Volleyball exercises: a warm-up, ankle, knee and shoulder protection, and jump training for indoor and beach players

Ankles first, and most sprains are repeats

Ankle sprains were 41% of all injuries in Dutch league players, and 79% of ankle injuries in Norway's top divisions were repeats. A sprain in the past 6 months raised the risk of another almost tenfold.

Sources 1, 2

Balance training helps players who've sprained before

A balance board programme in the team warm-up cut sprains only in players with a previous sprain. After a sprain, wear a brace or tape for 6 to 12 months.

Sources 3, 2, 4

Jumper's knee follows jump load

Almost half of Norway's national-level men had jumper's knee, and in young elite players each extra weekly hour of training and each extra set played in matches a week raised the risk. No programme has been shown to prevent it.

Sources 5, 6, 7

Shoulders: borrowed from handball

No shoulder programme has been tested in volleyball. In handball, a similar overhead sport, short shoulder routines cut shoulder problems.

Sources 8, 9

Jump training works without huge volumes

In 14 trials, jump training raised volleyball players' vertical jump, and programmes of 2 sessions a week and fewer than 2,000 jumps in total did as well as bigger ones.

Source 10

On the beach, add heat and sun

Beach players have fewer sudden injuries but plenty of overuse back, knee and shoulder problems, and they play in heat and sun.

Sources 11, 12, 13

Short, explosive efforts

Jumps, dives and sprints of a few metres, with rests between rallies. The Compendium of Physical Activities gives competitive indoor volleyball 6.0 metabolic equivalents (METs), non-competitive play 3.0 and beach volleyball in sand 8.0.

Source 14

Lots of jumping, unevenly spread

Filmed over 11,943 jumps, young elite players jumped about 62 times an hour in matches if they were boys and about 42 if girls. Over a training week, boys did anywhere from 50 to 666 jumps, and players differed far more than positions did.

Source 15

Where the load falls

The sites the studies point to:

• Ankles at the net: landing on another player and contact with the floor each caused 21% of US college women's game injuries.
• The patellar tendon below the kneecap, through repeated jumping (jumper's knee).
• The hitting shoulder, most in attackers and jump servers, including the nerve to the infraspinatus, a rotator cuff muscle, which is stretched as the arm cocks back and follows through.
• The low back when you arch to hit: arching caused about 70% of new back pain in a high-school trial.
• Fingers, at the block and in defence (our reading): 10.7% of injuries at international events.

Sources 16, 6, 17, 18, 19, 20

Beach

Sand softens landings but makes each jump harder work (our reading). In world-class beach players, overuse problems were most often in the low back (19% of overuse injuries), knee (12%) and shoulder (10%), and they play outdoors in heat and sun.

Source 11

What to train (our reading)

Jump height and repeated jumping, soft two-footed landings, ankle and hip control, outward-rotation strength and shoulder-blade control for the hitting arm, a strong trunk through arching and twisting, and managing how much you jump.

How often players get hurtEmerging evidence

Volleyball has fewer sudden injuries than most team sports. The numbers:

• Norway's top two divisions: 1.7 injuries that stopped play per 1,000 hours; 3.5 in matches and 1.5 in training.
• Dutch league players: 2.6 per 1,000 hours, 2.0 sudden and 0.6 overuse.
• International events of the FIVB, volleyball's world governing body: 3.8 injuries that stopped play per 1,000 player hours of matches, with senior players at twice the rate of juniors.
• US college women: 4.58 per 1,000 match exposures and 4.10 per 1,000 practice exposures.
• World-class beach players: 3.1 per 1,000 hours of competition and 0.8 per 1,000 hours of training.
• Recreational Dutch adults reporting every two weeks: 11.3 sudden injuries that stopped play per 1,000 hours.
• Elite men asked every week: at any one time, 31% had a knee problem, 21% a low back problem and 19% a shoulder problem, and 93% had one at some point in a season.

Sources 2, 1, 20, 16, 11, 21, 22

Ankle sprainsStrong evidence

Ankle injuries were 54% of sudden injuries in Norway, ankle sprains 41% of all injuries in Dutch league players, 25.9% of injuries at international events and 44.1% of US college women's match injuries. Most are repeats: 79% in Norway, where a sprain in the previous 6 months raised the risk almost tenfold and 42% of those ankles went again. Our sprained ankle and chronic ankle instability guides cover treatment.

