• Heading In
Not Just
SMA
We preview what to look forward to at the end of the year, the SMA Conference in the Gold Coast and the FIFA World Cups.
A packed schedule sees us gear up for the upcoming SMA conference and get ready for the 2022/23 sporting calendar.
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Differences in physical match performance and injury occurrence before and after the COVID-19 break in professional European soccer leagues: a systematic review
Dr Stefan Altmann compares key differences in performance levels and risk of injury before and after professional sport halted globally for the COVID-19 pandemic, specifically across the professional European football leagues
Heading In Football: Are we headed for change?
Dr Kerry Peek investigates the long, medium and short term effects of heading in football and looks at how this can impact football players at different ages and stages of the game.
Not Just a Sprain: Chronic ankle instability in soccer players
Exercise Physiologist, Nicola Carlish breaks down the frequency of ankle injuries and general instability in soccer players and how it can be managed and treated from grassroots to professional arenas.
Opinions expressed throughout the magazine are the contributors’ own and do not necessarily reflect the views or policy of Sports Medicine Australia (SMA). Members and readers are advised that SMA cannot be held responsible for the accuracy of statements made in advertisements nor the quality of goods or services advertised. All materials copyright. On acceptance of an article for publication, copyright passes to the publisher.
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Sports House, 375 Albert Rd Albert Park VIC 3206 sma.org.au ISSN No. 1032-5662 PP No. 226480/00028
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Head Physiotherapist for the Under 20s Matildas, Elyse Naylor, explores her experience at the last World Cup and the challenges of managing a squad in challenging tournament conditions.
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We had a chance to chat with titled Sports Physiotherapist, Dr Ebonie Rio, and Sport and Exercise Medicine Physician, Dr Liam West, to share their experience at the Commonwealth Games in Birmingham.
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Football Medicine Forum with Professor Dr Tim Meyer
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5 Minutes with Sue Monteath
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People who Shaped SMA: Dr Anita Green
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Sports Medicine Around the World: Poland
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Sports Trainer Highlight: Jess Barthelson
WE PREVIEW WHAT TO LOOK FORWARD TO AT THE END OF THE YEAR AND THE FIFA WORLD CUPS.
Welcome to Volume 40 of Sport Health
The Sports Medicine Australia annual conference is nearly upon us, with only a few months until we head out to RACV Royal Pines Resort on the picturesque Gold Coast. We look forward to welcoming some of the brightest minds and leading figures in sports medicine, alongside many likeminded individuals coming together to share their knowledge at the largest interdisciplinary sports medicine conference in the southern hemisphere.
With the SMA Conference Program now out and available on the SMA Conference website you can see the full extent of what to expect in November.
We have an exciting line up of speakers across the event, such as our Refshauge Lecturer Dr Susan White AM, who is the Director of Performance Health Services and Chief Medical Officer at the Victorian Institute of Sport. This is just one of the many leaders of their discipline speakers we have at the conference this year. I’d encourage everyone to take a look through the program and to see what is on offer.
Part of our conference program each year is the SMA AGM in which we look to welcome our members to hear and
have their say on the direction of SMA going forward and look to plan for the year ahead. We will also be holding the ASMF Fellows Dinner in which we gather the Order of Fellows to both promote the incoming Refshauge Lecturer and set the values of excellence and recognise the contributions in the Sports Medicine community.
The Conference is just the start of a packed calendar coming up for the sports community with the FIFA Women’s World Cup being held at the end of 2023 in various locations across Australia. With many of our members involved in football at a multitude of levels, having the pinnacle
of the sport in our own backyard is an opportunity I’m sure many are looking forward to. We also look towards the FIFA Men’s World Cup where we see the Socceroo’s travel to Qatar to take on some of the world’s best.
This is all whilst we continue to run our multidisciplinary events and safer sports courses across the country. One highlight of our upcoming events calendar is the Football Medicine Forum with newly appointed JSAM’s Editor in Chief Tim Meyer, who will be sharing his knowledge with a number of leading names in the sport. Make sure you take advantage of your SMA membership to experience a truly unique sports medicine forum.
We have focused this edition of Sport Health on the subject of Football and the various different elements of, and around it in relation to sports medicine. We look at topics such as management of elite to amateur footballing teams, addressing football specific injuries and reviewing the extent of the covid break on European football.
I hope you enjoy this iteration of Sport Health and the larger sporting calendar alongside the large number of SMA events and courses that are offered throughout 2022 and beyond.
Professor Gregory Kolt
Part of our conference program each year is the SMA AGM in which we look to welcome our members to hear and have their say on the direction of SMA going forward.
Welcome to the latest edition of Sport Health
As we look towards the end of 2022, we get ready for some of the biggest events on the world’s sporting calendar. This edition of Sport Health focuses on the King of Sports and curates some of the best minds within that discipline. With the Men’s World Cup taking place at the end of the year and Australia hosting the Women’s World Cup next year, there is no better time to immerse yourself in the sphere of football.
Here at Sports Medicine Australia, we are in the final stages of preparation for the 2022 SMA Conference at RACV Royal Pines Resort on the beautiful Gold Coast, Queensland. We welcome some of the finest minds in Sports Medicine to the conference this year with keynote speakers such as Professor Dr Vincent Gouttebarge PhD, Professor Jill Cook PhD and Dr Phathokuhle Zondi MBChB alongside many others.
Not only is this an opportunity to hear from the leaders in our industry, it’s also a chance to network with many likeminded peers from a plethora of different backgrounds and disciplines within the Sports Medicine community. This is in addition to accessing the latest from our trade and exhibition
With the Men’s World Cup taking place at the end of the year and Australia hosting the Women’s World Cup next year, there is no better time to immerse yourself in the sphere of football.
partners who will showcase the best of new trade opportunities.
Moving into the last quarter of the calendar year we have been working over the course of 2022 to provide an increasing number of events and courses for our members. This year we have hosted 34 events across the country with a mix of different topics, online as well as in-person delivery, from leaders in their respective fields. We’ve also conducted hundreds of Safer Sports Courses ranging from our industry-leading Sports Trainer Level 1 and 2 courses, to first aid and advanced sports taping.
As an SMA member, you get access to all of this and more as we continue
to provide expertise in Sports Medicine as the leading membership body in Australia. With our unique multidisciplinary focus, we provide a holistic approach to a network of peers and experts that is unbeaten.
In this issue, we are delighted to give you a preview of the upcoming Football Medicine Forum with Editor-in-Chief for the Journal of Science and Medicine in Sport (JSAMS) and Chair of both the German Football Association and UEFA’s medical committee, Professor Dr Tim Meyer, as our keynote speaker. Professor Meyer has been the team physician of the German men’s national football team for multiple World Cups, European Championships and Confederation Cups. He will be joined by a panel of leading sports medicine practitioners and coaches, and is a must attend for physios, doctors, sports trainers, coaches, and conditioning staff.
We hope you enjoy reading this edition of Sport Health which tackles subjects such as heading in football, managing football injuries, and preparing for and managing a tournament. Thank you for your continued support and effort towards our goals: enhancing health outcomes for all Australians, through knowledge, training and safe participation in sport, exercise and physical activity.
Jamie Crain jamie.crain@sma.org.au
The COVID-19 pandemic has not only severely affected our everyday lives but also professional sports such as soccer. During the 2019/2020 season, the majority of European leagues called off games and team practices between March and June 2020 to reduce the spread of the virus. The teams were not allowed to train with the whole squad for several weeks, with Germany having the shortest break (9 weeks) and Italy the longest (15 weeks). During this time-period, the players had to individually train for strength and endurance at home to preserve their physical performance, before training on the pitch with small groups and, eventually, the whole squad was again allowed. Also, the resumption of the season took
place under special circumstances. No spectators were allowed to watch the games in the stadiums and the frequency of matches per week almost doubled from 1 to 2 games in most leagues as compared to before the break. Lastly, coaches were now allowed to substitute 5 instead of 3 players in an attempt to account for this both mentally and physically demanding last phase of the season (Seequoteonnextpage).
Moreover, congested schedules with 2 or more matches per week have been shown to decrease the physicalmatch performance of soccer players (e.g., running and sprinting distance) while increasing the injury occurrence during such time-periods. These are all signs that both the physicalmatch performance and the injury occurrence would be affected in a
negativewayaftertheresumption of matches in the 2019/2020 season. But has this assumption really proven true? Reason enough for our research group to take a very close look at the available scientific literature that asked this exact same question in the European soccer leagues.
