Dr. Chris Koutures: Gradual return to activity important for young volleyball players

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Chris Koutures volleyball 8/9/2020-Alexia Gruszczynski-A4 volleyball club
Alexia Gruszczynski digs for the A4 volleyball club/Ed Chan, VBshots.com

By Dr. Chris Koutures for VolleyballMag.com

After long periods away from organized volleyball, there will be an understood eagerness by players and coaches to quickly return to previous levels of practice and competition. No matter when that happens — now, later this fall, or even the spring — you need a plan.

To best protect young volleyball athletes, realize that amping up the number and intensity of practice too quickly or at too high a level can be a recipe for bone and soft-tissue overload injuries that put players right back out of play for long periods of time.

Coaches and parents will best serve young athletes by promoting gradual returns to activity rather than rushing and pushing athletes back to “where we were” before a prolonged break. No on-line workout, individual training session, or home workout can match sport-specific speed, timing, and conditioning demands.

Some kids will return with video games as their highest level of physical exertion. It is best for coaches to realistically expect that all returning participants will be at some level of deconditioning – some more than others.

I’ve casually asked several of our current national team members to rate their level of strength, conditioning, and timing on a scale of 0-10 after several months away from organized activity. The majority are reporting scores of 6-7 (maybe a bit optimistic?) and I’ve asked them to continually reassess these self-reported scores as they return to our gym and more formal volleyball activities.

Overload and overuse injuries come from either too much acute stress on normal bones, joints and muscles, or normal stresses on weaker bones, joints and muscles. Athletes who have been inactive for a longer period of time and immediately elevate activity levels may suffer from both conditions. Coaches and players need to get comfortable expecting that this process may take several weeks.  Remember that we get in shape to play volleyball, not play volleyball to get in shape.

Click here for more information on bone stress injuries

A sensible recovery and rebuilding plan includes:

  • Starting with review of individual skills and techniques — not only are young athletes deconditioned, but some of them might actually have grown over the past several months. Growth periods and time away from activity are two big factors why young athletes lose technical skills.
    • A practical approach — step back and re-teach approaches to hitting, serving, passing, diving and jumping with simple drills that would have been performed years ago.
    • Initial return phases may limit use of balls, number of players on court, and distance between players. This presents a unique opportunity to focus on those basic technical skills.
    • This is great opportunity to review jump take-off and landing techniques as part of a solid jump training program that can also build strength and reduce injury risk. Check out this past Volleyballmag.com post on incorporating jump training for volleyball players.
  • Keep practices shorter — deconditioned athletes will fatigue quicker, and fatigued athletes get injured
  • Limit repetitive movements like hitting, serving or leaping/jumping – fewer reps with more rest between rotations.
  • Allow for at least one day off between practices. There is no logical role for double day or back-to-back daily sessions. Bones and muscles need time for repair. Coaches and parents need to plan accordingly since club practices are typically 2-4 days a week and many athletes add in private training lessons. The athlete’s body needs ample time for recovery in these important first weeks back.
  • Let’s not forget the mental game — some young athletes may not want to come back fast, or not at all. Give young athletes a voice to play an active role in deciding when and how quickly they return.

Now, even in the most thoughtful and well-intentioned situations, athletes are going to have pain and soreness as they start up activities. Some of this might be “normal and anticipated” while some may not.

When should a parent, athlete or coach get more worried?

  • A big concern is fingertip pain. 
    • If you can use the tip of your finger to point out a location of pain, there is a higher chance for a significant bone injury, ligament sprain or muscle tear/strain
  • Any lack of joint motion is a potential problem, especially in school-aged athletes. 
    • Volleyball-specific examples include limited ability to fully raise the shoulders to block or bend knees into a defensive stance
  • A sudden onset of pain and limited motion after hitting, landing, or changing direction. Hearing or feeling a pop sensation is even more worrisome.
  • Any limping or change in hitting, landing or running technique deserves further evaluation. 
  • Constantly thinking about an uncomfortable body part (have to limit jumping since my foot hurts) is not a good thing.
  • Obvious bruising or swelling around a joint
  • There should be no need for medication (ibuprofen, naprosyn, acetaminophen or similar products) either right before or after practice.
  • How about soreness or pain during or after exercise? 
    • Ask athletes to rate soreness and pain on a 0-10 scale
      • 0-3 during and right after practice is one thing, any score 4 or higher is a more of a concern
    • Soreness and pain should be gone by the next morning
    • Whole body or more general discomfort (both of my legs are really sore after practice) is one thing- again, that finger-tip pain is definitely more of a concern
  • Any pain or soreness while at rest 
    • Being awakened at night leading to poor sleep 
    • Just sitting, resting, or lying down watching Netflix 

There should be no hesitation to have an athlete see a sports medicine specialist for any concern. Pushing through pain, soreness, swelling or limited motion may lead to more serious damage and a longer recovery process.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, California. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton intercollegiate athletics, Chapman University dance department, and Orange Lutheran High School.
He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on Facebook
, Instagram, or Twitter at @dockoutures.

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