Netballers' Knee Pain: Causes, Common Injuries, and Prevention Strategies

Why do netballers have bad knees?

Netballers frequently experience knee pain and injuries due to the sport's unique blend of high-impact movements, sudden changes of direction, restricted pivoting, and repetitive jumping and landing, which collectively place significant stress on the knee joint and its supporting structures.

The Biomechanical Demands of Netball

Netball is a dynamic, high-intensity sport characterized by intermittent bursts of activity, demanding rapid acceleration, deceleration, jumping, landing, and sudden changes of direction. Unlike many other court sports, netball rules restrict players from running with the ball and require them to stop within a few steps of receiving it, often leading to sudden, forceful stops and pivots on a planted foot. This combination of movements creates a unique and often challenging environment for the knee joint.

Key Factors Contributing to Netball-Related Knee Issues

The prevalence of knee problems in netball can be attributed to a confluence of biomechanical stressors, training deficiencies, and inherent individual risk factors.

1. High-Impact Landing and Deceleration Forces

• Repetitive Jumping: Players frequently jump for intercepts, rebounds, and shots, subjecting the knees to high ground reaction forces upon landing.
• Sudden Stops: The "no running with the ball" rule necessitates abrupt deceleration, often from high speeds, which places immense compressive and shear forces on the patellofemoral joint and menisci.

2. Rotational and Valgus Stress

• Pivoting on a Planted Foot: While players are not allowed to step with the ball, they must pivot on one foot. This action, especially when performed rapidly or under pressure, generates significant rotational forces through the knee joint. If the foot is planted firmly and the body rotates, the tibia can twist relative to the femur, potentially stressing the ligaments (especially the ACL and menisci).
• Valgus Collapse: During landing or cutting movements, particularly when fatigued or lacking proper neuromuscular control, the knee may collapse inwards (valgus collapse). This position places the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) under extreme tension, significantly increasing the risk of non-contact ACL rupture, a common and devastating netball injury.

3. Quadriceps Dominance and Hamstring Imbalance

• Excessive Quadriceps Activation: Many players tend to be quadriceps-dominant, meaning they rely heavily on their thigh muscles for deceleration and landing. This can pull the patella (kneecap) against the femur with excessive force, contributing to patellofemoral pain syndrome (PFPS), often referred to as "runner's knee" or "jumper's knee."
• Weak Hamstrings and Glutes: A relative weakness in the hamstrings and gluteal muscles compared to the quadriceps compromises the knee's dynamic stability. The hamstrings are crucial for decelerating the shinbone and assisting the ACL in preventing excessive anterior translation of the tibia. Weak glutes (especially gluteus medius) contribute to valgus collapse by failing to adequately control hip adduction and internal rotation.

4. Ligamentous Laxity and Anatomical Considerations

• Female Athlete Triad/Tetrad: Female athletes, who constitute the majority of netball players, are disproportionately affected by certain knee injuries, particularly ACL tears. Factors contributing to this include:
  • Wider Q-angle: The angle formed by the hip and knee, which can increase valgus stress.
  • Hormonal Influences: Ligament laxity can vary throughout the menstrual cycle.
  • Neuromuscular Control Differences: Often, females exhibit different muscle activation patterns during landing and cutting, predisposing them to injury.
  • Smaller ACL size: On average, female ACLs are smaller than male ACLs.

5. Overuse and Inadequate Recovery

• Repetitive Stress: The cumulative effect of hundreds of high-impact landings, decelerations, and pivots over a season can lead to overuse injuries such as patellar tendinopathy (jumper's knee), quadriceps tendinopathy, and Osgood-Schlatter disease (in younger athletes).
• Insufficient Recovery: Inadequate rest between training sessions or games prevents tissue repair and adaptation, increasing susceptibility to injury.

Common Knee Injuries in Netballers

Given the biomechanical demands, specific knee injuries are highly prevalent:

• Anterior Cruciate Ligament (ACL) Rupture: Often non-contact, occurring during sudden deceleration, landing, or pivoting with a valgus collapse.
• Patellofemoral Pain Syndrome (PFPS): Pain around or behind the kneecap, exacerbated by activities involving knee bending (e.g., jumping, squatting, stairs).
• Meniscus Tears: Can result from acute twisting injuries or chronic degeneration due to repetitive compression and rotation.
• Patellar Tendinopathy (Jumper's Knee): Inflammation or degeneration of the patellar tendon, typically from repetitive jumping and landing.
• Medial Collateral Ligament (MCL) Sprain: Can occur from a direct blow to the outside of the knee or from valgus stress during landing/cutting.

Prevention Strategies for Netballers

Mitigating the risk of knee injuries in netball requires a comprehensive, multi-faceted approach focusing on strength, neuromuscular control, and proper technique.

1. Neuromuscular Training

• Landing Mechanics: Emphasize soft landings with bent knees and hips, absorbing impact through the major joints. Avoid stiff-legged landings.
• Deceleration Drills: Practice controlled stops, ensuring the knees track over the toes and do not collapse inwards.
• Agility and Change of Direction: Train efficient cutting techniques that minimize valgus stress and prioritize hip-dominant movements.

2. Strength and Conditioning

• Gluteal Strength: Focus on exercises like glute bridges, clam shells, side-lying leg raises, and hip thrusts to improve hip abduction and external rotation strength, counteracting valgus collapse.
• Hamstring Strength: Incorporate Nordic hamstring curls, Romanian deadlifts, and hamstring curls to improve dynamic knee stability and complement quadriceps strength.
• Calf Strength: Strong calves assist in absorbing landing forces.
• Core Stability: A strong core provides a stable base for lower limb movements, improving overall biomechanics.

3. Plyometric Training

• Progressive plyometric exercises (e.g., box jumps, broad jumps, single-leg hops) can improve the body's ability to absorb and redirect force efficiently, but must be introduced gradually and with proper technique coaching.

4. Movement Skill Refinement

• Coaches should actively teach and reinforce correct pivoting, landing, and deceleration techniques to minimize hazardous knee positions. Video analysis can be a powerful tool for feedback.

5. Proper Footwear and Surface Considerations

• Court Shoes: Wear appropriate netball-specific court shoes that offer good lateral support and cushioning.
• Surface: Be mindful of playing surfaces. Very sticky indoor courts can increase rotational stress on the knee if the shoe grips too much.

6. Progressive Overload and Recovery

• Ensure training loads are increased gradually to allow the body to adapt.
• Prioritize adequate rest, sleep, and nutrition to facilitate recovery and repair.

When to Seek Professional Help

Any persistent knee pain, swelling, instability, or "giving way" sensation should prompt a consultation with a healthcare professional (e.g., sports physician, physiotherapist). Early diagnosis and intervention are crucial for effective management and preventing chronic issues or further injury.

Conclusion

The high-intensity, multi-directional nature of netball, combined with rules that demand sudden stops and pivots, places significant and unique stresses on the knee joint. While netballers are indeed susceptible to knee issues, understanding the underlying biomechanical factors and implementing targeted prevention strategies – particularly focusing on neuromuscular control, balanced strength, and proper movement technique – can significantly reduce the risk and help players enjoy a long and healthy career on the court.