum between health and disease. The components are:

  • Energy Availability
  • Bone Mineral Density
  • Menstrual Function

Athletes who participate in sports that emphasize leanness, aesthetics, weight class sports and gravitational sports are at greater risk for this condition. The consequences of this condition can be irreversible and should be recognized and referred as soon as one or more components are present. When the body is in a negative calorie balance, normal growth and development and other normal physiologic functions are inadequate. Additionally, performance deficits can lead to frustration with training and increased risk of fatigue and injury.
Male athlete triad is becoming better understood and has similar causes and effects on young men. These include:

  • Energy deficiency
  • Impaired bone health
  • Reproductive suppression
  • Low testosterone
  • Oligospermia
  • Decreased libido

The International Olympic Committee has proposed “RED-S” (Relative energy deficiency in sport), consequences of low energy availability beyond the triad. Learn more at www.FemaleandMaleAthleteTriad.org.

What is the Role of Sleep in Recovery and Injury Prevention?

Sleep is important for physical, mental and cognitive well-being. It plays a key role in academic and athletic performance, injury and recovery. Insufficient sleep or poor sleep quality may increase risk for injury in adolescent athletes. Some studies show an increased risk of injury in athletes that sleep less than eight hours per night. Other studies show that recovery from a sport-related concussion is improved with better sleep quantity and quality.

Signs of poor sleep quality:

  • Decreased athletic performance
  • Recovery from exercise/training
  • Decreased reaction time
  • Impaired cognition
  • Changes in mood
  • Increased risk for injury
  • Reduced ability to tolerate load

How Can We Help Manage Stress and Address Mental Health in Young Athletes?

When an athlete is experiencing a training or stress overload, there are consequences that may show up on performance or health. These are often difficult to see but have a profound impact. These include:

  • Slowed reaction times
  • Decreased speed and agility
  • Decreased concentration
  • Mood changes
  • Disordered eating or an eating disorder
  • Sleep disturbances
  • Decreases in lean muscle or difficulty gaining lean muscle
  • Decreased academic performance
  • Relationship struggles

Since 1 in 5 youth meet the criteria for a mental health disorder, it is more important now than ever to recognize these signs and symptoms in young athletes and help connect them with an appropriate support system. Injuries can have psychosocial consequences as well as physical, including mood swings, depression and disconnection from peers.

Download the PDF to share with your patients.

Take Home Points

Athletes need guidance to understand how load, nutrition, sleep and mental health are interconnected. Together the appropriate balance of these can support improved performance and a reduction in injury and illness risk.

Nutrition

  • Three meals + needed snacks each day.
  • At least three food groups per meal..
  • Encourage fluids throughout the day and around/during games and practices.
  • Follow individualized hydration plan, if needed.
  • Positive food and body talk.
  • If a food group is eliminated, seek guidance to ensure nutrition needs still met.

Sleep

  • 8-10 hours of sleep each night for teenagers.
  • Establish a consistent sleep schedule (consistent sleep & wake time, even during the weekends).
  • Set a nighttime routine.
    • Read a book, meditation, take a warm bath.
    • 30-60 minutes prior to bedtime should be a time of relaxation.
  • Set a good sleep environment.
    • Quiet, dark, cool temp, comfortable/calming.
  • No electronics 1-2 hours prior to bedtime.
  • Avoid caffeine and large meals before bed.

Mental Health

  • Make mental health a priority with physical health.
  • Listen without judgement.
  • Question and remind athletes about effective ways of coping with stress, share you own experiences, initiate formal conversations about coping.
  • Early identification and action are important.

Resources for your patients

Ultrasound in Pediatric Sports Medicine

Ultrasound in Pediatric Sports Medicine

by | Dec 3, 2020 | Sports Medicine

This is a summary of a lecture provided by sports medicine physician Jacob C. Jones, M.D., RMSK, as part of the Coffee, Kids and Sports Medicine educational series.

Watch the full lecture.
Print the PDF.

Basic Ultrasound Physics
Most are aware that ultrasound uses sound waves to create an image, but that’s about where the knowledge stops. Here are a few key points to help with understanding the physics behind this technology:

  • The transducer probe delivers sound waves into the body to reveal a boundary between two types of tissue (e.g. ligament and fluid).
  • Some waves bounce back to the probe and some pass through the tissue to the next boundary.
  • The transducer calculates the distance and speed converts to volts (piezoelectric effect).
  • A 2-D, black and white image is produced on the screen based on a grayscale assigned to distances and intensities.

To improve the images produced, different transducers, also called probes, are available and are chosen based on size of field area, tissue depth and other variables.

Indications, Advantages and Disadvantages for Ultrasound in Pediatric Sports Medicine
Pediatric orthopedists have leaned on ultrasound in diagnosing conditions in the infant hip for many years. With a continued evolution of the subspecialty of pediatric sports medicine, there is a recognition that some conditions can be diagnosed safely and effectively with ultrasound.

Indications include:
Diagnostics 

  • Tendons
    • Tendinopathy
    • Strains
    • Tears
  • Muscles
    • Strains
    • Contusions
    • Tears
  • Nerves
    • Entrapment
  • Ligaments
    • Sprains
    • Tears
  • Joints
    • Effusion (swelling in the joint)

Interventional

  • Guided Injections
  • Tenotomies (procedure to a selected tendon)
  • Aspirations/lavage
  • Tendon/ligament releases
  • Biopsies

Advantages Over Traditional Imaging 

  • Real-time imaging that is also dynamic.
  • Needle guidance for procedures.
  • Allows interaction with patient and family during imaging.
    • Visual feedback can help patient commit to treatment.
  • Less metal artifact compared to MRI in some cases.
  • Contralateral limb can safely and easily be used as a control.
  • Easily used in exam rooms and on the sidelines.
  • Relatively inexpensive with reduced resource dependence.
  • No radiation.
  • Painless.
  • Sonopalpation (palpation during ultrasound) and active or passive range of motion can be performed to enhance exam.

