Netball Knee Pain: Causes, Symptoms, Prevention, and Management

Why does my knee hurt when I play netball?

Knee pain during netball often stems from the sport's high-impact, multi-directional movements, sudden stops, and jumping, which place significant stress on the knee joint's ligaments, menisci, and surrounding musculature, leading to various acute injuries or overuse conditions.

Understanding Netball's Demands on the Knee

Netball is a dynamic, high-intensity sport characterized by frequent accelerations, decelerations, sudden changes in direction, jumping, and landing. These actions place immense stress on the lower kinetic chain, particularly the knee joint.

• Deceleration and Landing: The forces transmitted through the knee during landing from a jump or sudden stops can be several times an individual's body weight, challenging the integrity of ligaments and cartilage.
• Pivoting and Twisting: The requirement for quick changes in direction while maintaining a stable base, often with one foot planted, creates significant rotational forces across the knee joint.
• Repetitive Impact: The continuous cycle of running, jumping, and landing can lead to cumulative micro-trauma, even if individual impacts are not severe.

Common Causes of Knee Pain in Netball

Knee pain in netball players can arise from various sources, broadly categorized into acute injuries (sudden onset) and overuse injuries (gradual onset).

• Acute Injuries: These typically occur due to a specific traumatic event.

  • Anterior Cruciate Ligament (ACL) Injury: Often caused by sudden deceleration, pivoting, or an awkward landing, resulting in a "pop" sensation, severe pain, swelling, and instability. This is a significant injury requiring medical attention.
  • Medial Collateral Ligament (MCL) Injury: Often results from a direct blow to the outside of the knee or a valgus (knee-inward) stress during a pivot or landing. Pain is usually on the inside of the knee.
  • Meniscal Tears: The menisci are cartilage cushions in the knee. Tears can occur from twisting with a flexed knee, leading to pain, swelling, clicking, or locking of the joint.
  • Patellar Dislocation/Subluxation: The kneecap (patella) temporarily or completely moves out of its groove, causing intense pain, visible deformity, and instability.
  • Contusions: Direct impact to the knee can cause bruising and localized pain.

• Overuse Injuries: These develop gradually due to repetitive stress without adequate recovery.

  • Patellofemoral Pain Syndrome (PFPS) / "Runner's Knee": Characterized by pain around or behind the kneecap, especially during activities involving knee flexion (e.g., jumping, squatting, going up/down stairs). Often linked to muscle imbalances (weak glutes, tight quadriceps/hamstrings) and poor biomechanics.
  • Patellar Tendinopathy / "Jumper's Knee": Pain located just below the kneecap, at the patellar tendon. It's an inflammatory or degenerative condition caused by repetitive jumping and landing.
  • Iliotibial Band (ITB) Friction Syndrome: Pain on the outside of the knee, often worse during repetitive knee flexion and extension. Caused by friction of the ITB over the lateral femoral epicondyle, often linked to weak hip abductors or glutes.
  • Osgood-Schlatter's Disease: While more common in adolescents, this is an inflammation of the growth plate at the top of the shin bone where the patellar tendon attaches. Repetitive pulling from jumping can exacerbate it.

• Biomechanical Factors: Underlying issues that predispose players to injury.

  • Poor Landing Mechanics: Landing with knees locked, valgus collapse (knees caving inward), or insufficient hip/ankle flexion increases stress on the knee.
  • Muscle Imbalances: Weakness in the glutes (especially gluteus medius), quadriceps, hamstrings, or core can compromise knee stability and alignment.
  • Inadequate Footwear: Worn-out shoes or those not designed for multi-directional court sports can reduce shock absorption and stability.

• Training Errors:

  • Sudden Increase in Load: Rapidly increasing training volume, intensity, or frequency without proper acclimatization.
  • Insufficient Warm-up and Cool-down: Failing to prepare the body for activity or aid recovery afterward.

Identifying Your Specific Pain

Understanding the characteristics of your pain can provide clues about its cause.

