10.1123 jsr.2018-0044

“Prevalence and Factors Associated With Injuries in Elite Spanish Volleyball”
by Cuñado-González Á, Martín-Pintado-Zugasti A, Rodríguez-Fernández Á L

Journal of Sport Rehabilitation
© 2018 Human Kinetics, Inc
Note: This article will be published in a forthcoming issue of

the Journal of Sport Rehabilitation. The article appears here
in its accepted, peer-reviewed form, as it was provided by the
submitting author. It has not been copyedited, proofed, or
formatted by the publisher.
Section: Original Research Report
Article Title: Prevalence and Factors Associated With Injuries in Elite Spanish Volleyball
Authors: Álvaro Cuñado-González1; Aitor Martín-Pintado-Zugasti2; and Ángel L Rodríguez-

Fernández2
Affiliations: 1Department of Physical Therapy and Nursing, University of Álcala de Henares,

Alcalá de Henares, Spain. 2Department of Physical Therapy, Faculty of Medicine, CEU-San
Pablo University, Madrid, Spain.
Running Head: Injuries in elite volleyball
Journal: Journal of Sport Rehabilitation
Acceptance Date: July 24, 2018
©2018 Human Kinetics, Inc.
DOI: https://doi.org/10.1123/jsr.2018-0044
TITLE PAGE
 TITLE
PREVALENCE AND FACTORS ASSOCIATED WITH INJURIES IN ELITE
SPANISH VOLLEYBALL
 AUTHORS´ FULL NAMES
Álvaro Cuñado-González PT1; Aitor Martín-Pintado-Zugasti PhD2; Ángel L Rodríguez-
Fernández PhD2.
 FULL AFFILIATIONS
1. Department of Physical Therapy and Nursing, University of Álcala de Henares, Alcalá de
Henares, Spain.
2. Department of Physical Therapy, Faculty of Medicine, CEU-San Pablo University, Madrid,
Spain.
CORRESPONDING AUTHOR’S CONTACT DETAILS
Aitor Martín-Pintado Zugasti,
Department of Physical Therapy, CEU-San Pablo University, Carretera Boadilla del
Monte, Km 5,300, Urbanización Montepríncipe, 28668 Boadilla del Monte, Madrid, Spain.
Telephone: 0034-913724700
Email: martinpintado.a@gmail.com.
 Disclosure statement: No potential conflict of interest was reported by the authors.

ABSTRACT
Context: Prevalence studies have been widely carried out on elite volleyball players.
However, the extent to which specific prevention strategies are used or the influence
of the sport equipment on the occurrence of injuries have been sparsely investigated.
Objective: To describe the prevalence of injuries sustained during one season in elite
Spanish volleyball leagues, and to investigate the association of injuries with multiple
factors such as player court position, injury mechanism, type of shoes used when
playing or participation in prevention activities. Design: Descriptive Cross-Sectional
Epidemiology Study: Observational study. Setting: European elite professional
volleyball. Participants: Professional volleyball players from the elite Spanish
volleyball. Main Outcome measures: A self-report questionnaire assessed injury
presence during a volleyball season. Questions included the type of injury, its
anatomical location, participation in prevention strategies, the shoe type, the injury
mechanism, the season period, the period of leave and the treatment received.
Results: Four hundred and ninety players (71.2% response rate) completed and
returned the questionnaire. The injury prevalence was 66.9% and the average of
injuries per player was 0.94±0.85 (range: 0-4). Most Spanish elite volleyball players
participated in prevention programs during the season (90.3%) and played volleyball
with low-top shoes (83.6%), but these factors were not associated with the prevalence
of injuries (p>.05). The anatomical regions with the most injuries were the ankle, knee
and shoulder, and the most common types of injury were sprains, tendinopathies and
strains, usually occurring during blocking and attack actions during the in season
period. Conclusions: Despite most of elite volleyball players participating in
prevention programs, the results reveal a high injury prevalence. Further prospective
research on the effectiveness of prevention strategies in elite volleyball is needed.
Key Terms: volleyball, injuries, epidemiology, prevalence, prevention.

