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Sports Medicine - Open

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Deloading Practices in Strength and Physique Sports: A Cross-sectional Survey

Authors: David Rogerson, David Nolan, Patroklos Androulakis Korakakis, Velu Immonen, Milo Wolf and Lee Bell

Effectiveness of Intervention Strategies to Increase Adolescents’ Physical Activity and Reduce Sedentary Time in Secondary School Settings, Including Factors Related to Implementation: A Systematic Review and Meta-Analysis

Authors: Ana María Contardo Ayala, Kate Parker, Emiliano Mazzoli, Natalie Lander, Nicola D. Ridgers, Anna Timperio, David R. Lubans, Gavin Abbott, Harriet Koorts and Jo Salmon

Athlete Mental Health and Wellbeing During the Transition into Elite Sport: Strategies to Prepare the System

Authors: Vita Pilkington, Simon Rice, Lisa Olive, Courtney Walton and Rosemary Purcell

Low Ankle-GO Score While Returning to Sport After Lateral Ankle Sprain Leads to a 9-fold Increased Risk of Recurrence: A Two-year Prospective Cohort Study

Authors: Brice Picot, François Fourchet, Ronny Lopes, Gauthier Rauline, Kinan Freiha, Pieter D’hooghe, Eugénie Valentin and Alexandre Hardy

Association Between Total Genotype Score and Muscle Injuries in Top-Level Football Players: a Pilot Study

Authors: Myosotis Massidda, Laura Flore, Paolo Cugia, Francesco Piras, Marco Scorcu, Naoki Kikuchi, Pawel Cięszczyk, Agnieszka Maciejewska-Skrendo, Filippo Tocco and Carla Maria Calò

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The Training and Development of Elite Sprint Performance: an Integration of Scientific and Best Practice Literature

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Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs

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Falls and injuries to Polo players: risk perception, mitigation and risk factors

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Running economy: measurement, norms, and determining factors

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The Applied Sports Science and Medicine of Netball: A Systematic Scoping Review

• Systematic Review
• Open access
• Published: 04 June 2021
• Volume 51 , pages 1715–1731, ( 2021 )

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• Sarah Whitehead   ORCID: orcid.org/0000-0002-6105-3160 1 , 2 , 3 ,
• Jonathon Weakley 1 , 4 ,
• Stuart Cormack 5 , 6 ,
• Helen Alfano 7 ,
• Jim Kerss 8 ,
• Mitch Mooney 5 , 9 &
• Ben Jones 1 , 3 , 10 , 11 , 12  

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Netball is the one of the most popular women’s sports in the world. Since gaining professional status in 2008 there has been a rapid growth in research in the applied sports science and medicine of the sport. A scoping review of the area would provide practitioners and researchers with an overview of the current scientific literature to support on-court performance, player welfare and reduce injury.

The primary objective was to identify the current research on the applied sports science and medicine of netball. Additionally, the article provides a brief summary of the research in each topic of sports science and medicine in netball and identifies gaps in the current research.

Systematic searches of PubMed, SPORTDiscus, MEDLINE and CINAHL were undertaken from earliest record to Dec 2020 and reference lists were manually searched. The PRISMA-ScR protocol was followed. Studies were eligible for inclusion if they investigated netball as a sport or the applied sport science and medicine of netball athletes.

962 studies were identified in the initial search, 150 of which met the inclusion criteria. Injury was the most highly investigated sport science and medicine topic ( n  = 45), followed by physical qualities ( n  = 37), match characteristics ( n  = 24), biomechanics ( n  = 15), psychology ( n  = 13), fatigue and recovery ( n  = 9), training load ( n  = 4) and nutrition ( n  = 3). A range of cohorts were used from school to elite and international standards. All cohorts were female netballers, except for one study. A rapid growth in studies over recent years was demonstrated with 65% of studies published in the last decade. There still remains gaps in the literature, with a low evidence base for nutrition, training load and fatigue and recovery.

This scoping review summarises the current evidence base and key findings that can be used in practice to enhance the applied sport science and medical support to netball athletes across a range of playing standards, and support the growth of the sport. It is evident that netball as a sport is still under-researched.

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1 Introduction

Netball is one of the most popular women’s sports in the world, with 20 million participants across 80 countries, and 70 National Netball Associations affiliated to the International Netball Federation (INF) across Africa, Asia, America, Europe and Oceania [ 1 ]. In 1995 it became a ‘recognised’ sport of the International Olympic Committee, and in 1998 was included in the Commonwealth Games programme for the first time [ 2 ]. In 2008, netball had its first semi-professional league formed (ANZ Championship), with professional or semi-professional leagues now in Australia (Suncorp Super Netball), New Zealand (ANZ Premiership), the United Kingdom (UK; Vitality Netball Superleague) and South Africa (Telkom Netball League). As the sport has transitioned to professional status, there has been an increase in research across a range of sport science and medicine areas [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Consequently, a scoping review of the area would provide practitioners and researchers with an overview of the current scientific literature to support on-court performance and reduce injury.

Netball is a dynamic, high-intensity, intermittent court-based team sport [ 1 , 11 , 12 , 13 ]. It is played over 60-min split into 15-min quarters, with 4-min breaks between quarters 1–2 and 3–4 and an 8–12-min half-time break between quarters 2–3, in professional leagues [ 11 , 14 , 15 ]. The traditional game of netball is played with seven positions: goal shooter (GS), goal attack (GA), wing attack (WA), center (C), wing defence (WD), goal defence (GD) and goal keeper (GK), on a 15.25 × 30.50 m court divided into thirds [ 16 , 17 ]. A five-a-side version has also gained popularity in recent years with the Fast5 Netball World series, which is played on the same court dimensions but has six-minute quarters [ 17 ]. The two teams competing in a game of netball strive to keep or gain possession of the ball and score a goal by shooting the ball through a ring that is 3.05 m high [ 17 ]. The rules restrict players to: playing position specified areas of the court, moving only one step when in possession of the ball, and releasing the ball within three seconds of receiving it [ 17 ]. Rule changes in 2016 were designed to increase the match speed by providing playing ‘advantage’ and reducing the number of timeouts [ 18 ]. Such rules and the discrete skill set required [ 19 ], demand a unique set of physical qualities and mental skills from the players, particularly at the elite level [ 18 , 20 , 21 , 22 ].

