Netball exercises: the KNEE warm-up, ankle and knee protection, and landing and jump training

Ankles and knees

Across 46 studies, the ankle accounted for 13% to 84% of netball injuries and the knee 8% to 50%. In professional Australian netball, knee joint injuries cost the most time in season, 44.9 days each.

Sources 1, 2

ACL tears come from landings

In videos of 21 elite netball ACL injuries, 17 happened on landing from a jump, and ACL rupture was the commonest diagnosis among netballers admitted to hospital in Australia.

Sources 3, 4

The KNEE warm-up: sensible, untested

Netball Australia's free four-part warm-up is meant for at least twice a week, all season. No study has tested it on injury rates, and in community clubs only 12% to 18% of its activities were done as intended.

Sources 5, 6

Borrowed evidence for ACLs

In young female athletes in other sports, warm-ups with strength and landing work cut ACL injuries from about 1 in 54 players to 1 in 111. There's no evidence yet from netball itself.

Sources 7, 8

After a sprain: a brace and balance work

Up to half of netballers who sprain an ankle sprain it again. Across sports, braces cut repeat sprains by about two-thirds, and balance training cut sprains in people who'd sprained before.

Sources 9, 10, 11

Pregnancy: your decision, with medical advice

England Netball leaves it to the player, with individual medical advice and regular check-ups; the UK's National Health Service (NHS) advises against sports with a risk of falling or bumping your tummy.

Sources 12, 13

Stop-start, and it depends on your position

In Australia's national league, centres covered about 5.5 km a match and goal shooters about 2.1 km, and the most restricted positions changed direction most per metre covered. In youth representative players, time above 85% of maximum heart rate ranged from 7% to 63% by position, highest in centres and goal attacks. The Compendium of Physical Activities gives netball 7.0 metabolic equivalents (METs), an estimated value rather than a measured one.

Sources 14, 15, 16

Landing and stopping

The footwork rule allows one step after catching, so players land and stop sharply, mostly on one leg. In 18 state and under-21 players, landing forces ranged from 3.5 to 5.7 times bodyweight; landings that ran on had the lowest forces, and taking an extra step didn't lower them.

Sources 17, 18

Where the load falls

The sites the studies point to:

• Ankles: the commonest injury, on landing and in contact.
• Knees: most elite ACL tears happened on landing from a jump.
• The Achilles: 15.9% of netball hospital admissions in Australia, at an average age of 35.
• Fingers, hands and wrists: from the ball, contact and falls, more often in under-16s.
• The lower back and feet: back pain and blisters were among the commonest problems at a junior national championship.

Sources 1, 2, 3, 4, 19

What to train (our reading)

Controlled one-leg landings with the knee over the foot, stopping in one step, quick changes of direction, jump height, ankle balance, hip and thigh strength, and repeat sprints for midcourt players.

How often players get hurtEmerging evidence

The numbers, by group:

• Across 46 studies: about 19 injuries per 1,000 player hours in elite netball and 11 to 14 in recreational netball, more in matches than in training.
• Professional Australian netball over 3 seasons: 866 injuries needing medical attention, and 393 that cost playing time, in 119 players.
• The 2019 Netball World Cup: 54.8 injuries per 1,000 player hours of matches, two-thirds of them without time lost.
• One Australian community club, players aged 7 to 42: 13.8 injuries per 1,000 hours, half of them stopping play or training.
• New Zealand insurance claims, 2008 to 2017: the highest ankle and knee rates at ages 20 to 24, and the biggest rises at 10 to 14.
• Only two netball studies have followed injuries continuously, and definitions vary widely.

Sources 1, 2, 20, 21, 22, 23

Ankle sprainsEmerging evidence

The commonest netball injury in most studies: 20.9% of medical-attention injuries in professionals, and the commonest injury at the 2019 World Cup. About four in five netballers sprain an ankle at some point, up to half sprain it again, and nine in ten report the ankle feeling unstable. In a community club, a previous injury went with about 7 times the odds of a leg injury, an association. Our sprained ankle and chronic ankle instability guides cover treatment and rehab.

Sources 1, 2, 20, 9, 21

ACL tearsEmerging evidence

ACL rupture was the commonest diagnosis among 4,596 Australian netball hospital admissions (16.5%, at an average age of 27). In videos of 21 elite injuries, 17 happened on landing from a jump, often while slowing down after a high pass on a wide two-footed landing with the knee nearly straight; in another series of 16, many followed a bump in the air or a twist and lean of the trunk on landing. Across sports, women injure an ACL about 1.7 times as often as men per game or training session. Our ACL injury guide covers what to do.

