Journal of Athletic Training 2021;56(7):666–673

doi: 10.4085/1062-6050-679-20
Ó by the National Athletic Trainers’ Association, Inc Injury Reports by Sport
www.natajournals.org

Epidemiology of Injuries in National Collegiate Athletic

Association Women’s Volleyball: 2014–2015 Through
2018–2019
Avinash Chandran, PhD, MS*; Sarah N. Morris, PhD*;

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Landon B. Lempke, PhD, ATC†; Adrian J. Boltz, MSH*;
Hannah J. Robison, MS, LAT, ATC*; Christy L. Collins, PhD*
*Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN; †Concussion Research Laboratory,
Department of Kinesiology, University of Georgia, Athens

Context: Women’s volleyball is a globally popular sport with for the largest proportion of all reported injuries, and most
widespread participation at the National Collegiate Athletic injuries were attributed to overuse (26.1%) or noncontact
Association (NCAA) level. (22.7%) mechanisms. Lateral ankle ligament complex tears
Background: Routine examinations of NCAA women’s (11.1%) and concussions (7.3%) were the most commonly
volleyball injuries are important for recognizing emerging
reported specific injury.
injury-related patterns in this population.
Methods: Exposure and injury data collected in the NCAA Summary: Results indicate an increasing burden of prac-
Injury Surveillance Program during the 2014–2015 through 2018– tice-related injuries and the need to further examine overuse
2019 athletic years were analyzed. Injury counts, rates, and injuries. Lower-extremity injury prevention strategies and mech-
proportions were used to describe injury characteristics, and anisms of concussion also warrant further attention.
injury rate ratios were used to examine differences in injury rates.
Results: The overall injury rate was 6.73 per 1000 athlete- Key Words: collegiate sports, descriptive epidemiology,
exposures. Knee (14.6%) and ankle (13.8%) injuries accounted injury surveillance

Key Points
 Overall, competition and practice injury rates were similar, though competition injury rates fluctuated across the
study period while practice injury rates increased during 2015-2016 through 2018-2019.
 Knee and ankle injuries accounted for the largest proportion of all reported injuries, and most injuries were classified
as sprains, strains, and inflammatory conditions.
 Concussion was among the most prevalently reported injuries during the study period, and concussion incidence
increased steadily during 2015-2016 through 2018-2019.

V
olleyball is a widely popular sport throughout the incidence and outcomes in this population to appraise the
world and across all demographics.1–3 Women’s burden of injury.
volleyball in the National Collegiate Athletic The NCAA Injury Surveillance Program (ISP) is a
Association (NCAA) has continued to gain traction in foundational prospective sports injury surveillance system
recent years as well, with a record high of 17 780 student- for monitoring injuries and exposures in NCAA sports.5,6
athletes across 1069 membership teams participating in the The NCAA ISP has served a vital role in monitoring NCAA
2018–2019 academic year.1 As the sport has continued to women’s volleyball-related injuries throughout its exis-
gather momentum at the collegiate level, the dynamics of tence.7,8 Prior researchers have indicated that injury rates in
NCAA women’s volleyball have evolved in recent years. practices and competitions are similar in women’s
For instance, notable playing rule changes such as the volleyball.7,8 Previous reports have also consistently
elimination of the ‘‘pursuit rule’’ (intended to reduce player identified that most injuries in this population are classified
collisions on the court) in 2016–2017 may have affected as ligament sprains and muscle/tendon strains, and have
game play and positively affected athlete safety.4 Given the indicated that concussions are a prevalently reported injury
continued participation growth in NCAA women’s volley- in this group.7,8 Furthermore, injuries in NCAA women’s
ball, coupled with recent playing rule changes and ever- volleyball are most often attributed to non-contact mech-
changing sport culture, it is important to monitor injury anisms, while player contact injuries account for nearly a
Authors Avinash Chandran and Sarah N. Morris have contributed one-fourth of all competition injuries.8 After recently
equally to manuscript preparation. The articles in this issue are implemented rule changes in NCAA women’s volleyball
published as accepted and have not been edited. and advancements in injury prevention practices,9 it is