Over the last 30 years research into the applied sport science and medicine of team sports has grown rapidly (e.g., rugby league [ 23 , 24 ] Australian Rules [ 25 , 26 ]). Specifically, recent increases have been observed in netball, likely due to the professionalisation and popularity of the sport as well as the development in technologies. Netball has unique physical (e.g., agility maneuvers, jumping, landing [ 12 , 27 ]), technical (e.g., guarding, passing, and shooting [ 19 , 28 ]) and tactical (e.g., set-plays [ 29 ]) requirements, which necessitates evidence-based support through sport science and medical provision. There is a high injury rate of netball players within the community [ 30 , 31 ] (e.g., 14 injuries per 1000 h [ 31 ]) and elite game [ 32 , 33 ] (e.g., up to ~ 500 injuries per 1000 h in elite South African players [ 33 ]), leading to the implementation of injury reduction strategies [ 34 , 35 ]. The physical qualities of players and activity profiles of match-play have also been quantified to aid in development and preparation for performance [ 11 , 12 , 15 , 16 , 18 ]. However, whilst practical recommendations for strength and conditioning coaches working with netball athletes have been provided [ 36 , 37 , 38 ], a review of the current applied sport science and medicine of netball literature following a systematic approach is yet to be carried out.

The purpose of this scoping review is to provide an overview of existing research on the applied sport science and medicine of netball. Four primary objectives were to: (1) conduct a systematic search of the published literature, (2) map out the characteristics of the research, (3) provide a brief summary of the research in each area of sport science and medicine, and (4) identify gaps in the current research.

2.1 Design and Search Strategy

A scoping review was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) [ 39 ]. A systematic search of electronic databases (PubMed, SPORTDiscus, MEDLINE and CINAHL) was performed from the earliest record to 28th Dec 2020. All study designs were included. The search strategy combined the term ‘netball’ AND terms covering topics of the applied sport science and medicine of netball: ‘demands’ OR ‘characteristics’ OR ‘match-play’ OR ‘matches’ OR ‘match’ OR ‘game’ OR ‘game-play’ OR ‘competition’ OR ‘performance’ OR ‘skill’ OR ‘technical’ OR ‘physical’ OR ‘testing’ OR ‘qualities’ OR ‘anthropometrics’ OR ‘composition’ OR ‘strength’ OR ‘speed’ OR ‘power’ OR ‘fitness’ OR ‘change of direction’ OR ‘agility’ OR ‘jump’ OR ‘physiology’ OR ‘training’ OR ‘load’ OR ‘exposure’ OR ‘fatigue’ OR ‘recovery’ OR ‘muscle damage’ OR ‘development’ OR ‘intervention’ OR ‘injury’ OR ‘wellness’ OR ‘wellbeing’ OR ‘risk’ OR ‘incidence’ OR ‘health’ OR ‘psychology’ OR ‘mental’. Reference lists of selected papers were manually searched for other potentially eligible papers.

2.2 Study Selection

After eliminating duplicates, search results were screened independently by two researchers (SW, JW) against the eligibility criteria. Disagreements were resolved through discussion or via a third researcher (BJ). Articles which could not be eliminated by the title or abstract were retrieved and evaluated for inclusion via a full-text review. The title and authors were not masked to the reviewers.

Studies were eligible for inclusion if they investigated netball as a sport or the applied sport science of netball athletes from a ‘performance perspective’, or investigated injury epidemiology with outcome measures reported for netball athletes. Only original research investigations in peer-reviewed journals were included.

Studies were excluded from the review if they did not investigate netball, or they used netball athletes as subjects but did not investigate netball as a sport or the applied sport science and medicine of netball athletes. For example, Ashton and Twist [ 40 ] used university netball players as subjects but the purpose was to investigate the impact of change of direction (CoD) on the physiological responses during generic shuttle running and the study was therefore excluded. Such studies that use netball athletes as subjects to examine a broader concept have limited direct application to impact upon netball specifically. Studies that investigated netball umpires only or that examined netball from a coaching or physical activity/participation perspective were excluded. Review articles and conference proceedings with abstracts only were excluded. Papers from all languages were included but excluded if translation to English could not be made. When authors could not be contacted to retrieve full texts, studies were excluded.

2.3 Data Extraction

Authors (SW, JW, BJ) reviewed the studies and discussed the overarching sport science and medicine topics. Studies were categorised into these topics, determined by their primary aims and outcome measures, with sub-categories identified where appropriate. The general characteristics (i.e., year of publication, geography, cohort investigated, sample size) of each study were extracted. Data relating to the participants’ characteristics (i.e., sex, age, stature, body mass), the aim, outcome measures, and key findings of each study relating to the purpose of this review were extracted. Outcome measures were converted into comparable units, e.g., stature converted from m to cm. Where necessary, means and measures of dispersion were extracted from figures in the manuscripts using WebPlotDigitizer v4.2 [ 41 ].

2.4 Data Synthesis

Given the purpose of a scoping review is to first map the extent, range, and nature of the literature on a topic, and secondly, summarise findings that are heterogeneous [ 39 ], no analysis was carried out. Study characteristics, key outcomes, and data are summarised with data presented as mean ± standard deviation (SD) where appropriate.

3 Results and Discussion

3.1 search and selection of studies.

The database search identified 957 articles, with five studies identified through other sources. Following the removal of duplicates and screening for eligibility, 150 studies remained for inclusion in the review. The flow of articles through identification to final inclusion is shown in Fig.  1 .

Flow of selection process for eligible studies for inclusion

3.2 General Characteristics of the Studies

3.2.1 sports science and medicine topics.

The 150 studies included in the review covered eight sport science and medicine topics: biomechanics ( n  = 15, 10%), fatigue and recovery ( n  = 9, 6%), injury ( n  = 45, 30%), match characteristics ( n  = 24, 16%), nutrition ( n  = 3, 2%), physical qualities ( n  = 37, 25%), psychology ( n  = 13, 9%), and training load ( n  = 4, 3%) (Fig.  2 ).

Netball sport science and medicine topics of included studies

3.2.2 Publication Year

Table 1 demonstrates the rapid growth in studies over recent years, with 65% of studies published between 2011 and 2020. Studies investigating injury range from one study before 1990 (2%) [ 42 ], to 22 studies between 2011 and 2020 (49%). All other topics had over 60% of studies published after 2010. The growth in studies coincides with the increased professionalism of netball and thus the potential increase in funding for research. Additionally, improvements in technology (e.g., inertial movement units) have enhanced the ability to quantify (e.g., external workload) team sports [ 43 , 44 ], which would explain the increase in match-characteristics research.

3.2.3 Geography of studies

Studies were identified from seven different countries: Australia, Jamaica, Malaysia, New Zealand, Singapore, South Africa and the UK (Fig.  3 ). The majority of studies were from Australia ( n  = 81), followed by the UK ( n  = 29) and New Zealand ( n  = 16) (Fig.  3 ), which have high participation rates and semi-/professional leagues. Within the topic of ‘match-characteristics’, 20 out of the 24 studies (83%) were from Australia, which is unsurprising given Australia has the most professional (in terms of funding and spectators) netball competition (Suncorp Super Netball). Nutrition and psychology were the only topics in which studies from Australia did not dominate with 67% ( n  = 2) and 54% ( n  = 7) from the UK, but with both still being under-investigated relative to other topics (Fig.  2 ). The countries of very low representation (Malaysia [ n  = 4], Singapore [ n  = 3], Jamaica [ n  = 2]) investigate injury [ 32 , 45 , 46 , 47 ], physical qualities [ 48 , 49 , 50 , 51 ] and biomechanics only [ 52 ].

