Preventing injuries in basketball - Purpose
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Preventing injuries in basketball
Purpose The factsheet has been developed for
national basketball federations and local
The purpose of this factsheet is to highlight associations and is in particular of interest
the main risks involved in basketball and to for coaches, trainers and players. It aims to
give an overview of promising measures and assist coaches and players in developing
implementation strategies for reducing and implementing safety management
basketball injuries in number and in severity schemes in clubs at national and local level
of outcome. and to promote sustainable compliance of
It also presents preliminary results of a pilot coaches as well as athletes to such
project in collaboration with FIBA-Europe, schemes. More detailed information as to
the European basketball federation, and the the methodology, results and literature used
Swedish and Slovak national Basketball can be found in the reports listed on the last
Federations, implementing a set of most page, which are accessible at
promising measures adapted to local needs. www.safetyinsports.eu
Key messages
· Basketball is characterized by intensive body contact, frequent intermittent
running and jumping, demanding one-on-one situations, quick direction
changes in combination with challenging technique and coordination aspects
like catching, throwing, passing and dribbling.
· The overall incidence of an acute injury in basketball is at around 3-6 inci-
dents over 1000 hours of exposure. In competition the incidence is at least
twice as high as during training practice. Within the EU-region it is estimated
that at least 720,000 basketball-related injuries occur each year, at a direct
medical cost of about € 500 million a year, among which knee injuries repre-
sent a cost of around € 100-200 million/year.
· Most of the incidents happen during matches, causing injuries to the lower
extremities, followed by head and finger injuries. Sprains, strains and contu-
sions are the predominant injury types. More than one third of all injuries
affect the ankle joint, mainly as a result from landing on an opponent’s foot
when coming down from rebounds and from jump shots. Women are in par-
ticular vulnerable to knee injuries, in particular to ACL-ruptures.
· Centre players seem to be more prone to injuries compared to other players.
The paint (or key) area is also a clear high-risk zone. Typical movement patterns are running with quick direction
changes, sharp cutting manoeuvres; and particularly jumping and landing.
· Quite some efforts are invested in preventing injuries in particular by adjusting the training protocols. Enhancing
athletic condition as well as improvements in balance, coordination and technique skills are typically recommended
to prevent injuries of the lower extremities. In addition, core stabilisation, flexibility and advanced elementary coordi-
nation and technique skills are being advised. In addition to these measures, the use of protective equipment is be-
ing promoted such as high-top shoes, mouth guards, taping, ankle braces and orthoses.
· Despite efforts of trainers to integrate injury prevention measures in the training schemes, the issue still seems to be
not very popular among basketball players themselves. Fortunately, the importance of the issue is increasingly being
recognised, in particular by coaches and trainers.
· Athletic training, e.g. muscle strengthening, stabilization and proprioception, contributes to performance enhance-
ment as well as injury prevention. It is therefore advised that training sessions should be tailored towards the prime
interest of players in enhancing their athletic performance and thus indirectly helping them to prevent injuries.
· More efforts should be invested in monitoring injuries in order to be better able to identify particular individual and
situational risk factors, to monitor injury trends and to evaluate effects of preventive interventions in the specific club
setting.Game characteristics one-on-one situations with inevitable body
contact frequently occur, such as in handball
Basketball is a so-called transition game, or in football. Research evidence indicates
continuously switching between defensive that the overall incidence is at about 3-6 inju-
and offensive play. The play includes running ries per 1000 hours of exposure.
forwards, backwards and sideward, planting,
cutting, feints, jumps, landings, turns during Taking into consideration an active population
repeated one-on-one situations where addi- of 1.7 million basketball players within the
tional contact can occur. EU-27 with an average 140 hours a year
Thus, the game action is characterized by spent in training and competition, one has to
frequent intermittent running and sprinting. expect at least 720,000 basketball-related
Motion analysis has shown that depending injuries a year, excluding injuries during rec-
on individual playing-time basketball players reational basketball. One fifth of these injuries
cover a distance between 4.6 and 5.8 km per are severe knee which cause an average of
game, with mean heart rates between 80 € 2,300 direct medical cost per case, while
and 90% of individual maximum heart rates. the average expenses of all other injuries are
Therefore, players need to dispose of highly- at around € 700 for treating the injury. A quick
developed basic endurance and a proper calculation indicates that basketball injuries
athletic condition with regard to strength, cost approximately € 500 million a year,
agility, acceleration, deceleration and in par- including knee injuries at a cost of around
ticular jumping. It also requires a well-trained € 100-200 million/year.