666 Volume 56  Number 7  July 2021

Table 1. Reported and National Estimates of Injuries, Athlete-Exposures (AEs), and Rates per 1000 AEs by Event Type Across Divisionsa
Number
AEs
Rate per 1000 AEs (95% CI)
Overall Practices Competitions
Division Reported National Estimate Reported National Estimate Reported National Estimate
I 1029 19 022 723 13 622 306 5400
158 181 3 049 924 116 272 2 265 915 41 909 784 009
6.51 (6.11, 6.90) 6.24 (5.84, 6.63) 6.22 (5.76, 6.67) 6.01 (5.56, 6.46) 7.30 (6.48, 8.12) 6.89 (6.07, 7.71)
II 626 12 698 414 8242 212 4456
92 254 2 188 689 60 504 1 503 481 31 750 685 208
6.79 (6.25, 7.32) 5.80 (5.27, 6.33) 6.84 (6.18, 7.50) 5.48 (4.82, 6.14) 6.68 (5.78, 7.58) 6.50 (5.60, 7.40)
III 692 22 587 503 16 215 189 6372
98 544 3 056 532 64 778 2 038 579 33 767 1 017 953
7.02 (6.50, 7.55) 7.39 (6.87, 7.91) 7.76 (7.09, 8.44) 7.95 (7.28, 8.63) 5.60 (4.80, 6.40) 6.26 (5.46, 7.06)

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Overall 2347 54 308 1640 38 079 707 16 228
348 979 8 295 145 241 554 5 807 975 107 425 2 487 170
6.73 (6.45, 7.00) 6.55 (6.27, 6.82) 6.79 (6.46, 7.12) 6.56 (6.23, 6.88) 6.58 (6.10, 7.07) 6.52 (6.04, 7.01)
a
Data presented in the order of reported number, followed by athlete exposures (AEs), estimated injury rates, and associated 95%
Confidence Intervals (CIs) for each cross-tabulation of division and event types. Data pooled association-wide are presented overall, and
separately for practices and competitions. National estimates were produced using sampling weights estimated on the basis of sport,
division, and year. All CIs were constructed using variance estimates calculated on the basis of reported data. A reportable injury was one
that occurred due to participation in an organized intercollegiate practice or competition, and required medical attention by a team Certified
Athletic Trainer or physician (regardless of time loss). Only scheduled team practices and competitions were retained in this analysis.

important to continue evaluating injury surveillance data to (Division I, Division II, or Division III), season segment
identify emerging injury incidence patterns as the most (preseason, regular season, or postseason), and TL (TL or
recent similar investigation of this population covered data non-TL [NTL]). An AE was defined as 1 athlete
captured through the 2013–2014 academic year.8 There- participating in 1 exposure event. A TL injury was one in
fore, the purpose of this study was to describe the which an athlete returned the day after or beyond with
epidemiology of sport-related injuries among NCAA respect to the date of injury, and TL due to an injury was
women’s volleyball student-athletes during the 2014–2015 determined on the basis of the injury and return dates
through 2018–2019 academic years. reported by ATs. Weighted and unweighted rates were
estimated; however, results were presented in terms of
METHODS unweighted rates (unless otherwise specified) due to low
frequencies of injury observations across levels of certain
Study Data explanatory variables. Temporal trends in injury rates
Women’s volleyball exposure and injury data collected in across the study period were described using rate profile
the NCAA ISP during the 2014–2015 through 2018–2019 plots stratified by levels of exposure characteristics.
athletic years were analyzed in this study. The methods of Similarly, temporal trends in rates of the most commonly
the NCAA ISP have been reviewed and approved as an reported injuries were also examined across the study
exempt study by the NCAA Research Review Board (RRB). period. Injury counts and distributions were examined by
The NCAA ISP methods are detailed in a separate TL, body part injured, mechanism of injury, injury
manuscript within this special issue.10 Briefly, athletic diagnosis, player position, and activity at the time of
trainers (ATs) at participating NCAA institutions contribut- injury. Injury rate ratios (IRRs) were used to examine
ed exposure and injury data by using their clinical electronic differential injury rates across event types, competition
medical record systems. A reportable injury was one that levels, and season segments. IRRs with associated 95%
occurred from participation in an organized intercollegiate confidence intervals (CIs) excluding 1.00 were considered
practice or competition and required medical attention by a statistically significant. All analyses were conducted using
team AT or physician, regardless of time loss (TL). SAS 9.4 (SAS Institute).
Scheduled team practices and competitions were considered
reportable exposures for this analysis. Data from 31 (3% of RESULTS
membership) participating programs in 2014–2015, 25 (2%
of membership) in 2015–2016, 35 (3% of membership) in A total of 2347 women’s volleyball injuries from 348 979
2016–2017, 41 (4% of membership) in 2017–2018, and 115 AEs were reported to the NCAA ISP during the 2014–2015
(11% of membership) in 2018–2019 qualified for inclusion through 2018–2019 academic years (rate ¼ 6.73 per 1,000
in our analyses. Qualification criteria are detailed further in AEs; Table 1). This equated to a national estimate of 54 308
the methods manuscript within this special issue.10 injuries overall. Across the study period, the competition
injury rate (rate ¼ 6.58 per 1000 AEs) was comparable to the
practice injury rate (rate ¼ 6.79 per 1000 AEs). Competition
Statistical Analysis
injury rates fluctuated across the study period and were
Injury counts and rates per 1000 AEs were examined by highest in 2014–2015 (Figure A). Conversely, practice
event type (practice or competition), competition level injury rates decreased between 2014–2015 and 2015–2016

