THE AFL INJURY REPORT 2013
AUSTRALIAN FOOTBALL LEAGUE
INJURY
REPORT
2013
1
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
AUSTRALIAN FOOTBALL LEAGUE
INJURY
REPORT
2013
Authors
Assoc Prof John Orchard, University of Sydney
Dr Hugh Seward, AFL Doctors Association
Ms Jessica Orchard, University of Sydney
Advisory Panel
Dr Andrew Daff, Medical Officer, AFL Players Association
Dr Greg Hickey, Medical Officer, Richmond Football Club
Dr Michael Makdissi, Medical Officer, Hawthorn Football Club
Dr Andrew Potter, Medical Officer, Adelaide Football Club
Matt Cameron, PhD, Physiotherapist, Sydney Swans Football Club
2
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
1 SUMMARY
The 2013 AFL Injury Report represents 22 years of recording injury data by the AFL and its medical officers.
The highlights are:
++ There were increases in overall injury incidence, prevalence and recurrence rates in season 2013 compared with season
2012. However, there has been no statistically significant increase or decrease in overall injury incidence or prevalence in
the three year period 2011-13 compared to the previous three years 2008-10. There was a statistically significant increase
in both injury incidence and prevalence over the years 2008-13 (“High interchange era”) compared to the years 2002-07
(“Low interchange era”).
++ Hamstring strains are still the number one injury in the game in terms of both incidence and prevalence (missed games).
Hamstring and groin injury incidence and prevalence in the period 2011-13 (since the introduction of
the substitute rule) were both significantly lower than the period 2008-10. By contrast, calf, knee tendon and
other leg/foot/ankle injury incidence and prevalence were significantly higher in the period 2011-13 compared
to 2008-10.
++ Knee ACL (anterior cruciate ligament) incidence of new injuries was high in 2013, but in keeping with the rates
of recent years. There were eight cases of ACL re-injury (graft failure) in 2013, three of them involving LARS ligament
grafts. Overall, this represents a high failure rate which warrants further analysis.
++ There was 100% participation in the injury survey for all clubs and players, with a public release of the data, the
17th year in a row that both of these have occurred. Whilst injury surveillance programs are now widespread in
professional sports leagues around the world, 100% participation and public release are not generally achieved,
making the AFL survey a genuine world leader in this field.
3
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
TABLE OF CONTENTS
1
Summary
3
2
Introduction
6
3
Methods
7
3.1
Injury definition
7
3.2
Injury categories
7
3.3
Injury rates
8
3.4
Statistical comparison of eras
8
Results
9
4.1
Injury Incidence
10
4.2
Injury Recurrence
12
4.3
Weekly player status and injury prevalence
13
4.4
Analysis and discussion for significant injury categories
16
(a)
Hamstring strain injuries
16
(b)
Groin injuries
16
(c)
Calf strains
17
(d)
Shoulder injuries
17
(e)
Knee PCL injuries
18
(f)
Knee ACL injuries
19
(g)
Concussion
20
4.5
Comparison between injuries between eras
21
5
Acknowledgements
23
6
References
25
4
4
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
Gold Coast’s Joel Wilkinson missed four matches
after injuring his ankle in round four. Ankle injuries
were higher in 2013 than previous seasons.
5
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
2 INTRODUCTION
There has been an annual Australian Football League (AFL)
injury surveillance report since 1992 [1-7], making this the
22nd AFL Injury Report. The first recorded study on injuries in
Australian football, in the Victorian Football League (VFL),
was published in 1965 [8]. The first VFL competition-wide
injury survey was done for three seasons in the 1980s [9]. The
Australian Sports Commission funded the first AFL injury survey
in 1992 [6-7], and the AFL made the decision to continue funding
annual surveillance in 1993. The 5th annual AFL Injury Report
was publicly released in 1996 [10], believed to be
the first occasion worldwide that a professional sport openly
tabled its injury data. For every subsequent season, the AFL
and AFL Doctors Association (AFLDA) have publically released
competition injury information. A summary of the methods
and results of the AFL injury survey was published in 2013
in the American Journal of Sports Medicine [11]. It is believed
to be the first co-publication of an annual injury report from
a professional sports league in conjunction with a leading
scientific sports medicine journal. Results of rule changes
which have come about through AFL injury surveillance were
recently presented in a symposium at the 4th IOC World
Conference of Illness and Injury Prevention in Sport in Monaco
(April 2014) [12].
Most other professional sports leagues now collect injury data
and many of them publish some of these results in the scientific
literature. Examples include the National Football League (NFL)
6
, Cricket Australia[19-20], the National Rugby League (NRL)
[21]
, the National Collegiate Athletic Association (NCAA) [22-24],
Union of European Football Associations (UEFA) [25-27] and the
Rugby Football Union (RFU) [28-29]. However, annual public
release of data by the AFL is the exception rather than rule
among professional sports leagues. Not only has the AFL been
a pioneer in the field of injury surveillance, but it leads the world
in transparency.
[13-18]
The AFL has also shown a long-term investment in high quality
additional research above and beyond the core funding of
injury surveillance. It was also the first professional sporting
body in Australia to implement a funded research board with
annual grants. The injury survey has been pivotal in guiding
the AFL Research Board to commission and fund projects
that further investigate injuries that are common, severe or
increasing in incidence. There has been a willingness to consider
and implement rule changes to improve player safety, where
necessary [12]. A documented successful example of this was the
centre circle rule change, which has decreased the incidence of
ruck-related posterior cruciate ligament (PCL) injuries [3].
It is an ongoing aim of the AFL and the AFL Doctors Association
to remain the ‘gold’ standard of injury surveillance in Australia
and worldwide.
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
3 METHODS
The methods of the injury survey are now well
established and have been previously described
in detail [2,11,30]. However, minor changes to injury
category codes are made on a regular basis
(discussed in section 3.2 below).
The standard AFL player contract now includes consent
for players’ injury records to be passed from team medical
staff to the researchers for the purposes of standard injury
surveillance. The methods of the survey are approved
by the AFLDA and AFL Research Board. For additional studies
(e.g. case follow ups of certain injuries) which require
identification of players to obtain extra information, further
consent from each player involved is required. Individual player
injury details are not revealed in any report of the injury survey.
Individual club details, and their injury rates and injury patterns
also remain confidential.
