Bump-Set-Ouch: Preventing Volleyball Injuries

by G. John Mullen, SPT, CSCS | mullen@myhousecallmd.com

Whether you’re Kerri Walsh or an annual beachgoer wearing 100+ sun block, you’re likely to get your hands on a volleyball during your next trip to the beach.  Beach Volleyball is a tough sport but remains omnipresent due to the ease with which newcomers can pick up the sport (almost anyone can hit a few volleys).  No matter your ability, injuries can occur which means that injury prevention should be an inherent part of your pre-beach routine.  You may remember the infamous kinesio tape on Ms. Walsh’s shoulder during the 2008 Olympics providing her the strength, stamina and the extra 6 inches (ok, maybe not the height) she needed to win the Olympic gold. The shoulder is the second most commonly injured site in volleyball, second only to the ankle.  (Read about the prevention and treatment of ankle sprains here).

Similar to baseball or swimming, the overhead motion used during a serve or spike places a large demand on the rotator cuff muscles, all of which hinges on proper strength and timing of the shoulder blade stabilizing muscles.  Before we get ahead of ourselves, lets talk about the role of each of these muscles.  There are four rotator cuff muscles whose main responsibility is to hold the humerus (your upper arm bone) into the glenoid fossa (the anchoring point for the humerus in your shoulder).  The muscles of the rotator cuff are small and weak and are placed under extreme amounts of tension during any overhead activity.  To perform this activity at the top level, the shoulder posses a delicate balance of flexibility and strength to stabilize this motion or injuries will be frequent. The hypermobility of the shoulder puts the athlete (or recreational 100 SPF wearer) at risk for shoulder injury.  We will discuss the exact shoulder muscles needed during serving and spiking as well as the proper preventive measures for any volleyball player, whether novice or pro.

Stat Fact: It is estimated 25% of volleyball players experience shoulder pain (1).


The serve and spike are nearly identical movements in volleyball.  During the serve, the goal is to hit the ball so it ‘floats’ over the net with a parabolic trajectory in an area that would be most difficult for the opponent to return.  On the other hand, during the spike, the primary objective is to hit the ball as hard as possible so as to convey maximum velocity to the ball (2).  The high velocity implemented during the spike increases the demand at the shoulder and puts it at risk for injury if proper strength, flexibility and timing are not achieved.  These attacks have been broken down into five phases and studies have indicated which muscles are most active in each phase (2):

  1. Wind-Up – This phase begins with shoulder to the side and extended.  The motion ends when the arm begins to come forward and “cock back” or externally rotate.  The most active muscles are: infraspinatus, supraspinatus, anterior deltoid
  2. Cocking – This phase begins with the full cocking of the arm through full external rotation, ending when you bring your arm overhead.  The most active muscles are similar to the wind-up phase: teres minor, infraspinatus, supraspinatus, anterior deltoid, pectoralis major
  3. Acceleration – This phase lasts from the full cocking position to the instance where the hand strikes the ball.  Main muscles employed include: supraspinatus, infraspinatus, teres minor, subscapularis, teres major, latissimus dorsi, pectoralis major
  4. Deceleration – The fourth phase is from the striking of the ball until the point where the arm is perpendicular with the body.  High activity is noted in the following muscles:  anterior deltoid, supraspinatus, infraspinatus, teres minor, subscapularis
  5. Follow-Through – This motion begins when the arm is perpendicular to the body and ends when the arm returns to the side of the body.  Similar muscles are activated in both the deceleration and follow-through phase: anterior deltoid, supraspinatus, infraspinatus, subscapularis

Each of these phases is integral for an optimal serve/spike.  The majority of shoulder injuries occur during either the acceleration or deceleration phases.  The most common injuries are rotator cuff strains/tears, labrum tears, and dislocations.

Stat Fact: Because overhead throwing motions (such as baseball pitching, football passing and the tennis serve) achieve shoulder internal rotation angular velocities between 4000 and 7000 degree per second, it is reasonable to assume that similar internal rotation angular velocities occur during the volleyball spike (2).  That’s pretty fast if you ask us.


To prevent shoulder injuries from occurring it is essential to develop proper strength, flexibilty and mechanics.  These three categories can be achieved with a comprehensive warm-up and cool-down.  The purpose of a warm-up is to engage the muscles prior to high athletic demands.  Warming up improves blood circulation (it literally warms up the muscles) and prepares the nervous system for the desired activity.  When warming up, dynamic stretching, targeted movements, strengthening and light plyometrics can be utilized to prevent shoulder injuries.


Upper and lower body dynamic stretching lengthens muscles in preparation for exercise.  Leg swings, bent elbow arm swings, overhead squats, stick rotations and lunges are a few exercises which can dynamically prepare the body for exercise and work.   Dynamic movements increase strength and range of motion before your big game.  Some examples include single leg Romanian dead lifts, push-ups and mid rows.  Specific exercises to warm-up your shoulder musculature (which will be put to the test shortly!) include exercises that strengthen the four muscles of the rotator cuff and scapular stabilizing muscles (Read more about scapular stabilizing muscles here).  Now for your ankles: a proper ankle warm-up can be completed with one simple tool, an exercise band.  Wrap the band around your ankle and perform forward, backwards and lateral lunges (see picture below for an example of a backwards lunge with a resistance band).  The purpose of the exercise band is to increase the activity of the ankle musculature during the exercise.  Research suggests that training with this increased load on the ankle will decrease the likelihood of ankle sprains during activity (3).

Stat Fact: Ankle injuries account for over 50% of all injuries in volleyball (1).


A warm-down is essential to relax the over-worked muscles you abused during your rigorous game of volleyball.  Warming down increases your muscles’ range of motion, preventing unwanted tight muscles.  You can use either static or isometric stretching after a workout (although our expert personal trainer prefers static stretching to optimize length post-exercise).  Static stretching is also referred to as “contract/relax” stretching and is performed by maximally contracting a muscle for 10 seconds and then stretching for 20 seconds following this contraction.  The most important muscles to stretch for volleyball include the pectoral muscles, hamstrings, hip flexors and calves.  Properly lengthening these muscles will allow for greater strength and flexibility the next time you are playing volleyball!


Shoulder and ankle injuries are common in volleyball.  Make sure you warm-up and cool-down properly to prevent injuries and improve strength and flexibility.  Lastly, don’t forget the sunscreen.  No one wants to be pink when they’re spiking balls in their opponent’s face!

Questions? E-mail the Author: mullen@myhousecallmd.com


  1. Bahr R, Bahr I. Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors. Scand J Med Sci Sports. Jun 1997;7(3):166-171.
  2. Escamilla R, Andrews J. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports. Sports Med. 2009;39(7):569-590.
  3. Han K, Ricard M, Fellingham G. Effects of a 4-week exercise program on balance using elastic tubing as a perturbation force for individuals with a history of ankle sprains. J Orthop Sports Phys Ther. Apr 2009;39(4):246-255.


07 2010

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