A Few Disadvantages to Consider When Using Ultrasound

  • Limited field of view.
  • Incomplete evaluation of bones and joints.
  • Limited penetration.
  • Operator-dependent.
  • Evolving certification/accreditation standards.
  • Equipment cost and variable quality
  • Anisotropy – a type of artifact in which changing the angle at which the ultrasound wave interact with a tendon or muscle can affect the brightness of the image. Non-perpendicular images will cause hypoechoic (darker) images.
  • Artifacts -causes unclear images.
  • Excessive or disruptive pressure from sonopalpation.

Watch the full lecture to hear case examples of how ultrasound augments musculoskeletal evaluations and interventions:

  • Knee: 11-year-old female soccer player with posterior knee popping and pain.
    • Observe hamstring tendons as patient volitionally caused popping.
  • Shoulder: Young baseball player, pain in cocking phase of throwing.
    • Visualize posterior labral pathology with shoulder active movement.
  • Hip: 17-year-old dancer with ongoing right hip pain.
    • Measure femoral head protrusion in various positions.
  • Calf: 18-year-old tennis player that felt some right calf pain while doing sprints.
    • Compare to normal side and use sonopalpation help to confirm diagnosis.
  • Humerus: Young baseball pitcher/catcher with pain in shoulder when throwing.
    • Quantify physeal asymmetries side-to-side.
  • Wrist: 9-year-old male tripped over opposing soccer player and landed on wrist.
    • Quickly determine need to seek further care or return to play.
  • Hip: 13-year-old male basketball player with chronic right hip pain and h/o a “pop” two years ago.
    • Ultrasound-guided procedure followed by second round of physical therapy.
  • Thigh: 16-year-old male sustained blow to thigh two months ago.
    • Multi-planar view to evaluate.

Changing Your Practice
This information does not necessarily need to change your practice. Ultrasound is a complement to many other evaluation tools and imaging resources.

For practitioners interested in learning more about ultrasound, Jones recommends looking for local workshops to get a feel for using a device before purchasing one. The learning curve is steep, but the flexibility and benefits over time make it a great option for some providers.

Musculoskeletal Ultrasound at Scottish Rite for Children
In addition to Jones use of ultrasound in his sports medicine practice, radiology staff and pediatric radiologists also provide ultrasound for sport-related conditions, hip dysplasia as well as other conditions. Patients referred to Scottish Rite for Children providers all have access to this resource.

About the Expert
Jacob C. Jones, M.D., RMSK, is a sports medicine physician caring for young athletes at Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco. After a pediatric sports medicine fellowship, he completed intensive training in a musculoskeletal ultrasound fellowship.

Helping Young Athletes Manage Stress

Helping Young Athletes Manage Stress

by | Nov 18, 2020 | Sports Medicine

For all kids, managing stress is important. However, young athletes have an added layer of pressures and our team is here to provide tips on properly managing those stressors. Pediatric psychologist Emily Stapleton, Psy.D., works closely with our young athlete population at our Frisco campus. As a former athlete herself, she has a passion for supporting athletes’ mental health for optimal performance, injury prevention and rehabilitation outcomes.

Below are a few tips to help parents, athletic trainers and coaches of young athletes manage stress.

CONNECT and help problem solve.
When overwhelmed, teens may struggle to break down a situation into manageable pieces. Talk to them and help them take one step at a time.

TIME your conversations wisely and keep it positive.
Let emotions from games or practices settle before talking about performance or outcomes. Waiting a couple of hours to discuss these topics allows athletes to reflect on their performance with less stress.

REFRAME success.
Expectations from parents and coaches can unknowingly increase pressure to perform and negatively affect self- confidence. Encourage athletes to focus on putting forth their best efforts and measuring personal progress rather than only focusing on end results or winning.

TEACH coping skills for life.
Coping skills can help an athlete learn to self-manage when stress starts to take over. Expose your athlete to yoga, taking walks, diaphragmatic breathing (i.e., deep breathing), progressive muscle relaxation (i.e., tensing/releasing muscles) and other techniques to relax.

MAKE ROOM for breaks.
Teach athletes the importance of down-time for rest and recovery. Helping athletes develop time-management skills and minimize over-scheduling will improve stress management.

ENCOURAGE life outside of sport.
Making time for other interests and hobbies apart from the primary sport, including fun activities and time with friends, helps create balance and build resiliency. Allowing athletes to have a breadth of interests and hobbies to draw from when experiencing distress.

PROMOTE healthy sleeping and eating habits.
Stress is easier to manage and less likely to build up with healthy habits in place. A balanced, sport-appropriate diet and quality sleep (at least eight hours for teens) support young athletes in academic, sport and social settings.

ASK for HELP when you need it.
Talking through stressors with a licensed psychologist or mental health counselor can be a healthy outlet for chronic stress and help athletes learn positive coping strategies to use in the future when experiencing negative stress.

Print the PDF

Learn more about pediatric sports medicine.