Medical Page
Updated 1/25/07
This page contains information from:
1.
Elite
Sports Medicine & Rehabilitation in

c.
Tennis Elbow
g.
How to Begin a Weight Training
Program
h.
Ankle Sprains: How to Speed
Your Recovery
i.
Recovering From a
Traumatic Shoulder Dislocation
j.
On-Field Evaluation of
Athletes with Potential
2. Medical Articles reprinted courtesy of Dr. Bryan Collier, D.C. (212-688-2016) and Volleyball Magazine
b.
Ankle Sprain
Rotator cuff injuries are the Achilles
heel in volleyball. Not only difficult
to heal, they require lots of rehab and can force you into early
retirement. As with many medical
conditions, most have heard of this but few know what it is. The rotator cuff is a series of four smaller
muscles originating on the top and back of the shoulder, which wrap over the
front. These muscles all end in tendons,
which attach to the anterior surface of the shoulder in the same area,
resembling a cuff. Although small in
size, they are in charge of fine movements of the shoulder, primarily of
rotation - hence their name. Irritation of these tendons creates inflammation,
yielding tendonitis, or worse, the dreaded tear.
The shoulder is more apt for injury by
the nature of its design. It is a typical ball and socket joint, but the socket
is much shallower then similar joints, causing the muscles, tendons and
ligaments increased wear and tear - a tradeoff for more flexibility and
movement. Diagram #1 shows the rotator
cuff muscles, originating from the shoulder blade and ending on the humorous.
The muscles found behind the shoulder act to rotate the shoulder
backwards. When you are engaged in a
high velocity swing after hitting a ball, these muscles get stretched as the
arm decelerates, and may tear. The most
common problem by far is the supraspinatus muscle, found on top of the
scapula. It sits in a gully on top of
the scapula and feeds through a tunnel underneath the coracoacromial ligament
(diagram #2). This muscle initiates the
action of pulling the arm up, until stronger muscles can take over. The problem arises when the arm gets to 90
degrees or higher. The tendon of this
muscle gets pinched under this ligament, causing friction and impingement
(diagram #3). Normally there is enough
room when the arm is under 90 degrees, but in
volleyball, the arm is raised not only when attacking the ball, but also with
blocking and serving. This could account
for hundreds of times of potential irritation in a single night of playing. Volleyball
is not the only culprit; our sport shares the same pathology with competitive
swimmers and pitchers. Luckily for us,
the tendons and muscles are pretty durable, and can tolerate a fairly good
amount of abuse. It is the overuse of an
irritated tendon with constant playing that leads to further degeneration, and
ultimately to a tear. Additionally, a sudden fall on an outstretched hand or
collision involving the shoulder could be the cause of rotator cuff pathology.
There are many pain locations and
conditions in the shoulder that are directly related to trauma associated with
volleyball, hence self-diagnosis is difficult.
It is always best get an evaluation by a Doctor with a good sports
injury background. Generally, the pain
with rotator cuff injury presents as a sharp, stabbing pain initiated with
movement. It may later progress to a
dull achiness deep within the joint. The mechanism that produces pain in the
tendon starts with localized trauma or friction, which leads to intermittent
swelling. As the frequency of swelling
continues, the blood supply to the tendon gets squeezed off due to
compression. This condition now is
considered tendonitis, or inflammation of the tendon. This continual disruption of blood flow and
chronic irritation leads to a fragmentation and rearrangement of fibers within
the tendon, thus weakening it.
Ultimately, this leads to a partial or total tear of the tendon. If the rotator cuff is completely torn, there
is no choice - you need surgery. Partial
tears, irritation, inflammation or impingement syndrome should all start with
conservative care. And this always
begins with rest.
REST No condition will get better if you
are constantly irritating it.
Inevitably, everyone learns that the only way to fully heal is to pull
back from playing and let Mother Nature take over. This is the hardest concept for younger
players to learn, because they are used to their body always getting better no
matter what they do to it. This
condition will not go away unless proper steps are taken. One initially does not need to completely
retire from playing, instead, cut down to once per week and see if you can get
any response while following the rest of this program. If all else fails, you need to stop playing
altogether for a few months.
SAVING
THE SHOULDER Closely
associated with the concept of rest is taking it easy on the shoulder if you
are still playing. Start with a thorough
warm up. This includes stretching,
throwing the ball a dozen times, and range of motion arm swings before
play. Next, you need to train your other
arm to hit the ball whenever possible.
Some great players have been made by putting this concept to use. Third, swing only at good sets. Shoulders are ruined by power swings at
poorly placed sets. Roll or dink the
ball instead. Lastly, incorporate a
shoulder saving serve, such as a floater, Asian serve or an underhanded
skyball. Jump serves look pretty, but
they tear up injured tendons with frequent use.
REDUCE
INFLAMMATION This of course starts with rest,
but is best accomplished with ice. Ice
calms down swelling and is a great painkiller.
You must ice the shoulder after every time you play, with
STRETCHING
PROGRAM The idea behind stretching is to
increase the length of an injured muscle.
All muscles undergo shortening once they are injured, as is evidenced by
a decrease in the range of motion as compared to the normal shoulder. The following stretching program should be
done daily, initially twice per day:
1. Place your hand on the opposite
shoulder. With your free hand, pull the
elbow to further stretch the posterior shoulder. Hold 1 min.
2. With both arms
extended over your head (as in blocking), slowly stretch each hand higher to
its maximum length. 20
apiece.
3. Arm behind your back, following up your spine
as much as it can go. Rotator cuff
injuries will not be able to move as high as the healthy arm. To further aid this stretch, hold a towel
with the good hand over your head, grab the other end
with your bad hand (shoulder) and pull up with the good hand slowly, to
increase movement.
4. Place your arm over your head, resting your forearm
on your head. Bend to the opposite side
until you feel a stretch in the shoulder.
Hold for 20 seconds, repeat.
EXERCISES Exercising works by putting a
controlled load on the damaged muscle or tendon, forcing the body to accelerate
repair of that area. There is however, a
fine line between therapeutic exercise and overdoing it, which recreates tissue
damage. The series of exercises
illustrated help to strengthen and repair the rotator cuff. These exercises can be done with hand
weights, or with surgical tubing, which is basically a strong rubber band that
offers resistance. You should do these
exercises until the point of pain, and stop if they create anything beyond
minimal pain. The best program is run
3-4 times per week, and must continue for several months. Once healing occurs, you should continue this
program indefinitely. Rick Bahr (Medical
Director of the Bud Light Tour) elaborated on a program used for the pro beach
athletes as well as our national team. Along with their drills and volleyball
workouts, they are all encouraged to hit the gym several days a week, as an
attempt to protect valuable body parts.
For rotator cuff, his advice is to use gym machines that force you to
pull towards you. Pushing away (i.e.
bench press) should be avoided. Pat
Powers, the famed veteran of an Olympic gold medal and former
Bryan Collier, D.C., C.C.S.P.
A sprained ankle is every player’s
nightmare. Just the thought of landing wrong on the ankle and the pain that
follows is sure to bring a shutter to those who have experienced it. And if you haven’t experienced it, law of
averages says you will within five years, considering frequent play. I recall talking with a fellow player a few
years back about injuries, and was amazed to hear that while playing 4-5 times
per week, he had never sprained an ankle in his 5 years of volleyball. Two weeks later, he developed one of the
worst ankle sprains I have seen to date.
