Incidence, Aetiology and Prevention of Musculoskeletal Injuries in Volleyball: A Systematic Review of The Literature
Incidence, Aetiology and Prevention of Musculoskeletal Injuries in Volleyball: A Systematic Review of The Literature
Incidence, Aetiology and Prevention of Musculoskeletal Injuries in Volleyball: A Systematic Review of The Literature
To cite this article: O. Kilic, M. Maas, E. Verhagen, J. Zwerver & V. Gouttebarge (2017):
Incidence, aetiology and prevention of musculoskeletal injuries in volleyball: A systematic review of
the literature, European Journal of Sport Science, DOI: 10.1080/17461391.2017.1306114
REVIEW ARTICLE
Abstract
Currently, there is no overview of the incidence and (volleyball-specific) risk factors of musculoskeletal injuries among volleyball
players, nor any insight into the effect of preventive measures on the incidence of injuries in volleyball. This study aimed to
review systematically the scientific evidence on the incidence, prevalence, aetiology and preventive measures of volleyball
injuries. To this end, a highly sensitive search strategy was built based on two groups of keywords (and their synonyms).
Two electronic databases were searched, namely Medline (biomedical literature) via Pubmed, and SPORTDiscus (sports
and sports medicine literature) via EBSCOhost. The results showed that ankle, knee and shoulder injuries are the most
common injuries sustained while playing volleyball. Results are presented separately for acute and overuse injuries, as well as
for contact and non-contact injuries. Measures to prevent musculoskeletal injuries, anterior knee injuries and ankle injuries
were identified in the scientific literature. These preventive measures were found to have a significant effect on decreasing
the occurrence of volleyball injuries (for instance on ankle injuries with a reduction from 0.9 to 0.5 injuries per 1000 player
hours). Our systematic review showed that musculoskeletal injuries are common among volleyball players, while effective
preventive measures remain scarce. Further epidemiological studies should focus on other specific injuries besides knee and
ankle injuries, and should also report their prevalence and not only the incidence. Additionally, high-quality studies on the
aetiology and prevention of shoulder injuries are lacking and should be a focus of future studies.
Highlights Introduction
. Ankle, knee and shoulder injuries are the most Volleyball is one of the most popular sports in the
common injuries sustained while playing in world and is played by 200 million people worldwide
volleyball. (Verhagen, Van der Beek, Bouter, Bahr, & Van
. Measures to prevent musculoskeletal injuries Mechelen, 2004). Volleyball-specific tasks such as
were found to have a significant effect on jumping, landing, blocking and spiking the ball
decreasing the occurrence of volleyball injuries, need to be combined with fast movements, which
especially ankle injuries. demands a lot from the musculoskeletal system
. Further epidemiological studies should focus (Bere, Kruczynski, Veintimilla, Hamu, & Bahr,
on the etiology and prevention of shoulder 2015). As a consequence, volleyball players are at
injuries. risk for musculoskeletal injuries (Bere et al., 2015).
Correspondence: Vincent Gouttebarge, Consumer Safety Institute, Overschiestraat 65, 1062 XD, Amsterdam, Netherlands. Email:
v.gouttebarge@veiligheid.nl
© 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License
(http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any
medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
2 O. Kilic et al.
Volleyball is also very popular in the Netherlands were searched up to May 2016, namely Medline (bio-
with a total of half a million players. The incidence medical literature) via Pubmed (from 1966), and
of volleyball injuries in the Netherlands is estimated SPORTDiscus (sports and sports medicine litera-
to be 170,000 per year (Volleybalblessures, 2014). ture) via EBSCOhost (from 1985). Literature was
Of these 170,000 injures 4700 volleyball players limited to studies involving humans and to the
with injury are treated in the Emergency room Dutch, English and French languages. Within each
(E.R.) per year (Volleybalblessures, 2014). This keyword, all search terms were combined by the
equates to 12 E.R. treatments per 100,000 played Boolean command OR, and the keywords (and
hours (Volleybalblessures, 2014). This is more than respective search terms) were linked by the Boolean
the mean for average sports, which is 7.9 treatments command AND. In Medline, we strived to use exist-
per 100,000 played hours (Volleybalblessures, ing medical subject headings [MeSH]. Search terms
2014). These specific injuries result in high costs for were truncated with∗ .
society, with direct medical costs at the E.R. or
through hospitalisation for volleyball injuries amount-
ing to 4.6 million euros a year, and indirect costs, due Eligibility criteria
to absenteeism, of 11 million euros a year (Volleybal-
blessures, 2014). Effective preventive measures are To retrieve articles relevant to the goals of this review,
needed not only to reduce the incidence of volleyball criteria for inclusion were:
injuries but also the costs caused by these injuries.
1. The population of interest consists of volleyball
According to the four steps of van Mechelen’s players (participating in volleyball training and/or
‘sequence of prevention’ model, it is essential to youth, adult, master indoor or outdoor competitions).
know what the incidence and aetiology (=risk
2. The article presents an original study.
factors and mechanisms) of musculoskeletal injuries 3. The article is written in Dutch, English, French
among volleyball players are, so that appropriate pre- or German.
ventive measures can be developed and implemented
4a. If related to descriptive epidemiology, prospec-
(van Mechelen, Hlobil, & Kemper, 1992). tive cohort design is used.
Currently, there is no systematic overview of the 5a. If related to descriptive epidemiology, inci-
incidence and (volleyball-specific) risk factors of mus-
dence rate (relative to volleyball exposure) or preva-
culoskeletal injuries among volleyball players, nor any lence rate (overuse injuries) is reported.
insight into the effect of preventive measures on the 4b. If related to aetiology, prospective cohort or
incidence of injuries in volleyball. Consequently,
case-control design is used.
three research questions were formulated: (a) What 5b. If related to aetiology, a description of the injury
are the most common volleyball-specific musculoske- mechanism is given and/or risk estimate is reported.
letal injuries occurring among volleyball players? (b)
4c. If related to prevention, randomised controlled
What are the volleyball-specific risk factors and mech- trial is conducted.
anisms of these most common musculoskeletal inju- 5c. If related to prevention, incidence rates and/or
ries among volleyball players? and (c) Which
effect are reported.
volleyball-specific programmes are effective for the
prevention of musculoskeletal injuries occurring
among volleyball players (participating in volleyball
Study selection
training and/or youth, adult, master competitions)?
