The Silent Epidemic: Why Non‑Contact Injuries Are Surging in Netball and What We Can Do About It
- Harry Stamper
- Jul 5
- 10 min read
Introduction
Over the past decade and alarmingly so in the last three to five years—non‑contact lower‑limb injuries have risen sharply across women’s sport. In netball the trend is unmistakable: Anterior Cruciate Ligament (ACL) ruptures and severe ankle sprains now out‑number contact injuries in many elite leagues (BOA, 2024; Reuters, 2025). Within this post we will explore why this spike is happening, how the unique demands of netball magnify risk, and what coaches, players and governing bodies can consider doing to turn the tide.
As Head Strength & Conditioning Coach for Netball Ireland I have witnessed the impact first‑hand. Four significant non‑contact cases in just two seasons (2023‑2024): one ACL rupture and three grade‑III lateral ankle sprains, fractures and ruptures. Each incident kept the athlete off‑court for months, disrupted team cohesion, and placed additional strain on resources. My reflections on those cases, coupled with emerging research, form the backbone of this deep dive.
The Data: An Injury Curve That’s Bending the Wrong Way
(Sanchez et al., 2023)
Why Netball Is Uniquely Vulnerable
High‑Force, Single‑Leg Landings
During a game a typical jump‑receive can generate anywhere between 3.9–4.3× athlete body‑weight. This is a ground reaction force—higher than running (not sprinting) or football (Hollins, 2023).– Strict footwork rules mean athletes must decelerate instantly, often on a stiff knee, increasing anterior and lateral shear on the ACL (Knee) as well as on the ankle.
Deceleration, Cutting, and the Hidden Load
What makes netball uniquely high-risk is the sheer volume and unpredictability of its multi-directional demands. A recent motion analysis of elite mid-courters found on average athletes performed 413 cutting or change-of-direction actions per match (Sanchez et al., 2023). Strikingly, 78 % of these occurred with less than 0.2 seconds of anticipatory time, meaning the athlete had virtually no time to organise their lower limb mechanics. Particularly the alignment of the hip, knee, and ankle before loading the joint. This kind of reactive deceleration places enormous strain on passive joint structures, especially the ACL and lateral ankle ligaments. When this sudden action is executed with suboptimal technique e.g., an inward collapsing knee, an extended landing leg, or delayed trunk stabilisation, we have seen the result can be catastrophic. Over the course of a 60-minute match, this amounts to a relentless barrage of high-risk moments, all accumulating in neuromuscular fatigue and compromising joint integrity.
Playing Surface & Footwear
One of netball’s defining features, its high-friction synthetic indoor court, plays a subtle but significant role in injury risk. When combined with court-specific shoes designed to maximise grip, this setup greatly limits foot slip during high-speed movements. While this enhances stability and performance, it also means more torsional force is transferred up the kinetic chain, particularly to the ankle and knee. The result? Increased joint loading during sudden stops, pivots, or awkward landings. Unfortunately, this is a necessary trade-off built into the game’s design; reducing grip would compromise gameplay and safety in other ways, making it a risk factor we must manage through smarter training, not surface change.
Sex‑Specific Risk Factors
Female netballers carry physiological risk factors that are difficult to mitigate but crucial to understand. Hormonal fluctuations, particularly oestrogen surges in the late-follicular phase are linked to increased ligament laxity, making knees more vulnerable during high-load phases of the cycle (Pursue Health, 2025).
Compounding this, many adolescent and adult female athletes develop quadriceps dominance throughout their career, where the anterior chain overpowers the posterior chain. This imbalance drives valgus-prone knee-extending landing patterns, a known ACL risk profile. While these traits are not easily altered, recognising and screening for them is vital in tailoring prevention strategies.
Heavier Competition Calendars
The domestic club calendar now kicks off in late September/October, with most squads completing 16–18 rounds by early May. Yet for dual‑registered athletes the NSL/NXT Gen League starting halfway through the main season stretches meaningful court exposure well into June and even July for the finals. From there International fixtures then drop into scattered windows (quad series, Fast 5, Euros, World Cup Qualifiers, UAE Cup, Nations Cup & World Cup). So there is never a fixed ‘international off‑season.’ This creates a saw‑tooth load profile: weeks of relentless match play (>350 cutting actions) are followed by an abrupt collapse in organised court time as seasons end, only for demands to spike again after a short pre‑season.
Compounding matters is the myth that players need a long total rest. Many switch off completely for 3–5 weeks, during which eccentric strength can fall by 15 %, tendon stiffness drops, and collagen turnover slows. When training and match load ramps back up, the musculoskeletal system experiences a double shock. First from detraining, then from sudden overload, degrading tissue resilience and neuromuscular control.
The Multi‑Factor Model of Non‑Contact Injury Aetiology
Internal Loads
Neuromuscular Control – poor hip‑core synergy → valgus collapse.
