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AFL and clubs getting heads around player injury minefield

Football

Australian football is changing its rules, team sheets and tribunal guidelines to add occupational health and safety cover for players and be on stronger ground for impending legal challenges. Michelangelo Rucci reports.

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Adelaide’s stirring 12-point win against 2020 AFL grand finalist Geelong at Adelaide Oval on Saturday will be remembered for far more than the greatest upset in the Crows’ 30-year history.

It also was the day the AFL was handed another reminder of how vulnerable the league is to legal challenges on player safety.

Fans cringe whenever they hear football fields described as “workplaces” for professional AFL players. But mounting evidence of the long-lasting damage to players from injuries, not just concussion, and the eagerness for lawyers to follow international precedent in Australian courts has the AFL on edge.

For the first time in an AFL game at Adelaide Oval, the interchange benches had five players for each team – including the new 23rd man as the medical substitute. In Adelaide’s case it was Brisbane recruit Mitch Hinge who was injured twice – and there was no 24th man substitute available to cover his place on the field. Not yet.

The record of “carnage” on the Crows interchange bench was severe.

Adelaide first lost defender Luke Brown with a pre-existing Achilles strain. Hinge immediately replaced Brown.

Adelaide then lost key defender Jake Kelly to concussion and a broken nose from the much-debated bump from his former housemate Patrick Dangefield, who was banned for three AFL matches by the league tribunal on Tuesday evening.

Should have there been another player on the bench, a 24th man – and, more importantly, a dedicated “concussion substitute” as proposed by Hawthorn premiership coach Alastair Clarkson on the eve of the AFL season – to replace Kelly?

“In theory, yes,” says former Crows AFL and Australian Olympic team doctor Andrew Potter.

Crows coach Matthew Nicks is “not sure where we are going to go with subs”.

“But we are trying to do the right thing to look after our players,” Nicks said. “First and foremost is the health of the individuals.”

Crows’ coach Matthew Nicks at the Geelong match. Photo: Michael Errey/InDaily

Hinge had his right shoulder “pop” from its joint twice while he kept being sent back to the field to help his Adelaide team-mates thwart Geelong’s second-half comeback.

Potter told InDaily it is safe to inject a dislocated shoulder with a local anesthetic to allow the player to stay in the game. In theory, no further damage was done to Hinge’s shoulder when it was dislocated again.

“But you would need only one doctor to contradict that in court,” adds Potter of the burden on AFL team doctors, 10 of whom left the game last season. The COVID lockdowns and cuts in football department spending have created a significant drain on medical expertise in elite Australian football.

Geoff Allen treated Brownlow Medallist Gary Ablett while the Geelong superstar battled a shoulder injury during last year’s Grand Final against Richmond at the Gabba.

“He would have been subbed out with a dislocated shoulder (this season),” said Allen who, after 15 years at Geelong, is one of those doctors to have left AFL clubs during the off-season.

“If we had the medical substitute during the Grand Final, there is now way poor Gary would have had to endure numerous injections and go obviously not at 100 per cent.”

The critical point of the medical substitute averting the risk of putting injured players back on the field was contradicted by the demands placed on Hinge on Saturday afternoon.

This would not have been lost on the AFL executives during their Monday review at their Melbourne headquarters, or any of the lawyers preparing briefs for the class action cases for former AFL players suffering trauma, physical and mental, in retirement.

“You are very much aware of that as a doctor too,” says Potter.

“You run the risk of being sacked by the club if they don’t like your decisions (to take injured players out of the game). You face litigation if the priority is not with player safety – and that could cost people a lot of money.

“A team doctor has to be mindful of player welfare. It is better for a player to miss three games so that his life in latter years is not adversely affected.”

But what if those three games are during an AFL finals series?

Which player would give up on his premiership dream rather than push through the pain barrier?

Which coach would prefer a star player in the stands rather than on the field, even if he is not 100 per cent fit?

Port Adelaide coach Ken Hinkley expects team doctors to be unchallenged with their decisions, although one former AFL club doctor told InDaily: “The pressure is intense when it is a young doctor dealing with an experienced coach. Those young doctors are subjected to huff and bluff from older senior coaches and club officials.

“This is where you need doctors who have been in the game long enough to be respected and do not have their judgements challenged or questioned.”

Even this is not certain, as well remembered with how Essendon club leaders reacted so poorly to the warnings of long-serving team doctor Bruce Reid during the infamous supplements saga in 2012.

Hinkley says his relationship with the Port Adelaide medical staff, led by Dr Mark Fisher, has the medicos “know they are in charge with the medical decisions”.

“And I am going to trust them,” Hinkley said. “That’s what I do.

“At some point I do expect there is going to be some challenging decision. But the doctors will make the right decision and I will respect the decision the doctor makes.”

Potter told InDaily the pressure on AFL team doctors had increased on many fronts with the advent of the medical substitute this season. Where doctors were once being urged by coaches to “jab” a player to keep him in the game, they could now be pressured by coaches to declare a player unfit to continue. This would allow the fresh-legged medical substitute to could come into the match as a decisive X factor.

“That could happen at three quarter-time,” says Potter. “The coach could be looking at one player seeing he is running at 75 per cent capacity. He looks at the medical substitute with fresh legs. The pressure is on the doctor.”