3.1 Injury definition
From 1997 onwards, the definition of an injury has been an
“injury or medical condition which causes a player to miss a
match”. This definition and methodology has been chosen
to promote consistency across all AFL clubs and from season
to season [31]. Player movement monitoring has allowed the
injury survey to achieve ‘100% compliance’ for all instances of
missed player games in the home and away season since 1997
[2,31]
. In 2001 this was extended to include rookie listed players
and finals matches. Player movement monitoring essentially
requires that all clubs define the status of each player each
round to be either: (1) playing AFL football, (2) playing football
at a lower level, (3) not playing football due to injury, or
7
(4) not playing football for another reason. In 2013 all teams
were required to roughly detail diagnosis (e.g. hamstring strain)
and date of onset for all injuries causing players to miss games
on the weekly player movement spreadsheets. Further details
for these injuries were then confirmed between the injury
surveillance coordinator and club contacts at the end of the
season. Diagnosis was coded according to the OSICS 9
system [32-34] and onset of injury (match vs training vs other)
was also recorded.
The definition of a condition “causing a player to miss a match”
includes illnesses and injuries caused outside football, although
these injuries are considered in separate categories when
grouped by diagnosis.
An injury recurrence is a condition to the same body part on the
same side which causes a later bout of missed matches in the
same season after return to play.
3.2 Injury categories
Injury categories are amended slightly on an annual basis
depending on which specific diagnoses (using OSICS codes
version 9 [33-34]) are included within each category.
A significant category change was made for the 2013 report.
“Hip joint & impingement injuries” was a category created
(extracted) from “other hip/groin/thigh injuries”. Hip joint
injuries (including femoroacetabular impingement) has been
considered a significant injury for many years but was no doubt
undiagnosed in the first decade of the AFL injury survey
(i.e. cases were probably considered to be “groin” injuries).
It is timely now that a separate category has been created.
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
Sydney defender Alex Johnson required a reconstruction after hurting
his knee in the NAB Cup.
Because this diagnosis has been well-recognised for many
years, trends in hip injuries over the last decade probably
represent valid statistics, rather than simply a change in
diagnosis category.
For example, a hamstring injury incidence of six new injuries
per club per season (for 40 players playing 22 weeks) would
be equivalent to seven new injuries per club per season
(for 45 players over 23 weeks).
Due to having low incidence and prevalence, the category of
“patella injuries” (which constituted patella instability and
stress fractures) has been eliminated. Patellofemoral instability
episodes will now be included in “other knee injuries” whereas
patella stress fractures will be included in “lower leg stress
fractures”. Patellar tendinopathy remains in a category of
“knee and patella tendon injuries”.
The modification is required so that the year-to-year figures
are comparable, because average list size changes from
year-to-year.
Where changes such these have been made, they have been
made retrospectively for all previous survey years. Therefore,
some of the category data presented in this report for previous
years varies slightly from previously published data.
3.3 Injury rates
The major measurement of the number of injuries occurring
is seasonal injury incidence measured in units of new injuries
per club per season (where a club is defined as 40 players and
a season is defined as 22 rounds). Incidences per 1000 player
hours (of training and matches) are not presented mainly
because records of club training hours are not provided as
part of the injury survey and therefore would not be accurate
if estimated. Since the average club now has approximately
45 players on the list and plays for slightly over 22 rounds
(including finals), the exact number of injuries occurring per
club is slightly greater than the figures tabulated.
8
The major measurement of the amount of playing time missed
through injury is injury prevalence measured in units of missed
games per club per season, or alternatively percentage of
players unavailable through injury.
The recurrence rate is the number of recurrent injuries expressed
as a percentage of the number of new injuries. A recurrent injury
is an injury in the same injury category occurring on the same
side of the body in a player during the same season.
Therefore, by this definition, an injury of one type that recurred
the following season was defined as a new injury in that
next season.
3.4 Statistical comparison of eras
Statistical analysis is made to compare injury incidence and
prevalence trends over the past 12 seasons. Seasons 2011-13
have coincided with the implementation of the substitute
rule (and reduction in interchange players from four to three)
and this era has been statistically compared to seasons
2008-10, using 95% confidence intervals (CIs). In addition,
seasons 2008-13 inclusive (high interchange era) have been
compared using 95% confidence intervals to seasons 2002-07
(low interchange era).
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
4 RESULTS
Key indicators for the 22 years of the survey are shown in Table 1. The injury incidence (number of new injuries per
club per season) for 2013 was 41.5, a 9% increase from 2012. Injury prevalence was 158.1 missed games per season,
the highest value reported for the 22 years although similar to the rate seen in 2011. The rate of recurrent injuries
(12%) was slightly increased in 2013 but also a low value compared to recurrence rates seen in the first decade
of the injury survey.
Table 1 Key indicators for all injuries over the 22 seasons
9
All injuries
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Incidence (new injuries per
club per season)
35.4
30.3
33.7
38.2
38.9
40.1
40.3
36.9
37.4
35.8
34.4
Incidence (recurrent)
8.8
7.3
6.0
6.2
4.9
8.0
7.6
5.2
5.9
5.5
4.4
Incidence (total)
44.2
37.6
39.7
44.4
43.8
48.1
47.9
42.1
43.3
41.3
38.7
Prevalence (missed games
per club per season)
145.9
122.5
116.3
133.1
140.0
151.2
141.9
135.9
131.8
136.4
134.7
Average injury severity
4.1
4.0
3.5
3.5
3.6
3.8
3.5
3.7
3.5
3.8
3.9
Recurrence rate
25%
24%
18%
16%
13%
20%
19%
14%
16%
15%
13%
Clubs participating
12/15
14/15
15/16
15/16
16/16
16/16
16/16
16/16
16/16
16/16
16/16
Average players per club
46.1
44.6
42.5
42.3
44.1
44.2
41.7
41.7
41.4
43.4
43.0
All injuries
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Incidence (new injuries per
club per season)
34.1
34.8
35.3
34.0
34.6
36.9
37.8
38.7
38.4
38.1
41.5
Incidence (recurrent)
4.6
3.7
4.8
4.1
5.6
5.4
3.6
4.7
3.6
3.6
5.1
Incidence (total)
38.7
38.5
40.1
38.2
40.3
42.3
41.4
43.3
42.0
41.7
46.6
Prevalence (missed games
per club per season)
118.7
131.0
129.2
138.3
146.7
147.1
151.2
153.8
157.1
147.7
158.1
Average injury severity
(number of missed games)
3.5
3.8
3.7
4.1
4.2
4.0
4.0
4.0
4.1
3.9
3.8
Recurrence rate
14%
11%
14%
12%
16%
15%
10%
12%
9%
9%
12%
Clubs participating
16/16
16/16
16/16
16/16
16/16
16/16
16/16
16/16
17/17
18/18
18/18
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
4.1 Injury Incidence
Table 2 (on the following page) details the incidence (new
injuries only) of all defined categories. Figure 1 (page thereafter)
summarises the statistically significant changes, although it
should be noted that this does not imply that the relationship
is necessarily causative (e.g. concussion rates may have risen
in recent years because of better awareness rather than high
interchange or substitute rule). The highlighted columns of
2013 and 2011-13 in Table 2 reveal the following major findings:
++ The years 2011-13 had an increase in incidence of
concussion compared to the nine previous years of the
injury survey, even though the incidence was still low
(on average one player per club missing games each
year due to concussion).
