Ep 172: SPORTS CORNER: Primary and secondary injury prevention in men's Australian football (AFLM), with Nick Kane

[00:00:00] Professor Laura Mamosley is running three face-to-face courses in North America in 2024.

[00:00:06] He's visiting Vancouver, San Francisco and New York City in late September and early

[00:00:12] October this year.

[00:00:13] The two day courses are designed to help you embed the latest in paint science in education

[00:00:18] in your clinical practice.

[00:00:21] Check out the show notes to see Professor Mamosley's program in each of these three iconic Canadian

[00:00:26] and US destinations.

[00:00:28] Yes, you heard correctly the latest in paint science in education in person with Professor

[00:00:34] Laura Mamosley, September and October 2024.

[00:00:43] Hello and welcome to JOSPT Insights, the podcast that aims to help you translate quality

[00:00:48] research to quality practice.

[00:00:51] I'm Clara Dern, the editor-in-chief of the Journal of Orthopedic and Sports Physical

[00:00:55] Therapy.

[00:00:56] It's great to have you listening today.

[00:01:01] This week on JOSPT Insights, we are here with another sports corner series.

[00:01:06] This time we're covering Men's Ozzy Rules Football, also known as Footy, with Nicholas

[00:01:10] Kane.

[00:01:11] Nick is a sports and exercise physiotherapist who has completed a Master's in Sports Physiotherapy

[00:01:15] from Letrobe University.

[00:01:16] He's also a head physiotherapist at the Essendon Football Club having worked at the club

[00:01:20] for nine years.

[00:01:22] My name is Dan Chapman.

[00:01:23] I'm a US-based physical therapist and owner of Chapman PT in Baltimore, Maryland.

[00:01:27] And I'm Chelsea Cument, a physical therapist and athletic trainer at Stanford University

[00:01:31] Athletics.

[00:01:32] Nick, thank you for joining us today on JOSPT Insights.

[00:01:35] We are so excited to hit footy again.

[00:01:37] Chelsea, Dan, thanks for having me.

[00:01:39] It's a pleasure to be here.

[00:01:41] We have talked to Mel Haberfield before on the women side of footy, and she was like,

[00:01:48] she was our intro into footy, which was embarrassing.

[00:01:50] We should know more, but now we do.

[00:01:52] We want to hear your take on your far more into the men's game.

[00:01:57] We want to hear a little bit of how they're different and then get into some other pre-season

[00:02:03] since that's where you guys are right now, how that changes the rehab and all that good

[00:02:08] stuff.

[00:02:09] Let's go first into what are the demands of men's footies?

[00:02:12] The men's game probably run a little bit more so it's probably very between 14 or 18

[00:02:17] kilometres a game.

[00:02:18] I'll let you do the maths on that for miles.

[00:02:21] We should work out different signs through our high speed running and mechanically what

[00:02:25] they are, but anything above six metres to second so to speak we might call high speed

[00:02:30] running.

[00:02:31] That can vary from anywhere from 500 to 1500 metres within a game, which is quite a lot

[00:02:36] and then obviously most of the time the players do hit their close to their maximum speed.

[00:02:41] That's causing that in every from 90 to 95 maximum speed in a game.

[00:02:46] That's how you might get one or two maybe exposures at that level so preparing the players

[00:02:50] ensuring they're ready to be able to hit that in exact paramount as long as as well

[00:02:54] as having a good base and chronic load around their six plus numbers is also really important

[00:02:59] at fast speed aspect.

[00:03:01] And then as Malaloo too it is something that NFLs generally up and back as per rugby,

[00:03:07] but if you think when I was in the States earlier this year I referred to fouls a little

[00:03:11] bit of a mix between soccer or football soccer and rugby.

[00:03:15] So in the sense it's sort of you know how soccer they kick it back and forward and all

[00:03:19] around but that's similar to that we can go any which way.

[00:03:23] It's on a big oval shape and then there is the contact element as well so there's no

[00:03:27] bads and things like that as Malpluched on, but there is some of his solid hits and

[00:03:31] there's different ways to sort of analyse that from a data point of view using GPS and

[00:03:36] what have you.

[00:03:37] I like that you just brushed over the fact that you wait what was the phrase that you used

[00:03:41] to just take a hit just no big deal just are you tracking the impact of that with GPS.

