Injuries In Netball
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Netball Netball is a ball sport played on a rectangular court by two teams of seven players. The primary objective is to shoot a ball through the defender's goal ring while preventing the opposing team from shooting through their own. It is one of a ...
is a sport that has one of the largest female participation rates within the
Commonwealth A commonwealth is a traditional English term for a political community founded for the common good. The noun "commonwealth", meaning "public welfare, general good or advantage", dates from the 15th century. Originally a phrase (the common-wealth ...
, most popular in the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...
,
Australia Australia, officially the Commonwealth of Australia, is a country comprising mainland Australia, the mainland of the Australia (continent), Australian continent, the island of Tasmania and list of islands of Australia, numerous smaller isl ...
and
New Zealand New Zealand () is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and List of islands of New Zealand, over 600 smaller islands. It is the List of isla ...
, with more than 20 million athletes participating in the
sport Sport is a physical activity or game, often Competition, competitive and organization, organized, that maintains or improves physical ability and skills. Sport may provide enjoyment to participants and entertainment to spectators. The numbe ...
. Netball is a
ball sport This is a list of ball games and ball sports that include a ball as a key element in the activity, usually for Score (sport), scoring points. Games that include balls Ball sports fall within many sport categories, some sports within multiple cate ...
played by two teams of seven players in which goals are scored by shooting the ball through a netted ring. Netball relies heavily on
muscular endurance Endurance (also related to sufferance, forbearance, resilience, constitution, fortitude, persistence, tenacity, steadfastness, perseverance, stamina, and hardiness) is the ability of an organism to exert itself and remain active for a lo ...
and bursts of rapid
acceleration In mechanics, acceleration is the Rate (mathematics), rate of change of the velocity of an object with respect to time. Acceleration is one of several components of kinematics, the study of motion. Accelerations are Euclidean vector, vector ...
to “break free” from an opponent as well as, sudden and rapid change of directions in combination with
jumping Jumping or leaping is a form of locomotion or movement in which an organism or non-living (e.g., robotic) mechanical system propels itself through the air along a ballistic trajectory. Jumping can be distinguished from running, galloping and ...
to receive a pass, intercept a ball or rebound. The sudden stop-start motion of the game is what often leads to serious
injuries Injury is physiological damage to the living tissue of any organism, whether in humans, in other animals, or in plants. Injuries can be caused in many ways, including mechanically with penetration by sharp objects such as teeth or with b ...
in participants. Higher grade players, in both senior and junior competitions, are more susceptible to injuries than lower grade players, due to the high intensity and rapid pace of the game. An injury is most commonly defined as one that has occurred while participating in sport and which led to one of the following consequences: a reduction in the amount or level of sports activity; need for medical advice or treatment; and/or adverse economic or social effects for the
athlete An athlete is most commonly a person who competes in one or more sports involving physical strength, speed, power, or endurance. Sometimes, the word "athlete" is used to refer specifically to sport of athletics competitors, i.e. including track ...
.


Common soft tissue injuries in netball

A
soft tissue injury A soft tissue injury is the damage of muscles, ligaments and tendons throughout the body. Common soft tissue injuries usually occur from a sprain, strain (injury), strain, a one-off blow resulting in a contusion or overuse of a particular part of ...
is the damage of
muscles Muscle is a soft tissue, one of the four basic types of animal tissue. There are three types of muscle tissue in vertebrates: skeletal muscle, cardiac muscle, and smooth muscle. Muscle tissue gives skeletal muscles the ability to muscle contra ...
,
ligament A ligament is a type of fibrous connective tissue in the body that connects bones to other bones. It also connects flight feathers to bones, in dinosaurs and birds. All 30,000 species of amniotes (land animals with internal bones) have liga ...
s or
tendon A tendon or sinew is a tough band of fibrous connective tissue, dense fibrous connective tissue that connects skeletal muscle, muscle to bone. It sends the mechanical forces of muscle contraction to the skeletal system, while withstanding tensi ...
s in the body. The most common soft tissue injuries in netball occur to the
ankle The ankle, the talocrural region or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular joint. The ...
s,
knee In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the hu ...
s and
hand A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the Koala#Characteristics, koala (which has two thumb#O ...
s. The main cause of these injuries is due to incorrect landing. Other factors influencing injury include; tripping,
collision In physics, a collision is any event in which two or more bodies exert forces on each other in a relatively short time. Although the most common use of the word ''collision'' refers to incidents in which two or more objects collide with great for ...
s with other players, being struck by the ball, over-exertion and
fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...
.