Without question, this is the most
common injury in Volleyball. In the
course of a game, the ankle is carrying the full body weight and is forced
repeatedly to cut and pivot. Due to the
weakness of its anatomical design, these motions often times push the joint
beyond the normal range of motion, thus creating injury. The ankle joint is intended to move only up
and down and tilt slightly inward and outward.
Rolling the foot outward jams the top of the ankle into the end of the
fibula. Because the fibula is longer
than the tibia, it is easier to roll the foot inward than outward. This is the mechanism of injury to the
ankle. When excessive inward rolling
occurs, the anklebone is forced or pried out of the ankle joint. What normally restrains the ankle from
allowing this to occur is the ligaments. It is the
ligaments on the outside of the ankle that get the brunt of the injury. Depending on the severity of the rolling, the
ligaments either get stretched or torn.
The rolling or turning of the ankle most commonly occurs by either
stepping into a pothole on grass or by coming down a player’s foot while
blocking or hitting. The symptoms take place immediately. Because the ligaments and surface of the bone
are laden with nerves, pain occurs spontaneously. Usually you can walk off the pain in the next
five to ten minutes. Your ankle then
goes into a period of pain-free ”shock” for approximately
30 minutes, where swelling, spasm and pain are minimal. This gives most players a false feeling of
security, and continuing into play often times exaggerates the injury. What follows next is severe pain and
swelling, usually located over the outside end of the fibula. Muscle spasm develops as a defensive
mechanism to protect the joint from further injury.
There are three grades of
ligamentous injury. Grade One is a
stretching of the ligament, which has minimal swelling and tenderness. You usually can walk home with this one.
Grade Two has more swelling and tenderness and you will have trouble walking
and moving your ankle up and down. Grade
Three requires crutches and has more swelling, tenderness and bleeding (black
and blue). Sometimes this results in a
total tearing of the ligaments, whereby surgery is required to stabilize the
joint. Often times a bad injury will
give pain on the outside and the inside of the ankle. This is an injury to both sets of ligaments,
damaging both sides of the joint. If you
have trouble walking after an ankle injury, you should see a doctor for proper
evaluation and x-rays. Although
ligaments do not show up on x-rays, fractures do, as well as dislocated or
slightly displaced bones.
Treatment starts immediately with
ice and immobilization. Healing is
accelerated following the PRICE method.
P is protection from further injury.
R is rest. I = ice. C is
compression, such as an ace bandage. E is elevation of the foot to reduce
swelling, best accomplished by sleeping with two pillows under your foot. Protection and compression are often
accomplished with the same thing. The
simplest defense is the ace bandage wrapped in a figure 8 around the
ankle. Much better than this is the air
cast or gel cast, which is strapped to the ankle and squeezes the swelling from
the joint while only allowing up and down motion of the ankle. This is the first protection most Doctors
recommend after an injury because it allows you to walk on the ankle much
sooner. You can wear this while playing
and get great protection although it is not as comfortable as a canvas brace,
which is worn over your sock and extends above your shoe to protect the
ankle. These are probably the best
therapy for older injuries, are easy to put on and are available from surgical
supply houses, drug stores or doctors.
Equally effective is a strap-on hinged brace produced by Active Ankle,
which completely secures the joint in place. If you have seen any recent photos
of the men’s or women’s national team, you would have noticed all players
wearing the active ankle brace bilaterally.
According to Rick Bahr, Assistant Athletic Trainer to both teams,
mandatory use of the brace has reduced ankle sprains from an average of 15 per
year down to 3. Taping also does a
great job of protecting the ankle and perhaps is the most effective protection
of all when applied properly.
Most ankle injuries take 4-6 weeks
to heal on the average. This can be
accelerated with proper therapy administered at a doctor’s office. I have seen ankle injuries heal in one
quarter of the time with the proper program. Advil or other over the counter
anti-inflammatory medications are critical to reducing
swelling. Chiropractors, physical
therapists and athletic trainers have access to machines, which can reduce the
swelling and inflammation and accelerate healing. Also, realignment of the ankle joint by
manipulation after an injury decreases healing time and prevents future
reinjury by establishing normal joint motion.
Rehabilitation of all ankle
injuries is extremely important. Many
times after an old, untreated injury the pain comes and goes with exercise and
can continue for years to follow. Additionally,
untreated injuries often times leave the joint weaker, which can lead to the
same sprain again. Each time the injury
occurs, the ligaments get stretched. If rehabilitation is not performed on
these ligaments, the joint gets looser and looser which leads to chronically
weak ankles.
The first stage of rehabilitation
is ice. The recommended regime is 10
minutes on, 15 minutes off. This cycle
can be repeated throughout the day until the swelling has stopped. Ice naturally reduces swelling and
inflammation. The ice is best applied
with cold packs or ice in a bag, which is separated from the skin with a thin
cloth like a tee shirt to prevent burns.
During this time period when swelling is present, light exercise is
encouraged such as the “gas pedal “ routine where you
flex and extend the ankle up and down.
You can also attempt to “write the alphabet” with your toes in mid air
to encourage the joint to work properly and to decrease spasm. Obviously, if
walking is painful at this time, crutches are a necessity. Strengthening comes after the swelling is
normalized. What is first recommended is
Achilles tendon stretching, because tight Achilles are
often associated with ankle sprains. Standing on a staircase with the balls of
your feet on the stairs and your hands on the handrail, slowly sink down with
your heel to get the maximum stretch. Strengthening exercises from a rubber
band kit is an absolute necessity to fully heal the ankle. This is easy to follow, cheap and begins
after the second week. SPRI Products in
A rehab program is boring to 80%
of the population. Most of us would like
to think that if you wait long enough, it will get better on it’s
own. The problem is,
it either takes a lot longer than you thought or the ankle remains weak. Rehab cuts the healing time way down and is
the ONLY thing that will properly strengthen injured tendons and
ligaments. Commitment to a daily program
is merely starting a new habit. All it
takes is a little time and discipline to regain strength. In the long run- you’ll be glad you did.
By Bryan Collier D.C.
Worse things could happen in life,
but either of these conditions usually led to heartbreak for the serious-minded
player. With a mild injury, it’s possible to continue playing, but further
damage and pain are often the consequences.
Inevitably, you are forced to realize the opportunity for spontaneous
healing is nil. As much as you’d like to
believe otherwise, chances are good you won’t be seeing over the top of a net
for a while.
Anatomy
The knee joint involves two bones,
the femur and the tibia, both of which have a poor surface for a good
union. This conformity problem is
alleviated by the meniscus, or cartilage.
The cartilage acts to “fill the space”, while providing shock absorption
and lubrication to the knee joint.
Additionally, the meniscus prevents the bones from rubbing on themselves. If they
wear down, this rubbing will lead to arthritis.
There are two oval bands of menisci in each knee, one inside and one
outside. These accept the two large
rounded ends of the femur and provide a runway or track for gliding as the knee
is in motion. Both bands of cartilage
are loosely attached to the bone, therefore, they move when the knee is put to
flexion and extension. These bands are
live tissue, but owe their high incidence of injury to their poor blood
supply. Only the outer edge of the meniscus have a viable blood supply, therefore,
an injury to this region may heal, whereby the interior sections will always
remain damaged or torn. Because they run
close to the edge of the joint, injury often produces tenderness at the space
between the femur and tibia.
