Netball Knee Injuries: How Physiotherapy Gets You Back on Court

Knee injuries are common in netball, from twists and landings to overuse. Here is how physiotherapy treats them and gets you back on court, with a real SWITCH patient example.

Playing sports can lead to knee injuries

Switch physiotherapy can help people with knee injuries and it is one of the more common conditions that we help treat in our clinics in Maroubra, Penshurst and Concord. Stephanie visited our physiotherapy clinic in February so we could help her with a right medial meniscus injury she sustained while she was playing netball. This type of knee injury can be common for a sport like netball due to the amount of fast changes in directions, pivots or short bursts of movement.

Stephanie wanted to start playing netball again as she hadn’t played in a few years, she also wanted to start doing regular gym sessions as well. Although Stephanie knew she had to get treatment for her previously injured knee before she could do either of those physical activities.

So the team at Switch physiotherapy helped Stephanie create a personalised care plan that included;

• A 2.5 month physiotherapy program to help treat her knee pain
• A focus on regaining strength in the knee
• Work with improving her balance
• Correcting the alignment and muscle imbalances she had (crucial for sports)
• Sports specific rehabilitation

The results?

Stephanie was very diligent with her rehab and made a recovery probably faster than expected, but a lot of this was due to her focus and determination. She made a return to netball and has been playing three times a week, plus going to the gym.

Why do people suffer knee pain?

Most knees do not need rest. They need the right load at the right time.

The knee is one of the most common body parts to be injured as it is obviously the main parts of our body that we use to move. The most common types of knee injuries include sprains, strains, bursitis, dislocations, fractures, meniscus tears, and overuse injuries.

Everyone would realise that most knee injuries are generally caused by twisting or a bending force applied to the knee, or a direct blow typically from sports, falls, or accidents. Although risk factors can increase for knee injury when it comes to overuse, improper training, having osteoporosis or playing high-impact sports that involve sudden changes in direction like rugby league.

Normally you would notice signs of a knee injury when you feel pain each time you move it or put weight on it, or there is swelling. It is important to have a professional examine your knee and sometimes an X-ray or MRI may be done.

Treatment of knee injuries really depends on the type and severity of the injury and can involve RICE therapy (rest, ice, compression, elevation), physical therapy, immobilization, or even surgery. Prognosis for knee injury depends on the type and severity of the injury and the need for physical therapy or surgery.

What are the types of knee injuries that can cause pain?

Sports, falls, and motor-vehicle accidents account for the vast majority of knee pain and injuries to the knee. The different types of common knee injuries to the knee are defined by the affected anatomy of the knee and the mechanism by which it’s injured. When clients visit Switch Physiotherapy Clinics for knee pain it is typically if they have experienced it when;

• Walking, running or exercise
• Late at night or when the person gets up in the morning
• They hear clicking noise in one or both knees
• They experience swelling in the knee
• Have just had knee surgery
• Incur an injury from sport

Some other situations that can cause knee pain can be

• Getting injured from trying to carry a heavy load during training or working
• Being overweight
• Age
• Grounding and alignment

Knee sprains are injuries to the ligaments that hold the knee together. There are multiple ligaments that stabilize the knee and keep it in alignment. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) stabilize the knee in movement from front to back and cross each other in the middle of the knee joint. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) stabilize the knee so that the bones do not slide from side to side.

Ligament sprains are graded by the amount of stretching or tearing of the ligament fibers and how much instability it causes as follows:

Grade 1 knee sprain: The ligament is stretched and painful, but fibers are not torn and no instability is present.

Grade 2 knee sprain: The ligament fibers are torn partially, mild instability may be evident.

Grade 3 knee sprain: The ligament fibers are completely torn and the knee is unstable.

Knee strains occur when tendons or muscles surrounding the knee are stretched, usually due to hyperflexion or hyperextension of the knee. These strains can lead to pain outside of the knee joint but can cause dysfunction of the normal range of motion of the knee. The patellar tendon stretches from the lower kneecap to the front of the tibia bone at the front of the leg.

Knee bursitis occurs when a fluid-filled pouch (called a bursa) in the knee is irritated, inflamed, or infected. Bursas are fluid-filled sacs located around joints that act as shock absorbers that minimize the friction between various tissues, such as the muscles and tendons around the joints. In the knee, there are two main bursas, one above the kneecap (patella), and one below the knee joint near the front of the tibia bone.

Tears of the meniscus can occur from damage to the inside of the knee. The medial and lateral menisci (plural of meniscus) are semi-round, articular cartilage that act as shock absorbers and smooth cushions for the thighbone (femur). These menisci can be injured acutely or can become dysfunctional gradually due to overuse and/or aging.

Knee joint dislocation can occur due to high-impact, large-force injuries to the knee (sports, motor vehicle accidents). This is a rare injury but causes severe damage to all the anatomical components of the knee and can include damage to the blood vessels and nerves about the knee. This requires emergency treatment or surgery.

The kneecap (patella) can dislocate to the side of the knee. Patellar dislocation can be very painful but is generally not life-threatening and can be treated by popping it back into place (reduction of the patella), splinting, and physical therapy.

Knee fractures occur from direct blows to the bones. Patella, or kneecap, fractures occur when a person falls directly down onto the knees and the kneecap cracks due to the force. Collapse of the top of the tibia bone in the knee (tibia plateau fracture) can occur from sudden compression injury to the knee, especially in people with osteoporosis. Other fractures of the long bones (fibula, tibia, and femur) are rare with isolated injures to the knee.

Other overuse injuries of the knee include patellofemoral pain syndrome (often referred to as “runner’s knee,” which causes pain on the front of the knee) and weakness and degeneration of the cartilage under the kneecap (chondromalacia patella). These injuries are due to an accumulation of repetitive damage to the knee structures. Congenital knee problems or improper mechanics of the knee movement may cause this.

Osteochondritis dissecans is a joint disorder that occurs most commonly in children. Bone and cartilage beneath the joints loses its blood supply, resulting in joint pain and stiffness. This condition typically affects the knees, but it can also affect other joints such as elbows and ankles.

What will your physio ask you if you experience knee pain?

• How long have they had the pain

• How bad is the pain

• How much exercise do you do

• What type of exercise and for how long

• When is the pain worse

• What treatment have they already tried

What are some strategies used to avoid knee pain?

• See a physio as soon as you first experience the pain so it doesn’t get worse

• Weight loss so that you can reduce the force being taken on your knees

• Movement and exercise, at least 30 mins of low intensity exercise a day

• Stretching exercises

• Listen to your body, do not over load your knees with incorrect and repetitive movements

• Improve grounding and alignment – making sure your hip, knee and foot are aligned whilst walking

Switch Physiotherapy can help you deal with knee pain by helping you find the root cause of the pain, helping to create an exercise program, treating the pain with hands on treatment or helping you get involved in group exercise classes. Switch physio offers pilates classes or movement and stability classes that are run by a physiotherapist to assist with ongoing rehabilitation or general exercise and fitness.

Frequently asked questions

What knee injuries are common in netball?

Twisting injuries, ligament strains and overuse problems are common from the quick stops and landings.

Do I need surgery for a netball knee injury?

Often not. Many respond well to physiotherapy. Your physio and doctor help you decide.

When can I return to netball after a knee injury?

Once strength, control and confidence are restored and you meet return-to-sport criteria.

How do I prevent netball knee injuries?

Build leg strength and landing control, warm up well, and address any niggles early.