All studies identified through the search strategy were
imported in a citation database (EndNote) and dupli-
Methods cates were removed. To identify potentially relevant
articles, titles and abstracts were screened indepen-
A systematic review of the scientific literature was dently by two authors (KO and GV). If the title and
conduct, being reported accordingly to the Preferred abstract did not provide sufficient information to
Reporting Items for Systematic Reviews and Meta- determine whether the eligibility criteria were met,
Analyses (PRISMA) statement (Liberati et al., 2009). it was included for the full text selection. Then, full
text articles were assessed independently for eligi-
bility by two authors (KO and GV). Any disagree-
Search strategy and databases
ments regarding the inclusion or exclusion of
A highly sensitive search strategy was built (Appendix articles were resolved by consulting a third author
1) based on two groups of keywords (and related (VE). To avoid missing any relevant publications,
search terms): ‘injury/epidemiology/aetiology/pre- the references of included studies and/or retrieved lit-
vention’ and ‘volleyball’. Two electronic databases erature reviews were screened.
Musculoskeletal injuries in volleyball 3
Agel et al. Moderate N: 30–109 Musculoskeletal injury: occurred as a result of participation in an • Overall
(2007) G: All females organized intercollegiate practice or competition and (2) Training: 4.10 inj//1000 hours athlete
A: College required medical attention by a team certified athletic trainer or 3.1% head/neck; 18.7% upper extremity; 17.4% trunk/back; 55.9%
L: Recreational physician and (3) resulted in restriction of the student-athlete’s lower extremity; 4.9% other
D: Cohort participation or performance for one or more calendar days Match: 4.58 inj//1000 hours athlete
(prospective) beyond the day of injury. 6.7% head/neck; 21.4% upper extremity; 10.8% trunk/back; 58.7%
F: 16 years Registration: annual injury surveillance system lower extremity; 2.4% other
• Preseason
Training: 6.19 inj//1000 hours athlete
Match: 3.26 inj//1000 hours athlete
• In season
Training: 2.82 inj//1000 hours athlete
Match: 4.52 inj//1000 hours athlete
• Postseason
Training: 1.17 inj//1000 hours athlete
Match: 2.67 inj//1000 hours athlete
• Ankle ligament sprain time loss (≥10 days) injury
Training: 0.83 inj//1000 hours athlete
Match: 1.44 inj//1000 hours athlete
• Knee internal derangement time loss (≥10 days) injury
Training: 0.22 inj//1000 hours athlete
Match: 0.46 inj//1000 hours athlete
(Continued)
5
6
O. Kilic et al.
Table I. Continued.
Bahr (1997) Low N: 273 Musculoskeletal injury: resulted from a sudden event during • All injuries
G: 130 males, 143 organized volleyball training or match, and caused an absence of Total: 1.7 inj/1000 player hours
females one or more day of training or match play. Match: 3.5 inj/1000 player hours
A: 21.7–23.1 Registration: reported by coaches Training: 1.5 inj/1000 player hours
L: Amateur 54% ankle, 11% back, 5% tigh/groin, 9% knee, 9% shoulder, 8%
D: Cohort finger, 9% other
(prospective) • All injuries men
F: One season Total: 1.7 inj/1000 player hours
Match: 3.9 inj/1000 player hours
Training: 1.5 inj/1000 player hours
• All injuries women
Total: 1.7 inj/1000 player hours
Match: 3.0 inj/1000 player hours
Training: 1.6 inj/1000 player hours
• Ankle injuries
Total: 0.9 inj/1000 player hours
Match: 1.7 inj/1000 player hours
Training: 0.8 inj/1000 player hours
• Ankle injuries men
Total: 1.0 inj/1000 player hours
Match: 2.6 inj/1000 player hours
Training: 0.8 inj/1000 player hours
• Ankle injuries women
Total: 0.8 inj/1000 player hours
Match: 0.7 inj/1000 player hours
Training: 0.9 inj/1000 player hours
Bahr et al. Low N: ? Musculoskeletal injury: causing cessation of the athlete’s Total: 2.5 inj/1000 hours exposure
(2003) G: males, females participation in competition or training for at least one day. Men: 3.8 inj/1000 hours exposure
A: Adults Registration: reported by medical staff Women :0.0 inj/1000 hours exposure
L: Elite Acute injuries: 17% neck, 17% hip, 33% knee, 17% ankle, 17%
D: Cohort shoulder
(prospective) Overuse injuries: 12% neck, 21% low back, 6% abdomen,3% hip,
F: Two seasons 12% thigh, 24% knee, 3% lower leg, 12% shoulder, 3% arm, 6%
fingers
Barber Foss Low N: 80 Musculoskeletal injury: causing cessation of participation in the • All injuries
et al. (2014) G: males, females current session and causing cessation of participation on the day Total: 3.68 inj/1000 athlete exposures
A: Youth after onset. Practice: 5.55 inj/1000 athlete exposures
L: Amateur Registration: reported by athletic trainer Games: 0.75 inj/1000 athlete exposures
D: Cohort 81.6% knee, 7.9% ankle, 7.9% shoulder, 2.6% wrist
(prospective) • Ankle sprain
F: Three seasons Practice: 0.32 inj/1000 athlete exposures
Games: 0.25 inj/1000 athlete exposures
• Knee contusion
Practice: 0.0 inj/1000 athlete exposures
Games: 0.25 inj/1000 athlete exposures
• Knee plica
Practice: 0.32 inj/1000 athlete exposures
Games: 0.25 inj/1000 athlete exposures
• Knee fat pad
Practice: 0.16 inj/1000 athlete exposures
Games: 0.0 inj/1000 athlete exposures
• Patellofemoral dysfunction
Practice: 2.54 inj/1000 athlete exposures
Games: 0.0 inj/1000 athlete exposures
• Patella tendinosis
Practice: 0.63 inj/1000 athlete exposures
Games: 0.0 inj/1000 athlete exposures
• Patella subluxation
Practice: 0.16 inj/1000 athlete exposures
Games: 0.0 inj/1000 athlete exposures
• Osgood-Schlatter disease
Practice: 0.79 inj/1000 athlete exposures
(Continued)
7
8
O. Kilic et al.
Table I. Continued.