The geography of included studies

3.3 Biomechanics

Fifteen studies investigated biomechanical outcomes related to netball (Supplementary Table S1). Studies used a range of athletes from recreationally trained ( n  = 3, 20%) to elite level ( n  = 4, 27%). The majority of studies (80%, n  = 12) investigated biomechanical outcomes related to injury risk [ 8 , 9 , 10 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ]. Movement analysis of the shoulder pass [ 19 ] and shooting [ 61 ] have also been carried out, and the influence of playing surface on landing has been assessed [ 62 ]. Differences in shooting action between age-groups have been investigated [ 61 ]. Senior-level players extend their elbows and knees simultaneously, while juniors appear to have greater dissociation between the upper and lower peripheries [ 61 ]. Furthermore, senior-level players have greater variability of movement between their upper limbs when shooting [ 61 ]. A case study ( n  = 1) identified that during the shoulder pass, the greatest ground reaction forces (GRF) have been observed to coincide with ball release [ 19 ]. However, it is unknown whether differences in experience and passing success elicit different passing strategies.

3.3.1 Injury Risk

During netball-related landing tasks, well-trained players demonstrated substantial valgus of the knee [ 10 ], with Collings et al. [ 53 ] demonstrating that experience level may not mitigate risk factors associated with poor frontal plane knee control. However, empirical evidence is still required to better understand whether differences in landing technique can modify injury risk.

Seven studies [ 8 , 9 , 54 , 56 , 58 , 60 ] investigated the use of strapping and bracing of joints collectively demonstrating that strapping and bracing may reduce the range of motion but do not influence joint kinetics or kinematics. Yet, there is evidence to suggest that proprioception is improved with ankle bracing [ 59 ] and athletes perceive greater stability in the strapped or braced joint [ 9 , 58 ]. Furthermore, whilst the joints may not be affected when landing, it is possible that muscle activity is reduced [ 8 ]. This information suggests that bracing and taping joints may provide the athlete a perceived benefit rather than actual changes in the kinetic and kinematic outputs and whether these practices cause worthwhile reductions in injury risk is still unknown. Additionally, further investigation is required on whether lower limb movement screening [ 55 ] can help identify future injury risk in netball athletes.

3.4 Fatigue and Recovery

Nine studies investigated fatigue and recovery within netball (Supplementary Table S2). The majority of studies used elite level cohorts ( n  = 7, 78%) [ 63 , 64 , 65 , 66 , 67 , 68 , 69 ], with the remaining studies using Australian state-level athletes [ 3 , 70 ]. Two studies (22%) quantified the fatigue response to competition [ 63 , 67 ], whilst two studies (22%) investigated the effect [ 64 ] and the perceived importance [ 68 ] of various recovery modalities. Four studies (44%) focused on sleep indices, patterns and/or behaviours [ 3 , 65 , 66 , 69 ]. Finally, one study investigated the influence of compression garments on netball-specific running performance during a circuit [ 70 ].

Studies investigating the fatigue responses have shown a varying time-course of recovery at 62 h post-match (i.e., not all variables returned to baseline) over a 3-day international tournament [ 63 ] and that subjective mental and physical fatigue were reported to be separate constructs, with limited relationships with performance variables following matches [ 67 ]. Sleep and fluid replacements were reported as the perceived most important recovery modalities in 215 netball players [ 68 ]. Additionally, Juliff et al. [ 64 ] found that following a netball-specific circuit contrast water therapy and contrast showers improved perception of recovery in comparison to the passive recovery condition, but no difference in physical recovery was reported. However, further research is required on recovery modalities and whether the development of specific physical qualities can positively influence transient (e.g., within match), acute (e.g., following a match) and chronic (e.g., over a season) fatigue and recovery profiles in netball players.

Studies investigating sleep found significant reductions in total sleep time following a match compared to training and rest days [ 66 ], which was consistent with perceived sleep duration and quality [ 69 ]. Napping (> 20 min) on the day of performance appears to improve performance [ 65 ] and teams who slept longer reportedly achieve higher tournament positions [ 3 ]. Given the importance of sleep and disruption following a match, future research should assess the efficacy and effectiveness of sleep hygiene strategies.

3.5.1 Epidemiology

Of the 45 studies to investigate injury in netball, 31 (67%) had an injury epidemiology focus (Supplementary Table S3). These studies involved a wide range of cohorts including populations such as club [ 42 , 71 , 72 , 73 , 74 , 75 , 76 ] and state or national level [ 32 , 33 , 34 , 75 , 77 , 78 , 79 , 80 ], whilst 23% ( n  = 11) of included studies reported netball injuries relative to “general population” patients [ 45 , 46 , 47 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ]. Studies also examined netball injury in both junior/youth [ 72 , 87 , 89 ] and senior/open age [ 77 , 78 , 79 ] athletes. The majority of epidemiological studies collected data over extended periods of a year or longer [ 32 , 45 , 46 , 47 , 74 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 90 , 91 , 92 , 93 ]. However, some studies utilised data representing much shorter periods, e.g., tournament weeks [ 71 , 72 , 73 , 76 , 94 ] or days [ 33 , 34 , 42 , 75 , 77 , 78 , 80 ].

Various approaches were taken when defining or classifying injury amongst the included studies. Some based classifications on accepted criteria [ 73 , 78 ], others utilised broad definitions including, for example, aspects such as an injury that occurs whilst participating in sport, that leads to either a reduction in the amount of level of sports activity, or the need for advice or treatment [ 30 ]. Finally, narrow definitions such as “trauma to a specific body part resulting in cessation of play” were also utilised [ 32 ].

