“Anecdotally,from the workshops we have run this year,we know that some coaches and players are tentative to practise contact skills at training,despite the game demanding a level of contact,” Dr Patterson says.
“This is where we can have a big impact - but it is about changing the culture. For example,replacing your typical jog and static stretch at the start and end of training,with a more dynamic warm-up involving multi-directional movement and contact,and strength work at the end of training. Or replacing some kicking and game-style drills with contact drills,as we know the majority of the game is actually in a contest,not kick-mark.”
What is it about knees?
Kyra,Mckayla and Shakira Attard are all involved in Dr Patterson’s research project and would appear to be living proof that knee problems can run in the family.
“There definitely is a family link[when it comes to ACL injuries],like I’ve had one and my mum’s had one and that’s a pretty common story,but this is next level,” Dr Patterson says of the sisters’ unfortunate treble of knee disasters.
Kyra and Shakira had been playing football for five years,while McKayla was in her third season,but their mother,Lee Attard,believes losing the entire 2020 season to COVID-19 may also have played a part.
“I do put it down to COVID last year,losing that muscle. We did fitness sessions,but it’s not the same as a full football season,” says Ms Attard,who is the trainer for Shakira’s senior team.
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“We will learn so much out of this,what coaches should be doing to protect the girls’ knees.”
Dr Patterson,who tore her ACL playing basketball when she was 21,is testing the effectiveness of an injury-prevention program in more than 2500 female footballers across the state.
“Thanks to community sports trainers,we are tracking head and knee injuries in 164 teams in Victoria in 2021 and 2022,” Dr Patterson says.
“Not every injured player goes to hospital,” she adds.
“We call the players to find out more,[like] how the injury happened,whether it be during tackles,ground balls,or aerial contests,which is valuable for informing[clubs and players on] how to reduce the injuries.”
Huntington says for too long,women’s footy has been judged as a lesser code than men’s footy. The Bulldogs star lauded Dr Patterson,but says the AFL should further invest in injury research.
“[And that research] can be potentially tailored to what certain clubs have available,” she says.
Why are men’s and women’s footy injuries different?
Periods used to be a taboo topic,and there was precious little research into how menstruation affected sporting careers.
Now,it’s common for female athletes to track their periods as part of injury research.
But with the unreliability of self-reporting,research into menstrual cycles is yet to deliver any definitive findings.
“The evidence behind menstrual cycle phase and risk of injury is weak - as is every other factor[shoes,movement,strength,fatigue,anatomy],” Dr Patterson says.
“At AFLW level,some clubs do[track menstrual cycles daily or weekly] but even then,the self-report is one thing,but what’s happening with your blood and your hormones is another.”
Anatomy is also a likely contributor. Women have wider pelvises,which means their thighbones meet their shinbones at sharper angles,putting their knees at greater risk.
ACL injuries made up just 5.1 per cent of all footy injuries across all participants in 2011-12 that ended in hospitalisation,according to the AIHW data. In 2018-19,that reached 8.7 per cent,behind concussion and thumb/finger injuries.
Research has found that female athletes who suffer ACL tears are six times more likely to develop osteoarthritis and twice as likely to require a knee replacement.
“[That’s because] the ACL injury and the surgery incurs a significant trauma to the joint that initiates a degenerative process,” Dr Patterson says.
“Combined with ongoing muscle weakness,changes in movement,weight gain,and not returning to sport or decreasing physical activity - all are factors that can change joint loading and increase risk of arthritis.”
Huntington says the social and physical benefits for women playing footy outweigh the risks.
“I think the narrative can often be hijacked and there can be this narrative that females are fragile or reckless and that’s why they’re getting injured,” she says.
“But I think it’s ridiculous. We all know sport and activity and community sport from a social perspective,too,has so many benefits to physical and mental well-being so the greater the access there can be for that,the better it will be for society in general.
“Injuries are an unfortunate reality of any sport at any level,regardless of gender or age group,and we need to figure out how to prevent them rather than deter them from playing sport.”
What about concussion?
Emma Grant has probably had eight to 10 significant concussions throughout her footballing life,but it was her last one - in match simulation - that put her into retirement.
“I had my arms pinned and got dropped on my head and that was it,” the former Collingwood AFLW forward says.
“I was out for five to 10 seconds but I walked off and I actually felt good. It wasn’t until 48 hours after that it hit me;the headaches,the irritability and sensitivity to light. The longer it went,the worse it got.
“I was off school,I wasn’t able to drive. I’m not back to 100 per cent.”
![Emma Grant in action for Collingwood in the first AFLW game.](https://static.ffx.io/images/$width_300%2C$height_150/t_crop_auto/t_sharpen%2Cq_auto%2Cf_auto/f945087248a6e5eb953ac8a9a91100585eb9dd05)
Emma Grant in action for Collingwood in the first AFLW game.Credit:Michael Dodge
AIHW data shows concussion has been the No.1 cause of hospitalisations in community football since 2012-13,with more than two-thirds of concussions sustained by young footballers aged between 10 and 19.
While the AIHW’s concussion data doesn’t differentiate between male and female footballers,Hood believes the increase in the speed in the women’s game is likely leading to more head knocks.
“The athletes have got fitter,faster and stronger at AFL level in each of the seasons and that probably means there’s a little less time for decision-making around the contest,and maybe that’s got a bit to do with some of the concussions,” Hood says.
“But as the players get more and more used to that and it plateaus out,I think that will reduce as well. Also,the players are getting better at taking care of each other.”
Grant says the education around how women should attack the contest has changed a lot from the days when she played junior footy.
“I remember playing against the boys and having an egg on my head and continuing to play,” says Grant,who is a development coach at Richmond AFLW and is also on the Bendigo Pioneers’ coaching panel.
“I didn’t play for about 10 years between playing with the boys and playing senior women’s footy,so the girls coming through and in the pathway,we’re seeing them hold themselves so much better than the older ones.
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“It just comes back to education,not only in the contest and where to put your head,but the follow-ups[after being concussed].”
Dr Patterson says concussion will be a key focus of her studies.
“We don’t have the injury rates finalised yet,but head knocks will be one of the most common[injuries in women’s footy],with a proportion resulting in concussion,” she says.
“In the future,we also hope to follow the players diagnosed with a concussion,and find out what factors are associated with recovery.”
What does the AFL say?
Nicole Livingstone,the AFL’s general manager for women’s football,says the sport is committed to funding injury-prevention research.
“Player health and safety at all levels of Australian football remains paramount and with the number of women and girls playing Australian football increasing by 722 per cent from 73,000 participants in 2010 to 600,000 today,we will continue to work towards ensuring the game is as safe as it can be for all women and girls currently playing our game,” she says.
![Nicole Livingstone says player health and safety is a priority.](https://static.ffx.io/images/$width_300%2C$height_150/t_crop_auto/t_sharpen%2Cq_auto%2Cf_auto/9ae959617b80c9c456f27dd088cfb4464289eec4)
Nicole Livingstone says player health and safety is a priority.Credit:Kristoffer Paulsen
“The AFL Female Football Prep to Play Programs,created and delivered in partnership with La Trobe University,have been a key resource for football communities from the grassroots to the elite to implement in their training programs.”
Like Huntington,Livingstone says the benefits of sport are countless and the risk of injury should not discourage women and girls from playing.
Nor does the Attard family have any regrets.
Lee Attard says Kyra and Shakira,both on the cusp of playing their 50th games,are keen to get back to the game they love when they have recovered. Mckayla,who has done the most damage to her knee and ankle,is less sure.
At least,they have each other. “We all know the pain,” says Kyra,“how to help each other out.”
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