Journal of Athletic Training 667

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Figure. Temporal patterns in injury rates between 2014–2015 and 2018–2019. A, Overall injury rates (per 1000 AEs) stratified by event type
(practices or competitions). B, Injury rates (per 1000 AEs) stratified by season segment. C, Rates of time loss injuries stratified by event
type (practices or competitions). D, Rates (per 10 000 AEs) of most commonly reported injuries. Rates presented are unweighted and
based on reported data.

and then followed an increasing trajectory thereafter, with Conversely, regular season injury rates fluctuated between
the highest rate in 2018–2019 (Figure A). Across the study 2015–2016 and 2018–2019 (Figure B). Temporal patterns
period, overall injury rates did not vary between Division I in postseason injury rates were not examined due to low
(rate ¼ 6.51 per 1000 AEs), Division II (rate ¼ 6.79 per 1000 frequencies (n , 5) of postseason injuries observed during
AEs), and Division III (rate ¼ 7.02 per 1000 AEs). certain years of the study period.

Injuries by Season Segment Time Loss

A total of 745 preseason injuries (national estimate: Approximately one-third (31.1%) of all reported injuries
17 968), 1546 regular season injuries (national estimate: resulted in TL of .1 day (TL was not recorded in ~21% of
35 186), and 56 postseason injuries (national estimate: all reported injuries). TL injuries accounted for comparable
1154) were reported between 2014–2015 and 2018–2019 proportions of reported practice (30.4%) and competition
(Table 2). The rate of preseason injuries was higher than injuries (32.7%). Rates of competition-related TL injuries
regular season (IRR ¼ 1.62; 95% CI ¼ 1.49, 1.77) and followed a generally decreasing trajectory across the study
postseason injuries (IRR ¼ 2.45; 95% CI ¼ 1.86, 3.21). period (Figure C). Rates of practice-related TL injuries
Although preseason and regular season injury rates fluctuated between 2014–2015 and 2016–2017 and then
decreased between 2014–2015 and 2015–2016, incidence remained relatively stable for the remainder of the study
period (Figure C).
trajectories by season segment varied for the remainder of
the study period (Figure B). Preseason injury rates
decreased between 2014–2015 and 2015–2016, steadily Injury Characteristics
increased between 2015–2016 and 2017–2018, and slightly Knee (14.6%) and ankle injuries (13.8%) accounted for
decreased during the final year of the study (Figure B). the largest proportions of all injuries reported during the

668 Volume 56  Number 7  July 2021

Table 2. Reported and National Estimates of Injuries, Athlete-Exposures (AEs), and Rates per 1000 AEs by Season Segment Across
Divisionsa
Number
AEs
Rate per 1000 AEs (95% CI)
Preseason Regular Season Postseason
Division Reported National Estimate Reported National Estimate Reported National Estimate
I 311 5857 694 12 727 24 438
35 846 713 450 115 096 2 214 934 7239 121 540
8.68 (7.71, 9.64) 8.21 (7.25, 9.17) 6.03 (5.58, 6.48) 5.75 (5.30, 6.19) 3.32 (1.99, 4.64) 3.60 (2.28, 4.93)
II 182 4262 429 8157 15 280
18 401 493 864 70 487 1 607 610 3366 87 215
9.89 (8.45, 11.33) 8.63 (7.19, 10.07) 6.09 (5.51, 6.66) 5.07 (4.50, 5.65) 4.46 (2.20, 6.71) 3.21 (0.96, 5.47)
III 252 7849 423 14 302 17 437
22 457 707 748 72 589 2 249 275 3499 99 508

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11.22 (9.84, 12.61) 11.09 (9.70, 12.48) 5.83 (5.27, 6.38) 6.36 (5.80, 6.91) 4.86 (2.55, 7.17) 4.39 (2.08, 6.70)
Overall 745 17 968 1546 35 186 56 1154
76 704 1 915 063 258 171 6 071 819 14 104 308 264
9.71 (9.02, 10.41) 9.38 (8.69, 10.08) 5.99 (5.69, 6.29) 5.79 (5.50, 6.09) 3.97 (2.93, 5.01) 3.74 (2.70, 4.78)
a
Data presented in the order of reported number, followed by athlete exposures (AEs), estimated injury rates, and associated 95%
Confidence Intervals (CIs) for each cross-tabulation of division and season segments. Data pooled association-wide are presented overall,
and separately for preseason, regular season, and post season. National estimates were produced using sampling weights estimated on
the basis of sport, division, and year. All CIs were constructed using variance estimates calculated on the basis of reported data. A
reportable injury was one that occurred due to participation in an organized intercollegiate practice or competition and required medical
attention by a team certified athletic trainer or physician (regardless of time loss). Only scheduled team practices and competitions were
retained in this analysis.

