AFL's Injury Crisis: Can We Explain It?

[sven_inc]

I'm a Physio, and I've noticed the narrative emerge over the last week or so of an injury "crisis" with several public players going down. (My apologies if there's already a thread on this but I couldn't see one.)

Treloar's out again. Phillipou and Marshall have developed stress fractures. Cumming, Daniel, Wardlaw, Walsh, Ridley etc with hamstrings. Guys like Darcy, Lewis and Gibcus looking overseas for added help with their respective knee injuries. The list seemingly goes on. No new ACL's yet thankfully, though there are plenty of guys on the tail end of their rehab.

I'm also hearing a lot of theories as to why: is pre-season too long? Is it too short with the season starting earlier and earlier? Are players training too hard, or having too much time off (Kane Cornes)? Is it the training surfaces or just all a weird dose of bad luck? Can we even do anything about them or are they just a part of professional football?

Seeing this discussion piqued my interest as someone passionate about uncovering the root cause of pain and injury.

I thought I might be able to share some interesting insights that may be able to help people better understand and digest their team's injury fortunes but perhaps also their own aches and pains.


Essentially, we need to take a step back and shift our perspective to really get to the bottom of why we get injured. It's also important to note that pain and injury is pretty complicated at times, but we can still simplify things a lot.

Currently, I think the public narrative is that what you were doing at the time of injury was the cause of that injury. Phillipou has been running a tonne this pre-season and developed a thigh bone stress fracture - makes sense. Perhaps George Wardlaw was sprinting at training and tore his hammy - sprinting makes sense. Nick Daicos has overused his Plantar Fascia so it became sore - again, makes sense. And so on.

But for me clinically, the best way to look at the onset of most non-traumatic pain and injury is this:

- It's the last straw, not the start of something new.

When you ping a hamstring, something like sprinting isn't specific enough to explain why your hamstring tore nor why you injured yourself on the one side and not the other. Especially because running and sprinting are normal.

But what these moments do, is that something like sprinting at high speeds and under fatigue is fantastic at exposing hidden underlying dysfunction you didn't realise was already there. Was Wardlaw's back subtly stiffer and tighter on that one side? Was one glute weaker than it should have been? Was there more neural tension going down the back of that leg but who cares because it wasn't painful?

Phillipou's femur didn't develop a stress fracture because he's killing it this pre-season. It happened because that part of his body stopped tolerating something about the way he was loading it up.

Nick Daicos is allowed to work hard and load up his Plantar Fascia - it's how we adapt and improve. But if his back is stiff, his hip flexors tight, or his ankle joint is stiffer than it should be all on that side, does it change the way he loads his entire leg and his PF was the structure that failed?

It's hard to know unless you assess each player individually, but these are the kinds of "abnormalities" that often get exposed by normal things.

One really interesting part of this conversation for me is most of these "abnormalities" are accrued during a person's non-athletic moments - slouching on a couch watching TV, playing PlayStation with your mates, sitting bored in a team meeting, wearing heeled shoes or thongs etc. We develop these things and then take them into our most dynamic pursuits, and in the right circumstances - genuine fatigue, awkward movements, high-intensity efforts etc, we're left vulnerable.

It may be no coincidence that the proportion of a player's work week may involve more downtime over the off-season and pre-season when compared to the routine of the premiership season.

Similarly, when we move beyond the "non-traumatic" accidents and into the more brutal hits and tackles and blunt force traumas, it's still important to respect that there's a level of force that may injure even the most healthy of tissue. But, the more optimal someone is functioning mechanically, the greater our chances of bending and not breaking. It's still important.

But the point I'd like to raise for discussion is that whenever we see an AFL player (or anyone for that matter) become injured, we need to take a step back and consider what they took into that moment - but perhaps didn't realise. It may not be visible to the naked eye, but should reveal itself with the right perspective.

If this is interesting to people, please feel free to throw a name out and I'll lean on my experience as a Physio over the last 20 years to talk generally about what I'd expect their hidden dysfunction to be and how it may have got there.

- Cheers

Also, if anyone is interested, I've gone deeper in the blog post below.

The AFL's Injury Crisis: Are We Missing the Bigger Picture?

