7   SA JournAl of PhySiotherAPy 2012 Vol 68 no 3 

Research

Article

INjUry preValeNce oF NeTball 
PLAYERS IN SOUTH AFRICA: 

THe Need For INjUry preVeNTIoN

Correspondence Author:
Tanushree Pillay 
47 Villeria Plataan Road,
Durbanville
7550
Cape Town
Email: tanushreeza@yahoo.com

AbSTrAcT:  This study aimed to establish baseline data for injury prevalence, 
mechanism of injury, injury severity and management of injuries in netball players 
in South Africa. A cross sectional descriptive design was employed to collect data 
by means of a questionnaire in 2010.  Participants consisted of 254 netball players 
who participated in a netball tournament. Permission was obtained from all the 
relevant organizations and informed consent obtained from the participants. The 
general injury rate was 61.8% with an injury rate of 1.9 injuries per player for 
the past season. The most commonly injured structures were the ankle 37.5 % and 
the knee 28.6% with the most common mechanism of injury being landing, 19% and 29% respectively. Of those who 
sustained injuries, 86 (44%) of the injured athletes’ sustained severe injuries, 31(16%) sustained moderate injuries 
and 78 (40%) sustained mild injuries. 67% of players reported they were able to continue with the game and 33% 
received medical assistance losing game and training time. The most common form of management accessed was 
physiotherapy, which accounted for 31%. It is evident that the ankle and knee injury rates amongst South African 
netball players are high in comparison to other netball playing nations. Injury surveillance is an integral part of 
developing preventative measures. The article lays a platform for developing these strategies against the backdrop of 
its findings and comparison with other authors. 

Key wordS:  INJury prEvAlENcE, NETbAll, MEchANISM of INJury.

pillay T (MSc)1 
Frantz JM (PhD)1

 1 University of the Western cape.

grammes, the extent and nature of the 
sports injury problem needs to be iden­
tified to define target groups for preven­
tion (Emery et al 2006).

Sport injuries are a cost burden on 
both individuals and society with respect 
to the duration and nature of treatment, 
the amount of sport and working time 
lost, permanent damage and disability, 
reduced quality of life and monetary 
costs (Parkkari et al 2011). It is therefore 
evident that preventative measures with 
regard to injury prevention strategies 
within South African sport are needed. 
Netball is a physically demanding game 
that requires high levels of endurance, 
strength, speed, power, agility and flexi­
bility (Murphy 1998). It has a high impact 
on joints due to the stop­start nature of 
the sport and the aerial requirements 
further predispose joints to injuries with 
considerable forces associated with land­
ing. Steele and Milburn (1987) noted 
vertical ground reaction forces up to 6.8 
x the body weight during landing. Joint 
motion and muscle activity are important 
in decreasing the impact forces associ­
ated with landing (McNitt­Gray 1991). 

INtRODuCtION
South Africa is a country that is unified 
by sport and this has been central to our 
nation building process through victo­
ries celebrated such as the 1995 Rugby 
World cup celebrated with our beloved 
Nelson Mandela. Netball in particular 
has received much support from the 
government, having being recognized as 
a very popular woman’s sport with high 
rates of participation. Linked to the high 
participation in the sport is a high preva­
lence of injuries. However, literature has 
shown that if effective injury prevention 
strategies are not in place, then the bene­
fits of sport and in particular in relation to 
non­professional sporting codes, may be 
lost (Chalmers 2002). As injury preven­
tion has become a major public health 
issue, the lack of systematic collection 
of sports injury­related data, particularly 
at a non­ professional level, is of con­
cern both nationally and internationally 
thus  creating a vacuum of validated data  
that forms the basis of injury prevention 
models (Chalmers 2002;  Macera and 
Pratt 2000). To counteract this negative 
effect by means of preventative pro­

Thus an understanding of these factors 
and mechanisms of injury can contribute 
to designing effective prevention and 
rehabilitation programmes.

Van Mechelen and Verhagen (2005) 
reported that measures to prevent sports 
injuries in young people should be based 
on knowledge of the incidence, likely 
severity of the particular injury and 
mechanisms that contribute to the risk 
of sustaining sport­related injuries. Once 
identified, preventive measures should 
be implemented and their efficacy eva­
luated. The authors emphasise that this 
process is important for all health pro­
fessionals involved in sports medicine 
including physiotherapist. The aim of 
this study was to establish baseline data 
for injury prevalence, mechanism of 



8   SA JournAl of PhySiotherAPy 2012 Vol 68 no 3 

injury, injury severity and management 
of injuries in netball players in South 
Africa, in order to establish a platform 
for further research in developing pre­
ventative measures.