++ By contrast, calf strains, knee tendon injuries
(including jumper’s knee), and a number of other
lower leg injuries had significantly higher incidence
in 2011-13 compared to 2008-10.
++ Other injuries in 2013 that varied slightly in
incidence from recent years included facial fractures
(higher), shoulder sprains and dislocations (lower)
and ankle sprains (higher).
++ There are a number of lower limb injuries that have a
++ Both hamstring strains and groin injuries
significantly higher incidence in the “High Interchange”
(2008-13) compared to the “Low interchange”
(2002-07) era (including ankle sprains, Achilles
injuries, calf strains and other lower leg injuries).
(traditionally the two injury categories with the
highest incidence) had significantly lower incidence
in 2011-13 compared to 2008-10.
Fremantle’s Kepler Bradley missed the
rest of the season after tearing his right
anterior cruciate ligament in round five.
10
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
Table 2 Injury Incidence (new injuries per club per season)
Body area
Injury type
2011
2012
2013
2002-04
2005-07
2008-10
201113
Head/neck
Concussion
1.1
1.0
1.0
0.4
0.4
0.5
1.0
Facial fractures
0.5
0.6
0.9
0.6
0.4
0.4
0.7
Neck sprains
0.1
0.1
0.1
0.0
0.2
0.1
0.1
Shoulder/arm/elbow
Forearm/wrist/hand
Trunk/back
Hip/groin/thigh
Knee
Shin/ankle/foot
Medical
Other head/neck injuries
0.2
0.2
0.1
0.2
0.1
0.1
0.2
Shoulder sprains and
dislocations
1.8
1.3
1.2
1.1
1.3
1.6
1.4
A/C joint injuries
0.7
0.5
0.9
0.9
0.9
0.7
0.7
Fractured clavicles
0.1
0.2
0.3
0.4
0.3
0.2
0.2
Elbow sprains or joint injuries
0.3
0.3
0.1
0.1
0.1
0.1
0.2
Other shoulder/ Arm/
elbow injuries
0.4
0.6
0.3
0.5
0.4
0.2
0.5
Forearm/wrist/hand fractures
1.6
0.8
0.8
1.0
1.1
1.2
1.1
Other hand/wrist/
forearm injuries
0.4
0.5
0.6
0.5
0.4
0.3
0.5
^
*
Rib and chest wall injuries
0.4
0.4
0.8
0.8
0.6
0.5
0.5
1.4
1.5
2.0
1.1
1.6
1.5
1.6
Other buttock/back/
trunk injuries
0.6
0.9
0.1
0.5
0.5
0.6
0.5
Groin strains/osteitis pubis
2.8
2.6
2.7
3.3
3.4
3.6
2.7
#
Hamstring strains
4.8
5.7
5.2
5.5
6.1
6.5
5.3
#
Quadriceps strains
1.4
1.6
1.7
1.8
1.8
1.9
1.6
Thigh and hip haematomas
0.5
0.4
1.3
0.8
0.9
0.9
0.7
Hip joint/impingement injuries
1.0
1.2
1.1
0.3
0.4
0.8
1.1
Other hip/groin/thigh injuries
0.0
0.0
0.0
0.0
0.0
0.1
0.0
Knee ACL
0.9
0.8
0.9
0.6
0.7
0.7
0.9
^
$
Knee MCL
1.0
0.9
0.7
0.9
1.0
0.9
0.8
Knee PCL
0.6
0.3
0.5
0.5
0.3
0.3
0.5
Knee cartilage
1.5
1.0
1.5
1.4
1.2
1.7
1.3
Knee tendon injuries
0.6
1.0
0.7
0.6
0.5
0.4
0.8
*
Other knee injuries
1.2
1.0
1.4
0.8
0.9
1.1
1.2
$
Ankle joint sprains, including
syndesmosis sprains
2.9
2.6
3.7
2.5
2.3
2.8
3.1
$
Calf strains
2.1
3.0
3.7
1.5
1.6
1.7
3.0
*$
$
Achilles tendon injuries
0.9
0.7
0.5
0.4
0.3
0.5
0.7
Leg and foot fractures
0.7
0.3
0.7
0.6
0.5
0.8
0.5
Leg and foot stress fractures
1.4
1.4
1.3
0.9
1.1
1.0
1.4
Other leg/foot/ankle injuries
2.5
2.0
2.3
1.4
1.3
1.5
2.3
Medical illnesses
1.8
2.2
2.2
2.2
1.6
2.4
2.1
Non-football injuries
0.1
0.5
0.2
0.3
0.1
0.3
0.3
38.4
38.1
41.5
34.4
34.6
37.8
39.3
$
CLUB/SEASON
11
*$
Lumbar and thoracic
spine injuries
NEW INJURIES/
Comparisons
Statistical significance tests were made at p<0.05 level between Sub Era (2011-13) and Pre-sub Era (2008-10)
and High Interchange Era (2008-13) and Low Interchange Era (2002-07):
* Significantly higher injury incidence in the Sub Era compared to Pre-sub Era
# Significantly lower injury incidence in the Sub Era compared to Pre-sub Era
$ Significantly higher incidence in the High Interchange Era compared to Low Interchange Era
^ Significantly lower incidence in the High Interchange Era compared to Low Interchange Era
22nd ANNUAL INJURY REPORT 2013
*$
$
THE AFL INJURY REPORT 2013
SIGNIFICANTLY HIGHER INCIDENCE
Knee Tendon Injuries
Ankle Joint Sprains/Syndesmosis
Calf Strains
Achilles Tendon Injuries
SIGNIFICANTLY LOWER INCIDENCE
Fractured Clavicles
Rib And Chest Wall Injuries
Groin Strains/Osteitis Pubis
Hamstring Strains
4.2 Injury Recurrence
Table 3 shows the rate of recurrence of some of the common injury types that are prone to high recurrence rates. Season 2013
demonstrated slightly higher recurrence rates than 2012 but the figure of 12% was in keeping with the low recurrence rates
of recent years. From Table 3 it can be seen that the major injuries (with respect to recurrence) have all had far lower rates
of recurrence in the second 11 years of the survey compared to the first.