study period. Trunk (10.7%), shoulder (10.4%; notably, of rates continued on an upward trajectory for the remainder
which 50.9% were classified as inflammatory conditions or of the study period, rates of lateral ankle ligament complex
as impingement or entrapment), and head/face (9.4%) tears (ankle sprains) steadily decreased between 2016–2017
injuries were also prevalent among all reported injuries and 2018–2019 (Figure D).
(Table 3). Knee injuries accounted for comparable
proportions of reported practice (13.8%) and competition Injuries by Volleyball-Specific Activities and Playing
injuries (16.4%), whereas ankle injuries accounted for a Positions
larger proportion of competition injuries (18.7%) than
practice injuries (11.7%). Nearly one-half of all reported Most injuries in women’s volleyball between 2014–2015
injuries were overuse (26.1%, of which 25.9% were upper and 2018–2019 occurred during general play (34.3%),
extremity injuries and 58.7% were lower extremity injuries) digging (13.9%), and blocking (13.8%). Spiking also
or noncontact (22.7%) injuries (compared with player accounted for a notable proportion (11.2%) of all reported
contact or contact with equipment or apparatus such as the injuries. Although general play (37.0% versus 28.3%,
ball or surface; Table 3). Noncontact injuries accounted for respectively) and spiking (12.1% versus 9.1%, respectively)
comparable proportions of reported practice (22.4%) and accounted for larger proportions of practice injuries than
competition (23.3%) injuries. Conversely, injuries attribut- competition injuries, digging (20.2% versus 11.2%, respec-
ed to overuse mechanisms accounted for a considerably tively) and blocking (18.1% versus 11.9%, respectively)
larger proportion of practice-related injuries (32.2%) than accounted for larger proportions of competition injuries
competition-related injuries (12.0%). than practice injuries (Table 4). Most injuries in women’s
volleyball were reported among outside hitters (27.5%) and
Overall, most women’s volleyball injuries reported
middle blockers (21.8%).
between 2014–2015 and 2018–2019 were sprains
(22.8%), strains (17.1%), and inflammatory conditions
(17.1%). Strains accounted for comparable proportions of SUMMARY
reported practice (17.1%) and competition (17.0%) injuries. Here, we described the epidemiology of injuries among
Conversely, sprains accounted for a larger proportion of NCAA women’s volleyball athletes during the 2014–2015
competition injuries (31.1%) than practice injuries (19.2%), through 2018–2019 academic years. Across the study
and inflammatory conditions accounted for a larger period, the competition and practice injury rates were
proportion of practice injuries (20.1%) than competition comparable, aligning with the existing literature in this
injuries (10.2%). The most commonly reported specific population.7,8 It may be noted that practice injury rates
injuries were partial or complete lateral ankle ligament followed an upward trajectory for most of the study period
complex tear (ankle sprains; 11.1%) and concussion (7.3%, and were higher than competition injury rates during the
of which 60.5% were attributed to ball contact). These final 2 years of the study period. Further examination of
specific injury rates followed comparable trajectories practice routines (particularly during 2015–2016 through
between 2014–2015 and 2016–2017 by initially decreasing 2018–2019 and across divisions) is warranted to better
and then increasing (Figure D). Although concussion injury elucidate factors contributing to the increasing burden of

Journal of Athletic Training 669

Table 3. Distribution of Injuries by Body Part, Mechanism, and Injury Diagnosis; Stratified by Event Typea
Overall Competitions Practices
Injuries National Injuries National Injuries National
Reported (%) Est. (%) Reported (%) Est. (%) Reported (%) Est. (%)
Body part
Head/face 221 (9.42) 4647 (8.56) 84 (11.88) 2017 (12.43) 137 (8.35) 2630 (6.91)
Neck 21 (0.89) 538 (0.99) 6 (0.85) 109 (0.67) 15 (0.91) 429 (1.13)
Shoulder 244 (10.40) 5553 (10.23) 51 (7.21) 1252 (7.72) 193 (11.77) 4302 (11.30)
Arm/elbow 61 (2.60) 1298 (2.39) 22 (3.11) 450 (2.77) 39 (2.38) 848 (2.23)
Hand/wrist 224 (9.54) 4543 (8.37) 76 (10.75) 1369 (8.44) 148 (9.02) 3173 (8.33)
Trunk 252 (10.74) 6046 (11.13) 58 (8.20) 1437 (8.86) 194 (11.83) 4610 (12.11)
Hip/groin 131 (5.58) 3294 (6.07) 43 (6.08) 1183 (7.29) 88 (5.37) 2111 (5.54)
Thigh 110 (4.69) 2322 (4.28) 27 (3.82) 468 (2.88) 83 (5.06) 1854 (4.87)
Knee 342 (14.57) 8124 (14.96) 116 (16.41) 2926 (18.03) 226 (13.78) 5198 (13.65)
Lower leg 220 (9.37) 5369 (9.89) 47 (6.65) 1119 (6.90) 173 (10.55) 4250 (11.16)

