Ep 37: AFLW physio insights: injury rehab, player support & the future of women’s footy

Michael Dermansky

Hi everyone and welcome to the show that helps you become more confident in your body so you can keep doing the things that you love. My name is Michael Dermansky, I’m the Senior Physiotherapist MD Health. We’ve got a special guest with you today, his name is Matt Pallozzi. Matt, welcome to the show.

Matt

Thanks for having me, Michael.

Michael Dermansky

Great, well I brought you in as a special guest today because I’ve got a very particular topic to talk about. Injuries in the AFL and how to prevent them. But tell me bit more about you, Instinct Health and your physiotherapy journey.

Matt

Yeah, so we as Instinct Health have been around for about seven and half years now. So I started this place in November of 2017 and previous to that I’d sort of spanned the private practice world. I’d done a couple of private practice gigs in mask practices and then started my career in hospital-based settings. yeah, did a couple of years hopping around hospitals, then went into clinic-based work and then Got the appetite for starting my own clinic and initially it was just me and now we’ve grown to two sites. So we’ve got Instinct Health here in Camberwell and most recently City South Physio based in South Melbourne. So a team of, what are we up to now? Eight physios across both sites, which is really cool. yeah, going from strength to strength, is really good fun.

Michael Dermansky

That’s really good. Well, tell me about your involvement in AFL, particularly AFLW.

Matt

Yeah, so I’ve always worked in women’s football. So the timing for me was pretty serendipitous. I happened to get presented an opportunity from a colleague of mine from when I was working actually in one of the public hospitals. She was our founding team manager when we were back at Hawthorne. Presented with an opportunity and really wanted to get involved. was sort of, the timing was really perfect because essentially it was just as the AFLW was kicking off. So that was in… was 2017 as well. And at that time, Hawthorne were didn’t apply for an AFLW license, they wanted to get the foundations of their program going through the VFL. And so started working with them in the VFLW. And then that progressed on to a couple of years with them. Then I got an opportunity to work at an AFLW club at Carlton. Over a three year stretch there, that then led the opportunity to head up that program. So I was a head physio at Carlton in their AFLW program for a couple of years. Then I tried to step out of footy and tried to get my weekends and weeknights back. And then the opportunity came up to work at Collingwood and I really struggled to say no. Yeah, so I took the opportunity to jump on board at Collingwood in that same role as the head physio and that was really good. I was there for a couple of years and then finished at the end of 2023. So all in all, my footy span was just on eight years and Yeah, really enjoyed my time there. And I think just as my sort of work life shifted and looked at expansion and second clinics and stuff, I just found that I couldn’t get the balance right of doing everything. So something had to give. so ultimately the clinic won out because that was going to be the slightly more sustainable path for me anyway.

Michael Dermansky

Yeah, well tell me a bit more about the clinical side. What were the main issues you to see with the football players in your time at the AFLW?

Matt

Yeah, so we did work quite closely with the men’s programs and so we were able to get a bit of insight into what was going on in their worlds as well. But the injuries and the pathologies in the presentations that we used to see in women’s footy, I used to see in women’s footy were much, much different to men’s footy. So the classic hamstring, calf, soft tissue type injuries, we didn’t really see a great deal of or nowhere near the same volume in women’s footy. and the exact reasons for that, think they’re sort of working through still, and I don’t know if the research really backs up what the anecdotal evidence has been so far. So from a soft issue point of view, it was nowhere near the same. in saying that, I think everyone is pretty aware of the statistics and how horrifying they are that, ACLs obviously have a significantly more prevalent presentation in AFLW. So yeah, we, had, one year at Collingwood where we had zero ACLs. And with the exception of that year, we had at least one ACL in every program that I was working in. So ACLs were obviously a massive part of what we did. But the girls are combative. So there was a lot of contact based injuries, AC joints, concussion was a huge issue and obviously still is in the AFL and AFLW circles today. And fractures, seemed like a lot of fractures. And again, it comes back to that really combative nature of those female athletes and they really didn’t hold back.

