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A COMPARISON OF KNEE INJURIES AMONG MEN
AND WOMEN VOLLEYBALL PLAYERS IN HONG KONG
YU NOK TING
14686244
(DR ROSETTA MUI)
25th April2016
HONG KONG BAPTIST UNIVERSITY LIBRARY
Honours Project Release Form
Thesis Title A Comparison of Knee Injuries Among Men and Women
Volleyball Players in Hong Kong
Author
Yu Nok Ting
Student No
14686244
Department
Physical Education
Programme
Bachelor of Social Science in Sports and Recreation Leadership
Declaration
I agree that the full text of my thesis may be consulted by the HKBU community
users in print version in the Hong Kong Baptist University Library according to the
circulation regulations currently in force All Rights are reserved and governed by the
Hong Kong Copyright Ordinance
Signature of Author Date 25th April 2016
HONG KONG BAPTIST UNIVESITY
25th APRIL 2016
We hereby recommend that the Independent Project by Ms Yu Nok Ting entitled
ldquoA COMPARISON OF KNEE INJURIES AMONG MEN AND WOMEN
VOLLEYBALL PLAYERS IN HONG KONGrdquo be accepted in partial fulfillment of
the requirement for the Bachelor of Social Science in Sports and Recreation
Leadership
DR ROSETTA MUI
Chief Advisor
DECLARATION
I hereby declare that this honours project ldquoA COMPARISON OF KNEE
INJURIES AMONG MEN AND WOMEN VOLLEYBALL PLAYERS IN HONG
KONGrdquo represents my own work and had not been previously submitted to this or
other institution for a degree diploma or other qualification Citations from the other
authors were listed in the references
_____________________________
Yu Nok Ting
25th APRIL2016
ACKNOWLEDGEMENTS
I would like to express my deepest gratitude to my supervisor Dr Rosetta Mui
for guiding and supporting me throughout the entire study Last but not the least I
would like to thank the participants and the coachers My project would have not been
conducted smoothly without their participation and supports
_____________________________
Yu Nok Ting
Department of Physical Education
Hong Kong Baptist University
Date 25th APRIL2016
ABSTRACT
AIMS This cross-sectional study aimed to examine the incidence rate and risk
factors among a sample of men and women volleyball player in Hong Kong
METHODS Members form university volleyball team volleyball club of
Division I and Hong Kong volleyball team were invited to participate into this study
Participants reported on the habit of volleyball training and knee injuries suffered
within the past one year IBM SPSS statistics 21 was used for data analysis
Chi-square test was performed to test between group differences of categorical
variables
RESULTS A total of 142 players aged 14-30 years (70 men 72 women) were
invited and all of them participated into the study with a participation rate of 1000
The overall incidence rate of knee injures within the past one year was 627 Most of
the knee injuries were minor (ie overuse injury) Women were more likely to suffer
from ACL tear injury than their counterparts (737 vs 263 p=0031) There was
significance difference in the amount of time for fitness training and weight training
between injured and non-injured players (p=0002 p=0005)
CONCLUSIONS Most of the injured players suffered from overuse injury It
was hard to prevent due to the sport nature of volleyball The amount of time spent in
fitness and weight training is significance factor to reduce the risk of getting knee
injuries Future research in a large-scaled sample should be conducted to confirm the
findings In addition preventive measures should be implement to prevent and reduce
the incidence rate of knee injuries among Hong Kong volleyball players
Keywords Knee injuries volleyball players Hong Kong
TABLE OF CONTENTS
CHAPTER Page
1 INTRODUCTIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1
Statement of Problemhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip3
Study Aims and Objectiveshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4
Hypothesishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 LITERATURE REVIEWhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Knee Injuries in Volleyballhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Gender difference in the knee injuries in volleyball helliphelliphelliphelliphelliphelliphelliphelliphellip8
Anterior cruciate ligament (ACL) injuries in volleyballhelliphelliphelliphelliphelliphelliphellip9
Summaryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip12
3 METHODShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Subject and Samplinghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Measurementshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Data Collection Procedureshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
Data Analysishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip16
Timeline of the Projecthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
4 RESULTShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip18
Demographic Informationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
Regular Training of Injured Players and Non-Injured Playershelliphelliphellip24
Fitness Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip27
Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip29
Warm Up and Cool Down Patterns of Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphellip31
Categories of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip35
Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
Rehabilitation of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
5 DISCUSSION AND CONCLUSIONShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Knee Injuries of Men and Women Volleyball Playershelliphelliphelliphelliphelliphelliphelliphellip43
Fitness Training and Weight Traininghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
Warm Up and Cool Down Patterns of the Playershelliphelliphelliphelliphelliphelliphelliphelliphellip45
Patterns of Knee Injuries of the Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip46
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip47
Treatments of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Recovery Timehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Prevention of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Summary of Resultshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip52
Conclusionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Recommendations for Future Studieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip57
REFERENCEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip59
APPENDICEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
Questionnairehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
HONG KONG BAPTIST UNIVERSITY LIBRARY
Honours Project Release Form
Thesis Title A Comparison of Knee Injuries Among Men and Women
Volleyball Players in Hong Kong
Author
Yu Nok Ting
Student No
14686244
Department
Physical Education
Programme
Bachelor of Social Science in Sports and Recreation Leadership
Declaration
I agree that the full text of my thesis may be consulted by the HKBU community
users in print version in the Hong Kong Baptist University Library according to the
circulation regulations currently in force All Rights are reserved and governed by the
Hong Kong Copyright Ordinance
Signature of Author Date 25th April 2016
HONG KONG BAPTIST UNIVESITY
25th APRIL 2016
We hereby recommend that the Independent Project by Ms Yu Nok Ting entitled
ldquoA COMPARISON OF KNEE INJURIES AMONG MEN AND WOMEN
VOLLEYBALL PLAYERS IN HONG KONGrdquo be accepted in partial fulfillment of
the requirement for the Bachelor of Social Science in Sports and Recreation
Leadership
DR ROSETTA MUI
Chief Advisor
DECLARATION
I hereby declare that this honours project ldquoA COMPARISON OF KNEE
INJURIES AMONG MEN AND WOMEN VOLLEYBALL PLAYERS IN HONG
KONGrdquo represents my own work and had not been previously submitted to this or
other institution for a degree diploma or other qualification Citations from the other
authors were listed in the references
_____________________________
Yu Nok Ting
25th APRIL2016
ACKNOWLEDGEMENTS
I would like to express my deepest gratitude to my supervisor Dr Rosetta Mui
for guiding and supporting me throughout the entire study Last but not the least I
would like to thank the participants and the coachers My project would have not been
conducted smoothly without their participation and supports
_____________________________
Yu Nok Ting
Department of Physical Education
Hong Kong Baptist University
Date 25th APRIL2016
ABSTRACT
AIMS This cross-sectional study aimed to examine the incidence rate and risk
factors among a sample of men and women volleyball player in Hong Kong
METHODS Members form university volleyball team volleyball club of
Division I and Hong Kong volleyball team were invited to participate into this study
Participants reported on the habit of volleyball training and knee injuries suffered
within the past one year IBM SPSS statistics 21 was used for data analysis
Chi-square test was performed to test between group differences of categorical
variables
RESULTS A total of 142 players aged 14-30 years (70 men 72 women) were
invited and all of them participated into the study with a participation rate of 1000
The overall incidence rate of knee injures within the past one year was 627 Most of
the knee injuries were minor (ie overuse injury) Women were more likely to suffer
from ACL tear injury than their counterparts (737 vs 263 p=0031) There was
significance difference in the amount of time for fitness training and weight training
between injured and non-injured players (p=0002 p=0005)
CONCLUSIONS Most of the injured players suffered from overuse injury It
was hard to prevent due to the sport nature of volleyball The amount of time spent in
fitness and weight training is significance factor to reduce the risk of getting knee
injuries Future research in a large-scaled sample should be conducted to confirm the
findings In addition preventive measures should be implement to prevent and reduce
the incidence rate of knee injuries among Hong Kong volleyball players
Keywords Knee injuries volleyball players Hong Kong
TABLE OF CONTENTS
CHAPTER Page
1 INTRODUCTIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1
Statement of Problemhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip3
Study Aims and Objectiveshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4
Hypothesishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 LITERATURE REVIEWhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Knee Injuries in Volleyballhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Gender difference in the knee injuries in volleyball helliphelliphelliphelliphelliphelliphelliphelliphellip8
Anterior cruciate ligament (ACL) injuries in volleyballhelliphelliphelliphelliphelliphelliphellip9
Summaryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip12
3 METHODShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Subject and Samplinghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Measurementshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Data Collection Procedureshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
Data Analysishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip16
Timeline of the Projecthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
4 RESULTShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip18
Demographic Informationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
Regular Training of Injured Players and Non-Injured Playershelliphelliphellip24
Fitness Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip27
Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip29
Warm Up and Cool Down Patterns of Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphellip31
Categories of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip35
Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
Rehabilitation of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
5 DISCUSSION AND CONCLUSIONShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Knee Injuries of Men and Women Volleyball Playershelliphelliphelliphelliphelliphelliphelliphellip43
Fitness Training and Weight Traininghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
Warm Up and Cool Down Patterns of the Playershelliphelliphelliphelliphelliphelliphelliphelliphellip45
Patterns of Knee Injuries of the Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip46
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip47
Treatments of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Recovery Timehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Prevention of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Summary of Resultshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip52
Conclusionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Recommendations for Future Studieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip57
REFERENCEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip59
APPENDICEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
Questionnairehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
HONG KONG BAPTIST UNIVESITY
25th APRIL 2016
We hereby recommend that the Independent Project by Ms Yu Nok Ting entitled
ldquoA COMPARISON OF KNEE INJURIES AMONG MEN AND WOMEN
VOLLEYBALL PLAYERS IN HONG KONGrdquo be accepted in partial fulfillment of
the requirement for the Bachelor of Social Science in Sports and Recreation
Leadership
DR ROSETTA MUI
Chief Advisor
DECLARATION
I hereby declare that this honours project ldquoA COMPARISON OF KNEE
INJURIES AMONG MEN AND WOMEN VOLLEYBALL PLAYERS IN HONG
KONGrdquo represents my own work and had not been previously submitted to this or
other institution for a degree diploma or other qualification Citations from the other
authors were listed in the references
_____________________________
Yu Nok Ting
25th APRIL2016
ACKNOWLEDGEMENTS
I would like to express my deepest gratitude to my supervisor Dr Rosetta Mui
for guiding and supporting me throughout the entire study Last but not the least I
would like to thank the participants and the coachers My project would have not been
conducted smoothly without their participation and supports
_____________________________
Yu Nok Ting
Department of Physical Education
Hong Kong Baptist University
Date 25th APRIL2016
ABSTRACT
AIMS This cross-sectional study aimed to examine the incidence rate and risk
factors among a sample of men and women volleyball player in Hong Kong
METHODS Members form university volleyball team volleyball club of
Division I and Hong Kong volleyball team were invited to participate into this study
Participants reported on the habit of volleyball training and knee injuries suffered
within the past one year IBM SPSS statistics 21 was used for data analysis
Chi-square test was performed to test between group differences of categorical
variables
RESULTS A total of 142 players aged 14-30 years (70 men 72 women) were
invited and all of them participated into the study with a participation rate of 1000
