Top 3. Most common Netball Injuries FREE BY MANDY HOPPER. Injury Prevention Movement Screen (Valued at $47) MHPERFORMANCECOACHING.

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1 op Top 3 3 Most common Netball Injuries FREE Injury Prevention Movement Screen (Valued at $47) BY MANDY HOPPER MHPERFORMANCECOACHING.COM

2 INTRODUCTION Netball is very well known for having a high incidence of injuries, specifically to the knees and ankles. Most injuries in netball occur in a non-contact situation, meaning there is no direct contact to the knee or ankle at the time the injury occurs. In fact, a study found 66.1 to 71.4 out of 1000 participants sustained some kind of serious, non-contact injury during competitive netball play (15). It is not often I speak to a netball athlete regardless of age who HASN T sustained some sort of injury from netball, whether it be ankle, knee, hip, lower back, hand or fingers. Therefore, the aim of this short ebook is to discuss three of the most commonly occurring netball injuries. ACL injuries, ankle injuries, and Patellofemoral Syndrome. Additionally I will be providing a general explanation of the structures involved in these conditions, the common mechanisms of injury and effective strategies for markedly reducing your risk of sustaining one of these injuries. 2

3 ACL (ANTERIOR CRUCIATE LIGAMENT) ACL or Anterior Cruciate Ligament ACL injuries can be absolutely devastating to young and elite level athletes alike. ACL rupture poses a substantial impact on the athlete with entire playing seasons lost, as well as the emotional and financial burden on the athlete and their family. Unfortunately, these injuries are much more prevalent in young women with the peak incidence of ACL injury occurring at ages In order to understand the mechanism of this injury, we must first understand exactly where the ACL is and what it does. ACL stands for Anterior Cruciate Ligament. It is one of the four major ligaments that stabilizes the knee joint and maintains the structural integrity of the entire knee complex. The ligament originates on the distal most part of the femur, runs through the middle of the knee joint, and attaches to the top of the tibia. The ACL basically acts as an anti-movement mechanism to protect the knee joint from too much forward movement of the tibia (shin bone) or too much rotation of the entire lower leg. This protection is incredibly important to the netball athlete because of the inherent high impact nature of the sport as well the frequent quick pivoting and hard rotational movements associated with netball training and competition. In the most general explanation, an ACL is damaged when there is a forceful twisting of the knee when the foot is planted. Too much rotational force of the tibia while the foot is planted can result in anything from the fraying of a couple of ACL fibers to a complete rupture along with other structures of the knee being involved as well (22). Generally, most ACL injuries occur landing from a jump. In contrast, ACL injury can occur from a forceful blow to the knee while the foot is fixed in place (however this is rare). IMAGE FROM GOALNATION.COM 3

4 v MECHANISMS OF ACL INJURY IN NETBALL Mechanisms of ACL Injury in Netball Landing with Knee Valgus Motion Valgus knee motion is referred to as knocked knees (the movement of the knees towards each other. Several studies have compared valgus knee motion between male and female athletes and in every instance females land with more knee valgus motion then males. Which may be one of the reasons female athletes experience ACL injuries 4-6 times more than males. Reasons for this increased valgus knee motion are wide spread but may be a combination of having a weak VMO muscle, weak glute muscles and weak hamstring muscles. VMO stands for Vastus Medialis Oblique. The VMO is the most distal aspect of the quadriceps and plays plays a huge role in stabilizing the knee during lower body movement. Different aspects of the VMO may play very different roles during explosive knee extension movements. Therefore, if the VMO is weak this may increase knee instability = valgus knee motion = ACL injury risk increases. Poor Hip and Glute Muscle Strength Interestingly our hip muscles are particularly important at preventing knee valgus motion occurring. During landing, cutting and pivoting our hip abductor muscles are activated to prevent the hip falling into adduction and internal rotation, which in turn prevents the knee falling into valgus motion. However, if the hip abductor muscles aren t strong enough then the hip will fall into internal rotation and adduction during dynamic movement influencing valgus knee motion and increasing load on the ACL. The glute muscles also play a role in externally rotating the hip and if they are weak will also influence hip internal rotation, studies have shown females land with decreased glute activation indicating female athletes have difficulty controlling the hip during dynamic movement. Which is bad news for our knees! 4

