Fivb medical injury_prevention

Principles of Prevention and Treatment of Common Volleyball Injuries

Jonathan C. Reeser, MD PhD
Roald Bahr, MD PhD

Injuries are, regrettably, an unavoidable hazard of sports participation. Although
volleyball and beach volleyball are by most estimates relatively safe sports –
particularly in comparison to other sports such as football (soccer) – epidemiologic
research has revealed that volleyball athletes are at risk for certain types of injuries.
Serious injuries which interfere with the athlete’s ability to participate have obvious
immediate consequences (time lost from training and competition) and may have
long term implications as well (chronic disability and functional limitation). Coaches
and trainers should therefore have an understanding of the most common volleyball-
related injuries in order to appreciate the potential impact injuries may have on the
both on the athlete and the team.

One of the first considerations in discussing the injuries for which volleyball athletes
are at risk is to define what constitutes an injury. One accepted definition used in
research is that an injury is any condition for which an athlete seeks medical
attention. Injuries so defined may in turn be further subdivided into conditions that
result in “time lost” from either competition or training and those that do not limit
playing time. The length of time loss (typically reported in days or weeks) therefore
provides a measure of injury severity that can be used to compare different types of
injury. For example, in their 2004 study chronicling the injuries that occurred during
one volleyball season in the Dutch professional league, Verhagen et al determined
that shoulder injuries resulted in an average time lost from training or competition of
6.5 weeks – by far the longest mean absence from participation compared to other
injury sites documented in their study.

Injuries are also commonly categorized by and compared based upon the body part
affected (e.g. shoulder, knee, ankle, lower back). One additional useful classification
criterion is whether the athlete was injured as the result of acute tissue overload or
whether the injury resulted from chronic overuse. Acute injuries, such as ligament

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sprains and muscle strains, occur when the limits of tissue distensibility and integrity
are suddenly overwhelmed. The athlete is usually able to recall an exact mechanism
of injury to correspond to the sudden onset of pain and functional limitation. In
contrast, overuse injuries (e.g. tendinopathies) often occur insidiously. As a result
the injured athlete often cannot recall a specific traumatic incident or a definite
mechanism of injury. A hybrid of these two injury mechanisms occurs when tissue
that has been weakened from overuse suddenly fails in response to an acute load.
The athlete will identify the moment of “injury”, but may not appreciate the impact of
the chronic tissue overload that predisposed him (or her) to ultimately develop
outright tissue failure.

Numerous studies reporting on injury patterns in volleyball have been published.
Unfortunately, differences in the definition of injury and in calculation of incidence
rates make it difficult (if not impossible) to directly compare these studies.
Nevertheless, it is generally accepted that the most commonly occurring injuries are
acute ankle sprains, followed by overuse conditions of the knee (patellar
tendinopathy) and shoulder (multidirectional instability, impingement) and the lower
back (nonspecific mechanical low back pain).

Acute Injuries – Ankle Sprains

Ankle sprains are clearly the most common volleyball-related injury, accounting for
just over half of the acute injuries recorded prospectively by Bahr et al and Verhagen
et al. Ankle sprains occur most frequently at the net when one player lands on
another player’s foot, inverting the ankle and stretching (or tearing) the ligaments on
the lateral (outer) aspect of the ankle. Athletes who have suffered an ankle sprain in
the past are more likely to suffer a subsequent injury. If the injured player has
difficulty accepting weight onto the involved ankle, or if bearing weight results in
severe pain, she or he should not continue playing and should seek prompt medical
attention.

The goal of initial treatment for ankle sprains (and for acute injuries in general) is to
limit internal bleeding and swelling, and to provide an environment conducive to


tissue healing. The acronym PRICE is easy to recall and nicely summarizes the
early steps in caring for an acute ankle sprain. PRICE stands for:

Protection - Protect the ankle from further immediate injury. Depending on
the severity of the sprain, a period of immobilization and restricted weight bearing
may be necessary. As the athlete’s condition improves, he or she may resume
progressively more advanced activity patterns. However, use of an external support
(brace, or taping) is generally recommended for the first six months following injury.

Rest - As mentioned, a period of restricted activity promotes early tissue
healing. Weight-bearing may resume as symptoms subside, and activity may
progress accordingly.