To bring light into the dark, we systematically searched several databases using specific keywords and found 12 studies that reported the physical-match performance and/or the injury occurrence pre and post the COVID-19 induced break in professional European soccer leagues. The German Bundesliga was investigated most often (5 times), followed by the Spanish La Liga (3 times), and the Italian Serie A (2 times). The Polish Ekstraklasa and the Croatian HNL were studied one time
each.Thisinformationisimportant because we found the results to be inconsistent over the investigated leagues. In particular, we found that after compared to before the break:
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The physical-match performance remained stable in the German Bundesliga, while it decreased in all other leagues
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The injury occurrence seemed to be unaffected in all leagues that were investigated But how can these differing results be explained and what do they mean for practice?
Physical-match performance: The German Bundesliga stands out Most of the studies carried out in the German Bundesliga did not reveal any meaningful differences in physical-
We know from several studies that the break in team training due to the COVID-19 pandemic placed the players at risk for reduced sprint and jump capabilities.FE ATURE: DID PHYSICAL-MATCH PERFORMANCE AND INJURY OCCURRENCE CHANGE AFTER THE COVID-19 BREAK IN PROFESSIONAL EUROPEAN SOCCER?
match performance before and after the COVID-19 break. For example, in the study of Thron et al. (2021), the Bundesliga teams covered on average 115.50 km before and 114.82 km after the break, which reflects a difference of only 680 m (-0.6%) per match for a whole team. Similar results were found for both the high-intensity distance (10.95 km vs 11.01 km) and the sprinting distance (4.34 km vs 4.36 km), showing a small increase of 60 m (+0.6%) and 20 m (+0.5%), respectively, per match and team.
By contrast, the physical-match performance in all other investigated leagues (i.e., Polish Ekstraklasa, Croatian HNL, Italian Serie A, and Spanish La Liga) seemed to be negatively affected after the break. More specifically, Radziminski et al.
(2021) found that the players in the Polish Ekstraklasa reduced their total running distance by 1.1%, their high-intensity distance by 2.1%, and their sprinting distance by 1.8%. Even larger decrements were observed in the Spanish La Liga by Garcia-Aliaga et al. (2021). Here, players ran less by 7.2% in total, by 7.7% in high-intensity zones, and by 8.6% in sprinting zones.
Also, the number of accelerations and decelerations performed by the players were 5.2% and 6.4%, respectively, less than before the break.
Different general playing conditions as potential explanations (Seequote)
By contrast, group training was stopped for 6 to 8 weeks, and matches even for 12 to 15 weeks in Poland, Croatia, Italy, and Spain.
While speculative, the different results between the German Bundesliga and the other investigated European leagues might be attributed to the shorter break between both the resumption of group training and matches which were 3 and 9 weeks, respectively, in Germany.
These long breaks could have yielded reduced physical capabilities which might have transferred to reduced physical-match performance.
Moreover, the number of matches per week after the COVID-19 break was only 1.5 in the German Bundesliga, while for example the teams in the Spanish La Liga and the Italian Serie A had to deal with more congested schedules of 1.9 to 2.0 matches per week. Consequently, less time to recover might have additionally affected physical-match performance in a negative way in these leagues.
Injury occurrence rather stable before and after the COVID-19 break
Differences in injury occurrence before and after the break were less frequently studied. Nevertheless, 2 out of the 3 investigationscarriedoutinthe
German Bundesliga (Thron et al., 2021; Krutsch et al., 2021) did not observe meaningful differences. These findings were supported by Marotta et al. (2021) who did also find no increased injury occurrence after the break in the Italian Serie A. However, the comparability of studies relating to injuries seems rather questionable. While physical-match performance is commonly captured in a relatively standardized way through validated video- or GPS-based tracking systems, the collection of injury data in published studies is usually less standardised, e.g., through the use of social media reports or established medical registries. (See quote on next page)
Our systematic search of scientific studiesrevealedthatthephysicalmatchperformanceintheGerman
Bundesliga did not change after the COVID-19 break during the 2019/2020 season, while there was a meaningful decline in the respective parameters for the other investigated European leagues. Conversely, injury occurrence seemed to be unaffected after the break, at least in the investigated leagues (i.e., German Bundesliga and Italian Serie A). While it cannot be ruled out that such a disruption of training and matches may occur again in the future, these results emphasise the importance of an optimal physical preparation of the players in such a situation. This aspect seems especially relevant during longer breaks, as it was evident in most of the investigated leagues, and when facing congested schedules of 2 or more matches per weekaftertheresumptionofmatches. Lastly,itseemsworthytopermanently risethenumberofsubstitutionsto5
FEATURE: DID PHYSICAL-MATCH PERFORMANCE AND INJURY OCCURRENCE CHANGE AFTER THE COVID-19 BREAK IN PROFESSIONAL EUROPEAN SOCCER?after the COVID-19 break in professional European soccer?
The reason for the rather stable injury occurrence in most studies again remains speculative, however, the increased number of possible substitutions from 3 to 5 after the break in all leagues might have reduced the external load per player and, consequently, the injury risk.
instead of 3 as this might reduce physical overload of players and thereby minimise injury risk in the increasingly crowded soccer schedule.
Detailed information about the systematic review and the included studies can be found in the following article:
Thron, M., Düking, P., Härtel, S., Woll, A., & Altmann, S. (2022). Differences in Physical Match Performance and Injury Occurrence Before and After the COVID-19 Break in Professional European Soccer Leagues: A Systematic Review. Sports Medicine-Open, 1-17. https://doi.org/10.1186/ s40798-022-00505-z
Dr Stefan Altmann is Head of Performance Diagnostics at the Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Germany as well as Coordinator of Science and Sports Physiology at the TSG ResearchLab, Zuzenhausen, Germany.
His research focuses on performance enhancement in soccer, thereby addressing aspects of match analysis, testing, and training. While his main interest is located in physiological factors, he recently started conducting research in other areas contributing to performance in soccer such as the psychological, technical, and tactical areas.
BY KERRY PEEK, PHD
The long-term effects of heading on brain health have come under increased scrutiny in recent years. This concern and uncertainty has led many football associations around the world to prohibit or restrict heading including US Soccer in 2015 (following a class action lawsuit) and more recently in England, Scotland, and Northern Ireland. These heading restrictions are mainly based on chronological age, for example, in the US, players aged 10 years and younger are prohibited from heading the ball with heading restrictions until 13 years of age. A similar trial is due to start in England for players aged under 11 years, in time for the 2022/2023 season. While prohibiting heading in younger age groups will greatly reduce heading burden in the short-term for these players, it will have limited impact once players can head the ball in training and games.
Long-term retrospective studies of deceased football players have reported an increased prevalence of neurodegenerative diseases when compared with non-playing agematched controls. However, linking these findings to the specific act of heading is problematic, given the retrospective design and the absence of heading data for each player.
While there may become a time when the scientific evidence unequivocally supports a complete ban on heading
across all age groups and skill levels, heading currently remains a significant part of the game. For example, in the recent Men’s European Championships (2021), 25% of all goals were from a header, with headers being one of the most common ways to score (or perhaps save) a goal. This begs the question, are there pragmatic strategies which could be
implemented right now to reduce heading burden in all players for as long as heading remains part of football, and while research into the long-term effects on brain health continues? This is the focus of my research for which I have been awarded funding from Sports Medicine Australia and through a FIFA research scholarship.
Initially we explored heading incidence in young players, to understand which players head the ball more often and under what circumstances. This led to two published papers on heading in boy’s football from under 10s to under 12s and from under 13s to under 20s in youth football for boys/men and girls/ women in Australia, with a further study completed in women’s football in the US. Pooling this data with data from studies completed across the world has shown a mean number of headers per player per game ranging from 0-8 headers in boy’s football; 0-7
When considering the short to medium effects of heading on brain health, review papers to date have reported equivocal collective evidence.
headers in girl’s football; 2-11 headers in men’s football; and 1-4 headers in women’s football. But what is really apparent is that some players head the ball much more frequently than others. Research consistently shows that most headers occur along the central corridor of the pitch with centre-backs being responsible for many of the defensive and attacking headers in the box. Research by others has also shown that headers from goal and corner kicks, result in higher head accelerations (measured by inertial measurement units such as instrumented mouth guards) than other types of headers. Our research has also demonstrated that headers of higher pressure and heavier balls also result in higher head accelerations
than lighter, lower pressure balls. While the association between higher head acceleration and increased injury risk isn’t yet established, head acceleration is one indicator of the potential stress placed on the brain during head impacts. While heading itself rarely results in the clinical signs or symptoms of a concussion, competition for aerial balls causing head-head and elbowhead contact is the most common mechanism of concussion in football with evidence showing that these impacts often demonstrate higher head accelerations than intentional ball-head impacts during heading. Therefore, strategies which reduce head acceleration during heading may reduce heading burden.
