September 20th, 2013

Health N' Sports: Stress fractures in female volleyball players

Staff Report

Health N' Sports: Stress fractures in female volleyball players
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As a part of the Louisville Orthopaedic Clinic, the Sports Rehab Team physical therapists are knowledgeable and trained in the latest advancements and techniques available in sports rehabilitation.

On a weekly basis, the Health N’ Sports Update will give information on prevention, recovery, and include special offers, as well as general health tips that would be beneficial to all. If there is a specific topic you’d like to know or hear more about, email future suggestions to


Risk Factors

Females are more susceptible to overuse injuries, such as stress fractures.  This can be related to, what researchers call, the female triad.  The female triad is a syndrome that consists of eating disorders (low energy availability), amenorrhea (absence of a menstrual cycle), and decreased bone mineral density.  Bone health may be impaired due the physiological/hormonal changes that may occur when an athlete is experiencing these conditions.  Risk factors may include a maternal family history of osteoporosis or low bone mineral density and the hours per week of participation in sports.  High risk stress fracture areas include the fifth metatarsal, anterior tibia, tarsal navicular, femoral neck, patella, medial malleolus, talar neck, and first metatarsal sesamoids.  Low risk fracture areas include the femoral shaft, medial tibia, fibula, ribs, ulnar shaft, calcaneus, and the first through fourth metatarsals. 

Causes and Symptoms

Although runners are associated with stress fractures due to the high frequency impact, volleyball players can be just as susceptible due to the higher impact, repetitive jumping motion.  In most cases of a stress fracture there has been an increase or change in physical activity, so it’s important to take a detailed history of an athlete with a potential stress fracture.  In volleyball, coaches should monitor training hours during the season and take into consideration downtime/off season when creating a gradual introduction back into the sport.  Symptoms of a stress fracture could include localized tenderness and or/pain in common stress fracture areas.  Swelling may persist, especially in lower extremities, such as the fifth metatarsal (lateral aspect of the foot). 


Treating a potential stress fracture should begin with pain control.  This can be accomplished using ice massage, physical therapy modalities, and oral analgesic medications.  NSAID’s (Non-steroidal anti inflammatory Drug) should be avoided due to the potential adverse effect on bone healing.  Sports should be discontinued and a fracture boot should be dispensed if the athlete is not able to ambulate without pain.  After 2 weeks of resolved pain the athlete should resume training at 50% on an every other day basis for another 2 weeks.  If successful, the athlete may resume pre-injury training level for another 4 weeks under supervision and may compete if pain free.

Prevention and Caution

Seasonal high school sports have migrated to a year round activity, due to the rules allowing coaches and players to be together during off season training.  This encourages coaches to take advantage of the opportunities to develop their athletes, and that privilege is sometimes abused.  Coaches should monitor training even closer and be smarter about their athlete’s health with the disappearance of an offseason.  Nutrition and preventive cardiovascular/weight training now becomes even more important as we are demanding more out of our young athletes.

By: Jordan Tinnell – DME Coordinator, B.S. Biology, M.S. Exercise Physiology

Sacred Heart Academy Volleyball Head Coach Eric Garvey comments on volleyball injuries:

“Most common injuries that I see in girls volleyball are ACL injuries and stress fractures. For torn ACL prevention, we try to teach proper techniques for landing both when blocking and attacking (landing with even weight distribution on both legs in an "athletic" stance is ideal). Also increased strength and flexibility in supporting areas such as hamstring, quadriceps, hip flexors, and core. For stress fractures, we just have to watch overuse in specific repeated physical patterns. Volleyball is a very high intensity impact sport with much jumping/landing and floor movement. Too much without proper breaks and variety often leads to stress fractures. Proper shoes with good support can help reduce impact. Also, I think that poor playing surfaces are a contributing factor (to injury). The "sport courts" that so many of these girls are used to playing on is for multiday club tournaments and often club practices are nothing more than a quarter inch of plastic laid on top of concrete. This provides for a very unforgiving surface and increased impact,” said Garvey. “For rehabilitation of ACL, we just encourage athletes to be aggressive in physical therapy program to work towards full recovery. I have referred athletes to a "ACL Bridge Certified" personal trainer to continue strengthening knee leading up to and beyond official Doctor's release. For stress fractures, generally just rest is the best remedy. Sometimes strengthening certain areas and tweaking specific movement techniques as to lesson the impact/stress on the given area of concern can help.”


Louisville Orthopaedic Clinic & Sports Rehab Center

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Physical Therapy: 502-897-1790


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