Ice - Application of ice (or other cryotherapy modality) provides analgesia and
helps to minimize swelling. Although there is no consensus on treatment
parameters, cold treatment is often applied for 20 minutes at a time (followed by 20
minutes without ice). Three such on/off cycles of cryotherapy may be administered in
succession several times per day over the first 24 – 48 hours following the injury.

Compression - Temporary compression immediately following the injury limits
swelling in the injured ankle, which in turn facilitates restoration of normal range of
motion.

Elevation - Elevating the injured ankle also helps to minimize swelling
immediately following the injury.

PRICE treatment should be initiated as quickly as possible following the injury (Figure
1). Acute injuries should also be promptly evaluated by a trained medical
professional in order to carefully assess the extent and severity of injury, arrange for
diagnostic testing as needed in order to arrive at an accurate understanding of the
nature and extent of the injury, and formulate a definitive treatment plan. The athlete
should be monitored carefully, and examined periodically to confirm that healing is
progressing as expected. In addition to range of motion and strengthening exercises,
the comprehensive treatment of ankle sprains should include instruction in a program


of neuromuscular (proprioceptive) re-education. This involves having the athlete
balance on the involved limb, limiting corrective motion to the involved joint to the
extent possible (Figure 2). As the athlete improves, these balancing exercises
should be made progressively more challenging (both in terms of duration, and in
terms of adding unstable surfaces or other challenges to the maintenance of
balance). Return to play decisions following an ankle sprain (or indeed any injury)
should be guided by functional recovery rather than mere absence of pain. In their
2004 study, Verhagen et al documented that ankle injuries resulted in a mean of 4.5
weeks of time lost from training or competition.

Since ankle injuries are so common among volleyball players and result in
considerable time loss, it makes sense to try to prevent them. Primary prevention
entails practicing proper footwork at the net, integrating proprioceptive exercises into
the athlete’s regular conditioning program, and consistent use of external ankle
braces. Only recently has there been any evidence for a significant prophylactic
effect from the use of semi-rigid external ankle orthoses (Figure 3) among volleyball
players. Despite some concern voiced by coaches and athletes alike, there is no
evidence in the literature to suggest that the use of ankle orthoses increases the risk
of knee injuries. Another means of reducing the risk of ankle sprains would be to
modify the existing centerline rule, which allows for a portion of the foot to penetrate
onto the opponent’s court without a violation. While such rule changes have been
discussed, it seems unlikely that any substantive modification of the centerline rule
would be possible without significantly altering the dynamic aspects of the sport as it
is currently played.

Overuse Injuries – Patellar Tendinopathy

Anterior knee pain represents the second most common diagnosis among volleyball
athletes. The most common causes of anterior knee pain among volleyball players
are patellofemoral syndrome, and patellar tendinopathy (also known as “jumper’s
knee”). Both of these diagnoses represent overuse conditions. Fortunately,
volleyball players appear to be at relatively low risk for acute knee problems, such as
injury to the anterior cruciate ligament. Nevertheless, overuse conditions such as


patellar tendinopathy can extract a very high cost in terms of loss of time, and may
lead to chronic debilitating symptoms that adversely affect the athlete’s quality of life.

Unlike acute injuries, which have a distinct mechanism and time of onset, overuse
injuries are insidious in nature. Athletes with overuse injuries generally cannot recall
a specific moment when their injury occurred, but report instead a history of activity
related discomfort that has become progressively more severe over time. Many
athletes attempt to “play through” or compensate for the initial symptoms of overuse
pathology, and only after the pain becomes limiting or the performance deficit
intolerable will the athlete take time off from training or competition. Consequently,
treatment of overuse injuries is often challenging. The first priority is to alter or
minimize the load on the injured area. This is generally accomplished through
activity modification. Reducing the load on the injured area allows the affected
tissues an opportunity to recover and begin healing. However, in order to adequately
treat an overuse injury, it is important to examine the athlete’s risk factors for injury.

