The AFL has released a discussion paper addressing some medicolegal issues relating to football, footballers, clubs, trainers and medical staff. This paper suggested ..."Before the beginning of each season a compulsory medical education session should be given to the players at your club. This session should address the following issues:" .... etc etc. In response to this release we have produced our own club's discussion of the long list of issues suggested by the AFL. These issues are listed (a) through (m). Forward any queries to the club secretary or head trainer.
a)Role of the sports trainers and other medical personnel;
This club has a support staff comprising of a club doctor and a group of sports trainers who possess varying degrees of knowledge and experience in the area of sports medicine. This club has a policy of ensuring that its trainers achieve a first aid certificate and a sports trainers certificate. Some trainers have basic and some have higher levels of certification. The training staff are involved in injury management and referral, injury prevention, strapping, general issues of sports health such as nutrition & fluid intake, control of bleeding and so on. If you are injured during a game or during a training session your injury will be dealt with by a team. The personel best qualified with an appropriate level of experience for your injury may not be your first contact. Your care may be "referred up the line" to more experienced team members if required. As a player you need to know who are the most experienced club support personel. If you have any concerns about an injury or the advice you have been given, seek out the head trainer or club doctor for advice. There may be times when limited personel are present ... eg at a training session or early morning games. Because it is important to upgrade the skills of our less experienced support staff we have a policy of involving them in the process of injury care as often as possible. Please understand that the care of your injury may involve education and hands-on learning for our less experienced trainers.
b) Our policy is "safety first".
There will be situations when the more senior support-staff members will decide that the best course of action involves either not allowing you to continue playing or referring you on to other professionals eg ambulance/hospital/GP. Please respect these decisions ... we understand that having to sit out a game is disappointing and trips to hospital etc can be very inconvenient. However, your health and welfare are more important than the outcome of any game. Bear with it. There will be times when continuing to play with an injury involves some risk of aggravation of the injury but the option is there to hold off or give it a go. Our trainers will try to inform you of the risks as we understand them. We don't pretend to know everything about everything or to be able to predict the future. In the end it will be your responsibility whether or not to risk further aggravating an injury. There will be some situations ... eg following a head injury ... where our medical staff will not allow you to play on. Full stop. This club accepts and supports the right of the medical staff to prevent your participation at any stage. There is usually a general understanding from players that the club's medical staff are trusted to make certain decisions concerning players' welfare, especially at the time of injury and during match conditions when there are competing interests .... eg the outcome of he game/the "warrior instinct"/the coach's expectations/mental confusion from concussion/and so on. A basic level of trust is vital for the training staff ability to function responsibly. If you have serious misgivings about the competence or trustworthiness of this club's support staff then it is your responsibility to voice these concerns with the club's committee. Feedback from players helps us improve and move forward. Ultimately, we accept the absolute right of each player to fully participate in decisions concerning their personal welfare. It is your right to refuse any of our staff's recomendations.. except for our decisions to prevent you continuing playing for saftey reasons. You can choose to consult your own doctor, physiotherapist, sport's physician and so on .. in fact it is pleasing to see players motivated in looking after their own welfare. If you are consulting professionals outside the club it is helpful if the club staff receives communication back. Otherwise we can end up trying to manage your rehabilitation or playing career "in the dark". Please ask for this feedback... otherwise it won't happen. Reports are best addressed to the club doctor.
(c) Risks of sustaining injury
Australian Rules is a high-speed, aggressive, contact sport. Very few players get through a playing career without sustaining at least one serious injury. At the upper end of the scale are injuries which seriously threaten life and limb. Head and neck injuries can cause death or serious brain injury or paralysis. There are footballers who haven't walked again following a football match. Some players with abnormal hearts have died during games. Footballers have lost kidneys or spleens after simple collisions during marking duels. Then there are injuries which can put you out of action for an extended time .. for instance a broken leg can prevent you from earning your living for up to 3 months or more. If you are an office-worker and can prop the plastered leg up on an office stool- fine... but if you run a business or work in a physically demanding profession ... potential economic disaster. The impact of loss of income varies from person to person... eg if you support a family, have a mortgage etc. We suggest, if you carry significant economic risks then please fully insure yourself for loss of income.
