INJURY REPORT 2013 - AFL Community Club · THE AFL INJUR REPORT 2013 THE AFL INJUR REPORT 2013 3 22nd ANNUAL INJURY REPORT 2013 The 2013 AFL Injury Report represents 22 years of recording

THE AFL INJURY REPORT 2013THE AFL INJURY REPORT 2013

2 2 n d A N N U A L I N J U R Y R E P O R T 2 0 1 31

INJURY REPORT

2013

A U S T R A L I A N F O O T B A L L L E A G U E



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

INJURY REPORT

2013

A US T R A L I A N F O O T B A L L L E A G UE



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.

1 SUMMARY



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

4 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

TABLE OF CONTENTS



Gold Coast’s Joel Wilkinson missed four matches after injuring his ankle in round four. Ankle injuries were higher in 2013 than previous seasons.



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)

2 INTRODUCTION

[13-18], 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.

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.



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 definitionFrom 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

3 METHODS

(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 categoriesInjury 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.



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.

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”.

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 ratesThe 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.

Sydney defender Alex Johnson required a reconstruction after hurting his knee in the NAB Cup.

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).

The modification is required so that the year-to-year figures

are comparable, because average list size changes from

year-to-year.

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 erasStatistical 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).



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.

4 RESULTS

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

Table 1 Key indicators for all injuries over the 22 seasons



4.1 Injury IncidenceTable 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).

+ Both hamstring strains and groin injuries

(traditionally the two injury categories with the

highest incidence) had significantly lower incidence

in 2011-13 compared to 2008-10.

+ 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

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).

Fremantle’s Kepler Bradley missed the rest of the season after tearing his right anterior cruciate ligament in round five.



Table 2 Injury Incidence (new injuries per club per season)

Body area Injury type 2011 2012 2013 2002-04 2005-07 2008-10 2011-

13

Comparisons

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

Other head/neck injuries 0.2 0.2 0.1 0.2 0.1 0.1 0.2

Shoulder/arm/elbow 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 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

Trunk/back Rib and chest wall injuries 0.4 0.4 0.8 0.8 0.6 0.5 0.5 ^

Lumbar and thoracic spine injuries

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

Hip/groin/thigh 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 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 $

Shin/ankle/foot 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 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

NEW INJURIES/

CLUB/SEASON

38.4 38.1 41.5 34.4 34.6 37.8 39.3 $ $

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



4.2 Injury RecurrenceTable 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.

SIGNIFICANTLY HIGHER INCIDENCE

Concussion

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

HIG

H IN

TER

CHA

NG

E ER

ASU

BSTITU

TE ER

A



Recurrence rates 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Avg

1992-

2002

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

2003-

13

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 prevalenceTable 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

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.

Table 3 Recurrence rates (recurrent injuries as a percentage of new injuries)



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.

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).

Table 4 Average weekly player status by season



Body area Injury type 2011 2012 2013 2002-04 2005-07 2008-10 2011-13 Comparisons

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/arm/elbow 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/

elbow injuries

1.3 2.1 1.2 2.2 1.6 0.7 1.5 * ^

Forearm/wrist/hand Forearm/wrist/hand fractures 5.4 3.3 2.9 3.2 3.5 3.8 3.8

Other hand/wrist/

forearm injuries

1.8 1.6 1.7 2.1 1.6 1.1 1.7

Trunk/back Rib and chest wall injuries 0.7 0.9 1.7 1.5 1.6 1.1 1.1 ^

Lumbar and thoracic spine

injuries

5.9 5.9 4.7 4.4 4.9 5.5 5.5

Other buttock/back/

trunk injuries

1.7 1.7 0.1 1.8 1.2 1.2 1.2

Hip/groin/thigh 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 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

Shin/ankle/foot Ankle joint sprains, including

syndesmosis sprains

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 Medical illnesses 3.2 4.2 4.2 3.6 2.5 3.4 3.8 $

Non-football injuries 0.5 2.1 0.3 1.3 0.7 1.6 1.0

MISSED GAMES/

CLUB/SEASON

157.1 147.7 158.1 128.2 138.1 150.7 154.2 $ $

Table 5 Injury Prevalence (missed games per club per season)

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



4.4 Analysis and discussion for significant injury categories

(a) Hamstring strain injuriesAlthough 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

(b) Groin injuriesGroin 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

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

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%

Table 6 Key indicators for hamstring strains over the past decade

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.