Risk factors for injury (which can be defined as those qualities which increase the
likelihood that an athlete will develop a certain type of injury), may be categorized as
either “intrinsic” or “extrinsic” to the athlete, and as either “modifiable” or
“unmodifiable”. Risk factors for jumper’s knee include the volume of jumping and
jump training which the athlete must endure (extrinsic, modifiable), the biomechanics
of the knee during the spike approach and upon landing from the jump (intrinsic,
modifiable), and the composition of the surface on which the athlete trains and
competes (extrinsic, modifiable). Ferretti and colleagues documented that hard,
unforgiving surfaces increase one’s risk of developing jumper’s knee. Not
surprisingly, therefore, jumper’s knee is less common among beach volleyball players
than it is among indoor volleyball athletes. The amount of knee valgus stress on the
lead (usually non-dominant) knee during the spike approach jump is a risk factor for
developing patellar tendinopathy, as is the degree of knee flexion achieved during
landing from the spike jump. Interestingly, those athletes who had the greatest
jumping ability were found to be at the greatest risk for developing patellar
tendinopathy. There are undoubtedly other genetic susceptibility factors involved in
the pathogenesis of jumper’s knee, since not all athletes who undergo comparable
jump training programs will develop symptomatic jumper’s knee. Practical prevention


strategies for jumper’s knee include strengthening and conditioning the muscles of
thigh, hip, and buttocks so that they can effectively absorb the shock of landing from
jump after jump. Analysis of technique is also important, as bending too deeply at
the knees when landing from a jump, or excessively "toeing in" during the loading
and take off phases of the jump can predispose the athlete to jumper¹s knee.
Perhaps the most effective preventive intervention is simply reducing the load on the
knee extensor mechanism by limiting the volume of jumping required during training
sessions.

Even with an appreciation of some of the modifiable risk factors for anterior knee
pain, effective treatment of jumper’s knee often remains elusive, further underscoring
the importance of prevention. Some athletes benefit from the use of an infra-patellar
strap, which is thought to redistribute the traction force on the patellar tendon during
activation of the quadriceps, thereby reducing the risk (or minimizing the symptoms)
of tendinopathy. Eccentric quadriceps training (Figure 4, shown without the incline
board that can be used to make the exercise more demanding) may be of some
benefit as a pre-season conditioning exercise, but this type of exercise has not been
shown to be effective in treating symptomatic patellar tendinopathy during the
competitive season. Advances in our understanding of the underlying cellular and
tissue pathophysiology have led to new methods to treat this condition, which at its
worst can be potentially career-threatening. Among these treatments is sclerosis of
neovessels under ultrasound guidance, which has been shown to be of some clinical
benefit. Other less proven methods of treatment include injections with platelet rich
plasma. Although thought to deliver concentrated growth factors and cellular
mediators involved in tissue healing direct to the site of tissue injury, there is little
scientific proof of the effectiveness this technique. Severe cases of patellar
tendinopathy may require surgical intervention.

Overuse Injuries – Shoulder Problems

The shoulder is the third most commonly injured body part overall. Injuries to the
shoulder most often occur as the result of chronic overuse. Acute shoulder trauma
(such as an anterior shoulder dislocation) does occur, but it often occurs in the
context of underlying overuse-related pathology. Spiking is perhaps the most


dramatic skill in volleyball. It has been estimated that an elite volleyball player,
practicing and competing 16 to 20 hours per week, may perform as many as 40,000
spikes in one season. The volume of overhead loading inherent in that much activity
places enormous demands on the glenohumeral joint specifically and the shoulder
girdle in general.

The shoulder is an extremely mobile joint that permits the volleyball athlete to swing
high for a spike or reach out for a block. Athletic shoulder function is dependent
upon the precise action of the rotator cuff and the muscles that stabilize the scapula
(shoulder blade). These muscles must be well conditioned and work in a coordinated
manner to ensure pain-free shoulder function. Unfortunately, through repetition and
the sheer volume of training, the muscles and tendons of the shoulder girdle may
become overloaded and fatigued. This is turn may result in “wear and tear” damage
to the shoulder, which over time may culminate in a time-loss injury. Regrettably,
treatment of overuse conditions of the shoulder girdle (such as rotator cuff
tendinopathy) is often incompletely successful. Accepted principles of non-operative
treatment include load reduction (limiting the number of spikes or serves performed)
and correction of any underlying imbalances of strength or flexibility through
appropriate training programs (Figure 5). Some conditions, such as shoulder
instability due to injury to the glenoid labrum, may require surgery if conservative
management does not restore the athlete to an acceptable level of function.