Evidence also suggests that lower head accelerations are seen with headers originating from the player’s forehead particularly when compared with the top or side of the head. Therefore, teaching players how to head a ball properly using lighter, lower pressure balls is another possible strategy, prior to exposing players to higher pressure match balls. Correct heading technique is also about being able to track the trajectory of the ball, time a run or jump and good body positioning, particularly when competing for the ball. Much of this can be taught without ball-head contact (as initially balls can be caught at forehead height during isolated training drills). Players also demonstrate differences in their readiness to head a ball
One obvious strategy given this data is to restrict headers from goal and corner kicks particularly in young developing players. This strategy also fits with many football curricula, which tend to encourage short corners and playing out from the back during the skill acquisition phase (typically aimed at players aged 8 to 12 years).
which may be more related to their level of maturation or biological age rather than their chronological age. Players who quickly close their eyes and flinch away from high balls, including low speed balls from throwins, are not ready to commence heading. Virtual reality is also an emerging area being trialled to teach heading technique.
Our published and unpublished research has explored the effect that higher neck strength and the implementation of neuromuscular neck exercises has on head acceleration and heading related injury risk. The results from our recent project support the addition of 90 seconds of neuromuscular neck exercises integrated into general neuromuscular exercises programs (such as Part 2 of the FIFA 11+) to reduce head acceleration during heading in adolescent players, as well as reducing self-reported pain on heading a ball and the incidence of concussion and potential concussive events. These exercises have now been incorporated into training for a number of clubs in Australia and internationally.
Removing unnecessary heading drills from training will also reduce heading burden. Unnecessary heading drills include those that do not translate to game scenarios or contribute to heading technique development. For example, juggling a ball with the head encourages different head positioning and neck muscle activation than heading.
Another strategy is utilising small-sided games (with fewer players and/or smaller pitch sizes) which will provide more opportunities for players to increase the number of individual touches on the ball, while also encouraging quick decision making. Studies have demonstrated that small-sided games have fewer ‘long balls’, which negates the need for as many headers, when compared with the 11 vs 11 format. Many clubs currently utilise small-sided game formats during training sessions for players of all ages and skill levels.
Finally, rule enforcement of foul play and deliberate elbow-head contact as well as providing education to referees, players and clubs on the importance of recognising potential and actual heading related injuries, as well as the removal of players from the field of play when appropriate, is paramount. We need to provide a culture in football which respects the seriousness of brain injuries such as concussion, where players can feel comfortable to report their symptoms and are supported to receive early and appropriate care without the pressure to return to training or playing until they are medically ready. As sports medical professionals we have a duty of care through good management, advocacy and governance to protect the current and future generation of football players. Are we headed for change? Almost certainly and ideally through pragmatic strategies which allow players to reap all the physical and psychosocial benefits of football while at the same time reducing the potential risk to their brain health.
Kerry Peek, PhD, is a physiotherapist, strength and conditioning coach, behavioural scientist, and sports injury researcher with the University of Sydney. Her research is focused on mitigating sports related head and neck injuries with a particular interest on heading in football. Kerry assisted in drafting UEFA’s Heading Guidelines, released in 2020. She has also been invited to present her research to the UEFA Medical Committee, the English Premier League’s Expert Group on Neck Strengthening as well as to Football Australia and Football New South Wales. Kerry is currently working on a machine learning project to code match headers with medical researchers at FIFA.
Kerry will be presenting on heading in football at SMA’s Football Medicine Forum on October 7th2022 at Valentine Sports Park in Sydney as well as presenting a workshop on neck strengthening at the SMA conference in November. If you would like to know more, please contact Kerry via kerry.peek@sydney.edu.au or via Twitter @peek_kerry
BY NICOLA CARLISH
Soccer has the average highest percentage of participants with recurrent ankle sprains when compared to all sports, with frequent reports of both mechanical and functional instability. The combination of these classifies an individual with chronic ankle instability (CAI), which can have varying impacts on the athlete’s performance.
Athletes with CAI often experienced frequent bouts of swelling, a feeling of giving way, joint instability and overall loss of function. In turn this can impact their capacity for static and dynamic postural control, and
neuromuscular dysfunction. Without these elements, the athlete will have issues with their jumping, landing and change of direction capacity, especially at higher speeds.
But ankle instability isn’t just an issue for the ankle. Other physical structures of the lower limb and torso can be affected with compensatory mechanisms to counter the changed movement capacity at the ankle joint. We often see athletes adopt an antalgic gait post injury – even in the short term these altered mechanics can result in undue stress on structures not prepared for this change in load.
Our first step to reducing the incidence of chronic ankle injuries is to ensure we are providing appropriate management in the acute phase for any initial injury.
“Don’t worry, it’s just a sprain” Those working within the sporting environment would have heard this often, from coaches and players alike.
It may be difficult at times to catch these injuries during game play – rapport with your athletes will help immensely with them being comfortable with self-reporting these within a reasonable time frame.
Despite the known impacts to physical capacity, general injury management guidelines for ankle sprains are often waived in community and semiprofessional sport. A minimum oneweek rehabilitation is recommended post-acute injury prior to return to play. This may be longer depending on injury severity and players’ response to rehabilitation. However, players often return to play immediately post injury or to the subsequent game without any rehabilitation with a “she’ll be right” mentality.
There is more we can be doing to assist with managing these injuries. Adopting a more structured approach to injury rehabilitation post-acute injury is the first level of athlete care. The updated acute injury management guidelines provide clear pathways for this. PEACE & LOVE (Figure 1) guidelines account for both initial symptom management and gradual muscle, tendon and ligament loading for appropriate preparedness on the athletes return to play.
From both a rehabilitation and performance perspective, there are a number of ways we can address CAI for our athletes to ensure they’re back on the pitch sooner, for longer.
The PAASS framework (Figure 2) provides us with a return to sport guideline for our most commonly diagnosed ankle injury – an ATFL strain. This framework acknowledges Pain Severity, Ankle Impairments, Athlete Perception, Sensorimotor Control, and Sport/Functional Performance.
This framework can be used either in conjunction with the PEACE & LOVE framework for acute injuries, or independently when CAI has been diagnosed with no specific injury mechanism.
Pain severity is mostly commonly assessed through a Visual Analogue Scale (VAS). This is determined on a
Figure 1 Figurescale of 0 – 10, where 0 is no pain and 10 is the worst possible imaginable pain. This scale is limited by the athlete’s perception of and tolerance to pain, so needs to be considered alongside other symptoms of injury. Ensure this is reviewed when the injury occurs, prior to when the injury occurred and at different intervals post injury to gain the greatest picture of athlete pain levels.
Physical capacity at the ankle joint should be assessed in all planes of movement. Passive and active ranges of plantar- and dorsi-flexion, inversion and eversion should be assessed on the affected and unaffected ankle for any between-side differences and what movements are limited by pain or mechanical restriction.
Strength, endurance and power must also be assessed. This may include reviews of calf and tibialis anterior strength and endurance, quadriceps, hamstring, adductor and gluteal strength/endurance, double leg and single leg hop capacity. This is not an extensive assessment list, but outlines the basic muscular group requirements necessary prior to moving forward with assessing.
Confidence in the injured limb is crucial to their on-field performance.
Athletes who have fear in using the previously injured limb will be less likely to play to their highest performance capacity, even though they aren’t physically limited. Instilling trust in the limb throughout the injury process is just as important as the structural recovery is. Graded exposure to challenging situations can assist the athlete to be less anxious in situations similar to the initial injury, and restore confidence that not all challenging situations will result in an injury.
Restoring sensorimotor control does not just relate to whether or not your athlete can control themselves in a single leg stance (eyes opened or closed). We need to consider their landing capacity with and without external perturbations and their spatial awareness in dynamic positions. This component is not always prioritised in our younger populations with the assumption of natural stability and ability to regain postural control with specific external input, and movement impairments only coming into effect with the ageing process. Injuries to nervous and musculotendinous tissue explain some of the proprioceptive deficits reported with these injuries. Therefore, care in re-training balance and postural control of the impacted area is important to be considered.
Once these four components have been achieved, we then need to ensure the athlete is prepared to return to the pitch. Pre-performance baselines are helpful in this phase to ensure that the athlete is returning to play at their best possible level of performance. This should consider all physical components of fitness, including:
Health-related Components:
ٚ Cardiorespiratory (aerobic) endurance
ٚ Body composition
Athlete perception is a key component often overlooked in injury management. An athlete may complete every physical test with flying colours, but if they do not feel ready to play then they are not ready.
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Muscular strength
ٚ Muscular endurance; and
ٚ Flexibility
Performance-related Components:
ٚ Agility
ٚ Coordination
ٚ Balance
ٚ Power ٚ Reaction Time; and
ٚ Speed
Assessing all of these components within the community environment can seem quite daunting, especially with limited time and access to resources. Methods that can assist with facilitating the best outcomes for injured players are to:
Create a battery of tests which you are qualified to run that are both meaningful for the injury and able to be reproduced within your environment.
