How to Prevent Netball ACL and Knee Injuries
April 13, 2023 / ASICS Australia
The most recent National Sport and Physical Activity Participation Report for netball shows that there are over 927k adults and children playing netball annually.
It is the leading women’s participation sport and the top team sport for ages 15 to 24. All ages play netball and it is a fantastic sport to develop health and fitness. Netball involves high speed, deceleration, twisting, and pivoting which make it a physically demanding sport, especially on the knee.
Injuries to the ankle and knee are the most common netball related injuries and prevention of these injuries should be a priority(2). The most common circumstances of injury are jump-landing, trips/slips/falls and contact with another player or the ball(2).
The Knee: One of the Most Commonly Injured Joints in Netball
The knee is one of the most commonly injured joints in netball. Injury to one of the major stabilisers of the knee, the Anterior Cruciate Ligament (ACL), is a common problem, annually representing 25% of serious injuries (Netball Australia National Insurance Data). This is a devastating injury to netballers as it usually requires surgery, prolonged rehabilitation, and time away from the sport. Other less severe knee injuries occurring during netball include other ligament sprains, knee-cap dislocations, meniscus tear, and joint surface trauma.
What are the common causes of ACL injuries in netball?
Associate Professor, Adam Bryant, of the University of Melbourne shares:
Research has identified numerous extrinsic (outside the body) and intrinsic (inside the body) factors that increase the risk of ACL injury amongst female athletes. Extrinsic factors include the playing surface, footwear, and physical contact with another player (often involves a forceful blow to the knee with the foot planted). Intrinsic factors include pubertal maturation, ACL mechanical properties (strength and stiffness), wide and internally rotated hips, cyclical changes in estrogen levels, low hamstrings-to-quadriceps strength ratio and poor neuromuscular control. As a result, many female netball players tend to land with a ‘knock-knee’ (knee valgus) posture which can increase the load on the ACL and risk of injury. Unfortunately, knee and lower limb biomechanics tend to worsen in females as they mature pubertally. This likely explains the dramatic rise in ACL injury rates in females aged 15 to 19 years.
What are the symptoms of an ACL injury?
Associate Professor, Adam Bryant, of the University of Melbourne shares:
Unfortunately, court sports like netball have relatively high rates of non-contact ACL injury. Mechanistically, ACL rupture occurs very quickly following initial foot contact (within the first 60 milliseconds) in movements involving sudden pivoting or cutting. At the time of ACL injury and in the period immediately following, a person is likely to report the following knee symptoms:
- A ‘popping’ sound and tearing sensation
- Giving-way and collapse
- Intense pain and swelling
- Inability to walk or weight bear on the affected leg
The medial collateral ligament and medial meniscus are often injured at the same time as the ACL (termed the ‘unhappy triad’). In Australia, surgical ACL reconstruction is the preferred treatment and is typically performed once knee swelling and pain have subsided, and knee range of motion has largely been restored.
Ways to prevent ACL and knee injuries
Physiotherapist and PhD candidate, Patrick Rowe, of the University of Melbourne shares:
Prevention of knee and ACL injuries is considered the ’holy grail’ in netball. However, the physical and technical characteristics of netball make it difficult preventing all knee injuries that occur. Although we can’t prevent all injuries, there is promising research showing we can significantly reduce ACL injury rates.
Netball specific knee programs Physiotherapist and PhD candidate, Patrick Rowe, of the University of Melbourne shares further:
Research shows that reducing ACL injury rates can be achieved by athletes completing an injury prevention program that includes leg strengthening, balance, and landing exercises(3). For netballers, the NetballSmart (https://netballsmart.co.nz/) and KNEE programs (https://knee.netball.com.au/) were developed to specifically reduce knee and ACL injuries by incorporating these preventative exercises into their warm-up for training and games. Both programs are freely available for all netballers and coaches and provide educational resources which are simple to implement and easy to follow.
Netball shoes support you during play and help minimise the risk of injury
All ASICS netball shoes are designed to handle the severe side to side movements players make on the netball court, with features that provide stability and keep the foot on the platform.
FOOTWEAR HIGHLIGHT
The ASICS NETBURNER™ SHIELD FF is ideal for players searching for the ultimate support and stability on court. The NETBURNER™ SHIELD FF incorporates footwear features that were identified by University of Melbourne research as reducing knee loads in girls and women during dynamic movements. The NETBURNER™ SHIELD FF is designed to provide advanced stability for netball athletes during ground contact when attacking and defending.
Featuring:
- Seamless Mesh upper and internal support panel that provides a comfortable, running shoe feel on foot, while adequately securing the foot
- Larger Flexion grooves in the forefoot allow for a more flexible, smoother transition on court
- Midsole design features including a 7mm heel drop and a tri-density midsole combine to reduce load on the knee during dynamic movements
What is the typical ACL injury recovery time for a netball player?
Physiotherapist and PhD candidate, Patrick Rowe, of the University of Melbourne shares:
Traditionally, ACL injuries were considered a ’12 month’ recovery before returning to netball. However, recovery is more complicated than just a timeframe and can vary significantly between athletes. Many factors contribute to a netballer’s recovery time, including the need for surgery (reconstruction vs. non-operative), healing timeframes, rehabilitation progression, access to health care/resources, athlete perception/goals, and netball-specific characteristics (position, competition level, time of season). Before returning to netball, it is highly recommended netballers seek return-to-play clearance by a clinician. This includes assessment of knee function, symptoms, physical and psychological capabilities to perform netball movements(4). The clinician’s role is to guide the netballer through their ACL recovery, adequately prepare them, and to safely return to netball by reducing re-injury risk.
Please note: This blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
References:
- Australian Sports Commission (2022) AusPlay, National Sport and Physical Activity Participation Report November 2022. Retrieved from https://www.clearinghouseforsport.gov.au/research/ausplay/results
- Downs, C., Snodgrass, S.J., Weerasekara, I. et al. (2021). Injuries in Netball-A Systematic Review. Sports Med – Open.
- Petushek, E. J., Sugimoto, D., Stoolmiller, M., Smith, G., & Myer, G. D. (2019). Evidence-based best-practice guidelines for preventing anterior cruciate ligament injuries in young female athletes: a systematic review and meta-analysis. The American journal of sports medicine, 47(7), 1744-1753.
- Kotsifaki, R., Korakakis, V., King, E., Barbosa, O., Maree, D., Pantouveris, M., ... & Whiteley, R. (2023). Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British Journal of Sports Medicine.
