Annabelle White [00:00:03] Hello and welcome to the Coaching and Officiating podcast series. My name is Annabelle White. I'm joining you from Eora Country, and I am the Coaching Advisor for the Coaching and Officiating team at the Australian Sports Commission. Over this series, we will look at what it takes to modernise Australia's coaching and officiating system. Each podcast, we will be joined by a special guest or guests who will share experiences and practical tips on their topics.

Today we will be discussing ACL injuries. We will be discussing more about the injury itself and its prevalence amongst women and girls. We will explore the personal impact of the injury and discuss prevention strategies that coaches can implement into trainings and game days.

We are lucky today to welcome Brooke Patterson and Kamahl Cogdon to the podcast. Kamahl is an enthusiastic footy player who suffered an ACL rupture in 2022. She's yet to make her return to the field but has remained engaged in coaching positions at Blackburn Football and Waverly Park Hawks.

Brooke is a Physiotherapist and Research Fellow at La Trobe University Sport and Exercise Research Centre. Brooke is also a former AFLW player and development coach and has also suffered an ACL injury in her time.

To support coaches working with women and girls in community sport the Australian Sports Commission is developing a series of resources to support coaches to enhance their practice. Brooke and Kamahl, we are thrilled to welcome two individuals to the podcast today who have both a wealth of experience, both personal and professional. Welcome.

Kamahl Cogdon [00:01:27] Thanks Annabelle.

Brooke Patterson [00:01:29] Thanks Annabelle. Thanks for having me.

Annabelle White [00:01:31] So, Brooke, in your work, you have researched ACL injuries amongst women and girls in sport both elite and in community settings. Can you explain what an ACL injury is?

Brooke Patterson [00:01:41] Yeah, sure. The ACL or the anterior cruciate ligament it's like a really tough ligament. Kind of like a rope that connects your shin bone to your thigh bone. And it's inside your knee joint. And essentially, without getting too technical, that helps keep your knee stable and it kind of events that shin bone from sliding forward and backwards and also rotating around a little bit. But what I think is important to know that it's only one of many ligaments inside and outside the knee that help keep the knee stable, as well as like your muscles as well help with stability. Which is why actually you might hear of some people who might be able to cope without actually needing surgery to repair a torn ACL, as they have those other structures that can help provide that stability. And when it gets injured, it's when essentially when the forces become too, too high, like kind of like a sprained ankle, but just inside the knee and the ligaments either strained or completely ruptured in half or it partially tears.

Annabelle White [00:02:39] Are there common ways that someone might tear their ACL?

Brooke Patterson [00:02:42] Yes. Well, the most common sports that we start there are when there's high speed running, cutting, pivoting and jumping. So if you think about all your different types of football codes, court sports such as netball, handball, basketball, skiing's another common one, outside of that team sport setting and they can occur kind of each motor vehicle accidents are in the workplace as well. But mostly we're talking about kind of team ball sports here today. So the majority of ACL injuries are what we call non-contact. So that means that there's no direct contact between the injured person and any other player or piece of equipment. So the typical one is, say, the player running out in open space, no one around them, and either changing direction or coming to like an abrupt stop or reacting to something that's happening on the field. And the knee just kind of collapses and they go down in, in a heap. Or they might be landing from one leg after a jump. So say a marking contest or receiving a pass, or from a header in soccer, or even just after kicking the ball, that kind of action of landing on one leg. So they are the non-contact situation. Some of the injuries are also what we called indirect contact. So quite similar situations on the field. But there is some contact from another player, whether it's the opponent or their teammate. So they might be going up for a mark or pass and they get a little slight bump in the air or on the way down. I guess the good thing about these indirect and non-contact injuries is that they tend to lend themselves to being more preventable, so they're often related to the way you know that the player is balanced when they land on one leg or the way they respond to contact in the air, or the way that their footwork is when they approach, a tackle or a contest. And then of course, those contact injuries. So, for example, when a player falls over another player's knee and kind of pushes it inwards. And for these mechanisms, sometimes there isn't too much we can do about it. And we know that injuries are just a part of sport. But we also know that the benefits of sport, usually outweigh, those, those risks. So I think for those contact injuries, I think we can still think about the stronger, more skilful the player in their sport and more aware of the things that are around them. They can potentially still avoid some of those situations. Like, you know, the way that they stand up in the tackle or roll with the tackle, so that's the kind of three main mechanisms. I guess the only other thing to add is they're often in defensive situations. So if you're a coach and you're training a lot of offence and training and drills designed around offence, you might not actually be exposing the players to the defensive reactive situation. So obviously when you've got the ball, you're a little bit more in control of what's happening. But if you're reacting and defending, that's when a lot of these injuries happen as well.

