Recreational Injury Interventions



Volleyball is one of the most popular sports in the world with more than 200 member countries and approximately 150 million players in the (FIVB) Federation of International Volleyball, Bahr & Bahr 1997. Despite, the relative low risk of injury in volleyball compared to contact sports such as soccer, basketball, and handball, volleyball players experience a similar rate of ankle sprains, Bahr et al, 1997. Ankle injuries account for half of acute volleyball injuries. It has also been reported that 78% of players that experience an ankle injury had a history of at least one previous ankle injury, Bahr & Bahr 1997.

The two main previously observed ankle injury mechanisms were a player landing on the foot of an opponent in the conflict zone under the net while either blocking or attacking. Restrictive rules that reduce the conflict zone under a net, however, are not highly recommended because of the increase in number of game interruptions due to foot faults which ultimately effects the flow of the game, Bahr et al, 1997. It is believed that proper technique for take-off and landing may reduce the number of ankle injuries endured at the net.

The study below outlines a prevention program that evaluates technique training and three other prevention strategies including; rule changes to reduce the conflict zone under the net, use ot tape and ankle braces, and proprioceptive or intensive balance board training after ankle injury.

Review of volleyball studies:


Bahr et al, 1997

Study design and target population

Prospective cohort study.

Population: 819 volleyball players from the two top men's and women's divisions took part in the study during the 1992-1993, 1993-1994, 1994-1995 Norwegian Volleyball Federation. seasons.

Mean age of women, 22.4 + 4.3 years. Mean age of men, 23.2 + 4.2 years.


Prevention program incorporated into team training by coaches.

Program included general injury awareness, technical training (for take-off and landing for blocking and attacking), and balance board training for players with recurrent sprains.


Total training exposure, match exposure, injury incidence, and injury risk.


The incidence of ankle injuries was significantly reduced from the 1992-93 season to the 1994-95 season (P<0.01 vs. 1992-93).

Overall injury rate reduced from 1992-93 season to the 1994-95 season (P<0.01 vs. 1992-93).

Number of ankle injuries due to landing on the foot of an opponent or team mate from the first season to the last reduced (14 injuries; P<0.05)

There was no significant change in the number of players reporting that they intended to use ankle braces or taping on a regular basis in the pre-participation form.

Study quality and conclusions

A twofold reduction in the incidence of ankle sprains after injury prevention program introduced.

47% observed reduction in the incidence of ankle sprains from 0.9 to 0.5 per 100 player hours from the baseline season to the 1994-95 season, when the program was believed to be in full effect.

Poor design. Using historical baseline data in results did not control for confounding variables.

Direct contact with the teams was not established. Reporting bias not controlled for. Additionally, the two elements of the prevention program could not be evaluated independently.

Additionally, results may not be applicable to players with less experience or lower level of skill.

Summary of volleyball studies

There was a two fold reduction in the number of injuries due to landing on the foot of an opponent. Prior to intervention the risk of reinjury for a previously injured ankle was increased fourfold compared with ankles without previous injury. Most of the reinjuries took place within the first 12 months after injury. Epidemiological studies evaluating the protective effects of tape and bracing have shown to benefit only players with pervious ankle injury. Most players reported that they did not intend to use ankle braces or taping on a regular basis. Injury prevention interventions should emphasize technical training, general injury awareness, and balance board training.

Recommendations on volleyball

A prevention program consisting mainly of an injury awareness session, technical training (with an emphasis on proper take-off and landing technique for blocking and attacking), and a balance board training program for players with recurrent sprains appears to have some effect on the reduction of ankle sprains.

Recommendations for future research

There is a need for well-designed, large-scale randomized controlled trials (RCTs) to evaluate the effect of technical training and balance board training in volleyball players. This is the only way that all the other confounders can be controlled for. Further studies that examine the the effects of previous ankle injury as an independent risk factor are recommended.