Injuries In Australian Football Research Articles

A profile of Australian football injuries presenting to sports medicine clinics

Most of the published data describing Australian football injuries is from hospital emergency departments and elite injury surveillance studies. There is a lack of good information about injuries to players at the lower levels of participation and those not severe enough to warrant hospital treatment. This study describes the profile of Australian football injuries that present to sports medicine clinics for treatment. New sports injury cases, presenting to five metropolitan Melbourne sports medicine clinics during a 12 month period in 1996-1997, were recorded through the Sports Medicine Injury Surveillance project. Both the patient and treating health professional provided personal and injury details. Australian football accounted for 29% of the 6479 recorded injury cases. The majority of injured players were male (99%) and from adult, community leagues (78%); the mean age was 23 years. Competition accounted for 78% of injuries and 72% of injured players presented for treatment to a sports physician/medical practitioner. Body contact accounted for half of all injuries and the most common injuries were medial ligament sprains of the knee (7%), lateral ligament sprains of the ankle (6%) and anterior cruciate ligament injuries (4%). In conclusion, sports medicine clinics treat a wide variety of football injuries and appear to be a good source of data about injuries to non-elite participants.

Rationale for training programs to reduce anterior cruciate ligament injuries in Australian football.

This commentary presents the rationale for training programs to reduce the incidence of knee injuries. Our studies have revealed that the external knee loading patterns during sidestep cutting are what put the anterior cruciate ligament at greatest risk for injury. Compared to running, sidestep cutting involves similar levels of knee flexion loading but increased loading in varus-valgus and internal rotation of the knee, and these external loads need to be stabilized or supported by the internal structures of the knee. People use a generalized hamstrings and quadriceps co-contraction to stabilize these external loads, thereby reducing ligament loading. It is proposed that perturbation of the joint receptors reinforces the use of selective hamstrings and quadriceps co-contraction patterns superimposed on a generalized co-contraction pattern. This is not by immediate ligamento-muscular protective reflex, which is too slow to provide any adequate support, but by enhanced proprioceptive information that may be used in learning. In contrast, the immediate effect of muscle stretch reflexes would be to reduce co-contraction, a possibly negative outcome for joint stabilization. The effects of different types of training on the control of joint stability are examined. It is proposed that resistance training may not be appropriate because it enhances muscle stretch reflexes, which may reduce co-contraction, and produces no reductions in voluntary activation times and time to peak torque. However, stability and balance training is thought to suppress muscle stretch reflexes and, in turn, enhance co-contraction. Also, stability and balance training that stimulates the knee joint ligament and capsular receptors may reinforce co-contraction patterns to facilitate greater improvements in joint stabilization. Stability and balance training and plyometric training produce reductions in voluntary activation times and times to peak torque, which may decrease muscle response times so players are more able to perform rapid and unexpected sports maneuvers. Training programs that emphasize these neuromuscular mechanisms may enhance protection of the anterior cruciate ligament and reduce the incidence of injury.

Intrinsic and extrinsic risk factors for muscle strains in Australian football.

Muscle strains are common injuries in Australian football and other sports involving sprinting. Between 1992 and 1999, 83,503 player-matches in the Australian Football League were analyzed for risk of muscle strain injuries using logistic regression analysis. There were 672 hamstring, 163 quadriceps, and 140 calf muscle strain injuries. All three types of muscle strains were associated with significant risk factors. For all injuries, the strongest risk factor was a recent history of that same injury and the next strongest risk factor was a past history of the same injury. History of one type of muscle strain increased the risk for certain types of other muscle strains. Age was a risk factor for hamstring and calf muscle strains (even when adjusted for injury history) but was not a risk factor for quadriceps muscle strains. Quadriceps muscle injuries were more common in shorter players and were more likely when there had been less rainfall at the match venue in the previous week. Quadriceps muscle injuries were significantly more common in the dominant kicking leg, whereas hamstring and calf muscle injuries showed no difference in frequency between the dominant and nondominant legs.