Annabelle White [00:05:27] Kamahl I’ll come to you. You suffered an ACL injury playing a sport that you loved a few years ago. Tell us about your injury.

Kamahl Cogdon [00:05:34] Yes, I did a complete rupture of my left ACL in my left knee. I was one of those unlucky people who mine was a contact injury. So I was being tackled and I thought it was really interesting what Brooke said about learning to roll with the tackle. I think in hindsight, I tried to stand up through the tackle and keep running. Probably not having had enough training along how to, yeah, how to roll and how to go with the tackle. So I did feel that pop, almost like a release. I didn't hear it, but I felt it, and it was almost that itself didn't seem painful, but by the time I hit the ground, it was excruciating. I also tore my meniscus. So, I think there was a lot of pain with that. I had two meniscal tears. And I just, I was carried off to the off of the, the grounds and sat on the side of the, of the the oval and watched the rest of the game in quite a lot of pain, until somebody came and picked me up and took me off to hospital and, and then the the rest is history, I suppose. I had surgery two weeks later. Again, in hindsight, I'm not sure if that was that was necessarily the best thing to do. I had a hamstring graft and it's been a pretty, torturous rehab for me unfortunately, it's, taken quite some time. I've had a few ups and downs which, you know, you kind of expect it's we know, recovery is not linear. And everyone says that to you when you, when you set out on the recovery journey. But, it those, those highs are quite good. But the lows can be quite deep too. So it's been very challenging. But, I'm coming through the other end slowly.

Annabelle White [00:07:19] Brooke, listening to Kamahl's story, what would put someone at a higher risk of suffering an ACL rupture or injury?

Brooke Patterson [00:07:26] Yeah. So it's the $65 million question, Annabelle. There's lots of, I guess, different factors that play into someone's risk of sustaining any injury. And in particular ACLs, there's, a big variety of factors that might play into it. But the only kind of two factors that we have strong scientific scientific evidence for is being female, born a female, and having a previous ACL injury. So it's like any injury, if if you've had one of them, you know, you're risk for having another one is is fairly, a lot higher than the rest. The other one that's probably close behind that with some moderate evidence is family history. But unfortunately, all those things I'm listing off, we can't do much about, which, is no good for coaches, no good for athletes. But there are a whole other range of things, that we can kind of modify that have shown some links to, to injury risk as well. So if we think about, you know, the way that people move, you know, their muscle strength and control, your training schedule or your training load or any training plans, footwear and ground, body weight, your general like, health and well-being and kind of all the things impacting the immediate athlete on the, on the field that we can modify with coaching and training. And then there's all the things on the outside of the field. So, if we think about that being that the training environment, the competition environment, the coaches, that the clubs, the leagues and how they can actually influence what's going on in the field. And so that's kind of access to resources and education that can actually help, that athlete, you know, minimise all of those potential risk factors.

Annabelle White [00:09:14] Brooke, you mentioned being born female is going to put someone at a higher risk of suffering this kind of injury. And we've seen a lot in the news of high-profile athletes like Ellie Carpenter, Sam Kerr, Katrina Gorry suffering these injuries in the last few years. The NRL saw ten season ending knee injuries, and nine AFL players in the 2023 season tore their ACL. What does put women at a higher risk of suffering this injury?