[00:03:46] We mortise use accelerometer so I guess from a accelerometer point of view acceleration

[00:03:50] in D sales but I would say that plays a role in you know if you are running and you

[00:03:55] do acceleration is you know from a contact related injury or contact related hit different

[00:04:00] in the sense so rugby and NFL might be one hit one tackle and that's the end of the play

[00:04:04] and then we'll sort of reset and start again in a style rules football it will be that

[00:04:09] tackle and hit the ball might fill out and then another player gets it and what two

[00:04:13] other players are after so I guess it doesn't stop unlike someone scores a goal and when

[00:04:18] someone scores a goal they get maybe a minute's rest if they reset in the middle of the ground

[00:04:21] and then they go again and the game goes for around 120 minutes for opening to four quarters

[00:04:28] and they get like maybe a five or ten minutes spell off the edge quarter so you know around

[00:04:33] two hours of solid work.

[00:04:34] I don't know how it hasn't come on more in the US because it's just nonstop.

[00:04:40] It's a lot of fun to watch.

[00:04:43] Are there differences in injuries here like let's talk about me with what the most common

[00:04:48] injuries are and Mel had mentioned that ACL concussion are pretty high on the women's

[00:04:53] field and then hamstring tears around the rise too is that different with men's.

[00:04:57] It is a little bit we don't have as many ACLs but on average we might get one of those

[00:05:01] in year or close to hamstrings are certainly not doubt the greatest incidents of injury

[00:05:06] that we get so average I think across the season for each team is around seven hamstrings

[00:05:10] or six to seven long streams throughout the year.

[00:05:13] Carve injuries are sort of say it's probably increased recently over the last five years

[00:05:17] into our football dad just anywhere from two to three injuries per season.

[00:05:21] Hamstrings calves from a soft tissue point of view are certainly there for us and they're

[00:05:24] now outside of that look generally probably knees and ankles make up the probably the next

[00:05:29] step of most games missed and that's a such a shame if you can be contact related aspect

[00:05:34] so many school and CL LCL and ACL of course but then ankles again you tend to get a greater

[00:05:40] incidence but they might not miss as many games but obviously we know some of the secondary

[00:05:44] things that can't make you know playing with an ankle that's not as not as structurally

[00:05:48] sound so often dealing with some secondary issues around for an ankle pathology that you

[00:05:52] carry to the season at times.

[00:05:54] First thing there's more soft tissue stuff in the men's game then it's more like calves

[00:06:01] and hamstrings than the ACLs and the concussions.

[00:06:04] The first and foremost I'm not an expert on the female data and injuries in what are coming

[00:06:09] out so much though I can't say exactly like what they're getting but yeah from the men's

[00:06:14] point of view that then yeah those injuries I spoke to certainly the swall ones we

[00:06:18] focus on the most you know the ones that give us the most great and I think as Mal said

[00:06:22] I think they haven't seen too many hand strings in the you know last five years but maybe

[00:06:27] to see a couple more now and you know I think I'll get the odd card as well.

[00:06:31] Okay so then how do these injuries and the demands that you talked about how you screen

[00:06:36] these athletes when they're coming in I guess before preseason starts what does that look

[00:06:40] like?

[00:06:41] I guess where I see the ankle environment can be unique compared to some other teams say

[00:06:46] let's say NBA we have 47 or players on our roster and they are with us full time so we

[00:06:52] also then have probably three full time equivalent physio star and we have a we have staff member

[00:06:58] and strength conditioning.

[00:07:00] Like any sort of injury surveillance we look at what are the key risk factors for those

[00:07:04] injuries so let's use hamstring as an example because probably the most prevalent greatest

[00:07:08] risk factor there is probably age and past history that anyone who really has had a

[00:07:12] past history of hamstring especially in the last couple years and he's a little bit older

[00:07:16] clearly goes into like a risk factor bucket for us so they might get some extra attention

[00:07:20] and to tell around that without even worrying about anything else.

