Protect Your Ankles this Netball Season! 6 Common Sense Physio tips
Netball can be quite destructive to your body. But it doesn’t have to be. One of the most frequent injuries we see from netball is ankle sprains. In this article we will look at the common lateral ankle sprain as opposed to a more complicated syndesmosis or less common medial ankle sprain. Jamie has previously written an article on syndesmosis or high ankle sprains here.
Why netball and why ankles?
Netball season is coming around again and it’s a sport with a high injury rate. In one season of the English Super League, 9 injuries were reported for every 1000 hours of play (training and competition) and 35% of these injuries were ankles. In Australia between 2011 and 2012 Netball accounted for almost 4% of all sporting related hospitalisations.
This is quite a bit considering all the sports available to our diverse country (the highest rate was AFL by the way at 8.8%). Also, to be hospitalised implies that you’ve done a properly decent injury.
Ankles are particularly at risk in netball due to the stop start nature of the sport. Not many sports demand that you stop within 1 step of receiving the ball. It’s especially difficult when you are more focused on catching something than landing.
Consequently there is a lot of force coming down from a height at all sorts of different angles. Your ankles have to cope with any landing that isn’t perfect. It doesn’t take much to get it wrong, or even just land on someone else’s foot.
The common rolled ankle
As I suggested above, the most common way to hurt your ankle is a lateral sprain. This is where your foot turns inwards and you go over the outside of the ankle. As a result there are 2 main ligaments that you can potentially tear – the anterior talofibular ligament and the calcaneofibular ligament.
If you do tear these ligaments the recovery can vary from short with no time off required, to long periods on the sideline and lots of physio. Some at times even require surgery if multiple ligaments are ruptured and the ankle is very unstable.
Having said that I have also seen clients cope exceptionally well and report no instability with previously fully torn lateral ankle ligaments. This was likely the result of them having some excellent lower limb muscle control.
1. Rehab and RICE
Rehab on these injuries can vary depending on the severity and complexity of the sprain. As with most injuries you should be following the RICE (rest, ice, compress, elevate) early then as the pain settles start to work on range of motion, strength and balance.
Usually we wouldn’t recommend you spend too long on crutches unless you have actually broken a bone. If you do spend too long not walking you run the risk of having a far stiffer ankle.
However as we always, prevention is better than the cure. One of the sayings about ankle ligaments is that they are like seat belts. They are always there but you hope you don’t have to use them. If you have rolled your ankle, getting proper rehab is part of preventing it happening again.
2. Taping or brace?
Why not both? You can actually tape under a brace if you need. However that will make your ankle particularly hard to move. A systematic review (basically a study that combines the results of any previous studies for better statistical analysis) showed that in elite and recreational athletes ankle braces reduced the incidence of ankle sprain by 69%.
Similarly, ankle strapping reduced the incidence of ankle sprain by 71%. As a result I would suggest go with whatever you prefer. The strapping is a bit less bulky so fits in a shoe better. Whereas ankle braces tend to be easier to get on and off and only require a one off purchase rather continuing to buy tape forever.
Here is a simple taping demonstration.
If you do get an ankle brace make sure it’s a decent one. The “ASO” brace has been one of the better ones on the market for a few years. There are also a few similar ones that have pretty much copied it and have the same effect. A sock or sleeve like thing from the chemist made of stretchy material or neoprene will keep you ankle warm but do nothing to prevent you injuring it.
3. Shoes
Can you spot the difference between running shoes and court shoes?
Running shoes are designed to go in straight lines. They are light and fast but provide little stability for your ankle in a sideways motion.
Netball shoes or court shoes are a little heavier and more durable. They are also generally a little wider and encompass the foot a little more to provide side to side stability.
Lots of netballers, even at an elite level, are still wearing running shoes as they are slightly lighter and can feel more nimble. However, with running shoes being narrower and less supportive laterally it is easy to fall over the outside edge of the shoe. This is where netball or court shoes can be of benefit. Also since court shoes are designed for court sports, they tend to last longer than running shoes on a netball court.
4. Fitter is better
For many injuries on the sports field fitness is a high prognostic factor. Ankles are no different. Getting fitter means that you won’t get tired as quickly. Consequently you spend more of the game or training with your muscles performing optimally. As you fatigue your muscle performance decreases.
As a result what may be an easy catch and land on one foot whilst twisting early in the first half can become quite a dangerous catch, land on one foot and roll your ankle late in the second half.
Getting fit if you have had a long off season or few seasons away can help reduce fatigue related risk. Generally for netball running is going to be better than say cycling or swimming. It is also useful if you add in some sprints, cutting and side stepping or hopping type drills into your fitness sessions.
5. Warm up
To have your muscles firing and ready to go at the start of a game a good warm up is crucial. And as I eluded to above, if the muscles are doing their job correctly hopefully you won’t roll your ankle and need to use the ligaments. For netball start with some light jogging, followed by some dynamic stretches, then progress to running side to side and twisting movements.
The final phase of any warm up needs to be dynamic and game specific. So for netball something like jumping and catching a ball in the air then landing. It is also useful to have not all the throws be perfect – not all the ones in your game will be!
At the elite level netballers are starting to more frequently warm up like contact sports. You will often see them jumping, catching, landing then having someone try to knock them off balance with a football style tackle bag. This makes sense considering how much incidental contact occurs out on the netball court.
To do a good warm up you need to safely replicate what is going to happen to your body in the game.
6. Recovery
Similar to being fit, if you aren’t recovering well after games or training then you’re potentially putting yourself in harms way for the next session. Jamie has previously looked at over-training in an article here. As a general rule good recovery means replacing lost fluid, eating well, sleeping well, and stretching where required.
Often the ability to recover is what separates an elite athlete from a weekend warrior. Elite athletes will be able to complete their next training session more effectively rather than be in a fatigued state during that next session.
So to recap:
- Rehab any of your previous injuries properly. The highest predictive factor for you getting injured is a previous injury.
- Figure out if you need/want to strap your ankle or put it in a brace. Get a good brace. It will pay for itself in physio.
- Decide if your shoes are appropriate for your body and style of play.
- Get yourself fit and strong over the pre season.
- Warm up your ankle stabilisers with some netball specific drills and movements.
- Play!
- Recover like an athlete.
References:
https://bjsm.bmj.com/content/51/4/297.1
https://www.aihw.gov.au/getmedia/5079eecc-944d-4c7e-8e4f-04f03dbd7c97/18053.pdf.aspx?inline=true
https://www.sciencedirect.com/science/article/pii/S1440244009001091