12
22nd ANNUAL INJURY REPORT 2013
SUBSTITUTE ERA
HIGH INTERCHANGE ERA
Concussion
THE AFL INJURY REPORT 2013
Table 3 Recurrence rates (recurrent injuries as a percentage of new injuries)
Recurrence rates
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Avg
19922002
Hamstring strains
45%
40%
31%
29%
25%
38%
36%
31%
37%
25%
30%
33%
Groin strains and
osteitis pubis
29%
43%
33%
27%
22%
36%
31%
6%
16%
20%
23%
25%
Ankle sprains or joint injuries
9%
28%
4%
9%
11%
20%
21%
9%
11%
17%
16%
14%
Quadriceps strains
35%
19%
15%
21%
26%
35%
20%
20%
18%
10%
17%
22%
Calf strains
28%
26%
0%
16%
15%
15%
15%
17%
32%
17%
13%
17%
All injuries
25%
24%
18%
16%
13%
20%
19%
14%
16%
15%
13%
17%
Recurrence rates
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Avg
200313
Hamstring strains
27%
22%
26%
16%
22%
27%
18%
14%
12%
14%
24%
20%
Groin strains and
osteitis pubis
20%
24%
23%
28%
39%
23%
19%
20%
15%
19%
11%
22%
Ankle sprains or
joint injuries
6%
11%
15%
10%
20%
9%
10%
5%
13%
5%
20%
11%
Quadriceps strains
9%
6%
20%
19%
18%
15%
15%
18%
7%
3%
19%
13%
Calf strains
14%
6%
12%
7%
9%
5%
0%
12%
5%
6%
16%
8%
All injuries
14%
11%
14%
12%
16%
15%
10%
12%
9%
9%
12%
12%
4.3 Weekly player status and
injury prevalence
Table 4 details player status on a weekly basis over the past ten
seasons. The ‘average’ status of a club list of 45 players in any
given week for 2013 was: 33 players playing football per week,
22 in the AFL; eight missing through injury; and four missing due
to other reasons (such as suspension, being used as a travelling
emergency, team bye in a lower grade, etc). There has been a
slight trend upwards in recent seasons in the category of “not
playing for other reasons”, which encompasses suspension,
lower grade team having a bye, player missing for personal
13
reasons and simply “rested/rotated”. In 2013 the “not playing
for other reasons” category fell and it is possible that there has
been a reversal of this trend (i.e. to label more of the “grey area”
rested/rotated players as injured in 2013 compared to 2011-12).
Subtle changes in the thresholds of deciding what constitutes
missing a game through “injury” compared to “general soreness”
are difficult to assess. There would perhaps be minor effects on
annual injury rates as result of any of these changes.
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
Table 4 Average weekly player status by season
All injuries
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Playing AFL
22.0
22.0
22.0
22.0
22.0
22.0
22.0
22.0
22.0
22.0
Playing lower grade football
11.9
12.2
11.8
11.9
11.7
12.8
12.8
12.5
12.5
11.4
TOTAL playing
33.9
34.2
33.8
33.9
33.7
34.8
34.8
34.5
34.5
33.4
Not playing because of injury
6.4
6.4
7.0
7.4
7.4
7.9
8.1
8.4
7.8
8.2
Not playing for other reasons
2.5
2.8
3.1
2.9
3.4
3.5
3.5
4.0
4.4
3.8
TOTAL not playing
8.9
9.1
10.1
10.4
10.8
11.4
11.6
12.4
12.2
11.9
Players in injury survey (per club)
42.8
43.3
43.9
44.2
44.6
46.1
46.4
46.9
46.7
45.4
Injury prevalence (%)
14.9%
14.7%
15.9%
16.8%
16.7%
17.2%
17.5%
17.8%
16.8%
18.0%
Table 5 (on the following page) details the amount of missed
playing time attributed to each injury category. The injury
prevalence categories tend to move with the injury incidence
results, i.e. similar categories in Table 5 showing increases and
decreases to those in Table 2.
Groin injuries and osteitis pubis has had lower than usual
prevalence in every year from 2011-13, which will be discussed
in detail below. The overall prevalence in 2013 was higher than
2012 with falls in shoulder injuries and hamstring strains being
offset by rises in ACL and other knee injuries, calf strains and
ankle sprains. The rise in games missed through calf strains has
been quite striking over the period 2010-13, in a similar fashion
to the fall in groin strains. In the time period 2002-10 there were
more than three times as many games missed through groin
injuries as there were from calf strains. However from 2011-13
there were actually more games missed through calf strains
than there were from groin injuries.
14
The fall in the number of players “not playing for other reasons”
(including suspended, rested, byes at lower league level) in
2013 in conjunction with the rise in number of players missing
through injury, suggests that in 2013 more of the “grey area”
cases between injured and rested have been classified by
clubs as injured. Consistent with this are both the drops in
average severity of injury, implying that there was a higher
number of one-week injuries in 2013, and perhaps even the
higher recurrence rates (suggesting that a player who had not
completely recovered from an earlier injury would be given a
further week off injured, which is defined as a recurrence,
to assist with full recovery).