Beneka et al. Moderate N: 649 Musculoskeletal injury: occurring during scheduled games or • Elite
(2007) G: 318 males, 331 practices that cause an athlete to miss a subsequent game or Total: 0.8 inj/player/year
females practice session. Training: 1.89 inj/player/1000 hours
A: 21.99–25.69 Registration: reported by players during interview Acute: 42% ankle/foot, 13% knee, 12% thigh. 12% shoulder, 7%
L: Elite and amateur hand, 6% spine, 2% elbow/arm, 4% leg
D: Cohort Chronic: 1% ankle/foot, 13% knee, 16% thigh. 22% shoulder, 42%
(prospective) spine, 4% leg
F: One season • Amateur
Total: 0.61 inj/player/year
Training: 2.8 inj/player/1000 hours
Acute: 45% ankle/foot, 13% knee, 16% thigh. 8% shoulder, 11%
hand, 2% spine, 4% elbow/arm, 2% leg
Chronic: 12% knee, 2% thigh. 42% shoulder, 19% spine
Beneka et al. Moderate N: 407 Musculoskeletal injury: occurring during scheduled games or • All players
(2009) G: All males practices that cause an athlete to miss a subsequent game or 0.6 inj/player/year
A: 13.3–26.7 practice session. 2.4 inj/player/1000 hours training or games
L: Elite and amateur Registration: reported by players during interview Location: 39% ankle/foot, 24% knee/thigh, 14% spine, 13%
D: Cohort shoulder, 10% hand
(prospective) Location acute (86.4%): 45% ankle/foot, 22% knee/thigh, 13%
F: One season spine, 10% shoulder, 10% hand
Location overuse (13.5%): 40% knee/thigh, 23% spine, 30%
shoulder, 7% hand
• Youth players (12–14 yrs)
0.3 inj/player/year
1.9 inj/player/1000 hours training or games
• Junior players (15–18 yrs)
0.37 inj/player/year
1.8 inj/player/1000 hours training or games
• Senior players (>18 yrs)
0.81 inj/player/year
2.8 inj/player/1000 hours training or games
Bere et al. Low N: ? Musculoskeletal complaint: newly incurred during match play and/ • All players
(2015) G: males, females or training during the event that received medical attention Total: 10.7 inj/1000 players hours
A: Junior, senior regardless of the consequences with respect to absence from Junior: 9.0 inj/1000 players hours
L: Elite competition or training. Senior: 11.9 inj/1000 players hours
D: Cohort Registration: reported by team doctor 4.5% face, 1.6% head, 0.9% neck/cervical spine, 0.9% thorax/upper
(prospective) back, 0.7% sternum/ribs, 8.9% limbar/lower back, 1.4%
F: Four years abdomen, 1.4% pelvis/sacrum/buttock, 5.0% shoulder/clavicle,
0.5% upper arm, 0.9% elbow, 0.2% forearm, 1.1% wrist, 2.5%
hand, 10.7% finger/thumb, 1.8% hip, 0.9% groin, 4.3% thigh,
15.2% knee, 4.5% lower leg, 1.8% Achilles tendon, 25.9% ankle,
3.9% foot/toe
• Male players
Total: 11.2 inj/1000 players hours
Junior: 10.5 inj/1000 players hours
5.8% face, 1.0% head, 1.0% neck/cervical spine, 1.0% sternum/ribs,
6.7% limbar/lower back, 1.9% pelvis/sacrum/buttock, 9.6
shoulder/clavicle, 1.0% forearm, 3.8% hand, 14.4% finger/
thumb, 2.9% hip, 1.0% groin, 1.0% thigh, 13.5% knee, 9.6%
lower leg, 1.0% Achilles tendon, 17.3% ankle, 7.7% foot/toe
Senior: 11.7 inj/1000 players hours
1.7% face, 2.6% head, 0.9% thorax/upper back, 0.9% sternum/ribs,
10.3% limbar/lower back, 2.6% abdomen, 1.7% pelvis/sacrum/
buttock, 3.4% shoulder/clavicle, 0.9% upper arm, 1.7% elbow,
0.9% wrist, 2.6% hand, 7.8% finger/thumb, 2.6% groin, 3.4%
thigh, 16.4% knee, 3.4% lower leg, 2.6% Achilles tendon, 29.3%
ankle, 3.4% foot/toe
• Female players
Total: 10.3 inj/1000 players hours
Junior: 7.8 inj/1000 players hours
5.6% face, 1.1% neck/cervical spine, 2.2% thorax/upper back, 4.5%
limbar/lower back, 7.9% shoulder/clavicle, 1.1% upper arm,
2.2% elbow, 2.2% wrist, 2.2% hand, 12.3% finger/thumb, 1.1%
9
F: Four years
(Continued)
10
O. Kilic et al.
Table I. Continued.
Bonza et al. Moderate N: ? Musculoskeletal injury: occurring as a result of participation in an Total: 1.07 inj/10 000 athlete-exposure
(2009) G: All females organized practice or competition, requiring medical attention Practice: 1.26 inj/10 000 athlete-exposure
A: High school and resulting in restriction of the person’s participation for at Competition: 0.72 inj/10 000 athlete-exposure
L: Amateur least one day beyond the day of the injury.
D: Cohort Registration: reported by athletic trainer
(prospective)
F: Two years
de Loes et al. Low N: ? Acute musculoskeletal injury: having been attended to by a Males: 0.14 inj/10 000 exposure
(2000) G: males, females physician. 11% ACL/PCL rupture, 11% patella luxation, 11% collateral
A: 14–20 Registration: reported by physician ligament rupture, 33% meniscal rupture, 11% non-specific
L: Amateur rupture, 6% chondral lesions, 17% other
D: Cohort Females: 0.27 inj/10 000 exposure
(prospective) 16% ACL/PCL rupture, 2% fracture patella + condyle, 13% patella
F: Seven years luxation, 15% collateral ligament rupture, 10% meniscal rupture,
37% non-specific rupture, 1% patella ligament rupture, 6% other
Fernandez Moderate N: ? Lower extremity musculoskeletal injury: resulting from 0.99 inj/1000 athlete exposures
et al. (2007) G: All females participation in an organized practice or competition, requiring
A: High school medical attention and resulting in a restriction from participation
L: Amateur in sports for one or more days beyond the day of injury.
D: Cohort Registration: reported by athletic trainer
(prospective)
F: One years
Junge et al. Low N: ? Any physical complaint: incurred during the match that received 11 inj/1000 player matches
(2006) G: All males medical attention from the team physician, regardless of the
A: ? consequences with respect to absence from the match or training.