Brooke Patterson [00:09:44] If we think about the things that we can't modify, we'll kind of knock them off first, is the, some of the anatomy factors. So women have potentially, some women, have different size and shaped, ligaments and, and bony structure. There's some thought around hormonal changes as well at certain times of the month. There might be a change in, in your collagen, which is in your ligaments, and that might put you at greater risk. Again, when we go and talk to to coaches, about these because it's a common question, right. We try and kind of get away from that notion that it's, and it's more than hips and hormones. That the hips, you might have heard as well is, because we've got kind of wider childbearing, keeps the angle of the thigh bones coming down, kind of puts more strain on the knee. So we try and we put a big slide up saying it's more than hips and hormones because that's what you hear in the media a bit. And we try and talk about all those other things like the movement patterns, the muscle strain, the training load and the plans and and getting the resources and the support around women. Those injury rates, I guess, have probably been there for a long time in terms of women being greater risk. It's just getting more and more attention now. And I think the professionalism of those competitions are going up, which is great, but that also means they're running at higher speeds. They're putting more load through their bodies.

Annabelle White [00:11:08] Kamahl listening to Brooke, then, particularly around the environmental factors that she's listed that put women at a higher risk of suffering injury to any of those resonate with you and your experience?

Kamahl Cogdon [00:11:17] Yeah, definitely. When I first saw my surgeon, I’ll just throw this in, he actually said that, women were keeping him in business. So that's how prevalent it is out there. It's not something I really wanted to hear at the time. But, but in terms of, I guess, the environment, my preparation at the time probably wasn't at its peak. I just it was a post-season, competition that we just thought we'd enter for fun. And I'd been away. I'd had five weeks overseas eating cheese and drinking wine and, not doing very much running. So I came back and thought, oh, why not? I'll play round robin of three games. And I think it was the second time that I was injured in, so definitely, I mean, some of that falls on the athlete themselves to, to prepare as best they can. But I think there's also a lot that, club land can do to support that. As I said before, I don't think certainly in my case, I don't feel that I had, I mean, we practised, tackling, of course, but never it was always as the tackler, not the person being tackled. So there were gaps, from my knowledge, missing. So there's that. And strength and conditioning was never like, and you know, yes, a lot of the girls do go to the gym. And I always thought for me, my game, I built my game around my running. So I was playing on the wing and I could run all day, so I was really, really fit. But I just thought, oh, the gym's kind of, you know, that's not really for me. I'm all about running. And in hindsight, I now, I mean, I always knew, but I didn't appreciate fully how important that strength and conditioning could be.

Brooke Patterson [00:13:09] You picked up on something, Kamahl, that I didn't, I kind of forgot to mention. Is that, yeah, sport-specific skill. So particularly, I think for the football codes where we're seeing these [at] higher rates. They are sports that women and girls haven't played traditionally in their formative years. And even if they are playing in their formative years, I mean, you know, under twelves onwards, even before that, this is a societal thing. They come into that organised sport setting already playing catch up because and the way that they develop is physically different to boys. So you touched on the ability to kind of roll and fall. We see that really commonly and in girls in particular, not being able to kind of go to ground and be confident to just fall on the shoulder of the body. And so they leave the arm out or the legs kind of get all caught up. So, yeah, they just, you know, just in society, girls don't kind of wrestle and roll around as, as much as boys, through through school as well. So I think that's a big reason why we're seeing those differences in injury rates as well.

Annabelle White [00:14:11] So, Kamahl, you started your footy career a few years ago, you mentioned to me on the phone, can you tell us a bit more about what drew you to the sport?

Kamahl Cogdon [00:14:19] Sure. Yeah. I was definitely a late bloomer, late to come to football. And that's probably because I think, I always joke that I was born 30, 30 years too early. If I was just a little bit younger, I think I would, you know, I would have been, playing football a lot sooner than in my late 40s. So I was very much a very sporty kid in the 1970s, but never, ever allowed to even entertain the idea of playing football, despite the fact that every lunchtime and recess I would be out there with the boys kicking, you know, that, kick to kick and taking speckies on my sister when I made his sort of kneel down in the backyard and things like that, I was just never allowed to play. So eventually I did find my way to footy, and I loved it. I just loved it. I felt like I was living my childhood dream every time I ran out there. It was. Yeah, it was just amazing. And it was, I miss, I still miss it. Like, I miss it every every week. Every every time I see my team run out, every time I see the under sixteens run out, I'm standing on the sidelines, sort of almost twitching to get back out.