Michael Dermansky

I say great and I mean I mean going with that because they’re tough injuries as well. ACL tears that’s out for at least a year and if not sometimes even longer than that too. Fractures are a slow injury too. It’s going to be a minimum six weeks up to who knows whatever it is as well. How did your rehab programs look like with these kind of injuries because they’re not the typical soft injury injuries? What did the rehab program look like? What did your preventive program look like? It had to look like with this kind of issues which are quite different to the men’s program.

Matt

Yeah, so I mean, to get back to your first point on that, I think the timeline one is a really challenging one. And I was working in these clubs during COVID. So there was one of our athletes who I distinctly remember did an ACL at the start of the 2020 season. the season has changed in my time, in terms of the time of year. So it used to be over summer. So it used to start in mid to late November and then it used to go through until the end of January and that was sort of the window that the AFL had found. That was pushed but over that period we had one of our players do an ACL and then at end of that season the AFL decided to move the timing of the season. So not only did she miss one full season because it was round one of that season where she did an ACL, she ended up missing the whole next season as well. I mean that’s a byproduct of condensed schedules and really short season I think. Last year, they were up to nine regular season games and then a four week final series. So it’s a really condensed season. And again, if you marry that against the men’s program, it’s a very different mechanism. talk about a four to six week injury in the men’s program, that’s a fraction of the season, but in the women’s program, that’s half the season or two thirds of the season or more. And again, if you talk about an ACL or an Achilles and we had a couple of Achilles in my time as well, it’s a whole seasonal or more that’s just gone literally in an instant. it’s a really heartbreaking thing. And more broadly speaking, probably getting a little bit off topic, but I’d love to see the program continue to evolve and get to a full fully fledged 20 game season where everyone can play each other once or 18 game season, certainly the women’s space where everyone can play each other once. But that’s a that’s probably a podcast for another day. In terms of the in terms of the rehab process. Yeah. So again, I think I got really lucky with a lot of the people that I worked with. But the key pillars, I guess in the rehab process and this probably gets neglected a lot, but the player themselves. So what’s the player’s expectations around it? And again, working really closely with the club doctors, a lot of our role was outlining timelines and giving players, if not an exact timeline or a timeframe, something that could really wrap their head around. The hardest thing is to just have this week by week rolling diagnosis and rolling plan that they don’t really know what the end game is gonna be for them. being really clear on the plan working with the player first and foremost, obviously really close working relationship with the club doctors and I was really lucky to work with some incredible club doctors in my time working in footy. High performance manager, so the person who heads up the strength and conditioning and loading phases of athletes programs as well. there was always this really nice interplay between physio and high performance. And then within all of that, they’ll have their sports scientists and their data people that sit in behind them to back up what we’re talking about in terms of their numbers. head coach, head of footy, also play a really key role, again, educating them on what we’re expecting in terms of availability. So when is a player going to be back? When are they going to be available for full game time, part game time, all of those sort of things. So they’re really closely involved. And then the players’ families as well. again, I think one of the great things about working in women’s footy was seeing how close the families are. Again, my most recent experience was at Collingwood, but the way that the club brought families in and educated them on everything that they do. And this is injury wise, but this is also just celebrating club day boos and celebrating milestones or even little things like birthdays. The families were a really key role in the rehab process as well. So yeah, there’s certainly a lot of moving parts and one of the best things you could often do was just get everyone in the room. So Every week we used to have a list management meeting, so effectively who’s injured, who’s not, and if they are injured, how long is it going to take them to get back? And as I just to get those key people in the room. So myself, club doc, the welfare person or yeah, the person monitoring how the players are actually going. As I said, head, footy, and then coaching staff were all in that room. That was a really good opportunity just to flesh out exactly what was going on with the whole list. And you just go, there was 30 players on a list and you just go. one to 30 on the list and work through the whole thing.