Ankles

In netball the ankle joint is most susceptible to injury and accounts for 31% of the injuries sustained in the sport. A
sprained ankle A sprained ankle (twisted ankle, rolled ankle, turned ankle, etc.) is an injury where sprain occurs on one or more ligaments of the ankle. It is the most commonly occurring injury in sports, mainly in ball sports (basketball, volleyball, and foo ...
is a tear or complete rupture of a ligament. The most commonly injured ligament is the Anterior Talofibular Ligament. This ligament is on the outside of the ankle and injury occurs when the sole of the foot rolls inwards. A minor sprain may only need a week to recover, however severe ankle sprains can result in a player being out for 6–10 weeks.


Knees

Knee injuries are the second most common injury in netball and are the most serious in regards to cost and disability. Studies show that majority of knee injuries are new injuries, and those who sustain a knee injury often withdraw from participation in netball. The most common knee injuries are meniscal and major ligament sprains/ruptures. The most commonly injured ligament is the
Anterior Cruciate Ligament The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments (the other being the posterior cruciate ligament) in the human knee. The two ligaments are called "cruciform" ligaments, as they are arranged in a crossed formation. In ...
(ACL). The ACL allows a twisting motion at the knee. Common symptoms of an ACL rupture include a “popping” sound at the time of the injury, severe pain, swelling and a feeling of instability. ACL injuries are difficult to effectively diagnose without the assistance of Medical Resonance Imaging (MRI). A ruptured ACL will require knee reconstruction surgery that will result in the athlete being out of the game for 9–12 months.


Hands/other

Hand injuries usually involve joint ligamentous
sprain A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or ...
s and fractures. Children most commonly injure hands, in particular their
finger A finger is a prominent digit (anatomy), digit on the forelimbs of most tetrapod vertebrate animals, especially those with prehensile extremities (i.e. hands) such as humans and other primates. Most tetrapods have five digits (dactyly, pentadact ...
s. “Other” types of injuries in netball vary including; lower leg strain, quadriceps haematoma,
rotator cuff The rotator cuff (SITS muscles) is a group of muscles and their tendons that act to stabilize the human shoulder and allow for its extensive range of motion. Of the seven scapulohumeral muscles, four make up the rotator cuff. The four muscles a ...
shoulder problems, an elbow joint dislocation, a radial fracture, and
back The human back, also called the dorsum (: dorsa), is the large posterior area of the human body, rising from the top of the buttocks to the back of the neck. It is the surface of the body opposite from the chest and the abdomen. The vertebral c ...
problems.


Treatment

As soon as an injury occurs game time must be held until the player has been properly assessed and removed from the court if need be. It is essential that players seek immediate help from a qualified
first aid First aid is the first and immediate assistance given to any person with a medical emergency, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is gener ...
provider or health practitioner. Any netball injury should be treated by using the P.R.I.C.E.S., D.R.S.A.B.C., T.O.T.A.P.S. AND R.I.C.E.R. regimes: P - Protect R - Rest I - Ice C - Compression E - Elevation S - Stabilise D - Danger R - Response S - Send for help A - Airway B - Breathing C - Circulation T - Talk O - Observe T - Touch A - Active movement P - Passive movement S - Skills test R - Rest I - Ice C - Compression E - Elevation R - Referral If an injury occurs ensure that all netball players receive adequate treatment and full rehabilitation before returning to play. Serious ankle and knee ligament ruptures will require reconstructive surgery. It is essential to follow all recovery and rehabilitation programs fully to prevent any injury from re occurring.


Netball injury prevention


Good preparation

In order to prevent netball injuries, essential
pre-season In an organized sports league, a typical season is the portion of one year in which regulated games of the sport are in session: for example, in Major League Baseball the season lasts approximately from the last week of March to the last week of S ...
training Training is teaching, or developing in oneself or others, any skills and knowledge or fitness that relate to specific useful competencies. Training has specific goals of improving one's capability, capacity, productivity and performance. I ...
is required before commencing the playing season. The distance travelled by elite players over a game ranges from 7 km (shooters/ defenders) to 8.8 km (centre court players). A game does not only consist of basic
running Running is a method of terrestrial locomotion by which humans and other animals move quickly on foot. Running is a gait with an aerial phase in which all feet are above the ground (though there are exceptions). This is in contrast to walkin ...
; players are required to accelerate in rapid bursts for the majority of the game. In pre-season training players must undertake fitness programs that focus on power,
strength Strength may refer to: Personal trait *Physical strength, as in people or animals *Character strengths like those listed in the Values in Action Inventory *The exercise of willpower Physics * Mechanical strength, the ability to withstand ...
,
agility Agility or nimbleness is an ability to change the body's position quickly and requires the integration of isolated movement skills using a combination of balance, coordination, speed, reflexes, strength, and endurance. More specifically, it ...
and flexibility, especially of
muscles Muscle is a soft tissue, one of the four basic types of animal tissue. There are three types of muscle tissue in vertebrates: skeletal muscle, cardiac muscle, and smooth muscle. Muscle tissue gives skeletal muscles the ability to muscle contra ...
around the ankles and feet. It is important that fitness testing is conducted prior to competition to ensure readiness to play the game.