There are several ligaments which
act to support the knee, however, there is one that when damaged renders the
most instability and consequences. This is the anterior cruciate ligament or
Mechanism of Injury
Although these are two separate
injuries, they are closely associated and are occasionally seen together. An external force applied to the knee, such
as a collision with another player or a fall, tests the strength and durability
of the knee joint. If the force exceeds
the strength of the
Symptoms/First Aid
The pain and swelling are
immediate with these injuries. If the
meniscus rips, you have a sensation that something is giving way in the
knee. The knee may actually buckle
without warning. If this ripped piece is
displaced within the knee, you will lock up, and be unable to straighten the
leg. All of this will be accompanied
with swelling, which won’t go down for many days. As time passes, you may have days of feeling
completely normal, but the tear will continue to plague you. You will feel unstable with running or
playing sports. Generally, you lose
confidence in your knee, not knowing when it will give out. An
The
There is still some debate as to
how severe the injury is before surgery becomes absolutely necessary. It is quite possible to have a small tear on
the edge of the meniscus where blood supply is minimally present, to heal on
its own. Likewise, a stretched or partially torn
You
might be lucky to have this condition. A
pain in the shoulder amongst volleyball players can be many things, some of
which are career threatening, others minor in comparison. A survey of the more common shoulder injuries
should start with the greatest fear of all players, a fully -torn rotator
cuff. This without question is time to
consult your surgeon. Following a close
second is repetitive shoulder dislocations, alias mandatory volleyball
retirement. Torn shoulder capsule or
avulsion fracture results in a long vacation from volleyball, maybe with a nice
new scar. Chronic loose shoulder from
years of heavy pounding should be time to consider competitive chess. Acromioclavicular separation starts with a
shoulder sling, then a fling with weight training. Tendonitis is one of the milder injuries,
which almost always results from overuse.
It is, however, relatively easy to fix.
First
of all, it helps to know what it is. A
tendon is found at the end of a muscle and is attached to the bone. It doesn’t contract like a muscle, and is
stronger in composition. It can become
frayed or irritated with constant use, which leads to the tendonitis. This condition only grows worse with
continued playing or exercise. Initially, what happens with tendonitis is after
the muscle warms up with use, the pain from the tendon stops. This is because more blood is directed to the
tendon, which soothes the injured area temporarily. The pain usually sets in after the activity
has stopped, and the blood flow has diminished.
Bicipital tendonitis involves the tendon of the long head of the biceps
muscle, (there are two muscles of the biceps).
This tendon as shown in the illustration runs upward over the shoulder
to attach on the scapula. The tendon
sits in a groove in the top of the humerus, which is where the friction
occurs. Normally, the tendon is secured
in place in the groove by a ligament.
This ligament often will rip with repeated stress and allow the tendon
to migrate out. As the arm is raised
over the head as in serving or hitting, the tendon can move out of the groove
and produce wear and tear as the tendon scrapes over the bone. The irritation almost exclusively occurs with
overhead motions and is worsened when swinging at a bad set or cutting a ball
around the block at high velocity. The
pain with this condition is almost always found in the same location, which is
right over the groove. Referring to the
diagram, as your arm hangs down normally at your side, the pain should be
mainly at the front of the shoulder, slightly off to the side and slightly down
from the top of the crest. The pain is
not felt deep inside the joint or behind the shoulder and does not generally
hurt unless the arm is raised above 90 degrees.
When the shoulder is inflamed, the area of pain can often be isolated
with a finger and made worse with deep pressure. It should be noted that pain in this general
area is not exclusively tendonitis and may also be other shoulder conditions
such as torn rotator cuff, torn bicipital tendon or capsular tears. It always pays to obtain a proper diagnosis
from a sports injury doctor especially when pain is prolonged and chronic. There are three stages to bicipital
tendonitis. Grade one is the mildest form, whereby the pain is present only
after playing, such as that night or the next day. Grade two has pain present while you actively
play, usually with a lot of hitting or when you swing hard at bad sets. Grade three has pain on and off, with or
without play.
Therapy
starts with a reasonable limitation of playing time. No shoulder pain is going to get better if
you are on the court every day. It may,
however, not be necessary to completely stop all play, usually a rest period of
two weeks followed by a one day of play with modified serves and hitting is
enough to get the healing process started. Increasing to twice per week
initially is fine if pain is low to none.
Serving should not involve any high velocity. Floaters or short serves are great to start
with, if they don’t produce pain. If
these give trouble, the best serve is the Asian serve, as this doesn’t stress
the bicep tendon. And there is always
the underhand serve, which doesn’t look pretty, but creates no stress
whatsoever. This is also the best time
to learn how to hit with your opposite arm.
There have been many terrific hitters who pinpointed their beginnings of
ambidextrousness to a bad shoulder.
Most
shoulders respond to ice rather than heat.
Always start with ice over the shoulder when the pain is acute. The best way to apply the ice is to use cubes
in a baggie, or reusable gel bags that mold to any body part. Ten minutes on, followed by a rest period of
20 minutes followed by ice again is the better program. Often times 3-5
applications are used over the first few days of treatment. It is also advisable to use a thin material
such as a tee shirt between the ice and your skin, to prevent ice burns. Heat may feel good as well and a trial is the
only way to find out. 30 minutes of heat
is the recommended time period for application.
If the shoulder is sore afterwards or throbs, go back to the ice.
Shoulder
stretches and exercises generally are the only way to truly heal the
tendon. Stretches are done initially
every day to limit the contraction of other shoulder muscles. Simple stretches are accomplished by pushing
the normal ranges of motion of the shoulder joint, such as up, down, forward,
backward left and right. The best
stretches are arm on opposite shoulder, arm behind the back, forward and
sideway windmills and trying to “reach higher” with alternating arms. The stretch that often is most difficult with
this condition is reaching behind the back and running the hand up the
spine. This is best aided by rolling up
a towel held over your head and grabbing it with the involved hand, having it
“pulled” up the spine by your other hand.
Stretches must always be done before hitting or playing.
Exercising
can involve free weights, nautilus/universal and tubing, depending on what you
have available. Exercise should only be
attempted when you can manage 50% of your normal upper body workout without any
pain. The ideal workout focuses on
biceps, lats and deltoids although other upper body machines can be
utilized. You should start with low
weight sets of 10-15 reps with no pain while performing, and little pain
afterwards. Always ice the shoulder
after workouts. Gradually build up the
weights until you can do 3 sets of 10-12 reps while exhausting the muscle. This must be done 3 times per week in order
to rehabilitate the biceps. If you don’t
exercise and strengthen the muscle, you will never get better. It’s that simple.
Probably the most important item to be considered in helping this condition is a shoulder strap. This is a neoprene Velcro band that wraps around the shoulder snugly, thus securing the bicipital tendon in place. It is worn up high on the arm, in the valley where the deltoid and biceps come together after you make a muscle. Pro-Tec, Body Glove and Professionals Choice all make good products for use as a knee band, which are good substitutes for the shoulder. While wearing this band, the tendon is secured in the groove where it belongs and remains there even when the arm is overhead. The relief from pain is rather immediate if worn properly. This should be worn during weight exercises and during playtime on the court to promote healing.