Michael Dermansky

Fantastic. mean, you’ve answered my next question. was going ask you how do you manage the multiple stakeholders? Because it’s not just, I mean, the first things you said, most importantly, and this is, guess, any, not just how I felt everywhere is what do I have? How long does it take to me feeling better? Just really giving as clear a timeframe as you can is just such an important factor because it just gives shapes expectations and allows people to work to something rather than, as you said, week to week to week, where am I going? Where am I going? Where am I going?

Matt

Yeah, and it translates really nicely into what we do in the clinic. someone comes in for an appointment in the clinic and will outline their treatment plan with them. So this is your diagnosis. This is your expected timeline. This is what I need you to do. This is what I’m going to do. And it presents all of the information to them in a really clear, succinct way so that they’ve got expectations. I think the last thing you can do, particularly in a clinical setting or even in a footy setting is I’ll see you next week. I’ll see you next week. I’ll see you next week. But they don’t know why or what the purpose of all of that is. So if you can be really clear and these are the phases of rehab. So, you know, if we give the ACL example, so phase one is zero to four weeks and it’s getting range of movement back, it’s controlling swelling, it’s getting early quads activation, getting early hamstring activation, depending on graft. If you can get all of their phases down pat really clearly and they buy into that, then you’re a long way ahead of your competition, think, particularly in a footy sense, but it relates to a clinic based setting as well.

Michael Dermansky

Yeah, absolutely. And how did you manage the different stakeholders? I guess the communication attention, the different needs of all the different stakeholders as well, the player, the family, the football manager, the coach as well, they’ve all got similar but different competing needs. How did that dynamic work?

Matt

Yeah, it definitely posed challenges at times. again, like I said earlier, there’s this really close working relationship between physio and high performance. And depending on the structure of the club and how that looks, some clubs will have a designated rehab physio. So they will have someone who will take them essentially from anything outside of the acute phase all the way through to return to play. at Collingwood, we had a slightly different structure. essentially physio would take the early phase management. So we would do range, early strength, early rehab phases. And then essentially once the athlete was back on field, that was at the time where we would hand, handball them effectively over to high performance, but we’d still have a really close working relationship there. And we’d still be working through any niggles that had popped up or any aches and pains that had come about as a result of some of that increased loading or variability in loading, I should say. but in saying that, you know, there’s always this kind of give and take. Coaches always want them to play more, we’re protective of them and we’ve got the players, you know, first and foremost in our mind and what we’re trying to protect them from and often with the female athletes that I worked with, it was protecting them from themselves. The girls are super passionate and they never want to miss a session and they never want to miss any part of a session but sometimes the biggest education piece for us was saying, hey, if we have a deload tonight it means that you can do full training on Thursday, which is going to be the major main training session for the week, which is going to be the one that actually makes you available for selection come the weekend. So yeah, it’s a really challenging one. And I think it’s the same in clinic as it is in footy. But if you’ve got really good communication and you’ve got the key stakeholders, player, high performance coach on the same wavelength, then everyone has the same expectation around it. That’s the easiest way to come about it, absolutely.

Michael Dermansky

Yeah, it’s interesting because there’s nothing to do with the injury there. So much to do with the expectations and the communication between all the stakeholders involved as well. It’s a really big deal.

Matt

Yeah, the pathology is obviously important, but it’s updating everyone at every step along the way. And the biggest thing that I learned is that you can never over communicate in that setting. The more the right people know at every possible time interval will be the best thing that you can do for sure.

Michael Dermansky

What do you think the biggest factors at the moment are leading to so many injuries in the AFLW? I mean, you’re talking about hard issue injuries as well, stuff that’s not as impact, stuff that’s harder to predict, but is there anything obvious that you think that, you know what, if we change this, it could be a better situation?