(d) Common injuries sustained
Where do we start? After any game look at the players in the changing rooms .. very few of them haven't got a bag of ice stapped onto them somewhere. Some of these "lesser" injuries are from the strains & collisions of the day, others are the painful outcome of years of football [old injuries playing up or chronic wear & tear]. Talk to old football veterans .. you can't play this game without a creak or two in later years. Trying to list the common injuries would probably be a boring endless exercise.. let's admit it .. if you own it - it can get damaged. Expect an ankle sprain, the odd corked muscle, muscle strain and a fracture or two.
Keys to injury prevention
• get fit • develop muscular strength & bulk • have a good pre-game warm-up • strap injury-prone joints • if your find that you are "injury prone".. 1. collision type injuries .. compare your playing style to other players doing the same task and achieving good results without injury. See how they enter a pack, how they protect themselves as they go for the ball or after a mark, how they break away.. and so on.. look closely. 2. strain & sprain type injuries ... go see a sports physio and a sports podiatrist .. find out if you have any correctable underlying mechanical imbalances.
Keys to injury management
• Inform the training staff ... the sooner the better. Some minor injuries, such as a tweaked hamstring may be better managed by resting out of the game rather than converting a minor strain into a major tear. Sometimes it is what you don't know which can hurt you. For example a sore wrist can be a scaphoid fracture. A bump on the head might finish you off.
• Rest it, don't provoke it .... any strain, sprain or contusion is best managed by icing & resting ... it is tempting to drink beer, forget the pain and party on .. but that isn't at all good for the injury. It will swell more, bleed more and take heaps longer to recover.
• Follow a Plan. Get the best advice and follow it. "She'll be right" is not an injury treatment plan.
• Head and Neck injuries are a special issue. On the day of injury ..... follow the advice of the club doctor. This club has a written head-injury management plan. Follow it to the letter. Stay with a responsible person and don't drink alcohol. Any problems in the following days which could possibly related to your injury should be reported. This includes headache, neck pain, poor concentration, weakness, tingling or numbness.
Recommended use of any protective equipment
• Mouth Guards: This club encourages the use of mouth guards. These provide support and padding for the teeth and jaw if you take a blow to the face or head. They reduce the risk of broken or lost teeth and other mouth injuries such as lacerations in the inside of the mouth. Selecting a Mouth Guard .....Fit is the most important part of selecting a mouth guard. It should stay securely in place during activity and you should be able to comfortable breathe and talk. 1. Off the Shelf Guards ... These are relatively inexpensive and come ready to wear 2. Boil and Bite Guards.....These are a step up from the off the shelf guards because you can get a better fit 3. Custom Mouth Guards ..These come from your dentist and are designed to fit perfectly.
• Protective Headgear: These are probably of more value in cushioning the face than preventing serious head injury. Repeated low-level head (sub-concussive) injury is probably not a long term worry. However, if you have suffered repeated head injuries involving loss of conciousness or concussion, the question will be whether or not to give the game away altogether .. a helmet is not the answer to that level of history of injury.
(e) Playing with an injury;
This is a complex question. Issues include the degree of recovery and risks inherent in playing. Some issues we consider are... Site of injury ... each type of injury has an known expected range of time to recovery. Severity of injury ... eg a minor ankle injury may not miss a game, a nasty one can take 6 weeks. Age of player ... Some injuries eg calf strains are much longer-term problems in the older player. Recurring injuries .. a recurring injury tends to do just that. Proximity to Finals ... early in the season it may make good sense to fully rehabilitate injuries. At the business end of the season, the decision to rest or play is a week by week issue for medical & coaching staff & player to decide on together. Risk of Aggravation .. some minor injuries such as hamstring strains may be converted to more serious injury. Newly healed fractures may rebreak. Danger Issues .. eg a second blow to a recent rib fracture may puncture internal organs. If in Doubt .. Get another Opinion The Fitness Test .... This is often an integral part of a decision whether or not to return to play. A fitness test is a highly individualised matter.
f) Risks of playing with injuries;
Short Term Risks
• risk of recurrence ... the longer you give an injury usually the better the final mend. However, waiting for every injury in every player to completely resolve would result in clubs finishing the season with no-one on the ground. Clearly there is a compromise between the degree of recovery and the desire to play. This is a complex issue which needs to be thought through for each player.
• risk of worsening the injury ... some injuries are notorious for being worse on recurrence, eg. hamstring strains. Get good advice.
