Soft Tissue Injuries - how do we address it?

[Eastdog]

Can this be reduced or is it that it is just commonplace in the game now as players today run a lot more compared to a long time ago.

Discuss?

[DOG GOD]

Our conditioning staff need to be looked at..full investigation...if it was a commonplace problem due to more run in the game, every team would be in our situation, and they aren’t...I’d be looking closely at what we are doing, and obviously doing wrong.

[bornadog]

Our conditioning staff need to be looked at..full investigation...if it was a commonplace problem due to more run in the game, every team would be in our situation, and they aren’t...I’d be looking closely at what we are doing, and obviously doing wrong.

Adelaide are worse than us and had 7 hammies at one stage

[Eastdog]

Adelaide are worse than us and had 7 hammies at one stage

Really I think it's across the board something that just happens more often than before but still would be good to review the match conditioning.

[Flamethrower]

This is all about the limitation of interchanges - the lawmakers at the AFL wanted the game to be a war of attrition by removing unlimited interchanges and that is what they now have in the form of an injury crisis across almost every club.

On top of that, the players are trying to conserve energy by staying close to the ball wherever possible, and that has led to growing congestion.

[bornadog]

This is all about the limitation of interchanges - the lawmakers at the AFL wanted the game to be a war of attrition by removing unlimited interchanges and that is what they now have in the form of an injury crisis across almost every club.

On top of that, the players are trying to conserve energy by staying close to the ball wherever possible, and that has led to growing congestion.

Totally agree with you. I can't see what was wrong with unlimited interchange. The thoughts were if you limit the capacity of players to run then they can't run and create congestion, plus they would have to rest in the forward pocket, so there wouldn't be many around the ball. That is just rubbish as the consequences are injured players, recruitment of elite running athletic players and not footballers, plus don't we want to see the best players on the ground after they have had a rest. No chance of players resting in the forward pocket, because of the forward press, so players push themselves and soft tissue injuries like hammies happen.

Another rule change based on kneejerk reaction. That is why I am so against changing rules, I don't trust the AFL.

[GVGjr]

Totally agree with you. I can't see what was wrong with unlimited interchange. The thoughts were if you limit the capacity of players to run then they can't run and create congestion, plus they would have to rest in the forward pocket, so there wouldn't be many around the ball. That is just rubbish as the consequences are injured players, recruitment of elite running athletic players and not footballers, plus don't we want to see the best players on the ground after they have had a rest. No chance of players resting in the forward pocket, because of the forward press, so players push themselves and soft tissue injuries like hammies happen.

Another rule change based on kneejerk reaction. That is why I am so against changing rules, I don't trust the AFL.

The problem is when an injury occurs early in the game. The stats showed that the team that lost a player early was at a distinct disadvantage as the other team just out rotated them on the IC bench. If you lose one now it's still the same number of rotations just spread around 21 players for one side and 22 for the other.

The game has changed, we went from having a 19th and 20th man to having 22 players, we tried a sub rule and now we have reduced the number of changes. I'm all for it and I'd actually like to see it lowered again. Too often good players are waiting to come back on and cant because the ball is over on the other side of the ground.

[bornadog]

The problem is when an injury occurs early in the game. The stats showed that the team that lost a player early was at a distinct disadvantage as the other team just out rotated them on the IC bench. If you lose one now it's still the same number of rotations just spread around 21 players for one side and 22 for the other.

The game has changed, we went from having a 19th and 20th man to having 22 players, we tried a sub rule and now we have reduced the number of changes. I'm all for it and I'd actually like to see it lowered again. Too often good players are waiting to come back on and cant because the ball is over on the other side of the ground.

I would like to see the stats on injuries v interchange rotations, ie have the injuries increased since the rotations have decreased.

[SonofScray]

The problem is when an injury occurs early in the game. The stats showed that the team that lost a player early was at a distinct disadvantage as the other team just out rotated them on the IC bench. If you lose one now it's still the same number of rotations just spread around 21 players for one side and 22 for the other.

The game has changed, we went from having a 19th and 20th man to having 22 players, we tried a sub rule and now we have reduced the number of changes. I'm all for it and I'd actually like to see it lowered again. Too often good players are waiting to come back on and cant because the ball is over on the other side of the ground.
Tend to agree, I like the idea of restricting interchange. Though I suspect going a man down early in games is still a huge disadvantage. I've been asking around for stats but I suspect the W-L ratio for teams with greater amount of minutes per player due to injury is highly skewed.