[00:07:24] If I touch on against how you mentioned preseason I'll start from the top prevention wise

[00:07:28] we are wanting to obviously prevent hamstring injuries and we utilize I guess framework

[00:07:32] of power book is the trick framework which starts with primary prevention which is we might

[00:07:37] implement some strategies that across the full group to address a known risk factor so

[00:07:42] an example of that is a hamstring injury hamstring strength deficit would be a risk factor

[00:07:47] for hamstring injury along with those other two though we will obviously get a screen

[00:07:51] for everyone on a hamstring strength program and if they are not at the level then we will

[00:07:56] prescribe an aspect to get them at the required strength level and in doing that however

[00:08:00] every single player will be getting an implementation to improve their hamstring strength that's

[00:08:04] just what everyone gets that's universal and then if you break that down to the second

[00:08:07] stage being a bit more selective around those at risk athletes they might get something a

[00:08:12] bit more targeted if it's a bit more specific. If you are older, how to pass history, weak

[00:08:16] hamstrings we measure fast school length as part of our screening and process that so that

[00:08:21] they show that I have short fast schools their program again will be tailored towards

[00:08:25] them to optimize that. I would prevent across the whole group and then how we might break

[00:08:29] it down being able to run fast regularly keep health being intensity to have good volume

[00:08:33] and chronic loads be strong in a gym, eat well, sleep well and their mental health is in

[00:08:39] a good place so there are obviously things that just goes without saying but then how

[00:08:42] we break that down from the geostan point and identify those things falls under those two

[00:08:46] bands. Step one, step two is the secondary prevention. So secondary prevention comes into

[00:08:53] the component where we are trying to keep up an injury before it becomes an actual issue

[00:08:58] or a main injury so I guess that falls under our screening aspect of what you're talking

[00:09:02] around there so every week we will do some monitoring based up from a screening standpoint

[00:09:08] which includes a growing squeeze, some hopping on the fourth place where we're looking at

[00:09:12] certain numbers in metrics and a hamstring isometric pool and we have a great sports scientist

[00:09:18] Josh Ruddy who pulls together some of that information and puts on a great display so we can

[00:09:23] see any change week to week. That can step around secondary prevention also includes

[00:09:28] a general screening thing that the videotapists will do on the table which is pretty systematic

[00:09:32] but looking around some general changes from week to week things you know hit range hamstring

[00:09:36] length, keep extension length, my abduction strength and some other factors around that

[00:09:41] sort of typical clinical things that we would do. Nick you mentioned checking fast go length

[00:09:46] I am fascinated about what that means I have no idea can you talk a little bit more about that?

[00:09:52] So some research was initially done in New Unistralia around measuring the fast go through

[00:09:57] the Oqir and Dave and Ryan Timmings group at Strait Catholic Uni it's a measure that they do with

[00:10:02] an ultrasound probe and it provides an estimated length of the biceps femurist, fast go length

[00:10:09] and some of that research would suggest that you know shorter and up quick in quotation marks

[00:10:13] shorter possible lengths is a risk backed out for injury longer it is a bit protected.

[00:10:19] They talked around a quadrant of doom in around that paper where it quantifies with hamstring

[00:10:24] strength on length so if you are weak in your hamstrings which was emitted on a general Nordic test

[00:10:30] and we're off within the path of the length then you're in sort of the bad quadrant where

[00:10:35] your risk factors probably heightened. So if I had acquired it sitting down there they've had

[00:10:39] parts hamstring issues I'm clearly needing to address that but when I'm sitting in an area

[00:10:45] where they're a bit stronger so for us it's you know five times body weight on a Nordic hamstring

[00:10:49] and their fast go length is longer you know a measure around 10.5 to 11 so that's where we work

[00:10:57] you know utilizing that we do that at three time points across the season so we just started

[00:11:01] pre-season as you mentioned we're doing the next couple of weeks then we'll do it sort of

[00:11:05] leading up to the season and we'll do it somewhere in the middle of the season and you know

[00:11:08] it can be transient at times but we keep an eye on things and it's not everything for us from

[00:11:13] a hamstring point of view part of the picture and pilot information along with what other things.