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.

(c) Calf strainsCalf 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.

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].

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

Table 7 Key indicators for groin and hip injuries over the past decade



(d) Shoulder injuriesTable 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).

(e) Knee PCL injuriesThe 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.

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%

Table 8 Key indicators for calf strains 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%

Table 9 Key indicators for shoulder injuries over the past decade

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

Table 10 Key indicators for PCL injuries over the past decade



(f) ACL injuriesThe 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).

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 long-

standing 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

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

reconstructions

9 10 19 13 17 13 9 20 16 23 14.9

Number of revision

reconstructions

2 1 4 2 4 1 0 4 1 8 2.7

Table 11 Key indicators for ACL injuries over the past decade

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



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

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.

(g) ConcussionConcussion 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].

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.



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

Table 12 Key indicators for concussion over the past decade

4.5 Comparison between injuries between erasIn 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

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.

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.

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.


2 2 n d A N N U A L I N J U R Y R E P O R T 2 0 1 322Bulldog Clay Smith suffered a

season-ending ACL injury in round 16.



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),

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.

5 ACKNOWLEDGEMENTS



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.



6 REFERENCES

1. Orchard J, Seward H. AFL 1999 Injury Report: Injuries on the

Decline. AFL Record 2000;89(5):29-32

2. Orchard J, Seward H. Epidemiology of injuries in the

Australian Football League, seasons 1997-2000. Br J

Sports Med 2002;36:39-45

3. Orchard J, Seward H. Decreased incidence of knee posterior

cruciate ligament injury in Australian Football League after

ruck rule change. Br J Sports Med 2009;43:1026-30

4. Orchard J, Seward H. Comparing AFL Injury Surveillance to

other codes. Sport Health 2009;27(2):38-41

5. Orchard J, Wood T, Seward H, et al. Comparison of injuries

in elite senior and junior Australian football. J Sci Med

Sport 1998;1(2):82-88

6. Seward H, Orchard J, Hazard H, et al. Football Injuries in

Australia at the elite level. Med J Aust 1993;159:298-301

7. Seward H, Orchard J, Hazard H, et al. Football Injuries in

Australia. Canberra: Australian Sports Commission, 1995.

8. Ferguson A. Injuries in Australian Rules football. Annals of

General Practice 1965(Sept.:):155-61

9. Seward HG, Patrick J. A three year survey of Victorian

Football League injuries. Aust J Sci Med Sport

1992;24(2):51-54

10. Orchard J, Wood T, Seward H, et al. AFL Injury Report 1996.

Football record 1997;86(8):S14-S23

11. Orchard J, Seward H, Orchard J. Results of 2 decades

of injury surveillance and public release of data in

the Australian football league. Am J Sports Med

2013;41(4):734-41

12. Seward H, Finch C, McCrory P, et al. Can rule and regulation

changes be used to prevent injuries in football codes? IOC

World Conference on prevention of injury and illness in

sport. Monaco, 2014.

13. Powell J, Schootman M. A multivariate risk analysis of

selected playing surfaces in the National Football League:

1980 to 1989: An epidemiological study of knee injuries.

Am J Sports Med 1992;20(6):686-94

14. Powell J, Schootman M. A Mutivariate Risk Analysis

of Natural Grass and Astroturf Playing Surfaces in the

National Football League 1980-1989. International

Turfgrass Society Research Journal 1993;7(23):201-10

15. Orchard J, Powell J. Risk of knee and ankle sprains under

various weather conditions in American football. Medicine

& Science in Sports & Exercise 2003;35(7):1118-23

16. Feeley B, Powell J, Muller M, et al. Hip Injuries and Labral

Tears in the National Football League. Am J Sports Med

2008;36(11):2187-95

17. Scranton P, Whitesel J, Powell J, et al. A review of selected

noncontact anterior cruciate ligament injuries in the

National Football League. Foot Ankle Int 1997;18(12):772-76

18. Torg JS, Vegso J, Sennett B, et al. The National Football

Head and Neck Injury Registry. 14-year report on cervical

quadriplegia, 1971 through 1984. JAMA 1985;254(24):3439-43

19. Orchard J, James T, Portus M, et al. Changes to injury profile

(and recommended cricket injury definitions) based on the

increased frequency of Twenty20 cricket matches. Open

Access Journal of Sports Medicine 2010;1:63-76

20. Orchard J, James T, Portus M. Injuries to elite male

cricketers in Australia over a 10-year period. J Sci Med Sport

2006;9:459-67

21. O’Connor D. NRL Injury Surveillance Report 2007 Season.

Sydney: National Rugby League + University of Sydney,

2008:28.