Good technique

Training should consist of netball specific exercises that focus on enhancing body balance, landing control, change of direction and catching passes. It is essential for
coaches Coach may refer to: Guidance/instruction * Coach (sport), a director of Athletes' training and activities * Coaching, the practice of guiding an individual through a process ** Acting coach, a teacher who trains performers Transportation * Coac ...
to undergo regular educational updates to make sure the information they have about correct training drills is current. It is very important that
child A child () is a human being between the stages of childbirth, birth and puberty, or between the Development of the human body, developmental period of infancy and puberty. The term may also refer to an unborn human being. In English-speaking ...
ren are properly taught the fundamentals of netball before they participate in game situations. Any incorrect techniques should be corrected at a young age before they become a bad habit.


Warm up

A
warm-up 'Warming up' is a part of stretching and preparation for physical exertion or a performance by exercising or practicing gently beforehand, usually undertaken before a performance or practice. Athletes, singers, actors and others warm up before s ...
should never be overlooked in netball as it plays a vital and effective role in preventing injury. A warm-up is essential before
physical activity Physical activity is defined as any voluntary movement produced by skeletal muscles that requires energy expenditure.Global Recommendations on Physical Activity for Health, 2009. World Health Organization. Geneva, Switzerland. Accessed 13/07/2018 ...
to; prepare the body for vigorous exercise, reduce the risk of injury, reduce
muscle stiffness Delayed onset muscle soreness (DOMS) is the pain and stiffness felt in muscles after unaccustomed or strenuous exercise. The soreness is felt most strongly 24 to 72 hours after the exercise. It is thought to be caused by eccentric (lengthening) ...
and mentally prepare the athlete. Any warm-up should consist of running, dynamic movements and dynamic stretches. It should last for a minimum of ten minutes.


Equipment/clothing

In netball it is essential that the goal posts are firmly fixed to the ground and have a padded post protector around them. All courts should be a firm, smooth surfaces with no loose gravel or hazards. The most important uniform item for any netball player is the
shoe A shoe is an item of footwear intended to protect and comfort the human foot. Though the human foot can adapt to varied terrains and climate conditions, it is vulnerable, and shoes provide protection. Form was originally tied to function, but ...
s. It is highly recommended that players wear netball specific shoes, as they are tailored to the demands of the game and provide the correct level of support and
cushioning Package cushioning is used to protect items during shipment. Vibration and impact shock during shipment and loading/unloading are controlled by cushioning to reduce the chance of product damage. Cushioning is usually inside a shipping container ...
. It is also recommended that players should wear braces or strap their ankles to provide extra support and decrease the risk of a major injury occurring.


Psychological effects of having a major injury

For many netball players a serious injury can be a traumatic life event that results in physical and
psychological Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...
ramifications. The main psychological effects include the initial
emotion Emotions are physical and mental states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavior, behavioral responses, and a degree of pleasure or suffering, displeasure. There is ...
al response of experiencing an injury, the psychological factors that influence the recovery process, and the psychological impact of an injury on the athletes future performance. It is important to remember that not all injured athletes will experience the same cognitive and emotional responses.


Emotional responses

During injury and recovery players may experience different mood states. The most commonly found mood disturbances are increases in depression, tension and
anger Anger, also known as wrath ( ; ) or rage (emotion), rage, is an intense emotional state involving a strong, uncomfortable and non-cooperative response to a perceived provocation, hurt, or threat. A person experiencing anger will often experie ...
. The emotional response will depend on how extreme the injury is.
Self-efficacy In psychology, self-efficacy is an individual's belief in their capacity to act in the ways necessary to reach specific goals. The concept was originally proposed by the psychologist Albert Bandura in 1977. Self-efficacy affects every area of hum ...
is defined as one’s belief in ones ability to succeed in specific situations. Physical self-efficacy is often affected by an injury. Players will often enter an extremely negative state of mind immediately after an injury, however; during recovery they often become exceedingly positive.