Sources 2, 1, 20, 16

Jumper's kneeEmerging evidence

44.6% of Norwegian national-level male players had it, and 14.4% of Dutch non-elite players, the highest of 7 sports. Men are more affected than women, and in young elite players, better jumpers were more likely to develop it. The jumper's knee section below covers jump load; our jumper's knee guide covers treatment.

Sources 5, 23, 6, 24

Shoulder problemsEmerging evidence

About 60% of US college club players had had shoulder problems, attackers and jump servers most. At any one time, 19% of elite men had one, and shoulders were 10% of beach players' overuse injuries. The shoulder section below and our shoulder pain guides cover them.

Sources 17, 22, 11

Low back painEmerging evidence

11% of sudden injuries in Norway and 8.9% at international events. 21% of elite men had a back problem at any one time, and 48% of elite Japanese high-school players had back pain in the past year. Our back pain guide covers treatment, and our spondylolisthesis guide covers teenage back pain that's worse arching back.

Sources 2, 20, 22, 25

FingersEmerging evidence

7% of sudden injuries in Norway, 10.7% at international events and 17% of beach players' sudden injuries. Our broken or jammed finger and mallet finger guides cover them.

Sources 2, 20, 11

Other knee injuriesEmerging evidence

The knee was 15.2% of injuries at international events and 30% of beach players' sudden injuries. Anterior cruciate ligament (ACL) tears seem rarer than in basketball: the two volleyball studies in one meta-analysis had none, though the number in US college volleyball rose from 2004 to 2013. Our ACL injury guide covers what to do.

Sources 20, 11, 26, 27

Balance boards in the team warm-up, as trialledEmerging evidence

The largest volleyball prevention trial:

• Who: 116 Dutch men's and women's teams over one season, randomised by region: 641 players did the programme and 486 trained as normal.
• What: a balance board programme done as part of the team warm-up, with volleyball exercises done in pairs, as a later study by the same group describes it. The trial's exact exercises, times and weekly sessions weren't available to us, so the board work in this page's routine is our own.
• Effect: ankle sprains fell by 0.4 per 1,000 hours of play, but only in players who had sprained an ankle before. In players with a previous knee injury, overuse knee injuries rose, and the authors suggest such players may be better off without balance boards.
• Cost: about €444 per sprain prevented; aiming it at players with a previous sprain could make it cost-effective.

Sources 3, 28, 29

The Norwegian programmeEmerging evidence

In Norway's top two divisions, an injury awareness session, coaching on take-off and landing technique for blocking and attacking, and a balance board programme for players with repeated sprains went with ankle sprains falling from 0.9 to 0.5 per 1,000 hours over three seasons. It compared seasons rather than randomised groups.

Source 30

After a sprain: a brace or tape, and balance trainingStrong evidence

Norwegian researchers advise a brace or tape for 6 to 12 months after a sprain. In 384 athletes, a brace worn for 12 months cut repeat sprains more than an 8-week home programme (15% against 27%), and across 6 trials, braces cut repeat ankle injuries. An 8-week home balance programme, 3 times a week, cut repeats from 33% to 22% in 522 athletes. Our sprained ankle guide sets out the programme.

For a first sprain, the evidence is weaker: balance training's effect is inconclusive across sports, and braces' rests on low-quality evidence, though in a large basketball trial lace-up braces cut first sprains too.

Sources 2, 4, 31, 32, 33, 34

VolleyVeilig, a 15-minute warm-up, as trialledEmerging evidence

The one volleyball team warm-up with a trial:

• Who: 672 recreational adult players in the Netherlands who played at least twice a week, over the 2017 to 2018 season.
• What: 15 minutes at least twice a week before training or matches: 2 to 3 minutes of cardio, 2 to 3 of core work such as a straight plank, 4 to 5 for the knees such as squats, and 4 to 5 for the shoulders such as band external rotations, with ankle exercises such as one-leg stands throughout. A new, harder programme came each week, in 6 phases of 5 to 6 weeks, from over 50 exercises in an app.
• Effect: 8.9 sudden injuries per 1,000 hours against 11.3, about a fifth fewer; once the researchers adjusted for other factors, the difference was borderline and no longer significant. Overuse injuries didn't change.
• Compliance: not reported in the summary we could read.