anaerobic metabolism: athletes that are in These estimations are quite conservative and
bad athletic condition are prone to injury. the actual costs are probably higher as lei-
sure time play is not included and chronic
Modern basketball is a highly dynamic and injuries are seriously underreported.
demanding sport, with frequent body contact,
even though the rules do not allow many Injuries in competition gain more significance
forms of body contact with other players. with advanced age: while in young players
The game is quite complex as it requires nearly two third of all injuries occur during
technical, tactical, athletic and cognitive training, among adolescents and adults al-
skills, all at the same time. In most cases, an most half of all injuries occur in match plays,
injury in basketball is not caused by one sin- even though with rising age more time is be-
gle factor but is often the result of a combina- ing spent in training compared to time spent
tion of multiple factors which are finally lead- in competition. There is no certainty as to
ing to an unintended result, respectively possible differences in injury rates between
causing a physical injury. recreational and elite athletes.
Injury characteristics Some studies suggest that the injury rate for
female players is higher compared to men.
For instance, WNBA players reported in one
In general terms we have to make a distinc-
study more injuries than NBA players, both
tion between acute and chronic injuries.
during training practices and in competitive
Acute injuries result from a specific, identifi-
games. However, it is absolutely certain that
able event whereas chronic injuries are
women are more vulnerable to specific inju-
caused by repeated micro-traumas without a
ries, in particular to suffering knee injuries.
unique identifiable event being responsible
for the injury.
Regardless age, gender and performance
Although chronic injuries, in particular
level of players, there is a general tendency
chronic knee pains (jumper's knee), fre-
that the majority of injuries affect the lower
quently occur among basketball players,
limbs with the ankle joint being the most af-
overuse injuries are not so well recorded yet.
fected body part: in more than one third of
Injury incidence rates in basketball are com-
all cases, ankle joints are injured. Women are
parable to those in other team sports where
2Body parts affected by acute injuries
among males (left) and females (right)
more prone to non-contact knee injuries pos- kle sprains typically occur while a player lands
sibly due to deficits in neuromuscular control on the opponent’s foot after a jump shot or
as well as greater joint laxity and lesser mus- rebound. The paint (or key) area is also a
cular stiffness. clear high-risk zone.
Younger athletes seem to be more prone to
injuries of the upper body regions, especially Knee injuries, in particular anterior cruciate
finger injuries, resulting from incorrect ball ligament (ACL) injuries, often occur in situa-
handling, or head injuries. With advancing tions while there is no immediate contact with
age there is an increase in injuries of the another player, typically while running with
lower extremities, in particular in knee inju- quick direction changes, in cutting manoeu-
ries. Still, throughout all age groups ankle vres, in dynamic starts and stops, in twisting
injuries are the leading injury cause. or turning and in single-leg landings.
Many so-called non-contact injuries may have
Irrespective of age, gender or performance been provoked by some minor contact shortly
level, sprains (ankle, knee and finger joints) before the injury event. It has been shown
are the most common type of acute injury that even a minor contact during jumping
followed by muscle strains, contusions and phase, pivoting or feinting can make players
fractures. Younger athletes are typically loose body control.
more vulnerable to fractures than older ath-
letes, in particularly affecting fingers or Centre players are destined to collect most of
wrists, as well as to facial and dental injuries. the rebounds. In addition, they normally play
most of their time in the key area, which is by
Chronic injuries usually result from repetitive definition a high risk area. Therefore it is not
stress on biological tissues such as cap- surprising to find that centre players have
sules, ligament or tendons, leading to insta- higher incidences compared to guards and
bilities of the affected joints. In basketball, forwards who have more game action around
the most common overuse injury is the so the three-point-arch.
called jumper’s knee resulting from patellar
inflammation, patellar tendinopathy or ante- Taking into account all these risk factors, it
rior knee pain. seems appropriate to educate and train play-
ers in how to successfully manage contact
Circumstances situations, to enhance performance in typical
basic motor patterns such as jumping, landing
At least half of all injuries occur in contact and cutting – also in combination with contact
with other players and also in rebounds. An- (body control) – and to improve the general
3fitness level of the athletes. As previous Experts opinion
injuries may often lead to recurring injuries
and therefore sufficient attention should be It is evident that athletic training, e.g. muscle
paid to proper rehabilitation and regenera- strengthening, stabilization and propriocep-
tion. tion, contributes to performance enhance-
ment as well as injury prevention. Therefore,
Prevention approaches it is advised by the consulted experts that
training sessions should be tailored towards
In general, measures aiming at preventing the prime interest of players in enhancing
sport injuries can be roughly divided into their athletic performance. There are ample
four more or less distinct categories, opportunities to integrate into these training
namely into measures focusing on ‘training programmes preventive measures that are
and physical preparation', ‘technical and addressing high risk injury situations, in par-
political approaches', ‘equipment and facili- ticular contact situations with opponents, and
ties’, and ‘medical and non-medical sup- the well known injury mechanisms. Also at
port’. early age, the correct technique should be
trained in basketball movement patterns, e.g.