A common theme of included studies was the reporting of injuries relative to hours of exposure [ 31 , 33 , 34 , 72 , 74 , 76 , 80 , 94 ] or number of athletes [ 32 , 34 , 42 , 73 , 75 , 81 , 88 , 89 , 91 , 92 , 93 ]. Injury incidence was commonly reported between 12 and 14 injuries per 1000 exposure hours [ 30 , 31 , 34 , 74 , 76 ]. In addition to injury incidence and prevalence, the activity participants were performing (e.g. matches or training) when the injury occurred was also considered [ 33 , 78 ], as was the specific movement or mechanism (e.g. landing, contact, overuse) involved [ 31 , 32 , 45 , 71 , 75 , 77 , 85 , 88 , 94 ]. Furthermore, the type and/or site of injury was commonly reported [ 30 , 32 , 33 , 42 , 47 , 71 , 73 , 74 , 75 , 76 , 77 , 79 , 80 , 82 , 83 , 84 , 86 , 87 , 88 , 89 , 90 , 91 ] with lower limb injury, particularly to the knee and ankle, common [ 30 , 32 , 42 , 45 , 71 , 74 , 75 , 79 , 80 , 83 , 84 , 88 , 90 , 91 , 94 ]. Whilst a systematic review of the mechanisms of non-contact knee injury has recently been carried out [ 95 ], the volume of injury epidemiology research in netball may warrant a systematic review and meta-analysis to provide researchers and practitioners with a high level of evidence regarding incidence and prevalence in addition to injury mechanism and site. Additionally, given there is no current evidence on the epidemiology and burden of concussion in netball, research in this area is also warranted.

3.5.2 Risk and Prevention

The remaining 14 injury studies included in the review had an injury risk, influence, or prevention focus (Supplementary Table S4). Junior ( n  = 4, 29%)[ 89 , 96 , 97 , 98 ] through to open age players ( n  = 8, 57%)[ 10 , 35 , 99 , 100 , 101 , 102 , 103 , 104 ] were investigated and a variety of athlete performance levels were found within the studies including, school or club [ 96 , 97 , 98 , 99 , 100 , 101 , 103 , 105 ], inter-district [ 99 , 100 , 101 ], state or elite [ 102 , 104 , 106 ] and international [ 35 ]. Although a range of athlete cohorts have been used in netball injury and prevention research, there may be value in extending this work, particularly in higher-level athletes as this group appears underrepresented in current studies.

A common purpose of these studies was the analysis of injury risk factors. These included prior injury [ 99 ] and the role of physical capacity (including movement quality) and anthropometry [ 89 , 98 , 101 , 102 , 103 , 104 ]. Other studies examined the impact of injury prevention strategies [ 35 , 96 , 97 ] and mechanisms/movement patterns involved in specific injuries (e.g. anterior cruciate ligament (ACL)[ 106 ]). Further work analysed the impact of netball on balance and postural sway [ 105 ]. Despite the large number of injury epidemiology studies (Supplementary Table S3) there is relatively little work examining injury risk and prevention strategies in netball and these could be the focus of future research.

Given the range of purposes of the studies included in this section, it is not surprising that a variety of data were collected. The most common related to injury history [ 35 , 98 , 99 , 101 , 102 , 103 , 104 , 105 ] whilst balance (e.g. STAR excursion test) was also commonly assessed [ 99 , 101 , 105 ]. Some studies measured physical capacity (e.g. vertical jump) [ 96 , 101 , 104 ]; others reported somatotype and anthropometric variables [ 98 , 102 , 103 ]. In addition, performance on movement screens [ 98 ] and mobility measures [ 89 ] were utilised along with subjective questionnaires relating to the landing technique [ 97 ].

The results of studies assessing injury risk and the value of prevention programs were varied. For example, no difference in balance between participants with and without previous ankle sprain was demonstrated in one study [ 99 ] whilst the odds of ankle sprain were four times higher when STAR excursion posterior and medial direction was < 77.5% leg length [ 101 ], and a large proportion of knee injuries were associated with knee valgus [ 106 ]. Similarly, studies examining the role of somatotype in injury risk produced equivocal results [ 102 , 103 ].

The findings regarding the role of physical capacity and/or movement skill in injury are also inconsistent. For example, whilst a functional stability program reduced injury occurrence in international level players [ 35 ] and a 6-week program improved landing mechanics associated with ACL injury [ 96 ], one study found no difference in movement competency, jump performance or ankle dorsiflexion in injured players [ 98 ]. In contrast, increased postural sway was evident on the preferred leg in those previously injured [ 105 ]. Paradoxically, there is also some suggestion that greater jumping ability and anaerobic fitness were associated with greater injury risk [ 103 ]. In comparison to other sports, there is very limited knowledge regarding the role of physical capacity (e.g. strength, aerobic capacity) and other factors (e.g. injury history) in injury risk in netball and this warrants further work. Furthermore, there may be a benefit from studies assessing injury burden (e.g. time lost for specific categories of injury), recurrence rate and the impact of specific rehabilitation protocols.

3.6 Match Characteristics

The details of the 24 studies investigating match-play in netball are displayed in Supplementary Table S5. Of those studies, 63% ( n  = 15) have examined match activity profiles [ 11 , 12 , 14 , 15 , 27 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 ], whilst seven have focussed on technical and tactical aspects [ 13 , 28 , 29 , 117 , 118 , 119 , 120 ], and two have examined performance outcomes [ 121 , 122 ]. A large proportion ( n  = 17, 71%) of the studies examining aspects of match play involved elite-level competition [ 12 , 15 , 27 , 28 , 29 , 107 , 108 , 109 , 110 , 111 , 112 , 117 , 118 , 119 , 120 , 121 , 122 ] and all (except one study [ 114 ]) evaluated female netballers.

3.6.1 Activity Profile

A range of metrics have been reported when examining the activity profiles of netball, including speed and distance, and non-locomotor activities (e.g., jumping). These were obtained using various approaches such as notational analysis, computerised analysis systems (e.g. Dartfish) [ 12 ], Inertial Measurement Units (IMU; accelerometers, gyroscopes, magnetometers) [ 113 ], Global Positioning Systems (GPS) [ 113 ] and Local Positional Systems (LPS) [ 112 ]. The accelerometery derived metric PlayerLoad™ was used to quantify external load in nine of the activity profile studies [ 11 , 14 , 15 , 110 , 111 , 113 , 114 , 115 , 116 ]. The predominance of technologies such as IMU and LPS to quantify the activity profile of netball is likely a function of many studies being conducted using high-level athletes participating in indoor matches, which precludes the use of technologies such as GPS commonly used in outdoor team sports.

A consistent theme across studies was the analysis of positional differences [ 11 , 14 , 15 , 108 , 110 , 111 , 113 , 115 , 116 ], with centre-court players displaying higher external loads than both GK and GS [ 11 , 15 , 108 , 110 , 111 , 113 , 115 , 116 ]. In addition, a small number of studies has compared the activity profiles of different groups (e.g. male vs female, differing standards) [ 11 , 14 , 113 , 114 ]. The ongoing development and increasing availability of measurement technologies provide an opportunity to develop a more detailed understanding of netball activity profiles at various performance levels.