Self-motivation

Most often players will be highly motivated to get back to playing netball as soon as possible. However it is important to remember that injured athletes will have good and bad days. During rehabilitation an athletes motivation and enthusiasm for treatment may decrease if they are experiencing setbacks or a period of little or no improvement. It is important for athletes to have a good
support network Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters (although it can be provided by peers without training), and can ...
to keep them positive and focused during these harder times.


Confidence

Physical recovery is critical, however, psychological rehabilitation is the most important part of recovery. Even though a player may be physically ready to return to netball, they may not be psychologically ready to play. Various doubts, fears and
anxieties Anxiety is an emotion characterised by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different from fear in that fear is defined as the emotional response to a present threat, where ...
may surface when thinking about returning to netball. The athlete may fear they are going to be a different player, they will not meet their coach or teammates expectations or that their physical fitness will not return to pre-injury state. This will result in the athlete putting a huge amount of pressure on themselves. This anxiety and tension can lead to the following outcomes: reinjury; injury to another body part; lowered confidence resulting in a temporary or permanent performance decrement; general depression; and fear of further injury, which can sap motivation and the desire to return to competition.


Dealing with psychological effects

The most successful psychological techniques that aid injury recovery are; good interpersonal
communication skills Communication is commonly defined as the transmission of information. Its precise definition is disputed and there are disagreements about whether unintentional or failed transmissions are included and whether communication not only transmit ...
,
positive reinforcement Positive is a property of positivity and may refer to: Mathematics and science * Positive formula, a logical formula not containing negation * Positive number, a number that is greater than 0 * Plus sign, the sign "+" used to indicate a posit ...
, setting realistic goals, knowing methods for positive self-thoughts, coach support, and keeping the athlete involved with the team.


Returning to pre-injury levels & goal setting

Determining a successful return to netball from injury for most athletes is the ability to train and compete at pre-injury levels and standards. Measuring this includes things such as; reaching past endurance fitness test levels ( beep tests); the ability to perform and complete sport-specific training exercises; and maintaining performance. Achieving these goals at training will best prepare an athlete for what they will experience during competition standards. It is important for the athlete to set realistic goals that they are able to achieve. They must understand that these goals may need to be long term, as not everything can be achieved over night. It is important that goals are flexible because when injured the rehab progress is often unpredictable.


Active participation in rehabilitation

Athletes that are engaged in their rehabilitation program are likely to cope with their injury more successfully.
Physiotherapists Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...
state that athletes who show interest in their rehabilitation by; communicating well, asking questions, listening well to advice, and providing
feedback Feedback occurs when outputs of a system are routed back as inputs as part of a chain of cause and effect that forms a circuit or loop. The system can then be said to ''feed back'' into itself. The notion of cause-and-effect has to be handle ...
, are more likely to have a positive psychological response to their injury.


Strong support systems

It is very important to have social support during the injury, rehabilitation and sports returning phase. This may include coaches, trainers, friends and
family Family (from ) is a Social group, group of people related either by consanguinity (by recognized birth) or Affinity (law), affinity (by marriage or other relationship). It forms the basis for social order. Ideally, families offer predictabili ...
. The support of these people is essential for times when the athlete may need positive encouragement around them. The athlete should talk to someone they feel most comfortable with and who is going to listen and support them.


Sports psychologist

It can be beneficial for an injured player to work with a
sports psychologist Sport psychology is defined as the study of the psychological basis, processes, and effects of sport. One definition of sport sees it as "any physical activity for the purposes of competition, recreation, education or health". Sport psychology i ...
. Coach and family can be helpful, however there may be times when they are too close to the situation and where an outside point of view is needed to help.


Take it slow

It is important to remember that there is no rush to get back to netball. Athletes should feel prepared and confident before returning to competition. It is important to take part in game play situations at training. The athlete may also want to start in a lower grade then usual to help ease back into the game. They should aim to play one quarter in their first game back, and slowly build from there aiming to play a full game as they have progressed and experienced success.


Controversies


Hypermobility and injuries in junior netball players

Hypermobility is defined as a condition in which an individual’s
synovial joint A synovial joint, also known as diarthrosis, joins bones or cartilage with a fibrous joint capsule that is continuous with the periosteum of the joined bones, constitutes the outer boundary of a synovial cavity, and surrounds the bones' articulati ...
s have a range of motion beyond normal limits. Hypermobile joints can be a performance enhancement in some sports, for example spin bowlers in
cricket Cricket is a Bat-and-ball games, bat-and-ball game played between two Sports team, teams of eleven players on a cricket field, field, at the centre of which is a cricket pitch, pitch with a wicket at each end, each comprising two Bail (cr ...
. However some studies suggest the increased risk of joint dislocations, sprains and joint hyperextension in athletes with hypermobile joints. They believe that recognising hyper mobility in young female athletes may reduce the risk of injuries occurring. On the contrary, others suggest that hyper mobility is not associated with an increased incidence of injuries in junior netball players.