MEtHODS
The study employed a cross­sectional, 
descriptive design as this presents a good 
framework to collect data on individual 
characteristics, including exposure to 
risk factors, alongside information about 
the outcome of injuries sustained. In this 
way cross­sectional studies provide a 
‘snapshot’ of the outcome and the charac­
teristics associated with it, at a specific 
point in time. The population for this 
study was netball players participating 
in a national netball tournament in South 
Africa during the 2010 netball season. 
Players represented 38 out of the 62 net­
ball playing regions in South Africa. The 
total number of players at the tournament 
was 360 and all were invited to partici­
pate in the study. The questionnaire used 
in this study was based on injury preva­
lence questionnaires that had been vali­
dated in previous studies (Walker 2010; 
Louw et al 2003). An injury was defined 
as any physical complaint sustained by 
a player that occurred during a match 
or training, irrespective of the need for 
medical attention or time loss from prac­
tices and matches (Fuller et al 2006). The 
main categories determined were expo­
sure time, type and location of the injury, 
injury severity and injury management. 
The revised version of the questionnaire 
was piloted for content validity using 

RESultS
The total sample consisted of 254 netball 
players of which 55 were club players, 
147 provincial players and 52 national 
players, thus yielding a response rate 
of 71%. Table 1 summarises the ages, 
starting age and playing years per each 
division.

The mean number of weekly training 
sessions reported was 3.7 and the mean 
number of gym sessions per week 
was 3.4 with at least 2 match days per 
week at all levels. Of the total number 
of participants, 61.8% (n=157/254) of 
play ers reported an injury within the 
last season. The injury prevalence at 
various levels was 54.5% (n=30/55) at 
club level, 59.2% (n=84/147) among 
provincial players and 84.3% (n=43/52) 
amongst national players. 

The injury prevalence according to 
body region is presented in Table 2. 
Among the 157 injured players, 301 
injuries were reported for the last season 
resulting in an injury rate of 1.9 injuries 
per player for the past season. The most 
commonly injured structures were the 
ankle and the knee.

Of the most commonly reported 
injuries (ankle and knee), the relation­
ship between the playing position and 
the commonly reported positions are 
reflected in Table 3. 

Provincial players sustained the high­
est percentage of ankle injuries 56.7%, 
followed by club players (22.5%) and 
national players (20.8%). In contrast, 
provincial players had the highest pre­
valence of knee injuries (61%), followed 

experts in the area of injury prevention 
and for face validity using a sub­sample 
of netball players (n=20). Reliability 
testing of the responses was done using 
a one­week test – retest technique on a 
subset of netball players (n=20). The 
responses were compared to assess 
the players’ ability to recall their injury 
occurrence. There was 100% agreement 
on 90% of the variables.

Ethical clearance was obtained for the 
study from the ethics committee of the 
University of the Western Cape. (Ref.: 
11/1/22) and permission to conduct the 
study was obtained from Netball SA  
and the tournament officials. Informed 
written consent was obtained from all 
the participants prior to completion of 
the questionnaire and confidentiality 
and anonymity was ensured to all par­
ticipants in a written letter detailing the  
purpose and procedures of the study. 
These were sorted into packs for each 
region together with stationery to com­
plete the questionnaire and were handed 
to each region’s manager. Managers 
were briefed at the manager’s meeting 
on day one of the three day tournament 
and were given a time and place for  
collection of the completed question­
naires. The packs were consolidated 
against the register of participating 
teams and all packs were collected 
including those not completed. Data  
was analysed using SAS V9 (SAS Inc. 
Cary, USA). Descriptive statistics were 
used and results are presented as percen­
tages, means and standard deviations.

Table 1: Sample description by age (n=254)

Playing level n label Mean STd dev. Min Max

Club 55 Age 24.13 6.27 16.00 44.00

Starting age of playing 12.01 3.24 6.00 21.00

Years played 12.11 6.23 0.00 28.00

Provincial 147 Age 23.89 5.10 14.00 42.00

Starting age of playing 11.48 4.61 5.00 33.00

Years played 12.40 6.15 0.00 31.00

national 52 Age 24.32 4.25 18.00 36.00

Starting age of playing 11.23 4.66 7.00 28.00

Years played 13.09 5.30 1.00 26.00



9   SA JournAl of PhySiotherAPy 2012 Vol 68 no 3 

by national players (26%) and club  
players (13%). The most common 
mechanism of injury for both the knee 
and the ankle injuries were landing with 
19% and 29% respectively. Tripping 
accounted for 8% of injuries in the ankle 
and 6% in the knee. The most com­
mon surface on which injuries occurred  
was outdoor concrete (29% and 13%) 
respectively among the knee injuries and 
ankle injuries.