Matt

Yeah, I think, I mean, again, if we talk about particularly in the context of the ACL injury pathology, I think there’s probably a couple of key factors. One is the maturity of the game. You know, we talk about now we’re up to AFLW season nine. So in a professional sense, the league has only been around for eight years and it’s been condensed as a because of COVID and because of two seasons in the one year and all that sort of stuff. the professional competition has only been around for seven or eight years. So only now are we seeing these girls who’ve come through from junior footy all the way through with proper pathways. And that means NAB league competitions. That means good junior coaches every step along the way. They’re getting conditioned from the ages of nine, 10, 11. The biggest problem that we saw for a long time for female athletes playing footy was they will get to a time, 13, 14, 15, and they’d played junior footy with the boys, but all of a sudden they weren’t allowed to. And so they had this three or four year hiatus. So their multi-directional changing, multi-directional conditioning had to completely change. It was either a different sport, it was different surfaces. They just weren’t exposed to it because the opportunity wasn’t there to play under 14s, 15s, 16s. They either had to make the jump straight into senior women’s football or they had to give away the game altogether. And I think now that we’ve got those pathways in place, it’s going to make a huge difference to try and prevent some of those injuries. so I think that’s a, that’s a massive factor, but something obviously that we’re now, we’ve now rectified and hopefully the athletes that we see from today onwards will be better placed to handle that. I think the other one is probably the changing of schedule and the changing of rules from the AFL. So what I mean by that is yes, we had the two seasons in the one year at one stage. So that was obviously made challenging, but The AFL is forever trying to change and evolve the women’s game as quickly as they possibly can without necessarily considering the athlete demands that are around that, whether that be regular changes in timing of the games, in length of games, length of quarters. There’s a whole range of factors that the AFL are trying to do to make it commercially viable. And I understand that element to it. But ultimately, I think that poses challenges for the players. And I think the other issue around the AFL is largely budgetary and when I say that the AFL has to operate the AFLW program on a shoestring budget and so as a result good practitioners, good healthcare professionals get spat out of the system because ultimately they can’t keep doing what they’re doing at such a discounted rate. So what does that mean? Well it means you get someone who’s less experienced who will come in who doesn’t have the same skin in the game, doesn’t have the same anecdotal experience that they can call upon. And so the quality of athletes is going up, but the quality of health professionals over time is getting diluted. So I think that’s a massive challenge. And the sooner that commercial viability comes into it, the more you’re going to be able to pay physios, medical, high performance, what they actually need to ensure that good people stay involved in the program.

Michael Dermansky

So there’s the practical element of it too and the commercial element too. It makes a big difference as well. So if you saw the design of a perfect program that the AFLW had, what would that look like in your mind?

Matt

Yeah, like I think there’s this very altruistic mindset that we have that, you we’re to be able to prevent all injuries. And the reality is we play a 360 degree full contact sport in really challenging conditions, wet conditions, dry conditions, hot conditions, freezing cold. We’ve seen AFL football played in snow, played in 35 degree heat, played at 100 % humidity and everything in between. So it’s a really challenging sport to try and prevent every single injury. but we want to try and put as much guardrail in place to do that as possible. I think what we have learned in the women’s space, we can learn, lean a lot on what they’ve done in the men’s space. And ultimately that means getting really good athletes committed for 12 months of the year and making sure that they are staying fit, staying in the gym, staying strong over that 12 month period. And yes, the boys get their allocated eight weeks off or 12 weeks off or whatever it is. But the expectation from clubs is the guys come back in just as good a condition as what they did when they left, if not better. And I’d love to see that evolve in the women’s space as well. And I think the more we can expand out the season, the more we have access to these players for longer periods of time. So the more that we can actually just put in the work with them. They want to put in the work. It’s just a matter of getting the timing right and expanding that season out and expanding the preseason out to make sure that they can stay professional athletes for yeah.

Michael Dermansky

Yeah, absolutely. That timing of making people strong and fit and conditioned as well before they ask for a performance, a really big deal. I mean, it’s just, again, similar to the clinical setting as well. People need time. They need time to get strong enough to be able to do what they’re being asked to do. And if everything’s condensed, you know, it’s great with an idea point of view, but you actually need the body just needs time to become stronger and fitter.

