The netball injury evidence base: a scoping review of methodologies and recommendations for future approaches

BACKGROUND

Netball is a sport with a large participation base and a high risk of injuries. Effective injury prevention strategies are dependent upon a clear understanding of injury issues, aetiology and mechanisms, requiring robust research methodologies to ensure a reliable evidence base. This scoping review aims to identify the characteristics and range of netball injury research methodologies, to inform recommendations for future research.

METHODS

A systematic search of SPORTDiscus, MEDLINE, CINAHL and Academic Search Complete, PubMed, Scopus and Web of Science, from 1985 to May 2023 identified relevant studies. Inclusion criteria included peer-reviewed studies assessing injury incidence, aetiology and mechanisms in netball.

RESULTS

Following screening, 65 studies were included (68% descriptive epidemiology, 32% analytic epidemiology). Descriptive epidemiology reported data from hospital/clinic and insurance databases (57%) and netball competitions (43%). Only two studies used ongoing, systematic injury surveillance in netball cohorts, and significant heterogeneity existed in study designs, data collection methods, injury definitions and injury incidence rates calculations. Studies assessed a limited number of risk factors (descriptive competition studies: median: n = 4; analytic studies median: n = 6), with 76% using a simplistic reductionist approach to determine causality. Basic descriptions and retrospective recall of injury mechanisms reduced accuracy. Only two studies conducted comprehensive assessments of injury mechanisms using video-based methods.

CONCLUSION

To establish an accurate netball injury evidence base, future research should prioritise the development of reliable, continuous surveillance systems. The International Olympic Committee (IOC) consensus statement guidelines are recommended for accurate injury data collection and reporting. A multifactorial approach should be adopted to assess the complex interaction between multiple risk factors, player load and the injury inciting event. Comprehensive descriptions of injury mechanisms using video methods, alongside descriptions from medical staff are recommended. This information is crucial for developing targeted prevention strategies.

Normative Standards for Isokinetic and Anthropometric Classifications of University-Level Netball Players

CONTEXT

The purpose of the study was to develop normative ranges and standards for knee and shoulder isokinetic and anthropometric values. These standards can be qualitatively interpreted and allow practitioners to classify isokinetic and anthropometric values more objectively for university-level netball players.

DESIGN

Posttest only observational study design. All players were only evaluated once during the in-season to generate normative ranges.

METHODS

A total of 51 female players volunteered. Participants were evaluated on an isokinetic dynamometer at 60° per second to obtain knee-extensor and knee-flexor values as well as shoulder-flexor and shoulder-extensor values. A total of 16 anthropometric variables were collected including stature, body mass, 8 skinfolds, and 6 circumferences. Between-group differences were calculated to determine whether playing level was a differentiating factor in data.

RESULTS

Normative standards were developed for isokinetic parameters associated with the knee and shoulder joints as well as skinfolds and circumference measures. No statistically significant between-group differences were evident (χ2Kruskal-Wallis[2] = 3.96, P = .140).

CONCLUSION

These standards can be used by coaches and practitioners to set attainable goals for individual players or those from secondary leagues, classify individual and team-based performances, and facilitate decision-making processes.

Effects of Age and Playing Position on Field-Based Physical Fitness Measures in Adolescent Female Netball Players

This cross-sectional study investigated the impact of age and playing position, controlling for maturity, on physical fitness indicators in 303 adolescent female netball players aged 12.0 to 15.9 years. Assessments included estimated maximal oxygen uptake (VO2max) via the 20 m shuttle run test, 10 m and 20 m sprints, change of direction speed (CODS) using the 505 test, and muscle power via the medicine ball chest throw (MBCT) and countermovement vertical jump (CMJ). Participants were grouped by age (12 to 15 years) and playing position (non-circle and circle players), with age at peak height velocity as a covariate for maturity. Results revealed that, at 15 years, CMJ height was greater than at 12 years and 13 years (p < 0.05, partial η2 = 0.048). MBCT distance increased across age groups (p < 0.01, partial η2 = 0.323). Age had no impact on sprints, VO2max, or CODS. Non-circle players outperformed circle players in the 10 m sprint (p = 0.042, partial η2 = 0.016) and 20 m sprints (p = 0.010, partial η2 = 0.025) and displayed higher VO2max (p < 0.001, partial η2 = 0.036). Circle players were taller (p = 0.046, partial η2 = 0.014) and heavier (p < 0.001, partial η2 = 0.040) than non-circle players. Playing positions showed no differences in CMJ and MBCT. In adolescent female netball players, only muscle power is influenced by age, while non-circle players exhibit superior aerobic fitness and speed compared to circle players. Coaches may be able to utilize the distinct age and playing position traits of adolescent netballers to inform player selection and design targeted training programs.