INTRODUCTION
Volleyball injury prevalence is considered lower than in other team sports, such
as basketball, handball or soccer1,2. These differences are thought to be the
consequence of the non-contact nature of volleyball3,4. However, volleyball injuries
accounted for 5.3% of all sports injuries reported at casualty departments in Denmark,
and volleyball was the fourth most likely sport to cause injuries5. It has been noted that
elite volleyball players present between 1.7 and 4.4 injuries per 1000 hours of play6–9,
and each player suffers between 0.6 and 1.5 injuries per season4,6,10. Acute injuries
including ankle and finger sprains are the most frequent. They may also arise from
chronic overuse, particularly to the knee and shoulder regions6,8,11; these are usually
suggested to be associated with a faulty technique, the amount of repetition or the

type of playing surface12.
Prevalence studies have been widely carried out on elite volleyball players from
Scandinavian or Anglo-Saxon countries;5,6,8,10,11,13,14 and various volleyball studies
from Greece 3,4,15–17 and Italy18 have also been published. However, there is a lack of
investigation about the prevalence of volleyball injuries in other European countries.
Prevalence studies that provide information about the presence of injuries, risk
factors and the injury mechanisms, have shown that it is possible to introduce
preventive or therapeutic strategies adapted to a particular sport19. Several preventive
strategies have been described in volleyball, such as technical training, proprioception,
eccentric protocols, strength training, flexibility, taping, scapular stability training, and
core strengthening20,21. However, it is not clear to what extent these are being used22
and further research on their effectiveness is needed3. In addition, the equipment,
such as the type of shoes used in each sport, has been described as an external risk
factor that can lead to an inciting event and result in injury23. Previous research has
shown that wearing high-top, rather than low-top, shoes may help to prevent some
ankle sprains24,25, but no relationship between shoe type and ankle sprains has been
observed in basketball players26. Further research about the influence of the shoe type
on the occurrence of injuries in volleyball players is needed.
The aims of this study were to describe the prevalence of injuries during one
season in elite Spanish volleyball leagues, and to identify the factors that are
associated with volleyball injuries, including player court position, injury mechanism,
type of shoes used when playing or participation in prevention activities.
METHODS
Design
A cross-sectional descriptive study of the injuries and their associated factors
that occurred during the 2012-2013 volleyball season was implemented.
Participants
Participants were recruited from the three national leagues of volleyball in
Spain, including men´s and women´s divisions of Super League, Super League-2 and
1st National League.
We performed a stratified sampling according to regions and leagues. These
were randomly chosen (online resource www.randomizer.org) and a sample of 61
teams from a total of 90 was finally selected (table 1), which represented two thirds of
the total sample. Players were included in the study if they played in the above-
mentioned categories during the 2012-2013 season and were able to understand the
Spanish language. We performed the sampling in order to verify that the
representation of a league from a particular region had men´s and women´s leagues.
Therefore, men´s and women´s teams from most of the Spanish Autonomous
Communities are included.
The total number of players selected for the team sampling was obtained from
the Royal Spanish Federation of Volleyball. The number of players that agreed to
participate was 688 from the 61 selected teams. All volleyball players were informed
about the purpose and procedures of the study, and voluntarily agreed to the
publication of data. Their personal information was processed anonymously.
Questionnaire design
The self-report questionnaire design was based on similar questionnaires
previously used10,11 that were translated into Spanish by 2 native Spanish speakers.
Various experts designed the questionnaire (comprising a sports physician
specializing in volleyball, two physiotherapists from volleyball clubs and a volleyball
coach). They also contributed with proposals and ideas that were considered and
included in the questionnaire.
The questionnaire included three parts: personal data, sport data and injury
data. The definition of “injury” was: “any mishap occurring during scheduled games or
practices that cause an athlete to miss a subsequent game or practice session”. Injury
severity was divided into three categories: mild (resulting in less than one week out of
playing), moderate (from two to four weeks out) and major (more than a month out).
This definition and classification of injury have been used in previous studies4,16,17.
The team medical staff or the club insurance company medical staff diagnosed
all injuries.
Variables
Personal data included the sociodemographic variables of age and gender and
the anthropometric variables of weight and height. Sport variables included league,
player court position, season period including pre-season (pre-competitive training
period), in-season (regular season competitive period) and post-season (after
competitive training period), number of hours and days of practice per week, type of
shoes used when playing, and participation in prevention activities. The injury
variables were type of injury, location of the injury, injury mechanism, when the injury
occurred, injury leave period and type of treatment received.
Data collection
The questionnaire was constructed by the computing platform of Google Docs,
in order to be distributed quickly and easily collected. The aim was that it should not
take the players long to complete it (5-10 minutes).
A researcher contacted and informed the medical director of each volleyball
club about the aim of the study, the guidelines that players should follow to complete
the questionnaire, and the website to access the online questionnaire. Then, the
medical staff informed the players about this information.
The questionnaires were initially distributed on January 15th 2014 and remained
open for 7 weeks until March 5th 2014. Within four weeks, all the questionnaires had
been distributed to all participating clubs. In the first week, we sent the questionnaires
to male and female Super League teams (14 teams); in the second week, to male and
female Super League-2 teams (15 teams); in the third week, to 13 male teams and
two female teams from the 1st National League (15 teams); and in the fourth week, to
the remaining 1st National female teams (17 teams). The authors sent reminders
weekly to all teams´ medical heads during three weeks.
Statistical analyses
Data from the questionnaire were analyzed with SPSS software version 21.0.
Descriptive analyses included the means and standard deviations for quantitative
variables, and percentages for qualitative variables. A normal distribution of
quantitative data was assessed by the Kolmogorov-Smirnov test.
The non-causal association between different variables was calculated using
the chi-square test for the following qualitative variables associations (participation in
prevention strategies-presence of injuries, shoe type-presence of ankle injuries, injury