Serious/career threatening injuries in elite netball players

* 2005 In October 2005, Australian captain
Liz Ellis Elizabeth Margaret Ellis, (born 17 January 1973) is a retired Australian netball player and television presenter who was a member of the national netball team from 1992 until 2007 and captain for the last four of those years. She is the most ca ...
, suffered a career-threatening knee injury after tearing her ACL in a match against
New Zealand New Zealand () is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and List of islands of New Zealand, over 600 smaller islands. It is the List of isla ...
. This injury ruled her out of the chance to play at the
2006 Commonwealth Games The 2006 Commonwealth Games, officially the XVIII Commonwealth Games and commonly known as Melbourne 2006, were an International sport, international multi-sport event for members of the Commonwealth of Nations, Commonwealth held in Melbourne ...
. Ellis said that she had to reignite her passion and love for the game that had been her life. Ellis states that “It was soul-destroying to watch my team walk out without me and realise, hey, they can play without me”. She worked extremely hard on her rehabilitation, her knee repaired and her passion was restored. Ellis produced some of the best netball of her career in the two years that followed. She ended her 18-year career in her 122nd test with
Australia Australia, officially the Commonwealth of Australia, is a country comprising mainland Australia, the mainland of the Australia (continent), Australian continent, the island of Tasmania and list of islands of Australia, numerous smaller isl ...
winning the world championship 42-38. She overcame all critics and odds after coming back from her knee injury. * 2012
West Coast Fever West Coast Fever is a professional Australian netball team based in Perth, Western Australia. Since 2017 they have played in Suncorp Super Netball. Between 2008 and 2016, they competed in the ANZ Championship. Between 1997 and 2007, as Pert ...
captain,
Ashleigh Brazill Ashleigh Brazill (born 29 December 1989 in Campbelltown, New South Wales) is an Australian rules footballer who plays for the Fremantle Football Club in the AFL Women's. She previously played netball for the Collingwood Magpies, and Australian ...
, ruptured the
meniscus Meniscus may refer to: *Meniscus (anatomy), crescent-shaped fibrocartilaginous structure that partly divides a joint cavity *Meniscus (liquid) In physics (particularly liquid statics), the meniscus (: menisci, ) is the curve in the upper sur ...
in her left knee late in the
2012 ANZ Championship season The 2012 ANZ Championship season was the fifth season of the ANZ Championship. The 2012 season began on 31 March and concluded on 22 July. With a team coached by Noeline Taurua, captained by Laura Langman and featuring Leana de Bruin, Irene va ...
. Brazill had been selected to represent Australia in the 2012 Constellation Cup, but unfortunately had to withdrawal from the team. Brazil worked to build the strength back in her knee and went on to resume playing in the following 2013 season. * 2014 In October 2014,
Casey Kopua Casey May Kopua (née Williams; born 19 June 1985) is a retired New Zealand international netball player and former captain of the New Zealand national netball team, the Silver Ferns, and the Waikato Bay of Plenty Magic. Kopua became a member ...
suffered a knee injury during the 2014 Constellation Cup. Kopua ruptured the patella tendon in her left knee and had knee surgery to repair the tendon that would result in her missing up to 6 months of netball. * 2015 In April 2015,
Melbourne Vixens Melbourne Vixens is an netball in Australia, Australian professional netball team based in Melbourne, Victoria, Australia, Victoria. Since 2017 Suncorp Super Netball season, 2017 they have represented Netball Victoria in Suncorp Super Netball. B ...
mid courter, Madi Robinson ruptured the anterior cruciate ligament in her right knee. Robinson missed out on the
2015 Netball World Cup The Netball World Cup Sydney 2015 (NWC2015) was the 14th edition of the INF Netball World Cup, the premier competition in international netball. It was held from 7–16 August, in Sydney, Australia, which secured hosting rights after defeating a ...
.


See also

*
Australian rules football injuries Australian rules football is a sport known for its high level of physical body contact compared to other ball sports such as soccer and basketball. High-impact collisions can occur from any direction, although deliberate collisions sometimes occur ...
*
Sports injury Sports injuries occur during participation in sports or exercise in general. Globally, around 40% of individuals engage in some form of regular exercise or organized sports, with upwards of 60% of US high school students participating in one or ...


References

{{Injuries by sport Netball
Netball Netball is a ball sport played on a rectangular court by two teams of seven players. The primary objective is to shoot a ball through the defender's goal ring while preventing the opposing team from shooting through their own. It is one of a ...