3.6.2 Technical-Tactical

The studies examining technical-tactical analysis have quantified a variety of common netball actions such as passing, interceptions, turnovers, and shooting percentage, all including elite level players [ 28 , 29 , 117 , 118 , 119 ]. An interesting finding is that experts appear to execute more passes under low levels of defensive pressure than developmental athletes and this resulted in more successful passes being completed by the elite players [ 29 ]; however this was the only study to compare levels of performer. In addition, one study has examined changes in technical-tactical aspects over time [ 118 ] and another study investigated potential strategies regarding the new ‘two-point’ rule in Suncorp Super Netball [ 120 ]. Further work examining differences in technical-tactical aspects between levels appears warranted and this may assist with both talent identification and training programme design. Furthermore, more research examining links between game events and performance outcomes (e.g. win vs loss) may provide coaches with important information for both training programme design and tactical decision making.

3.6.3 Performance

The impact of factors including travel and fixture scheduling on performance (e.g. win vs loss, points margin) has been examined in two studies [ 121 , 122 ]. The small volume of work in this topic limits the ability to definitively determine the importance of these aspects to netball performance and should be a focus of future research.

3.7 Nutrition

Three studies have investigated nutritional outcomes within netball (Supplementary Table S6) [ 6 , 123 , 124 ]. One study investigated the hydration status of international athletes [ 6 ], showing sweat and fluid intake rates of approximately 250 and 80 ml·h −1 , respectively. The other two studies investigated the energy intake, expenditure and appetite of junior athletes at the club [ 123 ] and school [ 124 ] level, identifying alterations in appetite in response to netball exercise. However, this is yet to be investigated in senior or elite-level netball athletes. Furthermore, investigation into nutritional and dietary behaviors of these athletes may assist in the provision of nutritional interventions.

3.8 Physical Qualities

Thirty-seven studies have investigated the testing methods and physical characteristics of netball athletes (Supplementary Table S7), ranging from junior ( n  = 3) [ 4 , 125 , 126 ] to elite ( n  = 12) [ 18 , 48 , 49 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 ] level. Twenty-two percent ( n  = 8) of studies specifically investigated the validity and/or the reliability of tests or testing outcomes [ 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 ] and 43% ( n  = 16) had a primary emphasis upon testing physical characteristics [ 16 , 18 , 20 , 50 , 125 , 129 , 130 , 131 , 132 , 141 , 142 , 143 , 144 , 145 , 146 , 147 ], with an additional four studies quantifying anthropometric characteristics [ 49 , 51 , 148 , 149 ]. Finally, 24% ( n  = 9) of studies investigated the effects of different training interventions on changes in physical characteristics and performance [ 4 , 48 , 126 , 127 , 128 , 150 , 151 , 152 , 153 ].

3.8.1 Testing

The 505 CoD test has been shown to demonstrate acceptable between-day reliability when 1–2 familiarisation sessions are provided [ 138 ]. Furthermore, the 30:15 intermittent fitness test (30:15IFT) may be able to detect changes in high-intensity running performance across a training mesocycle [ 139 ]. In comparison, the ‘Net-Test’ [ 134 ] and Netball Specific Fitness Test [ 140 ], two sport-specific assessments, have demonstrated acceptable reliability and may be able to discriminate between athletes of different playing standards. Similar trends have been shown within the Reactive Agility Test and Planned Agility Tests [ 135 ], although it should be noted that the typical variation between-days for these tests are still unknown. Finally, the GRF produced during a single leg horizontal jump can provide reliable outcomes when assessing balance [ 136 ], while the Netball Movement Screening Tool is reliable when implemented by practitioners with similar levels of experience with the tool [ 137 ]. However, it has not been ascertained whether the Netball Movement Screening Tool is a valid method for detecting increased injury risk for netball players. Considering these findings, the reliability of a narrow scope of tests has been assessed. Thus, further information is still required to ascertain the reliability and validity of a range of different tests and screening methods that assess different physical qualities.

3.8.2 Physical Characteristics and Anthropometrics

It has been demonstrated that, when compared to sedentary controls, netball athletes are taller and have greater lean body mass [ 148 , 149 ]. Additionally, athletes at higher playing standards are taller and demonstrate greater sprint and CoD ability [ 18 , 125 , 132 , 146 ], while centre-court players have greater fitness and jumping ability than other positional groups [ 16 , 144 ]. However, it appears that body fat percentage may not be able to discriminate between playing levels [ 49 , 51 ]. It has been shown that stronger athletes demonstrate greater acceleration (i.e., 5-10 m), CoD, and vertical jump [ 145 ], while the Functional Movement Screen has moderate relationships with trunk stability and CoD ability [ 130 ]. Finally, small asymmetries in lower limb stability and vertical hop performance have been shown to occur in club level players [ 141 ], while a high occurrence (63%) of general joint hypermobility has been observed in elite players [ 131 ]. From these findings, it is clear that differences in athletes are prevalent. However, a lack of systematic physical profiling has been completed (e.g., a standardised testing battery across age groups and playing standards) which is illustrated in a large number of tests, standardisation protocols, and outcome measures reported. Thus, researchers and practitioners should endeavour to work together to develop valid and reliable testing batteries that provide a comprehensive overview of the netball athlete.

3.8.3 Training Interventions

Plyometric and strength training can induce favourable adaptations in measures of isometric strength, power, and CoD, while decreasing potential injury risk factors (e.g., peak landing forces) [ 48 , 126 , 127 , 151 ]. Improvements in physical characteristics may be greatest in anaerobic qualities, which may be related to previous training exposure [ 128 ]. Additionally, training outcomes may be augmented through the use of blood flow restriction or hypoxia when using low relative intensities during resistance training [ 151 ]. However, practitioners must be wary of rapid improvements in physical performance during initial training periods and may require systematic alterations in the training stimulus to promote continued performance improvements [ 127 ]. When programming, it may be prudent for practitioners to implement specific training interventions. The NetballSmart Dynamic Warm-up has been shown to improve some performance outcomes (i.e., the vertical jump and prone hold) [ 4 ], the inclusion of barefoot training and backwards running may enhance CoD ability [ 150 , 152 ] and a combination of core stability, gluteus medius strengthening and proprioceptive exercises may enhance dynamic postural control [ 153 ]. These findings indicate that moderate to large improvements in physical performance occur with training, although further research is still required to elucidate the effects of strength and power training in well-trained netball athletes and whether changes in these physical capacities can reduce injury occurrence.