Partner with a suitably qualified allied health professional / company who you can integrate your support with for optimal athlete engagement and rehabilitation.
Early interventions provide athletes with the best chance of effective recovery. So, the next time an athlete reports “don’t worry, it’s just a sprain”, consider this may be the crucial time for you to intervene to improve their long term health and performance.
Nicola Carlish is an Accredited Exercise Physiologist, who completed her degree at the University of Queensland in 2017. She is also qualified as an ASCA Level 1 Strength & Conditioning Coach and SMA Level 2 Sports Trainer. Nicola is the owner/director at Movement Skill Performance Alliance and Head of Performance for senior football at UQFC. She has worked closely with numerous athletes and sporting teams across the years, including soccer, rugby league, swimming and netball. Her work as an exercise physiologist has lead her to see the repercussions of injuries that were not able to be well managed acutely, and the long term impact this can have on a person. She has an avid interest in preventative medicine, working to educate and empower individuals to live a healthier lifestyle earlier to decrease their risk of developing chronic disease and long term musculoskeletal injuries.
Given the likelihood that for the majority of soccer players we work with, this will not be their first ankle injury. We need to be more aware of the most effective management strategy for chronic ankle injuries.
EVERY FOOTBALLER’S DREAM IS TO COMPETE AT A WORLD CUP, AND AS A SPORTS PHYSIOTHERAPIST
THE FIFA U20 WOMEN’S WORLD CUP WAS THE HIGHLIGHT OF MY CAREER IN SPORTS TO DATE. THE CHALLENGE OF MANAGING A SQUAD FROM OUR FIRST CAMP IN APRIL THROUGH TO THE TOURNAMENT
AT THE END OF AUGUST WAS SOMETHING THAT HAS ALLOWED ME TO GROW AS A PHYSIOTHERAPIST.
three months before the tournament commenced. This allowed us to get to know our athletes, develop great relationships amongst the staff, and work with rehabilitation athletes in April to work towards having them ready for participation in August. We had a final camp in New Zealand where we got to practice our processes for the tournament, and develop strategies for our group of athletes with managing recovery following games three days apart.
Of course, one of the most significant challenges was COVID-19 in camp environments. Our first camp at the Australian Institute of Sports saw us lose most of our squad for a week of the two-week camp due to COVID, and the rules around close contacts. This provided us with the challenge of keeping athletes fit and healthy in
isolation and ensuring a smooth process to get them back to full availability following a period of illness or isolation.
The head coach of the Young Matildas, Leah Blayney, did an excellent job of securing several camps in the lead up to the tournament and 7 international matches for this squad in the space of
The World Cup preparation started with a two-week altitude acclimatisation training camp in Mexico. Mexico City is 7200 feet above sea level, and the effects of the high altitude were easily noted with higher perceived efforts and quicker fatigue in training reported from the athletes. Some of the athletes and staff suffered from altitude sickness,
and on top of that managing jet lag and the effects of 24 hours of plane travel. Our head of high performance, Georgia Brown, had developed strategies to ensure the group recovered as quickly from jetlag and maximised adaptations to the altitude, and as a SSSM team we focused on physically recovering the athletes from the travel and fatigue.
From a Physiotherapist perspective, camp life means long hours managing (with all the SSSM team) the wellness, physical preparedness, fatigue, and injuries of the playing group. It means knowing days by how far out from a match it is (match day -2), and having the day scheduled out for you hour by hour.
A typical day as a Physiotherapist would involve a morning wellness check-in with the group to check
subjective wellness and do a groin squeeze on certain days to have a look at soreness and as a general guide for neuromuscular fatigue screening. Typically, we would train in the morning so a strapping window, then into the training where we run “pre-activation” and then monitor the training group for any new/acute injuries or issues that occur. There may also be rehabilitation athletes that will be managed by one of the Physiotherapists and Strength & Conditioning Coach to execute the rehabilitation plan.
Following training, we run recovery which may be active recovery in the pool or ice baths and triaging any new injuries that may have come up from training. There is then a treatment block and massage window following lunch. With any new injuries, the assessment will also be done
with the Sports Doctor present. This means if any scans or medication is needed, we can quickly action it as well as allowing us as a medical team to ensure best early clinical diagnosis to inform the coaches with.
Following the treatments, a SSSM meeting will occur to discuss athletes, form plans for injured/modified athletes and discuss rehabilitation athletes. The SSSM team then meets with the head coach to discuss all athletes, and discuss the training planned for the following day and any modifications that may need to occur.
There are always big decisions and conversations that take place when it comes to injuries both prior to team selection for the pre-tournament camp and injuries that take place during camp. During our first week
One of the biggest lessons taken away from this camp for the entire staff and squad was being able to be resilient and roll with the punches when things don’t go smoothly.
in Mexico one of our starting athletes suffered a low-grade soft tissue injury on the back of just returning to full training from rehabilitation of a soft tissue injury on the other side. This athlete hadn’t returned to match time yet, however had been involved in full training for two weeks.
The difficulty in these situations is that although we organised imaging early, it can take some time to get the imaging and reports back.
In the case of this athlete, and with the athlete’s consent around understanding any risk of the injury worsening, it was decided that we would manage the athlete with rehabilitation with the aim of returning to some match minutes by the first game of the tournament three weeks later. We were extremely lucky to have a fantastic staff in our Head of High Performance, second Physiotherapist, and Sports Doctor
to be able to plan the progression of this athlete back to game availability.
Managing fatigue within the group was important for injury prevention, particularly with a young squad (including two of the youngest players of the whole tournament) and the intense training. For any athletes who presented with unilateral soreness, or a decreased strength or painful groin squeeze we would trial interventions to improve this initially and then make recommendations to the coaches regarding modifications during the session. For example, if an athlete had a >15-20% decrease in strength of a groin squeeze +/- pain, we might trial soft tissue therapy, isometric exercises or strapping to see if it improved the groin squeeze. We will then suggest that they limit kicking volume and are on the outside of small-sided drills to minimise the stress on the groin.
Therefore, it’s important to back your clinical decision making, and in this case have the involvement of all members of the SSSM team to have discussions with the coach regarding the athlete’s availability for the tournament.
We had 16 training sessions, and 6 matches across a 28-day period between arriving in Mexico and leaving Costa Rica. The day following matches would consist of a focus on recovery for the players who had started or played >60minutes, and training for the players coming off the bench or who didn’t get match time. One physiotherapist would lead active recovery (either on field, gym or pool), and the other would stay with the training group. The playing group also received a recovery massage following the match. With some matches starting at 8pm and the stadium an hour from the hotel, the focus post-match was on triaging any new injuries but having the athletes eat, hydrate, and get to sleep as soon as possible.
One of the most important factors in this sort of environment is communication and having clear
processes in place. Our SSSM team (which involved an exercise scientist, two physiotherapists, a massage therapist and Sports Doctor) worked brilliantly together, and had respect for each other’s role and opinion. This was important so that we could present a united front in discussions around injuries, prognosis, and management to coaching and technical staff. This meant that across our 4 weeks away we had 97% availability for matches, and 93% full availability (unmodified) for training sessions.
As we arrived in Costa Rica we were escorted through the airport, to our own customs line, and from then on anywhere we went in the team bus we had a police escort which moved traffic out of our way so that we never had to stop.
We had until 6pm the day before our first match to name our final squad and make any changes if there were injuries.
During our last training session (which was meant to start at 4pm but was delayed by an hour due to a large storm with lightning), one of our starting players sustained a soft tissue injury to her hip. As a team, we had to assess her on field and determine whether she would be able to safely perform at a World Cup level without significant injury risk. With player involvement, the decision was made that she would be able to play (with pain) and that the coach would accept the risk that this could be exacerbated with game time for the next two matches.
Each match of the group stage was only three days apart, so the recovery and treatment of these athletes between games was a priority. Both athletes mentioned
were able to play all three games, and progressively got better throughout the tournament with appropriate management around matches (modified training on the days between).
Our first match was against Costa Rica, and this was the highlight of the tournament and my Sports Physiotherapy career for me. We had an incredible crowd of 22,500 for this game and the fans lined the streets with flare guns cheering for Costa Rica as we approached the stadium. The crowd was so loud that we couldn’t hear each other on the pitch for warm up, and when they scored first, the stadium erupted with noise. We ended up winning 3-1 which was a fantastic result and incredibly special in front of such a large crowd.