A cross-sectional retrospective survey of injury situation and prevalence in female recreational netball players with a focus on knee injuries

OBJECTIVES

To examine situations of injury and injury prevalence in female adult recreational netball players with a focus on knee injuries.

DESIGN

Cross sectional retrospective online survey.

PARTICIPANTS

193 female adult recreational netball players.

MAIN OUTCOME MEASURES

Any injury sustained in the previous 12 months, situation of injury, any knee injuries sustained in the previous five years, the length of time unable to play netball, and knee injury management.

RESULTS

In the previous 12 months, 61% of respondents sustained injury to the lower limb, and 27% to the upper limb. Lower limb injury situations were mostly landings (46%). Upper limb injury situations were mostly collisions with an opponent (27%). 46% reported sustaining a knee injury in the previous five years. Following knee injury, players were unable to play netball for 6.8 ± 7.0 months (training); and 8.2 ± 7.4 months (matches) respectively.

CONCLUSIONS

Lower limb injury is more common than upper limb injury in recreational adult female adult netball players. Landing was the most common situation of injury for the lower limb including knee injuries. In the previous five years, nearly half of the players had sustained a knee injury resulting in more than six months out of the game.

A Comparison of the External and Internal Demands Imposed during Conditioning Training and Match-Play in Semi-Professional and Development Female Netball Players

This case series, team-based study aimed to compare the demands imposed during conditioning training and match-play in netball players. Female netball players competing at semi-professional (n = 9, age: 22.2 ± 3.8 years) and development (n = 9, age: 22.3 ± 2.9 years) levels had their internal (rating of perceived exertion (RPE)) and external (relative PlayerLoad (PL) in total and in the forwards, sideways, and vertical vectors) loads measured during conditioning-based training sessions and matches in a season. Demand variables were compared between conditioning and match-play across all players and according to position in each playing level. Conditioning training imposed higher relative PL in total and in each vector compared to match-play in semi-professional and development players (small to large effects). In contrast, RPE was significantly (p = 0.006) higher during match-play than conditioning training in semi-professional and development players (medium effects). Furthermore, according to playing position, significantly higher relative PL variables were evident during conditioning training than match-play in wing attack and goalkeeper semi-professional players and in goal attack, goal shooter, goal keeper, and goal defence development players. These results suggest conditioning training practices elicit adequate external intensities but inadequate internal intensities relative to match-play across positions in semi-professional and development netball players.

The Applied Sports Science and Medicine of Netball: A Systematic Scoping Review

BACKGROUND

Netball is the one of the most popular women's sports in the world. Since gaining professional status in 2008 there has been a rapid growth in research in the applied sports science and medicine of the sport. A scoping review of the area would provide practitioners and researchers with an overview of the current scientific literature to support on-court performance, player welfare and reduce injury.

OBJECTIVE

The primary objective was to identify the current research on the applied sports science and medicine of netball. Additionally, the article provides a brief summary of the research in each topic of sports science and medicine in netball and identifies gaps in the current research.

METHODS

Systematic searches of PubMed, SPORTDiscus, MEDLINE and CINAHL were undertaken from earliest record to Dec 2020 and reference lists were manually searched. The PRISMA-ScR protocol was followed. Studies were eligible for inclusion if they investigated netball as a sport or the applied sport science and medicine of netball athletes.