If you are not showing progress early on, be smart and get a diagnosis from a sports-oriented doctor. A torn rotator cuff along with other shoulder conditions are not helped much by this strap. Following this program should result in a healthy shoulder in a few months. The advantages from this program of course are many. With luck, you will have developed a fierce ambidextrous swing and will have a good shoulder once again. You will have also dispelled rumors of being a full time offensive dinker. And if you start training now, by the time summer begins without a closer look at your new shoulder strap, your friends might be convinced you’ve landed a new sponsor.
I
can recall a few words of wisdom delivered by a pro-volleyball player several
years ago about finger injuries. As he
finished taping up his knuckles, he looked up and replied- “If you have never
had an injury to your fingers playing volleyball, you just haven’t played
enough.” Pretty true, I thought,
considering all the taped fingers you see during play. When the injury occurs, several options
should be considered; is it necessary to see a doctor, tape it, ice it or just
leave it alone? In many cases, if the
injury is left untreated, you may have a permanent disability involving pain,
stiffness and loss of normal motion.
Most
injuries usually occur from blocking or inadvertently jamming the finger with a
head-on ball. The finger jam is more
serious, usually requiring a much longer time to heal. The shafts of bone in the finger are
compressed together longitudinally, causing damage to the connecting cartilage
plate. Occasionally, this may result in
fracture, which requires surgery of the joint and an incredibly long recovery
period. The most common injury involves
blocking a high-speed ball off the tip of a finger. Inevitably, the ligaments of the finger are
damaged, and depending on whether they are stretched or ripped will determine
when you go back to playing the game.
The function of the ligaments is to tie the bones of the joint together,
which control how much normal motion occurs.
A stretched ligament makes the joint looser, whereby a torn ligament
allows the joint to dislocate. A similar
high- velocity type injury involves the tearing of muscle tendon, which will
give a “crooked finger appearance” when you try to straighten out the joint.
The
finger should be x-rayed on most injuries to rule out fractures. An examination
of the finger joint is done to determine the degree of tearing of ligaments or
tendons. The joint is extended and then
moved side to side to test if the ligaments are loose. Torn or loose ligaments or tendons should be
secured in a finger splint for 4-6 weeks to allow proper healing.
Typical
symptoms of finger injuries are pain, loss of motion, stiffness, swelling and
occasionally bruising. Therapy should
always begin with ice placed over the joint for 5-minute intervals, being
careful to avoid frostbite. Ice is
generally used until the swelling subsides.
Heat should then be applied by using a heating pad for 10 minutes or
immersing the finger in a cup of hot water. The swelling can be reduced by
compressing the joint with a compression sleeve prescribed by a doctor or
simply by wrapping the joint with tape. The swelling and inflammation can also
be greatly minimized by taking aspirin or ibuprofen daily for the first few
weeks. As mentioned above with severe injuries, the finger may need to be
splinted to allow proper healing of the ligaments, tendons and cartilage plate.
The splint prevents the area from any further harm and allows Mother Nature to
heal the damage. As with any new injury,
time away from play is necessary to promote healing. Adequate rest often
depends on which hand is hurt (hitting and serving hand requires longer recuperation),
and how much swelling, pain and lack of motion is still present from the
original injury. When you finally return
to the game, taping the fingers to protect from additional injury is
crucial. The easiest taping procedure is
to secure two adjacent fingers together with tape above and below the involved
knuckles. This technique unfortunately
limits the surface area of the hand for blocking, interferes with setting and
doesn’t work for thumbs. Another similar
form of taping involves the same procedure, except the fingers are separated by
a “sling “of tape. This of course allows for more movement, and stops extreme
ranges of motion, which could add further injury. Taping the single finger is performed
according to the above diagram, and is used to add extra support to the surface
of the joint that is most painful. For
example, if the index finger was injured while blocking and was forced to the
side, the tape is applied in an X-pattern over the inside and outside of the
joint for support (Figure #4). If a
finger is forced backwards during injury, the “X” should be applied on the palm
side while the finger is slightly flexed.
As
the swelling and pain decrease, a rehabilitation program is begun to strengthen
the area. The easiest exercise is to
loop a rubber band around the injured finger and a healthy finger. Using the
tension from the rubber band, separate the two fingers in different directions
until you get fatigued. Squeezing a tennis ball repeatedly is also
effective. Both should be brought to
work and used repeatedly throughout the day whenever possible.
We
all know the importance of finger placement and coordination on ball setting,
hitting and serving. Painful or stiff
fingers can often leave you feeling “uncertain” that your next handset will
come out clean or your serve will float just right. Proper care and rehabilitation will yield a
good recovery now and ensure good hands for next year and seasons to come.
Bryan
Collier D.C. C.C.S.P.
Jumper’s knee. What a great name for a disease.
Not like Osgood- Schlatter’s syndrome or Chondromalacia patella, other
popular unpronounceable volleyball knee conditions. The name pretty much explains where it is and
how you get it. And it is not purely a
volleyball-related condition; basketball, the long jump and hurdling all share in jumping and makes one prone to developing this as
well. Repetitive jumping requires
tremendous contraction of the front thigh muscle, also called the quadriceps.
Coming from the Latin derivative quad, meaning four, this
muscle is unique in that it is the union of four muscles blending together into
one tendon, the patellar tendon. Most
muscles have one muscle linked to one tendon.
The quads therefore, are pulling with 4 times the force. The more you jump and exercise, the bigger
your quads get and the more pull is exerted on this tendon. Jumper’s knee (also
known as patellar tendonitis), involves an inflammation or slight tearing of
the patellar tendon. Ninety percent of the time this occurs just below the
kneecap, which is exactly where you will find the pain. Of all knee conditions,
this is by far the most common injury associated with volleyball.
Symptoms
The
symptoms of jumper’s knee involve pain and stiffness located in the front of
the knee; this makes for an easy differentiation over other knee problems,
which tend to have pain on the sides, back or deep in the joint. It is relatively easy to diagnose this
because the point on the tendon, which is torn or inflamed, will be extremely
sensitive to fingertip pressure. The
knee will also feel hot. There may be some localized swelling over the tendon,
although this is quite rare. The knee
will not involve any buckling, locking or unstable feelings, which are more
often seen with torn cartilage. The main
symptoms are pain during or after playing, and
stiffness in the knee when it is not being used. The classic symptom, however, is stiffness
and achiness while driving home after a tournament, especially in a small
car. A two hour-plus movie in a
non-aisle seat would do just as well for the diagnosis.
Diagnosis
X-rays,
Grade 1. This is the mildest form of jumper’s knee. Usually there is no pain while playing. Stiffness and/or pain will follow after
heavier workouts.
Grade 2. Pain is produced while jumping
on the court or crouched in the defensive stance. Stiffness and pain follow
most games. Climbing up stairs is a
problem.
Grade 3. Pain is present all the time.
Mechanism of Injury
Tendons
are normally one of the strongest soft tissue elements of the body. Tremendous stress is repeatedly exerted on
the patellar tendon with both jumping and landing, causing wear and tear to
occur in key areas. The tendon has been
shown to accept over 2500 pounds of force on the initiation of jumping. This along with the strain of "getting
low" in the defensive stance constantly irritates the tendon. The primary mechanism that produces the
actual problem is thought to be an imbalance in the pull of the four quadriceps
muscles. Two of these muscles are found
in the midline, and one is on each side of the thigh. Although all four muscles should pull
equally, the outer muscle usually dominates in strength over the inner one,
which causes misalignment of the patella.