The overall incidence rate of knee injures within the past one year was 627 Most of
the knee injuries were minor (ie overuse injury) Women were more likely to suffer
from ACL tear injury than their counterparts (737 vs 263 p=0031) There was
significance difference in the amount of time for fitness training and weight training
between injured and non-injured players (p=0002 p=0005)
CONCLUSIONS Most of the injured players suffered from overuse injury It
was hard to prevent due to the sport nature of volleyball The amount of time spent in
fitness and weight training is significance factor to reduce the risk of getting knee
injuries Future research in a large-scaled sample should be conducted to confirm the
findings In addition preventive measures should be implement to prevent and reduce
the incidence rate of knee injuries among Hong Kong volleyball players
Keywords Knee injuries volleyball players Hong Kong
TABLE OF CONTENTS
CHAPTER Page
1 INTRODUCTIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1
Statement of Problemhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip3
Study Aims and Objectiveshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4
Hypothesishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 LITERATURE REVIEWhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Knee Injuries in Volleyballhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Gender difference in the knee injuries in volleyball helliphelliphelliphelliphelliphelliphelliphelliphellip8
Anterior cruciate ligament (ACL) injuries in volleyballhelliphelliphelliphelliphelliphelliphellip9
Summaryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip12
3 METHODShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Subject and Samplinghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Measurementshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Data Collection Procedureshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
Data Analysishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip16
Timeline of the Projecthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
4 RESULTShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip18
Demographic Informationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
Regular Training of Injured Players and Non-Injured Playershelliphelliphellip24
Fitness Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip27
Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip29
Warm Up and Cool Down Patterns of Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphellip31
Categories of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip35
Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
Rehabilitation of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
5 DISCUSSION AND CONCLUSIONShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Knee Injuries of Men and Women Volleyball Playershelliphelliphelliphelliphelliphelliphelliphellip43
Fitness Training and Weight Traininghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
Warm Up and Cool Down Patterns of the Playershelliphelliphelliphelliphelliphelliphelliphelliphellip45
Patterns of Knee Injuries of the Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip46
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip47
Treatments of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Recovery Timehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Prevention of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Summary of Resultshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip52
Conclusionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Recommendations for Future Studieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip57
REFERENCEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip59
APPENDICEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
Questionnairehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
DECLARATION
I hereby declare that this honours project ldquoA COMPARISON OF KNEE
INJURIES AMONG MEN AND WOMEN VOLLEYBALL PLAYERS IN HONG
KONGrdquo represents my own work and had not been previously submitted to this or
other institution for a degree diploma or other qualification Citations from the other
authors were listed in the references
_____________________________
Yu Nok Ting
25th APRIL2016
ACKNOWLEDGEMENTS
I would like to express my deepest gratitude to my supervisor Dr Rosetta Mui
for guiding and supporting me throughout the entire study Last but not the least I
would like to thank the participants and the coachers My project would have not been
conducted smoothly without their participation and supports
_____________________________
Yu Nok Ting
Department of Physical Education
Hong Kong Baptist University
Date 25th APRIL2016
ABSTRACT
AIMS This cross-sectional study aimed to examine the incidence rate and risk
factors among a sample of men and women volleyball player in Hong Kong
METHODS Members form university volleyball team volleyball club of
Division I and Hong Kong volleyball team were invited to participate into this study
Participants reported on the habit of volleyball training and knee injuries suffered
within the past one year IBM SPSS statistics 21 was used for data analysis
Chi-square test was performed to test between group differences of categorical
variables
RESULTS A total of 142 players aged 14-30 years (70 men 72 women) were
invited and all of them participated into the study with a participation rate of 1000
The overall incidence rate of knee injures within the past one year was 627 Most of
the knee injuries were minor (ie overuse injury) Women were more likely to suffer
from ACL tear injury than their counterparts (737 vs 263 p=0031) There was
significance difference in the amount of time for fitness training and weight training
between injured and non-injured players (p=0002 p=0005)
CONCLUSIONS Most of the injured players suffered from overuse injury It
was hard to prevent due to the sport nature of volleyball The amount of time spent in
fitness and weight training is significance factor to reduce the risk of getting knee
injuries Future research in a large-scaled sample should be conducted to confirm the
findings In addition preventive measures should be implement to prevent and reduce
the incidence rate of knee injuries among Hong Kong volleyball players
Keywords Knee injuries volleyball players Hong Kong
TABLE OF CONTENTS
CHAPTER Page
1 INTRODUCTIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1
Statement of Problemhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip3
Study Aims and Objectiveshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4
Hypothesishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 LITERATURE REVIEWhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Knee Injuries in Volleyballhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Gender difference in the knee injuries in volleyball helliphelliphelliphelliphelliphelliphelliphelliphellip8
Anterior cruciate ligament (ACL) injuries in volleyballhelliphelliphelliphelliphelliphelliphellip9
Summaryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip12
3 METHODShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Subject and Samplinghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Measurementshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Data Collection Procedureshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
Data Analysishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip16
Timeline of the Projecthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
4 RESULTShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip18
Demographic Informationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
Regular Training of Injured Players and Non-Injured Playershelliphelliphellip24
Fitness Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip27
Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip29
Warm Up and Cool Down Patterns of Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphellip31
Categories of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip35
Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
Rehabilitation of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
5 DISCUSSION AND CONCLUSIONShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Knee Injuries of Men and Women Volleyball Playershelliphelliphelliphelliphelliphelliphelliphellip43
Fitness Training and Weight Traininghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
Warm Up and Cool Down Patterns of the Playershelliphelliphelliphelliphelliphelliphelliphelliphellip45
Patterns of Knee Injuries of the Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip46
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip47
Treatments of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Recovery Timehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Prevention of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Summary of Resultshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip52
Conclusionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Recommendations for Future Studieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip57
REFERENCEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip59
APPENDICEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
Questionnairehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
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66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
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Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
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1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
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doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
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60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
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Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
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Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
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Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
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Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
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Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
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Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
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Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
ACKNOWLEDGEMENTS
I would like to express my deepest gratitude to my supervisor Dr Rosetta Mui
for guiding and supporting me throughout the entire study Last but not the least I
would like to thank the participants and the coachers My project would have not been
conducted smoothly without their participation and supports
_____________________________
Yu Nok Ting
Department of Physical Education
Hong Kong Baptist University
Date 25th APRIL2016
ABSTRACT
AIMS This cross-sectional study aimed to examine the incidence rate and risk
factors among a sample of men and women volleyball player in Hong Kong
METHODS Members form university volleyball team volleyball club of
Division I and Hong Kong volleyball team were invited to participate into this study
Participants reported on the habit of volleyball training and knee injuries suffered
within the past one year IBM SPSS statistics 21 was used for data analysis
Chi-square test was performed to test between group differences of categorical
variables
RESULTS A total of 142 players aged 14-30 years (70 men 72 women) were
invited and all of them participated into the study with a participation rate of 1000
The overall incidence rate of knee injures within the past one year was 627 Most of
the knee injuries were minor (ie overuse injury) Women were more likely to suffer
from ACL tear injury than their counterparts (737 vs 263 p=0031) There was
significance difference in the amount of time for fitness training and weight training
between injured and non-injured players (p=0002 p=0005)
CONCLUSIONS Most of the injured players suffered from overuse injury It
was hard to prevent due to the sport nature of volleyball The amount of time spent in
fitness and weight training is significance factor to reduce the risk of getting knee
injuries Future research in a large-scaled sample should be conducted to confirm the
findings In addition preventive measures should be implement to prevent and reduce
the incidence rate of knee injuries among Hong Kong volleyball players
Keywords Knee injuries volleyball players Hong Kong
TABLE OF CONTENTS
CHAPTER Page
1 INTRODUCTIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1
Statement of Problemhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip3
Study Aims and Objectiveshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4
Hypothesishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 LITERATURE REVIEWhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Knee Injuries in Volleyballhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Gender difference in the knee injuries in volleyball helliphelliphelliphelliphelliphelliphelliphelliphellip8
Anterior cruciate ligament (ACL) injuries in volleyballhelliphelliphelliphelliphelliphelliphellip9
Summaryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip12
3 METHODShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Subject and Samplinghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Measurementshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Data Collection Procedureshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
Data Analysishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip16
Timeline of the Projecthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
4 RESULTShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip18
Demographic Informationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
Regular Training of Injured Players and Non-Injured Playershelliphelliphellip24
Fitness Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip27
Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip29
Warm Up and Cool Down Patterns of Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphellip31
Categories of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip35
Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
Rehabilitation of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
5 DISCUSSION AND CONCLUSIONShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Knee Injuries of Men and Women Volleyball Playershelliphelliphelliphelliphelliphelliphelliphellip43
Fitness Training and Weight Traininghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
Warm Up and Cool Down Patterns of the Playershelliphelliphelliphelliphelliphelliphelliphelliphellip45
Patterns of Knee Injuries of the Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip46
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip47