mechanism-location of injury, type of injury-location of injury, season period-type of
injury, type of injury-leave duration). In this analysis, Cramer’s V was used as indicator
for strength of association. Effect sizes of 0.10, 0.30, and 0.50 were considered as
small, medium, and large effects respectively27. Pearson´s linear correlations were
used to evaluate the relationship between quantitative variables (age, weight, height,
hours of volleyball practice/day) and the number of injuries/player. Univariate analysis
of variance (ANOVA) was conducted to determine if there were differences in the
number of injuries/player among player court positions or leagues. Effect sizes were
calculated by partial eta squared (p2). Finally, Student t-test was conducted to
examine differences between men and women in the number of injuries/player. The
level of significance was set at P<0.05.

RESULTS
Volleyball players
Four hundred and ninety players, out of 688 who agreed to participate,
completed and returned the questionnaire (female: 62.9%; male: 37.1%); the response
rate was 71.2%. Table 1 shows descriptive data of the sample.
The positions of respondents comprised receptors (29.8%), centers (28%),
setters (16.7%), opposites (14.5%) and liberos (11%). A significant relationship was
found between the position and the number of injuries/player (P=0.006; p2=0.19).
Regarding leagues, 25.9% of respondents were players from the Super
League; 23.7% from Super League-2; and 50.4% from 1st National. No significant
relationship was found between leagues and the number of injuries/player (P=0.096;
p2=0.01).
Injury prevalence
The injury prevalence of the studied sample was 66.9%. A total of 463 injuries
was registered. The percentage of players who presented one injury/season was
44.7%, while 17.1% suffered two injuries/season, 4.9% three injuries/season and 0.2%
four injuries/season. The average number of injuries/player/season was 0.94±0.85
(range:0-4). In the women, the mean number of injuries/player/season was 0.95±0.86;
in men, 0.93±0.82.
Prevention strategies and shoe type
Most elite Spanish volleyball players participated in prevention programs.
During the pre-season, 87.7% of players performed prevention activities, whereas
90.3% of players carried out prevention activities during the season. Stretching was
the most common prevention activity, followed by proprioception, eccentric protocols,
lumbopelvic stabilization and ankle taping (Table 3).
There were no significant relationships between the presence of injuries and
the participation in prevention strategies during the pre-season (P=0.526; V=0.03) or
during the season (P=0.403; V=0.04). Furthermore, participation in proprioception
activities during the pre-season was not associated with a lower prevalence of ankle
sprains during the season (P=0.993; V=0.01); and participation in eccentric protocols
during the pre-season was not associated with a lower prevalence of tendinopathies
during the season (P=0.105; V=0.09).
Most players (83.6%) practiced volleyball with low-top shoes; 16.4% used high-
top shoes. No relationship was found between the type of shoe and the presence of
ankle injuries (P=0.893; V=0.01) or sprains (P=0.737; V=0.02).
Injury characteristics
The most commonly injured anatomical locations were the ankle/foot (34.6%),
the knee (17.7%) and the shoulder (14.7%) (Figure 1). The most prevalent types of
injury were sprains, tendinopathies and strains (Figure 2; Table 3).
The number of injuries/player did not correlate with age (r=0.15, P=0.790),
height (r=0.27, P=0.622), weight (r=0.33, P=0.549), or hours of volleyball practice/day
(r=-0.73, P=0.188). No significant relationship was found between gender and the
number of injuries/player (P=0.828).
