A Volleyball Player at Risk for Knee Injury

I've known this ten-year-old girl since she was a baby, and now she is about to start playing team volleyball. At two-years-old, she could lower herself into a squat with both heels squarely on the floor. However, even at that young age, her right foot and leg would rotate slightly outward to compensate for slightly tight right ankle muscles. 

Eight years later, my assessment revealed this young athlete’s left ankle still has more flexibility than the right (photo 1), but now both are extremely tight and restricted. She now lacks the range of motion needed to squat with both heels on the ground. During a squat, her weight shifts to the left, putting a greater weight load on that side (photo 2). This is due in part to having more flexibility in her left ankle. The resulting dysfunction or asymmetry will be a left leg that is significantly stronger than the right leg.

While squatting with flat heels, the girl's right knee automatically dives inward (photo 3). This puts a great amount of strain on that joint. But if she compensated for muscle tightness by allowing her heels to lift, the bones of her forefoot would suffer undue stress, as would her calf muscles. Either way, such anatomical dysfunction puts her at increased risk for injury. 

When performing a lunge, the girl’s right foot rotates outward, as indicated by the
yellow arrow (photo 4). This demonstrates ankle tightness, which in turn stresses the ligaments in her right knee. 


To increase the range of the ankle joint, manual therapy and mobility work would be performed on the fascia and muscles of the lower leg and bottom of the foot. Corrective exercise would consist of learning to squat with proper knee alignment and lunge with correct rear foot position.

 Want to read more? Case study: A Young Gymnast with Back Pain