5 v MECHANISMS OF ACL INJURY IN NETBALL Poor Quadriceps: Hamstring Strength Ratio There is no doubt that a combination of overdeveloped and dominant usages of the quadriceps in combination with a comparative weaknesses in the hamstrings during sporting conditions directly attributes to increased possibly of ACL tears. Further, studies have shown us that compared to males, females tend to land with more quadriceps activation and decreased hamstring activation which increases the likelihood of landing with knee valgus motion. Another reason females athletes experience a higher risk of ACL injury. Interestingly, this deficit in quadriceps: hamstring strength ratios seen between male and female athletes emerges after puberty. A study showed following puberty females quadriceps strength increases relative to their body mass, however their hamstring strength remains the same. Which is why we see overdeveloped and dominant quadriceps in young female athletes. Incorrect Landing Technique Most ACL injuries occur due to rapid deceleration combined with incorrect landing technique. Improper landing technique can cause significant undue torque and stress on many aspects of the structure of the knee. Due to the high impact nature of netball, ensuring proper landing technique is important for the entire spectrum of preventable injuries. Not only will implementing correctly programmed landing strategies improve movement quality, it will also allow the athlete an opportunity to develop eccentric hamstring and hip control. These are technical skills that transfer to pivoting, acceleration/deceleration, and improving rate of force production. Developing landing technique and improving eccentric control can help dissipate that force and make a better all-around player. IMAGE FROM ATHLETICPERFORMANCETC.WORDPRESS.COM 5

6 ACL INJURY PREVENTION ACL Injury Prevention for Netball To tie all of the previous information together, being a female athlete, being involved in high impact sporting events, intense competition requiring jumps, pivoting and cutting, experiencing muscular imbalances that cause improper loading patterns, footwear, and almost innumerable numbers of individual knee joint kinematic variations attribute to increased risk of ACL issues. In short, netball is the perfect sporting storm for an ACL problem. Preparation for competitive netball at every level requires comprehensive preventative measures to give the athletes as good as a chance as possible to have a long and successful playing career. There is an overwhelming amount of evidence showing participation in a supervised, structured and progressive neuromuscular training program can prevent ACL injury and reduce risk factors associated with ACL injury. Neuromuscular training (NMT) is a combination of movement skill training with strength and conditioning activities such as; resistance training, plyometric training and balance training. Research has shown that NMT can; 1. Improve dynamic joint stability 2. Improve movement efficiency 3. Improve neuromuscular control 4. Improve landing technique 5. Reduce valgus knee motion during landing 6. Enhance glute and hamstring muscular strength 7. Enhance the quadriceps: hamstring strength ratio 8. Reduce loading on the ACL and knee joint 6

7 ACL INJURY PREVENTION Collectively, improvement in these areas will drastically decrease overall injury risk in female athletes. Exercise selection is important and will differ based on each athletes own biomechanical, anatomical and neuromuscular differences. However, the basis of the programming for the netball athlete should include; 1. Back Squats 2. Romanian 3. Lunge Variation Deadlift A study also found greater preventative effects from a higher volume NMT program inclusive of 2 or more sessions per week, exceeding 30 minutes (20). However, note these types of sessions must be supervised and administered by a strength and conditioning coach/sport scientist. 7

