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Physiotherapy


Volleyball Injuries

Introduction

Volleyball is an exciting and challenging sport involving many rules,technical skills and strategieswhile playing the game.

Playing volleyball involves higher levels of agility, power, speed, concentration and teamwork towards the play.

Volleyball involves different types of serving strokes which may lead to shoulder and finger injuries due to force applied while throwing the ball to other side.

 

Common Volleyball Injuries

Spinal Cord Injuries
 
    Spinal injuries are not that common. They happen when the collision happens between the players.

Back Injuries

    Muscle strain of back (Due to fall)
    Low back ache
    Stress fractures

Shoulder Injuries (Most common)

    Throwing volleyball over and over again leads to arm and shoulder muscle and tendons injury

    Rotator cuff injuries - Due to repeated strain
    Shoulder separation
    Shoulder dislocation

Elbow Injuries

    Tennis Elbow – This is due to overuse and repetitive wrist extension while forcefully throwing the ball to the other side players.
    Tennis elbow is the inflammation or degeneration of the tendon which attaches to the lateral epicondyle present on the outer side of the elbow. Extensor carpi radialis brevis muscle in involved.
    Radial Nerve Entrapment –Nerve passing through the lateral epicondyle is involved.
    Elbow bursitis

Hand Injuries

    Finger fractures - Due to force while playing volleyball
    They occur due to sudden force while movement. They include:
      - Jammed fingers – Occurs when the ball gets in contact with the end fingers causing swelling and pain.
      - Treatment – Ice application, Rest the finger and Buddy strapping to the adjacent finger is to be done.
      - Broken fingers
    Muscle pull/tear at a particular part due to overuse.
    Tendinitis
    Bursitis
    Wrist pain/strain.

Hip Injuries

    Hamstrings strain  -Due to vigorous running to reach the ball
    Groin pull/Tear  - Due to lateral movements and stretches

Knee Injuries

    Anterior/Medial/Lateral/Posterior cruciate ligament injuries.
    Menisci injuries

Leg Injuries

    Calf muscle pull/Strain

Ankles Injuries

    Ankle ligament sprains - Due to running, overstretching and overuse
    Achilles tendonitis  - Painful tendon at back of ankle
    It is acute in early stages but can rupture due to negligence.
    Blisters  - Fluid-filled sacks on skin surface seen on hands and feet

Foot Injuries

    Turf toe /Big toe injury - Occurs due to running/jumping on a hard surface
    Ankle sprain is most common in football than in other sports
    (Due to twisting motion of upper lower leg tibia and fibula over the ankle bone talus)

Heat-Related Injuries occur mainly due to practice sessions during summer. Heat cramps, Dehydration, Low mineral levels etc.

Muscle cramps

    Cramp is a sudden intense pain in the muscle which contracts involuntarily and forcibly which does not relax.

Skin abrasions and wounds

    They occur due to fall while playing causing outer layers of skin to rub off.

Sprains and Strains

    These are acute injuries causing Pain, Swelling, Bruising and Movement loss in the joint.

Overtraining syndrome

    This occurs due to repeated training and overuse of the same muscles beyond their limit and capacity during competition/work-out lead to over training syndrome.

Blisters

    Fluid filled sacs on the skin surface of the feet due to Improper shoes, playing on bare feet, playing for longer periods in sun and extreme climates etc

Physical Therapy Treatment

• Physical therapist helps in Restoring of normal activities, Strength and Movement following injury, trauma or surgery.

• They teach specific techniques of Exercises, Stretches, Movements to reduce the problem and improve Range of motion, Strength and Flexibility.

• Physical therapist knows about the surgical procedures and treatment goals and program in a way to improve to improve your well-being.

Shoulder Exercises

    Pain management

      - Rest to the injured limb
      - Ice therapy
      - Compression bandage
      - Elevation of the injured part if needed
      - Medicines like pain killers
      - Modalities like heat, straps, and supports.

    Passive movements - To prevent stiffness early mobilization
    Active movements - To improve strength resistive exercises are done.
    Muscle Strengthening Exercises
    Free-weight training Exercises.
    Stretching exercises
    Seated row exercises
    Lateral pull downs
    Military press/Shoulder press
    Side raises and external rotation with dumbbells
    Medicinal ball exercises
    Rotator cuff muscle strengthening stabilizes the shoulder joint and decrease hyper mobility.
    After early recovery of shoulder injury, swimming with a pair of fins helps in

     - Reducing pressure on the shoulders
     - Helps in good cardiovascular workout
     - Strength of legs is improved.

Knee Exercises

    Quadriceps exercises
    Squats
    Leg press
    Cycling
    Lunges
    Leg extensions
    Leg raises for adductors and abductors along with stretches.