Treatments of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Recovery Timehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Prevention of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Summary of Resultshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip52
Conclusionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Recommendations for Future Studieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip57
REFERENCEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip59
APPENDICEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
Questionnairehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
ABSTRACT
AIMS This cross-sectional study aimed to examine the incidence rate and risk
factors among a sample of men and women volleyball player in Hong Kong
METHODS Members form university volleyball team volleyball club of
Division I and Hong Kong volleyball team were invited to participate into this study
Participants reported on the habit of volleyball training and knee injuries suffered
within the past one year IBM SPSS statistics 21 was used for data analysis
Chi-square test was performed to test between group differences of categorical
variables
RESULTS A total of 142 players aged 14-30 years (70 men 72 women) were
invited and all of them participated into the study with a participation rate of 1000
The overall incidence rate of knee injures within the past one year was 627 Most of
the knee injuries were minor (ie overuse injury) Women were more likely to suffer
from ACL tear injury than their counterparts (737 vs 263 p=0031) There was
significance difference in the amount of time for fitness training and weight training
between injured and non-injured players (p=0002 p=0005)
CONCLUSIONS Most of the injured players suffered from overuse injury It
was hard to prevent due to the sport nature of volleyball The amount of time spent in
fitness and weight training is significance factor to reduce the risk of getting knee
injuries Future research in a large-scaled sample should be conducted to confirm the
findings In addition preventive measures should be implement to prevent and reduce
the incidence rate of knee injuries among Hong Kong volleyball players
Keywords Knee injuries volleyball players Hong Kong
TABLE OF CONTENTS
CHAPTER Page
1 INTRODUCTIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1
Statement of Problemhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip3
Study Aims and Objectiveshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4
Hypothesishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 LITERATURE REVIEWhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Knee Injuries in Volleyballhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Gender difference in the knee injuries in volleyball helliphelliphelliphelliphelliphelliphelliphelliphellip8
Anterior cruciate ligament (ACL) injuries in volleyballhelliphelliphelliphelliphelliphelliphellip9
Summaryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip12
3 METHODShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Subject and Samplinghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Measurementshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Data Collection Procedureshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
Data Analysishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip16
Timeline of the Projecthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
4 RESULTShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip18
Demographic Informationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
Regular Training of Injured Players and Non-Injured Playershelliphelliphellip24
Fitness Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip27
Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip29
Warm Up and Cool Down Patterns of Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphellip31
Categories of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip35
Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
Rehabilitation of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
5 DISCUSSION AND CONCLUSIONShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Knee Injuries of Men and Women Volleyball Playershelliphelliphelliphelliphelliphelliphelliphellip43
Fitness Training and Weight Traininghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
Warm Up and Cool Down Patterns of the Playershelliphelliphelliphelliphelliphelliphelliphelliphellip45
Patterns of Knee Injuries of the Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip46
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip47
Treatments of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Recovery Timehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Prevention of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Summary of Resultshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip52
Conclusionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Recommendations for Future Studieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip57
REFERENCEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip59
APPENDICEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
Questionnairehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
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66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
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Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
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Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
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doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
was hard to prevent due to the sport nature of volleyball The amount of time spent in
fitness and weight training is significance factor to reduce the risk of getting knee
injuries Future research in a large-scaled sample should be conducted to confirm the
findings In addition preventive measures should be implement to prevent and reduce
the incidence rate of knee injuries among Hong Kong volleyball players
Keywords Knee injuries volleyball players Hong Kong
TABLE OF CONTENTS
CHAPTER Page
1 INTRODUCTIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1
Statement of Problemhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip3
Study Aims and Objectiveshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4
Hypothesishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 LITERATURE REVIEWhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Knee Injuries in Volleyballhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Gender difference in the knee injuries in volleyball helliphelliphelliphelliphelliphelliphelliphelliphellip8
Anterior cruciate ligament (ACL) injuries in volleyballhelliphelliphelliphelliphelliphelliphellip9
Summaryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip12
3 METHODShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Subject and Samplinghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Measurementshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Data Collection Procedureshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
Data Analysishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip16
Timeline of the Projecthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
4 RESULTShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip18
Demographic Informationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
Regular Training of Injured Players and Non-Injured Playershelliphelliphellip24
Fitness Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip27
Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip29
Warm Up and Cool Down Patterns of Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphellip31
Categories of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip35
Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
Rehabilitation of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
5 DISCUSSION AND CONCLUSIONShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Knee Injuries of Men and Women Volleyball Playershelliphelliphelliphelliphelliphelliphelliphellip43
Fitness Training and Weight Traininghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
Warm Up and Cool Down Patterns of the Playershelliphelliphelliphelliphelliphelliphelliphelliphellip45
Patterns of Knee Injuries of the Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip46
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip47
Treatments of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Recovery Timehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Prevention of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Summary of Resultshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip52
Conclusionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Recommendations for Future Studieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip57
REFERENCEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip59
APPENDICEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
Questionnairehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
TABLE OF CONTENTS
CHAPTER Page
1 INTRODUCTIONhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1
Statement of Problemhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip3
Study Aims and Objectiveshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4
Hypothesishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5
2 LITERATURE REVIEWhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Knee Injuries in Volleyballhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6
Gender difference in the knee injuries in volleyball helliphelliphelliphelliphelliphelliphelliphelliphellip8
Anterior cruciate ligament (ACL) injuries in volleyballhelliphelliphelliphelliphelliphelliphellip9
Summaryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip12
3 METHODShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Subject and Samplinghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Measurementshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip14
Data Collection Procedureshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip15
Data Analysishelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip16
Timeline of the Projecthelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip17
4 RESULTShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip18
Demographic Informationhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip20
Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
Regular Training of Injured Players and Non-Injured Playershelliphelliphellip24
Fitness Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip27
Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphellip29
Warm Up and Cool Down Patterns of Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphellip31
Categories of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip35
Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
Rehabilitation of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
5 DISCUSSION AND CONCLUSIONShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Knee Injuries of Men and Women Volleyball Playershelliphelliphelliphelliphelliphelliphelliphellip43
Fitness Training and Weight Traininghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
Warm Up and Cool Down Patterns of the Playershelliphelliphelliphelliphelliphelliphelliphelliphellip45
Patterns of Knee Injuries of the Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip46
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip47
Treatments of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Recovery Timehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Prevention of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Summary of Resultshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip52
Conclusionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Recommendations for Future Studieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip57
REFERENCEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip59
APPENDICEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
Questionnairehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
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66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
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Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
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1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
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doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
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60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
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karate Analysis of national registry data BMJ British Medical
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Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
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Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
Warm Up and Cool Down Patterns of Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphellip31
Categories of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip35
Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
Rehabilitation of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
5 DISCUSSION AND CONCLUSIONShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip43
Knee Injuries of Men and Women Volleyball Playershelliphelliphelliphelliphelliphelliphelliphellip43
Fitness Training and Weight Traininghelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip44
Warm Up and Cool Down Patterns of the Playershelliphelliphelliphelliphelliphelliphelliphelliphellip45
Patterns of Knee Injuries of the Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip46
Antecedents of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip47
Treatments of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip49
Recovery Timehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Prevention of Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip50
Summary of Resultshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip52
Conclusionhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip56
Recommendations for Future Studieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip57
REFERENCEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip59
APPENDICEShelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
Questionnairehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip63
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
LIST OF TABLES AND FIGURES
TABLE Page
1 Frequency and Percentage of Playersrsquo Demographic Informationhelliphelliphelliphelliphelliphellip22
2 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip23
3 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
4 Fitness Training of Injured Players and Non-Injured Players helliphelliphelliphelliphelliphelliphellip28
5 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip30
6 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip33