3.9 Psychology

Thirteen studies have investigated an aspect of psychology in netball (Supplementary Table S8). Five studies (38%) focused on motor learning and decision making [ 21 , 154 , 155 , 156 , 157 ]. Other studies investigated a range of psychological skills or interventions [ 7 , 22 , 158 , 159 , 160 , 161 , 162 , 163 ], including communication [ 22 ], anxiety [ 158 ], stressors, [ 159 ], behaviour [ 160 ], team cohesion [ 161 ], and imagery [ 7 ]. The cohorts investigated ranged from club to elite and international, with six studies (46%)[ 154 , 155 , 156 , 157 , 159 , 160 ] investigating international level athletes of a range of ages (U17 to open age). Three studies investigated differences between playing standards or levels [ 155 , 156 , 157 ], while three studies made positional comparisons [ 22 , 155 , 162 ]. However, further research is required on the psychological skills of elite netballers and the effectiveness of mental skills training. Given the high prevalence of injury in netball (Supplementary Table S3), research into the psychological effect (i.e., anxiety and stress) of injuries and the impact of psychological support during injury rehabilitation would also be beneficial.

3.9.1 Motor Learning and Decision Making

Decision-making was found to be a key discriminator between highly skilled and less skilled performers, evident through greater accuracy in a decision-making task [ 155 , 156 , 157 ], while Richards et al. [ 21 ] demonstrated the ability of a coach to influence an elite team’s decision making process. Positional comparisons demonstrated limited position specificity in perceptual-cognitive skills in decision-making tasks [ 155 ] but GA and WD players have been found to possess greater coping skills compared to other positions [ 162 ].

3.10 Training Load

Four studies have investigated the external load of training in netball [ 5 , 164 , 165 , 166 ] (Supplementary Table S6), with the majority (n = 3) investigating professional level cohorts. Three studies compared the workload of training to competitive match-play [ 5 , 164 , 165 ], two of which investigated specific training dills [ 5 , 164 ]. One study highlights the need to combine internal and external workloads when monitoring elite netball athletes, suggesting the use of session rating of perceived exertion and CoD as the ideal combination [ 166 ]. However, further investigation is required into the training load and training practices of netball across the range of playing standards and age-groups.

4 Conclusion

This scoping review has identified 150 studies, based on the search criteria used, examining the applied sport science and medicine of netball, with an increase in research seen in recent years. The majority of research originates from Australia in female netball athletes. Across the eight sport science and medicine topics, physical qualities was the first topic studied (1981 [ 129 ]), followed by injury (1986 [ 42 ]), which has remained a priority of research across the years, likely due to the high injury rates reported in both elite and recreational netball (Supplementary Table S3). It is apparent that topics such as nutrition, training load, and fatigue and recovery are under-investigated within the netball population, likely due to the increased cost of such research due to the technologies required, and perhaps lack of funding compared to other professional sports. Whilst the research has been grouped into eight sports science and medicine topics in this scoping review there are relationships and links between each topic (Fig.  4 ). This is evident in studies identified in the review overlapping between different topics, which means developing the research in one area has the potential to impact upon another in practice and research. Furthermore, although a systematic search of studies investigating topics within the applied sport science and medicine of netball was carried out, it must be acknowledged that other studies may exist that were not identified by the search terms.

A visual representation of the current evidence base and the clinical and practical impact of netball sport science and medicine topics. Note: Lines between topics highlight potential links and relationships between the areas

This scoping review summarises the current evidence base and key findings that can be used in practice to enhance the applied sport science and medical support to netball athletes across a range of playing standards, and support the growth of the sport. However, it is apparent the sport of netball is still under-researched.

4.1 Gaps in the Literature and Future Recommendations

Whilst research into the applied sport science and medicine of netball is increasing, this review has identified gaps in the current literature. Areas for future research direction can be guided based on the current level of evidence, alongside the consideration of what is useful in practice [ 167 ], demonstrated in Fig.  4 . Table 2 summarises the identified gaps and provides some directions for future research. Whilst the process of determining what is useful and impactful (Fig.  4 and Table 2 ) is subjective, it may prove valuable for both researchers and policy makers in identifying areas to focus their future research.

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Whitehead, S., Weakley, J., Cormack, S. et al. The Applied Sports Science and Medicine of Netball: A Systematic Scoping Review. Sports Med 51 , 1715–1731 (2021). https://doi.org/10.1007/s40279-021-01461-6

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Research hotspots and trends on sports medicine of athletes: A scientometric analysis from 2003 to 2023

a Department of Physical Education, Beijing University of Posts and Telecommunications, Haidian district, Beijing, China.

Associated Data

This study aims to demonstrate current research priorities and predict future trends of sports medicine of athletes by scientometric analysis. We collected nearly 20 years (2003 to 2023) of publications related to Sports medicine of athletes in the Web of Science database, Citespace was applied to evaluate the knowledge mapping. There are 4820 manuscripts about post-cesarean section in total, and faster growth after 2018. The country, institution, and author posted the most are the USA, Harvard University, and Engebretsen, Lars. Brit J Sport Med publishes the most articles of this type. In addition, the most key cited reference is Hopkins WG (2009). Sports medicine of athletes research, including blood, biomedical imaging informatics, and activity monitor has been a research hotspots in recent years. Through scientometric analysis of the past 20 years, we know the blood, biomedical imaging informatics, and activity monitor is the focus of future research. The USA, Australia, and England have become the main research forces in this field with high publication rates and centrality. This is important for accurately and quickly locating trends in this field.

1. Introduction

After a sports injury, how to get back to the compete again quickly, the answer to this question is rarely straightforward and is influenced by many factors. However, in most cases the goals of the injured athlete and the treating clinician (plus other stakeholders in the decision-making team, such as coaches, parents and managers) are the same – to facilitate a timely and safe return to sport. Return to sport can be viewed as a continuum paralleled with recovery and rehabilitation – not simply a decision taken in isolation at the end of the recovery and rehabilitation process. [ 1 ] As injury is an inevitable part of sports participation, more and more attention has been paid to the research of sports medicine. Due to the rapid growth of sports medicine of athletes research, it is a challenge to entirely understand its research status and hotspots.

Scientometrics is a quantitative analysis of a specific discipline. Including the different database: Pubmed, [ 2 ] Web of Science (WOS), [ 3 ] Scopus, [ 4 ] Derwent, [ 5 ] etc. Among them, WOS is analyzed by different software (Histcite, [ 6 ] Citespace, [ 5 ] VOSviewer, [ 7 ] etc) that can be used for scientometric analysis. Readers can completely understand the hotspots, trends, and frontiers in this field through Citspace software, which helps us to illustrate the development background of certain areas of research. [ 8 ] Citespace is a mature visualization software. [ 9 ] It explores the key point in the evolution of subject fields. Citespace includes coauthor, co-citation, and co-occurrence analysis. [ 10 ] There are 3 concepts: burst detection, betweenness centrality, and heterogeneous network. [ 11 ]

There is currently no bibliometric method to study the sports medicine of athletes. Therefore, the researchers used Citespace software to analyze the global role and trend of sports medicine of athletes in the WOS database from January 1, 2003, to March 6, 2023, and established a field knowledge map in this study.

