There is a common theme of “no pain no gain” with athletes worldwide. Although this mentality helps people push through a hard workout or training session, that “pain” they feel normally goes away a few hours later. I’m sure you can think back to a time where your calf muscles were on fire from all the jumping you do in a training session [or maybe you are too embarrassed about this issue when jumping]. Normally that muscle burn goes away within the next day or so, right? What happens if low back pain in volleyball players never goes away? Are players supposed to continue pushing through and ignoring the pain?

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NO!

General muscle pain from an intense training session does not last for weeks or months! This prolonged pain usually indicates an injury has occurred. Without training modifications or physical therapy, the pain could be made worse. This is the case with low back pain in volleyball players.

Why is this important?

Low back pain is the 4th most common injury seen in volleyball players (Jadhav et al., 2010). One study reported that low back pain is experienced in 63% of volleyball players (Trumpeter et al., 2017). More than half of volleyball players experience low back pain during their sports career, but how many actually seek treatment? One study reported that less than 20% of players met with a physical therapist to receive the care they need (Jadhav et al., 2010). There is a HUGE gap between players with pain seeking the care they need. Does this sound like the best plan of action for an athlete in pain?

Why not just push through the pain and hope it goes away like everyone else? Because one study saw that 47.4% of volleyball players with low back pain continued to have low back pain for the rest of their sports career (Noormohammadpour et al., 2016). This constant pain can affect muscle performance, preventing athletes from reaching their maximal potential.

Constant low back pain in volleyball players can also affect players mental and emotional health. Most athletes play their sport because it brings them joy. But what happens if the pain is too much to play? Sitting on the sidelines and watching their teammates play the game they love can make players feel hopeless about their return. This hopelessness could spiral into players no longer wanting to play their sport — which is not what should happen! Everyone should be able to do what they love without pain taking over their lives.

Why does low back pain develop in volleyball players?

One common reason for low back pain in volleyball players is asymmetries in endurance for muscles that stabilize the low back (Coreia et al., 2016). The core muscles are not just for show. They provide stability to the low back and spine with all movements. If imbalances are present in the core muscles, then players may spike or serve the ball with increased turning and bending in their spine. These extra movements from less stability in the spine cause increased pressure in the joints of the lower spine. This repetitive pressure over time can lead to low back pain in volleyball players.

Other muscles that work in the hips and legs also affect the stability of the spine (Haddas et al., 2017). The gluteal muscles, for example, run from the back of your pelvis (the hip bones) down to the outside of your thigh. Your gluteal muscles work to prevent your trunk and hips from bending too far forward during landing. If your gluteal muscles do not have the endurance to perform this motion, then your upper body will bend further forward as you land. This poor landing posture results in decreased stability of the spine and increases the risk of low back pain in volleyball players.

What is an Anterior Pelvic Tilt?

Studies have shown that at rest, volleyball players with low back pain stand with an anterior pelvic tilt (Movahed et al., 2019) (Sheikhhoseini et al., 2018). Not only do players stand with an anterior pelvic tilt, but they also land in an anterior pelvic tilt. Studies have shown there is a correlation between landing with an anterior pelvic tilt and low back pain in volleyball players. Landing with an anterior pelvic tilt causes the lower back to be more arched and increases the pressure in the joints. As a result, this increased pressure during landing can also lead to low back pain in volleyball players.

Tips to reduce the risk of low back pain in volleyball players

1. Strengthen your core muscles. You need a lot of endurance in these muscles during a game to make sure the lower spine is stable. In order to strengthen all core muscles in different planes of motion, here are some key exercises:

1. 1. Front Plank
   2. Anti-rotation + Palloff press
   3. Bird dog

 2. Performing an abdominal contraction before any overhead motion (spiking, serving, setting) or landing. By performing an abdominal contraction, the core muscles help the pelvis rotate posteriorly. As a result, this posterior rotation reduces compression in the joints of the lower back. This also prevents players from landing in an anterior pelvic tilt.

3. Strengthen other lower body muscles that attach to the pelvis and provide stability to the spine. For the gluteal muscles try:

1. 1. Sidewalks with a band around the knees
   2. Bodyweight squats
   3. Side-lying clamshells

Who can you see for help with low back pain in volleyball players?

The good news is that physical therapists can help eliminate all of these contributors to low back pain in volleyball players! There is an abundance of effective treatment methods physical therapist can use to reduce the pain. Physical therapists will help with core muscle endurance and teach players how to move in safer ways. A physical therapist will also help volleyball players form strategies to keep the pain away long term. Working together to make a plan moving forward will reduce the risk of redeveloping low back pain in volleyball players.

Do you experience low back pain while playing volleyball? Have you met with a physical therapist? Do not wait any longer! Physical therapists are here to help and if you’re in the Bay Area, we are available to help!

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References

1. Coreia JP, Oliveira R, VazJR, Silva L, Pezarat-CorreiaP. Trunk muscle activation, fatigue and low back pain in tennis players. J SciMed Sport. 2016; 19: 311–316. https://doi.org/10.1016/j.jsams.2015. 04.002 PMID: 25987492
2. Haddas R, Sawyer SF, Sizer PS, Brooks T, Chyu MC, James CR. “Effects of Volitional Spine Stabilization and Lower-Extremity Fatigue on the Knee and Ankle During Landing Performance in a Population With Recurrent Low Back Pain.” J Sport Rehabil. 2017 Sep;26(5):329-338. doi: 10.1123/jsr.2015-0171.
3. Jadhav, K.G., Deshmukh, P.N., Tuppekar, R.P., Sinku, S.K.. A Survey of Injuries Prevalence in Varsity Volleyball Players. Journal of Exercise Science and Physiotherapy, Vol. 6, No. 2: 102-105, 2010 102
4. Movahed,Marziehet al. (2019). “Single leg landing kinematics in volleyball athletes: A comparison between athletes with and without active extension low back pain.”
5. Noormohammadpour et al., “Low back pain status of female university students in relation to different sport activities.” European Spine Journal, April 2016, Volume 25, Issue 4, pp 1196-1203
6. Sheikhhoseiniet al. (2018). “Altered Lower Limb Kinematics during Jumping among Athletes with Persistent Low Back Pain”
7. Trompeter K, Fett D, Platen P. Prevalence of Back Pain in Sports: A Systematic Review of the Literature. Sports Med. 2017;47(6):1183–1207. doi:10.1007/s40279-016-0645-3