7 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip34
8 Categories of Knee Injuries of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip36
9 Types of Knee Injuries Suffered by Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip37
10 The Rate of ACL Tear Injury among Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip38
11 Antecedents of Knee Injuries helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip39
12 Treatment for Knee Injurieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip40
13 Number of Knee Injuries requiring Surgeryhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip41
14 Amount of Time for Recovery of Injured Playershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip42
FIGURE
1 Knee Injuries in Different Gendershelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip24
2 Regular TrainingCompetition of Injured Players and Non-Injured Playershelliphellip26
3 Fitness training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip28
4 Weight Training of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphelliphellip30
5 Warm Up Activities of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphellip34
6 Cool Down Habit of Injured Players and Non-Injured Playershelliphelliphelliphelliphelliphelliphellip35
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
1
Chapter 1
INTRODUCTION
Volleyball is one of the most popular sports all over the world In Hong Kong it
is increasingly popular due to the promotion of Volleyball Association of Hong Kong
china (VBAHK) Every year the FIVB Volleyball World Grand Prix- Hong Kong
(WGP-HK) is hold in Hong Kong Coliseum with full house audience All matches are
broadcast live or delayed by local and international TV media with high audience
rating (Major Sports Events Committee 2009) Through WGP-HK and various
promotional activities it is significant in popularizing volleyball
Volleyball is unique among different team sports as it evolved into two distinct
disciplines indoor game that consists of six players in each team and outdoor game
that consists of two players per side It will focus on indoor volleyball in this study
Moreover volleyball is moderate level of activity that associated with numerous
health benefits including improved physical fitness weight control increased muscle
strength etc (The department of health 2011) According to the world health
organization (2015) it recommends that children and youths aged 5-17 to
accumulate at least 60 minutes of moderate- to vigorous-intensity physical activities
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
2
daily In addition volleyball is a kind of team sports players could learn how to
communicate and cooperate with others when they are participating in volleyball
games As a result Hong Kong physical education teacher would include volleyball
teaching in the syllabus
Apart from volleyball lesson in schools there are different levels of volleyball
competition in Hong Kong For instance inter- secondary school sports competition
organized by Hong Kong Schools Sports Federation inter-university sports
competition organized by University Sports Federation of Hong Kong China and the
Hong Kong Open Volleyball Championship Competition organized by Volleyball
Association of Hong Kong China Volleyball players need to engage in regular
training and fitness training to prepare for the competition The heavy physically
demanding sports including volleyball seems to have an increased risk for
developing patellar tendinopathy (Van Der Worp Frings-sen Van Den Akker-Scheek
Zwerver amp Kuijer 2011)
Among the different levels of volleyball competition inter-university
competition and HK open volleyball championship competition in division I would be
the most physically demanding Compare with other team contact sports such as
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
3
soccer basketball ice hockey the overall injury risk was lowest in volleyball
However injury in volleyball cannot be neglect Most injuries happen to the lower
limbs in volleyball Knee is the most common location for injuries resulting in
permanent disability (Kujala Taimela Antti-Poika Orava Tuominen amp Myllynen
1995) Also some reference suggest that waist girth may have a biochemical as well
as a mechanical influence on the development of patellar tendon pathology which lead
to increased risk of knee injury among women volleyball players
Normally it would take injured players around 1-2 weeks to return to play If
they suffer from kneedislocation they would return to their previous sport after a
median time of 55 months with some of them could return to pre-injury levels
(Hirschman Iranpour Mulle amp Friederich 2010) It depends on the severity of knee
injury To reduce the injury rate of knee injury among volleyball player we should
identify the risk factors and suggest a prevention plan
Statement of Problem
This study would focus on the comparison of the rate and types of knee injuries
between men and women volleyball team members in Hong Kong It also aimed at
examine the relationship between the gender and patterns of knee injuries
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
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Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
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Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
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60
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Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
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61
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Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
4
Study Aims and Objectives
This study would aim to compare knee injuries among men and women
volleyball players in Hong Kong This study would provide preliminary information
about knee injuries pattern among a sample of men and women volleyball player in
Hong Kong In addition the study would also examine the relationship between
various risk factors and incidence rate of knee injury
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
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66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
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Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
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1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
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doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
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60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
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Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
5
Hypothesis
The following are the research hypothesis of this study
1 There would be no significance difference in the rate of knee injuries between men
and women volleyball players in Hong Kong
2 There would be no no significant difference in volleyball training frequency
between injured and non-injured players
3 There would be no significant difference in fitness training frequency between
injured and non-injured players
4 There would be no no significant difference in weight training frequency between
injured and non-injured players
5 There would be no significance difference in the rate of ACL tear injury between
men and women volleyball players
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
6
Chapter 2
REVIEW OF LITERATURE
Some existing literature present the situation of knee injury in volleyball This
review of literature divided into four sections (i) knee injuries in volleyball (ii)
gender difference in the knee injuries in volleyball (iii) anterior cruciate ligament
(ACL) injuries in volleyball and (iv) summary
Knee Injuries in Volleyball
According to James Kelly amp Beckman (2014) ldquoVolleyball is recognized as one
of the most popular sports in the world amongst men and womenrsquorsquo It explains that
why there are more and more people participate in both indoor and outdoor volleyball
activities Through participation in volleyball the participants could get numerous
health benefits For instance increased in muscle strength improved cardiovascular
endurance coordination and balance (The department of health 2011) but there are
risks of getting injured due to sport-specific tasks such as landing and jumping
Bere Kruczynski Veintimilla Hamu Bahr (2015) conduct a study on the risk
and pattern of injuries among world-class players According to the result most
commonly injuries of volleyball players were to the lower extremity (583) with
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
7
152 of those injuries affecting the knee This distribution was similar between
match play (156) and training (132) The National Collegiate Athletic
Association (NCAA) (Agel Palmieri-Smith Dick Wojtys amp Marshall 2007)
suggested that the lower extremity accounted for more than 55 of all game and
practice injuries It found that the rate of injury in competition was slightly higher than
in practice in national level which is similar to international level Another study
conducted by Kujala et al (1995) reveal that 190 of the volleyball injuries occurred
in the knee
Throughout the 32 International Volleyball Federation (FIVB) events included
there were 440 injuries reported The most common injury type was joint sprains
(325) followed by muscle strains (141) and contusions (127) (Bere 2015) An
injury that result in at least 10 consecutive days of restricted or total loss of
participation is classified as severe injury Therefore the most common injury type
was ligament sprain (291) and followed by internal derangement (257) in NCAA
volleyball competition (Agel etal 2007) And Kujala et al (1995) shows that the
common injury type was knee sprains and muscle stains (154) for Finland
volleyball players
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
8
For the cause of injury there are 23 were reported as the result of contact
between players followed by 207 were overuse injuries and 173 were reported
as non-contact trauma The knee injuries mainly affected by overuse problem (Bere
2015) Refer to Agel J (2007) most injuries (gt50) did not involve direct external
contact to the injured body part The percentage of injuries in player contact other
contact (eg balls floor) and no contact were similar during games however the
result of injuries in practice was no contact (540) followed by other contact (270)
and player contact (150) According to Reeser (2006) Patellar tendinitis is an
overuse injury Symptom onset typically occurs gradually after a threshold of
cumulative tissue injury has been exceeded Therefore players who increase the
dynamic load on the patellar tendon would increase the risk of developing anterior
knee pain (jumperrsquos knee) (Reeser Verhagen Briner Askeland amp Bahr 2006)
Patellar tendinitis also known as jumpers knee is probably so common in volleyball
because of the high frequency of jumping in the sport (Briner Jr amp Kacmar 1997)
Gender difference in the knee injuries in volleyball
There is no significant difference between males and females in the international
volleyball competition (Bere 2015) However gender difference in peak torque
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
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66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
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Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
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1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
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doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
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Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
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karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
9
suggest that strength may influence the higher knee injury incidence in female athletes
(Bowerman Smith Carlson amp King 2006) The presence of a Hamstring quadriceps
(H Q) strength ratio below normal range
(lt60 at 60s and lt80 at 300s) was linked to an increased incidence of
overuse knee injuries among female collegiate athletes Male collegiate athletes
produced more peak torque work and average power compared to their female
counterparts (Anderson Dome Gautam Awh amp Rennirt 2001 Huston amp Wojtys
1996) Males also demonstrated significantly higher (plt004) H Q strength ratios at
601s compared to females (Anderson et al 2001) Several studies have revealed that
muscular strength deficits and low H Q ratios were linked to injury To reduce the
risk of knee injuries and maintain normal knee function a balance between the
quadriceps and hamstring muscles is important Women in general are more flexible
with looser ligaments tendons and muscles which increase the risk of knee injury
(Nora amp Aartan 2015) Therefore the strength deficit may be a possible risk factor to
explain the higher knee injury incidence in female athletes compared to male
Anterior cruciate ligament (ACL) injuries in volleyball
Although it is less common among volleyball player anterior cruciate ligament
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Correlation of anthropometric measurements strength anterior cruciate ligament
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Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
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httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
10
(ACL) injuries can be particularly devastating to an athlete The ACL injuries
frequently occur in minimal contact or non-contact situation The actions of cutting
manoeuvres landing from a jump sudden deceleration were the high risk mechanisms
for ACL injuries The leading cause of ACL injuries amongst volleyball players are
via non-contact mechanisms such as landing jumping Therefore middle left and
right hitters are at high risk of ACL injury as they have to perform these actions
repeatedly during practice and competition (Agel et al 2007amp Ferretti 1992)
From the result of Agel et al (2007) only 5 of all volleyball injuries were acute
knee injuries while 37 of injuries were to the ACL de Loeumls Dahlstedt and
Thomeacutee (2000) reported the incidence of ACL rupture as two injured athletes per
100000 athletes during 1 hour in male volleyball However an extended
rehabilitation period exists for ACL injury represented by an 11-month return-to-play
duration in addition to potentially permanent disability (Ferretti Papandrea
Conteduca amp Mariani 1992)
According to Hughes Watkins amp Owen (2010) the normalized knee varus
moment exhibited by males was significantly different from the normalized knee
valgus moment exhibited by females during active loading and the maximum
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
11