RESULTS

962 studies were identified in the initial search, 150 of which met the inclusion criteria. Injury was the most highly investigated sport science and medicine topic (n = 45), followed by physical qualities (n = 37), match characteristics (n = 24), biomechanics (n = 15), psychology (n = 13), fatigue and recovery (n = 9), training load (n = 4) and nutrition (n = 3). A range of cohorts were used from school to elite and international standards. All cohorts were female netballers, except for one study. A rapid growth in studies over recent years was demonstrated with 65% of studies published in the last decade. There still remains gaps in the literature, with a low evidence base for nutrition, training load and fatigue and recovery.

CONCLUSION

This scoping review summarises the current evidence base and key findings that can be used in practice to enhance the applied sport science and medical support to netball athletes across a range of playing standards, and support the growth of the sport. It is evident that netball as a sport is still under-researched.

Body composition in professional female netball players within and between seasons: a cohort study

Background

There is limited information on the physique attributes of female netball players from the highest playing standards and the typical body composition changes that occur with training and competition in these athletes. The purpose of this study was to examine the body composition of professional female netball players and changes that occur within and between national premier netball seasons.

Methods

Dual-energy X-ray absorptiometry (DXA) assessments were conducted in 20 female netball players (age = 26.5 [4.7] years, body mass = 77.3 [9.7] kg, stature = 182.7 [9.5] cm) contracted to a Suncorp Super Netball team. Total body lean mass, fat mass, bone mass and bone mineral density were derived for 127 assessments collected over three seasons. Linear mixed effects modelling was used to examine changes in body composition measures within and between seasons.

Results

Goal circle players were heavier (12.3 [3.5] kg, p < 0.001, g = 1.51) and taller (15.0 [2.7] cm, p < 0.001, g = 2.30) than midcourt players, and midcourt players had greater lean mass (3.1 [1.6] %, p = 0.07, g = 0.85) and less fat mass (-3.3 [1.7] %, p = 0.06, g = -0.84) than goal circle players when values were normalised to body mass. Players achieved increases in lean mass (2,191 [263] g, p < 0.01, g = 0.45) and decreases in fat mass (-835 [351] g, p = 0.09, g = -0.16) following a preseason preparation period. There were no changes in lean mass (-394 [295] g, p = 0.54, g = 0.07) or fat mass (102 [389] g, p = 0.99, g = 0.04) from the start to the end of the 14-week competition period.

Conclusions

Professional female netball players achieve small changes in lean mass and fat mass during preseason preparation and maintain their physique over the competitive season. The results of this study can inform practitioners on the training content necessary to promote or maintain desired body composition changes in these athletes.

Morphological and skill-related fitness components as potential predictors of injury in elite netball players: A cohort study

BACKGROUND

A limited number of studies on the epidemiology of injuries and fitness profiles of netball players in South Africa have been conducted, but no research on the potential morphological and skill-related fitness predictors of injuries could be located.

OBJECTIVES

We investigated whether morphological or skill-related factors measured in the pre-season could predict injuries sustained in-season.

METHOD

In our cohort study, 77 under-18 (U18), U19, U21 and senior elite netball players underwent pre-season testing including anthropometry, balance, flexibility, explosive power, upper and lower body strength, core strength, speed and agility testing. A questionnaire was used to collect demographic data, elite-level experience and injury history. Injuries in pre-season, training and matches were recorded during the subsequent 2017-2018 season using an injury profile sheet.

RESULTS

Amongst the 77 players who underwent pre-season fitness tests, 33 players (42.9%) had at least one injury. Regarding player morphology, a significant association of body mass and body fat percentage with injury risk was found in a simple logistic regression. In a multiple logistic regression analysis, only fat percentage (p = 0.0508) remained a significant predictor of injury at the 10% significance level, with higher fat percentage being associated with lower injury risk.

CONCLUSION

Heavier players and players with a higher fat percentage had a decreased injury risk.

CLINICAL IMPLICATIONS

As a result of the apparent protective effect of heavier weight of players, referees should more strictly enforce the no-contact rule in netball. Further research on functional movement screening as a tool for potential prediction of injury in netball is recommended.