2.1. Source of literature

We input the WOS database with subject words: TS= (((Sports Medicine) OR (exercise therapy medicine) OR (Rehabilitation medicine) OR (Evidence-based rehabilitation) OR (Therapeutic Exercise) OR (Exercise Rehabilitation) OR (rehabilitation)) AND ((athletes) OR (Athletics))). The search scope of the database is from January 1, 2003, to March 6, 2023, and the language type was English. After Citespace eliminated duplication, 4820 pieces of literature were used for quantitative analysis. The WOS database comes from the Beijing University of Posts and Telecommunications database in China. Therefore, in a way, it is better to add this point in the text that all the articles containing “search terms” have been checked (and therefore, some retrieved articles may not necessarily be 100% relevant).

2.2. Analysis software

Citespace analysis software version is Version 5.6.R2. [ 10 ]

2.3. Download and import of data

Export the results of the retrieved subject terms, keep the file format as “plain text.”

2.4. Parameter setting

Time slicing (from 2001 to 2023; node type (check 1 at a time); selection criteria (50); pruning(pathfinder); visualization (show merged network, cluster view-static).

2.5. Statistical methods

All literature on have been scientifically analyzed; Some data obtained include core countries, institutions, authors, keywords, and references. [ 11 – 13 ] The detailed analysis flow is shown in Figure ​ Figure1 1

Analysis flow chart of sports medicine of athletes.

3.1. Analysis of the publications

During the research period, the total number of articles increased and fluctuated. From Figure ​ Figure2, 2 , the research is divided into 2 stages: the first stage is from 2003 to 2014, and the second stage is from 2015 to 2022. The second stage was a speed development period. The publication published 198 references in 2014, rising to 230 references in 2015. In 2022, this number was growing to 506. These results indicate that sports medicine of athletes was receiving increasing attention in research for the last 6 years.

The number of sports medicine of athletes publications indexed by WOS from 2003 to 2023. WOS = Web of Science.

3.2. Analysis of countries and institutions

Generated a country map (Fig. ​ (Fig.3). 3 ). Research groups in 93 countries published 4820 references. The USA, Australia, England, Italy and Canada are the top 5 countries (Table ​ (Table1). 1 ). USA (0.23), Spain (0.2) and the Australia (0.17) are the top 3 countries from centrality (purple round). An analysis of publication and centrality shows that the USA, and Australia were the main research force in Sports medicine of athletes. Germany, Peoples Republic of China, and Brazil have continued to increase their research interest in this field. The research is mainly distributed in developed countries, and cooperation between countries is weak.

Top 5 countries and institutions researching sports medicine of athletes.

Analysis of the country map from 2003 to 2023.

Generated an institution map that had 382 nodes and 802 links (Fig. ​ (Fig.4). 4 ). The 4820 publications have been published in 382 research institutions. Harvard University, University System of Ohio, University of North Carolina, Harvard Medical School, and Pennsylvania Commonwealth System of Higher Education are the top 5 institutions (Table ​ (Table1). 1 ). In terms of centrality, the top 3 institutions were University of California System (0.1), Aspetar Orthopaedic and Sports Medicine Hospital (0.1), and University of Padua (0.1). In addition, the links between institutions are relatively thin, indicating that cooperation is weak.

Analysis of the institutional map from 2003 to 2023.

3.3. Analysis of journals and co-cited journals

The top 10 academic journals related to sports medicine of athletes (see Table S1, Supplemental Digital Content, http://links.lww.com/MD/J826 which demonstrates the top 10 academic journals). They are specialized journals in this field. Some articles are highly cited, such as “Progressive statistics for studies in sports medicine and exercise science.” [ 14 ] In this article provide a best practice for the use of statistics in sports medicine and the exercise sciences.

Generated a co-cited journal map that had 156 nodes and 169 links (Fig. ​ (Fig.4). 4 ). Brit J Sport Med, Med Sci Sport Exer, Sports Med, Am J Sport Med , and Clin J Sport Med are the top 5 co-cited journals, Am J Sport Med, Clin J Sport Med, JAMA-J Am Med Assoc, JAMA-J Am Med Assoc, Brit J Sport Med , and Med Sci Sport Exer are the top 5 centralities (Table ​ (Table2, 2 , Figure S1, Supplemental Digital Content, http://links.lww.com/MD/J824 which demonstrates the institutional map). In an analysis of publication, centrality, the core journal is the Brit J Sport Med , which was related to the topic of analgesia in our study. It published pieces of literature reflect the current state of research in this field.

Top five co-cited journals and centrality related to sports medicine of athletes research from 2003 to 2023.

3.4. Analysis of author and co-cited author

2558 research authors published 4820 articles. The top 10 authors with published articles about sports medicine of athletes (see Table S2, Supplemental Digital Content, http://links.lww.com/MD/J829 which demonstrates the top 10 authors) are experts in this field. Generated a coauthor map had 2558 nodes and 5185 links (see Figure S2, Supplemental Digital Content, http://links.lww.com/MD/J825 which demonstrates the coauthor map). Engebretsen, Lars, Pelliccia, Antonio, and Hainline, Brian were the top 3 centralities (see Table S3, Supplemental Digital Content, http://links.lww.com/MD/J831 which demonstrates top 5 co-cited authors; see Figure S2, Supplemental Digital Content, http://links.lww.com/MD/J825 which demonstrates the coauthor map).

As the author with the most published and co-cited articles, Meehan, William P is based at the Children’s Hospital Boston., he discusses therapies investigated for the treatment of functional traumatic brain injury as a whole, not solely those initially labeled as mild. [ 15 ] He suggests if the athlete has quantifiable cognitive deficits, a trial of pharmacologic agents may be considered. His research has contributed greatly to sports medicine of athletes.

3.5. Analysis of co-cited references

Generated the reference co-cited map that had 545 nodes and 2172 links (Fig. ​ (Fig.5). 5 ). An analysis of counts and centrality (Tables ​ (Tables3 3 and ​ and4) 4 ) revealed that the data usually comes in the form of Guidelines and consensus. Among them, “Progressive statistics for studies in sports medicine and exercise science” (impact factor: 6.289) was published in Med Sci Sports Exerc in 2009. This article was reported by William G Hopkins. This article provides a best practice for the use of statistics in sports medicine and the exercise sciences. It should achieve 3 useful outcomes. First, it should stimulate interest and debate about constructive change in the use of statistics in our disciplines. Secondly, it should help legitimize the innovative or controversial approaches that we and others sometimes have difficulty including in publications. Finally, it should serve as a statistical checklist for researchers, reviewers, and editors at the various stages of the research process. Guidelines are the most cited and illustrate the standardization of research and treatment.

