Fatigue-induced alterations in jump-landing biomechanics and knee injury risk in volleyball

  • Rudyanto Rudyanto 
    Universitas Negeri Padang
    Indonesia
  • ifdil ifdil
    Indonesia
  • Allysa Kholila Razak
    Indonesia

Abstract

Volleyball involves frequent jumping and landing actions that place substantial mechanical stress on the lower extremities, particularly the knee joint, thereby increasing the risk of anterior cruciate ligament (ACL) and other knee-related injuries. This systematic review aimed to synthesize current evidence regarding biomechanical risk factors, fatigue-related alterations, neuromuscular control deficits, and preventive interventions associated with knee injury risk during volleyball jump-landing activities. A systematic literature search was conducted in the Scopus database following PRISMA 2020 guidelines. Ten studies published between 2020 and 2025 met the inclusion criteria and were included in the review. The findings showed that fatigue-induced biomechanical alterations, particularly increased dynamic knee valgus and reduced neuromuscular control, were the most frequently reported risk factors associated with knee injury mechanisms during volleyball jump-landing tasks. Evidence further indicated that neuromuscular training, dynamic taping, feedback-based interventions, and Pilates conditioning effectively improved landing mechanics and reduced injury risk indicators. Overall, knee injury risk in volleyball appears to be multifactorial, involving biomechanical, neuromuscular, cognitive, and fatigue-related mechanisms. These findings support the implementation of multidimensional injury-prevention programs and provide direction for future volleyball-specific biomechanical research.

Keywords
  • Volleyball athletes
  • Neuromuscular fatigue
  • Landing mechanics
  • Anterior cruciate ligament (ACL) injury
  • Biomechanical analysis
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References
  1. Abbasi, S., Rahmatzadeh, D., Minoonejad, H., & Mousavi, S. H. (2025). The effect of fatigue on dynamic knee valgus during landing tasks: A systematic review and meta-analysis. BMC Sports Science, Medicine and Rehabilitation, 17(1), Article 166. https://doi.org/10.1186/s13102-025-01205-3
  2. Acar, N. E., Umutlu, G., Gencer, Y. G., Güven, E., & Taşman, G. A. (2025). Strength asymmetries and their impact on landing dynamics during countermovement jump and drop jump tests in professional female basketball players. BMC Sports Science, Medicine and Rehabilitation. https://doi.org/10.1186/s13102-025-01352-7
  3. Agel, J., Evans, T. A., Dick, R., Putukian, M., & Marshall, S. W. (2007). Descriptive epidemiology of collegiate men's soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2002–2003. Journal of Athletic Training, 42(2), 270–277. https://doi.org/10.4085/1062-6050-42.2.270
  4. Alentorn-Geli, E., Myer, G. D., Silvers, H. J., Samitier, G., Romero, D., Lázaro-Haro, C., & Cugat, R. (2009). Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surgery, Sports Traumatology, Arthroscopy, 17(7), 705–729. https://doi.org/10.1007/s00167-009-0813-1
  5. Barber-Westin, S. D., & Noyes, F. R. (2017). Training effects on knee biomechanics during cutting and landing in female athletes: A systematic review. Sports Health, 9(4), 390–400. https://doi.org/10.1177/1941738117700189
  6. Bere, T., Flørenes, T. W., Krosshaug, T., Nordsletten, L., & Bahr, R. (2011). Events leading to anterior cruciate ligament injury in World Cup Alpine Skiing: A systematic video analysis of 20 cases. British Journal of Sports Medicine, 45(16), 1294–1302. https://doi.org/10.1136/bjsports-2011-090517
  7. Bisseling, R. W., Hof, A. L., Bredeweg, S. W., Zwerver, J., & Mulder, T. (2007). Relationship between landing strategy and patellar tendinopathy in volleyball. British Journal of Sports Medicine, 41(7), e8. https://doi.org/10.1136/bjsm.2006.032565