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
Table 5 Injury Prevalence (missed games per club per season)
Body area
Injury type
2011
2012
2013 2002-04
2005-07
2008-10
2011-13
Head/neck
Concussion
2.2
1.6
1.3
1.0
0.5
0.7
1.7
*$
Facial fractures
1.6
1.5
2.6
1.5
0.9
1.0
1.9
*
Neck sprains
1.5
0.1
0.3
0.2
0.6
0.4
0.6
Other head/neck injuries
0.2
0.3
0.2
0.4
1.0
0.5
0.2
Shoulder sprains and dislocations
12.1
9.0
7.1
5.8
8.3
9.6
9.4
A/C joint injuries
2.3
1.0
2.0
1.9
2.0
1.4
1.8
Fractured clavicles
0.6
0.6
1.4
2.2
1.6
0.8
0.9
Elbow sprains or joint injuries
1.3
0.7
0.4
0.5
0.6
0.7
0.8
Other shoulder/ arm/
1.3
2.1
1.2
2.2
1.6
0.7
1.5
Forearm/wrist/hand fractures
5.4
3.3
2.9
3.2
3.5
3.8
3.8
Other hand/wrist/
1.8
1.6
1.7
2.1
1.6
1.1
1.7
Rib and chest wall injuries
0.7
0.9
1.7
1.5
1.6
1.1
1.1
Lumbar and thoracic spine
5.9
5.9
4.7
4.4
4.9
5.5
5.5
1.7
1.7
0.1
1.8
1.2
1.2
1.2
Groin strains/osteitis pubis
7.9
7.1
7.0
14.2
14.2
13.2
7.4
#^
Hamstring strains
16.5
21.5
20.8
18.6
21.6
22.7
19.7
#
Quadriceps strains
5.7
4.0
5.1
4.8
5.8
7.1
4.9
#
Thigh and hip haematomas
0.7
0.5
2.0
1.4
1.3
1.2
1.0
Hip joint/impingement injuries
5.7
5.6
4.6
1.4
2.6
4.2
5.3
$
Other hip/groin/thigh injuries
0.2
0.0
0.0
0.3
0.1
0.7
0.1
#
Knee ACL
13.6
13.5
17.8
12.1
12.9
11.4
14.9
Knee MCL
3.2
3.5
2.0
2.9
3.1
2.9
2.9
Knee PCL
4.8
2.0
3.3
3.6
2.0
2.2
3.4
Knee cartilage
7.6
4.8
9.7
6.4
7.5
10.8
7.3
#$
Knee tendon injuries
2.3
2.8
3.1
2.5
1.7
0.9
2.7
*
Other knee injuries
3.7
3.2
3.7
2.4
3.5
3.8
3.5
Ankle joint sprains, including
8.7
10.5
12.1
5.9
8.2
8.4
10.5
*$
Calf strains
5.5
7.1
10.6
3.3
3.7
3.7
7.7
*$
Achilles tendon injuries
4.0
5.0
2.2
1.1
2.0
3.2
3.7
$
Leg and foot fractures
4.6
4.5
4.3
4.9
3.7
6.1
4.5
Leg and foot stress fractures
10.6
9.1
10.9
5.4
7.0
9.0
10.2
$
Other leg/foot/ankle injuries
9.3
6.6
6.9
3.4
4.2
5.7
7.6
*$
Medical illnesses
3.2
4.2
4.2
3.6
2.5
3.4
3.8
$
0.5
2.1
0.3
1.3
0.7
1.6
1.0
147.7
158.1
128.2
138.1
150.7
154.2
$
Shoulder/arm/elbow
Comparisons
$
^
*^
elbow injuries
Forearm/wrist/hand
forearm injuries
Trunk/back
^
injuries
Other buttock/back/
trunk injuries
Hip/groin/thigh
Knee
Shin/ankle/foot
syndesmosis sprains
Medical
Non-football injuries
MISSED GAMES/
157.1
CLUB/SEASON
15
Statistical significance tests were made at p<0.05 level between Sub Era (2011-13) and Pre-sub Era (2008-10) and High Interchange Era
(2008-13) and Low Interchange Era (2002-07):
* Significantly higher injury prevalence in the Sub Era compared to Pre-sub Era
# Significantly lower injury prevalence in the Sub Era compared to Pre-sub Era
$ Significantly higher prevalence in the High Interchange Era compared to Low Interchange Era
^ Significantly lower prevalence in the High Interchange Era compared to Low Interchange Era
22nd ANNUAL INJURY REPORT 2013
$
THE AFL INJURY REPORT 2013
4.4 Analysis and discussion for significant
injury categories
(a) Hamstring strain injuries
Although there has been a reduction in the number of
hamstring strains over the past three seasons, it clearly remains
the most common and prevalent injury in the AFL.
Table 6 shows that the incidence and prevalence of hamstring
strains have both been lower than the 10-year average for
both 2013 and for the three-year period 2011-13. Comparison
of hamstring injury incidence for the period 2011-13 to the
period 2008-10 reveals an odds ratio (OR) of 0.81 for the
past three seasons (95% CI 0.70-0.93). Previous research of
the relationship between increasing interchange movements
and hamstring strains postulated that the increased speed of
players who were more rested had been driving up hamstring
injury incidence over the period 2003-10 [35]. The significant drop
in hamstring injury incidence since the implementation of the
substitute rule in 2011 is consistent with this theory, without
necessarily proving it. There have been other confounders in
the AFL competition since 2011 (including further increases in
interchange rates and introduction of expansion teams). It is
also true (to be discussed later) that decreases in hamstring
strains have been offset by increases in other injuries (such as
calf strains). It is possible (although a difficult hypothesis to
test) that AFL clubs have successfully implemented prevention
regimes for the most common injuries (i.e. hamstring and groin
injuries) but have not devoted as much specific preventive work
towards less common injuries (e.g. calf injuries).
It is also worth noting that the recurrence rate for hamstring
injuries in 2013 was, at 24%, higher than recent years, but still
well below the recurrence rates seen in the 1990s.
Table 6 Key indicators for hamstring strains over the past decade
Hamstring injuries
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Avg
2004-13
Incidence
6.3
5.2
6.4
6.7
6.6
7.1
6.0
4.8
5.7
5.2
6.0
Prevalence
21.6
18.6
21.8
24.3
25.8
21.8
20.6
16.5
21.5
20.8
21.3
Severity
3.4
3.6
3.4
3.6
3.9
3.1
3.4
3.4
3.8
4.0
3.6
Recurrence rate (%)
22%
26%
16%
22%
27%
18%
14%
12%
14%
24%
19%
(b) Groin injuries
Groin injuries (including osteitis pubis) have been put forward
as one of the “big three” injury categories that cause the most
missed playing time in the AFL (along with hamstring strains
and knee ACL injuries). However, compared to hamstring
strains and knee ACL injuries, groin injuries represent a more
heterogenous group of diagnoses. Groin injuries include adductor
muscle strains, tendinopathies, osteitis pubis and sports hernias.
However they specifically exclude hip joint injuries (including
labral tears and femoroacetabular impingement) which are
16
seen as being distinct. A gradual increase in the incidence
and prevalence of “other hip” injuries over the last decade
has reflected the trend to diagnose hip pathology more
often. This is particularly done in cases where hip surgery
has been undertaken.