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Ankle 323 (13.76) 7785 (14.33) 132 (18.67) 2915 (17.96) 191 (11.65) 4870 (12.79)
Foot 132 (5.62) 3282 (6.04) 32 (4.53) 733 (4.52) 100 (6.10) 2549 (6.69)
Other 66 (2.81) 1506 (2.77) 13 (1.84) 250 (1.54) 53 (3.23) 1257 (3.30)
Mechanism
Player contact 271 (11.55) 6224 (11.46) 123 (17.40) 2802 (17.27) 148 (9.02) 3422 (8.99)
Surface contact 336 (14.32) 7489 (13.79) 151 (21.36) 3209 (19.77) 185 (11.28) 4280 (11.24)
Ball contact 311 (13.25) 6282 (11.57) 105 (14.85) 2317 (14.28) 206 (12.56) 3964 (10.41)
Other apparatus contact 10 (0.43) 237 (0.44) 2 (0.28) 30 (0.18) 8 (0.49) 207 (0.54)
Out of bounds contact 18 (0.77) 415 (0.76) 13 (1.84) 310 (1.91) 5 (0.30) 105 (0.28)
Noncontact 533 (22.71) 13 283 (24.46) 165 (23.34) 4035 (24.86) 368 (22.44) 9248 (24.29)
Overuse 613 (26.12) 14 398 (26.51) 85 (12.02) 2035 (12.54) 528 (32.20) 12 364 (32.47)
Other/unknown 255 (10.86) 5981 (11.01) 63 (8.91) 1491 (9.19) 192 (11.71) 4489 (11.79)
Diagnosis
Abrasion/laceration 9 (0.38) 165 (0.30) 6 (0.85) 112 (0.69) 3 (0.18) 53 (0.14)
Concussion 172 (7.33) 3585 (6.60) 65 (9.19) 1555 (9.58) 107 (6.52) 2030 (5.33)
Contusion 148 (6.31) 3500 (6.44) 67 (9.48) 1633 (10.06) 81 (4.94) 1868 (4.91)
Dislocation/subluxation 45 (1.92) 883 (1.63) 12 (1.70) 235 (1.45) 33 (2.01) 648 (1.70)
Fracture 73 (3.11) 1556 (2.87) 22 (3.11) 383 (2.36) 51 (3.11) 1173 (3.08)
Illness/infection 16 (0.68) 469 (0.86) 4 (0.57) 109 (0.67) 12 (0.73) 360 (0.95)
Inflammatory condition 401 (17.09) 9308 (17.14) 72 (10.18) 1502 (9.26) 329 (20.06) 7806 (20.50)
Spasm 86 (3.66) 1875 (3.45) 13 (1.84) 194 (1.20) 73 (4.45) 1681 (4.41)
Sprain 535 (22.80) 12 423 (22.88) 220 (31.12) 4964 (30.59) 315 (19.21) 7459 (19.59)
Strain 401 (17.09) 10 022 (18.45) 120 (16.97) 3158 (19.46) 281 (17.13) 6864 (18.03)
Other 461 (19.64) 10 523 (19.38) 106 (14.99) 2384 (14.69) 355 (21.65) 8138 (21.37)
a
Data presented in the order of reported number, followed by the proportion of all injuries attributable to a given category. Data pooled
across event types are presented overall, and separately for practices and competitions. National estimates were produced using
sampling weights estimated on the basis of sport, division, and year. A reportable injury was one that occurred due to participation in an
organized intercollegiate practice or competition, and required medical attention by a team Certified Athletic Trainer or physician
(regardless of time loss). Only scheduled team practices and competitions were retained in this analysis.