• risk of danger ... there are some well known injuries which can cause major problems if aggravated by playing with them. They include: Head injuries : a previously unrecognised inside-the-skull bleed may re-bleed with fatal consequences. Neck Injuries : a painful neck might represent a fracture .. a second knock might shift this break, severing the spinal cord and causing permanent paralysis Wrist injuries : a sore wrist may be a scaphoid fracture .. the treatment of this might ultimately involve bone-grafts Chest injuries : the ribs are there to protect the heart and lungs. Badly broken ribs may be a real danger to internal organs if new collisions occur. Eye Injuries : all eye injuries need a medical clearance.
Long Term Risks
There is an inevitable accumulation of wear and tear during a football career. Expect some aches & pains in later years. You will have enjoyed your football but may curse it in old age. [wives and mothers will never understand why we do it to ourselves] Some injuries are notorious bad bed-fellows. It is unwise to play on with an un-repared anterior-cruciate tear.... knee arthritis will inevitably follow. Most long-term misery however is much less predictable ... you just realise in your 40's .. I shouldnt have played on with that sore foot (knee/ankle/hip) Head and neck injuries are a special issue: your brain is your most important organ. (no...not the one between your legs). Look after it.
(g) Importance of informed consent
Usually an injured player is capable making sensible decisions in his own interest. However in some situations he is not capable. For instance if he is unconcious or concussed, or is mentally impaired by extreme pain, extreme emotion or under the influence of medicinal drugs (eg high potency pain killers) or illicit drugs and alcohol (usually consumed in the post-match period when in club premises). In the situation where the player is capable of making sensible decisions .... it is accepted practice to inform the player about the nature & risks relevant to his injury or its treatment. Some simple proceedures (such as pulling a dislocated finger) carry a risk in themselves .. even if unlikely. The training staff will endeavor to the best of their ability to keep an injured player aware of what is going on and to allow him to participate fully in decision making. In the situation where a player is deemed incapable of making sensible decisions the club accepts it carries a legal and ethical responsibility to ensure the player's safety .. as far as it is reasonably possible to do so. The club may decide to hand the responsibilty of your care to a third party eg. ambulance, hospital, doctor. Sometimes a disoriented player disagrees with this sort of action. In this situation the club has no option but to carry its decision through. You can argue about that later. If you feel inadequately informed about any issue concerning your welfare.. ask.
(h) Emergency management procedures
Emergencies are many and varied. In the case of a head & neck injury of any level of severity the training staff are likely to put a neck collar on you before taking you off the field. Collars are uncomfortable. Better that than the risk of paralysis. If you are concussed or we decide that a head injury of any significance has occurred the club will make decisions in your interest. We will deem you incapable of making sensible decisions if you show any signs of irrationality. If a serious injury occurs we may call for an ambulance and ask for you to be transferred to hospital for further assessment and treatment. Please agree to follow this advice. Players who refuse to follow the advice of the medical staff in cases of serious or suspected serious injury lose the trust and respect of the club personel. Looking after your personal welfare is a serious issue. If you dont take it seriously, how can we. If you have an injury and you feel that it is unwise to move .. don't worry .. the game will stop for as long as it takes for the trained medical staff to stabilise your injury, get you onto a stretcher and remove you from the ground in safety. Don't let anyone move you or your injured part unless you are confident that they are trained and competent to do so. This is especially important in the case of neck injuries or major limb fractures. You may be able to feel what others can't see. It is your body .. protect it.
(i) Use of other medicines and drugs
This club supports the drugs policy of the AFL. If you are unsure about whether a particular medication or drug is acceptable or not, or poses a health risk to yourself, please ask your doctor. Unlike the elite levels of sport, there isn't a testing program in the SFL for legal or illicit drugs. The club relies on your good sense and judgement on these issues. If you feel you have a problem please talk about it with your doctor. It will be treated as a confidential issue. Under AFL rules, training staff are restricted in their ability to give out medications beyond simple Panadol or asthma sprays. Please ask your club doctor about any other medicinal needs.