[Greystache]

I don't think it's something we need to worry about. Much like goal kicking it'll just naturally resolve itself as the players get older. Being amongst the worst in the league year after year is just bad luck. Nothing to see here.

[bornadog]

I have gone through the whole list of injuries from the start of the year. We have 45 players on the list (I think I haven't counted) and we have had one calf injury, and hammies to Wood and Macrae. The rest of the injuries have been knees, foot, ankle, shoulder , hip, broken thumb, compound fracture of finger. Not the fault of medicos, these are football injuries.

Hardly a crisis.

[Greystache]

Dickson was out this week with his second hamstring this season and Suckling has an Achilles just for a start. No idea where your list came from.

4 in 2 games. Hardly not hardly not a crisis

[Twodogs]

Just as long as it's not a post flag plummet then I'm happy.

[bornadog]

Dickson was out this week with his second hamstring this season and Suckling has an Achilles just for a start. No idea where your list came from.

4 in 2 games. Hardly not hardly not a crisis

ok, I missed Suckling because I didn't take this weeks list (available tonight) and forgot him. The list for your information is the list produced by the Club every week.

So 45 players and we have Schache, Wood, Dickson, Macrae and Suckling.

I work on facts not on perception.

[SlimPickens]

This is all about the limitation of interchanges - the lawmakers at the AFL wanted the game to be a war of attrition by removing unlimited interchanges and that is what they now have in the form of an injury crisis across almost every club.

On top of that, the players are trying to conserve energy by staying close to the ball wherever possible, and that has led to growing congestion.

The one thing that goes against your argument is that the majority of hamstring and soft tissue injuries are occurring in the earlier stages of the game. This is particularly true for our players this year. When fatigue kicks in, there is a reduction in the rate of hamstring injuries simply because the explosive nature of the game decreases. It’s something that the afl medicos really struggle with and appear not to be getting much better at managing despite the level of sports science and rehab being the highest it has ever been.

[Axe Man]

Achilles injuries are in a category all of their own. They are very difficult to get rid of, I know from experience. Wasn't it Sucklings achilles that forced him out of the finals in 2016? If he's been managing that since then and this is the first game he's missed then i would say the medical staff have done a fairly good job.

However, I am just guessing, as we all are. We have no idea of the extent of the management and treatment that goes on behind the scenes. The notion that some people seem to have that the medical staff have no idea what they are doing as soon as we get a couple of hammy injuries is ridiculous. Of course it is an area that should be under regular review as all areas of operation of the club should be. I would be very surprised if our rate of soft tissue injuries is above the AFL average.

[Greystache]

ok, I missed Suckling because I didn't take this weeks list (available tonight) and forgot him. The list for your information is the list produced by the Club every week.

So 45 players and we have Schache, Wood, Dickson, Macrae and Suckling.

I work on facts not on perception.

Which is about as accurate as the club's goal kicking.

You need a better source if you're going to tell everyone they're wrong.

[azabob]

I’d like to hear from Slim Pickens as he was one of the first to call for a review to occur and from memory has a background in this field.

Slim what would you do if you headed up the review?

[bornadog]

Which is about as accurate as the club's goal kicking.

You need a better source if you're going to tell everyone they're wrong.


https://media.giphy.com/media/L29fiOMSDhhvi/giphy.gif

[The bulldog tragician]

I have gone through the whole list of injuries from the start of the year. We have 45 players on the list (I think I haven't counted) and we have had one calf injury, and hammies to Wood and Macrae. The rest of the injuries have been knees, foot, ankle, shoulder , hip, broken thumb, compound fracture of finger. Not the fault of medicos, these are football injuries.

Hardly a crisis.



BAD and others more knowledgeable about injuries than me - one thing that concerns me is about those with a history of knee problems such as Clay Smith and Jack Redpath and their recurrent issues. I get that these are guys with damaged knees in the first place but how are we managing their ongoing strengthening and protection? The fact of the recurrent hamstrings for Dickson and Wood is also frustrating.