normalized knee valgus moment was significantly greater in females than males This
could cause overloading of knee muscles and contribute to the greater incidence of
non-contact ACL injuries in females than their counterparts (Hughes Watkins amp
Owen 2010) Also Zahradnik (2015) showed that the step-back technique (after
unsuccessful block) resulted in a greater vertical ground reaction force reduced knee
energy absorption and increase hip energy absorption than the stick technique (after
successful block) (Zahradnik Jandacka Uchytil Farana amp Hamill 2015) The result
is supported by the study that investigate the the relationships between energy
absorption and prospectively identified biomechanical factors associated with
non-contact anterior cruciate ligament injury
Norcross et al (2010) reported that greater energy absorption by the hip and
ankle and less by the knee was associated with an increased risk of ACL injury
When determining ACL loading the degree of knee flexion is critical If the knee
flexion angle is between 0-30O ACL would be pre-disposed to injury (Norcross
Blackburn Goerger amp Padua 2010) Terauchi et al (2011) also suggested that the
majority of athletes indicate the knee position as being close to full extension at the
time of injury The position of the leg just before collapse in all the non-contact ACL
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
12
injuries was near the foot strike with the knee close to full extension (Terauchi
Hatayama Yanagisawa Saito amp Takagishi 2011) Besides the back steeping
extremity may be exposed to a greater risk of ACL injury during step-back landing
due to higher valgus moment (Zahradnik et al 2015) In addition hamstring relative
to quadriceps (H Q) weakness can increase the potential for anterior tibial shear
(DeMorat Weinhold Blackburn Chudik amp Garrett 2004) It may be that women are
at greater risk for anterior cruciate ligament injury in volleyball possibly because of
their greater incidence of knee recurvatum (Briner Jr amp Kacmar 1997) Therefore
female volleyball players may have a greater incidence of ACL injury compare to
their male counterparts
Identifying and understanding the biomechanical risk factors would help to avoid
and reduce the ACL injury rates
Summary
Volleyball is an increasingly popular sport all over the world It is different from
other contact sport such as soccer basketball injuries are resulted from non-contact
mechanism and overuse of muscle Volleyball players are required to have good
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
13
muscular strength and modify in landing techniques to avoid repeatedly overloading
the muscle
The most common body site susceptible to injuries is knee in volleyball during
both practice session and competition Players are sustained by different types of knee
injuries including knee sprain muscle stain ligament tear and laceration Female
players in volleyball would at a higher risk in sustaining knee injuries including ACL
injury It might due to intrinsic factors such as hamstring quadriceps ratio muscle
strength
Fortunately knee injuries could be prevented by some preventive measure For
instance modification in lower-extremity landing techniques hamstring specific
resistance training program muscle strengthening program etc
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
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doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
14
Chapter 3
METHODS
The study was a cross-sectional study The method of this study was divided into
the following sections including (i)subject and sampling (ii)measurement (iii)data
collection procedure (iv)data analysis and (v)timeline of the project
Subject and Sampling
The subjects were both male and female volleyball players The subjects were
members of university volleyball team in Hong Kong in the academic year of
20132014 to 20142015 who had been participating in regular training in volleyball
provided by the university team The subjects also from the volleyball club whom had
been consecutively participated in the HK open volleyball championship competition
division I in the year of 20132014 to 20142015 The subjects who represented Hong
Kong volleyball team or Hong Kong junior volleyball team in the year of 20132014
to 20142015 were involved
Measurements
A self-reported written questionnaire has been developed to collect information
of the participants The procedure of developing this questionnaire was based on
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
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66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
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Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
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1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
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doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
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60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
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karate Analysis of national registry data BMJ British Medical
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Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
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Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
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Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
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15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
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Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
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factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
15
reviewing the literature that related to the research topic It is also modified based on
honours project from HKBU honours project database (Hei L 2012) This
questionnaire was consisting of three parts
In the first part there were mainly demographic questions For instance age
gender height and weight In the second part it was focus on the habit in volleyball
training It included the categories of volleyball team that engaged in the past two
years playerrsquos position the average number of training hours spent on volleyball per
week the amount of time spent on fitness training and weight training and the habit of
warm up and cool down exercise
In the third part it was focus on the knee injury occurred during volleyball
training or competition within past 12 months The background information such as
the categories of knee injury the types of knee injuries the causeoccasion when knee
injuries occurred the types of medical treatment the amount of time for recovery
were included
Data Collection Procedure
A pilot study was conducted to access the understandability and suitability of the
questionnaire before distributing the self-designed questionnaire to participants Some
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
16
of the members from Hong Kong Baptist University men and women volleyball team
were asked to complete the questionnaire After that they were asked if the
questionnaire is understandable and stated out the problem when filling up the
questionnaire
The questionnaires were distributed to participants directly by the coaches The
purpose of study and instructions of filling up the questionnaire were explained to
participants clearly by the coach The participants submitted their completed
questionnaire back to the coach All complete questionnaires were gathered by the
coach and returned back to researcher
Data Analysis
All the data collected were inputted into the Statistical Package for Social
Science 210 for Windows (SPSS 210) and being analyzed The level of significance
was set at 005 for all statistical analyses
Descriptive statistics such as mean percentage frequency and standard
deviation were used to describe the demographic information of the participants for
example the amount of time spent in weight training the categories of knee injury To
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
17
determine if there was any significance difference in the rate of knee injury between
genders the amount of time of regular training fitness training and weight training
between injured and non-injured players the chi square tests were used
Timeline of the project
The project was conducted following the below timeline (Table 1)
Table 1
Timeline of the project
Before the time Completion of task
Week 1 2nd semester Data collection
Week 6 2nd semester Data analysis
Week 6 2nd semester Writing up results
Week 7 2nd semester Writing up discussion and conclusions
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
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Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
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Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
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Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
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61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
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Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
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httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
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49-55
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doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
18
Chapter 4
RESULTS
The purpose of this study was to investigate the rate and type of knee injuries
among men and women volleyball players in Hong Kong It also measured various
risk factors affect the incidence rate of knee injury The descriptive statistics chi
square test were used to analyze the data The analyses of the data were presented in
the following results
1 Description of the demographic information including gender age height and
weight types of volleyball team that players engaged in and playerrsquos position in the
team
2 Knee injuries in different genders
3 Amount of time for regular trainingcompetition of injured players and non-injured
players
4 Amount of time for fitness training of injured players and non-injured players
5 Amount of time for weight training of injured players and non-injured players
6 Warm up and cool down patterns of players
7 Categories of knee injuries
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
19
8 Types of knee injuries suffered by players
9 Antecedents of knee injuries
10 Treatment for knee injuries
11 Rehabilitation of knee injuries
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
20
1 Demographic information
The modified questionnaire obtained personal information of men and women
volleyball player in Hong Kong A total of 142 volleyball players were invited to
respond to the questionnaires There were 493 of the players (n=70) were men and
507 of the the players (n=72) were women The age of the players was 14-30 77
(n=11) aged 20 or below most of 796 (n=113) the volleyball players aged between
21-25 and 127 (n=18) aged 26 or above
For the height of players 28 (n=4) was 150-159m 331 (n=47) were
160-169m 394 (n=56) were 170-179m 218 (n=31) were 180-189m and
28 (n=4) were 190-199m
For the weight of players 7 (n=10) were 40-49kg 162 (n=23) were 50-59kg
451 (n=64) were 60-69kg 246 (n=35) were 70-79kg 63 (n=9) were 80-89kg
and 07 (n=1) were 90-99kg
For types of volleyball team that players engaged in within the past two years
most of the players 93 (n=132) and 662 (n=94) were represent volleyball team in
Division I and university volleyball team respectively 155 (n=22) were represent
Hong Kong volleyball team Junior volleyball team For playerrsquos position 338
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
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66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
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Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
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1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
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60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
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karate Analysis of national registry data BMJ British Medical
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Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
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httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
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Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
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15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
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Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
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Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
21
(n=48) were left side hitter 239 (n=34) were middle blocker 141 (n=20) were
setter 211 (n=30) were right side hitter and 7 (n=10) were libero This result was
shown in Table 1
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
22
Table 1
Frequency and Percentage of Playersrsquo Demographic Information
Background Demographics Frequency Percentage ()
Gender Men
Women
70
72
493
507
Age 20 or below
21-25
26 or above
11
113
18
77
796
127
Height 150-159
160-169
170-179
180-189
190-199
4
47
56
31
4
28
331
394
218
28
Weight 40-49
50-59
60-69
70-79
80-89
90-99
10
23
64
35
9
1
70
162
451
246
63
07
Types of
Volleyball Team
University
Volleyball Club
Hong Kong Team
94
132
22
662
930
155
Position Left Side Hitter
Middle Blocker
Setter
Right Side Hitter
Libero
48
34
20
30
10
338
239
141
211
70
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
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httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
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October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
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doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
23
2 Knee injuries in different genders
Refer to Table 2 it shown that there were 89 of the players (627) suffered
different types of knee injuries during training or competition within the past one year
Among all the knee-injured players (517) (n=46) were men volleyball players and
483 (n=43) were women volleyball players
In order to determine if there was any significance difference in the knee injuries
between genders a chi square test was used The result was found to be p=046
Therefore there was no significant difference (pgt005) in the knee injuries between
men and women volleyball players This result was shown in Table 2 and Figure 1
Table 2
Chi Square Test for Knee Injuries Suffered from Different Genders
Sport Gender Knee Injury