The Australian Football League (AFL) is no stranger to injuries, but the number sustained so far this pre-season has many fans and analysts scratching their heads. Whether it be Kangaroo young gun George Wardlaw's high-grade hamstring tear, the trio of long-term injuries to important Saints, Nic...

www.yourwellnessnerd.com

 

[jacquizc]

Great read. I'd like to hear your thoughts on whether a group of torn ACLs, like Richmond had in 2024 is just gotten to luck or whether other factors might be at play.

 

[flyinghi64]

I don't know how having 3 weeks off over Christmas after building up training loads over 5 or so week period then coming back and doing it all over again is a good thing.
A week off would be fine, 2 would be starting to lose what fitness you gained and 3 weeks would just waste a lot what you gained in that 5 week training period.
Does not make sense at all.

 

[Freomaniac]

well, the AFL season starts at March 6th, doesn't it?

wonder how off-season training is in the 1960s and 1970s compares to the 2020s?

 

[sven_inc]

Great read. I'd like to hear your thoughts on whether a group of torn ACLs, like Richmond had in 2024 is just gotten to luck or whether other factors might be at play.

ACLs are tricky, but like most other injuries - especially those that don’t come from direct trauma, should have some underlying vulnerability.

For me, I’d be looking at how stiff someone’s ankle is, as this accounts for so much knee dysfunction. Typically a restricted ankle - that isn’t left over from a previous ankle sprain, often seems to stem from things like heeled work/business/leisure shoes, thongs, or even something a basic as sitting with your ankles bent at the standard 90 degrees for hours on end.

Apart from this, a lack of hip rotation can cost someone the ability to buffet the non-linear trauma from a tackle or a fall.

Less than ideal hip rotation strength can also cost the legs ability to stay in a linear plain and allow the knee to be loaded as a glorified hinge joint.

One sneaky one in finding is there might be a role of low back dysfunction as well.

A large proportion of ACLs aren’t from a collision or tackle etc, but even those that are looking to trs tout the robustness of someone’s leg mechanics.

From a Richmond perspective, I’d be keen to see what those guys do when they aren’t training. How they sit, what shoes they wear, previous injury history etc. I’d be willing to bet they’re well conditioned, it just depends on how things work behind the scenes.

It all counts at the end of the day!

 

[kreuze_missile]

Carlton is cursed.

Can't be anything else.

 

[Sirlemsip]

Great read as always.

Something I have seen mentioned before is how strapping a certain area of weakness (e.g. ankle) can move stressors up the chain to the next joint (knee).

Is it possible that an individual training to their own regime (whether club directed or not) in the offseason likely doesn't do any strapping themselves, and then upon returning to formal club training starts to get strapped up.

Furthermore, when outside of the formal club training, are players more likely to be 'lazy' in regard to warm ups/cool downs? Could a resulting loss in flexibility increase risk of injury once intensity of training ramps up?

 

[sven_inc]

well, the AFL season starts at March 6th, doesn't it?

wonder how off-season training is in the 1960s and 1970s compares to the 2020s?

For me, the season can start whenever it wants. If it’s early, perhaps the players aren’t quite match-fit enough, perhaps their skills are still a little off, decision making’s off etc. It shouldn’t be the thing that causes these injuries if there’s nothing under the hood to expose.

 

[sven_inc]

I don't know how having 3 weeks off over Christmas after building up training loads over 5 or so week period then coming back and doing it all over again is a good thing.
A week off would be fine, 2 would be starting to lose what fitness you gained and 3 weeks would just waste a lot what you gained in that 5 week training period.
Does not make sense at all.

I think those conversations are valid from a strength and conditioning perspective - although an AFL player’s time off is still filled with a lot of training, just away from the club.

 

[sven_inc]

Carlton is cursed.

Can't be anything else.

Definitely throws a spanner in the works!

 

[sven_inc]

Great read as always.

Something I have seen mentioned before is how strapping a certain area of weakness (e.g. ankle) can move stressors up the chain to the next joint (knee).

Is it possible that an individual training to their own regime (whether club directed or not) in the offseason likely doesn't do any strapping themselves, and then upon returning to formal club training starts to get strapped up.

Furthermore, when outside of the formal club training, are players more likely to be 'lazy' in regard to warm ups/cool downs? Could a resulting loss in flexibility increase risk of injury once intensity of training ramps up?