Matt

Yeah. Exactly. And you look at where pre-seasons are sitting now and in the men’s program, the pre-season will sit at around about the 12 week mark. You know, it’s been condensed and there was horrible stories from the eighties and the nineties where, you know, players were told to come back and day after the AFL grand final, you know, first of October, they were expected back at the club. Fortunately, the AFL players association have had a strong enough voice now so that a lot of players aren’t coming back until the middle or even the end of November. Senior players might not come back until December now. But that still gives them a really solid and you just got to look at the timings, but you just look at that and you have, well, that’s a really solid 12, 14 week block of strength training, of conditioning that is going to best prepare those athletes for round one and in the men’s program, 24 rounds and in the women’s program, nine rounds plus finals. So I think that’s the biggest misnomer that we saw in the women’s program is that, you know, we had this great pre-season for a really condensed. in season phase. So if we can at least have those two marry up and have a 12 week preseason for a 12 week in season phase, that’d be a really good start. But I think getting that 12 weeks of really high quality training with the players is essential. And now data would certainly back it up. know, we used to track training completion through preseason phase and then in season phase. And it’s probably no surprise, but the players who had higher compliance in preseason sessions, higher compliance to training and completing 100 % of training. were the ones that didn’t get injured. So it becomes this positive spiral and this positive feedback loop where the more you train, the stronger you are, the better condition you are, and the less likely you are to get injured.

Michael Dermansky

fantastic that’s that’s really great insight as well I mean basically do the work beforehand and it’ll make a big difference afterwards as well so you know that’s

Matt

Yeah, absolutely. And the other element of that is yeah, preseason is important, but by training in season is if not as valuable, almost as valuable as that preseason phase, you know, in a condensed season, again, you’ve got to be really mindful of loads and six day breaks or five day breaks or whatever it is. But getting some training into these athletes in that in season phase is really, important. And we had real challenges at times because players were coming off injury interrupted pre seasons, they were really good players, know, on field, really, really good players, but just hadn’t done the work. So it was this really challenging balancing act with trying to make sure that they were still available for selection on the weekend. But that meant having to de-load them so significantly during the week that ultimately they were getting less fit and less strong during the season. And we know that that’s, it’s only a recipe for disaster.

Michael Dermansky

Yeah, absolutely. Anything else you want to finish up with before we finish up today?

Matt

No, think there’s certainly challenges working in the AFLW space and trying to prevent those injuries, as I say, but ultimately the players are committed and the players are in and I feel very, very lucky to have been in that environment for so long. When I first got into physio, I think probably like a lot of people, thought, oh, I would love to get into sport and I would love to get into footy and… If you had have told 15 year old me that by the age of 30, I would be the head physio of the Collingwood footy club, I probably wouldn’t have believed you, but to be able to now hang my hat on that and have that on my CV for the rest of my life is something that I’m incredibly proud of and incredibly grateful for to have had the opportunity. And as I said, I’m very, very blessed in being able to have worked with some really incredible people and the networks and the people that I’ve met along the way are absolutely what is what makes it worthwhile. I think when I decided to step away from footy at the end of 2023, you know, I wanted to spend time with the family. I wanted to get my weekends back and I wanted to get my weeknights back. But the thing that I was going to miss most was definitely the players, the players and the staff. That’s what makes footy great. And whether that be at a local level or whether that be at the highest of the elite levels, footy clubs are really special environments. And so, yeah, as I I feel very blessed to be a part of it for so long.

Michael Dermansky

Thank you very much for your time. It’s been really good insights really, really important, particularly that, I think, in making sure that if you’re going to be playing a football, not just AFLW, but any kind of football as well, that you’ve done the work first at any level so that you minimize your risk of injury during the game. Thank you. time again, Matt.

Matt

Yeah, definitely. Thanks, Michael. Appreciate it.