1 Return to Play Volleyball Evaluation, Treatment and Biomechanical Analysis of the Volleyball Athlete Erika Sandell-Savor DPT, SCS 2 3 4 5 No Disclosures Objectives 1. Background 2. 2. Evaluation/Assessment 3. 3. Biomechanical analysis 4. 4. Treatment and Return to Play >500 million athletes worldwide 460,000 high school athletes (410,000 girls) 13,000 collegiate athletes Lowest for all major sports Shoulder = Top 3 injuries College men: 50 60 mph Record: 82.02 mph College women: 45-55 mph Record: 64 mph 6 7 8 9 10 11 12 40,000 or more hits in one year (not including practice swings or serves) Reeser et al, 2006 AllinaHealthSystem 1
Extreme ranges of motion enacted and high forces generated, resulting in microtraumatic stresses placed on the shoulder. Hurd et al, 2009 13 80% of shoulder injuries could be linked to OH hitting Mitchenson et al, 2013 14 15 16 17 Differential Diagnosis Tendinopathy or tear Rotator Cuff Long head of Biceps Labral tear or Instability Impingement Internal/External Primary or Secondary Little league shoulder Suprascapular nerve Cervical radiculopathy Brachial Plexopathy 18 19 Scapular Mechanics 20 21 Merolla et al, 2010 Acquired scapular dyskinesis in overhead athletes can lead to rotator cuff weakness. Inhibition due to pain and the negative biomechanic effect of scapular dyskinesis results in specific infraspinatus dysfunction. AllinaHealthSystem 2
A functional rehabilitation protocol, designed to restore scapular muscles balance and shoulder mobility, is essential in the training program to prevent shoulder dysfunction and improve sports performance. 22 What happens in OH hitting SOFT TISSUE CHANGES: Decreased shoulder IR Decreased ER strength Increased shoulder depression Increased anterior glenohumeral laxity 23 24 25 26 Analyze the Mechanics of the Approach Side View Court View Take off and Jump The running approach =maximum momentum for the height of the vertical jump (Gyulai, 2010). Strong foot plant and push-off Build momentum with arms 27 Arm Swing Generate horizontal momentum then vertical momentum The arm momentum and position, along with truck rotation and flexion all influence the velocity of the ball (Moellendorf, 1993) 28 29 Hit and Follow Through Reach Snap wrist Follow-through AllinaHealthSystem 3
30 31 32 Challoumas et al, 2017 22 males DOM scapula Lateralized Dorsal capsule laxity Compromised stretching ability in posterior muscles Present/Past shoulders with pain Greater laxity in dorsal capsule Tightening of the inferior capsule Lower SS Dorsal capsule measurements bilaterally were significant predictors of SS Scapular lateralisation was more pronounced with increasing years of experience Scapular antetilting was greater with increasing age Adaptations of the DOM shoulder may be linked to pathology and performance.. 33 34 35 The best way to TREAT an injury is to PREVENT an injury (Dr. James Andrews) AllinaHealthSystem 4
36 37 38 39 Normalize Motion Consider total motion concept Caution when stretching into ER IR motion and stretching Focus on soft tissue Li-Fang et al, 2008 Range of Motion Always Remember Symptomatic patients cannot just strengthen/stretch 40 41 42 43 Soft tissue treatment (TFM, ART, Graston, etc) Decreases pain improves function and total ROM 35% with manual therapy 17% strengthening and stretching alone (Bang and Deyle, JOSPT 2003) Don t Neglect Posture Cervical position Thoracic position Strengthening Requires a Balanced Approach Emphasize muscle groups that have to decelerate arm and maintain stability Eccentric and Concentric LE and Core Strength Proprioception 44 Key Principles of Treatment Restore ROM and proper mechanics AllinaHealthSystem 5
Start strength with shorter lever arms watch for form/technique Scapular stability Introduce closed chain exercises Address dynamic stabilizers 45 Best Scapular Exercises: 1. Row (rhomboids, middle trap) 2. Push-up plus (serratus) 3. Seated press-ups (pec minor, lats) 4. Scaption (upper and lower traps, serratus and rhomboids) 46 47 48 49 Focus on Core Seated on ball and work on wind up Rotation vs. Piking Stretch 38% 50 51 52 Volleyball Specific Drills Arm Swing Mechanics Toss and Tilt (L hand points to ball) feel the stretch in the obliques/abs Swim move or bow and arrow Left hand to heart, reach up Give Shaq a high five Play tall not small 53 Toss and tilt for trunk rotation FOCUS ON TURNING AllinaHealthSystem 6