By pulling it more to the outside, undue tension is created on a weaker
area of the tendon. Foot pronation or
"flat feet" can also add to the problem. As the arch of the foot drops, it causes the
foot to roll inward which changes the alignment of the leg and knee. This makes the tendon shift in position,
placing it at a mechanical disadvantage.
Basically this is the same problem as the quadriceps mechanism, except
the trouble is coming from below, not above.
The surface of the court also plays a big factor in development of
jumper’s knee. Hardwood surface is the
least forgiving, transmitting the most shock up the leg to the knee with
jumping and landing. Grass tends to
absorb the shock much better and is a recommended alternative if available. Although sand offers the best cushion, it
creates more resistance to movement and takeoff, requiring more power. Additionally, the game of choice on sand is
usually doubles, which demands much more jumping and defense over indoor
6's. The player’s position on the court
may also contribute to the development of pain.
The middle blocker has to react more often than either outside blocker
while on defense, which can accelerate tendon wear. Additionally, the direction of approach to
the net while hitting determines which knee will accept more stress on takeoff. What about a player's height? Everyone wants to jump higher but shorter
players almost have to, in order to compensate.
Therapy
The
time to begin therapy for this condition is at the earliest onset of the
symptoms, not when the condition has become chronic. I can recall several years ago treating a
younger, talented volleyball player with chronic jumper’s knee. At age 18, he had developed a 38"
vertical leap with exceptional hang time.
Offensively, he was the team’s secret weapon at tournaments. As time went on, his knees began to ache to
the point that walking home after a tournament became impossible. He gave up volleyball and all other sports
completely for one year to rest and recover.
When the next season began, he started to notice severe pain again
within the first week of jumping.
Unfortunately, with this condition rest is not the only answer. You must engage in an active rehabilitation
program to strengthen and protect the knee.
Therapy
always begins with ice. A new injury or
a re-irritated chronic one should be treated with ice packs for 10-15 minute
intervals, or with ice massage several times per day. Ice massage is done with an ice cube rubbed
over the tendon in a circular motion for 5-7 minutes. You should progress to applying heat for 30
minutes alternating with the ice on days between play, as the pain
improves. The knee must be allowed to
rest in order for healing to take place.
I find most players dislike this aspect of advice. Traditionally, one should refrain from jumping
or climbing stairs for 4-6 weeks, especially in severe cases. While players are on a corrective program, I
like to put them on a plan of playing one or two light times per week to allow
healing to occur, while preserving their sanity at the same time. If this doesn't work, we need to increase the
time restricted from play. Another
consideration is foot pronation (flat feet), which needs to be corrected if
standard therapy isn't working. This is
accomplished by taking a cast or mold of the foot and creating a custom-made
arch for the foot to be worn in all shoes.
This is somewhat expensive and must be fitted by a podiatrist,
orthopedist or chiropractor. Store
bought generic brands are only slightly helpful. Treatment, which you can do at home, begins
with deep massage to the quadriceps.
This group of muscles basically encompasses the thigh. After applying a light cream to reduce
friction, begin by using the thumbs to dig into the muscles in a slow, deep
massage until every square inch of the front and sides of the thighs are
worked. This reduces the pulling of the
muscles while they are resting, thus reducing the tension on the tendon. Applying a heating pad to the quadriceps also
helps reduce tightness. Next, try grabbing the kneecap in one hand and moving it around in
a circular pattern. This helps to
realign the kneecap and tendon. Strengthening the tendon comes first by
correcting the imbalance of muscle pull from the quads. The best technique is using the knee
extension machine available at most gyms.
This is the machine you sit in with your knees bent as you attempt to
straighten your legs while pushing against resistance at your ankles. I recommend four sets with 10-12
reps/set. The first three sets are done
with the feet turned out, the way a duck looks.
This isolates the inner thigh muscle and strengthens it to balance
against the outer. The last set is done
with the feet turned in. If this
exercise causes pain, wait a week or so and try it again. I also like to balance the quads with
hamstring and calf work on appropriate machines. You must do these exercises for a minimum of
3 times per week for 2 months to strengthen the tendon. Never do squats or plyometric training drills
with a symptomatic jumper’s knee; save these until the healing is at 90%. Wearing a neoprene knee sleeve with the hole
cut out to stabilize the knee is a good idea.
Even better than this is a knee strap, which is a thin piece of material
worn just under the kneecap and wrapped around the knee. This creates a
"cinching" of the tendon, which locks the patella in place and
redistributes the stress on the tendon to a new, healthier area. The best design I've seen was created by Dr.
Tim Brown, Medical Director of the
Recovery
time for this condition varies with the severity of injury, the time it has
been present, ability to follow a rehabilitation program, and willingness to
stay away from the game during healing.
The
average case should get better in 2-4 months if all recommendations are
followed. Unfortunately, therapy and
healing do take time. The down side is
you may end up playing a little less than your buddies during your recovery,
but then again, a few extra inches in your vertical after all that gym rehab
isn't such a bad reward.
Dr. Bryan Collier
It
is estimated that 90% of the population will develop severe low back pain at
some point in their life. Volleyball
players seem to attract an earlier onset of this condition. The reason appears to be in the inherent
nature of the game. Good defense
involves pivoting, crouching and bending, all of which twist and strain your
spinal column. Add to that rolling or
diving and a clearer picture starts to develop.
Poor technique, such as overextending the low back while hitting or
serving , landing on stiff knees or no warm-ups all put the low back at
risk. Considering the compressive forces
placed on the spine while jumping up and down, the court surfaces (sand/wood)
make a significant difference on back pain development. Other contributing factors are poor posture,
past injuries, hereditary weaknesses and weight gain.
Your
spine is composed of 24 movable vertebras, which function to house and protect
the spinal cord and nerve roots while maintaining flexibility and support of
the upper body. The vertebras are connected to each other by ligaments, muscles
and a series of interlocking joints called facets, which allow for independent
movement when properly aligned. Between
the vertebra lie cushioning pads called discs, which absorb shock and allow
more fluid motion. Their center is filled with a gel-like substance surrounded
by a strong, fibro cartilage covering.
Connecting the vertebra together are ligaments, which are strong,
cable-like bands that act to limit the end range of motion. Likewise, muscles attached to the spine
determine what bending and flexing is possible as well as your overall
posture. The spinal cord is an extension
of the brain, which runs down through the spinal column, casting off pairs of
nerves in between each vertebra. These nerves exit the spine and travel off to
every square inch of the body to supply sensation and motor commands.
According
to Dr. Doug Anderson, Medical Director of the
There
are many varied factors, which can cause low back pain, however in volleyball, most can be classified in four distinct
categories.
The vertebras are joined together like
railroad cars on a train with a coupling device known as the facets. These joints glide upon each other to allow
all of the normal movements of the spine.
With hyperextension of the spine as in jump serving or hitting, the
facets tend to jam or dig into each other, producing pain. Classically, pain is felt with bending
backwards, and is relieved with forward flexion.
