Addressing the Injury Issue

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ACL tears and other lower leg injuries plague women's volleyball.

Michelle Neumayr was standing on the cusp of her eagerly anticipated NCAA-debut at the University of California. Just a week before moving to Berkeley to start her college career in the summer of 2011, Neumayr, one of the nation’s most highly regarded recruits boasting a distinguished prep and club record, was playing in the Junior Olympics when a split-second miscalculation triggered a disastrous chain of events.

Neumayr suffered a torn anterior cruciate ligament (the dreaded ACL) on a play in which she landed on one leg, a bad habit she admits spending years trying to shake.

After undergoing surgery and a full year of rehab, she tore the same ACL again. It wasnt until September of 2013 that she made her NCAA debut at Cal.

Two and a half years after her initial injury, and two reconstructive knee surgeries later, Neumayr’s once-promising career was over.

The former Under Armor First Team All-American and Volleyball magazine Fab 50 selection announced her retirement from the sport earlier this year, citing long-term concerns about the health of her knee. She admits giving up the sport that had been the main focus of her life for more than 10 years was exceedingly tough.

The one-legged landing that left her knee vulnerable and triggered the original injury was a bad habit Neumayr says she developed when she was young.

At one point, Neumayr’s coaches at Vision Volleyball Club in Los Gatos, California, tried to correct this bad habit. During practices they made players who landed on one leg do push-ups. Neumayr acknowledged that despite her efforts, landing on one leg during competition is a hard habit to break.

One-legged landings in volleyballespecially in the women’s gameare the leading cause of a multitude of lower-leg injuries, of which torn ACLs are the most serious.

With ACLs it only takes one bad landing on one given play to mess it all up, Neumayr said. In the heat of the moment I wasnt thinking about it and I tore my ACL.

Neumayr is among a growing number of high-profile players whove suffered severe lower-leg injuries over the last decade. Stanford’s Cynthia Barboza and Christa Harmotto (Penn State) suffered torn ACLs during their freshman years (both in 2005). Jessica Gysin (USC) missed most of her freshman year with a severe ankle sprain in 2004.

The increase in ACL and repetitive-use injuries has paralleled the sport’s explosive growth over the last 30 years, and in particular the proliferation of year-round competition on the club circuit over the last 15 years involving players as young as 10.

And coachesespecially those at elite NCAA programsare taking notice.

You cant ignore it, University of Florida head coach Mary Wise said. [Injury management] is certainly a big part of the game.

The acknowledgement that even the game’s best players cant carry a team when theyre carrying crutches has sparked a new age of injury-prevention innovation in volleyballparticularly on the women’s side, where injuries are more prevalent.

Stanford head coach John Dunning, one of the sport’s loudest injury-prevention advocates, has implemented some of the most aggressive measures designed to take the edge off of a dangerous game.

Last season the Cardinal started a jump count in practices, with assistant coaches literally counting how many times certain players jump in games and in practices along with restricting how hard players can hit in early-season practices. Perhaps most importantly, Stanford coaches are cracking down hard on one-legged landings in practice.

Other coaches may not look at it that way, but I look at injury management as one of the bigger pieces of the pie, Dunning said.

The University of Florida just started using a newly developed device that tracks how often and how high players jump. Thumb-sized and wearable, the Bluetooth-enabled gadget called VERT was developed by Fort Lauderdale-based Mayfonk Athletic in partnership with USA Volleyball.

The device was originally created as a marketing tool to help showcase volleyball players often remarkable leaping ability on televised matches and SportsCenter highlight reels. Its injury-prevention monitoring function is an added benefit, Wise said.

Every day [our players] roll it into their spandex and it goes real time to an iPad that our trainer has, Wise said. I can ask how many jumps [a player has] in the middle of practice and she looks down and tells me. It helps me be sensitive to the players, especially when theyre coming back from an injury, and not risk further injuries.

It’s objective feedback. It’s the exact number.

Wise believes that jump countswhether tabulated in the cloud or on a clipboardcan serve as a starting point for research desperately needed to reverse a tide that’s growing into an injury epidemic.

It is not known what, if any, relationship exists between overuse, impact injuries, and ACL tears.

Our issue is that we have so little data to work with, said Wise. Baseball figured out a pitch count for youth athletes decades ago. Will we get to a point where we have a good feel that players 12 and under should be jumping this many times and at 15 this many?

I think what we have to do is gather the data and get really smart people looking at it and start coming up with some ideas. Volleyball is still relatively new and there’s still not a lot of research being done.

Wise believes that the research will eventually help everyone involved with the sport understand what relationship exists between playing year-round and injury risk, if there is in fact a relationship, and if so, how much is too much.

We have better athletes playing above the net, Wise said. The game is faster and it’s more physical. Maybe the game has evolved and the research hasnt.

If there isnt better monitoring of the number of jumps, are we setting them up for injuries? I think those questions are being asked, we just dont have a whole lot of answers.

Dunning, who’s coached women’s volleyball for more than 40 years, was among the sport’s early adopters of injury management. His awareness of the potential health risks associated with the sport began when he was at the University of the Pacific in the mid-1990s and two of his players suffered serious injuries.

Elsa Stegemann, who played at Pacific between 95 and 99, was the first player Dunning coached to suffer a torn ACL. Addie Hauschild, the 1994 Big West Freshman of the Year, underwent surgery for a career-threatening back injury. Both made full recoveries and continued their distinguished careers.