[00:11:18] Do you see the fast go length changing over time or is that just a static measure like what

[00:11:22] you guys what you got? It does change over time that's so a lot of the research will suggest that

[00:11:28] you can get a good change within two weeks of a high stimulus so in order to get greater length

[00:11:34] across the passicles the intervention or the proposed intervention is basically super maximal

[00:11:40] eccentric loading so a lot of the time our management might still be the same and as I said our

[00:11:45] whole team might do that as a primary prevention strategy however if I've had guy who as I mentioned

[00:11:51] past history and is showing up in short practical lengths we'll probably

[00:11:55] detail their programs that they might get an extra dose here and there's a very heavy eccentric

[00:12:00] over the keep work though it might be two sets of single-leg audio followed by a really super

[00:12:04] maximal eccentric so it's down with one and then we might help them out with the weight and they

[00:12:08] lower it down again or it might be you know maybe not as effective but maybe it's like a two-up one

[00:12:14] down hamstring curl or there's different any any type of strategy you can think that's basically super

[00:12:19] maximal and an eccentric dominant to get that increased length and you can say some kind of

[00:12:24] it's basically two weeks but yeah within the research also talks to you know high speed running

[00:12:28] being good stimulus for increased flexible length and you know there are count arguments against

[00:12:33] the measures that have been done being at you know from that research being just a static measure

[00:12:37] but at the moment a research group under even dollar harnes out of double university of potentially

[00:12:42] more accurate measure of classical lengths I'm looking forward to that coming out which probably

[00:12:47] factors into the bar sits fan being more of a dynamic muscle that sort of rotates and it's not so

[00:12:51] much a static measure all these things to look at but then you can actually kind of like do some

[00:12:56] thing about it right you can you have the time people to address the type of exercises based on

[00:13:02] those screens the type of training you're going to do for them because you can't do that during

[00:13:06] the season when they're running around for 120 minutes and then they're going to follow it up with

[00:13:10] like a heavy East archipelago where we're at is the ability in preseason you're right in season

[00:13:17] it sometimes can be difficult because you're playing week after week and you know you don't

[00:13:21] really want to play around with hamstrings up too much when they're going to play two days later

[00:13:24] so that might be safe for you know if someone's in a rehab block or just small microdosing of

[00:13:29] some bits across the week typically earlier in the week but yeah some other things that we would do

[00:13:34] at the moment like we profile everyone's hip strength though we do some isometric testing on

[00:13:38] hip extension hip abduction hip adduction hip external rotation and hip flexion and what we are to do

[00:13:44] is then just provide that into a clear snapshot it's like a spider grah we have targets that we want

[00:13:50] each athlete out based on their body weight and if they're not at that level then we are saying

[00:13:53] this is minimum standard you have to be at this level but again you know we tie the knees

[00:13:58] across the global risk factor no if we're weak around the pelvis rig around the anterior chain

[00:14:04] you know are we predisposed to maybe kick out more injuries maybe we are based on you know when

[00:14:09] loads are really high and we're getting sick at energy leaks set of speed if I'm you know

[00:14:12] topping at the pelvis or electro hip control with strength calf strength predominately so both

[00:14:17] calf endurance and acety calf osmetic tests which you know we want them at least 1.8 times body weight

[00:14:22] on a seated calf test which fits with the research from Seth O'Neil who I know you had on a

[00:14:27] podcast not long ago talking about calf injuries we've used that research and we apply it with

[00:14:31] you now profiles as well and make sure that athletes can yeah exert decent to matter strength

[00:14:36] and endurance with your neck calves as a protective element and likewise with handstrings everyone

[00:14:41] across the group has some intervention around calf which is the primary and then other athletes who

[00:14:46] maybe have had calf injuries or a weak or having issues then they might get something really

[00:14:49] targeted selective stuff that we work closely with them on you talked about the 1.8 value for

[00:14:55] the calf you look at isometric hip strength as well what are the norms that you're

[00:15:00] facing these also or what are you looking for rather is probably the better question like in terms

[00:15:04] of hip strength around the hip it's a pretty one certainly there's research out there around

[00:15:08] normative values for hip strength and expected for athletes so some are related to ice hockey

[00:15:14] others some of the papers but you know I felt and all the rules but generally speaking and others

[00:15:19] are sort of you know anecdotal reports but I guess where we where out with our at the moment

[00:15:25] is we have been doing it for a couple of years so it's an element of pulling that

[00:15:29] information together from articles and things we've read as well as just speaking to some people that

[00:15:33] are value and think a really knowledgeable in around that space and what they see as good

[00:15:38] good measures and then it's also based on what we've seen a little bit to collate what we