practice-related injuries. Nearly one-third of all practice- inferential capacity of the estimates presented here. In
related injuries reported during the study period were future small-sample studies, researchers should examine
overuse injuries, potentially indicating that practice-related recovery after practice-related injuries and target capturing
injuries in this population may be related to chronic comprehensive TL data in this population. Based on the
accumulation of concentrated workload.11 Notably, prac- results of the present study, such examinations may also
tice-related TL injury rates remained relatively stable particularly focus on practice-related overuse injuries.
during the study period and overall practice injury rates Knee and ankle injuries accounted for the largest
increased, which implies that practice-related NTL injury proportion of all reported injuries during the study period,
rates have increased across the study period. The observed and injuries were most often classified as sprains, strains,
distribution of practice injuries by injury mechanism, and inflammatory conditions. Unsurprisingly for the nature
coupled with the increasing rate of practice-related NTL of the sport, trunk and shoulder injuries were also
injuries, are consistent with the notion that chronic injuries commonly reported during the study period. These findings
attributed to overuse mechanisms often manifest as NTL are consistent with previous reports in this population.7,8
injuries.12 Continued monitoring of the rates of practice- The biomechanics of the overhead swing require complex
related TL injuries is needed to determine whether this neuromuscular control, particularly between the shoulder
pattern is maintained. Importantly, approximately one-fifth and trunk.13 Shoulder and trunk injuries accounted for
of all reported injuries were classified neither as TL nor greater proportions of practice than competition injuries,
NTL due to missing (TL) data. The observed level of and as noted above, nearly one-third of all practice injuries
missing TL data may reflect an inherent limitation of the were attributed to overuse mechanisms. Furthermore, one-
NCAA ISP data collection methods and restricts the half of all reported shoulder injuries were inflammatory

670 Volume 56  Number 7  July 2021

Table 4. Distribution of Injuries by Injury Activity and Playing Position; Stratified by Event Typea
Overall Competitions Practices
Injuries National Injuries National Injuries National
Reported (%) Est. (%) Reported (%) Est. (%) Reported (%) Est. (%)
Activity
Blocking 323 (13.76) 7041 (12.96) 128 (18.10) 2774 (17.09) 195 (11.89) 4267 (11.21)
Conditioning 48 (2.05) 1515 (2.79) 3 (0.42) 50 (0.31) 45 (2.74) 1465 (3.85)
Digging 326 (13.89) 7141 (13.15) 143 (20.23) 3098 (19.09) 183 (11.16) 4042 (10.61)
General play 806 (34.34) 18 893 (34.79) 200 (28.29) 4845 (29.86) 606 (36.95) 14 048 (36.89)
Passing 112 (4.77) 2537 (4.67) 43 (6.08) 1009 (6.22) 69 (4.21) 1528 (4.01)
Serving 52 (2.22) 1090 (2.01) 10 (1.41) 196 (1.21) 42 (2.56) 894 (2.35)
Setting 57 (2.43) 1358 (2.50) 21 (2.97) 507 (3.12) 36 (2.20) 851 (2.23)
Spiking 262 (11.16) 6291 (11.58) 64 (9.05) 1505 (9.27) 198 (12.07) 4787 (12.57)
Other/unknown 361 (15.38) 8441 (15.54) 95 (13.44) 2245 (13.83) 266 (16.22) 6196 (16.27)
Position

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Libero 372 (15.85) 8174 (15.05) 128 (18.10) 2773 (17.09) 244 (14.88) 5401 (14.18)
Middle blocker 512 (21.82) 11 420 (21.03) 139 (19.66) 3130 (19.29) 373 (22.74) 8290 (21.77)
Outside hitter 645 (27.48) 15 089 (27.78) 204 (28.85) 4743 (29.23) 441 (26.89) 10 346 (27.17)
Setter 333 (14.19) 8213 (15.12) 116 (16.41) 2799 (17.25) 217 (13.23) 5414 (14.22)
Opposite/right-side hitter 243 (10.35) 5509 (10.14) 64 (9.05) 1480 (9.12) 179 (10.91) 4029 (10.58)
Other/unknown 242 (10.31) 5902 (10.87) 56 (7.92) 1303 (8.03) 186 (11.34) 4599 (12.08)
a
Data presented in the order of reported number, followed by the proportion of all injuries attributable to a given category. Data pooled
across event types are presented overall, and separately for practices and competitions. National estimates were produced using
sampling weights estimated on the basis of sport, division, and year. A reportable injury was one that occurred due to participation in an
organized intercollegiate practice or competition, and required medical attention by a team Certified Athletic Trainer or physician
(regardless of time loss). Only scheduled team practices and competitions were retained in this analysis.