Our second match against Brazil was in torrential conditions, and after 30 minutes
and being 1-0 down there was a rain delay of 60 minutes (see photo) because the field was waterlogged. This left us with the challenge of keeping the athletes warm and prepared to go back onto the field while in a very small changeroom. We were allowed a 10-minute warm up again before taking the pitch finally.
We unfortunately didn’t make it through the Group stage; however it was a fantastic four weeks working with some phenomenal athletes and staff. It was a great learning experience getting to work alongside my fellow Physiotherapist, Matt Grant-Smith, and our Sports Doctor, Karen Soo, as we got to work, assess and treat athletes together and challenge and push each other to think of how we can do the very best by the athlete and the team. My take-away message for anybody who wants to work in this field is ensure they respect the importance of working well with your team, ensure you find the best way to communicate with those around you, and be prepared for hard work but a lot of wonderful experiences.
The tournament itself was in San Jose, Costa Rica. Our group involved the previous winners, Spain, the host nation, Costa Rica, and the footballing nation giant, Brazil. FIFA put together an incredible tournament.
Elyse is an APA Titled Sports & Exercise Physiotherapist, the Head Physiotherapist for the Young Matildas & Brisbane Roar A-League Women’s Program and Director of SportsPlus Physiotherapy (Highgate Hill, Brisbane). Elyse’s passion in her sports career has been working with women in sport, particularly in Football. She has also worked with the QLD Firebirds and in elite swimming for the Queensland Academy of Sport and the Australian Junior Swimming Team. Outside of work, Elyse will spend her time with friends and family and her two cavoodles.
SPORTS MEDICINE AUSTRALIA WAS DELIGHTED TO HAVE MANY OF OUR MEMBERS PART OF THE MEDICAL TEAM THAT TRAVELLED WITH TEAM AUSTRALIA TO THE 2022 COMMONWEALTH GAMES IN BIRMINGHAM FROM 28 JULY – 8 AUGUST.
WE HAD A CHANCE TO CHAT WITH DR EBONIE RIO AND DR LIAM WEST TO SHARE THEIR EXPERIENCE.
Ebonie: I am a titled Sports Physiotherapist and I also work in research. I actually didn’t start my journey in sport. I started in a hospital, but I always wanted to do sport, but felt like I needed a more general kind of grounding. I started volunteering at a local football club working as a sports trainer to try and get a lot of different experience to eventually go down that path. I was lucky enough to work with Disney’s The Lion King as their physio for 18 months and that gave me really good experience in managing a large team. I did my Masters of Sports Physio at La Trobe University, and I was lucky enough to complete the AIS Postgraduate Scholar Sports Physio position which gave me wonderful opportunities for mentorship and to learn from the sports physios up at the Australian Institute of Sport.
Liam: I’m a Sport and Exercise Medicine Physician. Originally from the UK, I moved to Australia in 2015 to further my training here and undertake the specialist training program under the Australasian College of Sport and Exercise Physicians (ACSEP). I’ve actually finished that pathway and was awarded my Fellowship this year. At the moment I work at the Alphington sports medicine clinic in Northcote VIC. In actual official capacities, working for the England football team on the Sixteens and the Women’s Premier League back home were really standout moments. Since moving to Australia, I’ve worked across various domains, both as a team doctor and an event doctor. Now, I’m the head doctor for the Hawthorne Football Club in the AFL. I’ve also worked through different disciplines such as for The Diamonds netball team, which was a fantastic experience. With events, I worked at the 2018 Gold Coast Commonwealth Games (but that was just as an event doctor), the Invictus Games, and now more recently at the Commonwealth Games in Birmingham.
Can you tell us a little bit about your sports medicine journey?
Ebonie: Leading up to the games, there’s the opportunity to attend team information sessions where you start to get an insight into the background, how much work takes place behind the scenes, and you learn about the roles and responsibilities of different team members. In my experience at the games, I was working predominantly with weightlifting and para powerlifting. I had wonderful communication prior that was facilitated by the sport, where I could call the physiotherapist and the coaches from all around the country and talk to them about the athletes that they work with. I had a better understanding of the athletes that I would work with, as well as know a little bit more about their injury history. It also starts to build some rapport with the athlete and that can help them feel really comfortable and know that you’ve invested in their care. When you arrive at the Games, it’s all hands-on deck. You must be flexible and be prepared to do anything that needs to be done. You get to go to the athlete training, a competition, support any sort of access to recovery facilities that are needed, and you get into a routine of 24 hours a day of sport, which is awesome!
Liam: Originally, I applied and was lucky enough to be in line for a role with the medical HQ across the whole of Australia, and therefore my role was pretty minimal. It was probably 4-5 months out that I was approached by Athletics Australia, and their Chief Medical Officer, Dr Paul Blackman, who asked whether I’d be interested in interviewing for an actual team physician role with their sporting body for the Games, and I was lucky enough to get that position. My role was partly ensuring that we organised enough medical supplies, which includes drugs and different equipment so that we
could be self-sufficient whilst we were in the UK. And so, I was ordering and procuring equipment, and getting the import-export licenses, which is more of a logistical role. I was also helping to get across all the previous and current medical and musculoskeletal issues for the touring group. And then of course, I was working with Athletics Australia as to how we were going to tackle COVID-19. I was the lead doctor for the staging camp, which was held just outside south of London in a place called Tunbridge. I was basically employed by Athletics Australia to work with athletes across varying disciplines – from throwers to sprinters to endurance, across both able-bodied and para sport athletes.
What was the most common injury that you treated while at the games? Or how did you work with the athletes to reduce injury risk and help facilitate optimal performance?
Ebonie: As I said I worked predominantly with weightlifting and para powerlifting. And, wonderfully, we didn’t have any new injuries, which was fantastic. Athletes in weightlifting can get knee pain, and our power lifters can get shoulder and neck pain fairly commonly. So, we were managing athletes coming in with some soreness and mild injuries, but everyone was able to compete and with some brilliant personal bests and outstanding results. No one in those sports missed through injury, which is a fantastic effort
What were your responsibilities leading up to and at the Commonwealth Games this year?
for not only the sporting team, but the medical team they have looking after them at home before they come in.
I like to communicate really openly with athletes and their support staff, so the preparation actually starts before you go to the Games. I made sure I had touched base with the team before I even landed in Birmingham. Then when we got to Birmingham, it’s important to make sure the coach, support staff and athletes know who you are and have good lines of communication. I met with each athlete and worked out a plan to see what day they were competing, when their last heavy training session was, how often would they access physio or soft tissue therapy at home,
etc. I was lucky to have worked with amazing soft tissue therapists. We were also able to set up if anyone needed to see the doctor, touch base with recovery or nutrition, psychology or any of our other supports. We had a good team plan, and I think the certainty and routine around that helps people be more confident, which can help reduce their anxiety to allow athletes to be in the best mind set for performance.
Liam: The most common injury accidents were in the gym such as rolling ankles and falling off things. Athletics is a sport where we tend to see overuse injuries, but you don’t get to enter the Games environment if you’re not close to 100%. And so, we don’t see
athletes coming in with large injuries at that stage. That being said, during the Games, we had a crush fracture of a finger which was getting caught in the door, and a couple sprained ankles. But realistically it was staying on top of chronic issues such as pubic bone overload and chronic Achilles that have flared up. It was slightly different to Australian rules football that I’m used to where there’s a lot of contact injuries and concussions. With Athletics, it was more so staying on top of things that obviously can reduce performance.
Ebonie: We had a COVID team, who were absolutely amazing. We felt really well informed, and we knew the strategy if we were managing any illness, not just COVID. We had excellent sports medicine support, and the Australian team was conservative. Team Australia wore masks and minimised interactions with the community. So, at the start, I went to weightlifting, because that’s who I was working with, but we were very much in our own little bubble, and I wasn’t going and sitting in the crowd for any other sport (also not why I am there so that’s fine!). Everyone was really diligent with hand washing and I believe we were one of the few countries that wore a mask when indoors. We had very low cases of any athlete being unwell, but you know, there’s all the usual illnesses that happen when people are in close
I was employed by Athletics Australia to work with athletes across varying disciplines –from throwers to sprinters to endurance, across both ablebodied and para sport athletes.
(Dr Liam West)
proximity. However, everything was managed calmly and effectively.
Liam: Outside of the musculoskeletal presentations, the biggest amount of time that Paul and myself sectioned across was COVID management. There was a significant outbreak at the World Championships in America and a lot of those athletes came across to be managed in Tunbridge, and then Birmingham. We had three athletes test positive on arrival who had to be isolated. We were very fortunate with mitigation risk and the steps we put in place as no further athletes or staff tested positive. We had COVID outbreaks in different areas and so we were performing telehealth assessments and trying to work out logistics and the logistics themselves were the biggest component.