  8. Boden, B. P., Dean, G. S., Feagin, J. A., & Garrett, W. E. (2000). Mechanisms of anterior cruciate ligament injury. Orthopedics, 23(6), 573–578. https://doi.org/10.3928/0147-7447-20000601-15
  9. Brunetti, C., Poletti, N., Zago, M., Bertozzi, F., & Sforza, C. (2025). External focus of attention influences the performance–injury risk conflict during drop jumps. Sport Sciences for Health. https://doi.org/10.1007/s11332-025-01528-1
  10. Chappell, J. D., & Limpisvasti, O. (2008). Effect of a neuromuscular training program on the kinetics and kinematics of jumping tasks. American Journal of Sports Medicine, 36(6), 1081–1086. https://doi.org/10.1177/0363546508314425
  11. Decker, M. J., Torry, M. R., Wyland, D. J., Sterett, W. I., & Steadman, J. R. (2003). Gender differences in lower extremity kinematics, kinetics and energy absorption during landing. Clinical Biomechanics, 18(7), 662–669. https://doi.org/10.1016/S0268-0033(03)00090-8
  12. Dempsey, A. R., Lloyd, D. G., Elliott, B. C., Steele, J. R., & Munro, B. J. (2009). Changing sidestep cutting technique reduces knee valgus loading. American Journal of Sports Medicine, 37(11), 2194–2200. https://doi.org/10.1177/0363546509337167
  13. Distefano, L. J., Blackburn, J. T., Marshall, S. W., & Padua, D. A. (2009). Gluteal muscle activation during common therapeutic exercises. Journal of Orthopaedic and Sports Physical Therapy, 39(7), 532–540. https://doi.org/10.2519/jospt.2009.2796
  14. Faigenbaum, A. D., & Myer, G. D. (2012). Exercise deficit disorder in youth: Play now or pay later. Current Sports Medicine Reports, 11(4), 196–200. https://doi.org/10.1249/JSR.0b013e31825da961
  15. Ford, K. R., Myer, G. D., & Hewett, T. E. (2003). Valgus knee motion during landing in high school female and male basketball players. Medicine and Science in Sports and Exercise, 35(10), 1745–1750. https://doi.org/10.1249/01.MSS.0000089346.85744.D9
  16. Giesche, F., Stief, F., Groneberg, D. A., & Wilke, J. (2025). Effects of sport specific unplanned movements on ankle kinetics and kinematics in healthy athletes from systematic review with meta-analysis. Scientific Reports, 15(1), Article 32476. https://doi.org/10.1038/s41598-025-18746-9
  17. Hägglund, M., Waldén, M., Bahr, R., & Ekstrand, J. (2005). Methods for epidemiological study of injuries to professional football players: Developing the UEFA model. British Journal of Sports Medicine, 39(6), 340–346. https://doi.org/10.1136/bjsm.2005.018267
  18. Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes. American Journal of Sports Medicine, 33(4), 492–501. https://doi.org/10.1177/0363546504269591
  19. Hewett, T. E., Stroupe, A. L., Nance, T. A., & Noyes, F. R. (1996). Plyometric training in female athletes: Decreased impact forces and increased hamstring torques. American Journal of Sports Medicine, 24(6), 765–773. https://doi.org/10.1177/036354659602400611
  20. Hewett, T. E., Torg, J. S., & Boden, B. P. (2009). Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: Lateral trunk and knee abduction motion are combined components of the injury mechanism. British Journal of Sports Medicine, 43(6), 417–422. https://doi.org/10.1136/bjsm.2009.059162
  21. Hosseini, S. H., Gheitasi, M., & Hosseini, S. M. (2025). Effect of lower-limb fatigue on kinematic variables during an unanticipated block among adolescent female volleyball players. BMC Sports Science, Medicine and Rehabilitation. https://doi.org/10.1186/s13102-025-01331-y
  22. Krosshaug, T., Slauterbeck, J. R., Engebretsen, L., & Bahr, R. (2007). Biomechanical analysis of anterior cruciate ligament injury mechanisms: Three-dimensional motion reconstruction from video sequences. Scandinavian Journal of Medicine and Science in Sports, 17(5), 508–519. https://doi.org/10.1111/j.1600-0838.2006.00558.x