• Sharp, Sudden Pain with a "Pop": Strongly indicative of an acute ligamentous injury (e.g., ACL, MCL) or meniscal tear.
• Dull, Aching Pain that Worsens with Activity: Common with overuse conditions like PFPS, patellar tendinopathy, or ITB syndrome. It may improve with rest but return with activity.
• Pain with Specific Movements:
  • Jumping/Landing: Suggests patellar tendinopathy or PFPS.
  • Twisting/Pivoting: May indicate meniscal or ligamentous injury.
  • Going Up/Down Stairs: Often associated with PFPS.
• Swelling: Can be immediate (acute injury, especially ACL or significant meniscal tear) or gradual (overuse, fluid accumulation).
• Instability or "Giving Way": A feeling that the knee cannot support your weight, often a sign of ligamentous laxity or injury.
• Clicking, Catching, or Locking: Suggestive of a meniscal tear or a loose body within the joint.

When to Seek Professional Medical Advice

While some mild knee pain might resolve with rest and self-care, certain symptoms warrant immediate medical evaluation. Consult a doctor or physiotherapist if you experience:

• Severe pain that prevents you from bearing weight.
• A "pop" or "snap" sensation at the time of injury.
• Rapid or significant swelling of the knee.
• Visible deformity of the knee or leg.
• Inability to bend or straighten the knee fully.
• A feeling of instability or "giving way."
• Pain that persists or worsens despite rest and conservative measures.

Preventative Strategies and Management

Proactive measures are crucial for reducing the risk of knee pain and injury in netball players.

• Strength Training: Focus on developing balanced strength in the muscles surrounding the knee and hip.
  • Quadriceps: Essential for absorbing impact and stabilizing the kneecap.
  • Hamstrings: Crucial for knee stability and deceleration.
  • Gluteal Muscles (Gluteus Maximus, Medius): Key for hip stability, controlling knee alignment (preventing valgus collapse), and power generation.
  • Calves: Important for ankle stability and shock absorption.
  • Core Strength: Provides a stable base for lower body movements.
• Proprioception and Balance Training: Exercises like single-leg stands, wobble board exercises, and plyometrics improve the body's awareness of joint position and enhance neuromuscular control, particularly important for landing and pivoting.
• Proper Warm-up and Cool-down:
  • Warm-up: Dynamic stretches and sport-specific movements (e.g., light jogging, side shuffles, lunges) prepare muscles and joints for activity.
  • Cool-down: Static stretches held for 20-30 seconds help improve flexibility and aid recovery.
• Correct Landing Mechanics: Practice landing softly, with knees bent, hips back, and knees tracking over the toes, avoiding valgus collapse.
• Appropriate Footwear: Invest in quality netball-specific shoes that offer good cushioning, support, and lateral stability. Replace shoes regularly as cushioning and support degrade.
• Gradual Progression of Training Load: Avoid sudden increases in the intensity, duration, or frequency of training. Allow your body to adapt gradually to new demands.
• Nutrition and Hydration: Support tissue repair and overall joint health.
• Rest and Recovery: Adequate sleep and planned rest days are vital for muscle repair and preventing overuse injuries.
• Taping or Bracing: May provide additional support or proprioceptive feedback for individuals with known instability or during rehabilitation, but should not replace fundamental strength and control.

Rehabilitation Principles

If an injury occurs, a structured rehabilitation program guided by a physiotherapist is essential. This typically involves:

• Pain and Swelling Management: RICE (Rest, Ice, Compression, Elevation) initially.
• Restoration of Range of Motion: Gentle exercises to regain full knee movement.
• Progressive Strengthening: Targeted exercises for the injured area and surrounding musculature.
• Neuromuscular Control and Proprioception: Re-educating the body's control over the knee.
• Gradual Return to Sport: A phased approach, starting with low-impact activities and progressively increasing sport-specific drills, ensuring the knee can tolerate the demands without pain.

Conclusion

Knee pain in netball is a common but often preventable issue. By understanding the biomechanical demands of the sport, recognizing common injury patterns, and implementing comprehensive preventative strategies focused on strength, stability, and proper technique, players can significantly reduce their risk. If pain persists or is severe, seeking professional medical advice is paramount for accurate diagnosis and effective treatment, ensuring a safe and timely return to the court.