I don’t think it is a total indictment of our medical staff just to carefully review what we’re doing and compare to best practice elsewhere, just as I hope we do with all areas of our coaching at the end of this year. If it means even one more player has a better 2019 I’m all for it.

[SlimPickens]

Deleted post

[azabob]

I know there has been a lot of talk on BT who would you sack thread but Slim has provided a great overview of how the review should be conducted.

Especially now with Williams going down.

What I find bizarre is that each injury release has the comment - will be managed cautiously. Is that code for we have no idea what it is?!?

[bornadog]

I know there has been a lot of talk on BT who would you sack thread but Slim has provided a great overview of how the review should be conducted.

Especially now with Williams going down.

What I find bizarre is that each injury release has the comment - will be managed cautiously. Is that code for we have no idea what it is?!?

Aza, whilst there may be issues at our club, my view is there are injury issues across the whole AFL. It seems this year there are alot of injuries for some reason or another? I haven't verified it, and only going by this years injury lists.

* Is it training and preparation
* is it the way clubs play now with manic pressure around the ball
* Is it the surface at Etihad which has been spoken about in the past
* Is it lack of injury management

There are only a couple of clubs that are managing injuries better than others - see injury list here (http://www.afl.com.au/news/injury-list)

[ledge]

Check out the surface at whitten oval , is it too soft and then we go on Etihad where it's too hard ?
Do we need to make the surface at whitten oval the same hardness as Etihad ?

[Hotdog60]

Get a podiatrist to look at their boots. If it's foot related get in a foot specialist.
Maybe more cushioning?

[LostDoggy]

With all due respect, we have three bone stress injuries this year to Dale, Williams and English. Those injuries are actually a direct result of the workload the players. And it is the fitness and medical staff who devise and monitor the players workloads to ensure optimum fitness. How is that going? Seems very poor to me. These bone stress foot injuries can be career threatening, and we have three of them.


And before someone blames Etihad, I dont recall other tenants having the same severity and frequency of problems.

Also would be checking the number of recurrent injuries as they can be a marker for failed rehab or poor actions taken by fitness staff to mitigate the risk of re injury. Wood and Dickson in particular seem to be getting recurrent hammies. Whats going on there?

[bornadog]

With all due respect, we have three bone stress injuries this year to Dale, Williams and English. Those injuries are actually a direct result of the workload the players. And it is the fitness and medical staff who devise and monitor the players workloads to ensure optimum fitness. How is that going? Seems very poor to me. These bone stress foot injuries can be career threatening, and we have three of them.


And before someone blames Etihad, I dont recall other tenants having the same severity and frequency of problems.

Also would be checking the number of recurrent injuries as they can be a marker for failed rehab or poor actions taken by fitness staff to mitigate the risk of re injury. Wood and Dickson in particular seem to be getting recurrent hammies. Whats going on there?

two areas need to be reviewed

1. Fitness and conditioning - are we over loading? Eg Is the practise in the preseason of not using the full interchange now causing damage.

2. Are the recovery people giving the right advice to players?

[Mofra]

Aza, whilst there may be issues at our club, my view is there are injury issues across the whole AFL. It seems this year there are alot of injuries for some reason or another? I haven't verified it, and only going by this years injury lists.

* Is it training and preparation
* is it the way clubs play now with manic pressure around the ball
* Is it the surface at Etihad which has been spoken about in the past
* Is it lack of injury management

There are only a couple of clubs that are managing injuries better than others - see injury list here (http://www.afl.com.au/news/injury-list)
When we played North a couple of weeks ago, another Etihad tenant, they had one player on their injury list - Waite with a calf, which is an older player injury anyway.

I've spoken before at North being quite different to the rest of the competition in their pre-season, training, conditioning etc. There is merit in looking at things differently.

E.g. I used to see a physio who travels with the Australian Olympic team, often for an ongoing chronic knee injury (I still run, do weights, just manage the pain, etc). A mate of mine is an osteo and TBH I would see him (or any osteo) before my old physio.
I was talking about icing an injury (the old RICE protocol for injuries) a couple of years ago and he advised that icing isn't always the best thing to do for an injury and in some cases can hinder recovery. Horse for courses, do you want to ruduce inflammation to try and exercise through it or do you want to promote healing / stimulate bloodflow through the area to aid recovery?