L: Elite Registration: reported by medical representative
D: Cohort
(prospective)
F: 2004 Olympic
tournament
Kujala et al. Moderate N: ? Traumatic acute musculoskeletal injury: during competition and • Total
(1995) G: males, females training. Overall: 60 inj/1000 person years of exposure
A: ? Registration: reported by insurance company Age <15: 12 inj/1000 person years of exposure
L: Amateur Age 15–19: 51 inj/1000 person years of exposure
D: Cohort Age 20–24: 215 inj/1000 person years of exposure
(prospective) Age 25–34: 145 inj/1000 person years of exposure
F: Two years Age >34: 171 inj/1000 person years of exposure
Thigh: 1 inj/1000 person years of exposure
Knee: 11 inj/1000 person years of exposure
Leg: 1 inj/1000 person years of exposure
Ankle: 19 inj/1000 person years of exposure
Foot: 2 inj/1000 person years of exposure
Upper arm and shoulder: 6 inj/1000 person years of exposure
Forearm and elbow: 1 inj/1000 person years of exposure
Palm and wrist: 1 inj/1000 person years of exposure
Fingers: 5 inj/1000 person years of exposure
Teeth: 1 inj/1000 person years of exposure
Eye: 1 inj/1000 person years of exposure
Head and neck: 3 inj/1000 person years of exposure
Thorax and abdomen: 1 inj/1000 person years of exposure
Back: 5 inj/1000 person years of exposure
• Males
Age <15: 6 inj/1000 person years of exposure
Age 15–19: 52 inj/1000 person years of exposure
Age 20–24: 236 inj/1000 person years of exposure
Age 25–34: 155 inj/1000 person years of exposure
Age >34: 67 inj/1000 person years of exposure
• Females
Age <15: 16 inj/1000 person years of exposure
Age 15–19: 50 inj/1000 person years of exposure
Age 20–24: 192 inj/1000 person years of exposure
(Continued)
11
12
Table I. Continued.
O. Kilic et al.
Study Total risk Participation and
information of bias design Injury definition Incidence and pathology
Malliou et al. Moderate N: 689 Musculoskeletal injury: occurred during scheduled games or • All players
(2008) G: All females practices that caused an athlete to miss a subsequent game or 0.59 inj/player/year
A: >11 practice session. 2.5 inj/player/1000 hours training or games
L: Amateur Registration: ? Location: 50.4% ankle/foot, 15.7% knee/thigh, 10.6% spine, 9.6%
D: Cohort shoulder, 8.8% hand
(prospective) Location acute (68.6%): 71.7% ankle/foot, 12.5% knee/thigh, 6.5%
F: One years spine, 3.6% shoulder, 5.7% hand
Location overuse (26.5%): 4.6% ankle/foot, 26.9% knee/thigh,
23.1% spine, 26.9% shoulder, 18.5% hand
• Youth players (12–14 yrs)
0.38 inj/player/year
2.4 inj/player/1000 hours training or games
• Junior players (15–18 yrs)
0.52 inj/player/year
2.6 inj/player/1000 hours training or games
• Senior players (>18 yrs)
0.78 inj/player/year
2.5 inj/player/1000 hours training or games
Nelson et al. Moderate N: ? Ankle injury: occurring as a result of an organized volleyball Total: 6.21 inj/10,000 athlete exposures
(2007) G: All females practice or competition, requiring medical attention by a team Practice: 6.49 inj/10,000 athlete exposures
A: High school athletic trainers or a physician, and resulting in restriction of the Competition: 5.72 inj/10,000 athlete exposures
L: Amateur athlete’s participation for one or more days beyond the day of
D: Cohort injury.
(prospective) Registration: reported by athletic trainer
F: One years
Rechel et al. Moderate N: ? Musculoskeletal injury: occurring as a result of an organized Total: 1.64 inj/1000 athlete exposures
(2008) G: All females volleyball practice or competition, requiring medical attention by Practice: 1.48 inj/10,000 athlete exposures
A: High school a team athletic trainers or a physician, and resulting in restriction Competition: 1.92 inj/10,000 athlete exposures
L: Amateur of the athlete’s participation for one or more days beyond the day
D: Cohort of injury.
(prospective) Registration: reported by athletic trainer
F: One years
Rechel et al. Moderate N: ? Musculoskeletal injury: requiring surgery, occurring as a result of Total: 0.40 inj/10,000 athlete exposures
(2011) G: All females an organized volleyball practice or competition, requiring Practice: 0.21 inj/10,000 athlete exposures
A: High school medical attention by a team athletic trainers or a physician, and Competition: 0.78 inj/10,000 athlete exposures
L: Amateur resulting in restriction of the athlete’s participation for one or 9% head/face/mouth, 2.1% shoulder, 2.3% hand/finger, 79.2%
D: Cohort more days beyond the day of injury. knee, 3.2% ankle, 4.2% other
(prospective) Registration: reported by athletic trainer
F: Six years
Reeser et al. Moderate N: ? Musculoskeletal injury: any condition resulting in the loss of at least High school: 12.4 inj/10,000 athlete exposures
(2015) G: All females one day of training or competition. 5.4% head/face, 3.3% wrist, 9.0% hand, 8.3% shoulder, 6.4% lower
A: High school & Registration: reported by athletic trainer back/spine, 1.9% hip, 2.8% thigh, 10.9% knee, 4.6% leg, 36.6%
College ankle, 3.8% foot
L: Amateur College: 40.6 inj/10,000 athlete exposures
D: Cohort 5.5% head/face, 2.0% wrist, 6.5% hand, 9.8% shoulder, 8.2% lower
(prospective) back/spine, 4.3% hip, 6.8% thigh, 13.1% knee, 6.6% leg, 19.9%
F: Four years ankle, 4.5% foot
Robinson et al. Moderate N: ? Shoulder injury: (proximal humerus, scapula, clavicle, comion- Total: 0.81 inj/10,000 athlete exposures
(2014) G: All females clavicular joint, and surrounding tendons, ligaments, and Practice: 0.97 inj/10,000 athlete exposures
A: High school musculature) occurring as a result of an organized practice or Competition: 0.50 inj/10,000 athlete exposures
L: Amateur competition, requiring medical attention by a team athletic 9% head/face/mouth, 2.1% shoulder, 2.3% hand/finger, 79.2%
D: Cohort trainers or a physician, and resulting in restriction of the athlete’s knee, 3.2% ankle, 4.2% other
(prospective) participation for one or more days.