STRATEGIES FOR RECRUITING TEAMS AND PLAYERS INTO AN INJURY PREVENTION RANDOMIZED CONTROLLED TRIAL

The Australian Football Injury Prevention Project is a randomized controlled trial (RCT) of the effectiveness of protective headgear and mouthguards for the prevention of head/neck/orofacial injuries in Australian football players. The RCT involves teams of players randomly allocated to one of 4 treatment arms: headgear, mouthguards, head-gear+mouthguards, control. Whilst voluntary mouthguard usage exceeds 40–60%, very few players currently wear headgear. In preparation for the RCT, extensive background efforts were made to recruit teams and players into the study during 2000. These included establishing formal collaborative links with a large local football league; obtaining endorsement for the project from the national football body; creating a large media profile; using high profile football personalities as project spokespersons; securing co-sponsors to provide incentives for players and teams to participate in the study; attending the football league's annual general meetings; and ongoing correspondence with the football clubs from this league. In addition, a pilot survey of players from 3 senior football clubs was undertaken to determine attitudes towards protective equipment use. Overall, only 30% of surveyed players said that they would wear headgear rather than risk injury, compared to 67% who would rather wear a mouthguard than risk injury. Nonetheless, 82% of players said that they were willing to wear a mouthguard for a whole playing season to see if it could prevent injury, compared to just over 41% who said the same of headgear. Interestingly, just 41% of players said they didn't know if they were willing to wear headgear. These views were taken into account when the teams and players were actively recruited into the study. In summary, a broad range of activities is needed in the planning stages of an RCT to ensure adequate numbers of teams and players participate in the study. Different incentives and motivators need to be provided to teams and players. Supported by the Victorian Health Promotion Foundation

Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers.

The aim of this study was to examine the interaction between intrinsic (player-related) and extrinsic (environment-related) variables as risk factors for anterior cruciate ligament injury in Australian football. Between 1992 and 1999, 100,820 player-match exposures were analyzed for risk of anterior cruciate ligament injury using logistic regression analysis. There were 63 surgically proven noncontact anterior cruciate ligament injuries. The strongest risk factors were a player history of anterior cruciate ligament reconstruction either in the previous 12 months (relative risk [RR], 11.33; 95% confidence interval [CI], 4.02 to 31.91) or before the previous 12 months (RR, 4.44; 95% CI, 2.46 to 8.01). Weather conditions that were associated with dry field conditions--high water evaporation in the month before the match (RR, 2.55; 95% CI, 1.44 to 4.52) and low rainfall in the year before the match (RR, 2.87; 95% CI, 1.30 to 6.32)--were also significantly associated with these injuries. The increased risk of injury in the first 12 months after reconstruction was associated with the reconstructed knee, whereas after 12 months there was an even distribution of new injuries to the reconstructed knee and contralateral knee. A history of anterior cruciate ligament reconstruction is a risk factor for further injury. Weather conditions of high evaporation and low rainfall before matches are associated with noncontact anterior cruciate ligament injury.

Injury countermeasures in Australian Football

Australian football ranks as the thirteenth most popular participation sport in Australia yet it is the largest contributor of sports injury presentations to sports medicine clinics, hospital emergency departments and general practices. Australian football is a high intensity, running and full body contact sport which requires a high level of physical conditioning and technical skill to play. Due to the intense physical nature of Australian football, players are at risk of sustaining both acute and overuse types of injury. A critical review of the range of injury countermeasures used in Australian football was undertaken to determine to what degree these countermeasures have been proven to be effective. Injury prevention measures reviewed included preseason training, physical conditioning, preparticipation screening, warm-up and cool-down routines, playing equipment, footwear, ground conditions, rule adaptation, rule enforcement and protective equipment. Overall, there is a paucity of published studies that have investigated the effectiveness of injury countermeasures in Australian football. Very few countermeasures have undergone formal demonstration of their effectiveness in the field. Modified rules for children, thigh protectors and mouthguards have all been proven to be effective in preventing Australian football injuries. Ground hardness and preseason hamstring muscle weakness have been demonstrated to increase the risk of injury in elite level Australian football. There is evidence from other football codes that rule adaptation and enforcement, external ankle supports, thermal shorts, preseason training, helmets and shin guards can all have a role in reducing the risk of injury. In summary, this critical review demonstrated the lack of formal investigation of injury countermeasures in Australian football.

Deaths due to brain injury among footballers in Victoria, 1968-1999.

To determine the frequency and nature of fatal brain injuries occurring in Australian football. State of Victoria, January to July 1999. Retrospective case series of football-related deaths identified from the coronial autopsy records of the Victorian Institute of Forensic Medicine (1990-1999) and newspaper reports (1968-1989). Coronial autopsy findings and circumstances of injury. 25 deaths associated with Australian football were identified, nine due to brain injury. Coronial findings in the brain-injury deaths were intracranial haemorrhage in eight patients and infarct in the territory of the middle cerebral artery in one. In three of four cases of subarachnoid haemorrhage, vertebral artery trauma was noted. In all but one case, injury occurred as an accidental part of play. The most common findings in deaths due to brain injury in Australian football were intracranial haemorrhage, including subarachnoid haemorrhage from vertebral artery injury.

