Netball Injuries, their Treatment and Prevention
I am extremely grateful to a range of people for their help and support, either in teaching or treating me (sometimes both!). In particular I would like to thank Frank Asher a Serving Brother in the Order of St John, Di Hales, Physiotherapist to Crawley Swimming Club, Jo West of the Portland Physiotherapy and Sport Injury Clinic and Lisa Allen (Royal United and University Medical School). I know all of them would want me to say, always seek professional help in treating sports injuries.
This site does not set out to provide an alternative to seeking professional treatment. It is designed to give players and coaches some background to sports injuries as experienced by netballers. Also to explain the basics of sport "first aid" and some useful strategies for treating injuries. What's on this page:
1 - Hamstring
2 - Achilles Tendon
5 - Knees (General)
6 - Hamstring Bursa
9 - Locked Knee
10 - Medials and Laterals
11 - Quads
12 - Calf Muscles
On the next page are some ideas and suggestions on recovery training. This page is dedicated to describing the major injuries.
In many instances, no matter how small the injury, tissues, which have been stretched or torn in any way, result in blood loss. The extent of this blood loss (bleeding) will depend on the type of tissue involved. Muscles contain many more blood vessels than ligaments (which act to keep joints together) and tendons (which join muscles to bones). Bleeding may be increased if the injury occurs during a match or in a training session and preventative treatment is not taken at the time of injury (how often has the injured player said, plaintively "Its OK I'll carry on"?). The body has a very quick reaction to any sudden injury (shock) and will attempt to restrict the supply of blood into any damaged area by reducing the size of blood vessels. If you have had the misfortune of being involved in a Road Traffic Accident you will know, that unlike the portrayals in TV Soaps such as Casualty, that with even some very severe injuries there is not a vast amount of blood to be seen. The immediate first-aid action in these instances is to control all bleeding by applying firm bandages. Blood will flow out internally (seen as bruising) until these vessels are also restricted, using a compression bandage/dressing to prevent blood leaking into tissues. It is important to stop bleeding into tissues as the blood will act as an irritant, increase inflammation, and in turn delay the healing process.
Cells starved of nourishment from the blood supply, due to injury, will soon die. These dying cells in turn stimulate the release of histamine which in turn causes blood vessels to expand, thereby bringing increased blood supply and extra nutrients to help repair and rebuild the damaged tissues. During this phase the body adds a range of protein and inflammatory substances into the blood supply, this has a tendency to thicken the blood (as an aid to plug damaged blood vessels) which will cause the area around any injury to swell. This swelling may be the first real indication to a player of tissue damage. Left to its own devices healing continues at a rapid rate.
Muscle spasm may also occur during injury, causing the muscle to contract either voluntarily or involuntarily, helping prevent further movement (for example by 'locking' a joint). However, this may have adverse effects by further restricting blood flow (and slowing the healing process) and also placing more pressure on nerve endings, leading to increased pain. Some doctors will suggest treating these types of injury with anti-inflammatory drugs such as Ibuprofen. These should be avoided since they are only slowing the body's own (natural) healing. Pain killing drugs such as Aspirin or Paracetemol may be given to reduce the overall level of pain. ALWAYS READ THE LABELLING BEFORE YOU TAKE ANY MEDICINES. IF IN DOUBT, CONSULT A DOCTOR.
Where a player has ignored warning signs and continued to play/train before an injury has completely healed, they may suddenly find that their body has sent certain muscles into spasm to prevent further use of a particular joint/muscle. Treatment must generally follow that for a sudden (traumatic) injury.
Treating an injury.
As soon as possible apply ice or a specialised cooling pack if these is ANY sign of soft tissue damage. Immediate use of ice will act to reduce the level of swelling and limit the amount of blood allowed to leak out. This will also be assisted by compression, elevation and rest- hence "ICER", or more commonly "RICE" since the assumption in first-aid circles is that an individual can (and will) immediately stop what they are doing and rest. Because this page is about injuries to netballers, I'll use the term ICER.