Sources 35, 21

A school warm-up for girlsEmerging evidence

In a trial in schoolgirls, volleyball players who did a neuromuscular warm-up had 5.74 injuries per 1,000 exposures against 11.63 with a dummy warm-up.

Source 36

Low back pain: one small trialEmerging evidence

In 8 Japanese high-school teams (70 players aged 15 to 17), 4 weeks of a warm-up in which each player chose 1 or 2 exercises (upper-back mobility, trunk stability or stretches) after 9 physical tests went with new back pain in 8.8% of players against 33.3%. Across sports, a previous episode, high training volume and sudden rises in load are the risk factors.

Sources 19, 37

A Canadian volleyball warm-up is being tested

The University of Calgary's volleyball warm-up, 10 to 12 minutes with block and approach jumps, landings with a partner's nudge, Nordic hamstring lowers and shoulder raises, is being evaluated with Volleyball Alberta. There are no results yet.

Source 38

Balance boards after a knee injuryEmerging evidence

Overuse knee injuries rose in such players in the Dutch trial. Keep their balance work on the floor (our suggestion).

Source 3

Jump trainingStrong evidence

In 14 randomised trials, jump (plyometric) training raised volleyball players' vertical jump with a moderate effect. Programmes of 8 weeks or less did as well as longer ones, 2 sessions a week as well as more, and fewer than 2,000 jumps in total as well as more. The authors advise fitting the load to the player: liberos, for example, may be less ready for it.

Source 10

Sand or courtEmerging evidence

Jump training on sand also works. In 17 female indoor players, 8 weeks on sand or a hard court improved different tests; in 40 male players, sand and water training beat land training for the countermovement jump; and footballers who trained on sand had less muscle soreness.

Sources 39, 40, 41

Strength and complex trainingEmerging evidence

Alternating heavy lifts with jumps in the same session raised basketball and volleyball players' vertical jump.

Source 42

Shoulder strengthEmerging evidence

Weak outward rotators, relative to the inward rotators, are linked with shoulder pain in volleyball players. Shoulder Control's five groups, in the shoulder section below, are the trial-tested template.

Sources 43, 44, 9

Fitting it around volleyball (our suggestion)

Low volumes work, which matters because jump volume is linked with jumper's knee. In pre-season, do 2 strength and jump sessions a week for 6 to 8 weeks, with some of the jumping on sand if you can; in season, 1 session a week, cutting the jumps in weeks with many matches. Do the shoulder block in every warm-up in season, and count jumps where you can: players in the same squad differed more than tenfold.

Sources 10, 15, 6

Who gets shoulder painEmerging evidence

About 60% of 422 US college club players had had shoulder problems, attackers and jump servers more than setters, defenders and float servers. Poor shoulder-blade control and a weak core went with pain; a loss of inward rotation in the hitting shoulder didn't. In other studies, weak outward rotators relative to the inward rotators were linked with pain.

Sources 17, 43, 44

Painless wasting at the back of the shoulderEmerging evidence

12 of 96 top indoor players had painless wasting of the infraspinatus on the hitting side, with about a fifth less outward-turning strength, thought to come from stretching its nerve when serving. It was in 30% of professional beach players' hitting shoulders. In one follow-up, most players kept playing for years with it unchanged. New wasting or weakness should still be checked, as our infraspinatus page explains.

Sources 18, 45, 46

Shoulder Control, as trialled in handballEmerging evidence

Untested in volleyball. The trial:

• Who: Swedish handball school players aged 15 to 19; 199 did the shoulder programme.
• What: one exercise from each of five groups, at a level that's challenging with good technique: band raises and rotations, such as a Y-raise; push-up plus and plank variations; upper-back rotations; a one-arm "diver" on one leg; and trunk rotations and throwing motions against a band. Sets of 30 seconds, moving 1 to 2 seconds each way: 3 sets 3 times a week out of season, and 2 sets in the normal warm-up in season, about 10 to 15 minutes.
• Effect: shoulder injuries fell by more than half, though players averaged only 1.3 sessions a week.
• A similar programme in 660 elite handball players, 3 times a week in the warm-up, cut shoulder problems from 23% to 17%.

Sources 9, 8

Why borrow it (our reasoning)

Spiking and the jump serve are overhead throwing actions, and weak outward rotators are linked with volleyball shoulder pain. VolleyVeilig included band external rotations, but its published summary reports no shoulder result.

