Injury prevention is a highly sought after concept in the sporting world. Researchers evaluate multiple modifiable physiological factors thought to contribute to certain injuries to see whether addressing these lowers injury prevalence. Unfortunately, most injuries are multi-factorial and we can’t ever completely prevent certain injuries occurring. However, we have lots of high quality research that explores things we can modify to minimise risk. The following post will explore this concept in relation to netball injuries.

Netball is a highly intensive, taxing sport that places high demand on the body, particularly the lower limb. Lower limb injuries accounted for 68% of all injuries in Australia’s professional netball population across 3 seasons (Toohey et al., 2022). 21% of these involved the ankle, 16% involved the knee and 11% involved the foot (Toohey et al., 2022).

We will divide injury prevention for netball into two sub-categories

Soft-tissue injuries/strains
Ligament sprains (ankles, knees)

General prevention principles – soft-tissue injuries

There are a few commonalities in prevention programs for soft-tissue injuries. The following are factors to consider including in any form of a soft-tissue prevention program.

Factors that work:

Strength training

A general approach to injury prevention is to include some form of resistance/strength training in your weekly schedule. High quality research has evidenced that for every 10% increase in strength training volume reduces the risk of all injuries (both acute and oversure) by more than 4% (Lauersen et al, 2018). If you’re unaccustomed to strength training then it is safer to allow yourself a 4-5 week period of slowly building up volume and intensity.

Quantifying weekly sporting loads

Tracking your hours playing sport in a given week, including both training and competition, is an effective way to mitigate injury risk. Adolescent athletes who performed less than 10 hours of total sport per week had significantly reduced injury rates and severity compared to athletes involved in 10hours or more per week (Prieto-González et al., 2021)

Performing a specific, rounded warm-up

This can encompass varieties depending on preference. However, in general, including ways to elevate your heart rate, balance exercises, jumping/landing exposure and general activation exercises of legs, core and graduated exposure to high speed running are tough to go wrong with. Adopting programs such as FIFA-11 in children and adolescents resulted in a 36% reduction in overall injuries compared to groups who warmed up as normal (Ding et al., 2022)

Timing of strength training

Strength training should be a cornerstone for any athlete. However, it can be quite taxing and fatiguing on the same muscles used for playing sport. The forces and loads placed on your muscles during sport, particularly legs, are always far greater than majority of strength programs. For this reason, it is important to be fresh for any court sessions or competition. Performing a heavy strength session and then playing sport can work, especially if you’re well trained and play at a very high level. However, for most athletes this probably isn’t optimal and can potentially hinder performance and pose an injury risk. A good way to think of this is if you’re about to run 5 kilometres for time, do you think you will perform better or worse if you’ve just complete heavy sets of straight-leg deadlifts. And do you think your hamstrings will be able to withstand the same loads fatigued compared to fresh.

Rules to follow

Strength training early in the week and as far away from your competition schedule as possible.
Strength training is either on a separate day or after training, not before.

High speed metres exposure – and timing

As we discussed, no strength program will be able to truly replicate the forces and demands placed on your body running, especially at high speed. Therefore, making sure your muscles and system are trained and adapted to these demands is an effective way to mitigate injury risks, particularly soft-tissue injuries. There is a reason professional sporting teams will monitor high-speed metre exposure in their athletes – too little is an injury risk and too much is an injury risk. The dimensions of a netball court limit players from ever sprinting more than 20m in a straight line – therefore it isn’t applicable to do long bouts further than this in one hit. However, making sure your training has included high speed, repeated efforts, within the dimensions specific to your position is the most appropriate way to adhere to this principle. The timing of this, like your strength training, should be earlier in the week and as far away from competition as possible.