We've got sports science guys at VU who really know their stuff (i.e. broke down Wood's running gait in minute detail, re-worked it to protect his hamstrings and until a few weeks ago had a good run with injuries after a period when he questioned whether he could even have career). We seem to ignore a lot of 'new' science and keep doing what everybody else does.

North's decisions are against the grain but are working for them. They are also under instruction to ignore their conditioning staff if they feel good and want to practice shots on goal after training (something Ben Brown does regularly) but that's another story.

[Doc26]

two areas need to be reviewed

1. Fitness and conditioning - are we over loading? Eg Is the practise in the preseason of not using the full interchange now causing damage.

2. Are the recovery people giving the right advice to players?

At the very least a performance review of Chris Bell and his medical/sports science team must be undertaken to ascertain if he and his team are indeed competent for this vital area as from outside the sanctum it doesn't look or read well. I'm not suggesting that he and his team aren't, simply that a thorough review must occur to tick this rather large box.

[bornadog]

When we played North a couple of weeks ago, another Etihad tenant, they had one player on their injury list - Waite with a calf, which is an older player injury anyway.

I've spoken before at North being quite different to the rest of the competition in their pre-season, training, conditioning etc. There is merit in looking at things differently.

E.g. I used to see a physio who travels with the Australian Olympic team, often for an ongoing chronic knee injury (I still run, do weights, just manage the pain, etc). A mate of mine is an osteo and TBH I would see him (or any osteo) before my old physio.
I was talking about icing an injury (the old RICE protocol for injuries) a couple of years ago and he advised that icing isn't always the best thing to do for an injury and in some cases can hinder recovery. Horse for courses, do you want to ruduce inflammation to try and exercise through it or do you want to promote healing / stimulate bloodflow through the area to aid recovery?

We've got sports science guys at VU who really know their stuff (i.e. broke down Wood's running gait in minute detail, re-worked it to protect his hamstrings and until a few weeks ago had a good run with injuries after a period when he questioned whether he could even have career). We seem to ignore a lot of 'new' science and keep doing what everybody else does.

North's decisions are against the grain but are working for them. They are also under instruction to ignore their conditioning staff if they feel good and want to practice shots on goal after training (something Ben Brown does regularly) but that's another story.

I know you have mentioned North before, and maybe they are doing things better.

Here is their current list:



Player
Injury
Estimated Return


Taylor Garner
Hamstring
5-6 weeks


Billy Hartung
Hamstring
TBC


Ben Jacobs
Concussion
Test


Ben McKay
Knee
Test


Declan Mountford
Hamstring
2 weeks


Ed Vickers-Willis
Knee
Season


Jarrad Waite
Calf
TBC


Declan Watson
Knee
3-4 weeks


Mason Wood
Hamstring
TBC


4 Hammies and a calf - not looking good at present.

[Mofra]

4 Hammies and a calf - not looking good at present.
Not at the moment, but over the course of the season they are near the bottom for 'games lost' (can't find a recent table on it).

They are certainly doing better than us, and I'm willing to look at every avenue to improve out position.

[bornadog]

Not at the moment, but over the course of the season they are near the bottom for 'games lost' (can't find a recent table on it).

They are certainly doing better than us, and I'm willing to look at every avenue to improve out position.

I don't disagree at all. Pretty sure we were second on games lost to Adelaide some weeks ago, but we may have topped the ladder now.

[bornadog]

Injury survey: Hamstrings top the charts again

HAMSTRING strains remain AFL clubs' biggest injury headache, highlighted in the release of the competition's 2017 injury survey.

They remain the AFL's most common ailment and cause for missed matches, with 4.9 new incidences per club last year resulting in 16.6 games spent on the sidelines.

The good news is those numbers were the lowest in seven seasons, representing a small drop from each of the previous four years and 4.9 matches saved compared to 2012.

Clubs lost an average of 25.8 games to hamstring strains a decade ago.

The recurrence rate for hamstring injuries of 14 per cent last season is also trending in the right direction after being as high as 27 per cent in 2008.

But it is still a problem area despite the obvious progress.
Adelaide suffered through a hamstring epidemic this season, with its players at one stage sustaining nine such injuries in a seven-week period after new training methods were trialled.