If
you still have pain a month or two after landing on your backside, you probably
knocked something out of alignment. The
vertebra and pelvis are all designed to be in their proper placement, much like
machine parts. Trauma can weaken the
ligaments and muscles, which support the spine and allow the joint to
shift. This will still allow normal
movement but will produce pain with certain motions and will predispose you to
bigger injuries down the road. Why is it
that even though you may be warmed up and in shape, a
seemingly simple movement while playing can produce pain that lasts for months
thereafter? This often can be attributed
to joint misalignment. The spine and
joints of the body are influenced by cumulative events, and each fall or
off-balance twist can force a joint to move a notch or two more out of
alignment. You eventually reach the
point of pain, where the final trivial movement becomes “the straw that broke
the camels back. “
This
category accounts for the majority of acute low back injuries. Pain associated with muscle or ligamentous
damage generally goes away quickly, 3-6 days for a muscle pull, 4-6 weeks for
ligaments. The symptoms can go on
indefinitely if you continue to play or irritate the area. Muscles are the one structure of the body
that initiate all movement, and must be able to contract and stretch for normal
function. If a muscle is not properly
warmed up and won’t stretch, a quick motion that calls for the muscle to
elongate will rip the fibers resulting in a “pull”. This is why it is so important to stretch
before active play and anytime your muscles have had the opportunity to cool
down. Ligamentous injuries occur in much
the same way, but are not helped by stretching.
Because they limit the end range of normal motion of the joint, they are
subject to injury if sufficient force is applied to propel the joint beyond
normal range of motion. Ligaments are protected somewhat by the contraction of
muscles to slow down this end range of motion, but excessive force often will
injure both muscle and ligaments. A
micro tear in the ligament will heal nicely with proper therapy and rest,
whereby a complete tear will not and requires surgery. Ligaments are most often put at risk when the
joint is not in proper alignment.
The
nerves exit the spine through an opening carved between two adjacent
vertebras. These delicate structures can
be pinched between the bones if the vertebra have counter-rotated or tipped out
of position. Additionally, the nerve
root may be pinched by the disc, in a situation where the inner fluid-filled
section of the disc bulges out through a crack in its outer casing. The pain
associated with these is often referred to a different location, chiefly the
buttocks and legs. The most common
symptom is an electrical sensation, although dull ache and burning sensation
are common. The granddaddy of pinched
nerve conditions is sciatica, referring to the irritation of the sciatic
nerve. This nerve is composed of a
network of roots originating from the small of the back, which travels into the
leg supplying specific areas of the extremity. Pinching any of the component
roots will produce pain into their corresponding mapped area of the groin,
thigh or leg. Pain from this is often
excruciating, and prolonged discomfort often leads to atrophy of leg muscles.
A
rehabilitation program for low back pain is essential for proper healing. Any good rehab program should always start
with identifying all factors, which can influence your pain. First we must look at the subtle “innocent”
things you do on a daily basis. Do you
slouch while sitting? This always gives
back pain. Think about supporting the
curve in your low back with a small pillow or a rolled up towel. If your bed is soft, get a bed board or
replace it. Do you lift heavy objects
without bending your knees? Even
carrying lightweight objects on one side of the body for an extended period of
time can throw your back out. Once these
daily habits are corrected, a program of reducing inflammation, stretching and
strengthening exercises should be implemented.
If you don’t choose to participate, you become another volleyball
dropout statistic. A few months of a rigid program should provide security for
many seasons to come.
Low
Back Pain Part 2
Low
back pain can be mysterious. It can come
and go on its own and get better or worse with no apparent reason. How do you know if you need professional care
for your problem? Low back pain that
lasts a day or two and never returns is probably insignificant and shouldn’t
warrant further care. Extended
discomfort or recurrent pain should be treated seriously, and in these cases a
proper evaluation is essential. The
medical documentation is very clear; untreated chronic problems lead to
continued reinjury or progressive degeneration.
Once you have determined that you have a problem that isn’t going away, whom should you see for care and what should you be looking
for? Any practitioner who treats low
back pain effectively should do a comprehensive history and exam, which
includes a neurological and orthopedic portion along with x-rays of the
lumbosacral spine and/or M.R.I. if necessary.
Treatment is delivered by several types of medical protocol. In medicine, typically an Orthopedist will
administer painkillers, muscle relaxant or anti-inflammatories as drug therapy
to counter the pain and symptoms and/or prescribe bed rest. Commonly a referral to a Physical Therapist
is made, whereby a series of treatments are delivered which aim at reducing
spasms and inflammation and later strengthening trunk musculature.
Chiropractors
specialize in spinal-related disorders and follow a non-surgical, drugless
approach, which focuses on restoring normal alignment and nerve function in the
body. Chiropractors look for
misalignments of vertebra in the spine and correct them by a series of
adjustments, which involve gentle repositioning of misplaced bones. These adjustments help restore mobility and
relieve pain, stiffness and nerve impingement.
Their therapy commonly involves physical therapy modalities, exercise
and self-care. Interestingly enough, both the
The
first step of treatment that you can accomplish at home should be to reduce
inflammation and encourage healing. A
program of over-the- counter, non-steroidal, anti-inflammatory drugs such as
Advil, Unpin or aspirin best begins this.
These are quite effective when used properly but are never intended to
be used every day for months. Other
powerful agents, which help your back improve, are ice and heat. The typical rule is ice for the first 24-48
hours in 5 to 10 minute applications, 3-4 times per day. Afterwards, apply heat for 1/2 hour cycles,
separated by one-hour intervals of rest.
Ice reduces inflammation, pain and swelling, whereby heat increases the
blood flow to the area to promote healing.
Stretching is one of the first therapies utilized to stop muscle spasm
and tightness, which always accompanies low back pain. This should be done every day and especially
before play, once the back muscles have become “cold”. (Refer to the above diagrams illustrating
effective stretches for the back). When
the ice/heat and stretching therapies have helped alleviate some of the pain,
exercises are implemented to strengthen the area. Starting too early or too strong of a program
will reinjure the area, therefore, a fine balance of time and output is
necessary for proper healing. If you are
not inclined to do exercises, your pain and trouble will always reoccur. The first rule of exercise when just starting
back on a program is to avoid pain.
Slight to moderate pain is perhaps okay, but once moderate to severe
pain starts, your workout is over for that day. Additionally, if back pain is felt the next
day, this implies you overworked the back and you need to taper your program
down. If you were already on a program
at the gym before your injury, once you return you must dilute your original
workout by decreasing both sets and weights.
A recommended program for weight training once the back feels 50% better
is the following:
·
Crunches: work
up to 50
·
Bent knee
sit-ups
·
Bent knee torqued sit-ups
·
Standing side
bends with dumbbells: use 15-25 lbs.
·
Rowing machine:
10 minutes
·
Knee flexion
(hamstring) Nautilus/Universal machine
·
Latissimus pull downs
·
Back extensions:
Roman chair or prone extensions
Keep
in mind the following while working out:
1.
All of the above exercises should be started with one set of 10-12 reps
for the first few times, gradually building up to
three sets.
2.
Avoid bent over rows until the back is 95%.
3.
Avoid Squats for the time being, use the sitting knee extension machine
for quadriceps work.
4.
Compression of the spine (as in squats or military press) jams the
vertebra together and compresses the discs. Initially, these should be avoided and replaced by elongation of the spine, as in
traction. The best and easiest thing is to do pull-ups, or just hang from a
bar.
Massage
is wonderful for healing tight muscles and to increase blood flow to the
area. If you can afford it, have a
series of professional sessions at least once per week. If you are on a limited budget, try
this: Take two tennis balls and place
them on a carpeted floor, one inch apart.
