Injury in Elite Sporting Codes: Managing Our Sons and Daughters of the West – With Fiona Jacobs


fi.JPGI am an AustralianPhysiotherapy Association Titled Sports Physiotherapist, having completed both a Bachelor Degree in physiotherapy( honors ) in 2004 and a Masters in Sports Physiotherapy in 2013.

I have been fortunate to experience and work with some elite athletes and performers over the years. Highlights have included touring with Cirque du Soleil throughout South America with a big top show as head therapist of performance medicine amongst international artists and staff, and touring to Ireland with an International Rules Football Team. The icing on the cake has to have been working with the Western Bulldogs/Footscray Bulldogs during their premiership year, and holding both the VFL and AFL premiership cups!! Most recently I have had the absolute pleasure of being involved in the development of AFL Womens programs, and I am currently the head physiotherapist for the Inaugural AFL Womens Western Bulldogs team. When not at the club, I work at Melbourne Sports Physiotherapy Clinic in Essendon, treating elite athletes and weekend warriors alike!

You have just come off a history making season in 2016 with the Western Bulldogs taking out the AFL Premiership Cup over Sydney and Footscray taking the VFL Premier Cup over Casey. On top of that, the much anticipated AFL-W League has recently kicked off and your girls look to strong contenders to finish on top of the ladder. With such a rapidly growing list how do you manage and prioritise injuries when time is such a pressing factor?

Time certainly has been a constraint, as the team all have work commitments outside of football, and can be expected to train only up to 9 hours per week. To help streamline our services to those who need us most, good communication and education has been vital. We have utilised online wellness questionnaires pre training to flag concerns the players may be having with their health, and conduct weekly physical screenings across the entire group, to help identify players who may require training modifications or further assessment/treatment, to minimise risk of injury.

Preseason we conducted a thorough screening on the list, and from that we were able to identify areas that either needed work from the group as a whole, or individualised adjustments to their weights and conditioning programs. All players were also set up with individualised injury prevention programs, and as a group we integrated injury prevention strategies into our warm ups and strength programs.

We have an incredible support team of physios, doctors, strength and conditioning/performance coaches, sports science personnel including nutrition and player welfare, as well as trainers, myotherapists and coaches, who made this possible. We have a dedicated rehab team whose job is to take care of injured players and ensure a safe reintegration back into training and playing. We have all worked really hard together to provide an efficient yet all-encompassing program with the goal of elite performance and minimal injury.

 Working in a multidisciplinary team would have major benefits for both players and practitioners. Are there protocols for where one practitioner will pass on a player’s management to another practitioner or is open dialogue found to be the best practice?

I think each team you work in has its own structure. For us, we do have a dedicated rehabilitation team, who specifically take over the care of an injured player if they have an injury that affects their ability to train with the group. The process we have adopted involves the head physio and doctor working with the injured player to assess and diagnose the injury, and determine an estimated return to play timeline. From there, the rehab team take over that players care, however, there is always open dialogue amongst all the medical staff. As for the rest of the playing group, we tend to share the management of the playing group as a whole, but as all the players treated at the club, communication between therapists/trainers about players needs is easy. We have weekly meetings to review each of the players’ health and wellbeing, as well as a wrap up at the end of each session. This enables us to have a good continuum of care between everyone in the support team, including coaching.

 When managing a player at an elite level you would be required to take both team and individual sponsorship and endorsement into consideration. Have you found this to be a challenge at times?

 The main challenge that springs to mind, is with respect to the athletes footwear. There is no doubt that some brands of footwear may be better suited to some players than others. It is rare, but unfortunate, when the player’s sponsor requires a certain boot to be worn, that may not be ideal for that player’s body. Having said that, players sponsors want what’s best for their players too, and are fairly accommodating to our podiatrist’s recommendations. We were delighted to be sponsored by Birkenstock this year, so all of our players could avoid wearing dodgy flip flops throughout summer!

 With the introduction of the AFL-W League there is a risk that the type of injuries sustain by the female players will differ from that of the males, with ligament laxity and joint stability potentially being an issue. Have you noticed a difference in the way female players have prepared for the current season as opposed to the males?

 It has been identified already that female football players have a higher tendency for ACL injury, as well as concussion (and hand injuries!) (Fortington, Donaldson and Finch 2016).

 With respect to ACL injury, there have been a few predisposing factors proposed, some inheritable and genetic, and some to do with the conditioning/level of the athlete, which to be honest doesn’t really differ to the men. What does differ to the men relates to the shape of female bodies at the pelvis. Given female tend to have a wider pelvis relative to the knee, this increases the angle of loading through the knee, and can be one of the proposed risk factors of injury. Another speculation is that the collagen make up within the ligaments tends to slightly differ, and perhaps this could be a factor. However, on the whole, females’ ligaments tend to be more elastic, and one could argue that this makes them less susceptible to tissue failure compared to a stiff, inelastic ligament.

 While we can’t control anatomy or genetics, we can influence strength and neuromuscular control of the lower limb, and this is our primary focus with our injury prevention strategies. Lots and lots of landing practice!!

 The other reason we suspect female footballers have a higher incidence of ACL and concussion injury, has to do with how long they have been playing the sport, and the way this influences their neuromuscular control and peripheral awareness, or” reflex instincts” if you like. It will be fascinating to revisit the injury data in a few years’ time, once we see the first few waves of female footballers who have had a consistent pathway from juniors through to elite, coming through!

Thanks Fiona, this has given a fantastic insight into how practitioners deal with elite players. Once again congratulations for last year and all the best for the 2017 season.



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