22. Arendt E, Agel J, Dick R. Anterior Cruciate Ligament Injury

Patterns Among Collegiate Men and Women. J Athl Train

1999;34(2):86-92

23. Dick R, Ferrara M, Agel J, et al. Descriptive Epidemiology

of Collegiate Men’s Football Injuries: National Collegiate

Athletic Association Injury Surveillance System, 1988–1989

Through 2003–2004. J Athl Train 2007;42(2):221-33



24. Dick R, Putukian M, Agel J, et al. Descriptive Epidemiology

of Collegiate Women’s Soccer Injuries: National Collegiate

Athletic Association Injury Surveillance System, 1988–1989

Through 2002–2003. J Athl Train 2007;42(2):278-85

25. Ekstrand J, Hägglund M, Walden M. UEFA Injury Study

2007/08 season report. Linköping, Sweden: Linköping

University + UEFA Medical Committee, 2008.

26. Ekstrand J, Hägglund M, Walden M. Injury incidence and

injury patterns in professional football: the UEFA injury

study. Br J Sports Med 2011;45(7):553-8

27. Hägglund M, Walden M, Bahr R, et al. Methods for

epidemiological study of injuries to professional football

players: developing the UEFA model. Br J Sports Med

2005;39:340-46

28. Brooks J, Fuller C, Kemp S, et al. Epidemiology of injuries in

English professional rugby union: part 1 match injuries.

Br J Sports Med 2005;39(10):757-66

29. Brooks J, Fuller C, Kemp S, et al. Epidemiology of injuries in

English professional rugby union: part 2 training injuries.

Br J Sports Med 2005;39(10):767-75

30. Orchard J, Seward H. AFL Injury Report: Season 2007.

Sport Health 2008;26(2):23-38

31. Orchard J, Hoskins W. For Debate: Consensus injury

definitions in team sports should focus on missed playing

time. Clin J Sport Med 2007;17(3):192-96

32. Rae K, Britt H, Orchard J, et al. Classifying sports medicine

diagnoses: a comparison of the International classification

of diseases 10-Australian modification (ICD-10-AM) and

the Orchard sports injury classification system (OSICS-8).

Br J Sports Med 2005;39:907-11

33. Rae K, Orchard J. The Orchard Sports Injury Classification

System (OSICS) Version 10. Clin J Sport Med

2007;17(3):201-04

34. Orchard J, Rae K, Brooks J, et al. Revision, uptake and

coding issues related to the open access Orchard Sports

Injury Classification System (OSICS) versions 8, 9 and 10.1.

Open Access Journal of Sports Medicine 2010;1:207-14

35. Orchard J, Driscoll T, Seward H, et al. Relationship

between interchange usage and risk of hamstring injuries

in the Australian Football League. J Sci Med Sport

2012;15(3):201-6

36. Orchard J, Farhart P, Leopold C. Lumbar spine region

pathology and hamstring and calf injuries in athletes:

is there a connection? Br J Sports Med 2004;38:502-4

37. Orchard J, Alcott E, James T, et al. Exact moment of a

gastrocnemius muscle strain captured on video.

Br J Sports Med 2002;36(3):222-23

38. Orchard J. Biomechanics of muscle strain injury. New

Zealand Journal of Sports Medicine 2002;30(4):92-98

39. Wisbey B, Pyne D, Rattray B, et al. Quantifying Changes in

AFL Player Game Demands Using GPS Tracking: 2013 AFL

Season. 2014

40. Garrett W. Muscle strain injuries: clinical and basic aspects.

Med Sci Sports Exer 1990;22(4):436-43

41. Orchard J, Seward H, McGivern J, et al. Rainfall, evaporation

and the risk of non-contact Anterior Cruciate Ligament

knee injuries in the Australian Football League. Med J Aust

1999;170:304-06

42. Orchard J. The ‘northern bias’ for injuries in the Australian

Football League. Australian Turfgrass Management

2000;23(June):36-42

43. Orchard J. The AFL Penetrometer study: work in progress.

J Sci Med Sport 2001;4(2):220-32

44. Orchard J, Waldén M, Hägglund M, et al. Comparison

of injury incidences between football teams playing in

different climatic regions. Open Access J Sports Med

2013;4:251-60

45. Walden M, Hagglund M, Ekstrand J. Regional differences

in injury incidence in European professional football.