Lie on your back so that each ball falls just to
either side of the spine on your low back.
Perhaps
one of the best remedies for low back pain is a back brace. Long gone are the metal containing, bombproof
versions from years past. The new
designs are sleek and comfortable, allowing full movement with great
support. Almost immediate relief is felt
while strapping one of these on. The
idea is not to wear these forever, but to utilize them while recovering until
exercise cures you. If you don’t like
their appearance, keep in mind they are designed to be worn under your
clothes. Worried about how you look on
the beach? Many companies now have sport versions of low back braces available
in water resistant materials with great colors made to be displayed. Hey, even the pros wear them. Strap one on this summer and you’re sure to
shine.
Dr. Bryan Collier
The
general consensus among most athletes is that bigger muscles are better. Weight training in the gym builds stronger,
bulkier muscles, which will act to support and protect a joint and increase
power. But do bigger muscles
dramatically increase your jump or speed your spike? If you ask someone who has trained hard at
the gym trying to increase their vertical, you generally hear of months and
months spent for a mere few inches gained.
Why can’t we double our vertical with a committed program? Most of us
know of a player with skinny legs who can out jump everyone,
or an accomplished hitter with seemingly no upper body bulk. This apparent lack
of muscle development seems to contradict logic. There may be more to muscle
power than meets the eye.
ANATOMY
The
answer is in the fiber. Before we can
talk about that we need to know more about muscles. There are over 600 muscles in the body
accounting for approximately 40% of total body weight, which govern all
movement. Each muscle has a thicker
center called the belly, and a tough, fibrous tissue on each end, which
attaches to the bone, called a tendon. The muscle belly is where the
contraction or power occurs. Each
skeletal muscle is composed of thousands of long, narrow muscle cells, which
contain contractile elements. This unit
is the muscle fiber. They are bundled
together and enclosed in sheaths, to form the muscle belly. It is the fibers that determine speed and
strength. Slow or type I fibers obtain
energy from oxygen in the blood thus require a good blood supply, are smaller,
and contract slower. Fast or type II
fibers obtain energy from glycogen, a stored glucose supply in the muscle. They are not dependent on high amounts of
oxygen, and contract quickly - twice the rate of slow fibers. We all have a mix of fibers, but ultimately
your athletic ability is determined by the quantity and ratio of each. Long distance runners cross country skiers
and bicyclists have more slow twitch fibers. Explosive energy is found with the fast
twitch fibers, as in sprinters and great jumpers.
MUSCLE INJURIES
Muscle soreness and stiffness usually occurs shortly after exercise
and generally go away fairly quickly. It
is believed that increased intramuscular pressure is responsible for the pain.
This is often associated with being out of shape, and after proper
conditioning, the symptoms abate.
Muscle pulls, also called tears or strains are perhaps the most
common ailment among athletes. Each sport has specific muscles, which are
susceptible to tearing, based on the biomechanics involved. Within volleyball,
the most common muscles affected are the medial gastrocnemius (calf),
quadriceps, low back, shoulder and neck.
There are three grades or classifications of muscle strains. Grade I is
a stretching and tearing of a few fibers.
Grade II is a partial tear of fibers, between 10 and 50% of the total
muscle. Grade
When
a muscle is overstretched and torn, the ends retract and the area fills with
blood. This is known as a hematoma, and
if the bleeding rises to the surface, it will be visible as a purplish-blue
discoloration. The repair involves
several normal sequences: reduction of inflammation, formation of new muscle
fibers and production of granulation (scar) tissue.
Contusions result from direct force to a muscle, i.e. getting
“elbowed”. Usually, there is pain and
tenderness over the area, mild swelling and some difficulty recruiting the
muscle. Often, this injury may be
accompanied by a hematoma.
Tightness or spasm of muscle is a condition that everyone experiences
on occasion. This may be present in a
chronic form from poor flexibility, such as not being able to touch your
toes. You may also develop an acute muscle tightness from poor posture with inactivity
i.e. being bent over a computer for long hours, or from generalized
stress. Old, untreated injuries will
often heal with the involved muscles shortening, thus leading to a tightening
of specific muscles around a joint.
Likewise, if an injury is new, muscles often will splint or tighten
around the joint in an involuntary manner as a mechanism to protect the joint
from further injury.
Muscle cramps are characterized by prolonged, spontaneous
involuntary contractions. These are
often quite painful, and usually occur in the weight bearing muscles. They are frequently seen following a vigorous
workout, and are often associated with poor conditioning. Most likely, the cause can be attributed to
an impaired electrolyte balance and decreased blood flow. Heat cramps are the most common problem with
outdoor volleyball players. Normal muscle contraction utilizes several
minerals, which leave the body through perspiration. Various muscles will cramp unless fluids and
electrolytes are maintained, as in sport fluid replacement drinks, or in salt
pills.
Muscle “knots” or trigger points are commonly associated with spasm, or chronically
tight muscles. These are painful,
localized areas which are usually very small in size. Deep pressure over the area yields an
exquisite pain, and may refer pain to a remote area. Most people will develop
this condition in the upper back or neck, from time-to-time. The apparent cause can range from muscle
overuse, trauma, and chilling or prolonged stress. Deep tissue massage is perhaps the best
therapy for this condition, followed with an exercise program to balance the
muscles.
THERAPY
A
good healing program for these conditions always starts with rest. Too often, an injury is shrugged off as
minor, and is reinjured through continued play.
Muscle pulls generally heal quickly, with proper rest, depending on the
grade and severity of injury. Rest does
not mean only avoiding athletic activity; a pulled quad should require limited
walking and avoidance of stairs, until healed.
A Grade I or mild Grade II usually heals in 3-5 days. Bigger injuries can take weeks to several
months. How do you know if it is
healed? No pain is present upon deep
massage or utilization of the muscle. Returning to play involves trials of less
activity and time initially, followed by more rigorous exercise, always
stopping if pain is triggered.
Because
most muscle injuries involve spasm or contraction, a stretching program is
vital for healing. A slow, daily
schedule of stretching which increases in both time and effort will ensure
better healing. Consult with a book,
trainer or coach for more information on stretching. Ice is always used immediately after a muscle
injury. Applying ice directly to the
muscle for 10-minute intervals slows the inflammatory process and reduces
swelling. Heat should follow the ice
therapy after two days, with half-hour applications. Once heat therapy begins, deep massage can be
administered locally to increase blood flow and elongate muscle fibers. At the start of exercise, a compression
bandage such as a neoprene sleeve or ace bandage will help protect the
area. How effective are gels or
ointments? They are known as
counterirritants, which mean they produce a localized irritation, which helps
to distract the body from its source of pain.
Technically, they increase circulation to the skin and produce a
sensation of local heat. They are pretty effective- if you and your team can
live with the smell.
Dr. Bryan
Collier
Neck
pain isn’t often listed as one of the big injuries associated with
volleyball. It’s frequency and
subsequent disability; however, make it too important of a health issue to
ignore. Ever experience a stiff neck
after an occasional hard day of playing? It may be from the simple act of
constantly looking up while following a ball, as this puts an unusual strain on
the neck. This coupled with a forgotten, older injury can be all that is
necessary to trigger pain. Other factors
that contribute to injury: collisions with teammates, floor or net, acrobatic
somersaults while digging balls, pulled muscles from sudden movements and
unexpected six packs.