The most frequent mechanism of injury was blocking (29.4%), followed by
attack (23.3%), reception (4.8%), the serve (2.8%), placement (2.4%) and defense
(0.4%). There was an association between the mechanism of injury and the location
of the injury (P<0.001; V=0.36) (Figure 3). During the blocking action, 65.5% of finger
injuries occurred and 57.5% of ankle/foot injuries. The attack action was related to
72.7% of abdominal injuries and 43.9% of shoulder injuries. Considered together, the
blockade and attack actions were associated with 78.8% of ankle/foot injuries and
43.9% of knee injuries.
A significant relationship was found between the type of injury and the
mechanism of injury (P<0.001; V=0.32); 61.4% of sprains occurred when blocking and
20.69% when attacking. Moreover, 39,13% of tendinopathies occurred when
attacking.
Most (80%) traumatic fractures were associated with the wrist/hand and the
ankle/foot regions; 41.6% of dislocations were related to the fingers; and 82.7% of the
sprains were associated with the ankle/foot. Regarding muscle injuries, 27.7% were
located at the thigh, 22.2% at the abdominal wall and 19.4% at the leg. In the case of
tendinopathies, 54.3% were related to the shoulder and 41.3% to the knee.
Most injuries occurred during the in season period (81.6%), followed by the pre-
season (14.5%) and post-season (3.9%). They normally occurred during training
(49%), during a match (26.3%) or were of gradual onset (24.6%). A relationship was
found between the moment of occurrence of the injury (during match, during training
or gradual onset) and the type of injury (P <0.001; V=0.43). Regarding the
tendinopathies, 62% were of a gradual onset.
The most common time loss from play due to injury was 2-4 weeks (30.7%),
followed by more than 4 weeks (27.2%), less or equal to 1 week (24.4%), and injuries
not requiring leave (17.7%). A significant relationship was found between the type of
injury and the leave duration (P <0.001; V=0.41). A leave period longer than 4 weeks
was associated with traumatic fractures (89%) and tendon ruptures (83.3%).
Regarding sprains and strains, the most common duration of injury leave was 2 to 4
weeks (44.5% and 46% respectively). In the case of tendinopathies, 43% had no leave
period from games, and 22.9% were associated with an injury leave less or equal to 1
week.
Injury treatments
Of the total injuries, 95% needed treatment. Physical therapy was the most
frequently used treatment (97% of treated injuries), followed by medication (63.9%),
orthosis/splints (14.1%), surgery (6.2%) and injections (3.6%).
DISCUSSION
Injury prevalence
The present study found that 66.9% of Spanish elite volleyball players reported
at least one injury during one season. The number of injuries/player/season was 0.94.
This prevalence value is lower than that observed in another retrospective study of
Danish elite male and female volleyball players during one season, which reported 1.1
injuries/female player/year and 1.5 injuries/male player/year 6. The studied sample
comprised 137 Danish players, including 70 females whose mean age was 24.9 years
and who practiced a mean of 7.34 hours/week/player (257 total hours /35 weeks) and
67 males whose mean age was 25 years and who practiced a mean of 9.67
hours/week/player (339 total hours/35 weeks). Therefore, the mean age of these
Danish players was older than the present study (22.86 years) and the number of
training hours/week/player was inferior (11.76 hours/week/player). A possible reason
for the higher prevalence observed in Danish players could be associated to the
definition of injury, since contrary to the present study, the presence of an injury did
not necessarily imply to miss a subsequent game or practice session6.