This is how well the body coordinates muscles and joints during movement. Poor control, especially between the hips, core, and knees can cause the knees to collapse inward (valgus), a dangerous position that increases ACL and ankle injury risk during landing and cutting.
Strength Imbalances – quadricep‑domination : hamstring ratio > 0.6 increases ACL shear.
When the quadriceps (front of thigh) overpower the hamstrings (back of thigh), it creates an imbalance. If the hamstring-to-quad strength ratio drops below 0.6, the hamstrings can’t effectively stabilise the knee, increasing forward tibial shear forces that strain the ACL.
Hormonal & Genetic Predisposition, ligament laxity, collagen type I gene variants.
Some athletes are naturally more prone to injury due to factors like higher ligament laxity (often influenced by oestrogen levels) or inherited collagen structures. For example, having a certain variant of the collagen type I gene can reduce ligament stiffness and resilience, making joints more vulnerable under load.
External Loads
Sudden Workload Spikes – >30 % acute‑to‑chronic ratio triples injury odds (Impaired Recovery Study, 2020).
This is where we look at he sharp increase in how much work an athlete does week to week. If a player increases their training or match load by more than 30% compared to their recent average (the acute-to-chronic ratio), their risk of injury triples. The body needs time to adapt—rapid jumps in intensity or volume overwhelm tissues and increase breakdown.
Training & Match Congestion – Less than 72 h recovery raises ACL risk by 1.8× (Simpson et al., 2024).
When matches or heavy training sessions are scheduled too close together particularly with less than 72 hours between them—athletes don’t get enough time to recover fully. Fatigue builds up, movement quality drops, and the ACL becomes significantly more vulnerable to strain, especially under fatigue or poor landing conditions.
Environmental – High‑grip court, shoes with aggressive herringbone outsole.
The court and shoes matter! Indoor synthetic netball courts are highly grippy, and when paired with shoes that have aggressive outsole patterns (like deep herringbone treads), they create excessive traction. While this helps performance, it also reduces natural foot slip, transferring more rotational force through the knee and ankle during sudden cuts or pivots raising the injury risk.
Psychophysiological Moderators
Sleep & Recovery – <5 h sleep in 48 h prior raises injury probability to 4 % per session (Impaired Recovery Study, 2020).
Sleep is the foundation of physical repair and neurological reset. When athletes get less than 5 hours of sleep in the 48 hours prior to training or match play, their neuromuscular coordination suffers; reaction time slows, muscle firing patterns become inconsistent, and perception of joint position (proprioception) is impaired. This combination significantly raises the likelihood of poor landing mechanics or delayed responses during unanticipated movements, which in turn increases injury risk. The Impaired Recovery Study (2020) quantified this: the probability of sustaining a non-contact injury rises to 4% per session in sleep-deprived states. For context, that’s roughly 1 in every 25 exposures under-recovered athletes take.
Stress & Mood State – negative mood amplifies proprioceptive drift; injury risk increase.
The psychological stress that players deal with impacts the motor system more than most people realise. Negative emotional states such as anxiety, frustration, or low mood can reduce an athlete’s ability to finely control joint positioning and timing. This is referred to as proprioceptive drift, where the brain misjudges the position of limbs in space and time particularly during high-speed or reactive tasks. The consequence of this is faulty loading patterns, where you will most likely see knees collapsing in, poor balance on landing, mistimed pivots, all of which elevate injury risk. Notably, athletes under persistent stress also show increased muscle co-contraction, which can lead to fatigue earlier in match play and increase joint strain.
Now, you’ve probably been reading all this thinking: “Great, but how do we actually combat this and is there a real fix?” The good news is, there is. But it’s not one quick solution. It's a layered approach built on smart training, consistent monitoring, and a shift in how we prepare netball athletes for the realities of the game and training.
That said, we can never take away the risk of injury entirely. Netball is an explosive, high-contact, reactive sport—and injuries will happen. But while we can’t prevent every injury, we can try and significantly reduce the odds. It’s about mitigation, not magic.
So, here’s how we can go about this. Practical, evidence-based steps that coaches, athletes, and support teams can start applying straight away to build more robust, resilient players and reduce the risk of non-contact injuries.
Evidence‑Based Prevention Framework
Dynamic Movement Prep (5‑8 min) – Ensure there is a well programmed and designed warm-up; this has been shown to cut combined ankle‑knee claims by 33 % in NZ (Simpson et al., 2024).
A proper warm-up is more than just tradition, it should be seen and used as a first line of defence. Research shows that dynamic preparation routines within a programme can reduce combined ankle and knee injury claims by 33 % in elite netball settings (Simpson et al., 2024). These warm-ups go beyond jogging and static stretches! Instead they should focus on priming the neuromuscular system, reinforce safe movement patterns, and improve joint stiffness and proprioception. Importantly, they also need to elevate the bodies core temperature and muscle elasticity, making the body more responsive during high-intensity cutting, jumping, and landing actions. While a full pre-game warm-up should be longer—typically 15–25 minutes to adequately raise core temperature, activate key muscle groups, and rehearse sport-specific movements—the shorter 5–8 minute dynamic prep has a crucial role too. Think of it as the courtside top-up: something athletes can perform during stoppages, before coming on as a rolling sub, or at half-time to maintain readiness. When embedded into the daily training rhythm, this simple 5–8 minute routine can deliver outsized injury-prevention benefits.
