Understanding The Cause Of Injuries

A while ago I wrote about the real causes of fatigue for volleyball players, especially those causes that are not related to simple load (ie jumps). To recap, the number of jumps that a volleyball player does during practice is one, but only one, part of the total load that creates fatigue.

The reason that fatigue is of interest to volleyball coaches is the fatigue is one of the major precursors of injuries. But just as jumps / load is only a small part of the total fatigue for players, fatigue makes only a small contribution to the conditions that lead to injuries. Here is a short list…
Fatigue: This is a multi faceted concept that I have explained here.
Strength and Conditioning: The physical condition of players is a huge contributor to injuries. For volleyball, the most important of those factors is strength. Volleyball is enormously stressful on the skeleton and joints. The musculature must be correctly developed to effectively protect the joints. Specific prevention exercises are a big part of this, with the core being the obvious example. Other non specific conditioning, ie everything that is not strength training and not volleyball, is more or less a waste of time and effort.
Training: Training is one of the venues of strength and conditioning training and one of the causes of fatigue. Over and above that, the structure of training, for example how intensity builds (or doesn’t) over the course of practice impacts the stress load on the joints. In addition, a lot of acute injuries, eg ankle sprains, are caused by lack of attention in practice. The training environment that allows lack of attention creates an environment that causes injury.
Recovery Modalities: There has been a lot of time and effort expended in this area. Modalities such as ice treatment, stretching, various water activities etc etc are nice. However, I suspect it is the least important of all the areas that are listed here.
Physio: The physio (as the representative of the medical staff) is absolutely essential in preventing and minimising injuries. At the simplest level, a tight ITB if caught at the right moment can be fixed with a single physio treatment. If it isn’t, it leads to pain and potentially significant injury. The relationship between the physio and the players and the physio and coach is also important. Players have to know that they will be treated well. Coaches have to trust and have trust in the physio’s work and recommendations. I was once asked what is the most important for minimising injury. My reply was ‘The coach has to listen to the physio’.
Health Status: Obvious sick people have greater fatigue and are therefore at risk of injury (and more serious illness). Players who are returning from illness are also at greater injury risk, more often back injuries and especially those with a history of back problems. Presumably the prescribed inactivity impacts the fine musculature and control of the core.
Psychological State: In my very first year in Europe, the coach I was working with told me that players are injured because they want to be. I thought this was the dumbest thing I have ever heard. He was a bit of a hippy and went on to explain very briefly the theories of Louise Hay, which I then read into*. Whether or not there is any truth there, I do know with certainty that stress has a myriad of negative effects on the body, including impacting attention, focus and concentration, and that bad teams very often have more injuries than top teams.

In the same way that jumping is only a tiny component of the ultimate training load, so prevention exercises are only a tiny component of injury prevention. Coaching is just like life, both are frustratingly complicated and focusing on small details may provide comfort, but doesn’t really help very much.

*Her basic idea is that illness has a psychological cause (usually some stress of some kind) and by finding and treating that cause you can cure the illness.

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