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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) 25 th April,2016

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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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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-

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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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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Granan L (2009) Timing of anterior cruciate ligament reconstructive surgery and

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doi1011770363546508330136

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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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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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

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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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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

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-

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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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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doi101136bjsports-2015-094959

Bowerman S J Smith D R Carlson M amp King G A (2006) A comparison of

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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

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-

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)

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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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-

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

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-

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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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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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

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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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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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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-

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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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

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-

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

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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-

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-

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-

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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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

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-

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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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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Hei L (2012) A comparison of knee injuries among university basketball and soccer

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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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Janssen I Steele J Munro B amp Brown N (2014) Jump height is the critical

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60

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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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Pierce C M OrsquoBrien L Griffin L W amp LaPrade R F (2013) Posterior cruciate

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Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)

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Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports

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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-

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

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-

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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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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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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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

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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

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-

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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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

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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

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25(10) 1031e1036

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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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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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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

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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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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

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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-

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

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-

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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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-

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-

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-

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

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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-

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-

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-

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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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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de Loeumls M Dahlstedt L J amp Thomeacutee R (2000) A 7-year study on risks and costs

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1103-1109

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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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httpwwwmeventsorghkenevents_vbahkphp

Malliou P Rokka S Beneka A Mavridis G amp Godolias G (2007) Reducing

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Nora D amp Aartan K (2015) Epidemiology in Knee Injuries in Volleyball Players

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Reeser J C Verhagen E Briner W W Askeland T I amp Bahr R (2006)

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Reilly T (1992) Strength training for injury prevention In T Reilly (Ed) Sports

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Terauchi M Hatayama K Yanagisawa S Saito K amp Takagishi K (2011)

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The Department of Health (2011) Change4Health - Classification of Physical

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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

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49-55

Voloshin A S Mizrahi J Verbitsky O amp Isakov E (1998) Dynamic loading on

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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

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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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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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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

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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-

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

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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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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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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

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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

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-

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

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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

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

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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-

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-

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-

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-