As volleyball grows in popularity, I’ve noticed that its athletes are often overlooked in sports medicine. The mechanics of the game closely resemble those of tennis and baseball, requiring overhead movement and crossbody slings to generate power. With this rise in specialization—especially among younger athletes—the body begins to adapt to its environment in unique ways.
Consider a defensive specialist versus a setter. A defensive player spends most of their time with their arms below their shoulders, while a setter’s arms remain above their head. Over time, their bodies adapt to these positions, which can lead to different repetitive shoulder injuries.
Another common issue I’ve observed is the widespread use of ankle braces. While these were initially intended for injury prevention, they’ve become a common sight on the court—partly due to their use among professional athletes. While ankle braces have their place, wearing them without addressing underlying issues can do more harm than good. If you frequently suffer from ankle sprains but rely on braces instead of proper rehabilitation, you’re only masking the problem rather than fixing it.
Common Injuries in Volleyball
Below are the most common injuries in volleyball athletes:
Shoulder Injuries
Like other overhead athletes, volleyball players often experience repetitive shoulder trauma. Between hitting drills, intense games, and constant serving, the shoulder endures significant stress throughout a season. The rotator cuff, responsible for stabilizing the shoulder joint, absorbs most of this force, and without proper care, repeated stress leads to irritation, inflammation, and even tears.
Another common shoulder injury is secondary impingement, particularly among front-row players and setters. Constant overhead movements create a pinching effect on the muscles in the front of the shoulder, increasing the risk of injury if not properly addressed.
Knee Injuries
Jumping is a fundamental part of volleyball, making knee injuries vulnerable to injury. Overworked quadriceps can lead to excessive pulling on the kneecap, contributing insufficient patellar inferior glide and ultimately, the infamous “jumper’s knee”. This condition results in pain and inflammation, particularly with repetitive jumping on hard surfaces like gym floors.
Ankle Injuries
As mentioned earlier, chronic ankle sprains are extremely prevalent in volleyball. Whether due to early and excessive ankle bracing or the sport’s demands, weak and/or unstable ankles can really hinder performance and lead to long-term issues.
Addressing the Root Cause
With so many potential injuries, treatment can seem overwhelming. That’s where we come in. Our approach focuses on identifying the root cause of these issues, not just treating symptoms.
At The Charlotte Athlete, our physical therapy sessions are one-on-one, meaning you receive undivided attention during your treatment. Whether improving joint mechanics, increasing strength, or enhancing mobility, we create personalized programs tailored to your needs.
Education is a key component of our process. We ensure that athletes not only understand their injuries but also understand why the injury occurred in the first place. This is incredibly important, because we not only want you to feel better, but stay better long term. What’s the root cause? This article dives deep into our root cause methodology, but essentially – what are the prolonged positions and repeated movements (in and outside sport) that are leading to pain? If you don’t address these critical factors, pain will be up and down and up and down again which absolutely sucks.
Setters and Front-Row Players, This One’s for You
For shoulder health, we emphasize improving the scapula-humeral relationship, maximizing pain-free external rotation, and improving thoracic rotation mobilty. If you’re consistently performing overhead movements without proper shoulder blade support, the humerus bears excessive stress—eventually leading to tendinitis and impingement.
One common treatment we use is manual therapy to mobilize the shoulder blade, freeing it from restrictive positions and allowing it to move correctly with the arm. I’m also a strong advocate for dry needling, which helps release tight muscles (such as the lats and pecs), restoring mobility more quickly.
Once mobility improves, we reinforce healthy movement patterns through strength and stability training. One common target is strengthening of the serratus anterior, also known as the “boxer’s muscle”. This muscle assists with scapular elevation and upward rotation, supporting efficient and pain-free overhead motion. Why is this important in volleyball? This muscle plays a key role in enabling a stable overhead position, allowing the full reach and explosive power required for serves, hits, and blocks. When weak, the scapula can’t move around the rib cage like it’s supposed to, which in turn creates increased strain on the supraspinatus and infraspinatus (rotator cuff muscles), leading to tendinitis and impingement. Even when diving for a ball, the serratus anterior will assist in stabilizing the shoulder when the arm is extended forward, therefore reducing the impact taken on the shoulders.