8 ANKLE SPRAIN/LIGAMENT DAMAGE 02 Ankle Sprain/Ligament Damage The ankle (also called the talocrural joint) is a complex system of bones, ligaments, and muscles. It allows for flexion, extension, inversion, and eversion of the foot. The connective tissue of the ankle is incredibly strong in order to absorb cyclic repetitive stress involved in activities like long duration walking and running. The angle ligaments are also designed to dissipate high impact stimulus like landing from a jump or when the feet make contact to the ground during sprinting and cutting. Even with the structurally sound make-up of the ankle, it is not impervious to injury. As a matter of fact, ankle sprains account for 14% of all sport-related injury. 80% of those injuries involve damage directly to the ligament because of explosive inversion/eversion of the ankle. (9). In layman terms, this means the overwhelming majority of ankle sprains occur either immediately upon landing or during quick changes of direction where stability is lost and the foot rolls under the bulk of the ankle. Some factors that increase the likelihood of sustaining an ankle sprain (9): - Previous sprain history has a 4.9x greater chance of re-injury - Wearing shoes with air cells or air bubbles has a 4.3x great chance of injury - Not stretching before exercise or competition has a 2.6x greater chance of injury - Inferior single leg balance/a large bilateral balance deficit between legs has a 2.4x greater chance of injury - Overweight individuals have a 3.9x greater chance of ankle injury 8

9 ANKLE SPRAIN/LIGAMENT DAMAGE These factors along with improper landing foot position are conducive to pretty much guaranteeing an ankle issue at some point. In a typical netball match, players are constantly performing jumping, pivoting, and leaping movements. On average, a player will perform 28 leaps and 160 jumps per match (23). Because of the high impact explosive nature of the sport and the above mentioned factors, netball has an exponentially high ankle injury rate, accounting for 40% of all reported injuries (10). About half of these individuals will deal with recurring ankle issues after the first traumatic event (1). Signs and Symptoms There are different levels of ankle sprains (22): 1st Degree: 2nd Degree: 3rd Degree: little to no swelling; mild stiffness, mild pain and stiffness in the joint. Moderate swelling and stiffness, moderate to severe pain, difficulty weight bearing and some instability in the joint. Severe swelling and pain, inability to weight bear, instability and loss of function in the joint. 9

10 Mechanisms of Ankle Injury in Netball Ankle Instability Obviously, poor control of the ankle is going to lead to more circumstances where position is compromised during high intensity practice and play. Instability is a very broad term with almost innumerable variables at play. Instead of delving into the plethora of general ankle stability exercises in the strength and conditioning world, I want to expand into more specific factors that contribute to decrements in the structural integrity of the ankle. Reduced Dorsi Flexion ROM Dorsi Flexion is the motion of pulling the toes back towards the shin bone. A study in professional athletes (11) found they are at a much higher risk for ankle sprain (approximately 63%) when they have a disproportionate bilateral strength deficit between their plantar flexors (performs the opposite motion as dorsi flexion where the toes and forefoot move downwards to point the toes) and range of motion in the dorsi flexors. Basically, when the plantar flexors become overdeveloped (most likely from improper landing/cutting mechanics), they cause a limitation in dorsi flexion that has been shown to drastically increase the instance of ankle injury in sports with a large amount of jumping, landing, and pivoting. ANKLE INSTABILITY Poor Single Leg Balance and Stability One study found direct correlation in male and female high school and collegiate aged athletes in single leg balance score deficits and likelihood of ankle sprain injury (21). The methods used for testing involved standing on one leg for 30 seconds with the eyes closed while wearing competition/match grade athletic footwear. Researchers then counted how many times non weight bearing foot touched down. Basically, more foot touches equated to poor single leg stability. Through this testing and subsequent observation process, the researchers determined that the Single Leg Balance test used is an excellent predictor of future ankle sprain for high school and college team sport athletes. DORSI FLEXION Limb Dominance Almost everyone will vhave a preferred side they use to complete everyday tasks, as a result this side will be much stronger than their other side. Interestingly, a study brought to light that up to 92% of ankle sprains happen in the dominant leg (4). This could be due to the increased demand unconsciously placed on the dominant leg during sporting activities. Increased Ankle Eversion to Inversion Strength Inversion ankle sprains are one of the most common types of sprains (when the ankle rolls outward). Athletes with a greater ankle eversion-to-inversion strength ratio are at a higher risk of sustaining an inversion ankle sprain. This is most likely due to the inability to implement effective landing and pivot strategies. INVERSION EVERSIONV MIDDLE IMAGE FROM MILITARYDISABILITYMADEEASY.COM/ TOP IMAGE FROM FOOTANKLESPECIALISTALBUQUERQUE.COM 10