Ankle and knee injury characteristics 
were classified as mild, moderate and 
severe according to symptoms reported 
by the participants and then further cate­
gorized by the researcher. Among the 
injured participants, 86 (44%) of the ath­
letes’ sustained severe injuries, 31(16%) 
sustained moderate injuries and 78 (40%) 
sustained mild injuries. Based on the 
injury severity, 67% of players reported 
they were able to continue with the  
game and 33% had to receive medical 
assistance together with a loss of game 
and training time. Of those athletes 

injured, 55% had access to professional 
help. The most common form of manage­
ment accessed was physiotherapy, which 
accounted for 31%, followed by doctor’s 
consultation (17%). Medical personnel 
cleared 66% of injured athletes for 
return to play after sustaining an injury. 
32.43% of club players accessed profes­
sional help in comparison to the 60.19% 
of provincial players and 73.81% of 
national players.

DISCuSSION
Limited literature exists on the 
prevalence of injuries among netball 
players in South Africa. This study high­
lighted an injury prevalence ranging 
from 55% at club level to 84% amongst 
national players with an injury rate of 
1.9 injuries per player over one netball 
season. This injury rate is higher (1.1) 
than that compared to the study by 
Hume and Steele (2000) but lower (2.6) 
than the study by McManus, Stevenson 
and Finch (2006).

The distribution of injuries across one 
season in the current study highlighted 
the ankle (37.5%) and knee joint (28.6%) 
as the most commonly injured struc­
tures. These findings compare similarly 
to a recent study conducted by Ferreira 
and Spamer (2010) in South African 
among university netball players who 
reported an injury prevalence of 39% 
and 28% respectively for the ankle and 
knee across one season. A longitudinal 
study conducted by Hopper, Elliot and 
Lalor (1995), over a period of five years 
in Australia, also reported high ankle 
injury prevalence. It is thus evident that 
the ankle and knee are the most common 
joints injured in netball and thus needs 
effective injury prevention strategies as 
these structures are subjected to increased 
physical stress during the sport. 

The primary mechanisms of injury 
were tripping and landing for both the 
ankle and knee injuries, which are simi­
lar to the findings in other studies by 
Ferreira and Spanner (2010). Landing 
has been reported as being directly 
related to injuries in the joints of the 
lower extremity (Hewett et al 1999) and 
was one of the primary causes of lower 
limb netball injuries. Hopper (1986 and 
Steele (1990) recommended that all net­
ball players regardless of age, should 
incorporate specific landing techniques 
to ensure that players use correct body 
mechanics when landing, especially after 
striding forward to receive a pass in 
order to minimize injury.

The majority of injuries reported were 
considered either severe (44%) or mild 
(40%). This even distribution of mild 
and severe injuries highlights the need 
for effective education and prevention 
strategies linked to the management 
of all injuries with varying severity. 
A shortcoming of this study is that the 
diagnosis of an injury cannot be con­
firmed, as injuries were self reported, 
and thus the characteristics of the injury 
may have lead to the injury being cate­
gorized into a classification more severe 
than what it could have been on further 
diagnosis. 55% of the injured sample 
accessed professional help with 31% 
of netball players attending a consulta­
tion with a physiotherapist. This could 
possibly be due to the high number of 
mild injuries reported. However, if left 

Table 2: General injury rate (n=301)

Body Region % (n)

Ankle 37.5 (113)

Knee 28.6 (83)

Lower leg, calf 7.3 (22)

Hand, wrist 6.7 (20)

Shoulder 6.0 (18)

Back 4.7 (14)

Thigh 3.3 (10)

Head, Neck, Chest 3.0 (9)

Elbow, arm 3.0 (9)

Table 3: reported ankle and knee injuries per playing position

Playing position no. of ankle injuries reported 
(n=113)

no. of knee injuries
(n=83)

Wing attack (37) 19% (n=21) 12% (n=10)

Centre (46) 16% (n=19) 28% (n=23)

Wing defense (33) 15% (n=17)  6% (n=5)

Goal attack (37) 15% (n=17) 19% (n=16)

Goal defense (38) 13% (n=15) 14% (n=12)

Goal shooter (28) 12% (n=14) 14% (n=12)

Goal Keeper (22) 10% (n=11)  6% (n=5)



10   SA JournAl of PhySiotherAPy 2012 Vol 68 no 3 

untreated or inadequately managed, the 
ramifications of minor injuries at club 
level could impact severely at a national 
tier by predisposing to further injury.