However, in another similar one season retrospective study, Swedish elite
volleyball players reported 0.86 injuries/female player/season and 0.68 injuries/male
player/season10. It included 158 Swedish players who also were older (25 years for
males and 24 years for females) and practiced less hours/player/week (9.9
hours/week/male player and 9.4 hours/week/female player) compared to the present
study. The injury definition did not necessarily imply an absence from training or
match. The prevalence of injuries in elite Swedish female volleyball players was similar
to the present study (0.86 vs 0.95) but was lower in case of males (0.68 vs 0.93).
Further research may explore elite volleyball prevalence of injuries to replicate this
research and analyze the differences between countries or periods. These previous
retrospective investigations on Danish and Swedish elite volleyball were conducted

approximately 20 and 10 years ago respectively. The new training methods, the
increasing number of hours of training or advances in preventive strategies could also
explain the differences observed between studies.
A prospective study of Greek male volleyball players showed a similar
prevalence of injuries during one season compared to the present study; with 0.81
injuries/player/season in senior male players (>18 years)4. The definition of injury was
the same used in the present study, including the criterion of time lost from
training/match to be considered an injury. It was conducted 7 years prior to the present
study and the age of senior players was superior (26.7 years). The use of the same
definition of injury and the fact that it was published more recently than other previous
research mentioned above may explain the prevalence similarities between this Greek
study and the present research. However, it is evident that multiple differences in the
study designs, player population characteristics or injury definitions such as those
mentioned above, could explain the prevalence variability and may also explain the
different results between studies obtained regarding injury characteristics and
associated factors.
The volleyball prevalence of injuries in the present study is lower than other
team sports, such as soccer28–30. Elite professional European soccer players
sustained a mean of 2.0 injuries per season29. Other studies comparing injury
occurrences between various sports also noted that volleyball players had less injuries
than basketball, hockey, handball or soccer players1,2. The non-contact nature of
volleyball may explain these differences3,4 .
Participation in prevention programs and shoe type
There is a lack of research on the extent to which specific prevention strategies