The survey results follow award-winning PhD student and hamstring specialist Josh Ruddy telling AFL.com.au in January there was still not enough information to significantly reduce these injuries.

"If you think of it as a big pie, we currently have only a very small slice of it. There are a lot of questions and factors in why the injury is occurring," Ruddy said at the time.

"We'll never be able to predict injury with 100 per cent accuracy and prevent all injuries occurring, but the more injury data we can get, perhaps, we can build on this.

"Ultimately, if we can predict injury with any sort of accuracy, we will go a long way to preventing it."

There were fewer injuries per club than 2016 (35.1, down from 37) and the recurrence rate (eight per cent) dipped into single digits for the first time since 2012, but there was a small bump in games missed (141.3, up from 139.8).

Concussion rates remained on par with the previous year, with teams recording about seven diagnosed concussions each, including those that didn't result in a player missing a match.

The average number of matches missed per side with concussions last year (4.2) returned to 2015 levels after jumping to 5.6 in between, as more conservative management was introduced.

Only one of the 18 clubs elected not to be part of the AFL's concussion audit in 2017.

Elsewhere, calf injuries returned to historical levels, with an average club incidence rate of 2.1 after climbing to 3.7 five years ago.

The same was true for the incidence (0.9 injuries per club) and prevalence (7.4 games missed) of leg and foot stress fractures after an unexplained dip the season prior.

Key injury indicators 2007-18



All Injuries

2008

2009
2010
2011
2012
2013
2014
2015
2016

2017



Incidence (new injuries per club per season)
36.9
37.8
38.7
38.4
38.1
41.5
36.1
37.7
37.0
35.1


Incidence (recurrent)
5.4
3.6
4.7
3.6
3.6
5.1
4.4
4.0
3.7
2.7


Incidence (total)
42.3
41.4
43.4
42.0
41.7
46.6
40.5
41.7
40.7
37.8


Prevalence (missed matches per club per season)
147.1
151.2
153.8
157.1
147.7
158.1
146.0
156.2
139.8
141.3


New injury severity (average missed matches)
3.5
3.4
3.4
3.7
3.4
3.3
3.4
3.5
3.4
3.5


Recurrent injury severity (average missed matches)
3.7
4.8
4.4
4.6
4.9
4.0
4.7
3.7
3.0
3.9


Recurrence rate
15%
10%
12%
9%
9%
12%
12%
11%
10%
8%


Clubs participating
16/16
16/16
16/16
17/17
18/18
18/18
18/18
18/18
18/18
18/18


Average players per club
44.6
46.1
46.4
46.9
46.7
45.4
45.1
45.4
45.8
45.3



Injury severity breakdown



Injury Category

New Injuries


Recurrent Injuries





Incidence

Prevalence
Severity
Incidence
Prevalence

Severity



Concussion
1.46
3.38
2.32
0.09
0.80
8.50


Other Head and Neck
0.70
2.35
3.33
-
-
-


Shoulder
2.49
10.99
4.42
0.09
0.28
3.00


Elbow, Wrist and Hand
1.60
4.74
2.97
-
-
-


Trunk and Back
1.83
5.16
2.82
0.14
0.52
3.67


Groin and Hip
3.61
11.27
3.12
0.05
0.09
2.00


Hamstring
5.82
17.93
3.08
0.80
2.16
2.71


Quadriceps
1.55
3.57
2.30
-
-
-


ACL (Knee)
0.56
8.78
15.58
-
-
-


MCL, PCL, LCL (Knee)
1.17
4.51
3.84
0.33
2.49
7.57


Other Knee
2.35
6.06
2.58
0.38
1.22
3.25


Ankle
3.19
11.78
3.69
0.38
1.31
3.50


Calf
2.35
5.87
2.50
0.09
0.42
4.50


Achilles
0.47
2.11
4.50
-
-
-


Other Leg and Foot
3.15
19.20
6.10
0.23
0.75
3.20


Medical illness
2.30
4.18
1.82
0.14
0.47
3.33


General soreness /management
0.28
0.33
1.17
-
-
-


Non-football related injury
0.19
1.36
7.25
-
-
-


TOTAL
35.07
123.56
3.52
2.72
10.52
3.86






Would be interesting by club