Annabelle White [00:15:31] Kamahl, what drew you to footy in the first place?

Kamahl Cogdon [00:15:36] I've always loved footy. I've always been a mad Collingwood supporter and I just always wanted to play. It was just as I said, I was a really sporty kid, just so keen to play. And because I was never allowed it, I sort of just put it on the backburner for so long. And then when the opportunity arose, one of one of my girlfriends had actually joined the club, and she said, come down, come down. So I did, and I just, I just I loved it from the moment I stepped out there, put on the boots and, you know, I felt like a real player. It was rather funny. But, so I always knew I would love playing the game because I had watched the game and loved watching the game, so that didn't surprise me. I knew I would love it, but I guess what did surprise me was how much I loved being part of the team, and I, I played netball, I'd done all that, you know, softball at school, I played indoor cricket when I was an adult. And, you know, I had done team sports before. But there's something about football and putting your body on the line, I think, and the camaraderie that you have with your teammates, because there is something at stake when you go out there like it, it hurts to, you know, to get tackled, to get bumped off a ball, you know, to try and take a mark. It's it's the most challenging but rewarding experience I’ve ever had in sport.

Annabelle White [00:17:02] You mentioned that you just, you loved the sport the second you put your footy boots on that first time. So when you think about your life before AFL compared to now, what has playing the sport really brought to your life?

Kamahl Cogdon [00:17:16] Yeah, just being part of a club. It's it's yeah, really awesome to feel. It's that belonging I think we've, we've, yeah, something all women can relate to. I think we're really good at doing that when we're surrounded by a group of other women who appreciate the same things that we do. You find your tribe, I suppose. And that's the thing that I was surprised how much I really loved that, how much I needed that. The most awesome feeling to know that you're out there working as a team to hopefully have a win. But honestly, we've come off the grounds at the end of some huge thumpings and we've been the ones getting thumped and we are just as up as if we've done, you know, we've had a ten goal win because we just loved being out there, just having a go and trying something that a lot of people all our lives in at Masters level anyway, when we were younger, told us we would never do and we shouldn't do. And so we're sort of going, well, we are doing it and we're loving it, and no one's going to stop us except for an ACL.

Annabelle White [00:18:17] Kamahl 18 months ago, you were playing in an off-season friendly match when you tore your ACL. Can you tell us about that moment when you went down to the ground and you knew that this was a significant injury?

Kamahl Cogdon [00:18:30] Yeah, it didn't hurt. I didn't get that rush of pain initially. I did feel that pop. It was like a gentle release, I suppose. And so therefore, when I hit the ground, I was hopeful that it wasn't an ACL. It was very painful when I hit the ground though as as in not landing on the ground, but by the time I hit the ground, my knee was it was excruciating. And I did that, that classic sort of grasp for your knee. Almost in a foetal position because you're in so much pain. I, I assumed it was my meniscus because of the pain, because I'd heard stories about people basically having that really, you know, that sharp sensation of pain and then getting up and almost wanting to run off the ground. And that didn't happen to me. So I sat on the sidelines and I just sat there in excruciating pain. And by the time I went, by the time I had the diagnosis and went to the surgeon and was presented with the options, which was, well, if you want to play sport, if you want to continue sport, really surgery is the way to go, if you're happy not to play sport and hang up your boots and retire. And it wasn't just footy like it would be, you know, potentially any sport or even sometimes people can't walk properly because their knee gives way. So, you know, if I wanted to do any travelling or anything like that. Surgery seemed to be the best option for me. Following surgery, I remember waking up and it was I've had I've had children, so it was akin to childbirth, the pain. It was next level. And that probably, you know, it did subside a little. But I think it took probably ten days to really, for the pain to sort of be manageable.

