Knee Pain in Netball
Knee injuries are very common in netball, as it is a fast-paced sport with lots of jumping, running and turning. Two particular actions are responsible for the majority of knee injuries in netball, these being:
- repetitive bending and straightening of the knee
- twisting of the knee joint
In this article we look at just one particular knee injury frequently sustained by netballers, runners, hurdlers, basketballers and cyclists. This condition is commonly known as ‘mal-tracking of the knee cap’, or in medical terms, Patellofemoral Pain Syndrome (PFPS).
Presentation of PFPS
PFPS occurs if the back of the knee cap does not glide in the groove of the thigh bone (femur) in the correct way. In Patellofemoral Pain Syndrome, the knee cap can become tilted, rotated or pushed to the side by a number of factors. This means the wrong surfaces come together, and, when combined with the repeated action of bending and straightening the knee (for example, during jumping) the result is excessive friction between the cartilage and bone, resulting in inflammation and pain.
For netballers between the ages of 12 and 17 years, an added factor that can bring on PFPS is a rapid burst of growth. In a growing child, if the bone elongates at a faster rate than the muscles can keep up with, it causes extremely tight thigh muscles. The very tight muscles then pull the knee cap out of the groove it normally glides or tracks in. If a child is very active and participates in a fast-paced sport like netball, the higher frequency of abnormal tracking results in severe aggravation of the knee cap cartilage.
As physios we often treat children for PFPS whenever they have a growth spurt and for some children this occurs throughout their entire growing phase (12-17 years). By 18 years their growth slows and PFPS usually does not reoccur if the patient performs the correct stretches regularly. Children who are sedentary and do not do many physical activities, but still have large growth spurts, generally do not get PFPS. Young netballers can develop knee pain very suddenly without an apparent episode of injury and may feel:
- pain around the front of the knee
- pain with running, walking or squatting
- pain going up or down stairs
- pain on getting up after sitting with bent knees
Parents are often confused by the pattern of this particular condition: one moment the young netballer is running around happily and the next minute they are limping and experiencing excruciating pain. Some children are unable to put any weight on their leg and can’t sleep due to the pain at night but then get up in the morning with no pain. This is because inflammation settles rapidly in the young, resolving any pain and discomfort by the morning. As pain only comes on after a certain amount of bending and straightening, children may have several days of playing and running with no pain then suddenly develop severe pain again.
Over the years I have also observed that a child’s perception of pain has an ‘all or nothing’ aspect to it. That is, children do not perceive discomfort as pain, and they often do not even register pain until it is crippling.
When you come to see us, our assessment will include an examination of:
- kneecap alignment
- leg muscle weakness and tightness
- tightness of the iliotibial band (band of tissue on the outside of the thigh)
- weakness of the hip muscles
- foot alignment
- other anatomical factors
Treatment for PFPS can include releasing tight muscles or other structures, taping, knee joint mobilisation, strengthening exercises for the hip and/or knee and soft orthotics.
While contributing factors and symptoms can look identical in two netballers, they are never the same. Therefore the number of treatment sessions and the type of treatment given will vary from person to person. Even in the same individual, different episodes of knee pain may be due to the involvement of different leg structures. For these reasons, it is imperative not to self-diagnose and not to tape the knee unless your physio has instructed you to do this for the current episode. Incorrect taping will always cause pain and more damage.