F: Six years Registration: reported by athletic trainer
Solgard et al. Moderate N: ? Musculoskeletal injury: occurring during volleyball activities at a 6.5 inj/1000 hours of exposures
(1995) G: males, females sport area, causing the athlete to consult the casualty wards 5.0% arm/shoulder, 44.6% hands/fingers, 6.1 knee, 30.9% ankle,
A: 11–45 within 24 h of the injury. 5.8% foot
L: Amateur Registration: reported by player (interview)
D: Cohort
(prospective)
F: One years
Swenson et al. Moderate N: ? Fracture: occurring as a result of an organized volleyball practice or Total: 0.52 inj/10,000 athlete exposures
(2010) G: All females competition, requiring medical attention by a team athletic Practice: 0.55 inj/10,000 athlete exposures
A: High school trainers or a physician, and resulting in restriction of the athlete’s Competition: 0.46 inj/10,000 athlete exposures
L: Amateur participation for one or more days. 27.6% hand/finger, 13.5% wrist, 13.7% lower leg, 1.6% forearm,
D: Cohort Registration: reported by athletic trainer 8.9% foot/toe, 4.2% nose, 23.1% ankle
(prospective)
F: Five years
(Continued)
13
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O. Kilic et al.
Table I. Continued.
Tsigganos et al. Moderate N: 72 (12–14), 109 Musculoskeletal injury: occurring during scheduled games or Total: 2.4 inj//1000 hours of exposures per player
(2007) (15–18), 268 (>18) practices that cause an athlete to miss a subsequent game or 12–14: 1.9 inj//1000 hours of exposures per player
G: All males practice session. 15–18: 1.8 inj//1000 hours of exposures per player
A: 13.3, 16.1, 26.7 Registration: reported by player (interview) >18: 2.8 inj//1000 hours of exposures per player
L: Competitive 38.9% ankle/foot, 24.4% knee/thigh. 14% spine, 12.7% shoulder,
D: Cohort 10% hand
(prospective)
F: One year
Vauhnik Low N: 286 Traumatic ACL injury: confirmed by a surgeon. 0.019 inj/1000 hours of exposure
(2011) G: All females Registration: reported by player and coach
A: 18.1
L: Competitive
D: Cohort
(prospective)
F: One year
Verhagen et al. Low N: 486 Musculoskeletal injury: occurred as a result of volleyball and caused • Overall
(2004) G: 158 males, 261 the subject to stop this activity, or resulted in the subject not Total: 2.6 inj/1000 hours of play
females participating fully in the next planned sports activity. Training: 1.8 inj/1000 hours of play
A: 23.8–25.2 Registration: reported by player and coach Match: 4.1 inj/1000 hours of play
L: Competitive • Males
D: Cohort Total: 3.0 inj/1000 hours of play
(prospective) Training: 2.3 inj/1000 hours of play
F: One year Match: 3.8 inj/1000 hours of play
• Females
Total: 2.4 inj/1000 hours of play
Training: 1.5 inj/1000 hours of play
Match: 4.2 inj/1000 hours of play
• Ankle
Total: 1.0 inj/1000 hours of play
Acute: 1.0 inj/1000 hours of play
• Knee
Total: 0.3 inj/1000 hours of play
Acute: 0.1 inj/1000 hours of play
Overuse: 0.1 inj/1000 hours of play
• Other lower extremity
Total: 0.5 inj/1000 hours of play
Acute: 0.4 inj/1000 hours of play
Overuse: 0.1 inj/1000 hours of play
• Back
Total: 0.2 inj/1000 hours of play
Acute: 0.1 inj/1000 hours of play
Overuse: 0.2 inj/1000 hours of play
• Shoulder
Total: 0.2 inj/1000 hours of play
(Continued)
15
16 O. Kilic et al.
Prevention
N, number; G, gender; A, age; L, level of play; D, design; F, follow-up period; inj, injuries; ACL, anterior cruciate ligament; PCL, posterior cruciate ligament.
with a low risk of bias are presented in Figure 1.
Augustsson et al. (2011) researched a supervised
and individualised resistance training during 26
weeks and aimed to reduce musculoskeletal injuries
0.63 inj/player/year
(prospective)
design
A: ?
Discussion
The aim of this study was to present a systematic
Total risk
Moderate
of bias
Zetou et al.
(2006)
Figure 1. van Mechelen prevention model: available literature on incidence, aetiology and prevention of injuries among volleyball players.
18
O. Kilic et al.
Table II: Injuries among volleyball players: aetiology.
Agel et al. Moderate N: 30–109 Musculoskeletal injury: occurred as a result of participation in an organized intercollegiate • No contact
(2007) G: All females practice or competition and (2) required medical attention by a team certified athletic 54.0% of training injuries
A: College trainer or physician and (3) resulted in restriction of the student-athlete’s participation or 32.7% of match injuries
L: Recreational performance for one or more calendar days beyond the day of injury. • Player contact
D: Cohort (prospective) Registration: annual injury surveillance system 15.0% of training injuries
F: 16 years 30.4% of match injuries
• Other contact
27.0% of match injuries
35.4% of training injuries
• Games injuries
21.1%: injured player coming down
on another player
2.0%: another player coming down
on injured player
6.5%: other contact with another
player
0.8%: contact with standard
20.6%: contact with floor
9.0%: contact with ball
1.0%: contact with out-of-bounds
apparatus
25.8%: no apparent contact
13.0%: unknown
Bahr and Bahr Low N: 273 Musculoskeletal injury: resulted from a sudden event during organized volleyball training or . All injuries: Match vs. training
(1997) G: 130 males, 143 females match, and caused an absence of one or more day of training or match play. Total: RR = 2.3 (P < .001)
A: 21.7–23.1 Registration: reported by coaches Men: RR = 2.7 (P < .01)
L: Amateur Women: RR = 1.9 (P > .05)
D: Cohort (prospective) • All injuries: Men vs. women
F: One season Total: RR = 1.0 (P > .05)
Match: RR = 1.3 (P > .05)
Training: RR = 0.9 (P > .05)
• Ankle injuries: Match vs. training
Total: RR = 2.1 (P < .05)
Men: RR = 3.2 (P < .01)
Women: RR = 0.9 (P > .05)
• Ankle injuries: Men vs. women
Total: RR = 1.2 (P > .05)
Match: RR = 3.5 (P > .05)
Training: RR = 1.0 (P > .05)
Beneka et al. Moderate N: 649 Musculoskeletal injury: occurring during scheduled games or practices that cause an athlete • Total injuries
(2007) G: 318 males, 331 females to miss a subsequent game or practice session. 23.3%: incorrect sprawls
A: 21.99–25.69 Registration: reported by players during interview 10.8%: wrong technique
L: Elite and amateur 24.7%: stepping on others’ feet
D: Cohort (prospective) 8.9%: ball contact
F: One season 23.7%: fatigue
5.4%: inappropriate warm-up
Bere et al. Low N: ? Musculoskeletal complaint: newly incurred during match play and/or training during the • Ankle injuries
(2015) G:males,females event that received medical attention regardless of the consequences with respect to 4.4%: overuse (gradual onset)
A: Junior, senior absence from competition or training. 47.4%: contact with another player
L: Elite Registration: reported by team doctor 3.5%: contact with moving object
D: Cohort (prospective) 2.6%: contact with stagnant object
F: Four years 1.8%: overuse (sudden onset)
3.5%: field of play condition
25.4%: non-contact trauma
5.3%: recurrence of previous injury
1.8%: other
• Knee injuries
20.9%: overuse (gradual onset)
19.4%: contact with another player
1.5%: contact with moving object
9.0%: contact with stagnant object
7.5%: overuse (sudden onset)
1.5%: field of play condition
23.9%: non-contact trauma
11.9%: recurrence of previous injury
3.0%: other
• Finger/thumb injuries
14.9%: contact with another player
76.6%: contact with moving object
2.1%: contact with stagnant object
2.1%: non-contact trauma
19
(Continued)