11 ACL INJURY PREVENTION Ankle Injury Prevention for Netball If we break down the previous information into a needs analysis to determine where to begin with injury reduction and prevention strategies for ankle ligament injuries, we could see that our two main objectives for a strength and conditioning program should be: 1. Decrease the bilateral deficits in strength and stability in the lower limbs 2. Overall strengthening and mobility improvement For decreasing bilateral deficits, neuromuscular training is showing promise in the research. One study showed that a three time a week, 90 minute session for 6 weeks that focused on increasing single limb stability in 41 high school aged female athletes was enough to drastically improve single limb total stability (18). Although this study was geared towards decreasing the instance of non-contact ACL tears, it shows us that single limb stability is appropriate and beneficial for young netball athletes. 11

12 PATELLOFEMORAL SYNDROME 03 Patellofemoral Syndrome Patellofemoral Syndrome (also called patellofemoral pain syndrome or PFP) is a term used to define slow onset knee pain that is felt directly on or under the knee cap. It is the most common diagnosis for patients presenting with knee pain. PFP is mostly experienced by adolescents participating in cutting, jumping and pivoting sports with adolescent females being affected 2-10 times more than males (24). Symptoms are typically pain around of behind the patella that is increased with running, sitting, walking up and down stairs, and squatting. It can become so server that the athlete may have to reduce sport participation or even cease sport participation all together. Of more concern, PFP may be a precursor to patellofemoral osteoarthritis. There are many causes of PFP including weak and/or right quadriceps, chronic patella dislocation, incorrect running form, and wearing improper athletic shoes during training (22). If the patella moves out of its normal path, even slightly, it can cause irritation and pain. Tight tendons also place pressure on the patella, causing inflammation and resulting in PFP. IMAGE FROM MEDBRIDGEEDUCATION.COM 12

13 Mechanisms of PFP Poor Hip Strength: As I talked about in the ACL injury section, hip strength is particularly important to ensure proper alignment and stability of our knees. When our hip muscles are not strong enough they cause the hip to move into adduction and internal rotation during loading, influencing knee valgus motion. Knee valgus motion leads to lateral patella tracking (the femur rolls under the patella) when this happens repeatedly it leads to pain and inflammation. A study compared hip strength between female athletes with and without PFP. Results indicated females with PFP had significantly weaker hip abductors and external rotators (6). Quadriceps Muscle Imbalance and Poor Quadriceps Strength: The literature has focused largely on the imbalance between the VMO (which stands for Vastus Medialis Oblique) relative to the VL (Vastus Lateralis) as a cause of PFP. We discussed the importance of the VMO in the ACL injury section. The VL is located on the outside of the thigh and is the largest of the quadriceps muscles. Decreased and delayed activation of the VMO in relation to the VL results in abnormal lateral tracking, overtime leading to PFP. It has been reported that as little as a 5 millisecond VMO timing delay is enough to cause significant increase in lateral patellofemoral joint loading (8). Tight Quadriceps, Hamstrings, Calves and ITB: Tightness of the Quadriceps, Hamstrings, Calves and ITB have all be shown to be risk factors for PFP as poor flexibility in these areas increases stress on the patellofemoral joint. Quadriceps tightness can directly increase pressure between the articular surfaces of the femur and the patella. Whereas, hamstrings and calf tightness indirectly increase PFP by creating faulty movement patterns consequently placing higher forces through the patellofemoral joint (5). The iliotibial band (ITB) is a fascial band that originates at the hip bone and attaches at the glutes and the tensor fascia latae (TFL). The ITB plays a major role in lateral knee stabilization, when the ITB is tight it places excessive pressure on the lateral patella leading to pain, inflammation and PFP. SPINAL ERECTORS GLUTES ABS QUADRICEPS IMAGE FROM FLAVILICIOUSFITNESS.COM HAMSTRINGS 13