Ice - Apply ice for up to 10 minutes as soon after the injury as possible - do not wait for the swelling to start. This should be repeated every 2 hours during the first two days after injury (once or twice is NOT enough). It is important not to keep the ice on for any longer than 10 minutes as the body then reacts by increasing blood flow to warm the area and therefore exacerbating the swelling. Never apply ice directly to the skin, always put the ice into a plastic bag (a bag of frozen peas is a very good substitute) and then wrap it up in a towel and apply it to the affected area.
Compression - After ice, apply a compression bandage to help minimise the swelling to the tissues. Zinc Oxide tape is best avoided, a firmly applied crepe bandage is sufficient since it will need to be removed after 2 hours to allow for a further 10 minutes of 'ice' treatment. 'Tubigrip' can also be used since it is easy to apply and remove.
Elevation - Elevate the injured part to help limit blood flow and prevent use of muscles to injured part. If possible, aim to get the injured part above the level of the heart. Thus for a injured knee, a good resting position is to lie on the ground with the leg raised and resting on some cushions. Sitting up in a comfortable chair with the injured foot raised is the next best (but slightly more elegant) thing to do.
Rest - the injured part as much as possible to allow the healing of damaged tissues, the first 6 hours are the most important. Most muscle injuries will need at least 48 hours before any attempt is made to start using them. After 72 hours it should be possible to determine the damage and a method of recovery drawn up with your own GP/Sports Physiotherapist.
Failure to follow these 4 simple steps means that the period of recovery from injury may be considerably extended whilst the swelling and removal of dead tissue and blood cells is dealt with. If severe and not properly managed, these may create long term problems for the player. Sometimes surgical intervention becomes the only route to seek a cure.
Common Injuries 1 - Hamstring
The Hamstring is unique in the body, running as it does, up the back of the leg from below the knee to above the hip. It is required to perform two functions at the same time; with one end under tension and the other relaxed. A lot of injuries to Hamstrings can be traced to either insufficient/inadequate warming up and putting this muscle under too much strain too early in the match (the majority of these injuries occur in the first quarter). Another possible cause is over compensation for an injury to the other leg, thus putting an unequal strain on one leg. Treatment is ICER, and time. Hamstring injuries take along time to heal so do not expect miracles. Follow the notes on Recovery Training.
Common Injuries 2 - Achilles Tendon
The Achilles Tendon anchors the calf muscles to the heel. It is exceptionally strong and has only a limited blood supply, so whilst it will not tire through fatigue during training/match play, any injuries take a long time to recover. Most injuries are traumatic with the injured player reporting that they were brought down by a kick to the back of the leg (They weren't, the cause is usually always a bad landing with all the weight on one foot). ALWAYS seek expert medical treatment, in acute cases you will need an operation to re-attach the tendon, the leg may also need to be plastered to aid recovered. A simple test for injury to an Achilles Tendon is whilst sitting, try and alternate pointing the toes forward and drawling them back towards you, only if you can do this pain free, can you be sure that your Achilles Tendon has not been injured. Immediate treatment should be ICER (above) and then getting the injured player to specialist medical care as soon as possible.
Common Injuries 3 - Peroneal Tendon Strain
This injury is associated with 'rolling' over the outside of the foot and is frequently referred to as "a twisted ankle" because there is considerable pain in and around the outer anklebone. A quick test is to support the heal and place a hand alongside the other (small toe) side of the foot and to try and push the foot against the hand. Pain or an inability to push against the hand will confirm this as tendon strain. As well as ICER (above) massage all the tender areas to the pain limit of the injured player. This will help reduce a build up of blood and thus aid the healing process. The normal way to support this type of injury is to apply a couple of strips of zinc oxide tape from 3 inches above the ankle bone, around under the foot and finish 3 inches above the ankle bone on the other side of the foot. Then apply a strip in a figure of 8 fashion running from under the foot, over the top of the foot, around the back of the heal, back over the top and finish under the foot. This should support the foot without allowing too much freedom of movement. If applied in a match/training session then add a strip of tape around the foot above the anklebone to stop the tape slipping off any sweaty skin! If the pain persists after 48 hours then seek medical advice since one of the foot bones may have been fractured or there is severe muscle or tendon injury for which ultrasound or cortisone treatment is needed.
