Development and application of holistic injury prevention strategies in pre-elite sport : implementation in Australian netball

  • Erin Amanda Smyth

    Student thesis: Doctoral Thesis


    This thesis by publication is entitled ‘Development and application of holistic injury prevention strategies in pre-elite sport: Implementation in Australian netball’. Pre-elite athletes sustain high rates of injury at a critical point in their careers. Translating Research into Injury Prevention Practice (TRIPP) is a well-established framework for injury prevention. It consists of six stages and has provided the foundation for this investigation into injury prevention in pre-elite athletes as it has been promoted as an approach that leads to quantifiable real-world injury prevention outcomes. To assess the usefulness of this framework in pre-elite athletes, due to the time constraints of a PhD, netball was used as an exemplar sport.
    This thesis comprises five studies, of which four have been published, with one currently under review and being considered for publication. The first study applies TRIPP Stages 1 and 2 by conducting an injury surveillance study and establishing the aetiology and mechanisms of injury at the 2018 17/U & 19/U Australian National Netball Championships (ANNC). This study found an injury incidence rate of 89.4 injuries per 1000 player hours, with ankle sprains being the highest medical attention and sports incapacity injury. Foot blisters and lower back pain were also frequent medical attention injuries, while anterior cruciate ligament (ACL) rupture and sport-related concussion were the next most frequent sports incapacity injuries.
    TRIPP Stage 3 is focused on developing injury prevention strategies and the first step is to obtain research evidence. Therefore, our second study was a systematic review investigating injury prevention strategies specific to pre-elite athletes competing in Olympic and professional sports. Eleven studies were identified demonstrating limited evidence supporting exercise and psychology interventions and no evidence supporting the use of equipment or nutrition strategies for preventing injury. This work established that there is a need for high-quality methodologically rigorous research studies to evaluate the efficacy of injury prevention interventions for pre-elite athletes.
    The third study, demonstrating TRIPP Stage 4, consists of a randomised controlled trial to assess the effect of ankle tape and taping procedures on proprioception. Netball Australia has an ankle taping policy whereby pre-elite netball athletes are encouraged to prophylactically tape their ankles, but there is a lack of scientific evidence supporting this policy. This study demonstrated that proprioception improves and is maintained during a netball session with either Sport and Exercise Physiotherapist (SEP) applied or self-applied ankle taping.
    TRIPP Stage 5 encourages implementation planning to optimise injury prevention strategy effectiveness. Netball Australia introduced the KNEE (Knee injury prevention for Netballers to Enhance performance and Extend play) program to reduce lower limb injuries. Ankle and knee injuries were the injuries with the highest burden at the 2018 17/U & 19/U ANNC. Therefore, our fourth study investigated how the implementation of the KNEE program could be improved by using concept mapping to identify barriers to its implementation. The coaches, strength and conditioning coaches and physiotherapists working with the 17/U & 19/U State teams identified ‘athlete engagement’, ‘supervision & correction of technique’, ‘time constraints’, ‘athlete technique’, ‘education’ and ‘support staff resourcing’ as the most important and difficult challenges to implementing the KNEE program in pre-elite netball.
    The fifth study fulfils TRIPP Stage 6 by assessing the effectiveness of a foot blister prevention strategy at the 2019 17/U & 19/U ANNC. Foot blisters should be easily prevented with correct footwear and hygiene but were one of the most prevalent injuries at the 2018 17/U & 19/U ANNC. The strategy employed in 2019 consisted of every athlete receiving an advice sheet and blister prevention pack (Appendix 17) six weeks prior to the ANNC commencing. A no new shoe less than four weeks before the 2019 ANNC policy was also introduced. Injury surveillance was repeated in 2019, identifying an incidence rate of 82.5 medical attention injuries/1000 player competition hours. Ankle sprains, lower back pain and foot blisters continued to be the most frequently reported medical attention injuries. There was no change in foot blister frequency from 2018 to 2019.
    This thesis has identified that the TRIPP framework is useful in guiding essential steps for injury prevention but difficult to apply in the way it was intended in the ‘real world’. We identified that ankle sprains, lower back pain and foot blisters were the most prevalent injuries at the 2018 & 2019 17/U & 19/U ANNC, and that ACL rupture and sports-related concussion resulted in the greatest sports incapacity. Netball Australia had already implemented injury prevention strategies for ankle sprains and ACL rupture. Therefore, the TRIPP Stages should be used as a guide for continual improvement to add value rather than applying the TRIPP model sequentially as it was originally intended, particularly with sports with established prevention programs.
    Date of Award2022
    Original languageEnglish
    SupervisorGordon Waddington (Supervisor), Phillip Newman (Supervisor), Michael K. Drew (Supervisor) & Juanita WEISSENSTEINER (Supervisor)

    Cite this