Noncontact Knee Soft-Tissue Injury Prevention Considerations and Practical Applications for Netball Players
by Nick Mattis, SPT
Netball is a popular court-based game in Australia and New Zealand that is rapidly gaining popularity in the United States. The game involves a lot of movement with rapid change of direction and immediate stopping when in possession of the ball. These rapid movements and immediate stopping can place excessive amounts of force and stress on the joints of the body, specifically the lower extremity. Netball has several rules, with one being the footwork rule. Once receiving the ball, if the player lands on one-foot, single leg landing (SLL), they are allowed to place the opposite foot on the ground to slow their momentum and pivot. If a player lands with both feet on the ground, double leg landing (DLL), they are allowed to pivot around one foot. The footwork rule in netball may result in vertical ground reaction forces in which of the following ranges? The footwork rule results in the body absorbing vertical ground reaction forces (VGRFs) of up to 5.7 times the players bodyweight. This rapid absorption and stabilization of the forces by the soft tissues in the leg can stress the tissues to injury. One of the most injured joints in netball is the knee. A range of 4.5-32.7% of tears occur in which tissue? The meniscus is most common soft tissue injury in the knee (4.5-32.7%) with the Anterior Cruciate Ligament (ACL) following closely behind (17.2–22.4%). Due to the common occurrence of these injuries, it is important for practitioners to understand how the injury occurred and the level of activity required to return to sport to formulate an appropriate rehabilitation plan.
Situation and Mechanism of Knee Injury
Since netball requires a lot of agility and due to the high impact movements, there is a risk of soft tissue injury from the excessive loads. Medical professionals need to understand how, where, and when the injury occurred. So, it is important to look at statistics to get an idea of how the injuries frequently occur. Most netball soft tissue injuries of the knee happen during which of the following? The majority of netball injuries occur in match play compared to training. Incidence reports injuries occur 7 times more frequently in match play than in training. Which of the following statements is true regarding netball soft tissue knee injuries? Most netball soft tissue knee injuries occur on outdoor courts, specifically asphalt. There are not nearly as many reported injuries with the indoor courts. Most netball soft tissue injuries occur in which maneuver? Landing from a jump causes the highest frequency of soft tissue knee injuries in comparison to change of direction and deceleration. There have also been patterns of body kinematics that have been associated with knee injuries. Knee abduction and trunk aberrant motion occurs in as many as 83% of noncontact ACL injuries in netball. One of the patterns is knee abduction combining with ipsilateral lateral trunk flexion. This causes a knee valgus and puts the knee at a more susceptible position of injury to the ACL, MCL, and valgus collapse. Injuries are classified in three ways: contact, indirect contact, and noncontact. Contact injuries occur at the knee through an opposing player or object making direct contact with the players knee (1). A netball soft tissue knee injury that occurs after contacting another player’s foot would be an example of which type of injury? An indirect contact injury to the knee would occur through an opposing player contacting the player in another location besides the knee that results in injury to the knee. An example of this would be stepping on an opposing player’s foot (1). A noncontact injury to the knee would occur when there is an injury at the knee without an external factor such as contact from an opposing player or object (1).
As stated before, landing from a jump causes the highest occurrence of soft tissue injury to the knee. It is important to use and apply a screening tool to identify those at risk or who have sustained soft tissue knee injuries. This tool is called the Landing Error Scoring System (LESS) (1). Concerning movement screening, the real time landing error scoring system (LESS) evaluates which physical characteristic? The LESS is used to grade generic DLL movement patterns (1). This is a 17-question examination of movement identifying the landing movement from the head down to the toes. Through this assessment one can make predictions of those at risk of a soft tissue knee injury. Limitations on this measure include it only examining DLL and does not examine SLL that is often occurring in netball; therefore, it cannot be related specifically to netball requirements (1).
There are several types of training that can be applied and useful to the netball athlete including strength, balance, and plyometrics. There has been one specific type of training though that has been found to assist netball players and be sport specific to their requirements. Which of the following types of training have resulted in decreased vertical ground reaction forces, increased knee flexion angles, and decreased knee abduction angles during single-leg and double-leg landings? Plyometric training has been found to be extremely effective in improving the biomechanics (listed previously) of netball to allow for softer landings that place less stress throughout the knee; therefore, reducing the risk of soft tissue knee injury. During which of the following should landing mechanics that carry over to match play be emphasized? Netball landing mechanics should be emphasized when performing plyometric training. It is important to make the training sport specific to strengthen the musculature and surrounding soft tissue to meet the demand of sport to reduce the risk of injury when playing.
Here at Physical Therapy First, our team of skilled therapists are able to assess, educate, and rehabilitate you in the recovery from a soft tissue knee injury. Our therapists are also trained in injury prevention and can offer athlete specific consultations to help reduce the risk of injuries. Through manual techniques and other sport-specific interventions, we can restore your ROM, increase strength, and help you return back to activity. Your therapist can help you improve your biomechanics to get you back to your individual functional needs. Call today to schedule an appointment.
1) Clark NC. Noncontact Knee Ligament Injury Prevention Screening in Netball: A Clinical Commentary with Clinical Practice Suggestions for Community-Level Players. Int J Sports Phys Ther. 2021;16(3):911-929. Published 2021 Jun 1. doi:10.26603/001c.23553