Injury Prevention

Volleyball isn’t just a game of spikes and saves—it’s a relentless test for the wrist. Every overhead strike, quick flick of the wrist in a set, or sudden palm-first dive sends unique mechanical challenges surging through this intricate joint. When these demands collide with flawed technique or overtraining, the result? A cascade of injuries, from sharp, sudden twists to slow-burning, persistent strains. Let’s break down how volleyball targets the wrist, drawing on biomechanical studies and clinical insights to unpack the risks.

I. Wrist Injuries in Volleyball: Epidemiology and Pathomechanics

1. Acute Traumatic Injuries

• Ligamentous Sprains and Tears
  These account for 38% of volleyball wrist injuries, primarily involving the radiocarpal ligaments and ulnar collateral ligament (UCL) . Mechanism: Sudden valgus/varus stress during misaligned passes (e.g., when the ball strikes the side of the hand) or forceful overextension during spikes, exceeding ligament tensile strength (≈200–300 N) .
• Carpal Fractures
  The scaphoid is most frequently fractured (62% of carpal fractures), often from axial loading during palm-first landings after a block or dive . Delayed diagnosis is common due to subtle symptoms, increasing the risk of avascular necrosis (10–15% of cases) .
• Tendon Contusions
  Direct impact with the ball or collision with teammates can bruise the extensor carpi radialis tendons, causing hematoma formation and impaired wrist extension .

2. Overuse Injuries

• Tendinopathy and Tenosynovitis
  Repetitive wrist flexion-extension during serves and spikes leads to microtrauma in the flexor/extensor tendons, particularly the extensor carpi ulnaris (ECU) tendon . Tenosynovitis of the first dorsal compartment (de Quervain’s disease) is prevalent in setters due to repetitive thumb abduction .
• Wrist Instability
  Chronic ligament laxity (from untreated sprains) reduces joint stiffness by 30–40%, creating a cycle of recurrent injury . Athletes report "giving way" sensations during loaded movements .
• Synovitis
  Cumulative joint loading triggers synovial inflammation, with 41% of elite players experiencing wrist swelling after intense training .

II. Risk Factors

• Technical Errors: Over-reliance on wrist flexion for power in spikes (instead of full-body sequencing) increases joint loading by 27% .

• Inadequate Warm-Up: A 2023 study found that players who skipped wrist-specific warm-ups had 2.3x higher injury rates .

• Training Volume: >5 hours/week of high-intensity drills correlates with a 65% higher risk of chronic tendinopathy .

• Equipment: Low-quality 护腕 (<5 mm thickness) fail to reduce impact forces by >15% , while over-inflated balls ( >0.32 kg/cm² ) increase peak wrist loading during strikes .

III. Evidence-Based Prevention and Management

1. Preventive Strategies

• Biomechanical Optimization

• Coaches should emphasize "proximal-to-distal" sequencing: using leg drive and trunk rotation to generate spike power, reducing wrist contribution by 40% .

• Setters should adopt a neutral wrist position (10–15° extension) during passes to distribute force evenly across carpal bones .

• Warm-Up Protocols

• Dynamic drills: Wrist circles (30 seconds), resisted flexion/extension with resistance bands (3 sets × 15 reps), and ball-tossing with gradual force increments .

• Static stretching: Hold wrist flexion/extension stretches (30 seconds/side) to improve range of motion (ROM) .

• Protective Equipment

• Use neoprene wrist braces with rigid lateral supports to reduce valgus/varus stress by 25–30% .

• Select balls inflated to 0.26–0.28 kg/cm² to balance playability and impact force .

2. Acute Injury Management

• PRICE Protocol (first 72 hours):

• Protection: Immobilize with a volar splint (maintaining 10° wrist extension) to minimize ligament strain .

• Ice: 15–20 minutes every 2–3 hours to limit edema .

• Compression: Elastic bandaging to reduce swelling without compromising circulation .

• Imaging: X-rays for fractures; MRI for ligament tears (sensitivity 92% for UCL injuries) . Surgery is indicated for displaced scaphoid fractures or complete ligament ruptures .

3. Rehabilitation for Overuse Injuries

• Eccentric Training: 3 sets × 12 reps of slow wrist extension/flexion (2–3 seconds eccentric phase) reduces tendinopathy pain by 58% at 6 weeks .

• Shockwave Therapy: Focused extracorporeal shockwaves (0.1–0.3 mJ/mm²) improve ECU tendinopathy outcomes in 76% of cases .

• Proprioceptive Training: Using balance boards with wrist loading enhances joint stability, reducing recurrence risk by 40% .

References

• American Society for Surgery of the Hand (ASSH). (2022). Clinical Guidelines for Wrist Injuries in Athletes.

• Kim, J. H., et al. (2023). Biomechanics of wrist loading during volleyball spikes: Implications for injury. Journal of Biomechanics, 145, 111345.

• Volleyball Federation of International (FIVB). (2023). Injury Prevention Manual for Volleyball Athletes.

• van der Waal, E. J., et al. (2021). Epidemiology of wrist injuries in elite volleyball: A 5-year cohort study. British Journal of Sports Medicine, 55(12), 689–694.