Netball and ankle instability

Ankle injuries account for 31-42% of all injuries in netball (Hutson and Jackson, 1982 ) making them a high-risk injury, with ankle lateral sprains being the most popular of all lower limb netball injuries.

You are probably wondering why are they so common?

In netball, there are lots of stresses to the ankle which means the stability of the ankle is a must. A lot of people suffer from instability of the ankle and many studies show that there is a clear link between ankle instability and ankle injuries (Hubbard et al., 2007). Another issue is people suffer a lot from acute sprains and they ignore these and don’t fully rehab them.

In the future, this will affect your netball career as repetitive ankle sprains will affect your ankle joint.

Mechanism of injury for the famous ankle sprain

In netball, landing accounts for most ankle injuries. Just imagine you jump up to catch a ball then you go to land then instead of landing on your feet and in a good position your right foot twists inwards and causes you to land on the outside portion of your ankle. Yes, I can remember doing this a few times and it kills. This would be known as an inversion sprain, see the picture below.

How and why does this occur?

One reason is that when training/in-gameplay, fatigue can set in and our neuromuscular control, our unconscious activation of our dynamic restraints – which in netball will prepare our ankle when landing – may alter due to fatigue decreasing our ability to keep a stable ankle (Shaw et al., 2008).

Inversion sprains

• Anterior talofibular ligament (ATFL) is reported to be the weakest and likely to be the first ligament to be injured
• Calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL) are likely to follow injury of ATFL

Eversion sprain

This is less common in netball but can still occur. This sprain is the opposite of an inversion sprain and it is where you land on the inside of your foot. This is less common due to the strength of the deltoid ligament on the inside of your foot compared to the lateral (outside) ligaments, which are injured in inversion sprains.

Why is there so many ankle injuries in netball?

Netball is a sport, which involves a lot of jumping and landing with high ground reaction forces on the ankles. Rapid change of direction in netball can cause wrong placement of foot increasing chances of sprain. Many ankle injuries are ignored and being in a sport where a lot of ankle injuries occur, even if it’s just a low-grade sprain, it goes ignored which increases the chances of an ankle injury.

The nature of netball is very explosive with sprinting, jumping, landing, changing of direction and balance as a must otherwise you will end up falling on your face most of the time or injuring your ankle. Preventive measures need to be put in place for netballers to ensure we reduce the risk and keep everyone’s season injury free.

Management of ankle injuries

This is dependent on severity of ankle injury. If an ankle injury is severe it is advised that an x-ray is needed to ensure an ankle fracture is not present. An example of an acute ankle sprain management is rest, ice, compression, and elevation for the first 72hours then to ensure you then undergo a functional rehabilitation programme.

A study by McKay et al., 2001 showed that 55% of individuals who suffered an ankle sprain and then didn’t seek further treatment for the ankle had a decreased chance of the ankle ligaments healing properly. A lot of us do this, but it is important as a netballer due to the predominance of ankle injuries in the sport, it is essential that following an ankle injury you follow a functional rehab programme.

Rehabilitation is essential for the successful healing of the ankle, ensuring that the newly placed collagen fibres are stressed and forces applied within the ankle, to allow correct alignment of the collagen for a healthy ankle (Hubbard et al., 2007).

So why are so many people suffering from the instability of the ankle?

This is believed to be due to poor management of ankle injuries. For example, with an ankle sprain if treatment and rehabilitation were not applied to the ankle correctly this could mean netballers could be returning back to sport before ligaments have fully healed. If ligaments are not fully healed they could still be in the elongated state, causing an increase in joint movement, which means an increased chance of instability of the ankle and then an increased chance of re-injury.

Injury prevention

There are many ways to prevent ankle injuries from occurring however landing and changing direction seem to be the main areas in netball where these injuries occur.

Ways to prevent ankle injuries would be to increase the strength and stabilisation of your ankle. How would you do this? Easy, just follow some of the tips below which are outlined by England netball.

• Address weakness – you may know these but if not get someone to address them for you for example, are you stable when you land, are you landing with a stable base? Is your balance good? Can you change direction quickly with no feelings of instability in the ankle?
• Ensure you are playing netball regularly – attending training as well as games so your body is trained and used to the netball movements.
• Once weaknesses are addressed bring them into a participant-specific preventive programme or bring them into your warm up- practise jumping and landing, quick change of direction etc.

A good exercise for balance which England netball mentions, is to stand on 1 leg opposite a wall then make 20 chest passes to the wall whilst keeping balance then switching legs.

• Repetitive ankle sprains? Then think about using ankle support.

To wear an ankle support yes or no?

External ankle supports are used a lot through netball. It has been suggested that wearing ankle supports can increase your chances of a knee injury due to decreased ankle range of motion causing more load on the knee. In a study by Greene et al., 2014 this was not the case and highlighted some benefits of ankle supports.

Advantages:

1. Protect and prevent further ankle injury.
2. Gives enough stability to avoid inversion ankle injuries.
3. Shown to decrease the occurrence of ankle sprains, especially for people who have had previous ankle injuries.

Disadvantages:

1. Shown to reduce ankle range of motion- previous studies show increased loading of the knee leading to increased chances of a knee injury.
2. People become reliant on ankle supports, remember it is important to ensure your ankle is stable and don’t always take the easy option out such as wearing an ankle support.

If you are still feeling instability in your ankles/ pain refer yourself to a Sports Therapist so they can give a full assessment of your ankle and put together a sports and participant-specific rehab programme to treat or keep your ankle injury-free.

For any questions, feel free to get in touch by completing the form below.

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Jessica Woodhouse, BSc Sports Therapy MSST