conditions or impingement or entrapment. With these First, playing rule changes directed toward reducing
results, we indicate that chronic overuse mechanisms, opposing player collisions on the court have been
likely exacerbated by muscular imbalances and repetitive- implemented in NCAA women’s volleyball in recent years
high velocity movements,14–16 may offer insight into the (during the study period).4 In particular, the pursuit rule was
pathoetiology of the shoulder and trunk. Greater overhead eliminated in 2016–2017 with the intention of reducing
swing volumes and workloads examined among volleyball player collisions on the court.4 Although the implemented
players have been related to heightened injury risk17,18 and changes may have subsequently reduced the incidence of
further indicate that workload frequency and intensity are player contact injuries as intended, the observed noncontact
critical considerations for practice injury prevention. and overuse injury prevalence may be a natural function of
Similarly, given that noncontact injuries were prevalent in fewer player contact injuries occurring during game play
this study, and that nearly 60% of all overuse injuries (that is, fewer player contact injuries resulting in noncon-
occurred in the lower extremities, further attention to the tact and overuse injuries accounting for a larger fraction of
etiology of lower-extremity overuse injuries in this all reported injuries). Furthermore, a high prevalence of
population is also warranted, and the need to potentially early sport specialization has been observed in women’s
intervene with injury prevention programs or prophylactic volleyball over the past 2 decades.25 Early sport special-
taping or bracing may be indicated. More specifically, ization has been associated with a higher risk of overuse
lateral ligament complex tears (ankle sprains) were among injuries in particular,26 and the observed results may also be
the most commonly observed specific injuries during the indicative of this association. The NCAA ISP in its current
study period, and the benefits of preventative exercises and form does not collect information on sport experience or
prophylactic taping or bracing with regard to ankle sprain sport history and is therefore not well positioned to examine
injury risk have been previously demonstrated.19 Indeed, this relationship. Future researchers may need conduct
prior researchers have particularly shown prophylactic longitudinal studies to better study this paradigm.
support-based and exercise-based intervention programs Aside from lateral ligament complex tears (ankle
to be effective in the primary prevention of ankle sprains in sprains), concussion was the most commonly observed
various athlete samples,19–23 and these approaches may be injury during the study period. Concussion incidence
considered for women’s volleyball athletes as well. followed an upward trajectory for most of the study period,
Furthermore, dynamic neuromuscular warm up programs particularly during the latter years of the study. This finding
have also demonstrated effectiveness in reducing injury is striking given that participation in the ISP among
rates in volleyball athletes and may hold clinical utility.9 women’s volleyball programs improved considerably
The nature and prevalence of both lower extremity overuse between 2015–2016 and 2018–2019. NCAA ISP recruit-
injuries and ankle sprains suggest that injury prevention ment strategies have evolved over time, and improved
programs or prophylactic taping or bracing may have a participation during these years reflects the success of
positive effect on the reduction of injury in women’s recently used recruitment strategies (for instance, support
volleyball. and communication from the NCAA Sport Science
Noncontact and overuse injuries together accounted for Institute). As such, estimates from the latter part of the
nearly one-half of all reported injuries during the study study period may be considered a more valid representation
period, and this may be explained by a multitude of factors. of injury incidence in this population than those from the

Journal of Athletic Training 671

earlier years of the study period. With that said, it is 3. 2018–19 High school athletics participation survey. National
important to acknowledge that the observed concussion Federation of State High School Associations. Accessed March
incidence patterns may be attributable to several factors. 11, 2021. https://www.nfhs.org/media/1020412/2018-19_participa
Much attention has been directed in recent years toward tion_survey.pdf
improving concussion knowledge, awareness, and reporting 4. 2016 Women’s volleyball rules changes. National Collegiate
Athletic Association. Accessed March 11, 2021. https://www.
behaviors among athletes.26 Clinical practice in sports
ncaa.org/sites/default/files/2016-17_DIWVB_Approved_Rules_
medicine has also grown to implement multifaceted Changes_20160226.pdf
assessment batteries (ie, symptom, balance, and neurocog- 5. Kerr ZY, Dompier TP, Snook EM, et al. National Collegiate
nitive testing) more frequently than ever before, resulting in Athletic Association Injury Surveillance System: review of methods
improved diagnostic sensitivity.27 Together, these factors for 2004–2005 through 2013–2014 data collection. J Athl Train.
may have reasonably contributed to the observed patterns. 2014;49(4):552–560. doi:10.4085/1062-6050-49.3.58
However, it remains important for researchers to conduct 6. Dick R, Agel J, Marshall SW. National Collegiate Athletic
nuanced examinations of the dynamics of women’s Association Injury Surveillance System commentaries: introduction
volleyball to appraise concussion risk in this sport. Given and methods. J Athl Train. 2007;42(2):173–182.
the limited contact nature of the sport,28 further attention