It made me think about how to teach skills not based on what I heard somebody else do or what the exact physiological thing would be for speed or whatever. It’s based on health, Dunning said.

Prior to that, I think like everyone else I wasnt thinking of it that much because the sport was so new and I didnt really know about so many people getting hurt. Now there are lots of people that have issues with injuries.

The issues with injuries have coincided with the rise of club volleyball, which has stretched what was once a seasonal game to a year-round sport that critics say more closely resembles an injury factory for kids.

The January-to-June club season that’s no longer an option for aspiring collegiate athletes has athletes as young as 10 years old playing up to four matches a day on courts built upon thinly padded concrete convention-center floors.

Kids are playing more, the events are longer, and theyre playing on surfaces that really arent that forgiving, Dunning said. It’s easy to make the conclusion that that cant be great for you.

But it is a conclusion that Dunning himself is not ready to draw, at least not publicly.

Im not of the mind that it’s anybody’s fault but my own, Dunning said. [Stegemann and Hauschild] got hurt on my watch and I take that on myself.

Dunning attributes the spike in injuries in part to improper instruction at the early stages of player development. He’s especially concerned about the effects of players landing on one leg.

If you jump a million times [in your career] and you dont parachute in or you dont absorb the shock with [proper] technique, it makes sense that youre going to have patella tendinitis. Youre going to have hip issues and lower back and ankle issues and foot issues because youre not doing the skill properly, Dunning said.

A pattern exists, however, that at least on the surface appears to be strikingly similar to that which baseball pitchers are experiencing, with high school prospects throwing to light up radar gunsa factor that is suspected to play a role in the epidemic of elbow injuriesfor the same reason that aspiring volleyball scholarship athletes are playing an endless season.

Women’s athletics has followed the path of men’s athletics in so many ways, both the good and the bad. So if were chasing scholarships by trying to throw harder and play more often, be seen more often, as boys are doing, it’s not surprising [that the uptick in injuries] is happening to girls too, Wise said.

Dunning’s jump-count limits are position specific, with middle blockers and outside hitters on the shortest leashes and setters allowed virtually unlimited leaps. Players are shut down from specific drills once theyve hit their jump limit, Dunning said. He declined to state what jump limits he’s set for specific players.

Stanford junior outside hitter Jordan Burgess acknowledged that buying into the jump count isnt easy for intense athletes who thrive on the competition, but she said maturity factors in.

It’s difficult, but we have our whole team buy into it together, she said. It’s kind of like were doing it for the collective good.

But in some cases, players believe the opposite; they think they have to push themselves beyond the breaking point for the collective good, and because of that they end up hurting the team even more.

Senior Pepperdine middle blocker Samantha Cash acknowledged an unspoken pressure to play with potentially-serious nagging injuries. Cash played most of her sophomore year with a bum ankle that forced her to miss the team’s last five matches. She eventually had to have her ankle surgically repaired.

Cash found herself feeling guiltyeven apologizing to teammates, coaches, and boosterswhen she could no longer contribute.

Everyone doesnt mean to, but they make you feel guilty about being injured and not being able to practice, especially when theyre out there working hard and youre just kind of sitting there on a chair with people bringing you water, Cash said.

You feel pampered.

The pressure to perform at a high level can be overwhelming for healthy players, too, Cash said, noting that the all-expenses-paid scholarship rides come with strings attached.

You go [to college] and basically it’s a full-time job where if your coaches ask you to jump, you not only have to say how high, you have to learn how to defy gravity and fly for them.

That pressure trickles down to the lower levels of youth volleyball, where the fierce competition for scholarships often drives players beyond reasonable limits. That exposes athletes to greater risk for injuries, according to sports physiology expert Phil Wagner.

Wagner, a physician and founder of Sparta Performance Science in Menlo Park, California, said he’s seen a spike of ACL injuries in girls and women’s volleyball in recent years that matches the increase of elbow injuries in baseball.

The reality is there’s a big fear component, said Wagner, whose company provides training and rehabilitation services to athletes from high school to professional levels.

If Im a 15-year-old volleyball player, whether it’s coming from a coach, a parent, or the public, there’s always a fear that if I do something less, Im going to get less. That, If I only play one season or part of a season or only do high school or club or I dont do extra that Im not going to be as good.

Wagner acknowledged those concerns but added that those athletes will also likely not be as good if they end up sitting out a season with a torn ACL.

Getting young athletes to overcome the fear of not doing enough is a big challenge.

Rather than playing volleyball year-round, playing other sports or doing strengthening exercises is going to reduce your injury risk, Wagner said.

Although Neumayr isnt sure whether playing year-round contributed to her injury and not enough is known about the science to draw definitive conclusions, she still has her concerns.

When you play so much it just gives you that many opportunities to be put in a situation where you can tear your ACL, she said.

Neumayr said she supports the measures coaches are taking, such as jump counts, to reduce injuries. She said shed like to see players get more rest too.

She remains part of the local volleyball community in San Mateo County and still plays an occasional pickup game and gives informal lessons to young players.

And Neumayr mentioned she’s determined to keep her pupils from developing the bad habit that doomed her once-promising career.

I give lessons to girls and that’s one of the first things I mentionnot landing on one foot, she said.

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