Port Adelaide defence coach Brett Montgomery fears the AFL has created a new rule that is “too open for exploitation”.

“Which is a real shame,” Montgomery said. “This started with really good origins (as a concussion substitute as proposed by Hawthorn coach Alastair Clarkson). I’m not sure that is where we are going to finish up, unfortunately.

“Any time we can keep a game alive and uncompromised by injury, great.

But now with loopholes around the guidelines on the medical substitute, I think it is open now for exploitation.

“I am a big fan of games not being determined by injury. The AFL is on the right path, but if it was four on the bench with an extra two substitutes used at your discretion it would take away all those questions on why someone has been taken out of the game, and the doubt on whether a player is concussed or has a long-term injury. There would be two extra players to be used at your discretion.

“Rarely do two players come out of the game and have their absence become a decisive impact on the game’s result. That would be my way to ensure we have an even playing field for longer.”

Potter says this “exploitation” feared by Montgomery and Sydney premiership coach John Longmire has been part of Australian football since 1977, when the two reserves on the bench were replaced by interchange players.

“Before 1977, if a player came off the field to be replaced by the 19th or 20th man he was not allowed to return to the game – so many injured players refused to come off,” Potter recalled.

“The interchange system allowed for better assessment of a player before deciding if he needed to be substituted or not. But ultimately, the coaches got hold of the interchange and turned it from a system of injury management to a tactical tool.”

Potter notes the medical substitute protocols established  in a rush last week by AFL chief medical officer Peter Harcourt do give the league executives the power to heavily sanction a club for “bringing the game into disrepute” for abusing the medical substitute system.

“There must be a medical report sent to Peter Harcourt after any player is taken out of the game for the medical substitute,” Potter said. “If things do settle down quickly after the game, the player will need Peter Harcourt’s approval to play the next week.”

At least three of the players subbed out of Round One will seek that approval this week, creating some cynicism and suspicion on whether the team doctor took them out of the game for medical or tactical reasons.

“It is hard to make calls on some injuries during a match with no (X-ray) scans available on the bench at a football ground,” said Potter.

Allen adds: “Concussion is easy; there is not a lot of grey with that anymore. But there are other injuries that are hard to call on the bench, particularly soft-tissue injuries.

“You could remove a player with a sore calf, fearing he has a tear. Then the scans come back during the week to show only tightness in the muscle and you will be seen to have utilised the rules (on the medical substitute) to your team’s advantage.

“The medical substitute takes a lot of stress off the doctor and medical staff when an injured player needs to be removed from the game. It also puts a lot of stress on the team doctor to make a decision on whether the player is injured enough to activate the medical substitute.”

The demand to err on the side of caution – to avoid a legal battle later – will not be lost on the players. But there also will be the pressure from coaches to keep a star player on the field, as noted at the weekend when former Port Adelaide captain Travis Boak preferred to move to the goalsquare rather than sit on the bench to nurse a corked knee.

AFL Commission chairman Richard Goyder and his fellow “custodians of the game” – and its COVID-diminished treasury – do not need to look far for the risk Australian football faces when players question why they were asked to play with injury.

It is always American sport that gives the AFL of a preview of what is to come.

In 1989, Boston Red Sox pitcher Marty Barrett injured his right knee , tearing the anterior cruciate ligament, after tripping over first base. At the time, Barrett says he was not told how serious the injury was. The accusation his legal team took to court was the Red Sox averted major surgery to keep Barrett on the pitching mound while Boston chased an end to its cursed World Series drought.

Barrett sued the Boston Red Sox team doctor  and part-owner Arthur Pappas for negligence, arguing his decisions cut short his playing career. He sought $US15 million in damages; the US District Court in Worcester awarded Barrett $US1.7 million for lost wages.

This precedent scares more than the AFL. Potter is now advising the SANFL on concussion protocols. But the best guidelines are always vulnerable to abuse.

“We don’t need players (eager to stay on the field) telling porkies (when they are being assessed by team doctors),” Potter said. “And then later, those players say the club and the team doctor did not look after their welfare and they have a lawyer wanting some money.”

Potter’s point is made by the example of one AFL player recently admitting he “fudged” answers on concussion tests taken during the pre-season so that he would have a low base score to achieve with any test after taking a head knock during a match.

Australian football is on the verge of a legal quagmire and clearly adapting to avert an avalanche of lawsuits overwhelming the AFL and its 18 national league clubs.

In Adelaide, the group of former VFL-AFL players taking legal action includes Magarey and Brownlow Medalist John Platten and former Crows squad member Sam Shaw.

Platten, a SANFL great with Central District and premiership hero with AFL club Hawthorn, is part of a class action against the AFL, with his lawyers noting he had 36 bouts of concussion during his 258 VFL-AFL matches from 1986-1998. He fears he is already in the early stages of Alzheimer’s disease.

Shaw last year filed legal papers against the Adelaide Football Club, its doctors including Andrew Potter and other medical professionals, claiming he was forced into premature retirement by the Crows after suffering a head knock in an SANFL game in 2016.

Shaw has claimed in the Supreme Court of Victoria that his concussion “was not managed in accordance with reasonable medical practice”.

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