are used in elite volleyball22. Stretching was the most common prevention activity in
the present study, followed by proprioception, eccentric protocols, lumbopelvic
stabilization and ankle taping (Table 3).
Most of Spanish elite volleyball players participated in prevention programs
during pre-season (87.7%) and during the season (90.3%). This was found to be lower
than noted in elite Swedish players (96% and 97%, respectively)10. However, the
prevention training activities that were included in the questionnaires were not
comparable, since Augustsson et al10 included strength training, plyometrics and
technique drills whereas, in the present study, other specific prevention strategies
were assessed, namely proprioception, ankle taping, eccentric exercises, core
strengthening and stretching.
Proprioception training in athletes has been considered effective in the
prevention of ankle sprains31,32, while ankle taping could reduce the rate of recurrent
ankle sprains31. Studies of volleyball players showed that technical training and
proprioceptive training were effective methods of preventing ankle sprains3,33.
Eccentric strengthening, with good compliance, appeared to be successful in
preventing hamstring injuries34. Exercise programs to improve core stability are
thought to prevent injury rates; however, various studies have shown conflicting
results35. Studies have also reported inconclusive outcomes regarding the positive
effect of stretching on injury prevention36.
In the present study, elite volleyball players’ participation in prevention
programs was not associated with a lower prevalence of injuries. However, the
retrospective design of this study limits its ability to assess the effectiveness of
prevention strategies, since it is possible that some players participated in prevention
strategies because of a previous injury. Therefore, we only sought an association

between participating in prevention strategies during the pre-season with the
prevalence of injuries during the season. We found no associations between
participating in prevention strategies during the pre-season and the occurrence of
injuries during season globally, or when specifically assessing the association
between proprioception and ankle sprains, or between eccentric exercise and tendon
injury.
In addition, other factors reported by previous authors could also explain the
high injury prevalence despite the large percentage of players participating in
prevention strategies observed in the present study. The occurrence of an injury may
result from a complex interaction between internal and external risk factors. Some of
the factors that influence the occurrence of volleyball injuries, such as the environment
or volleyball rules to control contact with other players, could be beyond the
players´control23,37. Moreover, recent research have highlighted the lack of research