Yes No Chi
Square
p
Volleyball Men
(n=70)
Women
(n=72)
46
(657)
43
(597)
24
(343)
29
(403)
0545
046
Total
(N=142)
89
(627)
53
(373)
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
24
Figure 1 shows the knee injuries suffered from men and women volleyball players during
training or competition within the past one year
3 Amount of time for regular trainingcompetition of Injured Players and
Non-Injured Players
All players engaged in training and competition regularly It shown that 99
(n=14) of the players spent an average of 1to 5 hours in training or competition per
week 585 (n=83) of the players spent an average of 6 to 10 hours in training or
competition per week 254 (n=36) of the players spent an average of 11 to 15 hours
in training or competition per week and the remaining 63 (n=9) of the players
spent an average of more than or equal to 16 hours in training or competition per week
For the players who spent an average of more than or equal to 16 hours in training or
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
25
competition there were 333 (n=3) engaged in both university volleyball team
volleyball club in Division I and Hong Kong volleyball team
For injured players there were 652 (n=58) of the players spent an average of
less than or equal to 10 hours in training or competition and per week and 348
(n=31) of the players spent an average of more than or equal to 11 hours in training or
competition per week For non-injured players there were 683 (n=97) of the
players spent and average of less than or equal to 10 hours in training or competition
per week and 317 (n=45) of the players spent an average of more than or equal to
11 hours in training or competition per week
In order to determine if there was any significance difference in the amount of
time for regular trainingcompetition between injured and non-injured players a chi
square test was used The result was found to be p=0297 Therefore there was no
significant difference (pgt005) in the amount of time for regular trainingcompetition
between injured and non-injured players This result was shown in Table 3 and Figure
2
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
26
Table 3
Chi Square Test for the Amount of Time for Regular TrainingCompetition of Injured
Players and Non-Injured Players Per Week
Suffered Knee Injury
or Not
Regular Training Competition
(Hours)
le10 ge11 Chi Square p
Yes
(n=89)
No
(n=53)
58
(652)
39
(736)
31
(348)
14
(264)
1087
0297
Total
(N=142)
97
(683)
45
(317)
Figure 2 shows the amount of time for regular trainingcompetition of injured players and
non-injured players
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
27
4 Amount of time for fitness training of Injured Players and Non-Injured Players
Fitness training is another important component to enhance playerrsquos performance
All of the players engaged in fitness training There are 246 (n=35) of the players
spent an average of less than or equal to 30 minutes in fitness training 387 (n=55)
of the players spent an average of 31 to 60 minutes in fitness training 289 (n=41)
of the players spent an average of 61 to 120 minutes in fitness training and the
remaining 77 (n=11) of the players spent an average of more than or equal to 121
minutes in fitness training
For injured players there are 539 (n=48) of the players spent an average of less
than or equal to 60 minutes in fitness training 461 (n=41) of the players spent an
average of more than or equal to 61 minutes in fitness training For non-injured
players there are 792 (n=42) of the players spent an average of less than or equal to
60 minutes in fitness training and the remaining 208 (n=11) of the players spent an
average of more than or equal to 61 minutes in fitness training
In order to determine if there was any significance difference in the amount of
time for fitness training between injured and non-injured players a chi square test was
used The result was found to be p=0002 Therefore there was significant difference
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
28
(plt005) in the amount of time for fitness training between injured and non-injured
players This result was shown in Table 4 and Figure 3
Table 4
Chi Square Test for the Amount of Time for Fitness Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Fitness Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
48
(539)
42
(792)
41
(461)
11
(208)
917
0002
Total
(N=142)
90
(634)
52
(366)
Figure 3 shows the amount of time for fitness training of injured players and non-injured players
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
29
5 Amount of Time for Weight Training of Injured Players and Non-Injured Players
Apart form regular volleyball training and fitness training all of the players also
engaged in weight training There are 416 (n=59) of the players spent an average of
less than or equal to 30 minutes in weight training 254 (n=36) of the players spent
an average of 31 to 60 minutes in weight training 225 (n=32) of the players spent
an average of 61 to 120 minutes in weight training and the remaining 106 (n=15)
of the players spent an average of more than or equal to 121 minutes in weight
training
For injured players 584 (n=52) of the players spent an average of less than or
equal to 60 minutes in weight training and 416 (n=37) of the players spent an
average of more than or equal to 61 minutes in weight training For non-injured
players 811 (n=43) of the players spent an average of less than or equal to 60
minutes in weight training and the remaining 189 (n=10) of the players spent an
average of more than or equal to 61 minutes in weight training
In order to determine if there was any significance difference in the amount of
time for weight training between injured and non-injured players a chi square test was
used The result was found to be p=0005 Therefore there was significant difference
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
30
(plt005) in the amount of time for weight training between injured and non-injured
players This result was shown in Table 5 and Figure 4
Table 5
Chi Square Test for the Amount of Time for Weight Training of Injured Players and
Non-Injured Players Per Week
Suffered Knee Injury
or Not
Weight Training (Minutes)
le60 ge61 Chi Square p
Yes
(n=89)
No
(n=53)
52
(584)
43
(811)
37
(416)
10
(189)
7734
0005
Total
(N=142)
95
(669)
47
(331)
Figure 4 shows the amount of time for weight training of injured players and non-injured players
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
31
6 Warm up and cool down patterns of players
For warm up activities before the training most of the players 937 (n=133)
participated in warm up activities and 63 (n=9) of the players didnrsquot spend time for
warm up activities Of those who participated in warm up activities 526 (n=70) of
the players spent an average of less than or equal to10 minutes in warm up activities
451 (n=60) of the players spent an average of 11 to 20 minutes in warm up
activities and only 23 (n=3) of the players spent an average of 21 to 30 minutes in
warm up activities
For injured players 482 (n=41) of the players spent an average of less than or
equal to 10 minutes in warm up activities 506 (n=43) of the players spent an
average of 11 to 20 minutes in warm up activities and 12 (n=1) of the players spent
an average of 21 to 30 minutes in warm up activities For non-injured players 604
(n=29) of the players spent an average of less than or equal to 10 minutes in warm up
activities 354 (n=17) of the players spent an average of 11 to 20 minutes in warm
up activities and 42 (n=2) of the players spent an average of 21 to 30 minutes in
warm up activities
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
32
To determine if there was any significance difference in the amount of time for
warm up activities between injured and non-injured players a chi square test was used
The result was found to be p=0175 Therefore there was no significant difference
(pgt005) in the amount of time for warm up activities between injured and non-injured
players This result was shown in Table 6 and Figure 5
For the types of warm up activities 887 (n=118) of the players would do
jogging 902 (n=120) of the players would do stretching and 436 (n=58) of the
players would do specific warm up
Cool down activities after training could help your body to get recover from hard
workout 739 (n=105) of the players participated in cool down activities and 261
(n=37) of the players didnrsquot spend time for cool down activities For injured players
775 (n=69) of the players participated in cool down activities and 225 (n=20)
didnrsquot participated in cool down activities For non-injured players 679 (n=36) of
the players of the players participated in cool down activities and 321 (n=17) of the
players didnrsquot participated in cool down activities
To determine if there was any significance difference in the rate of knee injuries
between the players who were participated in cool down activities and those who were
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
33
not a chi square test was used The result was found to be p=0207 Therefore there
was no significant difference (pgt005) in the rate of knee injuries between the players
who were participated in cool down activities and those who were not This result was
shown in Table 7 and Figure 6
Table 6
Chi Square Test for the Amount of Time for Warm Up Activities of Injured Players and
Non-Injured Players
Suffered
Knee Injury
or Not
Warm up activities (Minutes)
le10 11-20 21-30 Chi Square p
Yes
(n=85)
No
(n=48)
41
(482)
29
(604)
43
(506)
17
(354)
1
(12)
2
(42)
496
0175
Total
(n=133)
70
(526)
60
(451)
3
(23)
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
34
Figure 5 shows the amount of time for warm up activities of injured players and non-injured
players
Table 7
Chi Square Test for the Cool Down Habit of Injured Players and Non-Injured Players
Suffered Knee
Injury or Not
Participated in cool down
activities
Yes No Chi Square p
Yes
(n=89)
No
(n=53)
69
(775)
36
(679)
20
(225)
17
(325)
159
0207
Total
(N=142)
105
(739)
37
(261)
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
35
Figure 6 shows the cool down habits of injured players and non-injured players
7 Categories of knee injuries
The categories of knee injury were divided in two main categories acute injury
and chronic injury The player could suffer more than one knee injuries within the
past one year and the injuries could be in different categories
There were 247 (n=22) of the players suffered from acute knee injuries and
775 (n=69) of the players suffered from chronic knee injuries For those who
suffered from acute knee injuries 318 (n=7) of the players were men and 682
(n=15) of the players were women For those who suffered from chronic knee injuries
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
36
565 (n=39) of the players were men and 435 (n=30) of the players were women
The result was shown in Table 8
Table 8
Categories of Knee Injuries of Injured Players
Sport Gender Knee Injury Category
Acute No Acute Chronic No Chronic
Volleyball Men
(n=46)
Women
(n=43)
152
349
848
651
848
698
152
302
Total
(n=89)
247 753 775 225
8 Types of knee injuries suffered by players
There were several types of knee injuries including contusion overuse injury
meniscus tear ACL tear PCL tear MCL tear and LCL tear Players were asked
whether they have suffered from any of these knee injuries within the past one yearpl
Each of them could choose more than one type of knee injury
It shows that there were 202 (n=18) suffered from contusion 753 (n=67)
suffered from overuse injury 146 (n=13) suffered from meniscus tear 213
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
37
(n=19) suffered from ACL tear no PCL tear 34 (n=3) suffered from MCL tear and
no LCP tear This result was shown in Table 9
Concern about the ACL tear there were 263 (n=5) of the players were men
and 737 (n=14) of the players were women To determine if there was any
significance difference in the rate of ACL tear injury between genders a chi square
test was used The result was found to be p=0031 Therefore there was significant
difference (plt005) in the rate of ACL tear injury between genders This result was
shown in Table 10
Table 9
Types of Knee Injuries Suffered by Players
Knee Injury Types Gender Total
Men
(n=46)
Women
(n=43)
(N=89)
Contusion 167 833 202
Overuse Injury 597 403 753
Meniscus Tear 308 692 146
ACL Tear 263 737 213
PCL Tear 0 0 0
MCL Tear 333 667 34
LCL Tear 0 0 0
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
38
Table 10
Chi Square Test for Men and Women Volleyball Players with the Rate of ACL Tear
Injury
Sport ACL Tear Injury Gender
Men Women Chi Square p
Volleyball Yes
(n=19)
No
(n=70)
263
586
737
414
4634
0031
Total
(n=89)
517 483
9 Antecedents of knee injuries
Knee injuries may cause by several reasons including inadequate warm up poor
fitness over-trained inattentive collision with others venue problem unsuitable
equipment and others Players were asked about the reason for their knee injuries
suffered within the past one year It could be caused by more than one reason
It shows that there were 225 (n=20) caused by inadequate warm up 371
(n=33) caused by poor fitness 573 (n=51) caused by over-trained 302 (n=27)
caused by inattentive during training 27 (n=24) caused by collision with others
56 (n=5) caused by venue problem and 67 (n=6) caused by unsuitable equipment
This result was shown in Table 11
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
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2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
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66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
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Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
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1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
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in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
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karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
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in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
39
Table 11
Antecedents of Knee Injuries
Antecedents Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Inadequate Warm
Up
65 35 225
Poor Fitness 545 455 371
Over-Trained 549 451 573
Inattentive During
Training
667 333 303
Collision with
Others
83 917 27
Venue Problem 60 40 56
Unsuitable
Equipment
333 667 67
10 Treatment for knee injuries
Players received treatments based on the severities of the knee injuries including
rest accident ampemergency general doctor family doctor orthopedic doctor
physiotherapy Chinese bone setter acupuncture and others
The most common treatment was rest 494 (n=44) followed by physiotherapy
472 (n=42) accident ampemergency 225 (n=20) Chinese bone setter 146
(n=13) acupuncture 112 (n=10) were other common treatments applied
