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Inside features
WORLD OF PAIN The reality of life after football
Some footballers pay for their glittering careers with a lifetime of debilitating injuries, writes DR JODI RICHARDSON.
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HE lifestyle of an AFL player can be glamorous. Well-rewarded footballers have access to the country’s top conditioning experts to train their bodies like highly tuned machines. They are sought after in every way imaginable and if they play their cards right, can launch them into rewarding roles once their playing days are over. That said, football has a not so glamorous side. It includes the physical repercussions of years of playing this demanding sport. For some, injuries and chronic pain can persist long after hanging up their boots. Dermott Brereton is one former player who has probably had more than his fair share of post football pain. Though he needs no introduction, it’s worth noting that his style of play as a powerful and aggressive forward likely contributed to his injuries. Brereton was hard at the ball and his opponents, and not easily benched. Few will forget the 1989 VFL Grand Final when Brereton was shirt-fronted by Geelong’s Mark Yeates. Brereton, the pain from broken ribs written all over his face, refused to leave the ground. Recovering in a forward pocket, he took an inspirational mark and kicked a goal. Two more goals were to follow. It’s hard to believe that was 23 years ago, and Brereton is right in saying it was a different era then and many rules have changed to reduce the likelihood of avoidable injury to players. Brereton suffered a career-ending hip injury at the hand of one of his own players, although it was just one injury in a long list. In fact, he sustained so many injuries over his career that he now struggles to recall them. The hip injury was caused by a blow to his left knee that caused the hip joint to briefly dislocate. “The hip injury was what stopped me from performing at the required level,” he said. “I got kneed directly from side on while my knee was tucked up going for a mark. It ripped my leg across and my hip joint popped out momentarily, tore the labrum and then popped back in. “Although it was what ended my career, it doesn’t curtail anything I do now.” The hip is a ball and socket joint. The “ball” is at the top end of the thigh bone and the socket is in the pelvis. The labrum is a ring of cartilage that helps to deepen the socket and stabilise the hip joint. These injuries are notoriously difficult to diagnose and this was the case for Brereton. He had many cortisone (anti-inflammatory) injections into the joint using a flexible needle, but ultimately needed surgery. Though Brereton’s football career was prematurely ended because of the injury, it’s his left knee that gives him the most grief now. He’s had more operations on one knee that most
BRERETON: Paying a long-term price for his cavalier approach to the game.
‘On cold days I wake up and can tell how cold it is before I get out of bed with all the osteoarthritis in my broken knuckles and fingers.’ – DERMOTT BRERETON people experience in a lifetime and will need more surgery in the future. “I’ve had seven operations on that knee; the first one took out the bed of the cartilage and left an ‘O’ ring in there, the second op removed the rest of it (cartilage). I was 19 years old. “I’ve had five chondroplasty (cartilage) operations since then. I’ll need a knee replacement at some stage but the longer we hold off the better. “Every game of footy I played in the last five years I had a local anaesthetic injection in my knee before playing and 24 hours after each game I had to have the fluid from the knee joint drained. “The doctor uses a 16 gauge needle (slightly smaller than a pencil lead); he would have to Inside Football
probe around the knee to find the pocket of fluid. That was horrible, really horrible, and it got to me in the end. “The scar tissue resulting from all of the injections meant you could hear the gristle as the needle was poking through.” Most of us will never truly understand the pain that Brereton willingly endured to keep playing the game he loved. The written word just can’t do the experience justice. Brereton explains that he wears foam heel inserts in his shoes and if he walks for an hour in dress shoes he ends up with acute soreness in his knee. He suffers from osteoarthritis in his knee and hands but keeps a genuine sense of humour about it all. “On cold days I wake up and can tell how cold it is before I get out of bed with all the osteoarthritis in my broken knuckles and fingers.” There is barely a region of Brereton’s body that has remained unscathed from playing football. Over a two and a half year period after retiring, he had six pea-sized calcification lumps removed from the back of his skull, possiblyXthe result of Wednesday, May 2, 2012
opposition players whacking the back of his head while trying to spoil the ball. Brereton has had a broken cheekbone, rotator cuff (shoulder stabilising muscle group) repairs in both shoulders and has had both biceps reattached. After a serious injury to his A-C joint (where the collarbone meets at the shoulder), Brereton’s orthopaedic surgeon Peter Wilson needed to remove a portion of the collar bone, which left Brereton unable to do any overhead weight bearing exercise and with residual pain in that joint. The surgery was conducted on a Sunday after a game; Brereton had the next week off – which was a bye – and returned to footy the following week. As if that’s not enough, he has had his ankle surgically “cleaned out” seven times and has thickening of the achilles tendon on one side. Throughout his career he has also experienced a great deal of lower back pain. It’s this and the knee that cause him the most discomfort now. Between 1986 and 1988 Brereton went to extreme measures to relieve the chronic lower back pain he suffered. “Once a month on a Sunday after a game I would go into Vimy House (private hospital) at 10am to have an epidural because my back pain was so strong,” he recalled. “I would get out at 4pm and go home. It was done to give me some comfort and allow me to relax. “I reckon it took me 18 months to get over where the puncture mark in my spine was.” This isn’t the only monthly procedure Brereton endured to manage