Sources 21, 44

Stretching the back of the shoulderMixed evidence

A loss of inward rotation in the hitting shoulder is common and wasn't linked with pain, so stretching to fix it isn't a priority. Strengthen the outward rotators instead.

Sources 17, 44

Load drives itEmerging evidence

In 141 young elite players followed for 4 years, each extra hour of volleyball training a week raised the odds of jumper's knee about 1.7 times, and each extra set played in matches a week about 3.9 times; boys were 3 to 4 times as likely as girls to develop it. Better jumpers were more at risk, and jump counts varied more than tenfold within a squad.

Sources 6, 24, 15, 47

No programme has prevented itMixed evidence

A review found no proven way to prevent tendinopathy, and in professional footballers whose tendons already looked abnormal on a scan, preventive eccentric training and stretching raised the risk. Screening tests didn't predict jumper's knee in 60 elite men, and landing style has only weak, cross-sectional links.

Sources 7, 48, 49, 50

Managing jump load (our suggestion)

Count jumps, spread jump-heavy sessions through the week, and avoid sudden rises in volume, such as a tournament after a break.

Sources 15, 6

If it hurtsEmerging evidence

Eccentric decline squats done during the competitive season didn't help elite volleyball players. In 76 patients, a staged programme that kept pain at 3 out of 10 or less beat painful eccentric training. Our jumper's knee guide sets out the stages, and many players keep playing with less jumping.

Sources 51, 52

Fewer sudden injuries, plenty of overuseEmerging evidence

At the 2001 World Championships, beach players had 3.1 sudden injuries per 1,000 hours of competition, mostly to the knee, ankle and fingers. Overuse problems were mostly in the low back, knee and shoulder, and in another study 30% of professionals had infraspinatus wasting.

Sources 11, 46

HeatStrong evidence

Heat exhaustion should improve within 30 minutes of resting somewhere cool, cooling down and drinking water or a sports drink. Call 999 if it doesn't, or for a very high temperature, hot skin that isn't sweating, a fast heartbeat, fast breathing, confusion, a fit or loss of consciousness.

Source 12

SunStrong evidence

Spend time in the shade between 11am and 3pm when you can, cover up, and use sunscreen of at least SPF (sun protection factor) 30 with at least 4-star UVA (ultraviolet A) protection, reapplied every 2 hours and after sweating or towel drying.

Source 13

Everyone: seven questions

The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) asks about a heart condition or high blood pressure, chest pain, dizziness or losing consciousness, other long-term conditions and their medicines, a bone or joint problem that activity could make worse, and being told to exercise only under supervision. If you answer yes to any, check with your GP or a qualified exercise professional first. If you're over 45 and not used to hard exercise, ask a qualified exercise professional before the hardest sessions, and delay if you're ill.

Source 53

A sprained ankle in the past year

42% of ankles sprained in the previous 6 months went again. Wear a brace or tape for 6 to 12 months and do balance training, as our sprained ankle guide sets out.

Sources 2, 4

A previous knee injury

Overuse knee injuries rose with a balance board programme in such players. Keep balance work on the floor and ask a physiotherapist (our suggestion).

Source 3

Jumper's knee now

Follow our jumper's knee guide, keeping tendon pain at 3 out of 10 or less and settled by the next morning. Eccentric decline squats done in season didn't help elite players.

Source 51

Hitters and servers with shoulder pain

Our shoulder guides allow discomfort up to about 5 out of 10 during exercise if it settles by your next session. New weakness or wasting at the back of the shoulder should be checked.

Teenagers with back pain when they arch

Spondylolysis, a stress fracture at the back of the spine, is the commonest structural finding in young athletes with back pain. Back pain that lasts more than a couple of weeks, is worse arching back or stops them training needs a GP or sports physiotherapist, as our spondylolisthesis guide explains.

Sources 54, 19

Beach players in hot weather

Plan for shade, water and sunscreen, and learn the heat warning signs below.

Sources 12, 13

Pregnant

The UK's National Health Service (NHS) advises avoiding sports where there's a risk of falling or bumping your tummy, and diving for the ball is one. Passing and setting drills without diving may suit; talk to your midwife or GP (our suggestion).

