The knee is the most frequent site of injury in volleyball players. More than 40% of high level players suffer overuse injuries during this activity; this particularly painful syndrome is caused by the amount of jumping typical in volleyball play, and in its training which aims at strengthening the quadriceps muscle. In volleyball players the extensor apparatus is subject to continuously high stress and the bone tendon junction, being the weakest point, is susceptible to lesion.

More severe injuries include bone bruises or damage to the cartilage or ligaments. There are two types of cartilage in the knee. One is the meniscus, a crescent-shaped disc that absorbs shock between the thigh (femur) and lower leg bones (tibia and fibula). The other is a surface-coating (or articular) cartilage. It covers the ends of the bones where they meet, allowing them to glide against one another.

Knee injuries can result from a blow to or twist of the knee; from improper landing after a jump; or from running too hard, too much, or without proper warmup.

Although volleyball is a sport without contact between players, traumatic acute injuries are more frequent and more serious than would be expected. It is therefore important to emphasise that volleyball must be considered among the high risk sports that expose the knee not only to twisting, but also to contact with other players. Generally, the lesions are caused by frequent jumps with loss of balance and a consequent ‘one-footed’ landing.

How to train muscles that support the knee

All strength exercises that aim to develop muscle power and volume should be performed slowly and in a controlled
manner in concentric mode for one to two seconds and in eccentric mode for three to four seconds. The exercise should be performed with 8 RM for three sets to achieve muscle hypertrophy and increased strength. The injured leg must initially be trained separately from the non-injured. Quadriceps muscle strength can be trained with leg press, squats or leg extension manoeuvres. The vastus medialis muscles require special attention after patella (kneecap) dislocation or in mal-tracking conditions that cause anterior knee pain. If the patella is subluxated or out of place and knee extensions cause pain, a soft knee brace can be useful and give very good results. The quadriceps muscles are essential for knee stability in activities such as jumping, sprinting, twisting and turning.

Hamstring muscle strength is trained with knee flexion and hip extension exercises, standing or sitting, using wires with weights or specific machines allowing a hamstring curl.

What should you do if you have knee injury

• Stay off your feet for 24 hours. After that, you can gradually increase the amount you use your injured knee when walking, as long as it doesn’t hurt too much.

• Use crutches or a cane until it is no longer painful to put weight on the knee when you stand.
• Put ice on the injury for 15 to 20 minutes each hour for the first 1 to 2 days. Place the ice in a plastic bag and place a towel between the bag of ice and your skin.
• To rest your knee and allow it to heal, wear your splint or elastic bandage (ace wrap) as directed by your doctor.
• You may take over-the-counter medications to relieve the pain. If the doctor prescribes any medicine, take it exactly as directed.

Call a doctor if…

• the bruising, pain, or swelling grows worse,
• the skin on your lower leg turns white or blue and feels cool to the touch.