Introduction
Volleyball is a dynamic sport that demands explosive power, agility, and repetitive jumping, making its athletes particularly susceptible to lower extremity injuries.
Among these, Achilles tendon pain and ruptures are a significant concern, especially within the female athletic population. This guide aims to provide volleyball players, their parents and coaches, with essential information on understanding, preventing, and addressing Achilles tendon issues, particularly given the year-round training structure we now have.
The Achilles Tendon: A Critical Component for Volleyball Performance
The Achilles tendon, the largest and strongest tendon in the human body, connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). It plays a crucial role in ankle plantarflexion (going up on toes), which is vital for jumping, running, and pushing off the ground – movements central to volleyball. Due to the high-impact nature of the sport, the Achilles tendon is subjected to immense forces, making it vulnerable to overuse injuries and acute ruptures.
Why Female Volleyball Players are at Risk
Research indicates that volleyball contributes significantly to Achilles tendon ruptures in female athletes. One study found that volleyball accounted for the largest proportion of sport-related Achilles tendon ruptures in female patients (15.2%) . Several factors contribute to this heightened risk:
•Repetitive Jumping and Landing: The constant cycle of jumping, blocking, and spiking places repetitive stress on the Achilles tendon.
•Sudden Direction Changes: Quick lateral movements and changes in direction can generate torsional forces on the tendon.
•Biomechanical Factors: Differences in female anatomy and biomechanics, such as wider Q-angles, can influence lower limb alignment and loading patterns.
•Training Load: Inadequate conditioning, rapid increases in training intensity, or insufficient recovery periods can overload the tendon.
•Previous Injuries: A history of ankle sprains, often dismissed as minor, can significantly increase the risk of Achilles tendon issues due to altered biomechanics and increased loading .
The Hidden Danger: Ankle Sprains and Achilles Overload
If you have read some of my other articles, you will know that “Untreated sprained ankles are the #1 predisposing factor to future achilles pain and achilles rupture.” This occurs because ankle sprains, particularly lateral ankle sprains, can lead to a cascade of biomechanical alterations:
1.Anterior Talar Shift: The talus bone in the ankle can shift forward, mechanically blocking full ankle dorsiflexion (the ability to bring the toes towards the shin) .
2.Dorsiflexion Deficit: This restricted dorsiflexion is a consistent finding after ankle sprains and can persist long after pain resolves . Studies show a significant reduction in dorsiflexion range of motion in individuals with chronic ankle instability .
3.Increased Achilles Loading: When the ankle cannot dorsiflex adequately to absorb force during movements like landing, the load is redirected. Biomechanical evidence shows that a ligament injury in the lateral ankle can increase the load through the Achilles tendon by 24% . This silent overloading, if left unaddressed, can lead to tendinopathy and eventually rupture.
Recognizing the Warning Signs: Before It’s Too Late
Early detection of Achilles tendon issues is crucial for preventing more severe injuries. Athletes and coaches should be aware of the following warning signs:
•Pain and Stiffness: Pain or stiffness in the back of the heel or lower calf, especially in the morning or after periods of rest.
•Pain with Activity: Pain that worsens during or after volleyball practice or games.
•Tenderness: Tenderness to touch along the Achilles tendon.
•Swelling: Mild swelling or thickening of the tendon.
•Reduced Performance: A noticeable decrease in jumping ability, speed, or overall athletic performance.
•Calf Weakness: Difficulty performing single-leg heel raises or a significant difference in strength between legs.
A simple at home test is that a healthy calf should be able to perform 30-40 single-leg heel raises in a row without a break with good form. This doesn’t rule out many athletes, but it does rule in a few.
Prevention Strategies for Volleyball Players
Preventing Achilles tendon pain and ruptures requires focusing on proper training, biomechanical optimization, and proactive care.
1. Paying Attention & Get Treatment
•Parents: Be aware of the risks after a sprained ankle. Pain is not the indicator of needing treatment but can be an important symptom. Monitor training volume and intensity. Avoid sudden spikes in activity, especially if you took a break for over 2 weeks. Be aware that the biggest risk for achilles rupture in volleyball players is taking time off. The typical model is first an ankle sprain, then athletes are put in a boot and then after 2-4 weeks in a boot they try to go 100%.
2. Targeted Strengthening and Conditioning
•Eccentric Training: Incorporate eccentric exercises (e.g., lowering phase of calf raises) to build tendon capacity and resilience. This type of training has been shown to be highly effective for Achilles tendinopathy.
•Soleus Strengthening: Focus on strengthening the soleus muscle, which plays a significant role in absorbing landing forces.
•Plyometrics: Gradually introduce plyometric exercises to improve explosive power and prepare the tendon for the demands of jumping and landing.
3. Biomechanical Optimization (Do NOT Stretch Calf)
•Ankle Mobility: Address any limitations in ankle dorsiflexion through targeted mobility drills and exercises. This should be active movement not passive like stretching.
•Foot and Ankle Mechanics: Practice proper foot and ankle mechanics during movements, especially landing. Focus on soft landings and distributing forces effectively. Deep-teir plymetrices train timing and the stretch-shortening cycle.
•Full-Chain Loading: Recognize that Achilles pain can be a symptom of issues higher up the kinetic chain (e.g., hip or knee weakness). Keeping the hips and glutes strong is critical.
4. Proactive Care and Rehabilitation
•Don’t Ignore Pain: Athletes should be encouraged to report any pain or discomfort early. “Pain is a terrible metric” for recovery, and persistent biomechanical issues can exist even after pain resolves, but sometimes its the only indicator athletes and their parents have.
•Proper Rehabilitation for Ankle Sprains: Ensure that ankle sprains are thoroughly rehabilitated, going beyond just pain resolution to restore full range of motion, strength, and proprioception. Your ankle should feel bulletproof at all times. Anyone that says they have “weak ankles” or if you have been diagnosed with chronic ankle instability, you need an entire treatment plan.
•Isometrics for Tendon Health: Isometric exercises can be beneficial for managing tendon pain and building tolerance to force. By aligning collagen inside the tendon they help to restore proper chemistry as the tendon absorbs load.
Conclusion
Achilles tendon pain may be common but its not a good sign.
Ruptures can be career ending as rehab require entire seasons off greatly effecting recruiting, possible scholarships and future NIL money.
For girls on top level teams understanding the risks, recognizing early warning signs, and implementing proactive prevention strategies are paramount. By focusing on comprehensive assessment, targeted strengthening, biomechanical optimization, and diligent rehabilitation, athletes can build resilient Achilles tendons and continue to excel on the court.
After we strenghten the achilles and lower leg, we often see a significant increase in vertical jump of volleyball athletes of 2-3″. So the achilles isn’t something to be feared, but rather to be loaded to be better at sport.
[1] Lemme, N. J. (2018). Epidemiology of Achilles Tendon Ruptures in the United States. PMC.
[2] Anderson Performance Rehab. (n.d.). Ankle Sprains Don’t Heal — They Compensate.
[3] Anderson Performance Rehab. (n.d.). The Achilles “Pre-Rupture” Warning: Before It’s Too Late.
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