Common Injuries 4 - Sprained Outer Ankle
The difference between Peroneal Tendon Strain and a Sprained Ankle is principally associated with the degree of pain which is most acute when resting but does not go with "walking off". Follow the treatment outlined above (ICER and strapping) but if possible provide the injured player with crutches for the first 48 hours so that no strain is placed on the ankle. Again, if the problem persists after this initial 48 hours, seek urgent medical advice.
Common Injuries 5 - Knees (General)
WARNING - NEVER rely on self-diagnosis for knee injuries, the knee is likely to suffer more from injury than any other part of the body, but it can come from a wide variety of causes and will display many symptoms. It is a diagnostic minefield for medical professionals, as many netballers will testify. However that should not put anyone off from seeking medical help or from keeping asking if treatment does not help.
Common Injuries 6 - Hamstring Bursa
This injury is likely to be experienced as a soreness at the back of and below, the front of the knee. Caused by overuse of the hamstring due to poor running technique, frequently experienced by umpires where there is a need to make frequent changes between running and side stepping. Treat with ICER; strap the knee to reduce movement. If still experiencing pain after 72 hours then seek medical help as ultrasound or cortisone treatment may be needed.
Common Injuries 7 - Prepatellar Bursa (Also known as Housemaid's Knee)
Experienced as build up of fluid around (but not in) the knee. Treat with ICER; strap the knee to reduce movement. Doctor's generally do not like to drain fluid of the knee since the body will seek to reduce inflammation as part of the healing process. When the knee has healed naturally, the fluid will also have gone. Caused by heavy impact, either through falling or collision with another player (who said netball is a non-contact sport?).
Common Injuries 8 - Rapid Swelling (Normal to Excruciating in about 3 hours)
Such a sudden change is likely to have been brought about by blood getting into the ligaments that hold the knee together (anterior and or posterior cruciate). Treat as CI6 (above) but if there is no easing of pain, then the blood may need to be drawn off so you should arrange to see a GP as soon as possible. Your GP should retain a sample for testing - the presence of fat globules may indicate a fracture. A MRI (Magnetic Resonance Imaging) Scan may be needed. A specialised training plan will be needed to recover fitness to allow a return to playing condition.
Common Injuries 9 - Locked Knee
A locked knee, in the absence of any other obvious causes is always a matter requiring careful treatment. The most obvious cause is due to a loose piece of cartilage, ligament, or bone in the knee. Although ICER should be used to bring immediate relief, medical intervention in the form of x-rays, MRI scans, Arthroscope (visual inspection) and surgery may be needed. A specialised training plan will be needed to recover fitness to allow a return to playing condition.
Common Injuries 10 - Medials and Laterals
These pairs of cartilage work to keep the knee joints working together, the medial is on the inside of the knee and the laterals on the outside. Unfortunately, the associated tendons can also easily be injured. In the main, injuries are traumatic (sudden) rather than progressive and a usually the result of a bad landing. Immediate treatment is ICER with every effort made to prevent any twisting movement. Some small tears may heal themselves, if however no obvious improvement has been achieved after 7 days then medical intervention in the form of x-rays, MRI scans, Arthroscope (visual inspection) and surgery may be needed. Be aware that ligament tears may take up to 4 months to heal.
Common Injuries 11 - Quads
Quads are the main muscles running up the back of the leg, any injury will result in an immediate loss of condition which will take some time to recover; risk of returning to play and putting more strain on your other leg and causing it problems as a result. Surgery is rarely needed but specialised medical treatment such as massage, ultrasound or cortisone treatment probably is needed. Injury can sometimes be felt as a 'lump' in the upper thigh. Alternatively sit upright in a chair with someone holding your ankle and push against them, pain will be felt in the upper thigh. Follow the advice on Recovery Training.
Common Injuries 12 - Calf Muscles
The Calf Muscles are the 'Quads' of the lower leg; treatment is also similar. Without medical intervention recovery can take 5 weeks.
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This page last updated on 29th June 2002 - If you find any errors, believe that presentation is giving out the wrong message or feel you can contribute exercises or drills to aid recovery for any netball related injury please feel free to let me know