Consequences of taping are real unfortunately. It has its uses but like any external thing can also have its downsides as well.

It wouldn’t be high on my list of root causes, but with any in-depth investigation it’d be something to at least consider.

This may sound strange, but in a perfect world we shouldn’t need to warm up to reduce injury risk. Most animals can get up and go if needed without warming up. A warm up is obviously optimal for peak performance but it shouldn’t be the deciding factor unless there are underlying issues under the surface to expose. If that makes sense?

 

[btdg]

Footy used to be a genuine winter sport. For the first 50-60 years of the league the season began in the last week of April. When the league expanded to 22 games it started on the weekend that transitioned March/April and as late as 2015 the season's first match was Thursday April 2.

Basically, for the entire transition from 'bunch of plumbers and dentists playing footy on the weekend' to 'fully professional elite athletic competition', there was a standard model for pre-season training which boiled down to 'rest up and don't get fat' before Christmas, then a full 3 month run in the new year.

Then in a very short window the AFL added a pre-finals bye, and brought the start date FORWARD. Then it added a 'gather round' and brought the start date FORWARD. Then it added an opening round and brought the start date FORWARD. Last year, we played our first real match in Brisbane on 5th March - that's a full month earlier than just a decade before.

March, in Melbourne, is objectively summer. It's part of a 4-month run where the average high temperature is 24+. In April the temperature drops to 21, and by May it is 17. Even the local Aboriginal people, who observed 6 seasons, grouped it as one of their 3 summer seasons late Feb-March was 'Eel Season', hot and dry and the time when eels migrate down the now dry rivers), then observed 'Wombat Season', which was the winter and ran April-August (hmmm... basically the old footy season).

It means two things:

• pre-season training routines ingrained in players and officials across 2-3 generations of footy are no longer appropriate. There's a full month less - less recovery AND less time to train and get ready for the year
• the first month of the season now takes place in Summer. Hotter weather = harder grounds, more fatigue and more dehydration

It's a bad combination. There's no doubt that footy injuries are tied to fatigue and overexertion and that the combination of 'just finished a heavy building load' and 'playing matches at full intensity' is particularly bad for this.

It's interesting to me that last year's premiers, Brisbane, stated the year atrociously (0-3 and then 2-5, with 3 losses at home) and seem to have just used the first month as an extended preseason. I think this is the model we should be copying (particularly if we have Richmond = a guaranteed round 1 win. Just use that as a practice match, punt the next couple, and start the real season at 1-3 or 2-2).

There's absolutely no reason IMO for the AFL to be playing in March, at all. Pushing the finals back into October would be much better IMO, with the GF at the end of October. That might impact on First Class cricket... but cricket is also ripe to negotiate for new season start and end dates (their current Sheffield Shield system of 'playing October-November, taking a break for Big Bash in December-January, then returning for Feb and March' is just stupid. And, hate to say it, Sheffield Shield cricket doesn't need the MCG....

 

[Obeanie1]

I don't know how having 3 weeks off over Christmas after building up training loads over 5 or so week period then coming back and doing it all over again is a good thing.
A week off would be fine, 2 would be starting to lose what fitness you gained and 3 weeks would just waste a lot what you gained in that 5 week training period.
Does not make sense at all.

Players still train over Chridtmas. They don't just stop and start eating Christmas pudding and get on the booze.

Reported several time the Brayshaw family do a huge running session on Christmas Day is one example.

Professional athletes train hard away from the club. Many haven't reached that level of professionalism. Come back underdone and when the training ramps up......ping.

As the OP explained its what has happened leading up to the injury that often tells the story.

 

[Hamingja]

How much of it is more players getting injured v saturation of coverage of the injuries?

I mean someone posted the Wardlaw injury on the Geelong board when it happened. Promising young player for North, fine, doesn't move the needle for me as a Geelong supporter. Back in the day you would have played North and said oh what happened to that Wardlaw guy, he was pretty good last year. Now it is posted and shared on social media the minute it happens.

 

[jacquizc]

ACLs are tricky, but like most other injuries - especially those that don’t come from direct trauma, should have some underlying vulnerability.