A literature search, carried out in the frame- jumping, landing and feints, that are fre-
work of the Safety in Sports project (see quently associated with increased injury risks.
acknowledgement section), identified 109
preventive recommendations in 70 publica- More specifically the following (mixtures of)
tions related to preventing injuries in bas- approaches are recommended by the con-
ketball. Most of the 70 references originated sulted experts in developing training and bas-
from the United States of America. Half of ketball practicing programmes:
the published recommendations were
based on · Very basic exercises focussing on stabilisa-
strong scientific evidence, all others were at tion of the core, balancing and coordination
least based on expert opinion. practices and proper jumping and landing
techniques. These exercises should be in-
In order to better asses the value of these tegral parts of the warm-up routine (10-15
conclusions and recommendations from the min).
literature survey, a selected group of ex- · The use of balance training in general is
perts in the field was invited to review each being strongly recommended as a routine
of the publications on three criteria: practice with the aim to prevent ankle
· potential effectiveness of recommended sprains.
measure or programme in terms of ex- · Structured warm-up programme are being
pected contribution to the reduction of advised that contain agility, balance,
injuries in number and/or severity; strength and playing technique exercises
· potential applicability of measure in term and that are designed to improve knee and
of required efforts for implementation ankle control during landing and pivoting
(e.g. time, money, infrastructures, com- movements with the aim to prevent knee
petencies); and and ankle injuries among youth athletes.
· potential chance of acceptance of meas- · Technique, such as cutting and landing
ures by athletes, coaches and associa- movements, and balance training on wob-
tions and expected level of compliance ble boards or mats should be trained from
on the longer term. the age of 12 years onwards.
· Preventive training programmes should
The feedback from the consulted 20 experts also include strength and power exercises,
led to a reduced list of recommended prac- neuromuscular training, plyometrics and
tices that are promising as to their actual agility exercises, and be integrated into
contribution to injury reduction and the po- warm-up routine.
tential of being accepted and applied in a · Twenty minute training programmes that
sustainable manner in day to day practices include warm up, stretching, strengthening,
and training of basketball players. plyometrics, agility drills and cool down can
4improve flexibility, strength and biome- In the framework of the Safety in Sports-
chanical aspects that are associated with project (see acknowledgement section), col-
ACL injuries. laborations could be established with the Slo-
· Neuromuscular training may help to re- vak and Swedish basketball federations.
duce ACL injuries in females athletes, These federations were invited to have
under the condition that it includes plyo- coaches and officials participating in surveys
metrics, balance, and strengthening exer- that aimed to better understand their views
cises and that the training sessions are and support needs. Many coaches positively
performed more than once in a week and responded to that invitation, more than one
over a period of at least 6 weeks in a row. hundred in each of the two countries. These
· Athletes playing basketball can also bene- coaches were also involved in developing
fit from a supervised athletic conditioning tailor made set of promising prevention strate-
programme that includes dynamic warm- gies and measures ('national toolkits') and in
up, agility/quickness drills, sport-specific pilot testing these toolkits within their respec-
plyometrics, functional weight training, tive clubs.
core training and an appropriate cool
down with static stretching. Awareness and consumer practices
· It is recommended to have young female The majority of Slovak coaches recognized
basketball athletes participating in pre- injuries as a (very) important issue, while the
season jump training programmes that Swedish coaches seemed to be less aware of
include progressive resistance weight the urgency. In both countries, coaches be-
training for the lower extremities. lieved that injuries can be reduced through
· Prophylactic neuromuscular and proprio- better athletic preparation and by allowing
ceptive training programme may also longer regeneration and rehabilitation peri-
have direct effect in decreasing the num- ods.
ber of ACL injuries in female athletes
when emphasizing proper landing tech- Stretching seemed to be the most preferred
nique. preventive measure among the Slovak
· Individualized season-attending athletic coaches, while the Swedish coaches are
conditioning and technique training with more focusing on muscle strengthening exer-
particular regard to basic basketball- cises. Coaches from both federations recog-
specific movement patterns that com- nised the moderate or even low level of inter-
monly lead to injuries. Ligament sprains est among players to increase training efforts
and knee internal derangements may be in view of preventing injuries. Nevertheless,
at least partially preventable with interven- simple measures such as taping and use of
tions such as taping, bracing and neuro- orthoses and protectors, appear to be more
muscular training. External ankle support, widely accepted.