Scand J Med Sci Sports 2013;23:424-30



46. Janssen K, Orchard J, Driscoll T, et al. High incidence

and costs for anterior cruciate ligament reconstructions

performed in Australia 2003-04 to 2007-08: time for an

anterior cruciate ligament register by Scandinavian model?

Scand J Med Sci Sports 2012;22:495-501

47. Orchard J, Chivers I, Aldous D, et al. Ryegrass is associated

with fewer non-contact anterior cruciate ligament injuries

than bermudagrass. Br J Sports Med 2005;39:704-09

48. Chechik O, Amar E, Khashan M, et al. An international

survey on anterior cruciate ligament reconstruction

practices. Int Orthop 2013;37(2):201-6

49. Erickson B, Harris J, Fillingham Y, et al. Anterior Cruciate

Ligament Reconstruction Practice Patterns by NFL and

NCAA Football Team Physicians. Arthroscopy 2014:doi:

10.1016/j.arthro.2014.02.034. [Epub ahead of print]

50. Reinhardt K, Hetsroni I, Marx R. Graft selection for anterior

cruciate ligament reconstruction: a level I systematic

review comparing failure rates and functional outcomes.

Orthop Clin North Am 2010;41(2):249-62

51. Persson A, Fjeldsgaard K, Gjertsen J, et al. Increased risk

of revision with hamstring tendon grafts compared with

patellar tendon grafts after anterior cruciate ligament

reconstruction: a study of 12,643 patients from the

Norwegian Cruciate Ligament Registry, 2004-2012.

Am J Sports Med 2014;42(2):285-91

52. Rahr-Wagner L, Thillemann T, Pedersen A, et al.

Comparison of hamstring tendon and patellar tendon

grafts in anterior cruciate ligament reconstruction in a

nationwide population-based cohort study: results from

the danish registry of knee ligament reconstruction.

Am J Sports Med 2014;42(2):278-84

53. Andernord D, Björnsson H, Petzold M, et al. Surgical

Predictors of Early Revision Surgery After Anterior

Cruciate Ligament Reconstruction. Results From the

Swedish National Knee Ligament Register on 13,102

Patients Am J Sports Med 2014:e-pub ahead of print

April 28, 2014, doi: 10.1177/0363546514531396

54. McCrory P, Meeuwisse W, Aubry M, et al. Consensus

statement on concussion in sport: the 4th International

Conference on Concussion in Sport held in Zurich,

November 2012 Br J Sports Med 2013;47:250-58

55. Orchard J, Seward H, Orchard J. AFL Injury Report: Season

2012, 2013:http://www.afl.com.au/staticfile/AFL%20

Tenant/AFL/Files/AFLInjuryReportFor2012.pdf.

56. Hodgson L, Gissane C, Gabbett T, et al. For Debate:

Consensus Injury Definitions in Team Sports Should

Focus on Encompassing all Injuries. Clin J Sport Med

2007;17(3):188-91

57. Makdissi M, McCrory P, Ugoni A, et al. Computerised

cognitive assessment of concussed Australian Rules

footballers. A prospective study of postconcussive

outcomes after return to play in Australian football.

American Journal of Sports Medicine 2009;37(5):875-6

58. Orchard J. More research is needed into the effects on

injury of substitute and interchange rules in team sports.

Br J Sports Med 2012;46(10):694-5



An ankle injury to Collingwood’s Quinten Lynch in round 23 saw him miss the club’s elimination final defeat the following week.

INJURY REPORT 2013 - AFL Community Club · THE AFL INJUR REPORT 2013 THE AFL INJUR REPORT 2013 3 22nd ANNUAL INJURY REPORT 2013 The 2013 AFL Injury Report represents 22 years of recording

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