This past weekend I was given the opportunity to swap my treatment room in the city for one on Coolangatta main beach to treat the athletes at the Australian Beach Volleyball Tour Finals. Many of the Australian beach volleyball squad (the Volleyroos) were in action that weekend. The players had an extremely busy schedule leading up to this tournament because some events had to be held on successive weekends to make up for lost time due to the lockdown. This meant that there were players who had picked up injuries in the weeks leading up to this tournament and we had to do everything we could to keep them out on the court.
Low back & shoulder pain were the most common problems that the players came to see us with.
Common Beach Volleyball Injuries
A retrospective study by Bahr & Reeser, 2003 found that the most common beach volleyball injuries that players would seek medical attention for at tournaments were injuries involving the low back, shoulder and knee. Interestingly, players with pre-existing low back and knee issues found that the severity of their condition correlated with sand quality and depth. The firmer the sand was at a particular tournament, the worse their back or knee pain would be. Indoor volleyball players said that that they experienced less low back and knee pain during the beach season because the softer surface helps absorb some of the impact that the joints, muscles and tendons of the leg need to deal with.
Low Back Injuries
Low back stiffness was one of the most common complaints that the athletes came to see us with. The jump serve requires players to forcefully hyperextend and rotate their trunk to generate power for the serve. This places increased stress on the joints of the lumbar spine (facet joints). The increased stress on these joints can irritate the ligament capsule surrounding the joint resulting in reflex muscle spasm of the erector spinae, multifidus and other paraspinal muscles in the low back. We noted that whenever a player complained of low back pain or stiffness that it was often on the same side as the arm that they serve with. I’ve seen this in tennis players and golfers who are unable to control their core and maintain a neutral spine, their low backs hyperextend and land up in what we call an “S-Posture”. Over time this will lead to increased strain on the spinal joints unless corrected with strength and mobility training.
Shoulder Injuries
The shoulder injuries that we saw presented in a way that throwing sports or racket sports shoulder injuries present. It was common for athletes to complain of pain running along the back toward the front of the shoulder. Repetitive overhead serves and spikes cause the internal rotators of the shoulder to become stronger and overdeveloped compared to the external rotators. A term that has been used to describe this condition is shoulder rotator muscle imbalance. The Infraspinatus muscle is one of the main shoulder external rotators that gets overloaded by the powerful internal rotators because it is constantly decelerating the athlete’s arm when they strike the ball overhead. Frequent practice sessions and decreased recovery time between matches leads to progressive overload of this muscle and it eventually becomes a source of pain felt over the back of the shoulder.
The imbalance between internal and external rotators of the shoulder causes the head of the humerus (your upper arm bone) to displace forward with certain overhead movements. This forward displacement of the humerus results in an increased strain on your bicep tendon that runs along the front aspect of the shoulder which can lead to biceps tendinopathy or pain felt over the front of the shoulder. Rehabilitation exercises can help prevent this type of shoulder pain. The key is to focus on improving thoracic spine mobility, scapular (shoulder blade) control and improving the strength of the external rotators of the shoulder.
What treatment did we provide for the athletes?
Many of the athletes were under the care of some well-respected physio’s and chiro’s from around the country. This meant that we had to adapt our treatment style and work in a way to what they were accustomed to. Several players would see us before the start of their warm-up while others would see us after their matches for deeper tissue massage, static stretching and joint mobilisation or manipulation. The handheld percussion massager gun, similar to a Theragun or Hyperice Hypervolt, was a favourite amongst the players.
Working on a beach is not the most hygienic setting and we decided it would be best to not perform any dry needling. I personally don’t like dry needling athletes during a competition. I usually recommend avoiding any strenuous activity for 24-48 hours after a dry needling session so that the body part has adequate time to recover. Instead, we chose to perform manual trigger point therapy, active release technique, and post-isometric relaxation stretching methods to help reduce muscle tension.
I was called out onto the match courts twice for medical time outs. On both occasions, the players landed badly and sprained a ligament in their ankle. I taped their ankles out on the court with rigid Leukotape P and both players were able to continue their matches. Dynamic tape and Kinesio tape were preferred by the players (especially on their shoulders) as it could be used to help decelerate the serving arm, and offload the weaker external rotator muscles.
In Conclusion
It was a really busy weekend but it’s always a great time working with athletes who are at the top of their game. I would like to say a big thank you to the mens & ladies division 1 champions for signing a tournament jersey for me. I’ve linked their Instagram accounts below:
Damien Schumann – @damien_schumann
Chris McHugh – @mchuge89
Mariafe Artacho sel Solar – @mariafe_beach1
Taliqua Clancy – @taliqua
About the author:
Dr Michael Benporath is a chiropractor with a postgraduate International Certificate in Sports Chiropractic. He practices at Prime Health Co. in Redland Bay & Grange.