• Start sporting activities only after getting 100% recovery.
• Psychological counseling is to be done to avoid depression, anxiety and negative attitudes which may develop during injury.
• Orthopedic and surgical treatments are to be undertaken at appropriate situations.
• Recovery phase includes aims to regain normal active and passive movements, Scapular control, and upper limb strength.
• Functional phase promotes increased power, strength in UL with increase in neuromuscular control and introduction of sports specific activity before return to active swimming

Exercises

Volleyball players should concentrate on strengthening of shoulders as the game involves more energy in the shoulder muscles especially in external and internal rotators to throw the ball.

Shoulder External Rotators

Lying

    Lie on the edge of the bench on your left side. Hold the light-weight barbell on right hand place right elbow on right hip at 90 degree angle keeping palms to floor.
    Lift the barbell towards ceiling as high as possible with elbow support on hip.
    Hold and Get back to normal position and relax.
    Repeat the same to other side

Standing

    Stand straight with arms to your side holding light weight barbells. Lift your arm straight until it reaches shoulder level.
    Hold and relax.
    Perform this exercise with cables and rubber bands which helps in providing maximum resistance strengthening the muscles.

Shoulder Internal Rotators

Lying

    Lie on the edge of the bench on your right side with arm at 90 degree angle. Place right arm next to right hip holding barbell with palms facing ceiling.
    Lift the weight towards ceiling, hold and relax.
    Repeat with other side. (Same as the above exercise but here the arm is under you)

Standing

    Stand straight with arms to your side holding light weight barbells. Lift your arm backwards as far as they go depending on your flexibility.
    Hold and relax.
    Perform this exercise with cables and rubber bands which helps in providing maximum resistance strengthening the muscles.

Shoulder Press-Up

    Sit on the floor with hands resting on your side and palms towards floor near hips. Slowly lift yourself up by pushing up with arms and heels supporting on the floor.
    Maintain straight/curved spine to balance your body. Hold for few seconds and relax.
  
Prevention

Injury prevention methods are similar to all most all the sports but slight variations regarding protective equipments and conditioning exercises should be taken care of.

Warm-up Program

    It should consist of 5 min Cardio/Pulse raising exercises like Jogging, Cycling, and Skipping etc.
    Stretching exercises (Static and Dynamic). They include Running, Marching with high knees etc.
    Specific sports exercises.

    Benefits

     - Increasing temperature of muscles.
     - Increases blood circulation and oxygen to muscles.
     - Increase the speed of nerve impulses making the muscle action faster.
     - Increase the range of motions of the joints.
     - Improves the performance of the joint action.

Stretching Exercises

    All muscles and joints stretching to be done. This helps in preventing injuries.
    Good stretching program for upper and lower limb muscles is to be done.
    Stretches should be static without any bounce and held for at least 30 sec.

Cool-down Program

    It consists of gentle jogging followed by light stretching.

    Benefits

     - Gradually lower your heart rate
     - Restoration of blood and oxygen to muscles as they were before exercise program
     - Removes toxic and waste products
     - Reduces muscle soreness present after activity.

First Aid Kit

    Adhesive bandages, Adhesive tape, Ace bandages
    Ice packs
    Pain killers
    Sterile gauze pads,
    First aid cream/Disinfections cream/Analgesic cream
    Scissors
    Cloth swatches for making slings in case of emergency.

Sports Massage

    Regular sports massage help in flushing of toxic and waste products.
    Relaxes the muscle stress.
    Releases tight lumps and bumps in the muscles.

Dress Appropriately

    Proper fitted equipments should be worn. They include

     - Shoes - Shoes with skid resistant soles. Always examine the shoe soles and if smooth areas are seen replace them as soon as possible.
     - Wear comfortable and appropriate shoes which absorb the force impact during jumping, hard running, side to side play and ball handling techniques. Shoes should also  have ankle support.
     - Proper socks are also needed. The sock should not allow the foot to slide more inside the shoe. Cotton socks absorb perspiration and add support to the foot.
     -  Ankle support reduce ankle sprains
     -  Knee pads
     -  Padded shorts
     -  Braces and Supports help in stabilizing the injured area improving movement.
     -  Knee cap/Ankle brace gives support to the injured part relieving stress and inducing healing.

• Minor injury should also be treated as early as possible as this may lead to severe injury in later stage.

• The playing court should be kept clean before and after play to avoid slippery spots and debris.

• Correct techniques of playing the game are to be practiced.

• Good fitness training and trainer are also necessary.

• During practice also wear good and protective equipments.

Volleyball court

   - It should have 23 feet of overhead clearance. The court should be cleared without any objects or tree limbs which cause obstacles while playing.
   - Volleyball net should be covered with soft material to prevent abrasions if gets into contact.
   - Focus on the good techniques of playing. Don’t grab the net or hang on it. This may lead to overturn of the net and you may fall resulting in injury.

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