Sources 4, 3, 24, 25

Other knee injuriesEmerging evidence

Knee injuries made up 8% to 50% of netball injuries across studies, and knee joint injuries cost professionals 44.9 days each in season. Our MCL sprain, meniscus tear and knee pain guides cover them.

Sources 1, 2

Achilles, fingers and wristsEmerging evidence

Achilles injuries were 15.9% of Australian netball hospital admissions, at an average age of 35, and fractures 29.5%, mostly of the forearm, wrist and hand. Children under 16 hurt their arms, wrists and hands more often than adults. Our Achilles rupture, broken finger and broken wrist guides cover these.

Sources 4, 1

Contact and concussionEmerging evidence

Netball isn't contact-free: at the 2019 World Cup, contact injuries outnumbered non-contact ones about 3 to 1, and collisions caused 28% of injuries in a community club. Three concussions were among the most disabling injuries at a junior national championship. See the warning signs below.

Sources 20, 21, 19

The KNEE programme, as Netball Australia publishes itMixed evidence

A free warm-up from Netball Australia, with junior, recreational (14 and over) and elite levels and a video for every exercise:

• What: four parts. Warm-up and footwork drills, then strength (lunges, squats, arabesques, bridges and planks), balance and landing (jump-and-land drills, partner nudges in the air, tuck jumps), and agility (bounds, shuffles and Y-drill decelerations).
• How often: before every court session or match, at least twice a week, kept up all season, with correct technique. Players who play once a week add it on another day.
• How much: every warm-up and footwork drill, then a choice from the other parts. Netball Australia's page and manual differ on how many exercises to choose, so the selection is the coach's. Our version on this page takes about 15 to 20 minutes, our estimate.
• Effect on injuries: not tested. In two state Premier League teams, it improved one direction of a balance-reach test compared with a usual warm-up, but not the overall score.
• In practice: in 4 community clubs, only 12% to 18% of its activities were done as intended, and the strength, landing and agility parts were mostly skipped.

Sources 26, 5, 27, 28, 6

NetballSmart warm-ups: performance and landing onlyEmerging evidence

Netball New Zealand's warm-ups haven't been tested on injuries either. In 81 secondary-school players randomised by team, 7 weeks of the Dynamic Warm-up improved a plank hold by 20.5 seconds and vertical jump by 6.7 cm against controls, though standing long jump fell by 9.9 cm. In 77 school players, it and a shorter version, done 3 times a week for 12 weeks, both improved landing technique, in a study that wasn't randomised.

Sources 29, 30

ACL programmes, borrowed from other sportsStrong evidence

In 18 studies of 27,231 young female athletes in other sports, warm-ups with strength and landing exercises cut ACL injuries from about 1 in 54 players to 1 in 111, more in school-age players and more with more landing and strength work in each session; they averaged 24 minutes, 2 to 3 times a week. Exercise and Sport Science Australia (ESSA) estimates about 60% fewer ACL injuries in female football, basketball and handball players aged 14 to 18, but says there's no evidence yet for netball. The ACL section below has more.

Sources 7, 8, 31

Ankle braces and balance training, borrowed from other sportsStrong evidence

None of these has been tested in netball. Across 6 trials in athletes, braces cut repeat ankle injuries by about two-thirds (moderate-quality evidence) and first ones by about half (low quality). In 1,460 basketball players, lace-up braces cut ankle injuries whether or not players had sprained before. A brace worn for a year beat an 8-week home training programme for preventing repeats (15% against 27%), and an unsupervised home balance programme cut repeats from 33% to 22%. Across trials, balance training cut sprains by about a third, clearly in people who'd sprained before.

Sources 10, 32, 33, 34, 11

Getting back properly after a sprainEmerging evidence

Netballers rarely rehabilitate a sprain properly and usually go back almost at once. Of 1,592 non-elite players, 60% sought care after their last sprain (53% in the UK) and 23% were cleared before returning (10% in the UK). Ankle tape improved ankle position sense in pre-elite netballers through a session, a change in a risk factor rather than in injuries. A brace for sport and the balance programme in our sprained ankle guide, 3 times a week for 8 weeks, are the tested route.

Sources 9, 35, 36

Load, age and tournamentsEmerging evidence

In New Zealand, ankle and knee claims spiked during trials and tournaments and rose most in 10 to 14-year-olds. Netball New Zealand advises its emerging players to play at most one other sport, and not during the netball season. Across sports, highly specialised young athletes had more overuse injuries, and so did those training more hours a week than their age in years.