(j) Importance of open and frank communication between medical personnel and players
Your medical history is your personal, confidential business. You do not have do divulge any issue full stop. This includes infection with blood-borne viruses such as HIV or Hep C. Your sexual preferences are your affair.... and so on. You do not have to accept the management of your injuries as suggested by the club's medical staff. You are free to seek alternative advice. However ... if you feel that.... (1) your health poses a risk to other players (eg HIV) or... (2) that you have a medical condition which might challenge the abilities of the support crew (eg epilepsy or an unstable heart rhythm) or ... (3) you have serious drug problems ... and so on ....... these sorts of problems need serious consideration. You need to talk them through with a medical practitioner and decide whether they either preclude you from playing, or whether they need to be brought out into the open by informing either club doctor, training staff, or coaching staff. At the very least, informing the club doctor in a confidential consultation, will give the club a chance to ensure its interests are considered. Your Injuries ... the club prefers to be informed about any significant injury. There are times when a player chooses not to tell. This is sometimes for fear of being excluded from playing and sometimes purely a macho thing. "How tough am I !!" However, there are a lot of good reasons why it is better to inform the medical staff. (1) Sometimes it is what you don't know which can hurt you. For example a sore wrist can be a scaphoid fracture. A bump on the head might finish you off. We are there to help you. Give us a chance. (2) We have a legal duty of care : The club makes decisions about what risks we put you to. If we don't know the dangers, how can we make the right choices. (3) The science of sports medicine has moved ahead leaps & bounds : we know a lot now about the best approach to all sorts of injuries .. give yourself the best chance to get through your injuries. Consult someone with a proven interest in sport's injuries. (4) Inform early ... obvious.
Our Responsibility
We want you to be informed as much as possible about your injuries and the risks they entail. Also we have an interest in keeping you informed about all sorts of sports issues ... such as keeping well watered on hot days, or rugging up on cold ones, fitness issues and so on. It is our policy to inform you as far as possible. If you feel you haven't enough information .. ask. We are also interested in your general welfare, your good and bad days, your joys and your despairs. In football clubs ... sometimes we call a spade a spade ... sometimes difficult issues are avoided like a leper with bird-flu. In recent years issues such as depression and anger management have become OK to talk about..... You might think.. well what has all that got to do with a football club. Well .. this is where your mates are. If your mates won't listen ... who will. Let's talk.
(k) Keeping of medical records
In this club, the club doctor keeps a written record of all injuries of medium to high grade severity. Injuries not reported to him are obviously not recorded. It may be important for a number of reasons to ensure your injury has been reported and recorded. These reasons include matters of insurance, referral and follow-up, medicolegal issues and so on. Even if you have your own doctor, please ensure you have informed this club's medical staff of any significant injury.
(l) Dissemination of information between medical personnel and the club for the purposes of assessing injuries and availability for selection;
We are used to the general idea of confidentiality in medical issues. However, in a football club setting, some information is shared. This is an issue which has probably not been thrashed out enough in football circles. We can offer the following observations. (1) Knowledge about your football injuries will be shared amongst the coaching & training & medical staff. Inevitably the lady in the tuck-shop and the guys in the ute in Bay 13 will also know all about your injury before the week is out. This is the real world. You may not like it, but anything which has serious impact on your fitness to play is likely to be shared around. A simple example follows : you turn up on game day with a streaming cold .. coughing, blowing, you can hardly breath. You don't tell the coach.. you tell the trainer. Now seriously ... do you think you are going to get away with it ... no ... of course not ... the trainers and the coaching staff will discuss the matter ... they will decide to get water to you more often, the Doc will give you some Panadol and an anti-inflammatory, you will be rested on the bench more often, and, when things are getting tough, you will be put in the forward pocket and someone-else will be thrown on-the-ball. You will still kick 4 goals from the pocket. You will be happy.. we will be happy. You didn't get confidentiality .. but heck.. lawyers don't go to the footy do they? (2) Your private life as a public hero/warrior will be a topic of public discussion. Smoke a joint on Friday night and everyone will know how long it was and how many seeds went pop.. on Saturday morning. Don't assume the coaching staff and club committee don't know all about you .. we know more than think. (3) If you want to keep an issue confidential then dont talk about it inside a football clubrooms. Talk to a doctor.
(m) Other Issues
1. Insurance ... over the past 30 years or so this club has had a changing relationship with insurance companies and what they can offer. There have been years when the club has funded insurance to the hilt .. it has proved to be an expensive issue. Other years we have taken a punt and had minimum cover, choosing to cover players' loss of income out of our own club funds. It is a bit of a gamble really. In the end, we usually offer a basic level of player insurance with an option for individual players to increase their level of insurance if they so desire. We advise players to familiarise themselves with the club's insurance arrangements on a year-to-year basis. We strongly recomend you to take further insurance options over the basic contributions .. especially if you carry significant economic responsibilties and risks.
