1st Place Volleyball — July 2010
Change Language:
Your First Hour Volleyball Injury Prevention
Training Strategies For The Knee
Reduced playing time, missed practices and/or games, and cessation of sport participation are all possible consequences of knee injury.
The knee is a common injury site among athletes, and in particular volleyball athletes. Knee injuries account for about 25% of all lower extremity related injuries in high school athletes.1 It was reported that of all the athletic injuries requiring surgery, injury to the knee accounts for over 60% of these surgeries.2 Reduced playing time, missed practices and/or games, and cessation of sport participation are all possible consequences of knee injury. By implementing a strength and conditioning program with exercises to specifically address knee biomechanics during volleyball movements, athletes may be able to prevent some traumatic and non-traumatic injuries.3 To better understand the implications of a training program to reduce injury risk, knee anatomy will first be discussed.
The knee is critical for transferring forces efficiently and effectively during jumping and cutting tasks. Four major ligaments help to maintain multidirectional knee stability: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) . Aside from ligaments, muscles are another key player in stability.The two primary muscle groups at the knee are the quadriceps and hamstrings.A balance between hamstring and quadriceps strength is important for knee integrity. Hip muscles are another important contributor to knee stability. Hip joint muscles are primarily responsible for the dynamic side-toside and rotational stability of the knee. Weak musculature at the hip or knee can lead to faulty movement mechanics (particularly during deceleration and landing activities) and can place additional stress on knee structures and lead to injury. For this reason, it is important to train both muscle strength and movement mechanics in an injury prevention program.
Below are four exercises that will help to improve strength and movement mechanics. Unless otherwise specified by a medical professional due to a pre-existing injury, ALL sports braces and tape should be removed prior to completing these exercises. Braces and tape provide a false sense of security and do not allow the body to receive all of its natural nervous system input for balance and stabilization. This input is critical for reducing chances of knee injury.
Table 1 Progressions of knee injury prevention exercises
Lateral Band Walks: Lateral band walks are a great exercise for strengthening the lateral hip muscles. As mentioned above, these muscles play a major role in stabilizing the knee and determining knee alignment.Weak hip muscles can lead to a valgus knee (knock-kneed) position during athletic movement. This position creates an unfavorable environment for knee structures and athletic performance. Valgus knee position during jumping and landing tasks has been associated with increased risk of knee injury in athletes.4 To perform a lateral band walk, place the band around your ankles. Step sideways while keeping your feet wide and toes pointing forward. It is also important to minimize trunk and upper body movement.Do not let your torso rock side-to-side. This is a compensation strategy and improper mechanics.
Forward Reach Lunge: The forward reaching lunge mimics deceleration during athletic events. One must effectively slow the forward translation of the body to change direction during this drill. The forward reaching component increases the demand on the hamstrings, glutes, and core musculature in a similar fashion to a defensive player reaching to pass a ball. Start this exercise from an upright standing position. Step forward lunging down and reaching forward with a medicine ball or other weight. Your forward foot should be directly under your knee. Do not let your knee bow inward or outward during this exercise.When pushing from your front leg to return to standing, make sure to maintain stability through the trunk and drive from the front leg. Incorrect technique is demonstrated by shrugging your torso and upper body backwards to gain momentum when returning to standing. This relationship between the hips and the shoulders is a primary component of transferring power during explosive volleyball movements.
Single Leg Squat: A great deal of athletic movements take place on a single leg, and thus single leg stability exercises are a must in any training program. Single leg squats are a great exercise for knee stability and mechanics.When standing on a single leg many deficits that would not appear during twolegged activities are exposed. The single leg squat places a high demand on quadriceps, hamstrings, and hip stabilizer muscles.This exercise can be performed using a box, chair, or bench. While standing on a single leg, squat downward touching your buttocks to the box and then stand back up. Note that the box is only used to quickly tap as a gauge of squat depth and not as a tool to regain balance.During this exercise, rotational compensations are common. Do not allow the knee to rotate inward or outward, as this can cause future problems if it becomes a learned strategy. Knee rotation can change the pull of the quadriceps tendon and lead to pain.
Forward Box Drops: A study by Bisseling and colleagues in 2007 found that athletes with previous patellar tendon injury used a stiffer landing strategy following a jump.5 This stiff landing strategy increases the rate at which the knee is loaded and stressed upon foot contact. Movement strategies that focus on “soft” and “controlled” landings help to reduce the stress at the knee. Forward box drops are wonderful for working on landing mechanics. Landing with hips back and not entirely on the toes is important for achieving contraction of all the knee stabilizers. Executing a proper box drop is done by stepping off a box and landing with both feet on the floor. It is important to hold the landing position for a moment to demonstrate stability and proper knee alignment. As previously mentioned, it is critical that your hips sit back during landing just as if sitting back into a chair.
References:
1. Fernandez WG, Yard EE, Comstock RD. Epidemiology of lower extremity injuries among US high school athletes. Acad Emerg Med. 2007;14(7):641-645.
2. Powell JW, Barber-Foss KD. Injury patterns in selected high school sports: a review of the 1995-1997 seasons. J Athl Train. 1999;34(3):277-284.
3. Alentorn-Geili E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee Surg Sports Traumatol Arthrosc.
2009;17(8):859-879.
4. Alentorn-Geili E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):705-729.
5. Bisseling RW, Hof AL, Bredeweg SW, Zwerver J, Mulder T. Relationship between landing strategy and patellar tendinopathy in volleyball. Br J Sports Med.