Orthopedic doctor 9 (n=8) and general doctor 34 (n=3) were not common
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
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Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
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doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Hei L (2012) A comparison of knee injuries among university basketball and soccer
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Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
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Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
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Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
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in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
40
treatment applied by players None of the players received treatment from family
doctor This result was shown in Table 12
Table 12
Treatment for Knee Injuries
Treatment Gender Total
Men
(n=46)
Women
(n=43)
(n=89)
Rest 591 409 494
Accident amp
Emergency
20 80 225
General Doctor 333 667 34
Family Doctor 0 0 0
Orthopedic Doctor 375 625 9
Physiotherapy 619 381 472
Chinese Bone
Setter
385 615 146
Acupuncture 20 80 112
11 Rehabilitation of knee injuries
Even injury is bane of athletersquos life we still need to overcome it All athletes want
to return to his or her pre-injury level of function after injury For some serious knee
injuries such as tear in ligament surgery was required as a treatment to help
rehabilitation
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
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doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
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Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
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203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
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Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
41
Refer to the result 18 (n=16) of the injured players receive surgery as part of the
treatment of their knee injuries Of those who receive surgery 63 (n=1) of the
players were men and 938 (n=15) of the players were women This result was
shown in Table 13
Concerning about the severity of the knee injuries the injured players required
different amount of time for recovery 112 (n=10) of the players spent less than or
equal to one week for recovery 382 (n=34) of the players spent 2 to 33 weeks for
recovery 135 (n=12) of the players spent 4 to 5 weeks for recovery and 371
(n=33) of the players spent more than or equal to 6 weeks for recovery and returned to
regular training This result was shown in Table 14
Table 13
Number of Knee Injuries requiring Surgery
Sport Gender Surgery
Yes No
Volleyball Men
(n=46)
Women
(n=43)
22
349
978
651
Total(N=89) 18 82
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
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Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
42
Table 14
Amount of Time for Recovery of Injured Players
Sport Gender Recovery Time
le 1 week 2-3 weeks 4-5 weeks ge 6 weeks
Volleyball Men
(n=46)
Women
(n=43)
196
23
391
372
87
186
326
419
Total
(n=89)
112 382 135 371
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
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Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
43
Chapter 5
DISCUSSION AND CONCLUSION
A total of 142 volleyball players responded in this study The result was used to
give a better understanding of the demographic effects on knee injuries patterns of
knee injuries causes of knee injuries rehabilitation of knee injuries of volleyball
players in Hong Kong The target group and sample size were different from similar
studies that have been conducted before Therefore it still be worth discussing
between studies
1 Knee Injuries of Men and Women Volleyball Players
The researchers thought that female players might might have a higher chance to
get knee injury compare to their male counterparts due to the biomechanical factor
However refer to the result of this study there was no significant difference (pgt005)
in the knee injuries between men and women volleyball players (p=046) Bere (2015)
also showed that there was no significant difference between males and females in the
international volleyball competition
Some studies revealed that female volleyball players could have higher risk for
acute knee injuries than male volleyball players Due to the significantly higher H Q
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
44
strength ratios it would be the possible factor to explain the difference in knee injury
incidence between male and female volleyball players Males demonstrated
significantly higher H Q strength ratios compared to females (Anderson et al 2001)
Sex-related differences in landing technique was not the major reason male players
landing from greater heights causing higher patellar tendon loading Male players
suffered from higher patellar tendon loading which would cause higher knee injury
incidence rate than female players (Janssen Steele Munro amp Brown 2014)
2 Fitness Training and Weight Training
Many researchers suggested that fitness training and weight training could help
reduce the incidence of sport injuries Nowadays it is not surprised that all of the
players were engage in fitness and weight training to help enhance their performance
To reduce the risk of knee injuries and maintain normal knee function a balance
between the quadriceps and hamstring muscles is important Reilly (1992) suggested
that the stability of a joint could be increased by muscles that crossed the joint The
stability of the knee joint could therefore be increased by strengthening the quadriceps
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
45
which secures the joint together with the cruciate ligaments and collateral ligaments
(Reilly 1992)
Other than strengthening muscle that across the knee joint Prentice (2008) found
that improving the body conditioning such as flexibility cardiovascular endurance
muscular endurance agility speed and balance could help to prevent knee injuries
(Prentice 2008) For the relationship between the rate of knee injuries and the
frequency of fitness training and weight training the result showed that there was
significant difference in the amount of time for fitness training (p=0002) and weight
training (p=0005) between injured and non-injured players Gabbet amp Domrow
(2007) found that reductions in training load during the early-competition training
phase can reduce the odds of injury without compromising agility performances
(Gabbett amp Domrow 2007)
3 Warm Up and Cool Down Patterns of the Players
Most of the players (937) participated in warm up activities before training It
helped to rise muscle temperature which had a significant effect on muscle function
power production and reduce the rate of injury The warm up and cool down before
and after a class would decreases the rate of injuries The result showed that there was
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
46
no significant difference (p=0175) in the rate of knee injuries between different
frequency of warm up activities also no significant difference (p=0207) in the rate of
knee injuries between the players who were participated in cool down activities and
those who were not When the warm up and cool down session is about 15 minutes
the number of injured appears significantly smaller In other words improve in
flexibility can prevent from injury conditions while the appropriate warm up and cool
down prepares the muscle groups for the different types of exercise (Malliou Rokka
Beneka Mavridis amp Godolias 2007)
4 Patterns of Knee Injuries of the Players
The occurrence of chronic knee injuries was more frequent than that of acute knee
injuries Many researchers stated that patellar tendonitis was the most common types
of overuse knee injury in volleyball due to the patellar tendon loading generated from
repeatable jumping and landing (Janssen et al 2014) Among all types of knee injuries
in this study the result showed that there were 753 of the players suffer from
overuse injury within the past one year Due to the high intensity and frequency of the
university team Division I volleyball club and even Hong Kong volleyball team
training they would easily develop overuse injury in their knees Anterior cruciate
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
47
ligament (ACL) injury (213) and contusion (202) were the next most common
types of knee injuries ACL injuries were occurred with less frequency but often carry
more significant health consequences ACL injury usually occurred under acute
situation and it was more likely to occur in female players In this study there was
significant difference (p=0031) in the rate of ACL tear injury between genders
According to Nora amp Aartan (2015) quadriceps strength asymmetry was related to
acute knee injuries Females consistently have weaker hamstring muscles relative to
their quadriceps as compared with their male counterparts and this imbalance
increases risk of ACL tear
Also the degree of knee flexion was important when concern about ACL loading
When the knee flexion angle increased the pressure on ACL would decrease Both
stick landing and step back landing may result in ACL injuries However the
back-stepping limb may be exposed to a greater risk of ACL injury during the initial
impact phase after a step-back landing (Zahradnik 2015)
5 Antecedents of Knee Injuries
The cause of knee injuries was related to the most common types of knee injury
that players suffer within the past one year According to the result it showed that
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
48
over 50 of the players (573) thought that over-trained was the cause of their knee
injuries Jumperrsquos knee is more prevalent among volleyball players who had large
volume of jump training Therefore middle blockers and left side hitters tend to suffer
from jumperrsquos knee than players at other position (Reeser et al 2006) In this study
there were 404 and 346 of players were middle blockers and left side hitters who
thought that over-trained was one of the cause of their knee injuries They would
develop the chronic overload easily
Poor fitness was the second most common causes of knee injuries Several studies
have revealed that muscular strength deficit was linked to injury Nora amp Aartan
(2015) suggested that adequate muscle strengthening training to high impact jump
training and plyometric is believed to be an important part of decreasing the risk of
tendon injury Therefore poor fitness would lead to muscle fatigue easily and increase
stress on the knee joint Players would suffer from knee injuries easily during training
or competition
Inattentive during training (303) and collision with others (27) were the third
common causes of knee injuries These two reason were interrelated Once the players
were not attentive during training they would easily bump into their teammates This
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
49
could explain by the types of knee injuries that players suffered Contusion was the
third common types of knee injuries in this study Volleyball is a sport that without
body contact between players the rate of injuries between competition and training
was similar (Agel et al 2007)
6 Treatments of Knee Injuries
The treatment of the knee injuries required a high degree of cooperation among
players and professionals or specialists Refer to the result it showed that there were
494 and 472 of players choose to rest and seek medical assistance from
physiotherapists
This could explain by the types of knee injuries that players suffered Most of the
players suffered form overuse injury The severity of overuse injury was low Those
injured players could recover from their own treatment such as RICE principle ie
rest ice compression and elevation
Besides there were 225 (n=20) of players seek medical assistance from
Accident amp Emergency Department in the hospital The majority of these injured
players (75 n=15) suffered from acute knee injuries and they received surgery
afterward Refer to the result 113 (n=16) of the players received surgery which
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
50
similar to the numbers of players that seek medical assistance form Accident amp
Emergency Department Moreover the result showed that over 90 of ligament tears
and meniscus tears (938 n=15) required surgery It was supported by Granan
(2009) ACL reconstruction surgery should be carried out within 12 months of injury
to minimize the risk of meniscal tears and degenerative changes (Granan 2009)
7 Recovery Time
According to the result 382 of injured players would take 2 to 3 weeks for
recovery which is supported by the types of knee injures that players suffered
Overuse injury (753) and contusion (202) were considered as minor injuries The
recovery time and time loss from functional ability would not be long
On the other hand 371 of injured players would take more than 6 weeks for
recovery The injured players who suffered from meniscus tear and ligament tear
(393) would required for such a long period of recovery time as most of them
received a surgery Return to athletics was allowed between 6 and 9 months following
surgery (Pierce OrsquoBrien Griffin amp LaPrade 2013)
8 Prevention of Knee Injuries
Compare to other contact sport the incidence of knee injuries in volleyball was
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
51
relatively low Due to the sport nature of volleyball most of the volleyball players
suffered from overuse knee injury Some prevention measures should be
implemented
The coach should get close attention to jumping technique during training
decrease the likelihood of symptomatic jumperrsquos knee (Briner Jr amp Kacmar 1997)
According to Michaelidis amp Koumantakis (2014) coach should focus on the
following components for injury prevention plyometric dynamic stabilization
strength training for the trunk upper and lower body as well as sport specific agility
training paired with education and feedback on correct technique (Michaelidis amp
Koumantakis 2014) As mentioned above players should improve their level of
fitness and engage in muscle strengthening training in order to reduce the risk in
developing knee injuries
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
52
Summary and Conclusion
There are three parts involved in this chapter (1) summary of results (2)
conclusion and (3) recommendations for future studies
Summary of Results
The results of the study were summarized as follows
First among 142 respondents there were 493 men volleyball players and
507 women volleyball players They were either the member of university
volleyball team volleyball club in Division I or Hong Kong volleyball team