Birmingham was an event whereby athletes could compete ‘hot’ and by that I mean, they could be COVID positive and still compete. So, we decided to create a sort of ‘athlete village’ outside of the actual village whereby our positive athletes would train to ensure that we could still facilitate them within the government rules. We also dealt with an ethical dilemma whereby we made sure they were segregated from the public, but also ourselves, so they could continue to train outdoors but not risk anyone else from a health and wellbeing point of view. That also extended when they came into the Games environment to compete. I think in summary, COVID took up most of the time for us doctors.
Ebonie: I have too many, but if I have to choose one – right before we walked out for the opening ceremony, our two flags bearers, Rachael Grinham and Eddie Ockenden, ran alongside our team with the Australian flag yelling at the top of their lungs ‘Aussie Aussie Aussie’, and the whole team replied, ‘oi oi oi’. It was spine tingling and just so special. You could actually hear
the Australian team over the sound of the opening ceremony. For me, walking out in team uniform, with the Australian team was incredibly special, but doing something so Australian in that moment, was just so fun.
Liam: For me, personally, there were a few moments that medically I was involved in. I really enjoyed watching the Women’s 4x100 metres relay. Though Australia came fourth, I’d got to know them over three and a half weeks and to see them do so very well and come so close was actually quite special. I know it’s not a victory, but they just put their all out there and it was rewarding to see them do so well. Also, I think Kelsey-Lee Barber with her last throw in the javelin. She, as has been on
We decided to create a sort of ‘athlete village’ outside of the actual Games village whereby our COVID-positive athletes would train to ensure that we could still facilitate them within the government rules. (Dr Liam West)
record, got COVID and we managed her in isolation and obviously took up a huge amount of our time to try and ensure that we balanced her health and performance which was really pleasing. There were just so many impressive athletes that I had the good fortune of working with, and I don’t really want to single anyone out. But it’s also perfect to work in a great team, have new individuals, learn a lot and be able to take that back to my clinical practice.
What would you say is your biggest takeaway from the Games which would help you in your clinic?
Ebonie: I think that people are capable of incredible things when everyone works together. We saw some amazing
I met with each Weightlifting and Para Powerlifting athlete and their coaches to help work out a plan to see what day they were competing, when their last heavy training session was, and how often they would usually access physio or soft tissue therapy at home. (Dr Ebonie Rio)
performances and that’s because the team allowed the athlete to shine. And so, I think just a reminder that if you work in a practice by yourself, get a team around you. Be part of a collaborative, multidisciplinary team. You don’t need to physically be in the same space. We often weren’t, but we had the support of doctors, psychology, soft tissue, recovery and nutritionists and everyone in Team Australia around us. The support staff to create such a
fantastic environment and run the ops are just incredible. People are capable of amazing things when the team works together, and I’m lucky I have that support and culture at The Australian Ballet and the Victorian Institute of Sport where I currently work. I would encourage everyone to seek that out!
Liam: I was very happy with the team that I went with. As it was only three and a half weeks, I was forever trying to
squeeze all information out of the coaches, the physios, the bio-mechanists, etc. I’d like to think that my biomechanical knowledge of different disciplines now within Athletics will make me much more proficient at looking after those type of athletes in the clinic. And furthermore, just with runners generally, I think you can never put a price on your knowledge of different movement patterns, which is really important. Always when working in a new team, you gain leadership skills, whether that’s you doing yourself or observing other leaders. And so that was useful for me, possibly in the clinic, but also in my role in the Australian Football League. And overall, I think it was working in a team that is really pushing towards high performance, seeing how every element gel towards that, and how important different aspects outside of medicine is. I think that’s really important for any budding sports physio or sports doctor to realise that you’re a cog, part of a very big wheel. And you need to know little bits about how everyone else does stuff so you can know how that interacts with your management plan. I gained a much greater understanding of psychology and nutritional input for these athletes at the elite level and that was really important for me.
Dr Ebonie Rio is a post doc researcher at La Trobe University and has completed her PhD in tendon pain, Masters Sports Phys, B. Phys (Hons) and B. App Sci. Her clinical career has included Australian Institute of Sport, Australian Ballet Company, Australian Ballet School, Melbourne Heart Football Club, Alphington Sports Medicine Centre, Victorian Institute of Sport, 2006 Commonwealth Games, 2010 Vancouver Winter Olympics, 2010 Singapore Youth Olympics, 2012 London Paralympics, 18 months travelling with Disney’s The Lion King stage show (Melbourne and Shanghai tour).
After completing a Sports Science degree with first class honours, Dr West graduated from his Medical Degree (Cardiff University, Wales, UK) in 2013. To further specialise, he then completed a Sports & Exercise Medicine Masters Degree before coming to Melbourne to practice as a Sports & Exercise Medicine Registrar and joining Alphington Sports Medicine Exercise + Rehabilitation in 2020. He subsequently finished his registrar training in 2022 and is now a Fellow of the Australasian College of Sport & Exercise Physicians.
Within elite sport, Liam has worked internationally for the England U16 Football (Soccer) team and the Australian Diamonds Netball team. He has provided medical services at international events including the 2018 Commonwealth Games, and the 2018 Invictus. He is currently the Head Doctor for the Hawthorn Football Club (AFL) and is a member of the match day medical team for the Melbourne Rebels. He has also previously worked across the sporting codes of Soccer, Rugby Union, Rugby League, Mixed Martial Arts, Horse Racing and Disability Sport.
In addition to these extensive clinical experiences, Liam has led UK & European-wide Sports Medicine committees, is a Senior Associate Editor for the British Journal of Sports Medicine (BJSM), sits on the AFL Doctors Association (AFLDA) Executive Committee, and in 2017 was elected the President of the Victorian Council of Sports Medicine Australia (SMA), serving 2 terms. He has multiple publications in respected medical journals, has presented at several international conferences, and produces regular BJSM podcasts & blogs with experts from around the world in Sport & Exercise Medicine.
It was such a privilege to be able to work alongside people in Sport (some absolute superstars) that I know by name, but I’ve never met. Everyone was respectful and collaborative, with just the right amount of fun. There was a great sense of unity amongst the whole team.
(Dr Ebonie Rio)
How did you first get involved with Football (soccer)?
When I started, competition was only open to boys, but I really love the game, and I played all the time in the backyard with my brothers. It was interesting because I tried to play with the boys at school and I was successful for a little while until one of the teachers saw me playing and said it wasn’t for girls. So I was actually formally banned from playing football in primary school. I liked all sports, I’m pretty much a sports nut, so I guess that was okay.
I really enjoyed watching my brothers who played some rep football, so it was great to go along and watch. That gave me more enthusiasm for it and eventually when I had the chance to play, I really enjoyed it.
How did you eventually get to become involved in organised football?
At the time there were no girls team, but there was one or two divisions of women’s football. I think my parents were thinking. as a schoolgirl, it’s not really the thing to just go straight into a women’s competition. So I waited till first year uni, and I was trying to demonstrate my interest in the game by doing a referees course and eventually they said, okay. I think it was actually one of my brother’s friend’s mother who got me to play at Newmarket Football Club, and that was my first club, so I was lucky.
WE SAT DOWN WITH THE INAUGURAL MATILDA’S TEAM MEMBER AND LATER CAPTAIN, SUE MONTEATH TO DISCUSS HER CAREER AND HER THOUGHTS ON THE DEVELOPMENT OF WOMEN’S FOOTBALL IN AUSTRALIA.
At the time the national team was chosen at national championships. I got chosen in the Queensland team and I went along to Perth for the national championships, and then I was straight away selected into the national team, which didn’t tour that year, but the following year we toured to Taiwan. But in terms of national caps and things like that, that wasn’t recognized as my first cap. Not because our team wasn’t a full national team, but because we played against club teams and not fully representative other countries, We played New Zealand in Sydney a year later, and that was the first cap officially. I was lucky enough I had parent support and then went on to play for another ten years in the Matildas.
Your family also got involved with the sports medicine side as well with the national team?
My mum was a physio, so I had excellent medicine at home. Lots of times I’d be having ultrasound on the bed afterwards, after games. Also my Dad travelled as a team doctor and he was just practicing for a long time. That was really good. It was so helpful because when we went overseas as it was a bit unpredictable what kind of medical treatment you’d get. One of the players had a UTI, so my dad had prescription medicine which he could administer. If he hadn’t been there, I think we could have been in a lot of trouble. In my first game, I got a tag in my shinbone, and so he had to stitch that up and then the next day I got a black eye.
What are some key progressions you’ve seen in Women’s football since you were involved with the national team?