Deceleration & Cutting Drills– Emphasis on eccentric control and foot placement; progress from 45° to 90° cuts.
Focus on developing eccentric control and accurate foot placement to safely and effectively slow down and change direction. Starting off with looking at the athletes ability to make 45° cuts to build fundamental mechanics, then progressing onto cutting at sharper 90° cuts that demand greater strength and coordination at all speeds.
While isolated drills are valuable for building physical qualities, deceleration and cutting in isolation don’t fully replicate game demands. In matches, these movements happen in response to unpredictable cues, requiring strong perception-action coupling — the ability to quickly interpret the environment and react appropriately.
Integrating drills into game-like scenarios trains this connection between perception and movement, which is essential for effective performance. We’ll dive deeper into this skill acquisition process in a future blog.
The Vital Role of a well programmed S&C plan.
Strong muscles act as natural shock absorbers and stabilisers for the joints. By improving the strength and coordination of muscles around the ankle and knee, such as the calf complex, peroneals, quadriceps, hamstrings, and gluteal muscles, athletes can better control joint alignment during high-impact and multi-directional movements. This enhanced control reduces abnormal stresses on ligaments and tendons, working towards mitigating the risk of injury. Furthermore, the use of strength training improves proprioception, the body’s ability to sense joint position and movement allowing athletes to react quickly and maintain balance in unpredictable game situations.
Athletic Movement Over Bodybuilding
While strength training is essential, netball-specific programs should differ from that of traditional bodybuilding programmes, which focus on muscle size (hypertrophy) and isolated exercises for aesthetics. Netball athletes don’t need to bulk up or prioritise isolated muscle development.
Instead, the focus should be on functional strength exercises that replicate the sport’s demands through multi-joint, multi-planar movements. Examples include squats, lunges, step-ups, single-leg deadlifts, and plyometric drills that build power, stability, and reactive control.
This type of training enhances key athletic qualities such as speed, agility, balance, and coordination, which are critical for performance and injury mitigation. Strength sessions should challenge the core and lower limb kinetic chain to mimic netball’s dynamic stresses (Behm & Sale, 1993; Hewett et al., 2006).
There is a place for the traditional strength exercises in correcting muscle imbalances but should complement and not replace athletic movement training.
Key priorities for a balanced netball strength program:
Develop joint stability and muscular resilience in ankles and knees
Emphasise functional, sport-specific movement patterns over isolated work
Enhance power, balance, and proprioception with multi-planar exercises
Improve neuromuscular control to prevent injury and boost performance
I believe that this approach supports injury mitigation and helps athletes perform confidently at their best.
Menstrual Cycle Mapping
Recent studies continue to highlight the critical role of the menstrual cycle in influencing injury risk and performance in female athletes. Hormonal fluctuations especially in oestrogen and progesterone impact ligament laxity, neuromuscular function, and joint stability, with implications for injury prevention strategies (Sung et al., 2022; Herzberg et al., 2017).
Late-follicular phase vulnerability: Just before ovulation, oestrogen peaks, which can increase ligament laxity and reduce neuromuscular control, potentially elevating the risk of non-contact injuries such as ACL tears (Sung et al., 2022).
To work alongside this coaches and athletes need to introduce training modifications. By reducing high-impact or high-load training during this phase, the focus is on avoiding excessive mechanical stress on vulnerable tissues. Instead we should look at this phase as an optimal time for emphasising neuromuscular control, proprioception, and technique refinement through drills focusing on joint stability (Wang et al., 2020).
Alongside this we need to ensure we never lose track that every athlete is an individual and that we need to incorporate Individualised approaches to training. To ensure that we know how each athlete is doing, they should be encouraged to consider the use of wearable technology for wellness and hormone tracking. Advances in technology allow for more precise menstrual cycle monitoring. This enables tailored training programs that adapt load and exercise selection according to each athlete’s unique hormonal profile, improving injury mitigation while maintaining overall training progression (Martin et al., 2023).
Conclusion
Non-contact injuries in netball are not an inevitable part of the game—they are largely preventable with the right approach. As the sport becomes faster, stronger, and more professional, our athlete preparation and injury prevention methods must evolve accordingly.
By combining evidence-based training, intelligent load management, and holistic athlete care, we can protect players’ knees and ankles and elevate performance. However, for true progress, these tools and strategies must be made accessible to all athletes—not just those with the resources to afford them.
Ensuring equitable access to modern injury prevention and performance programs will safeguard the health and longevity of players at every level, securing the future of netball worldwide. It’s only by democratising these advances that the sport can grow stronger, safer, and more inclusive for everyone.
Comments