20
O. Kilic et al.
Table II: Continued.
Rechel et al. Moderate N: ? Musculoskeletal injury: requiring surgery, occurring as a result of an organized volleyball • Competition vs. practice (reference)
(2011) G: All females practice or competition, requiring medical attention by a team athletic trainers or a RR = 3.73 (1.80–7.74)
A: High school physician, and resulting in restriction of the athlete’s participation for one or more days • All injuries:
L: Amateur beyond the day of injury. 47.3: jumping/landing
D: Cohort (prospective) Registration: reported by athletic trainer 13.4%: rotation around planted foot
F: Six years
Robinson et al. Moderate N: ? Shoulder injury: (proximal humerus, scapula, clavicle, comion-clavicular joint, and • Competition vs. practice (reference)
(2014) G: All females surrounding tendons, ligaments, and musculature) occurring as a result of an organized RR = 0.51 (0.31–0.85)
A: High school practice or competition, requiring medical attention by a team athletic trainers or a
L: Amateur physician, and resulting in restriction of the athlete’s participation for one or more days.
D: Cohort (prospective) Registration: reported by athletic trainer
F: Six years
Solgard et al. Moderate N: ? Musculoskeletal injury: occurring during volleyball activities at a sport area, causing the • Arm/shoulder injuries
(1995) G:males,females athlete to consult the casualty wards within 24 hours of the injury. 57%: non-contact jumping
A: 11–45 Registration: reported by player (interview) 21%: contact bruise object
L: Amateur 14%: contact bruise person
D: Cohort (prospective) 7%: acute overwork
F: One years • Hands/fingers injuries
9%: non-contact jumping
81%: contact bruise object
9%: contact bruise person
2%: acute overwork
• Knee injuries
82%: non-contact jumping
18%: acute overwork
• Ankle injuries
79%: non-contact jumping
2%: contact bruise object
9%: contact bruise person
10%: acute overwork
Swenson et al. Moderate N: ? Fracture: occurring as a result of an organized volleyball practice or competition, requiring • Competition vs. practice (reference)
(2010) G: All females medical attention by a team athletic trainers or a physician, and resulting in restriction of RR = 0.84 (0.40–1.77)
A: High school the athlete’s participation for one or more days. • All injuries:
L: Amateur Registration: reported by athletic trainer 32.1%: blocking
D: Cohort (prospective) 15.7%: conditioning
F: Five years 11.7%: digging
11.4%: passing
11.3% general play
Swenson et al. Moderate N: ? Knee injury: occurring as a result of an organized volleyball practice or competition, • Competition vs. practice (reference)
(2013) G:males,females requiring medical attention by a team athletic trainers or a physician, and resulting in Females: RR = 1.75 (1.29–2.38)
A: High school restriction of the athlete’s participation for one or more days. • Males:
L: Amateur Registration: reported by athletic trainer 100%: contact with playing surface
D: Cohort (prospective) • Females:
F: Five years 9.2%: contact with another person
42.9%: no contact
34.4%: contact with playing surface
9.2%: overuse/chronic
Tsigganos et al. Moderate N: 72 (12–14), 109 (15– Musculoskeletal injury: occurring during scheduled games or practices that cause an athlete • All injuries:
(2007) 18), 268 ( > 18) to miss a subsequent game or practice session. 23.3%: incorrect sprawls
G: All males Registration: reported by player (interview) 10.8%: wrong techniques
A: 13.3, 16.1, 26.7 24.7%: step on others’ foot
L: Competitive 8.9%: ball contact
D: Cohort (prospective) 23.7%: fatigue
F: One year 5.4%: inappropriate warm-up
Verhagen et al. Low N: 486 Musculoskeletal injury: occurred as a result of volleyball and caused the subject to stop this • Ankle
(2004) G: 158 males, 261 females activity, or resulted in the subject not participating fully in the next planned sports activity. 28%: contact with teammate
A: 23.8–25.2 Registration: reported by player and coach 31%: contact with opponent
L: Competitive 35%: no contact
D: Cohort (prospective)
F: One year
Visnes and Bahr Low N: 141 Jumper’s knee: a history of pain in the quadriceps or patellar tendons at their patellar • Gender (male) + total training
(2013) G: 69 males, 72 females insertions in connection with training or competition and tenderness to palpation volume
A: 16.8 corresponding to the painful area. Gender: OR = 4.03 (P = .007)
L: Amateur Registration: reported by school physician and physiotherapist Training volume: OR = 1.61 (P
D: Cohort (prospective) = .02)
F: One year • Gender (male) + volleyball training
Gender: OR = 3.65 (P = .01)
Volleyball training:
OR = 1.72 (P = .005)
21
(Continued)
22
Table II: Continued.