Short and long versions of a 12-week netball specific neuromuscular warm-up improves landing technique in youth netballers

OBJECTIVE

To investigate the efficacy of two 'NetballSmart', netball specific warm-ups in improving landing technique measures in New Zealand secondary school netball players.

DESIGN

Multi-site cluster experimental trial.

PARTICIPANTS

77 youth participants, mean ± SD age = 15.8 ± 0.9 were recruited from secondary school netball teams.

SETTING

12 teams from 6 schools performed either the NetballSmart Dynamic Warm-up (NSDW) (n = 37); or Power warm-up (PWU) (n = 40), three times a week for 12 weeks. All players within a school (2 teams) were assigned the same warm-up, avoiding treatment contamination.

MAIN OUTCOME MEASURES

A series of unilateral and bilateral drop vertical jumps on to a portable force plate were completed by all participants. Measures included peak vertical ground reaction force (GRF) for single-leg and bilateral landings; frontal plane projection angle (FPPA) for right and left single-leg landings and Landing error scoring system (LESS) for bilateral landings. Paired t-tests were used to assess mean differences pre and post the warm-up. Generalised linear mixed effects models were developed to evaluate the effects between the NSDW and PWU groups.

RESULTS

Significant improvements were found in all the landing technique outcome measures for both warm-up groups (ES Range- GRF = -0.6 to -1.1; FPPA = 0.8 to 1.2; LESS = -1.6 to-3.2; p < 0.05). Results of mixed effects models revealed that there was only a significantly greater improvement in LESS for the PWU group (β = -0.30, p = 0.001).

CONCLUSION

Results show both warm-ups can improve landing technique measures in youth secondary school netball players. It is recommended that coaches should consider implementing one of the two warm-ups in their netball programmes. Their choice of warm-up will likely be dependent on their environment and time demands.

Comparison of Physical Profiles of State-Level Netball Players by Position

Graham, S, Duthie, G, Aughey, R, and Zois, J. Comparison of physical profiles of state-level netball players by position. J Strength Cond Res 34(9): 2654-2662, 2020-Understanding the physical profiles of state-level netball athletes provides conditioning professionals with testing norms and an understanding of important capacities within particular positions. The purpose was to examine positional differences in physical capacities of state-level netball athletes. Forty-six state-level netball athletes completed physical capacity assessments in the second week of their preseason, over 2 seasons. Tests included stature, 20-m sprint (with 5 and 10 m splits), 505 change-of-direction, countermovement jump, single-leg bounding, and the Yo-Yo intermittent recovery test level one. A linear mixed-model with fixed and random effects was used in conjunction with magnitude-based inferences to determine meaningful differences with 90% confidence limits (CLs). Midcourt athletes were shorter in stature than shooters (effect size [ES]: 1.26, CL 0.88-1.63) and defenders (-2.58, -3.35 to -1.80). Midcourt athletes were faster than shooters and defenders in linear acceleration over 5 and 10 m distances and 505 change-of-direction (ES range: -0.34 to -0.59). Shooters presented poorer intermittent endurance than midcourt (-0.82, -1.34 to -0.31) and defenders (-0.56, -1.19 to 0.07). Defenders jumped higher than midcourt athletes (-0.56, -1.30 to 0.19) and shooters (-0.61, -1.18 to -0.04), and possessed greater bounding ability compared with shooters (ES range: -0.23 to -0.57). Midcourt athletes require a more holistic set of physical capacities including acceleration, change-of-direction, jumping, and intermittent endurance. For defender and shooter positions, results indicate physical requirements that may be more specific to their positions. Conditioning professionals can use these findings to target specific physical qualities to maximize position-specific performance.

Situations and mechanisms of non-contact knee injury in adult netball: A systematic review

OBJECTIVES

Noncontact knee injuries in netball are a concern due to a range of negative consequences. To reduce the number of injuries, identifying the situation and mechanism of injury is important. This systematic review examined the literature reporting the situation and mechanism of noncontact knee injury in netball.