As with jumper’s knee, comprehensive treatment of volleyball-related shoulder
problems requires that specific risk factors for injury be identified and addressed.
Our understanding of the risk factors for volleyball-related shoulder problems is
unfortunately quite limited. Kugler et al (1996) described the adaptive changes in
scapular positioning they observed in elite volleyball players, but there has been little
volleyball-specific follow-up to this insightful paper. In their recent study, Reeser et
al found that spiking volume (extrinsic, modifiable) and scapular dyskinesis (intrinsic,
modifiable) were associated with an increased incidence of shoulder problems.
Shoulder pain was also associated with core instability (intrinsic, modifiable),
reflecting the importance of the kinetic chain in generating power for the spiking
motion. Wang and Cochrane, along with other researchers, have documented the
ratio of eccentric shoulder external rotational strength to concentric shoulder internal


rotational strength among volleyball players. Their work, collectively, suggests that a
reduced ratio represents a risk factor for injury. Wang and Cochrane (2001) also
documented that those with a longer training history had a higher incidence of
shoulder problems. Lastly, there have been numerous reports in the literature
describing the suprascapular mononeuropathy that is common in volleyball players,
but the risk factors for the onset of this condition remain a matter of debate.
Similarly, treatment for this condition is somewhat controversial, since it frequently is
essentially painless and causes little or no performance deficit.

Prevention of shoulder pathology among volleyball athletes has been poorly studied.
It is not known whether intervening in any of the aforementioned areas, such as
instituting a program of flexibility training to address the deficit of glenohumeral
internal rotation commonly observed in the dominant shoulder, will minimize or
eliminate the volleyball athlete’s risk of developing shoulder pain. Nevertheless, it is
probably advisable to incorporate posterior capsular stretching into the shoulder
girdle strengthening and scapular stabilization program followed by elite volleyball
athletes. Most conditioning programs also include a program of core stabilization
exercise designed to promote correct posture and facilitate the generation and
efficient transfer of power throughout the kinetic chain.

Low Back Pain

Volleyball players, along with the rest of the general population, frequently complain
of lower back pain. More often than not, the pain will resolve spontaneously within
several weeks, and as such probably does not indicate serious pathology. However,
mechanical back pain is much less common among young athletes, and those
individuals 20 years of age or younger who have persistent back pain that limits them
from participating in activities (such as volleyball) should be evaluated by a sports
medicine physician. There are many different causes for back pain, and as a result
the exact cause of an individual’s lower back pain often cannot be precisely
identified. That said, if a young athlete’s low back pain is made worse by lumbar
extension (bending backwards), then a stress fracture of the lumbar spine
(“spondylolysis”) should be ruled out. If the athlete has suffered an acute strain of the
muscles of the low back, then the pain will typically be self-limiting and should


improve rapidly over a few days. Pain related to an intervertebral disc injury or spinal
nerve impingement may be disabling, and should be treated aggressively. Anti-
inflammatory medicines such as ibuprofen can help to control symptoms in the short
term. Volleyball training (especially jumping and strength training) should be curtailed
until the athlete is feeling better. Because of the different types of injury that may
give rise to low back pain, it is difficult to give general recommendations for exercises
that would be therapeutic in all situations. For this reason, an appropriate exercise
prescription should be developed in consultation with a trainer, physical therapist, or
sports medicine physician. Prevention of lower back problems includes minimizing
torsional stress on the spine, particularly while loaded, as well as minimizing
extremes of or repetitive flexion and/or extension - particularly in the young athlete.
Proper weight-training technique is an important aspect of a comprehensive injury
prevention program, as is an integrated program of core stabilization.

Principles of Injury Prevention

Over the last 20 years, the ability of sports medicine professionals to diagnose and
treat athletic injuries has improved dramatically. Athletes are now capable of
returning from serious injuries faster than ever before due to aggressive treatment
and rehabilitation programs. The greatest remaining challenge in the field of sports
medicine is to design and implement programs that will reliably prevent injuries from
occurring in the first place. Although injuries cannot be entirely avoided, our present
understanding of the basic risk factors associated with the most common volleyball-
related injuries can help coaches and athletes prepare themselves and their teams
for a successful season with minimal risk of injury. Several general strategies that
can be adopted in an effort to reduce an athlete¹s risk of volleyball-related injury are
presented below. Although certainly not exhaustive, the principles briefly outlined
form the foundation of a sound volleyball injury prevention program.