his chronic back pain. “The worst injection to have and it’s probably because it’s so invasive, is a cortisone injection right up under the coccyx. “It’s just so invasive to get a needle up under the inside of the tailbone and the position you have to get into to have the injection is humiliating. “That is the worst injection you could ever have!” Brereton endured a lot of embarrassing and painful medical procedures over years to keep playing AFL footy. His dogged determination on and off the field is why he is such a legend of the game. Brereton would rather not have the problems he does with his body but has no regrets and “would do it all again with worse repercussions”. One aspect that does bother him is being on and off anti-inflammatory medication for 25 years. The most noticeable side effect of long-term anti-inflammatory use is heartburn. “If I don’t take a Nexium (long lasting antacid) in the morning, I could be doubled over in pain from heartburn by the afternoon,” Brereton said. Brereton’s attitude to his physical health is admirable. He doesn’t dwell on what’s happened, he just deals with it and is appreciative of the experiences, career and lifestyle that being an AFL player has afforded him. He is sorest when inactive and encourages retiring players to stay fit. His motivation to stay active comes from being a parent, and he knows that if he stops he will be “in a world of hurt”. This tale of bodily damage is not the same for every retired player. By stark contrast another champion of the game, David Schwarz, has no tell-tale signs of his 12-year career as a forward for Melbourne. “I’m really lucky; I had 23 surgeries while I
played,” he said. “I’ve been out of the game now 10 years and I don’t have one ache or pain.” Schwarz tore the anterior cruciate ligament (ACL) in his left knee in the lead-up to the 1995 season. He returned to play only two games before reinjuring the knee and needing a second reconstruction. He injured the same ACL again the following year, requiring a third reco. Sports injury researcher Dr John Orchard reports that a player is almost 10 times more likely to reinjure their ACL in the first 12 months after the initial injury. It’s likely that Schwarz’s repeated ACL injuries were a product of returning to football too soon. After his third knee surgery Schwarz underwent 18 months of rehabilitation. He won his club’s best and fairest award in 1999 and went on play several more years of football, retiring in 2002 with 173 games under his belt. “I haven’t had surgery on my knee since ’98, so it’s been 14 years. I don’t get swelling, I’m pretty bloody lucky really,” he said. “I had three knee reconstructions, 12 ‘clean ups’, surgical tightening of the ITB (illio-tibial band), and a broken femur.” The ITB is a band of fibrous tissue that extends down the outside of the thigh from the hip to below the knee. Today Schwarz keeps fit and maintains a healthy body weight. He plays golf, has a kick of the footy, runs, goes to the gym and enjoys boxing. He is active with his children and, like Brereton, encourages retiring players to keep active. Injury and pain management are problems for many retiring players yet AFL players are specifically excluded from cover by worker’s compensation. To counter this, the AFL Players Association (AFLPA) has other measures in place to help players in retirement. There are entitlements in
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The focus of what he (Jack Riewoldt) is required to do now is something I don’t think he has completely got his head around. – Tim Watson on Morning Glory
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‘I had three knee reconstructions, 12 clean-ups, surgical tightening of the ITB and a broken femur.’ – DAVID SCHWARZ
SCHWARZ: “I don’t have one ache or pain.”
relation to expenses incurred due to injuries that can be linked back to football. The AFLPA records all injuries during an exit medical. The improved injury compensation was negotiated under the new Collective Bargaining Agreement (CBA) and is in addition to the existing coverage for players which includes payments for matches missed (capped at 30 games) if the injury occurred during a senior game, during a pre-season game, or during the player’s employment duties when his last game was a senior game. General manager of player relations at the AFLPA, former Carlton player Ian Prendergast
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explains: “For injuries in second-tier competitions, a defined injury benefit for primary list match payment players or eligible rookies who miss more than three matches has been introduced. “This benefit is $775 a match for each match in excess of three matches, capped at $8250. If a player misses three matches, returns from injury and then later misses another three matches, he is not entitled to any injury payments. “Another change we negotiated under the new CBA is a substantial increase in the amount of compensation a player receives for an injury in his final year that is career ending.
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“This means they cannot play football at any level. It’s a one-off payment based on the player’s current contract, and the benefit structure is staged related to player age. “If the player is under 25 he will get 200 per cent of the base contract; if over 25 but under 30 he gets 150 per cent, and if he is 30 or over he is entitled to 50 per cent of his final year base contract.” Players are also entitled to bulk billing for medical appointments and for a full refund of any excess paid to a health insurance company for a hospital admission. The AFLPA is also in the process of developing the first Players Trust to which $250,000 a year will be contributed. The pool of money was negotiated with the AFL on behalf of current players and stems from the understanding that eventually they will be past players themselves. A proportion of this money is contributed by the deal done with AFL broadcasters. The AFLPA approached this negotiation on the basis that it believed players were entitled to 25 per cent of gross AFL revenue and this was then applied to all of the benefits players received, including injury compensation. This trust will offer players support on top of that already offered through the Geoff Pryor Hardship Fund, where assistance is capped at $5000.