14 PATELLOFEMORAL SYNDROME Prevention of PFP When it comes to preventing and treating PFP, participation in a structured and periodised neuromuscular training (NMT) program is key. There is evidence that shows NMT reduces knee pain in female athletes with PFP. However, not all NMT programs are created equal. The goal of the NMT program should be; 1. Improving movement efficiency 2. Strengthening the glute, hip and hamstring muscles 3. Improving quadriceps firing patterns 4. Enhancing ankle and hip mobility 5. Enhancing hamstring flexibility It is vital that technical competency is upheld at all times. As such, supervision by a qualified and experienced strength and conditioning coach/sport scientist is a must. 14

15 CONCLUSION: Most of the injuries that occur in netball are preventable through properly supervised and appropriately structured neuromuscular training. Each athlete is different and will have different requirements in the weight room based on their individual muscular imbalances, movement issues, injury history and anatomy. As such, ensuring programming is implemented by an experienced and qualified strength and conditioning coach is a must. Technical competency and movement proficiency must be prioritized at all times especially when working with youth and adolescent athletes. If you would like more information on preventing injuries in netball, or if you have experienced any of the above injuries and want information on how to prevent it happening again feel free to contact me at mandy@mhperformancecoaching.com 15

16 FREE Injury Prevention Movement Screen If you would like to get a complimentary injury prevention movement screen (valued at $47) to see if you are at risk of injury, simply complete, scan and back this form or send an to mandy@mhperformancecoaching.com with your contact number and we will contact you to arrange a time for your test. Here s exactly what we will do together Thoroughly review your unique scenario Place you through a series of movement tests specific to netball to identify muscular imbalances, movement deficiencies and strength deficits Make recommendations on specific exercises for you to do to address these issues and lower your injury risk Advise on a solution that allows long-term injury prevention and improved performance To apply for your free Injury Prevention Movement Screen simply complete the form on the next page. 16

17 FREE INJURY PREVENTIONMOVEMENT SCREEN Yes, I would like to apply for an Injury Prevention Movement Screen Test. I understand that this is an obligation free, 100% confidential, opportunity for me to get clear on my individual injury risk profile and the options I have when it comes to preventing injury. Name: Describe any injuries or pain you currently have or have previously had: Describe the top 3 outcomes you would like from this test: Contact Number: Address: 1st preference date and time / / : 2st preference date and time / / : *Perth Only Scan and this page to mandy@mhperformancecoaching.com and we will contact you to arrange a time for your FREE assessment. 17

18 WHO is Mandy Hopper? Mandy has a Masters in Sports Science from Edith Cowan University in Perth. Her research titled Reducing biomechanical risk factors associated with injury during landing and improving performance in year old netball athletes focused entirely on reducing injury risk and improving performance in young netball players. Her passion for netball originated from working as a strength and conditioning coach with an academy netball team (Western Region Academy of Sport) in Bathurst, NSW whilst she was completing her undergraduate degree. Through this experience, she was able to see firsthand the reputation netball had for high incidence of knee and ankle injuries. Leading her to become highly interested in the biomechanics around the sport, why the injury rate were so high and how to prevent injuries occurring so netball athletes can have long and successful playing careers. Mandy has worked with the West Coast Warriors state league teams for the past 3 years (and still currently does!) as their strength and conditioning coordinator. She places a large emphasis on movement quality and competency to reduce injury risk and improve performance. Her goal is to increase awareness of the importance of properly structured and appropriately supervised strength and conditioning programs at all netball levels and ages, reduce the stigma around the sport as being responsible for a high injury rate and increase the health of the sport. Mandy has more than 5 years experience working specifically with netball athletes in strength and conditioning. She has experience working with youth, adolescent and professional athletes. She has also worked with some of the bets S&C coaches and sport scientists in the world. Mandy s qualifications include but are not limited to; Masters in Sports Science Bachelor of Education (Health and PE) Western Region Academy of Sport S&C Intern ( ) Winner of NSCA Strength of America Award *Awarded to S&C programs that display the gold standard for S&C for high school aged athletes Intern of the Year ACSA Level 2 S&C Coach* ASCA Professional Coach Intern Coach Working with Children Check Senior First Aid #STAYFITHASHTAG 18