1. Follow a sport-specific program of strength training and conditioning.

Volleyball is primarily an anaerobic sport. Nevertheless, volleyball athletes should
maintain good cardiovascular fitness as it will enhance their ability to recover


between points and after matches. Elite volleyball players also train to become
strong and powerful, not only for the performance advantage offered but because
well-conditioned muscles are better able to endure the demands of sport
participation, and are less likely to become injured. In addition, fitness allows the
athlete to maintain optimal form and technique throughout a match, thereby
minimizing the risk of fatigue-related injuries. Warm-up prior to and proper cool-down
following a competition readies the athlete for the demands of the event and
facilitates subsequent recovery.

2. Avoid overtraining.

Adequate rest is almost as important to an athlete’s development and performance
as proper training. Athletes who train too hard may not give their bodies sufficient
time to recover, resulting in an increased risk of overuse injuries. Each athlete has a
unique tolerance for training and individual needs for rest and recovery, making it
difficult for a coach to take a "cook book" approach to training for all members of the
team. Athletes who persistently train without sufficient rest are at risk for developing
a syndrome of mental and physical fatigue commonly referred to as "burnout". Elite
athletes train for volleyball throughout the year, but vary the intensity and composition
of their workouts so that they achieve and maintain peak fitness during the
competition season. There is evidence that this practice, known as periodization,
further reduces an athlete’s risk of injury.

3. Pay attention to and practice proper technique.

As we have seen, most ankle sprains occur when an athlete lands on a teammate's
or opponent's foot while making a play at the net. Practicing good blocking footwork
and controlled spike jump approaches and landings can minimize the likelihood of
contact-related injuries about the centerline. It is also important to attend to
technique, since subtle alterations in performance and technique often provide the
earliest clues that an athlete is developing (and attempting to compensate for)
overuse related dysfunction.


4. Train (and maintain) core stability.

To function properly, joints (and in fact the body as a whole) must be mechanically
stable. Stability is conferred through both passive and active mechanisms: the
musculoskeletal anatomy provides the joint with an underlying passive structural
stability which is augmented through dynamic (active) neuromuscular control. Such
control can be learned, and indeed is an essential component of the athlete's ability
to adapt to the demands of and excel in their chosen sport. When actively engaged
in sports, athletes are rarely static - their position in space is constantly changing as
they react to the competitive situation. In volleyball, although most of the activity is
initiated by the legs, the culmination of a given movement often involves the upper
limbs reaching overhead. Thus, even though the skill may be performed by the
upper body, the energy to perform those skills is generated by the lower limbs and by
the trunk. The smooth and efficient transfer of energy from lower limb to upper limb
is dependent on an integrated response from the intervening segments of the "kinetic
chain" - particularly the pelvis and the thoracolumbar spine.

Together the pelvis and the thoracolumbar spine form the foundation of what has
become known as the athletic "core." Research has demonstrated that a stable,
well-conditioned core plays a critical role in coordinating the body's movements and
in minimizing the athlete's risk of both upper and lower limb injuries, as well as low
back pain. The core may therefore be thought of as a functional integration of the
associated anatomical structures of the pelvis and thoracolumbar spine, including the
hip flexors, hip extensors, hip abductors and adductors, abdominals, paravertebral
musclature, and the diaphragm. Developing and maintaining the athlete's dynamic
core strength and stability will reduce his or her global risk of injury by facilitating
proper coordination and energy transfer along the kinetic chain. Suggested
exercises are presented in Figure 6.

5. Properly rehabilitate injuries.

Research has shown that a body part, once injured, is more likely to be injured again
upon returning to play. To prevent acute injuries from becoming chronic recurrent
injuries, it is imperative that the injured athlete receive careful evaluation from a


sports medicine provider, so that an accurate diagnosis can be made and a
comprehensive treatment program started. Typically the athlete will be allowed to
return to competition once they can perform sport-specific skills- such as jumping and
spiking - without pain. However, a truly thorough program will rehabilitate the athlete
"beyond the absence of symptoms". This philosophy requires that the athlete’s
trainer, therapist, or team physician identify and address any structural and/or
functional factors that contributed to (or resulted from) the injury. For example, an
athlete with a stress fracture of the lower back may develop inflexibility of the
hamstrings and subconsciously alter his or her spiking form so as to minimize stress
on the lower back. Unless these factors are identified and corrected during the
rehabilitation process, the athlete may subsequently develop shoulder pain as a
consequence of the altered mechanics.