Annabelle White [00:20:21] Brooke, Kamahl has spoken a little bit about that moment when she knew that she was injured, but she didn't necessarily know that it was an ACL injury. A little bit of hope there that it was another, maybe a less significant injury. Is this common amongst participants, coaches, volunteers, in particularly, in community sport? Regarding having a lack of understanding of the injury.

Brooke Patterson [00:20:44] Yeah. As I mentioned, often the pain subsides and you feel, you know, relatively normal. So it's not until you go to the physio, the sports doctor, and you have the ACL test and they might be able to feel it. You do often see on the TV, them doing pulling on the shin, it's the ACL test. But often even that is hard to tell. So it's often not until you kind of get referred to the MRI and don't have the MRI, which can can take some time for community athletes that actually get that confirmation. And so that time waiting can be hard. Not knowing what I kind of wanted to pick up on, on what, Kamahl was saying about an injury in that immediate management is that there's no disadvantages of having that delay. And I, I think particularly for community athletes where, potentially, you know, time isn't, time is always a factor for everyone, but there's no disadvantages in terms of, you know, damaging the knee further. You know, as long as you're being sensible and looking after yourself and having a bit of a delay, and in fact, if you do a little bit of what we call pre-rehab or some some physio on some strengthening and some range of movement stuff before surgery, those people actually recover better. So I think there's that thought that, you know, you just have to go and get booked in straight away. That's going to be the best. So that was the first thing I wanted to kind of mythbust I guess. And then the other thing is that surgery is the only option. Certainly, there's some kind of early evidence to suggest that some people can cope without having surgery straight away. And most of these, is in, in Scandinavia and that about one third, in these studies can actually cope without having surgery. And can I just say Kamahl I love listening to your description of why you love sport and why you love footy, and why you've got into coaching. A lot of that, resonates with me, but I think. The, for the listeners hearing that seeing hearing your passion and you're obviously now, you know rehabing to want to get back and I think too many too often particularly women and particularly women who are a little bit older, it might be just like, oh, you know, don't bother. You know, you're not going to get back to sport or, you know, the the bar is often lowered, I think a little bit. So I just, you know, 100% love your passion and motivation. I think it's inspiring for everyone to, to listen to and coaches to be like, right now, we've got to keep these women on the field and we've got to educate them involved as well.

Kamahl Cogdon [00:23:17] Thank you. Yeah, look, I definitely feel I've encountered that too, that I think people I think, the experts that are on some of the experts that I've consulted, I've had some great support, don't get me wrong. But there had been some who I think have thought, why would you bother? You you know, you're now in your 50s. Well, you know, well, what are you going to get out of having surgery and, and why would you want to get back on the footy field.

Annabelle White [00:23:45] Kamahl, you've spoken about the opportunity to remain engaged in your club in coaching positions. Do you think that's helped you feel like you still belong as part of the club, maybe lessened those feelings of isolation?

Kamahl Cogdon [00:24:00] Now, yes. At the time, I found going back to the club really difficult. I didn't have so much of an issue coaching the under 16s because I was never involved as a player with them. I was always the coach, so that was easier. That was a, a continuation of what what had already been in place. But going back to the club, as a like, an injured player who was definitely out for at least one season and sort of, you know, sort of, dancing around the edges of what was happening because I couldn't get that involved even at training. I could give advice and I could, you know roll a ball, a handball, maybe, but I couldn't, I wasn't very hands on. I couldn't be I was, you know, it's just wasn't possible for quite a long time. So yes, it was good, but it was also hard because it was a reminder of what you didn't have.

Annabelle White [00:24:57] Do you have any recommendations for coaches who are maybe working with participants who have suffered a significant injury and how they can make them still feel like they're part of those teams?