This highlights a need for sport medi­
cine professionals to focus on preventa­
tive measures as well as health promotion 
and injury prevention education within 
South African communities. Although 
preventative solutions are known to be 
multifaceted, there is a need for a con­
certed and coordinated intra­and inter­
sectoral approach to reducing the mag­
nitude and frequency of the burden of 
injury in netball. A motivation for this 
is to ensure that sports medicine adopts 
best practice principles to dealing with 
injury prevention. To date, preventative 
sports medicine has largely ignored the 
issue of how best to translate research 
evidence into effective interventions 
that have high adoption levels and there 
is a major gap in the international lite­
rature about how best to engage the 
target groups in sport safety to develop 
and implement injury prevention poli­
cies and practices. Consequently, there 
is very little guidance to inform decision 
– making or for identifying appropriate 
injury prevention strategies for specific 
sporting codes.

CONCluSION
Injury surveillance is an integral part of 
developing preventative measures and if 
physiotherapists are to influence sports 
injury prevention policies, there is a 
need for baseline data in order to inform 
prevention strategies. 

REfERENCES

Chalmers DJ 2002. Injury Prevention in Sport: 

Not Yet Part Of The Game. Injury Prevention (IV): 

iv22–iv25

Emery CA, Meeuwisse WH, McAllister JR. 

2006. Survey of sports participation and sports 

injury in Calgary and area high schools. Clinical 

Journal of Sports Medicine (16): 20­26

Ferreira MA , Spamer EJ 2010. Biomechanical, 

Anthropometrical and Physical Profile of Elite 

University Netball Players and the Relationship 

to Musculoskeletal Injuries. South African Journal 

for Research in Sport, Physical Education and 

Recreation. 32(1): 57­67.

Finch C 2006. A new framework for research 

leading to sport injury prevention. Journal of 

Science and Medicine in Sport. 9(1­2): 3­9

Finch C, Donaldson A 2010. A sport­seeking 

matrix for understanding the implementation  

context for community sport. British Journal of 

Sport Medicine. 44(13): 973­978

Fuller CW, Ekstrand J, Junge A, Andersen T, 

Bahr R, Dvorak J, Hagglund M, McCrory P, 

Meeuwisse W 2006. Consensus statement on 

injury definitions and data collection procedures 

in studies in football (soccer). British Journal of 

Sport Medicine. (40): 193­201

Hewett T, Lindendfeld T, Riccobene J, Nayes F 

1999. The effect of neuromuscular training on 

the incidence of knee injury in female athletes. 

A prospective study. American journal of sport 

medicine. Vol 27 no 6.

Hopper D, Elliot B, Lalor J. 1995. A descriptive 

epidemiology of netball injuries during competi­

tion: A five­year study. British Journal of sport 

medicine. (29): 223­228

Hopper D 1986. A survey of netball injuries 

and conditions related to these injuries. Australian 

Journal of Physiotherapy (32): 231­9

Hume P, Steele J 2000. A preliminary investi­

gation of injury prevention strategies in netball:  

Are players heeding the advice. Journal of Science 

and Medicine in Sport. 3(4): 406 – 413.

Kostopolus N, Dimitrios P. (2010). Injuries in 

Basketball. Biology of Exercise. (6.1): 47­55

Louw Q, Grimmer K, Vaughan K 2003. Knee 

Injury Patterns Among Young Basketball Players 

in Cape Town. South African Journal of Sports 

Medicine. 18(1): 9­15  

Macera C, Pratt M 2000. Public health sur­

veillance of physical activity. Res Q Exerc Sport 

71(2): 97—103.

McManus A, Stevenson M, Finch C 2006. 

Incidence and risk factors for injury in non­elite 

netball. Journal of Science and Medicine in Sport 

9(1­2): 119­124

McNitt­Gray JL 1991. Kinematics and Impulse 

Characteristics of Drop Landings from Three 

Heights. International journal of Biomechanics 

(7): 201­224.

Murphy LA 1998. Train for success: strength 

and conditioning for netball. Victoria, Australia: 

Bouquet Productions.

Parkkari J, Kujala U, Kannus P. 2001. Is it  

possible to prevent sports injuries? Review of 

controlled clinical trials and recommendations for 

future work. Sports Med 31 (14): 985­995.

Steele JR 1990. Biomechanical factors affecting 

performance in netball. Implications for improv­

ing performance and injury reduction. Sports 

Medicine, (10): 88 – 102.

Steele JR, Milburn PD 1987. Ground reaction 

forces on landing in netball. Journal of Human 

Movement Studies (13): 399­ 410

Van Mechelen W, Verhagen E 2005. Essay: 

Injury prevention in young people – time to accept 

responsibility. Medicine and Sport. Vol 366. www.

thelancet.com

Walker S 2010. Exploring the relationship 

between floor type and risk of injury in netball. 

The University of South Australia. http://sportsurf.

lboro.ac.uk/workshops/STARSS/SE/SW.pdf