Second out of the 142 respondents there were 627 suffered different types of
knee injuries within the past one year 517 were men volleyball players and 483
were women volleyball players The chi square test has shown that there was no
significant difference (p=0545) in the knee injuries between genders
Third 99 of the players spent an average of 1to 5 hours in training or
competition per week 585 of the players spent an average of 6 to 10 hours in
training or competition per week 254 of the players spent an average of 11 to 15
hours in training or competition per week and the remaining 63 of the players
spent an average of more than or equal to 16 hours in training or competition per week
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
53
The chi square test has shown that there was no significant difference (p=0297) in the
amount of time for regular trainingcompetition between injured and non-injured
players
Fourth all respondents were engaged in fitness training 246 of the players
spent an average of less than or equal to 30 minutes in fitness training 387 of the
players spent an average of 31 to 60 minutes in fitness training 289 of the players
spent an average of 61 to 120 minutes in fitness training and the remaining 77 of
the players spent an average of more than or equal to 121 minutes in fitness training
The chi square test has shown that there was significant difference (p=0002) in the
amount of time for fitness training between injured and non-injured players
Fifth all respondents also engaged in weight training 416 of the players spent
an average of less than or equal to 30 minutes in weight training 254 of the players
spent an average of 31 to 60 minutes in weight training 225 of the players spent an
average of 61 to 120 minutes in weight training and the remaining 106 of the
players spent an average of more than or equal to 121 minutes in weight training The
chi square test has shown that there was significant difference (p=0005) in the
amount of time for weight training between injured and non-injured players
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
54
Sixth most of the players (937) participated in warm up activities 526 of the
players spent an average of less than or equal to10 minutes in warm up activities
451 of the players spent an average of 11 to 20 minutes in warm up activities and
only 23 of the players spent an average of 21 to 30 minutes in warm up activities
The chi square test has shown that there was no significant difference (p=0175) in the
amount of time for warm up activities between injured and non-injured players
Seventh for the types of warm up activities 887 of the players would do
jogging 902 of the players would do stretching and 436 of the players would do
specific warm up
Eighth 739 of the players participated in cool down activities The chi square
test has shown that there was no significant difference (p=0207) in the rate of knee
injuries between the players who were participated in cool down activities and those
who were not
Ninth there were 247 of the players suffered from acute knee injuries and
775 of the players suffered from chronic knee injuries For those who suffered from
acute knee injuries 318 of the players were men and 682 of the players were
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
55
women For those who suffered from chronic knee injuries 565 of the players were
men and 435 of the players were women
Tenth there were 202 suffered from contusion 753 suffered from overuse
injury 146 suffered from meniscus tear 213suffered from ACL tear no PCL
tear 34 suffered from MCL tear and no LCP tear
Eleventh concern about the ACL tear 263 of the players were men and 737
of the players were women The chi square test has shown that there was significant
difference (p=0031) in the rate of ACL tear injury between genders
Twelfth the most common antecedent of knee injuries was being over-trained
(573) followed by poor fitness (371) inattentive during training (302)
collision with others (27) and inadequate warm up (225) Unsuitable equipment
(67) and venue problem (56) were some uncommon antecedents
Thirteenth he most common treatment was rest (494) followed by
physiotherapy (472) accident ampemergency (225) Chinese bone setter (146)
acupuncture (112) Orthopedic doctor (9) and general doctor (34) were not
common treatment applied by players None of the players received treatment from
family doctor
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
56
Fourteenth 18 of the injured players receive surgery as part of the treatment of
their knee injuries Of those who receive surgery 63 of the players were men and
938 of the players were women
Fifteenth 112 of the players spent one week or below for recovery 382 of
the players spent 2 to 3 weeks for recovery 135 of the players spent 4 to 5 weeks
for recovery and 371 of the players spent more than or equal to 6 weeks for
recovery and returned to regular training
Conclusion
This study provided general knee injuries patterns among volleyball players in Hong
Kong Although the incidence of knee injuries in volleyball was relatively low it was
essential to prevent the occurrence of knee injuries
Most of the injured players suffered from overuse injury It was hard to prevent due to
the sport nature of volleyball However we could notice that the amount of time spent
in fitness and weight training is significance factor to reduce the risk of getting knee
injuries The coach should pay attention on the landing techniques A well planned
training program can help to prevent knee injury and enhance playerrsquos performance
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
57
Recommendations for Future Studies
Based on this study the following recommendations are made for future studies
1 The types of knee injuries were limited which is not able to reflect all problems
2 Study may focus on specific types of knee injury (eg ACL tear) which may give
detailed information of the injury patterns and suggest specific preventive
measures
3 Study may focus on other training group eg general public and volleyball players
who participated in Hong Kong Inter-School Volleyball Competition
4 Study may focus on the injury patterns of specific position It would provide
detailed information for setting up specific training program and preventive
measure
5 Study may include the psychological impact of injury towards injured players
6 Longitudinal study can be conducted to examine the effectiveness of the
rehabilitation program and follow up the playerrsquos participation in volleyball
competition after injury
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
58
REFERENCES
Agel J Palmieri-Smith R M Dick R Wojtys E M amp Marshall S W (2007)
Descriptive epidemiology of collegiate womens volleyball injuries National
collegiate athletic association injury surveillance system 1988-1989 through
2003-2004 Journal of Athletic Training 42(2) 295-302
Anderson A F Dome D C Gautam S Awh M H amp Rennirt G W (2001)
Correlation of anthropometric measurements strength anterior cruciate ligament
size and intercondylar notch characteristics to sex differences in anterior
cruciate ligament tear rate The American Journal of Sports Medicine 29(1) 58ndash
66
Bere T Kruczynski J Veintimilla N Hamu Y amp Bahr R (2015) Injury risk is
low among world-class volleyball players 4-year data from the FIVB injury
surveillance system British Journal of Sports Medicine 49(17) 1132-1137
doi101136bjsports-2015-094959
Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of
factors influencing ACL injury in male and female athletes and non-
athletes Physical Therapy in Sport 7(3) 144-152
doi 101016jptsp200605003
Briner Jr W W amp Kacmar L (1997) Common injuries in volleyball mechanisms of
injury prevention and rehabilitation Sports Medicine 24(1) 65-71
doi10216500007256-199724010-00006
de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs
of knee injuries in male and female youth participants in 12 sports Scandinavian
Journal of Medicine amp Science in Sports 10(2) 90e97
DeMorat G Weinhold P Blackburn T Chudik S amp Garrett W (2004)
Aggressive quadriceps loading can induce noncontact anterior cruciate ligament
injury The American journal of sports medicine 32(2) 477-483
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
59
Ferretti A Papandrea P Conteduca F amp Mariani P P (1992) Knee ligament
injuries in volleyball players The American Journal of Sports Medicine 20(2)
203-207
Gabbett T J amp Domrow N (2007) Relationships between training load injury and
fitness in sub-elite collision sport athletes Journal of Sports Sciences 25(13)
1507-1519 doi10108002640410701215066
Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and
risk of cartilage lesions and meniscal tears A cohort study based on the
Norwegian national knee ligament registry Am J Sports Med 37(5) 955-961
doi1011770363546508330136
Hei L (2012) A comparison of knee injuries among university basketball and soccer
players in Hong Kong Physical Education and Recreation Management 88-89
Hirschmann M Iranpour F Muller W amp Friederich N (2010) Surgical Treatment
of Complex Bicruciate Knee Ligament Injuries in Elite Athletes What
Long-term Outcome Can We Expect The American Journal of Sports Medicine
1103-1109
Hughes G Watkins J amp Owen N (2010) Differences between the sexes in knee
kinetics during landing from volleyball block jumps European Journal of Sport
Science 10(1) 1-11 doi10108017461390903108117
James L P Kelly V G amp Beckman E M (2014) Injury risk management plan for
volleyball athletes Sports Medicine 44(9) 1185-1195
doi101007s40279-014-0203-9
Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical
factor affecting between-sex differences in patellar tendon loading during landing
in volleyball British Journal of Sports Medicine 48(7) 611-611
doi101136bjsports-2014-093494138
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
60
Kujala U M Taimela S Antti-Poika I Orava S Tuominen R amp Myllynen P
(1995) Acute injuries in soccer ice hockey volleyball basketball judo and
karate Analysis of national registry data BMJ British Medical
Journal 311(7018) 1465-1468
Major Sports Events Committee (2009) FIVB Volleyball World Grand Prix
Retrieved September 25 2015 from
httpwwwmeventsorghkenevents_vbahkphp
Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing
risk of injury due to warm up and cool down in dance aerobic instructors Journal
of Back and Musculoskeletal Rehabilitation 20(1) 29-35
Michaelidis M amp Koumantakis G A (2014) Effects of knee injury primary
prevention programs on anterior cruciate ligament injury rates in female athletes
in different sports A systematic review Physical Therapy in Sport Official
Journal of the Association of Chartered Physiotherapists in Sports Medicine
15(3) 200 doi 101016jptsp201312002
Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players
European Scientific Journal 11(15)
Norcross M F Blackburn J Goerger B M amp Padua D A (2010) The
association between lower extremity energy absorption and biomechanical
factors related to anterior cruciate ligament injury Clinical Biomechanics
25(10) 1031e1036
Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate
ligament tears Functional and postoperative rehabilitation Knee Surgery Sports
Traumatology Arthroscopy 21(5) 1071-1084 doi101007s00167-012-1970-1
Prentice W E (2008) Essentials of athletic injury management (7th ed) New York
NY McGraw-Hill
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
61
Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)
Strategies for the prevention of volleyball related injuries British Journal of
Sports Medicine 40(7) 594-599 doi101136bjsm2005018234
Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports
fitness and sports injuries (pp 71) London Wolfe Publishing Limited
Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)
Sagittal alignment of the knee and its relationship to noncontact anterior cruciate
ligament injuries The American Journal of Sports Medicine 39(5) 1090-1094
doi1011770363546510393305
The Department of Health (2011) Change4Health - Classification of Physical
Activity and Level of Intensity Retrieved October 11 2015 from
httpwwwchange4healthgovhkenphysical_activityfactsclassificationindex
html
The World Health Organization (2015) Physical activity and young people Retrieved
October 11 2015 from
httpwwwwhointdietphysicalactivityfactsheet_young_peopleen
Van Der Worp H Frings-sen M H W Van Den Akker-Scheek I Zwerver J amp
Kuijer P P F M (2011) The impact of physically demanding work of
basketball and volleyball players on the risk for patellar tendinopathy and on
work limitations Journal of Back and Musculoskeletal Rehabilitation 24(1)
49-55
Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on
the human musculoskeletal systemmdasheffect of fatigue Clinical Biomechanics
13(7) 515-520
Zahradnik D Jandacka D Uchytil J Farana R amp Hamill J (2015) Lower
extremity mechanics during landing after a volleyball block as a risk factor for
anterior cruciate ligament injury Physical Therapy in Sport 16(1) 53-58
doi101016jptsp201404003
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
62
APPENDIX I
Knee Injury Questionnaire
香港排球運動員膝蓋創傷問卷調查
你好本人是香港浸會大學運動及康樂領袖學社會科學學士(榮譽)學位課程的
四年級生現在進行有關香港排球運動員膝蓋創傷的研究希望收集不同隊伍
及大專院校的校隊成員的受傷紀錄本調查問卷共19題問題約需要5-8分鐘
完成在完成問卷的過程中部分問題可能涉及閣下的私隱和價值取向是次
研究並不為閣下提供個人利益但所搜集數據將對研究香港排球運動員膝蓋創
傷的問題提供寶貴的資料請依據自己的實際情況選擇答案這項調查是以不
記名的方式進行參與純屬自願性質閣下提供的資料只作研究用途且絕對
保密本人深感有關研究給你帶來諸多不便在此對您的體諒和幫助深表感
謝如你明白以上內容並願意參與是項研究請在下方簽署
簽署_______________________ 日期_______________________
請在適當的 內加上ldquo 及在ldquo___________rdquo填上適當的內容
=====================================================================
甲部個人資料
A1 性別 男 女
A2 年齡 ___________
A3 身高 ___________米 體重 ___________公斤
乙部 參加排球訓練的習慣
B1 過去二十四個月內你是否參加過以下各類排球代表隊
1 大專院校排球代表隊 0= 否 1= 是(請說明) _____________
2 排球球會代表隊 0= 否 1= 是(請說明) _____________
3 香港運動香港青年運動代表隊 0= 否 1= 是(請說明) _____________
4 其他 (請說明) _________________ 0= 否 1= 是(請說明) _____________
編號________
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
63
B2 在排球運動中你最常擔任的位置
主攻手 快攻手 二傳手
接應二傳 自由人
B3 過去十二個月內你平均每星期進行多少小時訓練比賽
1-5小時 6-10小時 11-15小時 16小時或以上
B4 過去十二個月內你平均每星期進行多久體能訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B5 過去十二個月內你平均每星期進行多久重量訓練
30分鐘或以下 31-60分鐘 61-120分鐘 121分鐘或以上
B6 訓練前你有否進行熱身運動
有(請往第7條作答) 沒有(請往第9條作答)
B7 你平均花多少時間進行熱身運動
10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上
B8 你進行的熱身運動包括 (可選多項)
緩步跑 肌肉伸展(拉筋) 針對性熱身運動
其他(請註明) _________________
B9 運動後你有沒有進行舒緩運動
有 沒有
丙部 膝蓋受傷狀況
C1 過去十二個月內你有沒有在排球訓練比賽時出現膝蓋受傷(至少連續3天妨
礙日常活動及排球訓練)
有(請繼續回答以下問題) 沒有(請停止本部份的答題)
C2 是次受傷是哪類型的受傷 (可選多項)
急性 慢性
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-
64
C3 膝蓋出現的受傷是 (可選多項)
撞傷 勞損 半月板碎裂
扭傷(可選多項) 前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂
內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂
C4 你認為是次受傷的原因是 (可選多項)
熱身不足 體能欠佳 訓練過度 精神不集中
與人碰撞 場地問題 裝備不合適
其他(請註明) ______________________
C5 是次受傷後你到哪裡處理(可選多項)
自行休息 急症室 普通科門診 家庭醫生
骨科醫生 物理治療 跌打 針灸
其他(請註明) ______________________
C6 是次受傷後 你有沒有進行手術
有 沒有
C7 你的康復時間大概是多久
1星期或以下 2-3星期 4-5星期 6星期或以上
-問卷完謝謝-