Down to the Knee-ty Gritty
With constant jumping, volleyball athletes tend to become quad-dominant. This excessive quadriceps demand reduces quad flexibility, preventing the patella from gliding as it needs to, often causing pain in the patellar tendon during knee bending/ squatting movements.
To address this, we often focus on patellar tracking—mobilizing the patella while improving flexibility in the hips and ankles. Restricted ankle dorsiflexion (toes moving toward the shin) and limited hip posterior glide are extremely important targets to improve patellar tracking ability.
Our treatment often includes soft tissue work, active release techniques, and dry needling to reduce quad tightness. We then reinforce these flexibility gains by strengthening the posterior chain (primarily glutes) and eccentrically training the quads to create balance. A weak posterior chain and eccentric quad control can lead to instantaneous inward knee collapse (knee valgus), which promotes lateral patellar tracking (not good) and occasional pain.
Strengthening will not only help your knees keep up with the demands of the sport but also significantly reduce the stress within the patellofemoral joint itself. Exercises that involve glute activation and quad flexibility are essential in pre-game warm-ups to slow down this painful pattern.
Crunchy Ankles? You’re Not Alone
Ankle braces may seem like an obvious tool for injury prevention, but they can actually cause long term dorsiflexion mobility problems and weaken the muscles responsible for stability. If you rely on braces (an external source) instead of the strength of your muscles surrounding your ankles, you’re setting yourself up for injuries down the road.
Chronic ankle sprains typically result from three factors: limited ankle dorsiflexion mobility, ankle eversion weakness, and poor proprioception / balance. One of the best ways to improve ankle dorsiflexion is through manual therapy to the talocrural joint, distal tib-fib joint, and achilles soft tissue stripping. Dry needling can also be an amazing tool to assist in fast mobility gains!
Strengthening the tibialis anterior (the muscle responsible for dorsiflexion) is just as important. Yes, stronger dorsiflexors improve agility and power during approaches and jumps, but most importantly, they aid in eccentric “knee over toe” control, which is crucial for high level pain-free performance. It also increases foot and ankle awareness, increasing the neuromuscular control and allowing for quicker corrections when landing in awkward positions or while pivoting mid-play.
The Next Move, Explained
So, how can you prepare before practice or a game? A solid warm-up is key.
- For flexibility & mobility: focus on improving ankle dorsiflexion and quad flexibility
- For activation and stability: warm-up those shoulders, serratus wall slides and prone swimmers, and get those glutes going with activation drills like this one or this one
If you’re still experiencing pain despite these measures, we’re here to help. Every athlete is unique, and while these exercises improve common trends we see, a personalized treatment is almost always necessary.
At The Charlotte Athlete, we bridge the gap between rehab and peak performance. As a volleyball athlete myself, I’ve had my fair share of injuries and understand the sport’s demands. With my doctorate in physical therapy, I can not only guide you through every step of your recovery, but help you reach a level in your sport you never thought possible!
Let’s Keep You in the Game
Interested in learning more about injury prevention? I’ve written two additional articles on our website to help you stay at your best.
Article 1: Volleyball Injuries Part 1: When Your Shoulders Have More Battle Scars Then The Ball
Article 2: Volleyball Injuries Part 2: Jump, Spike, Ouch: Your Guide to Keeping Your Knees and Ankles Happy
One thing I always tell my athletes: I would never recommend something I wouldn’t do myself. With over a decade of volleyball experience, I’ve been through it all—injuries, recovery, and everything in between.
The biggest takeaways?
- Staying on top of your game requires work outside of regular training.
- Over-cautious approaches can sometimes do more harm than good.
If you’re unsure about an injury or need guidance, reach out to us. We’re here to help!
–Dr. Marissa