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7. Agel J, Palmieri-Smith RM, Dick R, Wojtys EM, Marshall SW.
may be directed towards the frequency and nature Descriptive epidemiology of collegiate women’s volleyball injuries:
(including the impact biomechanics) of particularly ball National Collegiate Athletic Association Injury Surveillance
contact-resultant concussions (which accounted for ~61% System, 1988–1989 through 2003–2004. J Athl Train.
of all concussions reported), in order to better understand 2007;42(2):295–302.
concussion incidence in women’s volleyball. The NCAA 8. Kerr ZY, Gregory AJ, Wosmek J, et al. The first decade of web-
based sports injury surveillance: descriptive epidemiology of
ISP is not equipped to capture detailed concussion
injuries in US high school girls’ volleyball (2005–2006 through
characteristics, and researchers may need to conduct
2013–2014) and National Collegiate Athletic Association women’s
small-sample, targeted studies to study this further. Such volleyball (2004–2005 through 2013–2014). J Athl Train.
future studies notwithstanding, continued monitoring of 2018;53(10):926–937. doi:10.4085/1062-6050-162-17
concussion incidence in this population beyond 2018–2019 9. Gouttebarge V, Barboza S, Zwerver J, Verhagen E. Preventing
is needed to determine whether or not the upward trajectory injuries among recreational adult volleyball players: results of a
is maintained. prospective randomised controlled trial. J Sports Sci.
The findings of this study highlight the need for large- 2020;38(6):612–618. doi:10.1080/02640414.2020.1721255
sample examinations of injury incidence and patterns in this 10. Chandran A, Morris SN, Wasserman EB, Boltz A, Collins CL.
population and offer insight into avenues for further Methods of the National Collegiate Athletic Association Injury
exploration. The results observed here indicate the need Surveillance Program, 2014–2015 Through 2018–2019. J Athl
to closely monitor practice-related injury incidence, Train. 2021;56(7):616–621.
evaluate the etiology of overuse injuries, and probe 11. Drew MK, Finch CF. The relationship between training load and
mechanisms of concussion incidence among NCAA injury, illness and soreness: a systematic and literature review.
women’s volleyball athletes. Routine injury surveillance Sports Med. 2016;46(6):861–883. doi:10.1007/s40279-015-0459-8
in this population should continue monitoring injury 12. Clarsen B, Myklebust G, Bahr R. Development and validation of a
new method for the registration of overuse injuries in sports injury
trajectories of specific injuries that are most commonly
epidemiology: the Oslo Sports Trauma Research Centre (OSTRC)
reported in this context. Surveillance-based descriptive
overuse injury questionnaire. Br J Sports Med. 2013;47(8):495–502.
epidemiological studies are important for identifying doi:10.1136/bjsports-2012-091524
emerging temporal patterns, although targeted studies are 13. Shih YF, Wang YC. Spiking kinematics in volleyball players with
needed to further expand upon observed results. shoulder pain. J Athl Train. 2019;54(1):90–98. doi:10.4085/1062-
6050-216-17
ACKNOWLEDGMENTS 14. Seminati E, Minetti AE. Overuse in volleyball training/practice: a
review on shoulder and spine-related injuries. Eur J Sport Sci.
The NCAA Injury Surveillance Program was funded by the
2013;13(6):732–743. doi:10.1080/17461391.2013.773090
NCAA. The Datalys Center is an independent nonprofit
organization that manages the operations of the NCAA ISP. 15. Forthomme B, Croisier JL, Ciccarone G, Crielaard JM, Cloes M.
The content of this report is solely the responsibility of the Factors correlated with volleyball spike velocity. Am J Sports Med.
authors and does not necessarily represent the official views of the 2005;33(10):1513–1519. doi:10.1177/0363546505274935
funding organization. We thank the many ATs who have 16. Cools AM, Witvrouw EE, Mahieu NN, Danneels LA. Isokinetic
volunteered their time and efforts to submit data to the NCAA- scapular muscle performance in overhead athletes with and without
ISP. Their efforts are greatly appreciated and have had a impingement symptoms. J Athl Train. 2005;40(2):104–110.
tremendously positive effect on the safety of collegiate student- 17. Wolfe H, Poole K, Tezanos AGV, English R, Uhl TL. Volleyball
athletes. overhead swing volume and injury frequency over the course of a
season. Int J Sports Phys Ther. 2019;14(1):88–96.
18. Timoteo TF, Debien PB, Miloski B, Werneck FZ, Gabbett T, Bara
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Address correspondence to Avinash Chandran, PhD, MS, Datalys Center for Sports Injury Research and Prevention, 6151 Central
Avenue, Suite 117, Indianapolis, IN 46202. Address email to avinashc@datalyscenter.org

Journal of Athletic Training 673