Notwithstanding the possibility that there has almost certainly
been a transfer of cases diagnosed as “groin injury” to “hip region
injury” gradually over the last decade, Table 7 reveals that there
has been quite a dramatic fall in groin injuries (both in incidence
and prevalence) since 2011. Comparison of groin injury incidence
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
for the period 2011-2013 to the period 2008-2010 reveals an odds ratio of 0.78 for the past three seasons (95% CI 0.63-0.95).
Even when adding hip and groin injuries together, there has been a fall in the past three seasons. Groin injuries also exhibited a low
recurrence rate for season 2013.
Table 7 Key indicators for groin and hip injuries over the past decade
Groin injuries
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Avg
2004-13
Incidence
3.1
2.9
3.3
4.0
3.2
3.3
4.1
2.8
2.6
2.7
3.2
Prevalence
13.3
11.2
14.0
17.5
12.4
11.7
15.3
7.9
7.1
7.0
11.8
Severity
4.4
3.9
4.3
4.3
3.9
3.5
3.7
2.8
2.7
2.6
3.6
Recurrence rate
24%
23%
28%
39%
23%
19%
20%
15%
19%
11%
22%
Hip/impingement
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Avg
2004-13
Incidence
0.3
0.2
0.3
0.8
0.7
1.0
0.6
1.0
1.2
1.1
0.7
Prevalence
1.9
1.0
2.3
4.4
2.8
5.4
4.5
5.7
5.6
4.6
3.8
(c) Calf strains
Calf strains have not been specifically analysed in AFL Injury
Reports of previous years, as they have generally exhibited low
incidence and prevalence. In the past they have been seen as
an injury mainly affecting older players [36]. However during
the past three seasons the incidence and prevalence of calf
strains has actually equalled or even exceeded the incidence
and prevalence of groin injuries. Comparison of calf strain injury
incidence for the period 2011-13 to the period 2008-10 reveals an
odds ratio of 1.76 for the past three seasons (95% CI 1.38-2.25).
Calf strains do remain an injury for which age is a relevant risk
factor. In 2013, the average age of a player missing with a calf
strain was 25.5 (compared to average age 23.5). The only
injury category with a higher average age was Achilles
tendon injuries (26.0).
Calf strains have been suggested to occur during the
“take off” or acceleration phase of running gait in a case
study[37], whereas hamstring strains occur closer to full speed [38].
Although it is not fully proven, an attractive hypothesis of the
substitute rule (and further interchange increases since 2011)
has been that they have decreased the amount of time that
players run at full speed, but increased the amount of stopping
and starting.
17
This has possibly had the effect of decreasing hamstring strain
incidence but increasing calf strain incidence. This hypothesis is
partially supported by data presented in the annual GPS Report
[39]
, which shows a decrease in time above 18 km/h of the order
of 25% since the introduction of the substitute rule. However,
acceleration measures have also decreased by over 50% in the
same period.
It has been noted that a high proportion of calf strains in
recent years have affected the soleus muscle, rather than
gastrocnemius muscle. An exact proportion cannot be given
using the injury survey data, as many injuries are simply coded as
“calf strain” rather than coded with the specific muscle involved.
Further studies on calf injuries in AFL players using MRI will be
able to determine the percentage of soleus strains and also
whether the prognosis between different muscles is different.
It is interesting that this moves away from the hypothesis that
two-joint muscles are the main ones predisposed to injury [40].
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
Table 8 Key indicators for calf strains over the past decade
Calf strains
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Avg
2004-13
Incidence
0.9
1.9
1.6
1.2
2.0
1.3
1.7
2.1
3.0
3.7
1.9
Prevalence
1.7
4.5
3.4
3.1
4.4
3.0
3.7
5.5
7.1
10.6
4.7
Severity
1.9
2.4
2.1
2.6
2.2
2.3
2.2
2.6
2.3
2.8
2.3
Recurrence rate
6%
12%
7%
9%
5%
0%
12%
5%
6%
16%
8%
(d) Shoulder injuries
Table 9 shows that the increase in the prevalence of shoulder injuries over the past decade has tended to reverse over the past
two seasons (2012-13). At this stage it is unclear whether the trends of the past two seasons relate to game factors (such as
number of tackles and player speed) or that there has been a regression to the mean from the high rates seen from 2008-2011.
When comparing the odds ratio from 2011-13 for shoulder incidence to 2008-10, there has not been a significant fall
(OR 0.91, 95% CI 0.68-1.22).
Table 9 Key indicators for shoulder injuries over the past decade
Shoulder sprains &
dislocations
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Avg
2004-13
Incidence
1.0
1.4
1.6
1.0
1.8
1.3
1.6
1.8
1.3
1.2
1.4
Prevalence
5.9
7.7
10.8
6.4
10.2
7.7
10.9
12.1
9.0
7.1
8.8
Severity
5.9
5.6
6.7
6.3
5.8
5.7
6.9
6.8
6.8
6.0
6.3
Recurrence rate
11%
20%
13%
16%
9%
12%
26%
11%
14%
4%
14%
(e) Knee PCL injuries
The two major knee ligament injuries are anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries.
There have been dramatically lower rates of PCL injuries since the introduction of the centre circle rule in season 2005
(Table 10) [3]. After five centre bounce PCL injuries in 2004, there have been only nine in total for the nine seasons from
2005-13 (an average of one per season). There was one centre bounce ruck-related PCL injury in 2013.
Table 10 Key indicators for PCL injuries over the past decade
18
PCL injuries
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Avg
2004-13
PCL incidence
0.7
0.4
0.3
0.2
0.3
0.3
0.4
0.6
0.3
0.4
0.4
PCL prevalence
6.5
2.7
1.8
1.6
2.2
1.2
3.2
4.8
2.0
2.1
2.8
Number of PCL injuries (total)
13
7
5
3
5
6
8
13
7
10
7.5
Number of centre bounce PCL injuries
5
1
0
0
2
1
0
4
0
1
1.5
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
(f) ACL injuries
The number of knee ACL reconstructions performed was higher
in season 2013 than at any time over the past decade (Table
11). The injury incidence was also relatively high but as incidence
measures new injuries it was comparable to recent seasons.
There were actually three players in 2013 that suffered two
ACL reconstructions in the one season and eight of the 23
reconstructions in 2013 were “revisions” (35%), the highest
number or percentage recorded in the 22 years of the survey.
When comparing the odds ratio from 2011-13 for ACL incidence
to 2008-10, there has not been a significant increase (OR 1.23,
95% CI 0.82-1.84).