e.g. orthoses, tape and/or high- top
shoes, may in particular help to prevent Both national groups of experts underlined
injuries to re-occur. the importance of educating coaches, as in
team sports particularly coaches play a deci-
sive role in translating the prevention evi-
How to get the right mix of inter- dence into practice. Therefore, coaches are
ventions the best advocates and change managers for
implementing effective, applicable and ac-
In team sports, coaches play a decisive role ceptable injury prevention.
in implementing prevention evidence into Both federations are already active in educat-
practice and to integrate injury control meas- ing coaches. In Sweden, the “Basketsmart”
ures into current training and practices. knee prevention programme is being pro-
Therefore, it is essential to understand the moted through coaching clinics and a website
perception and knowledge of these practitio- for clubs, coaches and athletes. In Slovakia,
ners as to the injury problem itself as well as there is a strong university-based tradition in
their views on how to tackle the issue within educating basketball coaches, however, the
existing training practices, organisational curriculum of these courses are addressing
structures and capacities.
5injury prevention not always in a consistent agement programme for basketball players,
manner. to be implemented at national and club level,
can be specified as follows:
Pilots
Both groups of experts were involved in criti- Training and physical preparation
cally reviewing the evidence based recom-
mended practices and in assessing the appli- - Basic physical preparation
cability and acceptability of these practices Basketball is a highly demanding team sport.
within their federation. Based on the results To meet the demands of the game, players
of that review, a draft toolkit of promising in- at all levels and ages need a proper basic
jury prevention measures was made for each athletic condition as to endurance, strength,
of the two groups for integration in current flexibility and speed. Athletes in bad athletic
programmes offered by the national federa- condition are significantly more vulnerable for
tions to their coaches and into the training acute injuries and in particular for developing
practices of the involved coaches. This proc- overuse symptoms like jumper’s knee or low
ess included a couple of consultation meet- back pain.
ings with the respective national basketball
associations, consultations with national ex- Structured and supervised athletic condition-
perts and the organisation of coaching clinics ing programmes should be offered to sports-
and training seminars in the respective two men and women at all ages and at all levels
countries. A baseline and follow up survey of performance, as part of pre-season physi-
was carried out to assess the impact of the cal preparation and condition training during
pilot programme on the attitude of coaches seasons. Such programmes should include
as well as their training practices. individually adapted endurance training,
functional weight training, dynamic mobiliza-
The results of these pilot-projects are en- tion and agility drills.
couraging:
· Through the pilots, coaches became more - Structured warm-up routines
aware of the necessity to invest in injury General cardiovascular activation for 10-20
prevention; minutes prior to basketball sessions is
· Owing to the pilots, coaches became more essential and should include basic running
willing and able to direct their training drills but also neuromuscular, proprioceptive
practices towards training contents that and balance exercises, and core stabilization
are more effective in reducing injuries, in and coordination practices. Plyometrics and
particular muscle strengthening and co- agility drills should be included at the end of
ordination exercises; warming up.
· Through the programme, coaches seem to All these highly effective training elements
have found better opportunities to motivate can be easily included in routine training and
their team members in appreciating and warming up practices and do not require ex-
accepting the training practices offered; tra time and efforts.
· The information provided, including web-
pages, reached the target audiences very - Basic and advanced technique training
well; and Technique training is not only most helpful in
· The pilots led to injury prevention injury enhancing the game performance of athletes
prevention being more strongly anchored but also to reduce the risks related to crucial
into the education and training curricula of movement patterns and game situations.
these federations. Proper jumping and landing technique in
terms of knee and ankle control help athletes
What needs to be done to sustain crucial situations like single-leg
landings. Correct ball handling is an impor-
tant factor to prevent numerous finger
While taking into consideration the results of
sprains and quick and controlled feet assist
the expert consultations as well as the pilot
in coping pivoting movements.
testing of recommended measures, the four
components of a comprehensive safety man-
Technique training, should start at young
6age. With increasing age and performance for professional players but also for lower
level technique training should be adapted to level players, a revision of the competition
the advanced demands of the athletes. This schedule can help to shrink the dramatic
means for example, progressively adding number of injuries during and immediately
controlled perturbations during exercising after (inter-) national competitions.