  23. Leppänen, M., Pasanen, K., Kujala, U. M., Vasankari, T., Kannus, P., Äyrämö, S., & Parkkari, J. (2017). Stiff landings are associated with increased ACL injury risk in young female basketball and floorball players. American Journal of Sports Medicine, 45(2), 386–393. https://doi.org/10.1177/0363546516665810
  24. Lian, Ø. B., Engebretsen, L., & Bahr, R. (2005). Prevalence of jumper's knee among elite athletes from different sports: A cross-sectional study. American Journal of Sports Medicine, 33(4), 561–567. https://doi.org/10.1177/0363546504268280
  25. Mandelbaum, B. R., Silvers, H. J., Watanabe, D. S., Knarr, J. F., Thomas, S. D., Griffin, L. Y., & Garrett, W. (2005). Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: Two-year follow-up. American Journal of Sports Medicine, 33(7), 1003–1010. https://doi.org/10.1177/0363546504272261
  26. McLean, S. G., Huang, X., & van den Bogert, A. J. (2005). Association between lower extremity posture at contact and peak knee valgus moment during sidestepping: Implications for ACL injury. Clinical Biomechanics, 20(8), 863–870. https://doi.org/10.1016/j.clinbiomech.2005.04.001
  27. Meeuwisse, W. H., Tyreman, H., Hagel, B., & Emery, C. (2007). A dynamic model of etiology in sport injury: The recursive nature of risk and causation. Clinical Journal of Sport Medicine, 17(3), 215–219. https://doi.org/10.1097/JSM.0b013e3180592a48
  28. Memain, G., Carling, C., Bouvet, J., Fourcade, P., Maille, P., & Yiou, E. (2025). Effect of a visual dual-task on single-leg countermovement-jump in male professional soccer players with lower-limb injuries: A cross-sectional observational study. Sports, 13(12), Article 419. https://doi.org/10.3390/sports13120419
  29. Myer, G. D., Ford, K. R., Brent, J. L., & Hewett, T. E. (2006). The effects of plyometric vs. dynamic stabilization and balance training on power, balance, and landing force in female athletes. Journal of Strength and Conditioning Research, 20(2), 345–353. https://doi.org/10.1519/R-17955.1
  30. Myer, G. D., Ford, K. R., Palumbo, J. P., & Hewett, T. E. (2005). Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. Journal of Strength and Conditioning Research, 19(1), 51–60. https://doi.org/10.1519/13643.1
  31. Nagelli, C. V., & Hewett, T. E. (2017). Should return to sport be delayed until two years after anterior cruciate ligament reconstruction? Biological and functional considerations. Sports Medicine, 47(2), 221–232. https://doi.org/10.1007/s40279-016-0584-z
  32. Nordin, A. D., & Dufek, J. S. (2017). Lower extremity variability changes with drop-landing height manipulations. Research in Sports Medicine, 25(1), 56–72. https://doi.org/10.1080/15438627.2016.1258638
  33. Padua, D. A., Marshall, S. W., Boling, M. C., Thigpen, C. A., Garrett, W. E., & Beutler, A. I. (2009). The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics: The JUMP-ACL study. American Journal of Sports Medicine, 37(10), 1996–2002. https://doi.org/10.1177/0363546509343200
  34. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
  35. Paterno, M. V., Schmitt, L. C., Ford, K. R., Rauh, M. J., Myer, G. D., Huang, B., & Hewett, T. E. (2010). Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. American Journal of Sports Medicine, 38(10), 1968–1978. https://doi.org/10.1177/0363546510376053
  36. Petersen, W., Ellermann, A., Gösele-Koppenburg, A., Best, R., Rembitzki, I. V., Brüggemann, G. P., & Liebau, C. (2014). Patellofemoral pain syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 22(10), 2264–2274. https://doi.org/10.1007/s00167-013-2759-6
  37. Quatman, C. E., & Hewett, T. E. (2009). The anterior cruciate ligament injury controversy: Is valgus collapse a sex-specific mechanism? British Journal of Sports Medicine, 43(5), 328–335. https://doi.org/10.1136/bjsm.2009.059139