Table 11 Key indicators for ACL injuries over the past decade
ACL injuries
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Avg
2004-13
ACL incidence
0.5
0.6
0.9
0.6
0.9
0.7
0.6
0.9
0.8
0.9
0.7
ACL prevalence
10.1
9.3
14.1
15.1
15.3
11.1
7.8
13.6
13.5
17.8
12.8
Number of ACL
9
10
19
13
17
13
9
20
16
23
14.9
2
1
4
2
4
1
0
4
1
8
2.7
reconstructions
Number of revision
reconstructions
The rate of ACL injury in 2013 was again far higher in pre-season
and early rounds (16 ACL reconstructions reported by mid-May)
compared to the winter months, a trend which was reported
more than a decade ago [41] and which persists. There is a further
trend, which is probably related, that northern AFL teams tend
to have slightly higher rates of ACL injury than southern AFL
teams [42-44]. This trend is seen in soccer teams in the warmer
versus cooler regions of Europe [44, 45] and in ACL reconstructions
in the Australian community [46]. A link between these two longstanding observations is that warm-season grasses tend to
have higher traction (and perhaps therefore lead to higher ACL
injury rates) [44, 47].
The high number of revision reconstructions in 2013 (and
even in the last decade, where revision reconstructions make
up 18% of all surgeries) in the AFL is a concern. Since the first
AFL player had a LARS artificial ligament reconstruction in
2008, over a dozen reconstructions have been performed using
an artificial ligament (either in isolation or in combination with
a partially-preserved ligament or allograft). The rate of revision
for ACL reconstructions which involve an artificial ligament
appears to be approximately 50% in AFL players so far to
date, with the longest surviving graft lasting approximately
three years. Because a recent attempt to re-create an ACL
register in the AFL does not yet have complete surgical
19
data, it is not yet valid to statistically analyse failure rates of
LARS reconstructions compared to traditional (autograft)
reconstructions. To date it does appear to be a trade-off
between quicker recovery time (and less post-operative pain)
for LARS reconstructions but also higher failure rate.
Even the so-called “traditional” reconstructions in the AFL have
quite a high failure rate. Of the eight revision reconstructions
done in 2013, three were failures of LARS grafts whereas five
were failures of autografts (grafts taken from the patient’s
own body). Further research – which the AFL and AFLDA are
now undertaking – is required to assess the apparently high
rates of failure of ACL reconstruction in AFL players. The AFL
appears to be the only major professional sports league in the
world where a significant proportion of reconstructions are done
with artificial ligaments, with the international orthopaedic
community not generally using artificial ligaments for ACL
reconstruction [48]. Australian orthopaedic surgeons appear
to have mainly abandoned patella tendon autografts (in favour
of hamstring tendon grafts) in AFL players, although these are
still the preferred graft option for players/surgeons in the NFL
and other high level athletes in the USA [48, 49]. There are valid
reasons for choosing hamstring tendon over patella tendon
grafts, such as reduced stiffness and knee pain after surgery
[48, 50]
. Recent data from national surgical registers in both
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
Norway [51] and Denmark [52] have recently found lower revision/
failure rates in patella tendon grafts compared to hamstring
tendon grafts, even though hamstring tendon grafts were
more commonly used. This supports systemic review of RCT
data where hamstring tendon grafts had a failure rate of 16%
compared to 7% for patella tendon grafts [50]. In the latest
findings from the Swedish register there was also reduced
(g) Concussion
Concussion has been a major injury concern for all sports
in recent years with further understanding that there is a
possible link between concussions suffered in sport and
neurodegenerative conditions in later life [54]. Reflecting
these concerns, the AFL and AFLDA introduced revised
Concussion Management Guidelines at the beginning of
the 2011 and 2013 seasons that reinforced a more
conservative approach to concussion management.
The figures reported in Table 12 are those concussions that
require a player to miss a match. Recent research, that has
been undertaken on concussions in AFL matches not requiring
a player to miss a match, has demonstrated these additional
concussions to be approximately 6-7 per team per season [55].
In the past three seasons the incidence of concussions which
have caused players to miss games has significantly increased
(or 2.18, 95% CI 1.38-3.44). For other injury categories which
have increased, the AFL and AFLDA would generally be
concerned to find out the reasons why and address them. With
respect to concussion, the increase in players missing games
is considered to be more of a positive development, in that
it almost certainly reflects that all stakeholders in the game
(including doctors, players and coaches) are treating concussion
as a more serious injury and having players miss games more
readily if in doubt.
While additional research on concussion in the AFL is already
underway, any change to the definition of concussion for the
survey should be avoided so as to not affect the ability to detect
long-term trends. Although the injury definition of concussion
attracts some criticism [56], its strength is that a consistent
comparison can be made. For a longitudinal study such as the
current analysis, if a broader definition were used there would
be more concern about changing thresholds for reporting an
injury by team medical staff over time [31].
20
revision rate with patella tendon graft compared to hamstring
but it was not statistically significant [53]. In Sweden however
90% of the ACL grafts used hamstring tendon [53].
A critical analysis of techniques used by surgeons in AFL players
is required given the high, and apparently increasing, rates of
ACL graft failure.
AFL players are strongly encouraged by clubs to report all
instances of suspected concussion, and research to date has
suggested the current AFL practices are consistent with the best
available standards [57]. This has been demonstrated by several
other sports using the new AFL Concussion Guidelines
as a benchmark for adjusting their own approach to
concussion management.
The AFL remains strongly committed to player welfare and
has introduced several law and tribunal changes in recent
years to reduce the risk of head and neck injury such as a
reduced tolerance of head-high contact, stricter policing of
dangerous tackles, and the introduction of rules to penalise
a player who makes forceful contact to another player with
his head over the ball.
Ultimately the AFL and AFLDA recognise that the injury
surveillance provided by the annual report is not comprehensive
enough for the field of concussion to provide a broad enough
view of the subject, particularly relating to any long-term
effects of concussion, which is why further major research on
concussion has been commissioned and is underway.
One further point of note to make on the topic of concussion
management has been that the substitute rule and
concussion rule have both enabled concussion management
to be improved and for the Zurich guidelines [54] to be best
implemented. With respect to the substitute rule itself, if a
player suffers a concussion early in the game and the doctor
determines that he has been concussed and medically should
not continue, his team (after invoking the substitute) will not
be adversely affected from a rotation perspective.
This also alleviates any previous pressure on players to
downplay concussion symptoms and doctors to make timely
concussion assessments. The interchange cap implemented
for the 2014 season will also ensure clubs will not be adversely
affected from a rotation perspective if a player requires
a concussion assessment and the substitute has already
been activated.