The
neck can be fragile and temperamental.
All it seems to take is one good injury to the area and you may be left
with a repetitive pain cycle that comes and goes at will. A lot of this has to do with the shape and
design of the neck itself. The vertebrae
are the smallest at the neck or cervical region and must support the weight of
the head while protecting the spinal cord. Throwing the head quickly in one
direction with high force as in a whiplash accident pulls the spine with it,
often distorting the normal curve and damaging its components. This type of injury stretches ligaments and
misaligns vertebrae, which place pressure on delicate spinal nerves. Additionally, damage is done to muscles that
support the neck resulting in imbalance in their pull.
ANATOMY
The
vertebrae are bones that surround and protect your spinal cord. They can become misaligned from injury and
can wear down from friction, eventually leading to arthritis. The ligaments are connective tissue that
joins bones together, limiting their motion.
They can become torn or stretched.
Muscles are supportive tissues that can tear, stretch or tighten. They often retain a memory of an injury,
holding onto their tightness or spasm for months at a time, until the area is
repaired. Discs are shock-absorbing pads that are found between vertebrae. They can rupture, causing the fluid-filled
center to ooze out, placing pressure on the nerves. Another common problem with
discs is their tendency to degenerate after an injury.
Nerves
carry the brain’s messages and can be pinched, stretched or irritated.
A
high-velocity injury to the neck, whether it is created by sports injury, car accident
or simply being pushed from behind can damage many of the structures listed
above, but primarily affects the alignment of the vertebrae. The normal neck when viewed from the side has
a gentle curve. This curve straightens
or is reversed with a high-velocity force.
Because the spinal nerves exit through small holes between vertebrae, a
curve change may vary the diameter of these holes, creating a pinched
nerve. The muscles which normally
support and maintain alignment of the spine often are damaged with this type of
injury and are stretched or locked in spasm, thus are unable to provide proper
support. When a damaged neck is forced
to move through quick motions as in volleyball, the misalignment causes grinding
among vertebrae, tearing of tightened muscles and can further pinch
nerves. If not treated, the grinding or
friction of vertebrae can lead to a degenerative condition of the bones,
effectively wearing them down as well as the discs.
It
seems interesting that virtually half of all patients seen for neck pain by
doctors know why their pain occurred (i.e. from a recent injury) and the
remainder hasn’t a clue. Why is it that
if you play three times a week, month after month, sometimes you injure your neck
without any good reason? Mostly this is
related to an untreated older injury.
The damaged area is often an “accident waiting for a place to happen”,
and when the right circumstances occur, the pain pattern starts again. Areas of injury are also subjected to the
“cumulative factor” meaning multiple injuries to the same area put you at
greater risk for reinjury, even if they are relatively minor. Other factors
that significantly contribute to “waking up old neck injuries” are a cold draft
(that’s wind...not beer), repeated, prolonged stress and poor posture.
COMMON CONDITIONS
Muscle Pulls
This
is probably the most common injury resulting from playing with a tightened or
spastic muscle. The muscle is forced to
stretch beyond what it is able to do and consequently rips.
Hopefully,
the muscle is not torn in half, which would demand surgery. Rather, a minimal tear occurs which hurts
like hell every time you use it. If left
untreated, it may go away in a week or last months. Without rehabilitation, you can re-tear the
same muscle each time you play, resulting in a chronic condition.
Spinal Pain
An
ache, which is centrally located probably, is related to a spinal
condition. This commonly is due to
misalignment of vertebrae, or straightening of the cervical curve. Moving the neck around in circles often
produces a grinding sound from within.
Pain can usually be elicited by touching the center of a vertebra with
one finger. If the condition is due to
an old injury, there may be some degenerative changes in the bone or disc. Only a proper examination and X-ray/
Pinched Nerve
An
electrical sensation or a shooting pain involving the neck and arm is classic
for this condition. This is much more
serious than the above mentioned maladies, and takes longer to heal. The pain can manifest as many sensations,
such as numbness, sharp or dull pain, loss of feeling, etc. and may only be
found in the arm and not the neck. This can be the result of a slipped disc, or
could be from two misaligned vertebrae compressing a nerve as it exits the
spine. A consultation with a doctor
skilled in this area is essential. It is possible that ignoring this condition
could result in a permanent disability.
Slipped Disc
As
injuries go, this is perhaps the worst thing that can happen to you. The inner fluid filled center of the disc
oozes out into the spinal canal and places pressure on the exiting nerve root,
producing pain wherever that nerve goes.
Usually, there is severe pain with certain motions of the neck, and pain
follows down the arm. There is no way
you can continue to play. In the past this was remedied by surgery, although a
host of conservative treatments exist which can alleviate the problem.
TREATMENT
A
good rule to follow with any type of injury is to seek out medical help if the
initial injury is severe, involves lots of pain or has persisted past one
week. Most minor injuries will
spontaneously heal in this length of time.
If the pain is still present after one month, you are only fooling
yourself if you think you are getting better.
Most people continue playing, assume they are getting better and
ultimately reinjure the area. You should
be concerned with getting an examination from a competent Doctor that deals
with sports injuries. A reasonable
office visit should entail an exam, with X-rays or
It
is difficult to prescribe treatment for all neck injuries without a proper
exam, however, for most soft tissue injuries, the
following program should be helpful. If the outcome is not favorable within
reasonable time, you should consult a Doctor.
New
injuries always should start with ice. A
program of 8 minutes of ice with a rest period of 20 minutes then repeating the
ice is good for 3-4 applications per day.
The ice should be applied with a reusable ice bag or ice cubes in a zip
loc baggie, with a T-shirt against the skin as a buffer. Additionally, Aspirin or Ibuprofen for
anti-inflammatory purposes is helpful.
Give yourself a week or two off from the sport to effectively rest the
area. Cross train if you want with a sport that doesn’t involve the neck, or
exercise using a stationary bike or Stairmaster. Heat should follow the ice therapy after 48
hours from the time of injury. Apply a
heating pad for 30 minutes, twice per day, in order to stimulate blood flow to
the area and aid in healing. Topical
ointments are very helpful, such as tiger balm, Mineral Ice, Kool and Fit or
Flexall 454. They should be applied to the area as necessary, a few times per
day. Stretching is done initially while
still in pain to reduce muscle spasm. A
routine stretching program is: Chin to
chest, full extension of the head backwards, rotate chin to shoulder
bilaterally, and laterally flex the head so the ear approximates the
shoulder. The stretches should be done
first only to the point of pain, and then later assisted with your hand to
increase motion. When most pain is gone,
isometric exercises are done the same as the stretches, but with resistance
from your hands. For example, the chin
to chest is done with hands on your forehead, resisting the chin to chest
motion for a count of 5 seconds. Deep
tissue massage is extremely helpful for healing muscle injuries. This you can
do on your own. Work your fingers into
the painful muscles with deep kneading strokes for one or two minute intervals,
several times per day. Of course, a
professional massage is the best bet. The last recommendation is a cervical
pillow. This is available at most drug
stores or surgical supply houses, and is worth its weight in gold. It is built with a curve in the pillow that
helps restore the normal curve to your neck.
If you can sleep on your back, you may be able to get 8 hours of
therapy, night after night, for the low price of $20-30.