There’s a number of things. For instance, when we played, it was just a matter of going out and training, kicking a ball, but there was nothing about injury prevention. Even with the younger players now, they’re going to try and make sure that the muscles around the knees particularly, which is a key injury point, they’re a little bit
stronger, and there’s all sorts of warm up exercises that now take place. Then there’s technology where you can measure the heart rate, the fitness and all that sort of thing, but also the instant feedback that you get from digital television. When I was at the World Cup in 2019, I went as a member of the family and friends and each player was given an iPad with snippets of the match that they had to study. The first time I played, we got some footage on eight millimeter tape, which would take weeks to develop. Then maybe you got to see it when you went to someone’s place who took it. You didn’t have your own personal feedback system and I did human movements at UQ, so I recognize the value of having good and instant feedback.
Is there any advice you’d have for people who want to make a career in football or push onto the level that you were at?
I think the pathways are very much clear, so I guess there’s a lot more information in terms of the QAS and things like that. But, primarily if you enjoy the game, seek out a club that’s supportive of you. I think UQ is a great club and I’m sure there’s lots of clubs in Australia. But certainly getting out there and having a go, then if you get noticed, take advantage of that chance and go and do the training camps or the football academies that are on offer. It looks like it’s in a great place for football. I was lucky
enough to travel over to the European Championships in England that has just been played and I think the girls continually said, now young girls have the chance to see role models and they can identify with. I remember some of the Matildas that were after me even commented then that there were no role models and that’s possibly because there was no media, there was no real promotion of the game at the time. Now there’s real acceptance.
What impact do you think the upcoming Women’s World Cup may have on women’s football in Australia?
There’s the chance for the general public to be more aware of the fact that girls can play. It surprises and delights me that so many people say they actually prefer watching women’s football, largely to the extent sometimes people don’t like football because of the players taking a dive, and it doesn’t seem to happen that much in women’s football. I think a lot of people that like football have now taken that up and say, yes, that’s a good thing. They just get on with it, and they don’t question the referee as much. The sort of things that you don’t like about football are not happening in the women’s game. You’d like to think that the women can get more media attention and get on TV and just be accepted in the community, and it would just be a normal thing to go and support a female team as well as the male team.
How did you go from playing club football to being selected for the National Team?
I love sport. I enjoy seeing the beauty of how people can put a performance together that encapsulates all that they’ve learned in their training. Psychologically achieving the focus, getting into the most productive mindset to achieve the best they can at a particular time, whether it’s a team sport, or an individual sport. It’s sort of magical – that really fantastic performance, either a fantastic time or a fantastic game, that a team has put together and all the elements that need to come together. I wanted to be part of that process. In my medical career, I realised early on working at the hospital that a multidisciplinary team working around a patient was the best way to provide the best possible care. Similarly, in sports medicine, it was the model that everyone was trying to aspire to achieve. And that was a way to maximise someone’s performance whilst minimising the risk of injury when returning to sport after they had been unwell or injured. So, that multidisciplinary model that I’d seen in my general medicine, I noticed was actually already being undertaken in sports medicine.
I completed my undergraduate medical degree at the University of Queensland and undertook a broad range of work in Queensland hospitals, taking the opportunity to obtain experience in a wide range of areas of medicine. My first
interaction with SMA was in the early 90’s when I completed their 6-month postgraduate sports medicine course at the University of Queensland.
While undertaking a Masters in Sports Medicine at UNSW I had the opportunity to get to know a number of esteemed sports physician and sports physiotherapy colleagues who were also SMA members. As a long-time member (and sometimes chair) of the SMA national Conference of Science and Medicine in Sport, I have continued my multidisciplinary education in sports and exercise medicine.
How did you get involved with sporting events like the Commonwealth Games and the Australian Paralympic team in 2020?
I took the opportunity to volunteer to provide medical coverage for major international sporting events in Southeast Queensland, to obtain experience in planning and providing sports medicine services. I volunteered to provide medical coverage throughout the Melbourne 2006 Commonwealth Games. The beauty of the Commonwealth Games is that it’s a multi-sport event. So, I had the opportunity to provide coverage for swimming (my sport) and diving at the venue, which was the Melbourne Sports and Aquatic Centre, but also Squash, and Table Tennis which are sports that you don’t normally get the opportunity to work with.
I had the privilege of being appointed the Chief Medical Officer for the 2018 Gold Coast Commonwealth Games. This combined my sports medicine coverage experience with my knowledge of health system planning and reform in Southeast Queensland.
I volunteered to provide medical coverage for the Invictus Games in Sydney, an amazing opportunity to see sport and being part of a team used as ‘medicine’ and healing for veterans.
I then had the privilege of being appointed to work with the Australian Paralympic team in Tokyo in 2020. This presented two enormous but rewarding challenges; working with athletes with a wide range of medical conditions
and keeping everyone safe during covid. I believe I learnt more from many of these athletes than they did from me.
In 2021, I was appointed to the Commonwealth Games Federation, Medical and Anti-Doping Committee for the Birmingham 2022 Commonwealth Games. My experience as CMO for the Gold Coast Games was invaluable for this role. Experience with infection control in the Games Village was essential in planning for and managing COVID-19 during these games. Working with highly skilled sports medicine colleagues, with broad complementary skills from across the Commonwealth allowed us to meet the challenge of supporting and working with Chief Medical Officers from large teams and less resourced ones, in a more challenging environment than usual.
How has being part of Sports Medicine Australia helped your career so far and your involvement within sports medicine?
After I completed the SMA course, that’s when I got involved with SMA on the Queensland Board of Sports Medicine Australia. I then got involved in providing coverage for major events, but also working with and educating our sports trainers, as most of the sports medicine professionals did in those days. Most of our professional members participated in teaching the sports medicine courses, which no one else was really doing at the time. This included Sports First Aid, Level 1 & Level 2 courses and other advanced courses targeted to physical education teaching professionals. And so, I got involved in teaching the courses, working with providing coverage in Queensland and setting up a system for our sports trainers to undertake sports medicine coverage. For major international sporting events coming to Queensland, organising sports medicine professionals to provide coverage. And then a long time serving on the National Board of SMA, with opportunities to advocate for sports medicine and influence government policy and provide media comment.
Do you have any advice for people going into a career in sports medicine? Acknowledging that you are part of a multidisciplinary team, and you learn as
much from professional colleagues with complementary skills as you do within your own profession. It’s like a team sport, it’s a team profession. You don’t manage athletes alone. It is very much that opportunity to gain experience from your colleagues in a considerable number of other professions, whether that be sports physiotherapy, sports science, nutrition, etc. It’s to do the best by any of your athletes, whether they are elite or not. You provide the best care by having a deep understanding of what your colleagues can provide and also learning from them to apply that to the way you manage your athletes as well. That’s the joy of it – It’s a team environment when you’re managing patients in your clinic, but also when you have the opportunity to provide coverage at home or travel away with the team.
Since joining SMA, and collaborating with people, I’ve been able to work with some of the country’s premier clinicians and scientists in sports medicine. It has given me the opportunity to learn from the best and at times the privilege of working with the best. I believe that when you join an organisation like SMA, you get support, you develop a valuable network, and you get the opportunity to have mentors who can assist you throughout your career. And then it gives you the opportunity to mentor the next generation as well.
Medical University of Lodz, Poland
President of Polish Society of Sports Medicine(PSSM) 2005-2013
Vice President of European Federation of Sports Medicine Associations (2017- )
Polish Society Of Sports Medicine Is A Scientific And Didactic Society Of Doctors And Other Specialists With Higher Education, Who Are Interested In The Activities undertaken by the Society.
Polish Society of Sports Medicine was founded 86 years ago in 1936 at the 1st Congress of Polish Sports Medicine
Physicians in Worochta (now Ukraine), however, it is noteworthy that Polish structures which provided sport and health counselling as well as education for sports medicine doctors had
already been formed in 1928-1929. Polish representatives participated in the Congress of Association International Medico-Sportive (AIMS) held at the Winter Olympics in St. Moritz in 1928. Dr W. Dybowski was elected a board member of FIMS and held this position till 1939. In 1929- 1937 Polish physicians participated regularly in FIMS activities and were as regularly invited to present their papers at FIMS congresses. After World War II, in 1947, the polish Society of Sports Medicine Physician was reactivated and nowadays PSSM had 8 regional divisions. Currently, PSSM
has approximately 800 members and several Committees for: Science, Education, Legislation, Foreign Affairs and International Relations.
Major mission of PSSM is to be engaged in the activities which lead to health status improvement via increased physical activity. PSSM objective is to provide inspiration for scientific research, to promote knowledge of sports medicine, to cooperate in upgrading occupational skills of doctors, physical therapists, dietitians and other health professionals. PSSM
provides assistance and supports its members in their scientific, occupational and educational activities.
