Women brave injury concerns for the love of AFL

Turning right into a long, pitch black driveway with only one open gate, it’s easy to wonder if perhaps you’ve taken a wrong turn.

Then, like a stage lit with flood lights, emerges a football oval.

A bit of a navigational maze to newcomers, but this is Marles Playing Field, home to Old Trinity Football Club’s men’s and, for the last three years, women’s teams.

It’s a cold night. VERY cold! The sort of bitter Melbourne evening that keeps most rugged up at home.

But the women training here tonight, weather-appropriately clad in compression and active wear, are preparing for game day this weekend – the mud, the cold, the dark, this is just a backdrop, not a deterrent, to their weekly preparation.

These women love the game, not just for the competition but also the social aspects. Vanessa Murphy, co-captain of Old Trinity’s women’s team, is in her third season with Old Trinity and believes the women have been warmly welcomed into the club.

“I really love it … I really like the physicality of football, but also at my club they’ve really nurtured us and taken care of us … it’s so fun!” says Murphy.

It is this physicality however, which has many concerned.

Women are at greater risk of suffering ACL and concussion injuries than males, according to researchers and medical professionals. This is compounded by the fact that many female players are beginning AFL for the first time in their late teens or early twenties with no prior experience in contact sport.

“Obviously females are proportioned differently to men. But [injuries] probably also stem from a background of not playing football,” says Old Collegians physiotherapist Laura To.

Physio Laura To attends to a player who is experiencing symptoms of concussion. Photo Freya Fajgman.

Female participation is the fastest growing demographic in Australian Football, with a 38 percent increase in participation from the 2017-18 seasons in the Victorian Amateur Football Association (VAFA) competition.

Dr Alan Pearce, neuroscientist at La Trobe University, specialises in the field of sports related concussion research. Pearce says that “we’ve stuffed up” in male teams by allowing the development of a “macho culture” which discourages players from seeking the help they need. Now, years later research is suggesting causal links between concussion and severe brain pathologies.

Dr Alan Pearce explains the effect a concussion can have on nerve response time. Photo Freya Fajgman.

Concussions are characterised as a brain injury resulting in temporary loss of normal brain function. Symptoms include dizziness, headaches and nausea, photophobia and loss of consciousness. However new research questions how ‘temporary’ this loss of normal brain functioning might be.

Ongoing research suggests that concussive injuries may contribute to the onset of mental conditions later in life including Parkinson’s, Epilepsy, depression and dementia. But with limited access to data and many variables at play it is too easy for sporting institutions to dismiss such research as “tenuous”, says Pearce.

As the pool of female players getting severely injured continues to increase, including the death of Maggie Varcoe, who died in Adelaide in 2018 as a result of a concussion, experts are concerned that a lack of research and therefore appropriate rehabilitation is exposing players to unwarranted harm.

“We need more research investment from the NMHCR [National Medical Health and Research Council] generally. The problem at the moment is people don’t view the seriousness of concussion as they probably should,” says Pearce.

Despite reports from the AFL Medical Officer Association estimating six to seven concussions per team per season, there have been no studies investigating the neurobiological outcomes of concussion in Australian Football.

The lack of research means there isn’t a conclusive theory about why women are more at risk. But according to Pearce the working hypothesis sees a few possible causes: variance in hormones, biomechanical differences and muscular development particularly around the neck.

Currently it’s a matter of “watch this space”, says Pearce.

However, there’s also a cultural aspect which need to be considered according to Pearce.

“Females are more willing to disclose their symptoms than males because of the ego thing,” says physiotherapist Laura To. This could indicate that the disparity between male and female concussion rates may be closer than thought.

At a club level there are rules around player recovery following the diagnosis of a concussion, according to To.

To, who is a physio for both women’s teams at Collegians Football Club, says that for injuries like concussion recovery is quite regimented.

“It’s something that shouldn’t be taken lightly, being a traumatic brain injury,” says To.

To joined the Collegian’s this year. She is surprised by the number of concussions she’s seen so far in the women’s team, “approximately two-three per game”.

Pearce’s research using Transcranial Magnetic Stimulation has demonstrated that the disappearance of concussion symptoms doesn’t necessarily coincide with a return to normal brain function. This leaves players who resume playing with a margin of time during which they are at risk of a secondary concussion – an injury which, though rare, can prove fatal.

However, To doesn’t feel there is sufficient evidence or research to support her keeping players on the bench once their symptoms disappear.

“I don’t feel like I can concretely and definitively say that [to players] yet because the evidence doesn’t exist,” says To.

Some players remain undeterred despite knowing the risk.

“You can get hit by a car… stuff happens all the time. Don’t, not play a game of football because the injury rates are high in women,” says Murphy.

Murphy’s opinion is common among female club players, who acknowledge there is an inherent risk in most sports.

Clare Cameron, a former member of the Old Brighton Grammar Women’s team, retired as a player during the 2018 season, following her second full ACL tear.

“Someone knocked me from the side… and I felt my right knee pop inwards and back out… I knew I had done something to my ACL,” says Cameron.

Cameron, who played numerous sports growing up, first tore her ACL playing basketball several years earlier and had been playing AFL for over a season when the injury happened the second time.

Cameron said she would be open to some rule changes in the younger female teams, if there was evidence to show it helped women’s health.

However, VAFA doesn’t see that is enough evidence at this point to make changes to the game.

Shona MacInnes, women’s football development manager and general manager of business and projects at VAFA, says it would be a waste of resources to continue changing the game based on a hunch without research and evidence to guide such changes.

“We don’t have any evidence to show that by changing the rules we will prevent injuries,” says MacInnes.

Even if such evidence existed for many players it’s not something they want.

“I’d be kind of offended,” says Murphy. “Women playing basketball, women playing soccer, you play with the exact same rules as the men so I don’t think it should be any different just because it’s a physical game.”

A point well supported in the research.

According to studies published in the Journal of Orthopaedics, females are 3.5 times more likely than their male counterparts to injure their ACL playing basketball and 2.8 times more likely in soccer, yet still they play with the same rules.

So, if injury rates in female sport teams is nothing new, why the public outcry?

“I think maybe the introduction of women playing footy has brought it a bit more to people’s consciousness because… people don’t like seeing women being hurt,” says MacInnes.

That said, at both a club and VAFA level, more resources are being made available.

In conjunction with research conducted by La Trobe University, the AFL National Female Community Football Guidelines and Prep-to-Play videos have been created to educate coaches and players.

The growth of the game among females has created a need to “provide community football Leagues and Clubs with the tools to ensure all females have an opportunity to play… in a safe sporting environment”, says Nicole Livingston, head of Women’s Football.

But clubs still experience some cultural push-back.

At Collegians, To introduced a program called FIFA11 to the women’s training sessions. It’s designed to focus on physical alignment, reducing the risk of hamstring injury by up to 50 percent, says To.

However, the introduction of this program has been met with time pressures.

“I am under the pump to … finish. So there’ve been 10 training sessions this year and I reckon we’ve finished the program twice,” says To.

A big part of injury prevention circles back to educating non-clinical staff, says To.

Despite this, many players seem happy to just keep enjoying the game.

“I think it’s such a fantastic thing that women have embraced football, so if they wanna play football, play football,” says Murphy.