[00:15:43] think are our values within our club and you're really looking at like leg length or are you just

[00:15:48] looking for just like specific kind of finding what numbers are going to work best for like

[00:15:53] positions or something like that it's not too position but and to do if you were to do it 100%

[00:16:00] on especially for our abduction could we do an abduction in sideline into the force frame with

[00:16:05] it with a long lever so yeah I think sometimes the lever length can disadvantage you

[00:16:10] who are the great just for eating where are out we do do some metrics around incorporating

[00:16:15] leg length but where we display it to the players just keep it as appealing to body weight ratio

[00:16:19] done like look if they're a little bit disadvantaged I'm so lucky I can but yeah you still need

[00:16:24] a bit this number so just work harder to get there and it's providing that extra challenge across

[00:16:29] the time so and then yeah and you just purely across the group and I'll just say it's a minimum

[00:16:33] standard so from there you might be like well this guy is a recommend you need to be stronger at

[00:16:37] this all that this guy is really fast he needs to make sure of this and this and that aspect

[00:16:42] you at the level but yeah if you're looking at I'd get fainted as you're just playing get by

[00:16:47] and across the full group try to simplify it and go over there so I hit the extension is yeah 10

[00:16:51] times body weight we do that over the edge of a clip at sort of 45 degrees hip angle hip ab and ad

[00:16:59] 2.5 times body weight and looking at a ratio you know at least you know they should be around one

[00:17:03] to one some of the research yes 1.1 to 1 ad to abductor ratio from external rotation I think we've

[00:17:10] had 1.7 part times body weight but from there closer to two he's pretty sound and then the hip flexion

[00:17:15] yeah a little bit more than I think it's around follow six times for you we have it at the moment

[00:17:20] maybe 10 more so it's about at this time of the show I should probably interject retroactively

[00:17:25] to clarify a couple points for our American listeners our international listeners please forgive us

[00:17:31] which else you and I are both red blooded Americans and so when we heard 2.5 times body weight

[00:17:36] we assumed you know someone who was a hundred pounds would be kicking out a 250 pound forces

[00:17:41] because that's how we generally measure force here when using a handheld dynamometer which would

[00:17:45] be an astronomical number upon further questioning we we finally understood that Nick is measuring in

[00:17:52] newtons which makes no sense to us in America whatsoever and in comparing that to kilograms so it's

[00:17:57] 2.5 times body weight newtons to kilograms so for our American listeners just to give some sort of

[00:18:04] context here and so if you have a hundred kilogram athlete that would be a 220 pound athlete for our

[00:18:08] American listeners 100 kilogram athlete kicking out at 2.5 times body weight for sidelining abduction

[00:18:14] would be 250 newtons 250 newtons into pound forces is about 56 pound forces okay so a much more

[00:18:22] reasonable number and so far international listeners who already understood that from the get go thank

[00:18:28] you for bearing with us while we help our American listeners pick their jaws up off the floor

[00:18:33] breaking out of the preseason mode then what we talked about again the demands injuries

[00:18:39] how are these influencing your rehabs now one of the key things that you want to pass on to

[00:18:44] clinicians who are treating footy athletes making a ranger eventually we're still getting

[00:18:48] injuries right and we always want to have this pursuit of perfection within the sports environment

[00:18:52] but if we're getting no injuries they might not work any hard enough so continue severe balance

[00:18:55] of really pushing for performance and training really hard and not being soft and safe but also then

[00:18:59] just having strategies underneath that to you know make sure we're covering off on those known

[00:19:04] risk factors and using our secondary prevention to pick up things early and that comes in line with

[00:19:09] the players communication to you around what's happening well mostly if you're doing that type of thing

[00:19:14] so I think it's really important to have a process around all right this is injury and communicate

[00:19:19] around injury diagnostics and then one clear message to the to the athlete from one person that's

[00:19:24] like a really strong one so then the high performance team is really aligned with what we're on and

[00:19:28] we're communicating out to the player I think early on in rehab from practical standpoint let's just

[00:19:33] you know get an athlete moving get some I call it early wins though you know they want to feel like

[00:19:38] they're doing something and moving so even if it's just basic movement patterns or if it's just

[00:19:42] really some early loading around the tissue that I want to sit around and wait you know I'll wait