Acromioclavicular joint injury in Australian Rules football

Objective: The treatment of Grade III acromioclavicular joint {ACJ) injury remains controversial. Literature reports advocate both operative and non-operative management of these injuries. Few studies have reviewed outcomes in a specific sporting population. This retrospective study compared the return to sport times and outcome for both operative and non-operative treatment regimes in Australian Rules Football (ARF) players sustaining Grade III ACJ injuries.

Comparison of injuries in elite senior and junior Australian football

Three thousand and thirty one AFL and 1034 injuries in the VSFL U/18 competition were recorded by club doctors over the 1992, 1993 and 1994 seasons. Hamstring strains had the highest incidence (86.4 per 10,000 player hours) and prevalence (30.2 hours missed per 1000 hours) of any injury in the AFL, but were significantly less common in the U/18 competition. Other injuries which were common in both competitions were ankle sprains, thigh haematomas, concussion, groin strains and head lacerations. Injury prevalence was higher overall in the AFL, with lower limb muscle strains (hamstring, calf, quadriceps) being significantly more prevalent than in the U/18 competition. Injuries which were significantly more prevalent in the U/18 competition included stress fractures and concussion. Subsequent to this study, coaches and medical staff in the U/18 competition were made aware of the high risk of stress fractures in young footballers with heavy training loads. The AFL injury survey is ongoing and in the process of being computerised; risk factors for specific injuries with high rates are being studied further.

Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers.

Hamstring muscle strain is the most prevalent injury in Australian Rules Football, accounting for 16% of playing time missed as a result of injury. Thirty-seven professional footballers from an Australian Football League team had preseason measurements of hamstring and quadriceps muscle concentric peak torque at 60, 180, and 300 deg/sec measured on a Cybex 340 dynamometer. Players were studied prospectively throughout the 1995 season. During that time, six players sustained clinically diagnosed hamstring muscle injuries that caused them to miss match-playing time. The injured hamstring muscles were all weaker than in the opposite leg in absolute values and hamstring-to-quadriceps muscle ratios. According to our t-test results, hamstring muscle injury was significantly associated with a low hamstring-to-quadriceps muscle peak torque ratio at 60 deg/sec on the injured side and a low hamstring muscle side-to-side peak torque ratio at 60 deg/sec. Flexibility (as measured by the sit-and-reach test) did not correlate with injury. Discriminant-function analysis using the two significant ratio variables resulted in a canonical correlation with injury of 0.4594 and correctly classified legs into injury groups with 77.4% success. These results indicate that preseason isokinetic testing of professional Australian Rules footballers can identify players at risk of developing hamstring muscle strains.

Australian Rules football injuries in children and adolescents.

To ascertain the incidence, severity, risk factors, and outcomes of injuries in children and adolescents playing Australian Rules football. A prospective cohort study of football injuries in children and adolescents playing community football. We studied a stratified random sample of 54 teams and clinics (18 under-15 teams, 18 under-10 teams and 18 Vickick clinics for children under 10 years) from the Melbourne metropolitan area. Football exposure, injuries and associated risk factors were recorded for 1253 players during the 1992 football season. Vickick, a modified form of the game, had the lowest rates of injury for all levels of injury severity, with an overall rate of 3.49 injuries per 1000 player-hours. The rate in the under-10 age group was 2.4 times higher (95% confidence interval [CI], 1.5-3.8) than that in Vickick, and the under-15 rate was 1.2 times (95% CI, 0.9-1.6) that of the under-10s. The under-15 age group had significantly more injuries that led to use of health services than the under-10 and Vickick groups, with rates of 3.93 (95% CI, 2.9-4.9), 0.64 (95% CI, 0.2-1.4), and 0.33 (95% CI, 0.1-0.8) injuries per 1000 players-hours respectively. Injuries were largely to soft tissues (sprains 26%, haematomas 25%) and to the lower limb (43%). Very few serious injuries occurred (19 fractures and three injuries with loss of consciousness); nearly all of these were in the under-15s. Rule modifications in under-10 teams and clinics were associated with an injury rate of 5.8 injuries per 1000 player-hours (95% CI, 4.4-7.3) compared with 7.5 injuries per 1000 player-hours (95% CI, 5.2-9.8) when no modification was used. Alterations to the ruck contest, decreased contact, field size and player numbers were significantly associated with lower injury rates, while body size was not. Of the 30% of injuries resulting in a health service consultation, the most common health provider was a medical practitioner. Very few required expensive investigation or treatment. Injury rates were low in children under age 10, but higher in adolescents. Most injuries were minor, and did not result in a health professional consultation. Rule modifications were associated with substantially lower injury rates at the under-10 level, and should be promoted as a safe way to learn football skills.