on preventive strategies regarding volleyball injuries and the scarcity of research
supporting effective preventive measures38.
Most respondents in this study used low-top shoes, with only 16.4% used high-
top shoes. We found no association between shoe type and injury prevalence. This
finding agrees with previous research that suggested that high-top shoes are not
effective in increasing ankle joint stability39. To the authors´ knowledge, there is no
published work on the use and influence of the shoe type in elite volleyball players. No
scientific consensus has been reached with regard to the stabilizing effect of high-top
shoes39, and the shoe type was not associated with the occurrence of ankle sprains
in basketball players26.
Injury characteristics
We have shown that the most prevalent volleyball injuries involved the ankle,
knee and shoulder. Several studies of volleyball players have reported similar
results4,10,16,17. However, Solgard et al5 noted that the most frequent injury location
was the hand, and some studies have reported that injuries of the lumbar spine are
more frequent than shoulder injuries4,10,16.
The most frequent type of injury in this investigation were sprains, followed by
tendinopathies, muscle injuries and fractures. Sprains have been reported as the most
prevalent type of injury in volleyball4,13,15,16. Maillou et al.16 also reported that
tendinopathies were more frequent than muscle injuries, but most studies have
reported that muscle injuries are more frequent than tendinopathies and
fractures4,13,15.
In the present study, receptors and centers were the positions with the higher
risk of injuries. There is a lack of consensus in this; whereas some studies have noted
that receptors and centers are the most injured15, other investigations have reported
that the opposites suffered the highest number of injuries 4,16. In concordance with
previous research6,10,13, the volleyball actions accounting for most of the injuries were
blocking and attack. Also in accordance with other studies, we found that the number
of injuries was not influenced by gender6,11 or age4,16.
Therefore, in the present study the most commonly affected joint was the ankle,
frequently associated with sprains occurred during blocking actions normally
performed by specific player positions such as the centers. As suggested in previous
research, landing on an opponent’s foot after blocking is a major inciting event causing
ankle sprains20 and may account for a high number of injuries in the present study.
We found the most frequent injury leave duration was between two and four
weeks. Other studies have noted that moderate injuries (leading to leave of one to four
weeks) were more prevalent than mild or minor injuries16. However, other authors have
reported that most players presented mild injuries, since they were able to resume
play within one week6 or a few days22. In the present study, the percentage of major
injuries leading to a leave period of more than four weeks (27.2%) is higher compared
to other studies6,16. The retrospective design of this study may have meant that not all
the mild injuries were reported, which could explain these differences14.
Most of the injuries occurred in the competitive period. Only a few occurred in
the pre-season and post-season; this finding agrees with those of Malliou et al16 which
reported that 24.3% of injuries occurred in pre-season, 69.3% in the competitive period
and 1.5% in the post-season period. Most of the treated injuries in our study received
physical therapy (97%); other medical treatments included medication (63.9%),
surgery (6.2%) and injections (3.6%). The percentage of players that received physical
therapy is greater than that reported in other studies of elite volleyball players, in which
more than half of injuries did not receive physical therapy treatments6. These
differences may be explained by the relative scarcity of physical therapists in elite
volleyball teams when some of the older studies were carried out. As noted by Malliou
et al6 in their study significantly higher number of injuries were treated with physical
therapy compared with another study conducted 10 years before40.
Study limitations
The present study has various limitations. The retrospective design of the study
may potentially introduce recall bias when relying on self-reporting of previous
diagnosis of injury and may have influenced the precision with which the players
recorded all the injuries suffered during one complete season. In addition, its
retrospective design limits the capacity to attribute causation in relation to the factors
associated with injuries, such as participation in prevention strategies, or the type of
shoe used.
CONCLUSION
Despite volleyball being a non-contact sport, the results reveal a high
prevalence of injuries; the percentage of injuries during one season was 66.9% and
the average of injuries/player/season was 0.94±0.85. Most of Spanish elite volleyball
players participated in prevention programs during the season and practiced volleyball
with low-top shoes, but these factors were not associated with injuries. The
retrospective design of the study and the lack of evidence on effective prevention
strategies in elite volleyball could explain the absence of associations.
The anatomical regions with a higher prevalence of injuries were the ankle,
knee and shoulder. The most common types of injury were sprains, tendinopathies
and strains, normally associated with blocking and attacking actions during the in
season period. Most players received physical therapy for the treatment of their
injuries.
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Figure 1.
Figure 2.
Figure 3.
TABLE 1. Sociodemographic variables and characteristics of participating elite volleyball

players
n Minimum Maximum Average Standard Deviation

Age 490 13 44 22.86 5.85
Height 490 155 206 178.83 9.68
Weight 490 47 110 71.81 11.77
Hours of practice per week 490 2 30 11.76 4.92
Days of practice per week 490 1 7 4.76 1.04
Hours per day of practice 490 1.14 5 2.42 0.65
TABLE 2. Participation in prevention strategies
Season
Stretching Proprioception Eccentric Stabilization Taping Others
period
Pre-season 383 (78.2%) 304 (62%) 178 (36.3%) 134 (27.3%) 114 (23.3%) 84 (17.1%)
Season 352 (71.8%) 231 (47.2%) 130 (26.5%) 123 (25.5%) 75 (15.3%) 101 (20.6%)
TABLE 3. Prevalence by type of injury
Type of injury Number of cases (%)

Sprains 166 (35.9%)
Tendinopathies 83 (17.9%)
Muscle injuries 63 (13.6%)
Traumatic fractures 27 (5.8%)
Cartilaginous / meniscal injuries 23 (5%)
Luxations 17 (3.7%)
Tendon ruptures 12 (2.6%)
Arthritis/synovitis/bursitis 4 (0.9%)
Nerve/spinal cord injuries 4 (0.9%)
Plantar fasciitis 3 (0.6%)
Contusions 3 (0.6%)
Stress fractures 2 (0.4%)
Concussions 2 (0.4%)
Other injuries 54 (11.7%)

