Introduction: Ankle sprains are the most common injury in netball. Approximately three in four netballers report sustaining an ankle sprain, with half suffering recurrent sprains and two-thirds reporting moderate-severe instability. There is limited evidence on ankle sprain management and return-to-play decisions, and differences between countries have not been explored. This study aims to compare netballers' health-seeking behaviours, management practices, and return-to-play decisions after an ankle sprain and compare inter-country differences.
Methods: Netballers aged >14 years with a history of an ankle sprain were recruited from non-elite competitions in Australia (AUS), United Kingdom (UK), and New Zealand (NZ). Participants completed an online survey describing their most recent ankle sprain during netball, health-seeking behaviours, management strategies, return-to-play decision making, and the presence of residual symptoms when returning to netball. Data were described using mean (standard deviation) or number (proportion) as appropriate, and between-country differences were compared using chi-square tests.
Results: A total of 1,547 netballers from Australia (N=846), UK (N=454), and NZ (N=292) completed the survey. Overall, most undertook self-management strategies (N=1,572, 99%) and three in five netballers sought medical care from a health professional after their ankle sprain (N=951, 60%). Of those, most received strengthening (N=771, 81%), balance (N=665, 70%), and range of motion (N=656, 69%) exercises, in addition to taping (N=636, 67%) and bracing (N=291, 31%). When returning to netball, nearly a quarter returned within 1-7 days (N=338, 21%) and received medical clearance (N=362, 23%). Concerningly, nearly all netballers reported the presence of residual symptoms (N=1,496, 94%). When comparing countries, UK netballers reportedly sought less medical care than AUS and NZ netballers (53% vs. 60% vs. 68%, respectively, p=0.000). Of those who sought medical care, UK netballers compared to AUS and NZ netballers reportedly received less strengthening (73% vs. 84% vs. 84%, p=0.001) and balance exercises (60% vs. 71% vs. 80%, p=0.000), as well as taping (39% vs. 74% vs. 82%, p=0.000) or bracing (23% vs. 33% vs. 34%, p=0.01). When returning to netball, fewer UK netballers received medical clearance than AUS and NZ netballers (10% vs. 28% vs. 28%, p=0.000). However, a greater proportion of AUS netballers than UK netballers returned to play within 1-7 days (25% vs. 15%, p=0.000). Fear of re-injury was greater in AUS netballers compared to UK and NZ netballers (62% vs. 72% vs. 70%, p=0.000), but pain was greater in NZ netballers than UK netballers (58% vs. 69%, p=0.01).
Discussion: Health-seeking behaviours were poor for all netballers across all countries. Netballers from the UK were less likely to seek medical care, undertake strengthening and balance exercises or receive taping or bracing. They were also less likely to obtain medical clearance before returning to sport. These findings suggest current health-seeking behaviours are suboptimal, particularly in the UK.
Impact and application to the field: This international cross-sectional survey revealed that a very low proportion of netballers undertake appropriate health-seeking behaviours after sustaining an ankle sprain, particularly those from the UK. Our findings suggest greater education and resources regarding best-practice management of ankle sprains are needed.
Conflict of interest: The co-authors of this abstract acknowledge no conflicts of interest, financial and/or personal relationships which may result in research bias.