  38. Rahimi, S., Norasteh, A. A., & Mottaghitalab, M. (2025). The effect of Pilates training on knee functional tests in youth female volleyball player. BMC Sports Science, Medicine and Rehabilitation. https://doi.org/10.1186/s13102-025-01258-4
  39. Saragiotto, B. T., Di Pierro, C., & Lopes, A. D. (2014). Risk factors and injury prevention in elite athletes: A descriptive study from the medical staff perspective. Brazilian Journal of Physical Therapy, 18(2), 137–143. https://doi.org/10.1590/S1413-35552012005000147
  40. Schilaty, N. D., Bates, N. A., Nagelli, C. V., Krych, A. J., & Hewett, T. E. (2021). Sex-based differences in knee mechanics with muscle co-contraction in a simulated jump landing. American Journal of Sports Medicine, 49(5), 1272–1279. https://doi.org/10.1177/0363546521994113
  41. Sell, T. C., Ferris, C. M., Abt, J. P., Tsai, Y. S., Myers, J. B., Fu, F. H., & Lephart, S. M. (2006). The effect of direction and reaction time condition on female soccer athletes' lower-extremity kinematics during jump landing. American Journal of Sports Medicine, 34(11), 1872–1878. https://doi.org/10.1177/0363546506287538
  42. Sigward, S. M., & Powers, C. M. (2006). The influence of gender on knee kinematics, kinetics and muscle activation patterns during side-step cutting. Clinical Biomechanics, 21(1), 41–48. https://doi.org/10.1016/j.clinbiomech.2005.08.001
  43. Silvers-Granelli, H. J., Bizzini, M., Arundale, A., Mandelbaum, B. R., & Snyder-Mackler, L. (2017). Does the FIFA 11+ injury prevention program reduce the incidence of ACL injury in male soccer players? Clinical Orthopaedics and Related Research, 475(10), 2447–2455. https://doi.org/10.1007/s11999-017-5342-5
  44. Soligard, T., Myklebust, G., Steffen, K., Holme, I., Silvers, H., Bizzini, M., & Andersen, T. E. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: Cluster randomised controlled trial. BMJ, 337, a2469. https://doi.org/10.1136/bmj.a2469
  45. Sugimoto, D., Myer, G. D., Barber Foss, K. D., Pepin, M. J., Micheli, L. J., & Hewett, T. E. (2016). Critical components of neuromuscular training to reduce ACL injury risk in female athletes: Meta-regression analysis. British Journal of Sports Medicine, 50(20), 1259–1266. https://doi.org/10.1136/bjsports-2015-095596
  46. Szeles, K. T., & Green, A. (2025). The impact of landing complexity and knee taping on stability: A continuous kinetics and kinematics analysis. Sports, 13(12), Article 431. https://doi.org/10.3390/sports13120431
  47. Wen, J., Xu, D., Gao, X., Qu, X., Zhang, Z., Zhou, H., Radak, Z., Gao, Z., & Gu, Y. (2025). Effects of foot rotation on ankle control and injury risk during badminton lunge landings. BMC Sports Science, Medicine and Rehabilitation. https://doi.org/10.1186/s13102-025-01393-y
  48. Wilkerson, G. B., Colston, M. A., Short, N. I., Neal, K. L., Deskin, P. E., & Gallier, E. A. (2004). Neuromuscular changes in female collegiate athletes resulting from a plyometric jump-training program. Journal of Athletic Training, 39(1), 17–23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC385269/ (PMC: PMC385269)
  49. Zazulak, B. T., Hewett, T. E., Reeves, N. P., Goldberg, B., & Cholewicki, J. (2007). Deficits in neuromuscular control of the trunk predict knee injury risk: A prospective biomechanical-epidemiological study. American Journal of Sports Medicine, 35(7), 1123–1130. https://doi.org/10.1177/0363546507301585
  50. Zhu, J., Yang, X., Li, T., Xing, W., Zhang, Z., Chen, Z., & Zhu, W. (2025). Preventive interventions on ACL injury reduction based on the landing error scoring system evaluation tool: A systematic review and network meta-analysis. BMC Musculoskeletal Disorders, 26(1), Article 1061. https://doi.org/10.1186/s12891-025-09290-8

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