The society’s prime interest concentrates on a physically active human at all stages of life, both in good and poor health. The Society activities focuses on the understanding of the physiological and pathological processes that are related to physical activity and its lack, as well as health promotion, chronic disease prevention (primary and secondary) and treatment of exercise-induced pathologies.
Every two years, PSSM organize International Scientific Congresses where general Assembly of PSSM Members is held. The Society Executive Bodies: President, Executive Board, Audit Committee and Arbitration Committee are elected every 4 years. Symposia and Scientific Conferences (annual) are organized in between the Congresses and about 600-700 people participate in these events.
PSSM Education Committee deals with the organisation of ABC of Sports Medicine courses which are intended for physicians with specialities other than sports medicine. The courses are provided by Polish expert in sports medicine.
Polish Society of Sports Medicine is a member of International Federation of Sports Medicine (FIMS), European Federation of Sports Medicine Associations (EFSMA) and cooperates with other scientific societies by participation and lecturing at conferences and congresses, by preparing opinions and standpoints on current and significant issues of sports medicine among others: Recommendations of the PSSM on age criteria while qualifying children and youth for participation in various sports (Kostka T. et al: Br J Sports Med 2012); Type 1 Diabetes Patients Qualification for Sport; Stress test application in sports medicine; Anthropometric measurements in sports medicine, Athletes nutrition and many others.
Official journal PSSM from 1985 is Polish Journal of Sports Medicine (Polish J Sport Med)
The Polish Journal of Sports Medicine is a peer-reviewed medical journal publishing original scientific papers based on authorial research, as well as review and opinion articles and case studies involving the broadly conceived interdisciplinary specialty of sports medicine. The Advisory Board includes specialists from many countries around the world, representing various medical specialties, a guarantee of the high scientific quality of the papers published. Polish J Sport Med is published quarterly and is also available in electronic form at http:// medycynasportowa.edu.pl Polish J Sport Med is indexed in Index Copernicus, Central and Eastern European Academic Source, PSJD, EBSCO, Google Scholar, EMBASE Collection, EuroPub and Polish Medical Bibliography (GBL). Papers are published in English and Polish
Since 2013 the position of President of Polish Society of Sports Medicine has been held by Andrzej Bugajski MD, PhD,
who was preceded by prof. Anna Jegier MD, PhD (2005- 2013), who is currently Vice President of EFSMA (since 2017).
Education in Sports Medicine for medical doctors in Poland Sports Medicine in Poland is taught for medical doctors as pre-graduate and post-graduate education.
There are 12 Universities in Poland with faculty of Medicine. At several of them Sports Medicine is taught as the pre-graduate education. For example at Medical University of Lodz sports medicine course is compulsory for all the students of the faculty of Medicine and currently it composed of 14 hours of didactic classes, seminars and lectures. Additionally, students may choose of 40 hours of elective courses.
The post-graduate level of education in Poland is coordinated by the Ministry of Health and lead by The Medical Centre of Postgraduate Education (CMKP) and Polish Society of Sports Medicine.
Since 2013 speciality in sports medicine in Poland has the full speciality status with the minimum duration of training of 5 years. For consultants in paediatric surgery, general surgery, internal medicine, general medicine, family medicine, orthopedics and traumatology, pediatrics and medical rehabilitation a required training period in sports medicine is on average 2,5-years, depending on the basic specialization. All the above consultants must be recognized by Polish Ministry of Health.
Sports Medicine requires of training on the basis of sports medicine speciality programme core curriculum to approved by the Minister of Health and ends with the state examination (written test and oral exam). The National Consultant -who is appointed by the Minister of Health- is responsible for the exam in sports medicine in Poland;
Doctors who are interested in sports medicine can also apply for Polish Society of Sports Medicine Certificate. Polish Society of Sports Medicine certifies the completion of introductory Sports Medicine Speciality Training Course. PSSM Certificates can be obtained by doctors of medicine who:
1) have specialization in at least one of the following: internal medicine, pediatrics, general surgery, pediatric surgery, orthopedics and traumatology, medical rehabilitation and family medicine;
2) have completed the ABC of Sports Medicine course- “Introduction to sports medicine speciality”, on the basis of Sports Medicine Speciality Training Program and in accordance with speciality course scheme or professional advanced course scheme which are approved annually by the Medical Centre of Postgraduate Education (CMKP)
3) have passed the ABC of Sports Medicine exam (written test)
4) have received a positive opinion from a regional sports medicine consultant
5) are professionally involved in a group or individual medical practice, registered in the sports medicine health care facility;
6) are authorized to practice medicine by a valid medical license;
The courses are provided by Polish expert in sports medicine (4 x 10-hour meetings) on the following subjects:
1. The history of sports medicine. The organisation of medical qualification for sport and exercise. Introduction to exercise physiology.
2. Orthopaedics, traumatology and sports rehabilitation.
3. Basic issues of internal medicine and cardiology in sports medicine.
4. Doping and enhancement of human physical capacity.
Each set of courses is completed with an exam on the basis of which the physicists obtain certificates that entitle them to provide medical examination and qualification for particular sports for children, adolescents and athletes of up to 23 years of age, except for national sports team representatives, Olympic games athletes and athletes with disabilities.
The PSSM certificate is valid for 2 years and can be renewed provided that some specific conditions are met. Each year the courses are attended by 40-120 physicians. So far PSSM has issued over 1100 certificates and currently about 600 medical specialists are entitled to qualify children, adolescents and athletes of up to 23 years of age for sport and exercise.
More details on sports medicine in Poland are available on: Polish Society of Sports Medicine http://en.ptms.org.pl and https://cmkp.edu.pl/ wp-content/uploads/pdf/0751program-1-2018-D.pdf (in polish) https://medycynasportowa.edu.pl
What is your experience working with football (soccer) as a sports trainer?
I haven’t done a lot of stuff with soccer prior to working with the Kanga Cup this year. I worked with the Under 10’s and Under 11’s, so there weren’t too many injuries, mostly just giving out lots of ice, band aids and talking to parents – convincing them that their child was going to be fine a lot of the time. So that’s my main experience. Otherwise, I do play soccer, so I help my team out with strapping and injury management.
What are some differences between working with older and younger age groups?
The kids seem to bounce back a lot quicker. So, you’ll see them crash into another player, and they’ll both stop for a second and then get straight back up, and you’ll go talk to them, and they didn’t even know that they fell over. Then their parents will race over, and they’ll be more concerned about
an injury than the kid is. Whereas I think with my soccer team, it tends to be a lot more of severe injuries that happen at higher speeds, bigger collisions and that sort of stuff. I tend to do more actual strapping with my teammates so that they can get back out there, whereas the little kids just accept it and keep going.
What got you interested in being involved with the Kanga Cup?
I actually tried to volunteer to help out at the Kanga Cup the last two years, but it got cancelled. I didn’t put my name down to volunteer this year, but I got an email from Zeb from SMA, he said we need some people. I just really like event volunteering. I didn’t even think about doing sports trainer stuff until I got that email and I thought, this works out perfectly.
I’m studying exercise physiology at the University of Canberra, and I wanted
to do something that could help me get a bit more hands-on experience with injury management because I’m really interested in working with sports teams. So, I started an internship with the Vikings Rugby Club and they offered to support me through the Level 1 Sports Trainer course. I help with their games every week with their fourth grade and do strapping and sideline injury management under
their supervision. That’s been a really big help, having them there all the time to walk me through new things. But I definitely say that the experience with injury management with the sporting team is what drove me most to get the sports trainer certification.
Are there specific differences in working with the different codes? With the Vikings, I’ve noticed they require a lot of strapping. So, the first thing I do is get there an hour before the game and just strap mostly ankles, but also shoulders, knees, that sort of stuff. Whereas with my soccer team, it’s mostly strapping for, I guess, injuries that happen on the day. With rugby, I spend a lot of time sort of on the sideline just watching every player, trying to make sure that nothing has happened and if they stay down for too long, do I need to go straightaway.
With rugby, it’s a lot more hands on, mostly because I’m actually playing soccer most of the time. But with the Kanga Cup and the little kids, their parents are always right on top of it.
I definitely appreciate getting the emails with the magazine and all of the courses that are available. I’ve gone to some of the free ones, and they’ve definitely been interesting.
I really appreciated them reaching out because I didn’t realise that there was a job posting for the ACT page on SMA website. So, I check that regularly for any events that I might be able to do. They also reach out to me fairly regularly with different courses that I’m able to do, like the Level 2 Sports Trainer and similar. it’s been a really positive experience so far. I have only become a member, I think in March, so I haven’t been with you guys for too long. But yeah, it’s been good so far.
How has SMA helped your career so far?
I wanted to do something that could help me get a bit more hands-on experience with injury management because I’m really interested in working with sports teams.