Top five co-cited references related to Sports medicine of athletes research in terms of co-citation.

Top five co-cited references in sports medicine of athletes research in terms of centrality.

Analysis of the co-citation reference map from 2003 to 2023.

3.6. Analysis of keywords

Figure ​ Figure6 6 shows the occurrence network of keywords. The analysis divided them into 10 clusters (Fig. ​ (Fig.7A 7 A and B): cluster 1 (catastrophic injury; blood; biomedical imaging informatics; activity monitor; bone fractures, red); cluster 2 (second-impact syndrome; oculomotor; cardiovascular system; overuse injury; occupational injuries, yellow); cluster 3 (dynamic motor imagery; hand; glycerphospholipid; beta (2)-agonists; exercise stress testing, canary yellow); cluster 4 (evidence-based medicine; medicine ball throw; force couple; autologous; international sport). In cluster 1, high rates were “sports medicine (194.34, 1.0E-4); injury prevention (79.26, 1.0E-4); pediatric sports medicine (41.67, 1.0E-4); physical therapy (28.48, 1.0E-4); baseball (27.07, 1.0E-4).” In cluster 2, the high-rate keywords were “concussion (150.58, 1.0E-4); mild traumatic brain injury (102.71, 1.0E-4); adolescent (54.2, 1.0E-4); return to play (36.63, 1.0E-4); sports injury (32.73, 1.0E-4).” In cluster 3, the high rate was “athlete (129.33, 1.0E-4); sport (122.9, 1.0E-4); injury (97.2, 1.0E-4); exercise (96.2, 1.0E-4); doping (55.28, 1.0E-4),” and in cluster 4, the high rate keywords were “rehabilitation (134.9, 1.0E-4); electromyography (72.59, 1.0E-4); athletic performance (42.1, 1.0E-4); resistance training (41.39, 1.0E-4); exercise therapy (37.75, 1.0E-4).” Keywords can reflect the hotspots and research directions in the field of research to a certain extent. From these keywords, we can know that biomedical imaging, blood may become the focus of research in the future.

Shows the occurrence network of keywords.

(A) Analysis of the co-occurrence network of keywords map from 2003 to 2023. (B) Analysis of the co-occurrence network of keywords map from 2003 to 2023.

4. Discussion

From the analysis of Citespace, we found that the annual articles about sports medicine of athletes was increasing from 2003 to 2023. It may be because that sports medicine has not been widely recognized.

Research cluster has been selected as the main research topic in this field. In a cluster, the main keywords were Biomedical imaging informatics and blood was the main modality of sports medicine of athletes. Biomedical informatics is the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision-making, motivated by efforts to improve human health. [ 16 , 17 ] Blood flow restriction (BFR) training has garnered increased attention in recent years because of the potential for individuals to achieve an increased degree of muscle burden and physiologic change at a lower level of resistance training. [ 18 ] BFR has been used during physical therapy to aid in the recovery of elderly patients after knee arthroscopy or more complex knee surgery, such as anterior cruciate ligament reconstruction. [ 20 , 21 ] Hughes et al [ 19 ] concluded that low-load BFR training could provide a more effective approach to low-load resistance training in a broad population undergoing clinical musculoskeletal rehabilitation. [ 22 ] so it has become a recent research hotspots.

By analyzing references and keywords, “concussion,” “injury prevention,” “adolescent” appears more frequently. It means that sports medicine often appears in these 3 aspects. Although concussion is a common sports injury, there are few published data on effective treatments. Many current recommendations are based on anecdotal evidence and consensus. Even when the search is expanded beyond the realm of sports, to include all forms of concussive brain injury, data remain scarce. Concussion is common in athletes. [ 23 , 24 ] Headache is the most common symptom reported after concussion, [ 25 , 26 ] and sport-related concussion specifically. [ 27 ] As every clinician who manages concussions can attest, postconcussive headaches can be difficult to treat. There seems to be an inverse relationship between the severity of head trauma and the occurrence of posttraumatic headaches. [ 28 , 29 ] Although the use of analgesics, such as ibuprofen, may be beneficial in the short-term, rebound headaches are common and can complicate treatment and recovery. [ 30 ] Therefore, their frequent use should be discouraged.

There is limited research on the impact of medications on sports medicine, such as sedatives and hypnotics. Sports performance may suffer, recuperation may be hampered, and injury risk may rise. [ 31 ] Additionally, it impairs athletes’ capacity to keep up strong performance levels and a happy attitude. Anxiety may also be a risk factor for sleep problems in athletes. [ 32 , 33 ] In fact, a recent meta-analysis of elite athletes in the present day revealed that 34% of them displayed signs of anxiety/depression. [ 34 , 35 ] For this reason, occasionally, the loss of this equilibrium could lead individuals to seek solace in sleeping pills. Research has attempted in recent years to draw the athletic community’s attention to the usage and abuse of benzodiazepines (BZDs) in sport. Several years ago, some research attempted to further the discussion surrounding the usage of BZDs in sports. The most recent literature review suggests that BZDs do not have an ergogenic effect on exercise performance and may even be detrimental.

5. Conclusion

Bibliometric analysis of sports medicine of athletes publications from 2003 to 2023 revealed. The biomedical informatics and blood flow restriction is the focus of future research. The USA, Australia, England have become the main research forces in this field with high publication rates and centrality. Many developed countries have the strongest cooperation with well-known institutions, which is conducive to the development of sports medicine of athletes research. These articles are widely cited because they are guideline or highly impact factor.

6. Limitations

This technique may have missed publications published in other databases since we solely used CiteSpace software for visual examination of the WOS database in this investigation. Additionally, the search technique was developed to gather as much information as possible, therefore it cannot be assumed that all included articles are entirely pertinent to the subject of the study.

Author contributions

Conceptualization: Xiongce Lv.

Data curation: Xiongce Lv, Ye Tao.

Formal analysis: Xiongce Lv.

Funding acquisition: Xiongce Lv.

Methodology: Xiongce Lv.

Project administration: Ye Tao.

Resources: Xiongce Lv, Ye Tao.

Software: Xiongce Lv, Ye Tao.

Supervision: Ye Tao.

Writing – original draft: Xiongce Lv, Ye Tao.

Writing – review & editing: Xiongce Lv.

Supplementary Material

Abbreviations:.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Beijing University of Posts and Telecommunications basic scientific research business cost new teacher talent project (No.2022RC55).

Supplemental Digital Content is available for this article.

The authors have no conflicts of interest to disclose.

The ethical approval was not necessary, because there is no data to be approved by the Ethics Committee in this document.

How to cite this article: Tao Y, Lv X. Research hotspots and trends on sports medicine of athletes: A scientometric analysis from 2003 to 2023. Medicine 2023;102:39(e35254).

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