6. Maintain proper nutrition and hydration.

Consuming a balanced diet with adequate caloric intake ensures that the athlete will
have sufficient energy stores to allow full participation throughout the season.
Dietary protein intake provides the building blocks to repair injured tissues, while fats
and carbohydrates serve as fuel for the athlete’s fire. Sufficient fluid intake
(preferably water or - during competition - a sport’s drink) prevents dehydration and
minimizes the risk of developing heat illness. Coaches should be particularly
attentive for recurrent injury among female athletes, as this may indicate the
presence of the "female athlete triad" - a condition characterized by disordered eating
(typically anorexia), which in turn leads to irregular or even absent menstrual cycles
(amenorrhea), and eventually to loss of bone mass (osteoporosis).

7. Avoid early sport and position specialization.

Volleyball is a sport that can be enjoyed by the young and old alike. However,
engaging young athletes in overly structured, competitive programs may increase
their risk of injury. The American Academy of Pediatrics Committee on Sports
Medicine and Fitness has discouraged "specialization in a single sport before
adolescence", and it seems reasonable to conclude that the volume of training in
developing athletes should be limited in order to reduce the risk of developing


overuse injuries. Unfortunately, no studies have been done to quantify what
represents an appropriate training load for the young volleyball athlete. Athletes,
coaches, and parents must therefore be particularly attentive to the early warning
signs of overuse injury, including activity-related pain and deteriorating performance.

A Final Thought

It has been stated that great success comes from great collaboration. It seems
reasonable to extrapolate on that theme and suggest that the modern international
volleyball player may potentially benefit from the input of a myriad of professionals
spanning the entire sports medicine spectrum, including biomechanists, nutritionists,
physiologists, physiotherapists, and physicians. Of course, one must include the
coach (trainer) in that list, since it is the coach who must decide how to best train the
athlete and who ultimately implements the advice of the medical professionals
regarding return to play following injury. In that regard, it should be acknowledged
that on occasion the coach and the medical team may be at odds regarding their
motivation. In the long run, however, it is the athlete’s health and well being that
should serve as the principle motivation behind all recommendations offered by the
sports medicine team, in addition to serving as the deciding factor in all related
decision-making.

For additional information on volleyball sports medicine and science, the interested
reader is referred to “Volleyball” (part of the Blackwell Olympic Handbook of Sports
Medicine and Science series) edited by Reeser and Bahr.


Selected References

Bahr R, Bahr IA. Incidence of acute volleyball injuries: a prospective cohort study of
injury mechanisms and risk factors. Scand J Med Sci Sports. 1997 Jun; 7(3):166-71.

Bahr R, Reeser JC; Fédération Internationale de Volleyball. Injuries among world-
class professional beach volleyball players. The Fédération Internationale de
Volleyball beach volleyball injury study. Am J Sports Med. 2003 Jan-Feb; 31(1):119-
25.

Ferretti A. Epidemiology of jumper's knee. Sports Med. 1986 Jul-Aug;3(4):289-95.

Kugler A, Krüger-Franke M, Reininger S, Trouillier HH, Rosemeyer B. Muscular
imbalance and shoulder pain in volleyball attackers. Br J Sports Med. 1996 Sep;
30(3):256-9.

Reeser JC, Verhagen E, Briner WW, Askeland TI, Bahr R. Strategies for the
prevention of volleyball related injuries. Br J Sports Med. 2006 Jul; 40(7):594-600.

Verhagen EA, Van der Beek AJ, Bouter LM, Bahr RM, Van Mechelen W. A one
season prospective cohort study of volleyball injuries. Br J Sports Med. 2004 Aug;
38(4):477-81.

Wang HK, Cochrane T. Mobility impairment, muscle imbalance, muscle weakness,
scapular asymmetry and shoulder injury in elite volleyball athletes. J Sports Med
Phys Fitness. 2001 Sep; 41(3):403-10.


The Author:
Jonathan Reeser, MD PhD is the past chair of the USA
Volleyball Sports Medicine and Performance Commission,
and a former member of the Medical Commission of the
Federation Internationale de Volleyball (the International
Federation governing the sports of volleyball and beach
volleyball world-wide).
He currently serves as a team physician for the USA
Volleyball National Teams. He works at the Marshfield Clinic
Research Foundation, and resides in Marshfield, Wisconsin with his wife and two
sons.


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