Factors that don’t work:

Static stretching

As you will read in the article, muscle flexibility is not well supported in the literature for predicting future injuries during sport. Static stretching, still to this day, is a cornerstone for many athletes warm-up and training regime. Although it can feel quite nice, it is not well substantiated for preventing injuries. A systematic review concluded there is strong evidence to suggest static stretching during a warm-up has no effect on reducing injury rates (Small, Mc Naughton, & Matthews, 2008)

Preventing soft-tissue injuries

Soft-tissue injuries encompass acute muscle/tendon strains and tendon overloads (tendinopathies). We will look at both separately but both have a similar modifiable risk factor. Unfortunately, addressing strength deficits in season whilst the demands of training and competition are at play is a harder task than during off-season. The time of this post is in the middle of the season so it can never hurt to start. However, think about these possible factors during your next off-season and how you can optimise your strength.

Hamstring strains

Across a 3 season period in the Suncorp Super Netball League hamstring strains were prevalent in 13 athletes of the 119 player cohort (Toohey et al., 2022). There are a few non-modifiable risk factors for hamstring strains such as older age, history of hamstring injury, recent hamstring injury, previous ACL injury and previous calf strain (Green, Bourne, van Dyk & Pizzari, 2020). However, given these are factors we can’t change we will be focusing on modifiable factors for prevention. Modifiable factors include:

Hamstring strength deficits
Sudden increases in high speed running exposure (previous 7-14 days) (Green, Bourne, van Dyk & Pizzari, 2020)

Addressing hamstring strength deficits should include some version of exercises that bias lengthening under load or “eccentric”. These can include:

Hamstring sliders
Nordics
Romanian deadlifts
Harrop curls

Hamstring slider

Romanian deadlift

The only downfall of eccentric exercises is that they are quite taxing and create a lot of tissue disruption. It becomes even more important to time these earlier in the week and after field or court sessions so the fatigue doesn’t impact your court/field performance. For example, if you train Tuesday and Thursday and play Saturday, performing your strength exercises earlier in the week such as Tuesday will have a good effect whilst minimising impact on your court sessions or games.

Not as specific to netball as field based sports but exposure to high speed running in your training can be a really good way to mitigate risk. Sprinting places such a high force demand on your hamstrings and is typically when they tear. However, when dosed appropriately it allows your hamstrings to adapt to the high demand and can be a great way to minimise hamstring strains.

Calf strains

Across a 3 season period in the Suncorp Super Netball League calf strains were prevalent in 33 athletes of the 119 player cohort (Toohey et al., 2022). The superficial calf (gastrocnemius) produces up to 3 times our bodyweight in force running and the deepest aspect (soleus) produces nearly 9 times your bodyweight in force running (Dorn, Schache, & Pandy, 2012). This means they need to be incredibly strong and resilient to force, otherwise they can be prone to injury.

Unfortunately, calf strength exercises are only part of the puzzle as not many people can lift the equivalent of 9 times their bodyweight through their calf. Instead, coupling strength exercises with jumping exercises and appropriately dosed high speed running is your best antidote to minimise future strain risk. For further information about calf injuries, see our previous blog here.

Exercises to create more resilience in your calves include:

Strength exercises in gym

Standing calf raises (machine – double)
Seated calf raises (machine – double)
Single leg calf raises (bodyweight)

Single leg calf raise from step

Court-based movements

POGOs (double-leg, single-leg)
Broad jumps
Drop jumps
Skipping

Quadriceps strains

Across a 3 season period in the Suncorp Super Netball League quadriceps strains were prevalent in 16 athletes of the 119 player cohort (Toohey et al., 2022).

Previous history of quadriceps muscle injury and a recent history of hamstring strains are both risk factors of future quadriceps strains (Pietsch and Pizzari, 2022). Despite common belief, quadriceps flexibility has no association with future quadriceps strain (Pietsch and Pizzari, 2022). If you have had a previous hamstring strain then please ensure you include the hamstring strain prevention section as part of your training for quadriceps strain prevention.

Exercises to build more robustness in your quadriceps include:

Strength in gym:

Bulgarian split squats
Squats
Leg press
Lunges
Reverse nordics

Bulgarian split squat

Reverse Nordic

Court-based movements

Vertical jumps (double-leg/single-leg)
Drop jumps

Free Netball specific prevention programs:

The KNEE program: https://knee.netball.com.au/
NetballSmart: https://netballsmart.co.nz/netball-smart/home.html

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