netball ankle

Netball Ankle Injuries – Part 2

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Author: Tim Welsh (Physical Performance Coach)

So… We’ve recognised the enormity and spread of acquiring an ankle injury within netball, and discussed some key areas for minimising the risk – this is all well and good, but what can you do now?

Let’s go over some basic exercises that you can complete at home, training, or in the gym to provide structural integrity to your ankles, minimise the risk of injury, and maybe even offer some benefit to your performance.

When looking at the risk of ankle injury, the two major areas assessed in the previous article were:

• Jumping and landing manoeuvres

• Change of direction through agility acts

Whilst we have considered the risk of injury within these two facets, we don’t need to be scared! The idea isn’t to head out onto the court cautiously jumping; rather to be smart with our training and enter the game physically prepared.

Top 5 exercises to build lower limb strength:

1. Single leg hop and stick.

Given that a netball game can move at a rapid pace, we often see players of all positions diving to force the intercept, jumping into an awkward position to receive the ball, or leaping to provide defensive pressure. Further compounding the challenge of this is the step ruling, often forcing players to immediately stop and hold their ground following this awkward landing. By working on our single leg hop and stick exercise, we can look to increase the strength of the musculature and connective tissue around the joint, increase proprioception (feel) and incidentally balance, along with autonomic recall of appropriate form when performing any single leg jump or land throughout a game or training. This exercise can be completed at home by using any obstacle of appropriate height e.g. cones, balls, be creative! The emphasis should be on landing in the strongest position you can manage – which will include some flexion at the knee and hips. Ideally, we want to keep the hips balanced and in line with the knee and ankle, avoiding lateral movement at these joints, whilst ‘giving’ at the knee to absorb the load. You can do this with the aid of a mirror, partner, or even visual feedback from video recording on your phone. In terms of volume there’s no real magic number, but we want to ensure we’re performing the skill enough to learn.

Let’s aim for at least three sets of five per leg twice per week, meaning that each leg performs at least 30 reps across a week period.

2. Lateral bounds

Given the constant nature of sideways movement throughout a game (4), and the fact that some of this movement occurs aerially, it’s always beneficial to develop our skills in this commonly ignored motor pattern which receives little designated attention. The most frequently reported method of a ‘rolled ankle’ is landing on the outside of the foot (1). If we can manufacture a similar landing pattern and correct our movements to land in a stable position, we decrease our risk of injury in this facet. For the purpose of the exercise we want to ensure that we are landing with our feet in appropriate line to the body, with toes pointing directly away from the body. Start with minimal distance, and then progress to efforts resulting in maximal distance. We can also progress the drill to hold distractions in the form of ball passing, or in to acts of agility in response to a stimulus of a partner suggesting an appropriate direction to travel in.

Let’s aim for at least three sets of five per leg twice per week

3. Standing single leg calf raises

We can’t really emphasise the importance of the strength of the supporting structures of the ankle enough when looking to maintaining integrity. The two calf muscles act as a plantar flexor for the joint – a movement we see when taking off from the ground, alongside contracting eccentrically upon landing (contracting whilst lengthening). A common misconception of plyometric based activities such as these jumps is that a strength stimulus is not elicited. Research shows that whilst plyometric tasks don’t offer superior strength gains when compared to traditional weight training, improvements in localised strength still occur (3). This means that while we do get some strength gains from jumping drills, overload for comes from constantly repeated exercises (i.e. body weight), or by adding a stimulus in the form of additional load (i.e. a dumbbell). Given that every step, jump, or landing we perform puts a great deal of load through the calves, and we may take 15,000+ steps a day, we can see the need for a directed and isolated stimulus to promote strength gains in this area.

This exercise can be self-directed in regards to the issuance of weight, however we should get to a point of completing around 15 loaded reps which elicit a great deal of fatigue for 5 sets.

4. Single leg arabesque (S/L RDL)

Netballer's need to become experts at being one leg - and the S/L RDL is a great way to improve your single leg balance while also working on hamstring and glute strength. Being able to control the body out through full range requires great strength and proprioception through the hip knee and ankle, all working together to ensure the body doesn't topple over. As the body reaches out long (stay strong from head to heel) the demands are increased on all the little control muscles in the feet to help stabilise the body, the hamstring is then the main driver to pull the body back to its upright position. Initially start this exercise with just body weight using the arms to help balance, but once this is nailed progress to adding weight to the movement, or go on an unstable surface. 

3 sets of 5 reps each leg

5. Barbell Back Squat

The back squat is synonymous with building major quad and glute strength, but one of the underlying factors is ankle mobility and stability. As we come down with a loaded bar, the entirety of the weight is spread across two points of contact – our feet. This means that our ankles act as stabilisers to ensure that force is applied through the body to the ground to generate movement. The notion of triple extension (simultaneous extension at the ankles, knee and hips) is present, replicating actions such as running and jumping, offering specificity to these tasks, although they look completely different. Any loaded squat will be beneficial if correct technique is ensued, with normal strength based squat protocol ranging from

four to five sets of three to eight reps.

Jump squats can be a great progression from the barbell back squat - In the previous article we discussed the importance of building muscle stiffness as a tool for both avoiding injury and improving performance. Work by Morgan and colleagues (2017) suggests that the use of a dumbbell jump squat targets the load around the ankle upon landing to the greatest magnitude, resulting in the best rates of development of muscle and tendon stiffness (2). We want to jump for maximal height, whilst following our key landing cues of ‘giving’ at the knee, and maintaining good joint alignment. A weight of 10-20% body weight is recommended, and given the additional load we want to keep our rep ranges relatively low.

Aim for three sets of six reps to begin with.

Three terms which are constantly thrown around by strength and conditioning and rehab specialists alike are to build robust, resilient and durable athletes. I feel these three terms sum up the ideals of ankle injury prevention perfectly. A netballer (along with their ankle joints) must be robust – strong and able to withstand tremendous force; they must be resilient – able to withstand that force again and again, continually progressing their worth; and finally they must be durable – tough, resistant, and long lasting.

Give these exercises a go in your own time and see what you think. Smart and effective athletes are always prepared!

References

(1) Hopper, D., Elliott, B., & Lalor, J. A descriptive epidemiology of netball injuries during competition: a five year study. British Journal of Sports Medicine. 29: 223, 1995. 

(2) Morgan, J., Hileman, L., Pollalis, S., Maeda, A., Jagodinsky, A., & Torry, M. Hip, Knee and Ankle Joint Power in Three Weighted Squat Jump Techniques. Medicine & Science in Sports & Exercise. 49: 127, 2017. 

(3) Sáez de Villarreal, E., Requena, B., Izquierdo, M., & Gonzalez-Badillo, J. Enhancing sprint and strength performance: Combined versus maximal power, traditional heavy-resistance and plyometric training. Journal of Science and Medicine in Sport. 16: 146-150, 2012. 

(4) Williams, R., & O’Donoghue, P. Lower limb injury risk in netball: A time-motion analysis investigation. Journal of Human Movement Studies. 49: 315-331, 2005. 

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