these movement patterns. Intense physical
contact is inherent element of modern bas- Equipment and facilities
ketball and players should be trained to cope
with intense body contacts in match plays. - Mouth Guards
Basically, this also helps athletes performing Dental injuries are rather severe and are of-
better e.g. better scoring efficiency in con- ten leaving long-lasting scars. Custom-made
tested jump shots. mouth guards have shown to prevent dental
and orofacial injuries as well. It is therefore
- Neuromuscular training strongly recommended that basketball play-
There is sufficient scientific evidence that ers, in particular centre players wear custom-
exercises on unstable devices such as wob- made mouth guards.
ble boards, slings or mats in combination
with core stabilization and plyometrics are - Ankle Support
helpful when conducted It is evident that ankle sprains are at least
regularly (at least 1-2 times per week) during partially preventable when athletes use ankle
preseason and season. These training com- braces, orthoses or taping as means of ex-
ponents can be easily integrated into warm- ternal protection. Especially, players with a
up routines and have even stronger positive history of ankle injuries should be advised to
effects while athletes are not yet tired out. use external ankle support to prevent
recurring injuries.
Technical and political measures
Medical and non-medical support
- Awareness raising
Continuous awareness of the positive contri- - Pre-Season Screenings
bution of injury prevention measures to At least for professional athletes it is recom-
sports performance is essential. Individual mended to have a pre-season screening to
athletes and coaches and the responsible detect potential risk factors for injuries, e.g.
staff in clubs and federations need to sys- cardiovascular problems, muscular imbal-
tematically share information on basketball- ances, athletic and neuromuscular deficits.
specific injuries, risk factors, Moreover performance diagnostics will help
injury mechanisms as well as available to identify better the athlete’s individual
knowledge on effective, applicable needs for a training programme to enhance
and acceptable countermeasures. his/ her physical condition. If this is carried
out under close supervision of coach and/ or
- Adaptation of the education programmes physiotherapist this will contribute to in-
Athletes and in particular coaches should crease overall performance and to reduce
receive at least a basic education in acute and chronic injuries.
basketball injury prevention. The develop-
ment and implementation of a safety man- To conclude
agement scheme at club level and at national
level should be one of the core learning ob- Basketball associations and clubs should
jectives within current curriculums for con- follow a pro-active strategy as to the risk of
tinuous education of coaches and club man- injury and communicate with members and
agers. the general public openly about risks in-
volved and necessary measures to be taken
- Restriction on number of matches by clubs and individuals. Players should be
Sufficient regeneration will reduce overuse provided with educational materials, such as
symptoms and acute injuries due to fatigue brochures and video productions presenting
or inadequately cured disorders. Therefore, basic exercises, which should be for instance
downloadable from the FIBA’s Coaching
7Website and national websites. University in Bochum and published under
Such a pro-active approach will also contrib- the titles:
ute to the positive image of the game and the
organisations involved, and will help to at- · P. Luig & T. Henke, Inventory of the bur-
tract new members. den of basketball injuries, existing preven-
tion measures and safety promotion strate-
It is recommended to have all national asso- gies, Ruhr University, Bochum, March
ciations to include an injury prevention mod- 2010
ule in their trainer education curriculums and · P. Luig & T. Henke, Best injury prevention
to designate an official staff member as measures and implementation of strate-
'safety promotion ambassador' of the federa- gies in handball and basketball, Ruhr Uni-
tion. And last but not least, all sustained inju- versity, Bochum, November 2010
ries should be reported to trainers and · P. Luig & T. Henke, Safety in Sports,
coaches and should be systematically re- Safety management schemes in Basket-
corded at club an national level, in order to ball, implementation and testing, Ruhr Uni-
identify individual and situational risk factors, versity, Bochum, August 2011
to monitor injury trends and to evaluate ef-
fects of measures taken. For references to sources of information pre-
sented in this fact sheet and for further refer-
References ences, readers are advised to consult the
above mentioned reports which will be also
All information presented in this Factsheet accessible through the websites: http://
are based on studies carried out by the Ruhr www.safetyinsports.eu and http://
www.eurosafe.eu.com/
Acknowledgements This factsheet has been produced in the framework of the Safety in Sports project, initiated by the consortium
Kuratorium für Verkehrssicherheit (KfV), Ruhr University Bochum (RUB), European Association for Injury Prevention
and Safety Promotion (EuroSafe) and Consumer Safety Institute (CSI).
Co-sponsored by the European Commission under the Public Health Programme 2003-2008, and by ARAG Sports
Insurance Germany.
The research and piloting activities related to basketball have been carried out in close collaboration with the
European Basketball Federation (FIBA-Europe), which is the governing body for basketball in Europe, and the
Slovak- (SBA) and Swedish basketball federations.
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