DESIGN

Systematic Review.

METHODS

PRISMA guidelines were followed and specific key-term combinations used to search databases. Descriptive and analytic-observational studies reporting the situation or mechanism of noncontact knee injury in females playing netball were included (evaluated using frequency counts).

RESULTS

Six articles were included (combined sample 11,401). Players self-reported the situation of injury in five studies, only one study reported both the situation and mechanism of injury. Landing was the most reported situation of knee injury, representing 46.6% of all knee injuries whilst knee abduction (valgus) collapse was the most observed mechanism. Situation and mechanism of noncontact knee injury in netball were not adequately reported.

CONCLUSIONS

Despite the variations in reporting methods, landing is the most common situation of injury. As only one study reported mechanism of injury, it is difficult to draw conclusions but the mechanism of noncontact knee injury in netball appears similar to those identified in other female athletes.

Performance Profiling of Female Youth Netball Players

McKenzie, CR, Whatman, C, and Brughelli, M. Performance profiling of female youth netball players. J Strength Cond Res 34(11): 3275-3283, 2020-The purpose of this study was to investigate the physical performance characteristics of New Zealand secondary school netball players to provide a physical performance profile and determine whether there are differences between playing grade and playing positions for this group. A total of 102 female netball players (mean ± SD: age 13.3 ± 0.50 years, height 166.95 ± 5.72 cm, and body mass 60.94 ± 12.80 kg) participated in this study. Measurements included anthropometry, horizontal and vertical jump performance, balance, core strength, change-of-direction speed, and split sprint times. Magnitude-based inferences were used to determine differences in all measures. Grade 1 players jumped further and higher (effect size [ES] = 0.41-1.37) and ran faster with small to moderate differences. They demonstrated faster change-of-direction speed (ES = -0.73 to -1.31), greater core strength (ES = 0.28-1.17), and a faster time-to-stabilization (ES = -0.69). Grade 2 circle players jumped further (ES = -0.29), compared with noncircle players who jumped higher (ES = 0.35). Noncircle players had faster sprint and change-of-direction speed (ES = -0.33 to -0.55) and measures of balance (ES = -0.47 to 0.55). Grade 1 circle players were found to be faster over 20 m (ES = 0.75). The results of this study showed differences in the physical performance capabilities between youth netball players competing in different grades, as well as differences between playing positions. These findings have provided a physical performance profile of female youth netball players in New Zealand, suggesting that physical performance measures could be used for position-specific training and talent identification and selection.

Ten-year nationwide review of netball ankle and knee injuries in New Zealand

OBJECTIVES

To review netball ankle and knee injuries between 2008 and 2017.

DESIGN

Audit of insurance injury claims.

METHODS

Data were divided into 5 equal year groups (2008/9, 2010/11, 2012/13, 2014/15, 2016/17), and 3 age groups (10 to 14 years, 15 to 19 years, 20 to 24 years old). Raw injury counts and injury rates per 1000 affiliated players were reported. Changes in injury rates over the 10-year period and differences between age groups were expressed as Incident rate ratios (IRRs). A Shewhart control chart was created to identify monthly injury patterns.

RESULTS

10-14-year-olds showed the biggest increase in injury counts (ankle 84% increase and knee 133% increase). 20-24-year-olds had the highest mean injury rate over the ten-years (ankle = 77.8, knee = 71.6 injuries/1000 players). 10-14-year-olds had the biggest increase in risk of injury between 2008/09 to 2016/17, (ankle IRR = 2.0; knee IRR = 2.5), 15-19-year-olds (ankle IRR = 1.4; knee IRR = 1.5), 20-24 year olds (ankle IRR = 0.5; knee IRR = 1.9). The older two groups had a significantly higher mean risk of ankle and knee injury (IRR = 1.9 to 2.2; p < 0.001). Higher than expected yearly injury incidence was repeatedly seen in 10-19-year-olds.