For me, I’d be looking at how stiff someone’s ankle is, as this accounts for so much knee dysfunction. Typically a restricted ankle - that isn’t left over from a previous ankle sprain, often seems to stem from things like heeled work/business/leisure shoes, thongs, or even something a basic as sitting with your ankles bent at the standard 90 degrees for hours on end.

Apart from this, a lack of hip rotation can cost someone the ability to buffet the non-linear trauma from a tackle or a fall.

Less than ideal hip rotation strength can also cost the legs ability to stay in a linear plain and allow the knee to be loaded as a glorified hinge joint.

One sneaky one in finding is there might be a role of low back dysfunction as well.

A large proportion of ACLs aren’t from a collision or tackle etc, but even those that are looking to trs tout the robustness of someone’s leg mechanics.

From a Richmond perspective, I’d be keen to see what those guys do when they aren’t training. How they sit, what shoes they wear, previous injury history etc. I’d be willing to bet they’re well conditioned, it just depends on how things work behind the scenes.

It all counts at the end of the day!

Thanks

 

[NetworkNerd]

Curnow sent for scans

 

[Obeanie1]

ACLs are tricky, but like most other injuries - especially those that don’t come from direct trauma, should have some underlying vulnerability.

For me, I’d be looking at how stiff someone’s ankle is, as this accounts for so much knee dysfunction. Typically a restricted ankle - that isn’t left over from a previous ankle sprain, often seems to stem from things like heeled work/business/leisure shoes, thongs, or even something a basic as sitting with your ankles bent at the standard 90 degrees for hours on end.

Apart from this, a lack of hip rotation can cost someone the ability to buffet the non-linear trauma from a tackle or a fall.

Less than ideal hip rotation strength can also cost the legs ability to stay in a linear plain and allow the knee to be loaded as a glorified hinge joint.

One sneaky one in finding is there might be a role of low back dysfunction as well.

A large proportion of ACLs aren’t from a collision or tackle etc, but even those that are looking to trs tout the robustness of someone’s leg mechanics.

From a Richmond perspective, I’d be keen to see what those guys do when they aren’t training. How they sit, what shoes they wear, previous injury history etc. I’d be willing to bet they’re well conditioned, it just depends on how things work behind the scenes.

It all counts at the end of the day!

Well that certainly helps explain Sheeds ACL last week.

Described as an innocuous event that ended in an ACL.

Sheeds has had multiple foot / ankle problems for years and has struggled with increased training loads. Recall reading his foot was becoming numb and losing feeling in it.

 

[sven_inc]

Footy used to be a genuine winter sport. For the first 50-60 years of the league the season began in the last week of April. When the league expanded to 22 games it started on the weekend that transitioned March/April and as late as 2015 the season's first match was Thursday April 2.

Basically, for the entire transition from 'bunch of plumbers and dentists playing footy on the weekend' to 'fully professional elite athletic competition', there was a standard model for pre-season training which boiled down to 'rest up and don't get fat' before Christmas, then a full 3 month run in the new year.

Then in a very short window the AFL added a pre-finals bye, and brought the start date FORWARD. Then it added a 'gather round' and brought the start date FORWARD. Then it added an opening round and brought the start date FORWARD. Last year, we played our first real match in Brisbane on 5th March - that's a full month earlier than just a decade before.

March, in Melbourne, is objectively summer. It's part of a 4-month run where the average high temperature is 24+. In April the temperature drops to 21, and by May it is 17. Even the local Aboriginal people, who observed 6 seasons, grouped it as one of their 3 summer seasons late Feb-March was 'Eel Season', hot and dry and the time when eels migrate down the now dry rivers), then observed 'Wombat Season', which was the winter and ran April-August (hmmm... basically the old footy season).

It means two things:

• pre-season training routines ingrained in players and officials across 2-3 generations of footy are no longer appropriate. There's a full month less - less recovery AND less time to train and get ready for the year
• the first month of the season now takes place in Summer. Hotter weather = harder grounds, more fatigue and more dehydration

It's a bad combination. There's no doubt that footy injuries are tied to fatigue and overexertion and that the combination of 'just finished a heavy building load' and 'playing matches at full intensity' is particularly bad for this.