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
Table 12 Key indicators for concussion over the past decade
Concussion
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Avg
2004-13
Incidence
0.3
0.7
0.3
0.3
0.4
0.5
0.5
1.1
1.0
1.0
0.5
Prevalence
0.3
0.9
0.3
0.3
0.5
0.7
0.8
2.2
1.6
1.3
0.9
4.5 Comparison between injuries
between eras
In 2011, the interchange system was changed from an unlimited
bench of four interchange players to three interchange players
and one substitute player who can only enter the ground to
replace another player who stays off permanently. The AFL
is the first sport which has created a hybrid bench, although
team sports in general have a diverse variety of interchange and
substitute arrangements [58]. There were multiple rationales for
the institution of the substitute rule, including: (1) congestion,
(2) fairness and (3) injury.
Although the injury report does not present a thorough overview
of the substitute rule (particularly with respect to congestion
of play), it can be stated that the game under the substitute
rule has become more fair in terms of the situation where one
team loses a player to injury early in the game. As mentioned
Table 13 Key comparative indicators for
three-year periods over the past 12 seasons
Era
2002-04 2005-07
2008-10 2011-13
Interchange players/subs
4/0
4/0
4/0
3/1
Interchanges/game
27
47
99
131
Average player age
23.5
23.6
23.4
23.5
Teams Victorian/northern
10/6
10/6
10/6
10/8*
Incidence (total)
34.4
34.6
37.8
39.3
Prevalence (total)
128.2
138.1
150.7
154.2
Hamstring incidence
18.6
21.6
22.7
19.7
Groin incidence
14.2
14.2
13.2
7.4
Calf incidence
3.3
3.7
3.7
7.7
*7 northern teams in 2011 and 8 in 2012 and 2013.
21
in the previous section of this report, it is easier for concussion
management to adhere to the Zurich guidelines when “rotation
pressure” is relieved from teams.
With respect to the overall effect of the substitute rule on injury
incidence, there has been no net effect. The injury incidence in
2011-13 compared to 2008-10 has been quite similar (OR 1.04,
95% CI 0.98-1.10). The small increase could have easily
occurred by chance. Alternatively it may have been due to
the effect of two additional northern expansion teams, as
teams based to the north of Australia have slightly higher injury
incidence [44]. Although the northern teams contained higher
numbers of younger players on their list, as Table 13 shows
there was no major change in the average age for players in
the competition, so this should not have affected injury rates
over the past three seasons.
Although these statistical reports reveal associations
(that there have been changes in injury profile in eras that are
unlikely to be due to chance) it is a complex subject where
causation is difficult to prove. From 2008-2010 to 2011-13 for
example, the substitute rule was implemented and may have
been responsible for some of the changes seen in the injury
profile. However, interchange numbers per team per game still
increased over this time period and it is hard to differentiate
which of these factors may have been more responsible for
changes to the injury profile (or whether, for example, the
introduction of expansion teams may have played a role).
What can be stated quite clearly is that the injury profile
appears to have changed over the past three seasons, with
certain injuries clearly increasing in incidence (calf strains,
knee tendon injuries) and other injuries clearly decreasing
in incidence (hamstring strains, groin injuries). The common
denominator appears to have been that “full speed” injuries
may have become less likely in the past three years, but if so,
this has been offset by “stop-start” or fatigue-related injuries
which have increased.
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22
22nd ANNUAL INJURY REPORT 2013
Bulldog Clay Smith suffered a
season-ending ACL injury in round 16.
THE AFL INJURY REPORT 2013
5 ACKNOWLEDGEMENTS
The authors and AFL Medical Officers would like to
acknowledge the following people who contributed to
the survey in 2013:
Dr Andrew Potter, Jarryd Wallace (doctor and physical
performance staff, Adelaide), Dr Andrew Smith, Dr Paul
McConnell, Shane Lemcke (doctors and physiotherapist,
Brisbane), Dr Ben Barresi, Dr Rob Voritch, Jason Patten
(doctors and football staff, Carlton), Dr Greg Shuttleworth
(doctor, Collingwood), Cullan Ball (physiotherapist, Essendon),
Jeff Boyle (physiotherapist, Fremantle), Dr Chris Bradshaw &
Dr Drew Slimmon (doctors, Geelong), Dr Barry Rigby and
Nathan Carloss (doctor and physiotherapist, Gold Coast),
Leroy Lobo and Nick French (physiotherapists, Greater Western
Sydney), Dr Dan Exeter, Dr Michael Makdissi and Andrew
Lambart (doctors and physiotherapist, Hawthorn),
Dr Zeeshan Arain and Gary Nicholls (doctor and physiotherapist,
Melbourne), Dr Andrew McMahon (doctor, North Melbourne),
23
Dr Mark Fisher and Tim O’Leary (doctor and physiotherapist,
Port Adelaide), Dr Greg Hickey, Anthony Schache (doctor and
physiotherapist, Richmond), Dr Tim Barbour, Andrew Wallis
(doctor and physiotherapist, St Kilda), Dr Nathan Gibbs, Matt
Cameron (doctor and physiotherapist, Sydney), Dr Gerard
Taylor, Paul Tucker (doctor and physiotherapist, West Coast
Eagles), Drs Gary Zimmerman, Dr Jake Landsberger, Andrew
McKenzie (doctors and football staff, Western Bulldogs),
AFLMOA Advisory Panel (Andrew Daff, Greg Hickey, Michael
Makdissi, Andrew Potter & Mark Cameron), Dr Peter Harcourt
and Dr Harry Unglik (AFL Medical Directors), Dr Patrick Clifton,
Ken Wood, Michelle Thomson and Mark Evans (AFL), Touraj
Vizari (Athletic Logic), Greg Planner (Champion Data) and
all football operations staff at clubs who complete weekly
player movement monitoring forms along with all those
acknowledged in the injury reports for previous years.
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24
22nd ANNUAL INJURY REPORT 2013
Dylan Roberton is assisted from the ground after hurting his
leg in round 14 at the MCG. The incidence of leg injuries was
significantly higher in the 2011-13 period compared with 2008-10.
THE AFL INJURY REPORT 2013
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27
22nd ANNUAL INJURY REPORT 2013
THE AFL INJURY REPORT 2013
An ankle injury to Collingwood’s Quinten
Lynch in round 23 saw him miss the club’s
elimination final defeat the following week.
28
22nd ANNUAL INJURY REPORT 2013