CONCLUSION

Ankle and Knee injuries have increased with the biggest increase in 10-19-year-olds. Injuries in 20-24-year-olds still represent the highest cost and continue at a higher rate than in younger players. Spikes in injury are likely associated with intense periods of trialling and tournament play.

Physical movement demands of elite-level netball match-play as measured by an indoor positioning system

Physical movement demands in elite netball match-play have been limited to notational analysis or accelerometer-derived measures, due in part to the indoor environment in which they are played. Commercially available local positioning systems (LPS) using ultra-wideband communication have been designed to bring similar capabilities as global positioning systems (GPS) to indoor environments. This study aims to quantify both spatiotemporal and traditional accelerometer-derived measures, to assess the movement demands of all playing positions, during Australian national netball league matches. Total distance, metreage per minute, acceleration density, acceleration density index, acceleration load, jumps, velocity bands, acceleration bands and PlayerLoad variables have been presented for each position. Mean total distance-covered in match-play differed substantially between positions. Centre position accumulated the highest mean distance (5462.1 ± 169.4 m), whilst the Goal Shooter consistently covered the lowest mean distance (2134 ± 102.6 m). Change of direction relative to movement area was highest for the two most restricted positions based on average acceleration per 10 m covered during match-play (Goal Shooter; 7.21 ± 0.88 m · s ^{- 2} and Goal Keeper; 6.75 ± 0.37 m · s ^{- 2}, remaining positions; 5.71 ± 0.14 m · s ^{- 2}). The positional profiles outlined in this study can assist skill and conditioning coaches to prescribe training sessions that will optimise the athlete's physical preparation for the demands of competition.

The effect of the NetballSmart Dynamic Warm-up on physical performance in youth netball players

OBJECTIVES

To investigate the efficacy of the NetballSmart Dynamic Warm-up in improving physical performance measures in New Zealand secondary school netball players.

DESIGN

Cluster randomised controlled trial.

SETTING

A seven-week intervention study in secondary school netball.

PARTICIPANTS

81 youth netball players (Intervention group, n = 45; Control group, n = 36).

MAIN OUTCOME MEASURES

Performance measures included prone hold, change of direction, sprint, vertical and horizontal jump, Y-balance and time-to-stabilisation. Mixed effects models and t-tests were used to determine significant differences of pre and post measures between groups.

RESULTS

Significant improvements in prone hold (β = 20.46 s; p = 0.01) and vertical jump (β = 6.73 cm; p = 0.01) were found in the intervention group compared to the control group, while horizontal jump was found to significantly decrease (β = -9.86 cm; p = 0.03) in comparison to the control group.

CONCLUSIONS

The results of this study show the NetballSmart Dynamic Warm-up can improve some physical performance measures in youth netball players. It is recommended that coaches should consider implementing the warm-up in their netball programmes.

Physical profiles of elite, sub-elite, regional and age-group netballers

Physical profile data from elite, sub-elite, regional, under 21s (U21), under 19s (U19) and under 17s (U17) (n = 845) players from a state netball association in Australia were analysed. Within season changes were examined for the elite and sub-elite players. Longitudinal changes were examined for the elite across four consecutive netball seasons. Elite were significantly older (24.3 ± 3.4years), taller (182.4 ± 7.2cm) and heavier (73.42 ± 6.95kg) than other playing levels (p < 0.001, ES 0.49-3.26) and had higher vertical jump (VJ) data compared to all groups (p < 0.001, ES 0.47-0.93). U17's were significantly faster than elite, sub-elite and U19 players over 5m (p < 0.05, ES 0.36-0.58) while elite were faster over 20m compared to all groups (p < 0.01, ES 0.45-0.72). Elite achieved a greater distance (1350.8m; p < 0.05, ES 0.32-0.50) in the Yo-YoIRT1 compared to the sub-elite, regional, U19 and U17. VJ height significantly increased from the 2014 (51.6 ± 4.8cm) to the 2017 season (59.6 ± 6.3cm) for the elite players (p < 0.01, ES 1.18). Yo-YoIRT1 test scores increased significantly between the pre-season and in-season phases (p < 0.05, ES 0.17).