Shoulder tilt with arm wind up to maximally engage abdominal muscles 54 Jumping and Landing Drills 55 56 Return To Play Interval hitting program (Hurd et al, 2009) By position 6-10 steps Number of steps reflects volume of hitting Similar to long toss program (full-court hits) 57 One for the books 58 59 References Bahr R, Bahr IA. Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors. Scand J Med Sci Sports. 1997 Jun; 7(3):166-71. Bahr R, Karlsen R, Lian O, Ovrebø RV. Incidence and mechanisms of acute ankle inversion injuries in volleyball. A retrospective cohort study. Am J Sports Med. 1994 Sep-Oct; 22(5):595-600. Verhagen EA, Van der Beek AJ, Bouter LM, Bahr RM, Van Mechelen W. A one season prospective cohort study of volleyball injuries. Br J Sports Med. 2004 Aug; 38(4):477-81. Stasinopoulos D. Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players. Br J Sports Med 2004; 38: 182 185 Bahr R, Lian O, Bahr I A. A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study. Scand J Med Sci Sports 1997; 7: 172 177 Verhagen E, van der Beek A, Twisk J. et al The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med 2004; 32: 1385 1393. Reeser, J., Fleisig, G., Bolt, B., & Ruan, M. (6, March 1). Abstract. Retrieved December 7, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3445065/#!po=50.5682 Wang HK, Macfarlane A, Cochrane T. Isokinetic performance and shoulder mobility in elite volleyball athletes from the United K ingdom. Br J Sports Med. 2000;34 :39-43. Data-Based Interval Hitting Program for Female College Volleyball Players (PDF Download Available). Available from: https://www.researchgate.net/publication/231215600_data- Based_Interval_Hitting_Program_for_Female_College_Volleyball_Players [accessed Jun 18, 2017]. Romer, Karen and Kuhlmann, Claas. (2008). Investigation of Shoulder Kinematics in Volleyball Spikes. International Symposium on Biomechanics in Sports. Conference Proceedings Archive, 26. AllinaHealthSystem 7
60 References Fleisig GS, Bolt B, Fortenbaugh et al, Biomechanical comparison of baseball pitching and long toss: implications for training and rehabilitation. Journal of Orthopedic and Sports Physical Therapy May 2011, Vol 41 (5). Slenker NR, Limpisvasti O, Mohr K, Aguinaldo A, Elattrache NS. Biomechanical comparison of the interval throwing program and baseball pitching: upper extremity loads in training and rehabilitation. Am J Sports Med. 2014;42(5):1226-1232. Decker MJ1, Tokish JM, Ellis HB, Torry MR, Hawkins RJ. Subscapularis muscle activity during selected rehabilitation exercises. Am J Sports Med. 2003 Jan-Feb;31(1):126-34. Bailey L.B., Thigpen, C.A., Hawkins, R.J., Beattie P.F., Shanley E. Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits. Sports Health. 2017; 9 (3): 230-237 Challoumas D, Artemiou A, Dimitrakakis G. Dominant vs. non-dominant shoulder morphology in volleyball players and associations with shoulder pain and spike speed. J Sports Science. 2017 Jan;35(1):65-73. Epub 2016 Mar 4. Briner WW, Jr., Kacmar L. Common injuries in volleyball. Mechanisms of injury, prevention and rehabilitation. Sports Med. 1997;24:65-71. Litchfield R, Hawkins R, Dillman CJ, et al. Rehabilitation for the overhead athlete. J Orthop Sports Phys Ther. 1993;18:433-41. Li-Fang, Liu and Gin-Chang, Liu. (2008). The Application of Range of Motion (ROM) and Coordination on Volleyball Spike. International Symposium on Biomechanics in Sports. Conference Proceedings Archive, 26. Merolla G, DeSantis E, Sperling JW, Campi F, Paladini P, Porcellini G. Infraspinatus strength assessment before and after scapular muscles rehabilitation in professional volleyball players with scapular dyskinesis. J Shoulder and Elbow Surgery. 2010 Dec;19(8):1256-64. doi: 10.1016/j.jse.2010.01.022. Epub 2010 Apr 24. Mitchenson L, Campbell A, Oldmeadow D, Gibson W, Hopper D. Comparison of upper arm kinematics during a volleyball spike between players with and without a history of shoulder injury. J Appl Biomech. 2013 Apr;29(2):155-64. Epub 2012 Jul 6. Wilk KE, Meister K, Andrews JR. Current concepts in the rehabilitation of the overhead throwing athlete. Am J Sports Med. 2002;30:136-51. 61 Thank You! Erika Sandell-Savor DPT, SCS esandel1@fairview.org 763-420-9960 AllinaHealthSystem 8