September 25

Volleyball injuries start at the knee

PHOTO: Korean substitutes watching on the sidelines sport a variety of knee wraps and tapings. The volleyball team lost to the Russians in the preliminary round.

Given the speed and power of their play and the unforgiving surface on which they land, it's not surprising that indoor volleyball players are injury prone. But the Korean Olympic men's team personified the risks: All but one starting player had one or both knees wrapped or taped.

Because of all the jumping and landing in volleyball, players are by definition at risk for "jumper's knee," or patellar tendinopathy. Patellar pain was particularly apparent on the Korean team, as several players wore athletic tape strategically placed to support the kneecap. This taping technique, known as physiotaping, is popular in Japan and other East Asian countries but is just beginning to draw attention in the U.S.

Jumper's knee can present as a focal hypoechoic region on ultrasound and hyperintense signal at the junction of the tendon with the patella on MRI, but researchers have not yet been able to reliably correlate imaging findings with symptoms or prognosis, as Dr. Jill Cook of LaTrobe University in Bundoora, Australia, and colleagues wrote in the September sports imaging supplement to Diagnostic Imaging. Researchers from Kristiansund Hospital in Norway support this assessment; they saw ultrasound changes associated with jumper's knee in 12 of 51 asymptomatic knees but no abnormal ultrasound findings in seven of 30 knees with a positive clinical diagnosis. The Norwegian findings were published in 1996 in the Scandinavian Journal of Medical Science and Sport.

Indoor volleyball players, particularly ones who spike the ball, also incur some of the same shoulder injuries that plague athletes in other sports with overhand motions, such as baseball or tennis. Researchers from Staatliche Orthopadische Klinik in Munich performed clinical and ultrasound examinations on 30 competitive volleyball players and found different muscular and scapular patterns in the dominant shoulder compared with the nondominant shoulder. Depression of the playing shoulder, lateralized scapula, and shortening of the dorsal muscles and the posterior and inferior part of the shoulder capsule were all more pronounced in athletes with shoulder pain than those without symptoms. The German findings appeared in the September 1996 issue of the British Journal of Sports Medicine.

One less obvious consequence of the power with which volleyball players strike the ball with their forearms -- serving, digging, or spiking -- can be vascular damage, which is visible on echographic and Doppler ultrasound examination. Researchers from the Institute of Internal Medicine and Endocrine and Metabolic Sciences at the University of Perugia, Italy, found evidence of vascular damage in one-third of the volleyball players they studied. Their findings appeared in 1992 in the American Journal of Sports Medicine.

Whether years of playing indoor volleyball also contributes to later onset of ankle osteoarthritis has yet to be determined conclusively, but 1999 research from the Swiss Sports School in Magglingen suggests that there may be a link. The Swiss team studied 22 former elite volleyballers who had played for at least three years in the most competitive league in Switzerland and 19 normal age-matched, untrained controls. A radiologic score of degenerative ankle disease was elevated in 19 of 22 (86%) of the former players but in only 2 of 19 (11%) of the control subjects. No severe grades of osteoarthritis were seen in either group, however. The study was published in the International Journal of Sports Medicine.

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