2007;41(7):e8.
Reduced playing time, missed practices and/or games, and cessation of sport participation are all possible consequences of knee injury.
The knee is a common injury site among athletes, and in particular volleyball athletes. Knee injuries account for about 25% of all lower extremity related injuries in high school athletes.1 It was reported that of all the athletic injuries requiring surgery, injury to the knee accounts for over 60% of these surgeries.2 Reduced playing time, missed practices and/or games, and cessation of sport participation are all possible consequences of knee injury. By implementing a strength and conditioning program with exercises to specifically address knee biomechanics during volleyball movements, athletes may be able to prevent some traumatic and non-traumatic injuries.3 To better understand the implications of a training program to reduce injury risk, knee anatomy will first be discussed.
The knee is critical for transferring forces efficiently and effectively during jumping and cutting tasks. Four major ligaments help to maintain multidirectional knee stability: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) . Aside from ligaments, muscles are another key player in stability.The two primary muscle groups at the knee are the quadriceps and hamstrings.A balance between hamstring and quadriceps strength is important for knee integrity. Hip muscles are another important contributor to knee stability. Hip joint muscles are primarily responsible for the dynamic side-toside and rotational stability of the knee. Weak musculature at the hip or knee can lead to faulty movement mechanics (particularly during deceleration and landing activities) and can place additional stress on knee structures and lead to injury. For this reason, it is important to train both muscle strength and movement mechanics in an injury prevention program.
Below are four exercises that will help to improve strength and movement mechanics. Unless otherwise specified by a medical professional due to a pre-existing injury, ALL sports braces and tape should be removed prior to completing these exercises. Braces and tape provide a false sense of security and do not allow the body to receive all of its natural nervous system input for balance and stabilization. This input is critical for reducing chances of knee injury.
Table 1 Progressions of knee injury prevention exercises
Lateral Band Walks: Lateral band walks are a great exercise for strengthening the lateral hip muscles. As mentioned above, these muscles play a major role in stabilizing the knee and determining knee alignment.Weak hip muscles can lead to a valgus knee (knock-kneed) position during athletic movement. This position creates an unfavorable environment for knee structures and athletic performance. Valgus knee position during jumping and landing tasks has been associated with increased risk of knee injury in athletes.4 To perform a lateral band walk, place the band around your ankles. Step sideways while keeping your feet wide and toes pointing forward. It is also important to minimize trunk and upper body movement.Do not let your torso rock side-to-side. This is a compensation strategy and improper mechanics.
Forward Reach Lunge: The forward reaching lunge mimics deceleration during athletic events. One must effectively slow the forward translation of the body to change direction during this drill. The forward reaching component increases the demand on the hamstrings, glutes, and core musculature in a similar fashion to a defensive player reaching to pass a ball. Start this exercise from an upright standing position. Step forward lunging down and reaching forward with a medicine ball or other weight. Your forward foot should be directly under your knee. Do not let your knee bow inward or outward during this exercise.When pushing from your front leg to return to standing, make sure to maintain stability through the trunk and drive from the front leg. Incorrect technique is demonstrated by shrugging your torso and upper body backwards to gain momentum when returning to standing. This relationship between the hips and the shoulders is a primary component of transferring power during explosive volleyball movements.
Single Leg Squat: A great deal of athletic movements take place on a single leg, and thus single leg stability exercises are a must in any training program. Single leg squats are a great exercise for knee stability and mechanics.When standing on a single leg many deficits that would not appear during twolegged activities are exposed. The single leg squat places a high demand on quadriceps, hamstrings, and hip stabilizer muscles.This exercise can be performed using a box, chair, or bench. While standing on a single leg, squat downward touching your buttocks to the box and then stand back up. Note that the box is only used to quickly tap as a gauge of squat depth and not as a tool to regain balance.During this exercise, rotational compensations are common. Do not allow the knee to rotate inward or outward, as this can cause future problems if it becomes a learned strategy. Knee rotation can change the pull of the quadriceps tendon and lead to pain.
Forward Box Drops: A study by Bisseling and colleagues in 2007 found that athletes with previous patellar tendon injury used a stiffer landing strategy following a jump.5 This stiff landing strategy increases the rate at which the knee is loaded and stressed upon foot contact. Movement strategies that focus on “soft” and “controlled” landings help to reduce the stress at the knee. Forward box drops are wonderful for working on landing mechanics. Landing with hips back and not entirely on the toes is important for achieving contraction of all the knee stabilizers. Executing a proper box drop is done by stepping off a box and landing with both feet on the floor. It is important to hold the landing position for a moment to demonstrate stability and proper knee alignment. As previously mentioned, it is critical that your hips sit back during landing just as if sitting back into a chair.
References:
1. Fernandez WG, Yard EE, Comstock RD. Epidemiology of lower extremity injuries among US high school athletes. Acad Emerg Med. 2007;14(7):641-645.
2. Powell JW, Barber-Foss KD. Injury patterns in selected high school sports: a review of the 1995-1997 seasons. J Athl Train. 1999;34(3):277-284.
3. Alentorn-Geili E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee Surg Sports Traumatol Arthrosc.
2009;17(8):859-879.
4. Alentorn-Geili E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):705-729.
5. Bisseling RW, Hof AL, Bredeweg SW, Zwerver J, Mulder T. Relationship between landing strategy and patellar tendinopathy in volleyball. Br J Sports Med.
2007;41(7):e8.
Message