It's interesting to me that last year's premiers, Brisbane, stated the year atrociously (0-3 and then 2-5, with 3 losses at home) and seem to have just used the first month as an extended preseason. I think this is the model we should be copying (particularly if we have Richmond = a guaranteed round 1 win. Just use that as a practice match, punt the next couple, and start the real season at 1-3 or 2-2).

There's absolutely no reason IMO for the AFL to be playing in March, at all. Pushing the finals back into October would be much better IMO, with the GF at the end of October. That might impact on First Class cricket... but cricket is also ripe to negotiate for new season start and end dates (their current Sheffield Shield system of 'playing October-November, taking a break for Big Bash in December-January, then returning for Feb and March' is just stupid. And, hate to say it, Sheffield Shield cricket doesn't need the MCG....

I hear you mate.

What you’ve said makes perfect sense. The challenge is that running and training hard are just variations of normal things - things that the body should be able to tolerate. Yes they will absolutely get fatigued and maybe underdone in some capacities, but it should mean they tear a muscle in one part of their leg for example - unless there’s something else going on that leaves it vulnerable.

Hammies are an interesting example where so many guys this preseason are having decent ones. There was even a recent herald sun article where a guy with a phd also blamed training intensity.

But for me clinically, all hamstrings should be considered back-related until proven otherwise.

And all training intensity, less rest, more heat etc are just a way to test the robustness of a persons mechanics.

 

[flyinghi64]

Players still train over Chridtmas. They don't just stop and start eating Christmas pudding and get on the booze.

Reported several time the Brayshaw family do a huge running session on Christmas Day is one example.

Professional athletes train hard away from the club. Many haven't reached that level of professionalism. Come back underdone and when the training ramps up......ping.

As the OP explained its what has happened leading up to the injury that often tells the story.

Haha, I understand that. But what they do and to what intensity would vary between players. Without the clubs fitness specialists and trainers guiding them on what they should and shouldn't do it could have an effect. I am sure they would be given a schedule for the 3 weeks or something but they are all individuals with varying degrees of application.

 

[sven_inc]

How much of it is more players getting injured v saturation of coverage of the injuries?

I mean someone posted the Wardlaw injury on the Geelong board when it happened. Promising young player for North, fine, doesn't move the needle for me as a Geelong supporter. Back in the day you would have played North and said oh what happened to that Wardlaw guy, he was pretty good last year. Now it is posted and shared on social media the minute it happens.

Whether it’s a genuine crisis or not is really one for the stats guys and gals. If there’s significantly more this year, or the severity of each injury turns out to be worse then that’s fair enough.

Injuries are injuries at the end of the day, it’s just that broader perspective that I think we miss a lot that helps us better understand why they happen.

 

[sven_inc]

Well that certainly helps explain Sheeds ACL last week.

Described as an innocuous event that ended in an ACL.

Sheeds has had multiple foot / ankle problems for years and has struggled with increased training loads. Recall reading his foot was becoming numb and losing feeling in it.

It certainly might.

Same thing with Sean Darcy’s knee issues over the last few years. Sounds like he’s gone in for an ankle operation to take a plate out. Not sure if it’s the same side, but it’s these kinds of things that don’t register for most of us because we call them two different things. One’s and ankle and one’s a knee.

For me, injury prone players often have some underlying central dysfunction that expresses itself in different ways. But it’s often something you need to look for to find.

 

[emuboy]

I've seen players out training in 40-degree plus temperatures in the pre-season.

Surely things like this wouldn't help with players getting injured and not being able to run out the season?

 

[Obeanie1]

I've seen players out training in 40-degree plus temperatures in the pre-season.

Surely things like this wouldn't help with players getting injured and not being able to run out the season?

Heat training and altitude training apparently have similar advantages.

 

[Obeanie1]

Haha, I understand that. But what they do and to what intensity would vary between players. Without the clubs fitness specialists and trainers guiding them on what they should and shouldn't do it could have an effect. I am sure they would be given a schedule for the 3 weeks or something but they are all individuals with varying degrees of application.

Correct. It's why clubs want more contact with players. To monitor their progress.

Some players are just more professional than others. And that pesky skin fold test and 2km time trial when they return they can't hide from.

 

[Percel]

Enough is enough