O. Kilic et al.
Study Total risk of
information bias Participation and design Injury definition Risk factors and mechanism
de Vries et al. Low N: 295 Patellar tendinopathy: having pain at the inferior pole of the patella and/or diagnosed by a • Gender (ref = female)
(2015) G: 100 males, 195 females physician or physical therapist with patellar tendinopathy. OR = 2.6 (P < .05)
A: 25.1 Registration: reported by player • Age
L: Amateur OR = 1.0 (P > .10)
D: Cohort (prospective) • Height (5 cm increase)
F: Three years OR = 1.3 (P < .05)
• Weight (5 kg increase)
OR = 1.2 (P < .05)
• BMI (5 cm increase)
OR = 1.0 (P > .10)
• Playing level (ref = regional)
OR = 0.4 (P > .10)
• Years playing
OR = 0.9 (P < .10)
• Hours training per week (5 hours
increase)
OR = 1.2 (P > .10)
• Playing surface (ref = vinyl/rubber)
Wood/cork/parquet: OR = 1.1 (P
> .10)
• Training increase compared to last
year (ref = no)
OR = 0.6 (P > .10)
• Other sports (ref = no)
OR = 1.2 (P > .10)
• Hours other sports
OR = 1.2 (P > .10)
• Profession (ref = mentally
demanding work)
Light/mixed physical work: OR = 1.5
(P > .10)
Heavy physical work: OR = 2.3 (P
< .10)
Student/other: OR = 1.7 (P > .10)
• Squatting at work (ref = no)
OR = 1.0 (P > .10)
• Lifting at work (ref = no)
OR = 0.7 (P > .10)
• Jumping at work (ref = no)
OR = 2.4 (P < .05)
Musculoskeletal injuries in volleyball 23
O. Kilic et al.
Study Total risk
information of bias Population Injury definition Preventive programme Outcome
Augustsson Low N: 27 Musculoskeletal injury: occurred as a result of Supervised and individualized resistance training • Baseline season:
et al. (2011) G: All females participating in volleyball, forcing the player to during 26 weeks: Control: 3.8 inj/
A: 16–18 leave the court for the rest of the game/training • familiarization phase during 4 weeks (also for 1000 hours exposure
L: Competitive session and/or leading to an absence from or control group): 70% of 1 RM (15 repetitions), 1 Intervention: 5.3 inj/
D: comparison between reduction in play lasting one day or more. training session/week 1000 hours exposure
groups over two Registration: reported by coach • progression phase 1 during 10 weeks, 80% of 1 13% shoulder; 13% wrist;
subsequent seasons RM (10 repetitions), 1 training/week 47% knee; 13% ankle;
• progression phase 2 during 12 weeks, 90–100% of 13% lower leg
1 RM, 2 training/week • Intervention season:
Control: 3.7 inj/
1000 hours exposure
Intervention: 0 inj/
1000 hours exposure
12% shoulder; 12% thigh;
25% knee; 50% ankle
Cumps et al. Low N: 169 Anterior knee pain: overuse injury that causes physical Twice a week during the practice session in addition • Pre–post-intervention
(2008) G: 91 males, 78 females discomfort in the anterior part of the knee, and to normal training routine: Control: 0.91 (0.38–2.17)
A: ? pain/stiffness of the musculoskeletal system which • month 1: isometric strength in open kinetic chain Intervention: 0.86 (0.46–
L: Competitive has an insidious onset and is present during and/or • month 2: isometric strength in closed kinetic 1.60)
D: comparison between after volleyball activity for at least three volleyball chain
groups over one active days. • month 3: sports-specific skills and plyometrics
season Registration: reported by player • month 4: eccentric load exercise
Verhagen et al. Low N: 1127 Ankle injury: caused the subject to stop his or her • 14 basic proprioceptive exercises on and off a Acute injury:
(2005) G: 483 males, volleyball activity or caused the subject to not fully balance board during 36 weeks (with variations on Control: 0.9 inj/
644females participate in the next planned volleyball activity. each exercise)/exercises using either no material, ball 1000 hours of play
A: 24.2–24.4 Registration: reported by player only, balance board only, or both ball and balance Intervention: 0.5 inj/
L: Amateur board 1000 hours of play
D: comparison between • four exercises a week prescribed to the coach RD = 0.4 (P < .05)
groups over one • to carry out during the warm-up RR = 0.5 (P < .05)
season • gradual increase in intensity
Visnes (2005) Moderate N: 29 Jumper’s knee: a history of pain in the quadriceps or Eccentric training programme on a 25° decline • VISA score:
G: 19 males, 10 females patellar tendons at their patellar insertions in board at home. No significant difference
A: 26.4–26.8 connection with training or competition and • 3 sets of 15 repetitions twice a day between control and
L: Elite and competitive tenderness to palpation corresponding to the • can be done without warm-up intervention (P > .05).
D: comparison between painful area. • eccentric component with the symptomatic leg and • Counter movement
groups over six Registration: reported by clinical physician the concentric component with the asymptomatic jump:
months leg Improvement of 1.2 cm
• two seconds for each eccentric component in the intervention group
(P < .05).
Notes: N, number; G, gender; A, age; L, level of play; D, design; inj, injuries; RR, relative risk; RD, risk difference.
Musculoskeletal injuries in volleyball 25
among young and adult footballers (Bizzini & Dvorak, injury rates, such as injuries per 1000 hours per
2015). The FIFA11+ is based on several exercises that player (Bahr & Bahr, 1997; Bere et al., 2015; Verhagen
are embedded within the warming up (Bizzini & et al., 2004, 2005), injuries per 1000 hours exposure
Dvorak, 2015). Several randomised controlled trials (Augustsson et al., 2011; Bahr et al., 2003; Vauhnik
have shown that the FIFA11+ was effective in redu- et al., 2011), injuries per 10,000 exposures (de Loes
cing the occurrence of overall and lower-limb injury et al., 2000) and injuries per 1000 athlete exposures
rates among both young and adult footballers (by up (Barber Foss et al., 2014). Ideally, all studies should
to 50%) (Bizzini & Dvorak, 2015). use the same descriptive injury rates to enable studies
In the Netherlands, an integral evidence-based and their results to be compared with each other.
intervention (more than 50 exercises; age- and A potential limitation worth mentioning is that we
gender-specific) was developed to prevent musculos- did not include studies based on a cross-sectional or
keletal injuries in the lower limbs among youth/adult retrospective design. We are aware that these studies
hockey players (Gouttebarge & Zuidema, 2017). might be largely published in the scientific literature
While an effect study is ongoing at the present time, but we chose to focus exclusively on high-quality
this warming-up programme had a moderate effect studies in order to formulate valid answers to our
on the level of knowledge and skills of hockey research questions. With regard to the use of a
coaches/trainers about injury prevention. Analo- highly sensitive search strategy and the screening of
gously, a similar approach could be relevant in volley- the references of included studies and/or retrieved lit-
ball and an integral preventive programme embedded erature reviews, we remain confident that our review
in the warming up might prevent the occurrence of presents a thorough overview of the available scienti-
shoulder, knee and ankle injuries. fic literature related to the incidence, aetiology and
Furthermore, it is unusual that there is no high- prevention of musculoskeletal injuries in volleyball.
quality data concerning the prevalence of volleyball
overuse injuries. However, although, overuse injuries
Implications for practice and further research
occur gradually and players continue to play with
pain, there should be data about the prevalence of Our findings show that three different volleyball-
volleyball injuries. Also some studies presented specific preventive strategies have a significant effect
other volleyball-specific injuries than ankle, knee on musculoskeletal volleyball injuries. This means
and shoulder injuries. We were not able to include that effective preventive strategies are of great impor-
these ‘other injuries’ in our results as these injuries tance to reduce the numbers of musculoskeletal inju-
were presented in studies that were scored moderate. ries in volleyball. Even though shoulder injuries are
More high-quality volleyball-specific studies need to also a common injury in volleyball, no volleyball-
be done on the incidence, prevalence, aetiology and specific preventive measures seem available for the pre-
eventually preventive strategies of these injuries. vention of shoulder injuries, as can be seen in Figure 1.