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“Prevalence and Factors Associated With Injuries in Elite Spanish Volleyball”

by Cuñado-González Á, Martín-Pintado-Zugasti A, Rodríguez-Fernández Á L

Note: This article will be published in a forthcoming issue of

Section: Original Research Report

Authors: Álvaro Cuñado-González1; Aitor Martín-Pintado-Zugasti2; and Ángel L Rodríguez-

Affiliations: 1Department of Physical Therapy and Nursing, University of Álcala de Henares,

Running Head: Injuries in elite volleyball

Journal: Journal of Sport Rehabilitation

Acceptance Date: July 24, 2018

©2018 Human Kinetics, Inc.

PREVALENCE AND FACTORS ASSOCIATED WITH INJURIES IN ELITE

 AUTHORS´ FULL NAMES

Álvaro Cuñado-González PT1; Aitor Martín-Pintado-Zugasti PhD2; Ángel L Rodríguez-

1. Department of Physical Therapy and Nursing, University of Álcala de Henares, Alcalá de

2. Department of Physical Therapy, Faculty of Medicine, CEU-San Pablo University, Madrid,

CORRESPONDING AUTHOR’S CONTACT DETAILS

Aitor Martín-Pintado Zugasti,

Department of Physical Therapy, CEU-San Pablo University, Carretera Boadilla del

 Disclosure statement: No potential conflict of interest was reported by the authors.

Key Terms: volleyball, injuries, epidemiology, prevalence, prevention.

as basketball, handball or soccer1,2. These differences are thought to be the

consequence of the non-contact nature of volleyball3,4. However, volleyball injuries

suggested to be associated with a faulty technique, the amount of repetition or the

type of playing surface12.

Scandinavian or Anglo-Saxon countries;5,6,8,10,11,13,14 and various volleyball studies

investigation about the prevalence of volleyball injuries in other European countries.

preventive or therapeutic strategies adapted to a particular sport19. Several preventive

strategies have been described in volleyball, such as technical training, proprioception,

and further research on their effectiveness is needed3. In addition, the equipment,

on the occurrence of injuries in volleyball players is needed.

type of shoes used when playing or participation in prevention activities.

A cross-sectional descriptive study of the injuries and their associated factors

that occurred during the 2012-2013 volleyball season was implemented.

Participants were recruited from the three national leagues of volleyball in

1st National League.

We performed a stratified sampling according to regions and leagues. These

were randomly chosen (online resource www.randomizer.org) and a sample of 61

Spanish language. We performed the sampling in order to verify that the

Communities are included.

publication of data. Their personal information was processed anonymously.

The self-report questionnaire design was based on similar questionnaires

Various experts designed the questionnaire (comprising a sports physician

specializing in volleyball, two physiotherapists from volleyball clubs and a volleyball

included in the questionnaire.

player court position, season period including pre-season (pre-competitive training

period), in-season (regular season competitive period) and post-season (after

occurred, injury leave period and type of treatment received.

The questionnaire was constructed by the computing platform of Google Docs,

take the players long to complete it (5-10 minutes).

A researcher contacted and informed the medical director of each volleyball

medical staff informed the players about this information.

weekly to all teams´ medical heads during three weeks.

variables, and percentages for qualitative variables. A normal distribution of

quantitative data was assessed by the Kolmogorov-Smirnov test.

The non-causal association between different variables was calculated using

prevention strategies-presence of injuries, shoe type-presence of ankle injuries, injury

mechanism-location of injury, type of injury-location of injury, season period-type of

hours of volleyball practice/day) and the number of injuries/player. Univariate analysis

of variance (ANOVA) was conducted to determine if there were differences in the

level of significance was set at P<0.05.

rate was 71.2%. Table 1 shows descriptive data of the sample.

The positions of respondents comprised receptors (29.8%), centers (28%),

Regarding leagues, 25.9% of respondents were players from the Super

four injuries/season. The average number of injuries/player/season was 0.94±0.85