Background Ankle sprains are the most prevalent injury in volleyball and it is suggested they result from player contact at the net. Traditionally, ankle sprains are thought to happen in a plantarflexed position, but case studies suggest plantarflexion may not be involved.

Objective To describe the injury situations and mechanisms for ankle injuries in elite volleyball based on systematic video analyses.

Design Descriptive video analysis.

Setting National teams participating in major Fédération Internationale de Volleyball (FIVB) senior-level tournaments.

Material All acute ankle injuries with subsequent time-loss (n=32) reported through the (FIVB) Injury Surveillance System (ISS) 2010–2014. Of these, video footage of 24 injuries was available for analysis.

Assessment of Risk Factors Injury situation variables included playing situation, player positions, and center line infringement. Variables examining injury mechanisms included lower extremity (ankle, knee, hip) joint positions at first contact and the index injury frame, joint movement between initial contact and the index frame, and the relationship between ankle dorsiflexion and supination.

Results The majority of injuries occurred during blocking (n=15) and attacking (n=6). Injuries to blockers resulted from landing on an opponent (n=11) or teammate (n=4). Attacking injuries mostly occurred when a backrow player landed on a front row teammate (n=4). When landing on an opponent, the attacker landed into the opponent's court in 11 of 12 situations compared to 2 situations for the blocker. When landing on another player, the ankle moved into a neutral dorsiflexed position prior to rapid pronation/supination in 15 situations compared to 1 situation of supination in plantarflexion.

Conclusions The majority of injuries occur while blocking, often landing on an opponent. The attacker is responsible for injuries at the net secondary to crossing the center line. Landing-related injuries mostly occur with the ankle rapidly supinating in a neutral dorsiflexed position.