19 Reference List 1. Attenborough, A. et al. (2016). A snapshot of chronic ankle instability in a cohort of netball players. Journal of Science and Medicine in Sport. 19: Baumhauer, J. (1995). A Prospective Study of Ankle Injury Risk Factors. The American Journal of Sports Medicine. 23(5). Pp Beck, N. Et al. (2017). ACL Tears in School-Aged Children and Adolescents Over 20 Years. Pediatrics. 7(139). 4. Beynnon, B. et al. (2002). Predictive Factors for Lateral Ankle Sprains: A Literature Review. ProQuest. 37(4). Pp Collado, H., & Fredericson, M. (2010). Patellofemoral pain syndrome. Clinics in sports Medicine, 29(3), Cichanowski, H. R., Schmitt, J. S., Johnson, R. J., & Neimuth, P. E. (2007). Hip strength in collegiate female athletes with patellofemoral pain. Medicine and science in sports and exercise, 39(8), Dedinski, R. et al. (2017). Exercises That Facilitate Optimal Hamstring and Quadriceps Coactivation To Help Decrease ACL Injury Risk in Healthy Females: A Systematic Review of The Literature. International Journal of Sports Physical Therapy. 12(1). Pp Fagan, V., & Delahunt, E. (2008). Patellofemoral pain syndrome: a review on the associated neuromuscular deficits and current treatment options. British journal of sports medicine, 42(10), Fong, D. et al. (2009). Understanding Acute Ankle Ligamentous Spain Injury in Sports. Biomed Central Sport Science, Medicine, and Rehabilitation. 10. Fong, D.et al. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports Medicine. 37: Hadzic, V. et al. (2009). Risk Factors for Ankle Sprain in Volleyball Players: A Preliminary Analysis. Isokinetics and Exercise Science. 17(3). Pp Hale, S. et al. (2007). The Effect of a 4-Week Comprehensive Rehabilitation Program on Postural Control and Lower Extremity Function in Individuals With Chronic Ankle Instability. Journal of Orthopaedic & Sports Physical Therapy. 37(6). Pp

20 Reference List 13. Hoffman, M. et al. (1998) Unilateral Postural Control of the Functionally Dominant and Nondominant Extremities of Healthy Subjects. Journal of Athletic Training. 33(4). Pp Lefebvre, R. et al. (2006). Vastus Medialis: Anatomical and Functional Considerations and Implications Based Upon Human and Cadaveric Studies. Journal of Manipulative and Physiological Therapeutics. 29(2). Pp N. Saunders, L. Otago (2009). Elite netball injury Surveillance: Implications for injury prevention. Journal of Science and Medicine in Sport, 12, p. S Nguyen, A. Et al. (2016). Logitudinal Changes in Hip Strength and Range of Motion in Female Youth Soccer Players: Implications for ACL Injury. Journal of Sport Rehabilitation. 17. P.A. Hume, J.R. Steele (2000). A Preliminary Investigation of Injury Prevention Strategies in Netball: Are Players Heeding the Advice? Journal of Science & Medicine in Sport, 3, pp Paterno, M. et al. (2004). Neuromuscular Training Improves Single-Limb Stability Female Athletes. Journal of Orthopedic Sports Physical Therapy. 34(8). 19. Renstrom, P. et al. (2014). Non-Contact ACL Injuries in Female Athletes: An International Olympic Committee Current Concepts Statement. British Journal of Sports Medicine. 20. Sugimoto D, Myer GD, Foss KD, and Hewett TE. Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses. Sports Medicine 44: , Trojian, T. et al. (2006). Single Leg Balance Test to Identify Risk of Ankle Sprains. British Journal of Sports Medicine. 40(6). Pp Walker, B. (2013). The Anatomy of Sports Injuries: Your Illustrated Guide to Prevention, Diagnosis and Treatment. Lotus Publishing. Nutbourne, Chichester. 23. Williams, R. et al. (2005). Lower limb injury risk in netball: A time-motion analysis investigation. Journal of Human Movement Studies. 49: Myer, G. D., Ford, K. R., Foss, K. D. B., Goodman, A., Ceasar, A., Rauh, M. J.,... & Hewett, T. E. (2010). The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clinical biomechanics, 25(7),