Sources 22, 37, 38, 39

Netball shoes and high-topsMixed evidence

There's no evidence that netball shoes, high-cut or not, prevent ankle sprains, and few players wore high-cut shoes when it was studied. Braces have the trial evidence.

Sources 9, 40

Stretching before playStrong evidence

Across 25 trials, stretching programmes didn't prevent sports injuries, while strength training cut them to about a third. Our warm-up guide explains what to do instead.

Source 41

Changing the footwork ruleEmerging evidence

In a lab study, an extra step after landing didn't lower landing forces, so it doesn't support a rule change; landings that ran on had the lowest forces.

Source 18

Jump training, from court sportsStrong evidence

In 32 studies of 818 basketball players, jump training improved jump height, short sprints, change of direction and balance, and programme length and frequency didn't predict the gains. In 14 volleyball trials, it raised vertical jump, with no clear difference between 2 or fewer and more sessions a week, or between programmes under and over 2,000 jumps in total.

Netball's own studies are small: the NetballSmart warm-up raised vertical jump by 6.7 cm, and 3 weeks of jump training improved jumps and agility in Jamaica's national team, without a comparison group.

Sources 42, 43, 29, 44

Strength and better landingsEmerging evidence

In 23 netballers aged 11 to 13, 6 weeks of coached strength and jump training, three 1-hour sessions a week, lowered landing forces and knee rotation compared with a control group. Across sports, strength training cut injuries to about a third, and the ACL programmes that work include leg strength and landing exercises in every session. Netball New Zealand's resource for emerging high-performance players builds strength in phases, adds power work with maximal jumps, and gives testing benchmarks such as a 45 cm vertical jump.

Sources 45, 41, 7, 37

Fitness for the gameEmerging evidence

Centres run the most, and how hard young players worked varied hugely by position. In players aged about 11, one 8-minute netball interval session a week for 5 weeks improved a shuttle-run fitness test more than the KNEE warm-up did. Our HIIT guide covers intervals.

Sources 46, 14, 15

Fitting it around netball

Netball New Zealand's weekly structure for emerging players: in pre-season, 2 to 3 strength sessions, 1 power session, 1 to 2 fitness sessions, 1 speed and agility session, 1 to 2 netball sessions and 1 to 2 rest days; in season, 2 strength sessions, 1 to 2 games and a rest day.

Our suggestion for club players: the KNEE warm-up every session, a strength and landing session twice a week for 6 to 8 weeks of pre-season and once or twice a week in season, no heavy legs or hard jumping the day before a match, and an easier week after a tournament weekend.

Sources 37, 22

How netball ACL tears happenEmerging evidence

In 21 elite injuries on video, 17 came on landing from a jump, often while slowing down after a high pass, on a wide two-footed landing with the injured knee nearly straight and the player leaning back. In another series of 16, the landing was knocked off balance by a bump in the air, or the player twisted and leaned the trunk as she landed. In a review and expert consensus, poor landing technique was the top risk factor to fix.

Sources 3, 24, 47

Programmes that work, across sportsStrong evidence

Across 8 meta-analyses, warm-up programmes halved ACL injuries and cut non-contact ACL injuries in female athletes by about two-thirds. The best had strength exercises and jump-and-hold landings in every session, about 24 minutes 2 to 3 times a week, and younger athletes gained most. ESSA says effective programmes combine jump, strength, balance, mobility and agility exercises for 10 to 30 minutes, 2 to 3 times a week, often in place of the usual warm-up.

Sources 31, 7, 8

In netball itself: untestedMixed evidence

ESSA says there's no evidence yet for ACL programmes in netball, Australian football or rugby. Netball's own trials measured landing, not injuries: coached strength and jump training improved how girls aged 11 to 13 landed. Our reading: the evidence across sports is strong enough to do the work, but the size of its effect in netball isn't known, and the strength and landing parts of the KNEE warm-up are the ones most often skipped.

Sources 8, 45, 6

Landing with control (our reading)

On a high pass, land with your feet about shoulder-width apart, knees bent and balanced, keep the ball secure above hip height, and turn your whole body towards your next pass rather than just your head: the authors of the video study suggested these. Coach with cues about the result, like the KNEE manual's "imagine sitting back in a chair" rather than "bend your knees", as ESSA also advises.