Kamahl Cogdon [00:25:09] Yeah, definitely. My, the coach who coaches our Masters team is fantastic. He is always asking me for, you know, what I think about, this, this drill or did I want to add something to, you know, the halftime address or the, the pre-game address? He's very inclusive. He knows that, I’ve, you know, through the ringer with the injury. So I think just keep including, including the player, basically, follow the lead a little bit because it is hard at the start, but I think, you know, just offering your support constantly, even if they're not accepting it at the time, that just keep just keep offering it because they're just probably going through some stuff in their own minds or in their own heads that maybe they're not quite in that spot yet, but knowing that that supports their even if you can't accept it at the time, is really important to know that it's there.

Annabelle White [00:26:08] Brooke, coaches certainly don't want to see their participants suffer these significant injuries. What can coaches do to try and prevent their participants suffering an ACL injury?

Brooke Patterson [00:26:19] Great question. I think there's probably that notion out there that, you know, they are just a part of sport and you can't prevent them that the scientific evidence would tell us otherwise. So there's what we call kind of neuromuscular training programs. So essentially, they're like a dynamic warm up where and then some strengthening exercises. And then some of the programs also have some of the sports-specific skills. So doing those things, can reduce ACL injuries by 40 to 60%. And this is from lots and lots of studies, hundreds of thousands of, you know, participants, across many years of research. And then what they do is kind of summarise in what we call systematic review. So there's some some good evidence out there that these programs do work. And, if I go into a little bit more detail without getting into the nitty gritty, but the warm up would be doing some balancing, doing some jumping and landing on one leg, getting a little bit of a push when you're in the air. So you get used to kind of landing, in awkward positions and being pushed. It's working on your footwork when you kind of sprint and then have to stop, change direction, cut. It's learning how to fall and roll. And then it's working on, on all the muscles in the core, in the lower limb that actually enable you to kind of cope with the demands of the game.

Annabelle White [00:27:36] So Brooke there's a wealth of resources out there for coaches who want to understand this injury better, and how they can prevent injuries within their teams. Do you have any favourite resources out there that coaches can review before their next training session?

Brooke Patterson [00:27:52] Yes. And most sports will have their own injury prevention program. So I'll put a lot of the links in the show notes, but say, Football Australia has the Perform Plus. Rugby Australia had the Activate program. And then in terms of, so that's prevention stuff, in terms of rehab the Melbourne ACL return to sport guide is a really good one. Just have an overview of the rehabilitation steps and the criteria that you need to achieve. The Super Knee program got some really good photos of different types of ACL rehab exercises. Jess Cunningham’s book, POP goes through experiences of elite Australian athletes and it just really humanises them as they talk through the challenges in their rehab. I think it can help community athletes understand that everyone's journey is different and not to compare themselves. And then one of your best resources is your local sport and exercise professional kind of come out and help you implement injury prevention or having a list of good professionals in the area that might specialise in ACL or it might be concussion. So you can refer your athletes to, to, people with that expertise.

Annabelle White [00:29:00] Kamahl what's helped you the most during your recovery?

Kamahl Cogdon [00:29:03] Definitely having my physio and trainer I think without them, I don't know where I'd be. My new physio has been amazing, as has my trainer Tom. He's just been by my side the whole time. They together work on a program for me that, is adjusted any time I sort of meet a milestone or I'm lacking in a particular area that shows up in tests, regular testing. To to have to do that independently by, like, just at home, by myself. I just don't know if I could have done it.

Annabelle White [00:29:39] So thank you Kamahl and Brooke both for your time. Some really valuable insights and information today.

Thanks for listening. To learn more about community coaching and officiating, head to the ASCs Community Coaching and Officiating web pages. My name is Annabelle White and I look forward to you joining me for the next podcast in the Coaching and Officiating series. If you like today's podcast, please follow us wherever you get your podcasts and share this with your teammates, fellow coaches and officials, and friends.

This podcast was produced on the lands of the Ngunnawal people. I wish to pay my respects to the traditional custodians and recognise any other people or families with connection to the lands of the ACT and region. I wish to pay my respects to their elders, past and present, and acknowledge and respect their continuing connection to country.