With the winter sport season being upon us, associated injuries are unfortunately rising in conjunction. Some individuals who have already been unlucky enough to sustain injuries are now watching from the side line. To reduce risk or duration of this, it is important to understand the necessary steps in injury prevention and treatment. Netball is an immensely popular sport in New Zealand, and physiotherapists are essential in helping both younger and older players return to the court after aches and sprains.
Research highlights that netball players most commonly injure their ankles and their knees (1). This article will focus on knee injuries that occur on the netball court and both the treatment physiotherapists can offer after injury, and ways Habit Rehabilitation physiotherapists can work with you to prevent these occurring. In New Zealand, there were nearly 4000 ACC claims for knee injuries in the year 2016 (2). To understand why the knee is so commonly injured in netball, it is important to grasp the biomechanics involved in the sport. Netball is a fast paced sport that involves lots of jumping and landing, sprinting, and change in direction. Although not a contact sport like rugby, it involves large forces being transmitted through the body on landing. Landing was found to be one of the most common mechanisms of injury in netball, as the nature of the game can lead to abrupt landings from jumps and incorrect single leg landing technique (1, 3). Various structures in the knee can be damaged, and a few of these are explained below.
Ligamentous Injuries (4)
Ligaments are connective tissue in our bodies that increase the stability of our joints. When sudden forces are applied to them they can be strained or even ruptured. The anterior cruciate ligament (ACL) is a ligament deep inside the knee that can be injured during single leg landing, and during cutting manoeuvres when playing netball. Unfortunately, females are at a higher risk of ACL injuries than males. Players sustaining an ACL injury can experience extreme pain and sometimes hear a “pop” during the injury. The damaged ligament causes the knee to swell and may feel unstable or give way when walking. Another ligament that can be injured is the medial collateral ligament, which runs along the side of the knee joint. Unfortunately for some people, both the ACL and MCL can be injured together.
Meniscus injuries (4)
The menisci are two pieces of extra joint cartilage that sit on top of the tibia (shin bone) and buffer some of the forces going through the knee—like small shock absorbers. They also help to increase the stability around the knee. When excessive twisting occurs at the knee joint, small tears can be caused in these structures. If you have injured your meniscus, in addition to swelling and pain you may experience clicking and locking of your knee. Again, the meniscus can be injured simultaneously with the ACL.
Dislocation (or subluxation) occurs when the patella (or ‘knee cap’) moves from its usual position, resulting in the player often experiencing a sensation of something “moving” or “popping out”. Patella’s often can relocate themselves, but the knee will still become very swollen and painful. It is very important to rest for the first 72 hours after patella dislocation. One should also apply ice to reduce pain, elevate the leg and apply a compression bandage to reduce swelling. Your physiotherapist will be able to refer you for any further investigations if needed, such as X-rays.
The Role of Physiotherapy
If you have injured your knee, it is extremely important to seek treatment from a physiotherapist. Here at Habit Rehabilitation, we believe early assessment and advice is crucial to knee rehabilitation, so we recommend you book yourself in as soon as possible after sustaining an injury. We ensure a comprehensive assessment of the structures within the knee, to determine what is needed for recovery and returning to the court. Our initial approach to treating knee injuries focuses on minimising your pain, improving movement, and strengthening the muscles around the knee. If you have sustained a significant injury, such as a complete ACL rupture, referral to an orthopaedic surgeon may be required. In this case, physiotherapy will still be essential to prepare you for surgery and restore function post-operatively. After injuring structures within the knee joint, the muscles that allow movement can experience what is referred to as arthrogenic muscle inhibition, which is when the nerves in the body are not able to send messages to the muscle to turn on and fully contract (5). At Habit Rehabilitation, physiotherapists are trained to help you get these muscles working again. We have specialised equipment such as neuromuscular electrical stimulation (NMES). This is a device that sends electrical impulses to the nerves to help communicate with the muscle again to get contracting. NMS has been proven to be beneficial in patients with knee conditions, such as those recovering from ACL surgery (6). Your physiotherapist will train you how to use this equipment safely if it is needed. Further down your rehabilitation journey, we progress to sport specific drills to ensure safe return to sport.
The physiotherapists at Habit Rehabilitation are trained in injury prevention as well as injury management- we want all netball players to be prepared for the physical demands of getting back on the court. Pre-season biomechanical assessments can ensure you have good muscular strength and movement control. Furthermore, Habit Rehabilitation utilises tools such as the Functional Movement Screen, which has been validated to identify individuals at greater risk of injury (7). The FMS consists of simple functional movement tests that allows physiotherapists to examine the quality of movement, identify weaknesses or imbalances, and then use this information to tailor strengthening programs specifically to that individual (8). Research has shown that exercise programs which focus on strengthening and explosive power of the lower limb can improve landing and reduce risk of knee injuries in netball. Another piece of fantastic technology Habit Rehabilitation physiotherapists use is the TOG Gait Scan. The TOG Gait Scan analyses walking biomechanics, capturing the distribution of pressure through your feet as you walk. From this, we can determine if orthotics will be appropriate for you throughout the season to minimise injury risk.
If this has been relevant to you or any of your whanau, please pop in and chat with our team at Habit to see how we can best help you in your journey to full health.
1.Saunders, N., & Otago, L. (2009). Elite netball injury surveillance: Implications for injury prevention. Journal of Science and Medicine in Sport, 12, S63. doi:10.1016/j.jsams.2008.12.148
2.Netball New Zealand.(2016). Netball-specific injury prevention programme launched. Retrieved from http://www.netballnz.co.nz/news/detail/netball-specific-injury-prevention-programme-launched
3.Hopper, A. J., Haff, E. E., Joyce, C., Lloyd, R. S., & Haff, G. G. (2017). Neuromuscular Training Improves Lower Extremity Biomechanics Associated with Knee Injury during Landing in 11–13 Year Old Female Netball Athletes: A Randomized Control Study. Frontiers in Physiology, 8. doi:10.3389/fphys.2017.00883
4. Frobell, R., Copper, R., Morris, H., Hutchinson, M. (2017). Acute knee injuries. In P. Brukner & K. Khan (Eds), Clinical Sports Medicine. (5th ed., pp. 713-768). NSW, Australia; McGraw-Hill Education.
5. Rice, D. A., & McNair, P. J. (2010). Quadriceps Arthrogenic Muscle Inhibition: Neural Mechanisms and Treatment Perspectives. Seminars in Arthritis and Rheumatism, 40(3), 250–266. doi:10.1016/j.semarthrit.2009.10.001
6. Fitzgerald, G. K., Piva, S. R., & Irrgang, J. J. (2003). A Modified Neuromuscular Electrical Stimulation Protocol for Quadriceps Strength Training Following Anterior Cruciate Ligament Reconstruction. Journal of Orthopaedic & Sports Physical Therapy, 33(9), 492–501. doi:10.2519/jospt.2003.33.9.492
7. Cook G, Burton L, Fields K, Kiesel K. The Functional Movement Screen. Danville, VA: Athletic Testing Services Inc, 1998
8. Kiesel K, Plisky PJ, Voight ML. Can serious injury in professional football be predicted by a preseason functional movement screen? N Am J Sports Phys There. 2007; 2:147-158.
Figure 1: WebMD. (2019). Picture of the knee human anatomy. Retrieved from https://www.webmd.com/pain-management/knee-pain/picture-of-the-knee#1