The same applies for shoulder injuries. As knee and ankle injuries are not the only injuries
Since preventive measures that are represented in occurring in volleyball, more high-quality aetiological
this review are shown to have a significant effect studies concerning preventive strategies regarding
(for knee and ankle injuries), we hypothesize that vol- other volleyball-specific musculoskeletal injuries,
leyball-specific research concerning preventive strat- especially shoulder injuries, are needed. In order to
egies against other injuries, will also show a develop effective preventive strategies for volleyball-
significant effect. The same hypothesis applies for specific injuries, such as volleyball-specific shoulder
volleyball-specific studies on preventive strategies injuries, more data about the aetiology of these injuries
against shoulder injuries. is needed. As can be seen in Figure 1, a lack of volley-
ball-specific high-quality studies concerning the aetiol-
ogy in shoulder injuries persists and should be a focus
Methodological aspect
for future studies. Subsequently, volleyball-specific
In our systematic review, no study was scored with a preventive strategies regarding these injuries should
high risk of bias. All the studies were scored with be developed and researched in effect studies, after
moderate or low risk of bias. Only the articles with which proper strategies, about implementing these
a low risk of bias were used for the results to maintain preventive programmes, should be chosen. In Appen-
the highest quality as possible. Unfortunately, most of dix 3 wherein the scores of the risk of bias assessment
the studies were scored moderate and thus a major can be found, can be seen that most studies score mod-
part of the found studies are not represented in the erate especially on the items attribution (23 of 30),
results. It was hard to compare and represent the confounding (16 of 30) and participation (13 of 30).
findings in one figure or as one result, since different In order to improve the quality especially these items
studies reported the outcome in different descriptive should be a focus for future studies.
26 O. Kilic et al.
Agel et al. (2007) Low Moderate N/a Low Moderate Low Moderate
Bahr and Bahr (1997) Low Moderate Low Low Moderate Low Low
Bahr et al. (2003) Low Low N/a Low N/a Low Low
Barber Foss et al. (2014) Low Low N/a Low N/a Low Low
Beneka et al. (2007) Low Moderate Moderate Moderate Moderate Moderate Moderate
Beneka et al. (2009) Low Moderate N/a Moderate N/a Moderate Moderate
Bere et al. (2015) Low Low Low Low Moderate Moderate Low
Beynnon et al. (2014) Low Low N/a Moderate N/a Moderate Moderate
Bonza et al. (2009) Moderate Moderate N/a Low N/a Low Moderate
de Loes et al. (2000) Moderate Low N/a Low N/a Low Low
Fernandez et al. (2007) Moderate Moderate N/a Low N/a Low Moderate
Junge et al. (2006) Moderate Low N/a Low N/a Low Low
Kujala et al. (1995) Moderate Moderate N/a Low N/a Low Moderate
Lanese et al. (1990) Moderate Moderate Moderate Low Moderate Low Moderate
Malliou et al. (2008) Low Moderate Low Moderate Moderate Low Moderate
Nelson et al. (2007) Moderate Moderate Moderate Low Moderate Low Moderate
Rechel et al. (2008) Moderate Moderate Moderate Low Moderate Moderate Moderate
Rechel et al. (2011) Moderate Moderate Moderate Low Moderate Low Moderate
Reeser et al. (2015) Moderate Moderate N/a Low N/a Low Moderate
Robinson et al. (2014) Moderate Moderate Moderate Low Moderate Low Moderate
Solgard et al. (1995) Low Moderate Low Moderate Moderate Low Moderate
Swenson et al. (2010) Moderate Moderate Low Low Moderate Low Moderate
Swenson et al. (2013) Moderate Moderate Low Low Moderate Low Moderate
Tsigganos et al. (2007) Low Moderate Low Moderate Moderate Low Moderate
Vauhnik et al .(2011) Low Moderate N/a Low N/a Low Low
Verhagen et al. (2004) Low Moderate Low Moderate Low Low Low
Wan g and Cochrane (2001) Low Moderate Moderate Low Moderate Low Moderate
Zetou et al. (2006) Low Moderate N/a Moderate N/a Moderate Moderate
Aetiology of volleyball injuries
Agel et al. (2007) Low Moderate N/a Low Moderate Low Moderate
Bahr and Bahr (1997) Low Moderate Low Low Moderate Low Low
Beneka et al. (2007) Low Moderate Moderate Moderate Moderate Moderate Moderate
Bere et al. (2015) Low Low Low Low Moderate Moderate Low
Malliou et al. (2008) Low Moderate Low Moderate Moderate Low Moderate
Rechel et al. (2008) Moderate Moderate Moderate Low Moderate Moderate Moderate
Rechel et al. (2011) Moderate Moderate Moderate Low Moderate Low Moderate
Robinson et al. (2014) Moderate Moderate Moderate Low Moderate Low Moderate
Solgard et al. (1995) Low Moderate Low Moderate Moderate Low Moderate
Swenson et al. (2010) Moderate Moderate Low Low Moderate Low Moderate
Swenson et al. (2013) Moderate Moderate Low Low Moderate Low Moderate
Tsigganos et al. (2007) Low Moderate Low Moderate Moderate Low Moderate
Verhagen et al. (2004) Low Moderate Low Moderate Low Low Low
Visnes (2013) Low Low Low Low Moderate Low Low
de Vries et al. (2015) Low Moderate Low Moderate Low Low Low
Wang (2001) Low Moderate Moderate Low Moderate Low Moderate
Prevention of volleyball injuries
Study Sequence Allocation Blinding Incomplete Selective Other Total risk of bias
Augustsson et al. (2011) 1 1 0 1 1 1 Low
Cumps (2008) 1 1 0 1 1 1 Low
Verhagen et al. (2005) 1 1 0 1 1 1 Low
Visnes (2005) 1 1 0 0 1 1 Moderate