Sources 55, 53

A head injury: call 999

The NHS says to call 999 if someone has hit their head and:

• Has been knocked out and hasn't woken up, or can't stay awake or keep their eyes open.
• Has a fit (seizure).
• Has problems with their vision or hearing, or clear fluid coming from their ears or nose.
• Has new numbness or weakness in any part of their body, or problems with walking, balance, understanding, speaking or writing.
• Has a dent in their head, or their behaviour has changed, such as being more irritable or distracted.

Source 56

Suspected concussion

Stop playing: if in doubt, sit them out. The UK grassroots guidelines say no training, matches or PE (physical education) lessons for at least 24 hours and an assessment by a healthcare professional or NHS 111 within 24 hours. Volleyball England's guidelines: remove the player, spend at least 24 hours at each stage of the return, and no return to play before 21 days unless an enhanced care pathway with medical oversight applies. Get help from NHS 111 straight away if they're being sick or feel dizzy.

Sources 57, 58, 56

A sprain or a crack

Call 999 or go to A&E (accident and emergency) if you heard a crack when you were injured, the injured part has changed shape or points at an odd angle, it's numb or tingling, or the skin has turned blue or grey or is cold to touch. Get help from NHS 111 or an urgent treatment centre if it's very painful, very swollen or bruised, or you can't put weight on it or walk more than a few steps.

Source 59

A jammed or broken finger

Go to A&E if a finger points at an odd angle, looks blue or feels numb, or is cut with bone showing. Get help from NHS 111 if it's painful, swollen and bruised, or stiff and difficult to move. A finger that crosses its neighbour when you make a fist, or a fingertip that won't straighten, needs urgent advice, as our finger guides explain.

Source 60

A knee that gives way

Get advice from NHS 111 now if your knee is very painful, you can't move it or put any weight on it, it's badly swollen or has changed shape, or it locks, gives way or clicks painfully. A pop at the front of the knee after which you can't straighten it or lift the straight leg can be a torn kneecap tendon: get it checked the same day, as our kneecap tendon rupture guide explains.

Source 61

Shoulder pain

Ask for an urgent GP appointment or get help from NHS 111 if you have sudden or very bad shoulder pain, you can't move your arm, your arm or shoulder has changed shape or is badly swollen, you have pins and needles that don't go away or no feeling in your arm, or it's hot or cold to touch.

Source 62

Back pain

Call 999 or go to A&E for back pain with pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or bottom, changes in your bladder or bowels, or chest pain. Ask for an urgent GP appointment or get help from 111 if you feel hot, cold, shivery or generally unwell, or the pain starts suddenly and is severe or getting worse quickly.

Source 63

Fainting or chest pain: call 999

Call 999 if someone faints while exercising, or for sudden chest pain that doesn't go away, pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness.

Sources 64, 65

Heat on the beach

Call 999 if someone with heat exhaustion isn't better after 30 minutes of resting somewhere cool, being cooled and drinking, or has a very high temperature, hot skin that isn't sweating, confusion, a fit or loss of consciousness.

Source 12

"Balance boards prevent everyone's ankle sprains"Emerging evidence

In the Dutch trial they helped only players with a previous sprain, and overuse knee injuries rose in players with a previous knee injury.

Source 3

"Eccentric decline squats will fix jumper's knee during the season"Emerging evidence

They had no effect in elite players who kept playing. A staged programme that kept pain low did better in the largest trial, as our jumper's knee guide explains.

Sources 51, 52

"Jumper's knee comes from bad landing technique"Mixed evidence

Landing studies show only weak, cross-sectional links. Training volume, sets played and jumping ability predicted it.

Sources 50, 6, 24

"A tight back of the shoulder causes spiker's shoulder pain"Emerging evidence

The loss of inward rotation wasn't linked with pain; weak outward rotators were.

Sources 17, 44

"Shoulder wasting means you must stop playing"Emerging evidence

Painless infraspinatus wasting is common in volleyball players, and most kept playing for years with it unchanged. New wasting or weakness should still be checked.

Sources 18, 45, 46

"Beach volleyball is injury-free because sand is soft"Emerging evidence

Sudden injuries are fewer, but overuse back, knee and shoulder problems are common, and 30% of professionals had shoulder wasting.

Sources 11, 46

"Strength training will make you less springy"Strong evidence

Jump training raised volleyball players' vertical jump in 14 trials, and heavy lifts combined with jumps raised it too.

Sources 10, 42