Sources 3, 27, 8

After an ACL reconstructionEmerging evidence

In 267 Australian netballers followed for at least 7 years after a reconstruction, 10% tore the ACL in the other knee and 4% ruptured the graft, and players who had surgery as teenagers had about 4.5 times the risk of a graft rupture and 2.5 times the risk of a tear on the other side. 62% went back to netball. Keep a prevention warm-up going for both legs, and follow the return-to-sport checks in our ACL injury guide.

Source 48

No test can pick out who will tearStrong evidence

No screening test has been shown to predict who will tear an ACL, so train everyone's landings rather than testing them.

Source 8

Different injuriesEmerging evidence

Under-16s hurt their arms, wrists and hands, including fractures, more often than adults, who hurt ankles and knees most. In New Zealand, the knee injury claim rate in 10 to 14-year-olds rose 2.5-fold and the ankle rate doubled over a decade. In a community club, players older than about 13 and a half had 3 times the odds of a leg injury of younger ones.

Sources 1, 22, 21

How much is enoughEmerging evidence

Netball New Zealand advises its emerging high-performance players to play at most one other sport, and not during the netball season, with rest days every week. Across sports, highly specialised young athletes had more overuse injuries, as did those training more hours a week than their age in years. The NHS asks children and young people for an average of at least 60 minutes of activity a day, across a variety of activities.

Sources 37, 38, 39, 49

Strength and landing work is for young players too

Coached strength and jump training improved landing in girls aged 11 to 13, and our children's guide explains that supervised strength training is safe for children. Netball Australia has a junior version of the KNEE warm-up; the version on this page is for players aged 14 and over. Use bodyweight or light loads with a coach watching (our suggestion).

Sources 45, 26

Pregnancy: two positionsStrong evidence

England Netball follows World Netball's guidelines: whether to play while pregnant is the player's decision, but it strongly recommends getting individual medical advice before playing and having regular check-ups, because netball involves contact and a risk of injury to mother and baby. World Netball says playing during pregnancy is at the player's own risk.

The NHS advises against sports where there's a risk of falling or bumping your tummy, and our pregnancy guide advises avoiding contact sports and activities where you could fall. Talk to your midwife or GP; shooting practice and non-contact drills may suit (our suggestion).

Sources 12, 50, 13

After giving birth

Landing and running load the pelvic floor, so work through our postpartum guide and return-to-running workout before match play (our suggestion).

Walking netballEmerging evidence

In an evaluation in England's Women's Institutes, walking netball reached 3,148 members, many of them inactive, and 87.7% of groups kept going beyond the first 20 sessions; players' physical function, wellbeing and activity improved. It counts towards the NHS's 150 minutes a week of moderate activity.

Sources 51, 52

Everyone: seven questions

The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) asks about a heart condition or high blood pressure, chest pain, dizziness or losing consciousness, other long-term conditions and their medicines, a bone or joint problem that activity could make worse, and being told to exercise only under supervision. If you answer yes to any, check with your GP or a qualified exercise professional first. If you're over 45 and not used to hard exercise, ask a qualified exercise professional before the hardest sessions, and delay if you're ill.

Source 53

After an ankle sprain

A previous injury went with about 7 times the odds of a leg injury in a community club, and up to half of netballers sprain again. Wear a brace for sport, do the balance programme in our sprained ankle guide, and get checked before you return to matches.

Sources 21, 9, 10, 34

After an ACL reconstruction

Tears in the other knee were more common than graft ruptures in netballers after surgery, especially in teenagers. Follow the return-to-sport checks in our ACL injury guide, and keep the KNEE warm-up going.

Source 48

Pregnant

Get individual medical advice before playing, as England Netball strongly recommends, and read the pregnancy section above.

Sources 12, 13

After giving birth

Landing and running load the pelvic floor: work through our postpartum guide and return-to-running workout before match play.

Growing children with knee or heel pain

Pain and swelling just below the kneecap in a growing teenager can be Osgood-Schlatter disease, pain at the lower tip of the kneecap Sinding-Larsen-Johansson syndrome, and heel pain in a growing child Sever's disease: see our guides.

Fainting, chest pain or dizziness

The NHS advises seeing a GP if you've fainted, and the PAR-Q+ asks you to check first if you get chest pain or dizziness: do that before you play. If you're new to hard exercise, walking netball is a gentler start (our suggestion).

Sources 54, 53

A knee that gives way

Get advice from NHS 111 now if your knee is very painful, you can't move it or put any weight on it, it's badly swollen or has changed shape, or it locks, gives way or clicks painfully. A pop, quick swelling and a knee that gives way point to an ACL injury: our ACL injury guide says what to do.