[00:19:46] good too they want to feel like they're moving forward and progressing so I think having that

[00:19:50] within our process early on is great to start with get some confidence to make sure we really

[00:19:56] load the tissue well and to get back to absolute optimal strength and adaptation so I mean across

[00:20:02] different injuries all look differently but you know what are we what's your measures of

[00:20:06] astronomy to be and how robust they need to be across the gym in some things and elements of

[00:20:11] your testing for a for a safe return to play out of that process throughout the rehab you are on the

[00:20:16] field and they are running through similar metrics and hitting those top speeds the same level and

[00:20:22] the intensity if not more and at this the cycles whether that's exposure just once or twice a

[00:20:27] week that they're going to need to do when they're in season so I think pulling all that together

[00:20:32] is key and then once they have returned to play awesome you've done well they've played their first

[00:20:37] game and got through well I think it's almost like a different process that starts there

[00:20:41] to at least the next four to six weeks that we know the risk of re-anger is probably heightened

[00:20:45] in that first couple of months from a return to play so what's your process assistance from

[00:20:50] there so I think that's where some of the monitoring aspects around you know that falls in with

[00:20:54] that screening so it's whether it's some hamstring strength monitoring some hamstring length monitoring

[00:20:59] that's more to surround flexibility and how they're responding from their their loads as well as

[00:21:03] some of the changes around the hip and pelvis I think keep an eye on that so that might just be a

[00:21:06] process of having a look over that once or twice a week for the next few months and and maintaining

[00:21:11] some good loading in the gym and really consistent aspects there so I think once I have returned to play

[00:21:16] looking at again what are we going to do for the next four to six weeks it not letting happen

[00:21:21] for PT's that are listening to this and they want to dive into treating footy athletes or just

[00:21:26] learn more about screening footy athletes where would you point them in terms of resources

[00:21:30] and the sports network is the leading provider of sports physiotherapy and rehab education here in

[00:21:35] Australia and we're set up moving a broad little bit into the UK this year we actually ran a

[00:21:40] course for the for in our life for the LA Clippers and LA Kings start in LA early in this year

[00:21:45] what we do at the sports night be run by in-person events which are still you know really beneficial

[00:21:50] and great for clinicians to network and collaborate with other clinicians and also see

[00:21:55] presented live but we've also have what I think is a tremendous resource for the ugly bad

[00:21:59] own in the sense of a sports night masterclass platform though I guess what we've developed now

[00:22:04] is this platform where we're essentially getting that expert putting an athlete in front of them

[00:22:08] and we film them we make these sixty to nine minutes interactive and practical based masterclass

[00:22:13] videos from some of the world's best clinicians set their meal in coming when you got down the

[00:22:17] podcast along with a number of others from the UK and in a lot of spare and actual work in

[00:22:21] shoulders and yeah we have a huge array of videos there and you and you masterclass comes out

[00:22:25] every month you get all you see for the day there in one place it's a tremendous resource because I

[00:22:30] think what we do is like some of the great you know researchers at JOSPT I think we're in a great

[00:22:36] spot where we can help translate some of that research to the clinicians and pass that through

[00:22:40] faster we're not trying to review people's work and like put our own biases on it it is literally

[00:22:47] grabbing the expert if it's clear a darn and say talk about return to pay for us it's there but

[00:22:52] it's probably in a bit more of a you know visual visual aspects I can see the expert assess I can

[00:22:57] think I see what Reid had exercise through doing rather than trying to picture it in my head that's

[00:23:01] what we have there and encourage people to head over and have a look and you know he's ready for

[00:23:06] a crawl week to just jump on her and have a look and see if you like it but I think the guys who

[00:23:10] jumped on from the States where we were at the institute and really enjoyed that content

[00:23:15] Nick thank you again for joining us we are going to throw the link to the sports map network

[00:23:19] into the show notes also some links as well to some of the resources the references that you

[00:23:23] mentioned during the podcast they were a lot there so definitely take the time to go check those out

[00:23:27] Nick thank you so much for coming on the show and as always we want to thank all of you

[00:23:32] for listening to Joe's PT Insights

[00:23:38] thanks for listening to this episode of JOSPT Insights

[00:23:41] for more discussion of the issues in musculoskeletal rehabilitation that are relevant to your practice

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