Source 55

A sprain or a crack

Call 999 or go to A&E (accident and emergency) if you heard a crack when you were injured, the injured part has changed shape or points at an odd angle, it's numb or tingling, or the skin has turned blue or grey or is cold to touch. Get help from NHS 111 or an urgent treatment centre if it's very painful, very swollen or bruised, or you can't put weight on it or walk more than a few steps.

Source 56

A snap at the back of the ankle

Contact NHS 111 if you heard a snap or popping noise, can't walk on tiptoe or up stairs, or have swelling and bruising in your calf and ankle. Our Achilles rupture guide says to get it checked the same day.

Source 57

A jammed or broken finger

Go to A&E if a finger points at an odd angle, looks blue or feels numb, or is cut with bone showing. Get help from NHS 111 if it's painful, swollen and bruised, or stiff and difficult to move. A fingertip that won't straighten needs same-day advice, as our mallet finger guide explains.

Source 58

A hurt wrist

Go to A&E or call 999 if an injured wrist or arm is numb, tingling or has pins and needles, a bone is sticking out of the skin, or it has changed colour or shape or is at an odd angle. Get help from NHS 111 if it's very painful, you can't use it, or the swelling or bruising is large or getting worse.

Source 59

A head injury: call 999

The NHS says to call 999 if someone has hit their head and:

• Has been knocked out and hasn't woken up, or can't stay awake or keep their eyes open.
• Has a fit (seizure).
• Has problems with their vision or hearing, or clear fluid coming from their ears or nose.
• Has new numbness or weakness in any part of their body, or problems with walking, balance, understanding, speaking or writing.
• Has a dent in their head, or their behaviour has changed, such as being more irritable or distracted.

Source 60

Suspected concussion

Stop playing: if in doubt, sit them out. Under the UK's grassroots concussion guidelines, there's no training or matches for at least 24 hours, an assessment within 24 hours by a healthcare professional or NHS 111 (the UK National Health Service's urgent advice line), and no return to competition before day 21. Contact NHS 111 straight away if they're being sick, feel dizzy or take medicine that thins the blood. Our concussion guide covers the stages.

Sources 61, 60

Fainting or chest pain: call 999

Call 999 if someone faints while exercising, or faints and can't be woken within a minute, or has chest pain, a pounding, fluttering or irregular heartbeat, or a fit. Call 999 for sudden chest pain that doesn't go away, pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness.

Sources 54, 62

"Netball is a non-contact sport, so it's safe"Emerging evidence

At the 2019 World Cup, contact injuries outnumbered non-contact ones about 3 to 1, collisions caused 28% of injuries in a community club, and ACL rupture was the commonest diagnosis among Australian netball hospital admissions.

Sources 20, 21, 4

"ACL tears are just bad luck"Emerging evidence

Most elite tears happened on jump landings, in patterns that repeat, and warm-ups with strength and landing work cut ACL injuries in young female athletes in other sports. Netball itself hasn't been tested yet.

Sources 3, 24, 7, 8

"Two-footed landings are always safe"Emerging evidence

A common pattern in elite ACL videos was a wide two-footed landing with the knee nearly straight, while slowing down after a high pass. Land with your feet about shoulder-width apart, knees bent and balanced; in the lab, landings that ran on had the lowest forces.

Sources 3, 18

"Netball shoes or high-tops prevent ankle sprains"Mixed evidence

There's no evidence that netball shoes reduce sprains. After a sprain, braces and balance training have the trial evidence, from other sports.

Sources 9, 10

"Ankle braces and tape weaken your ankles"Emerging evidence

Braces cut repeat ankle injuries in trials, and tape improved ankle position sense in pre-elite netballers. No study we read showed braces or tape weakening the ankle.

Sources 10, 33, 36

"The KNEE programme is proven to cut injuries"Mixed evidence

It's well designed and free, but no study has measured its effect on injuries, and most of it goes undone in community clubs. Do it anyway, strength and landing parts included: it's built from what works in other sports.

Sources 6, 28, 8

"Playing on after an ankle sprain is fine"Emerging evidence

Most netballers go back almost at once without rehabilitation, and a previous injury was the strongest risk factor for the next leg injury in a community club.

Sources 9, 35, 21

"Strength training will make you slow"Strong evidence

Jump and strength training improve jumping, sprinting and change of direction in court-sport players, and coached strength and jump training improved how girls aged 11 to 13 landed.

Sources 42, 43, 45