The frightening mid-match collapse of Luton Town’s captain Tom Lockyer during last weekend’s Premier League fixture was a timely reminder of the importance of player pre-season health screenings.
The PFA and the players send their best wishes to Welsh international Lockyer who was hospitalised after he suffered a cardiac arrest in a match against Bournemouth on December 16.
Health screenings are mandatory for all players who play in the A-Leagues under the 2021 – 2026 A-Leagues Collective Bargaining Agreement between the Australian Professional Leagues and Professional Footballers Australia.
Within the A-Leagues CBA, players and clubs agree to prescribed Minimum Medical Standards (MMS), with a medical assessment required prior to players participating in on-field, weights, or conditioning training each season. The MMS is updated and enhanced at the conclusion of each season.
The mandatory medical assessment includes:
- An assessment of a players’ medical, family and injury history;
- A general physical, cardiovascular and musculoskeletal examination; and
- A baseline concussion test for all players and psychometric testing for any players with history of multiple concussions or prolonged recovery from concussion.
These screenings are essential to the identification of unknown health conditions which may place an athlete at risk from participating in football. These can include an underlying cardiac condition but also double as an assessment that ensures optimal performance and player safety.
In addition, the MMS outline the minimum qualifications required for medical staff and, critically, the medical support services that must be available on a match day.
ECG and ECHO heart testing
Under the MMS, an ECG (electrocardiogram) is mandatory in a player’s first year at a club. A player must then undergo an ECG once every two pre-seasons, calculated from the season at which the player undertook the original ECG. This is unless there is ‘clinical indication for more regular testing’. An ECG records the electrical signal from the heart to check for heart conditions or abnormalities.
In addition to an ECG, each club must ensure an echocardiogram (ECHO) is conducted on a player in a player’s first year at the club, and once every two pre-seasons thereafter. An ECHO uses high frequency sound waves (ultrasound) to capture pictures of the heart. These pictures can be used to determine a player’s general heart health.
Acknowledging that heart health is also an issue for players post-career, the PFA has also partnered with Australian charity Heartbeat of Football to improve the health and wellbeing of footballers once they retire. The partnership includes free heart screenings via the PFA’s Past Players Program.
ACL testing and prevention
Several players have suffered anterior cruciate ligament (ACL) tears this season in the A-League Women, sparking concern over the frequency and susceptibility of female players to the injury.
Through the MMS, each club must initiate an ACL injury prevention program for all players, prior to the commencement of each A-League Men and Women season. This program should continue throughout the season and must be evidence-based and industry accepted.
“The collective bargaining agreement and minimum medical standards have been important measures for enhancing the high-performance environment for players,” PFA Co-Chief Executive Kathryn Gill recently told Code Sports.
Training and prevention programs cannot prevent ACL injuries occurring altogether – given players are at a risk when they make sudden directional changes, suddenly stop or slow down, make an unstable landing from a jump, or from direct contact or collisions. These are all features of a professional player’s body mechanics on a match day or in training.
“The research to date indicates there are a variety of factors that have an impact [on ACL injuries] but far more female-specific research is required to ensure the industry can make football as safe as possible for players through effective preventive measures,” Gill said in the Code Sports feature.
Research into ACL injuries
International global professional football players’ union FIFPRO recently released research on the increasing demands on professional women’s football players. The research highlighted “a notable increase in knee, thigh, hamstring and anterior cruciate ligament (ACL) injuries”.
The analysis of 139 elite footballers playing in England, Germany and Spain across the 2021/22 and 2022/23 seasons demonstrated 58 players suffered injuries.
The research demonstrated that those players who suffered from an ACL injury had “made more appearances, had more instances of less than five days between matches, and had less rest time in the 28 days prior to the injury compared to non-injured players.”
The report indicates that match congestion is associated with higher number of injuries (especially ACL injuries) in elite female footballers.
Emergency Medical Support at Matches
The injured suffered by Adelaide United’s Juande Padros Lopez last season brought into focus the emergency medical support services that must be available to players on a match day. Through the MMS, the following must be in place at all matches:
- an emergency physician with the relevant emergency medical equipment and supplies that would otherwise have been provided by the relevant state or territory ambulance service. It is recommended that an on-site ambulance transport vehicle is also present at the venue; or
- an on-site ambulance with two (2) trained and AHPRA registered paramedics that:
- have the relevant emergency medical equipment and supplies;
- have the ability to possess and administer schedule four (4) drugs (e.g. adrenalin) and schedule eight (8) drugs (e.g. opiates); and
- can perform advanced life support.
Last season there was signficant discussion regarding an ambulance not being at an A-League Men match between Melbourne City and Adelaide United. The reason for this was because Ambulance Victoria withdrew stationary ambulances from A-Leagues matches in 2018.
As a result, where public ambulances are not available, emergency physicians must be in attendance in addition to club doctors.
Emergency physicians are doctors who are specialised in emergency medicine and, as special practitioners, they are able to provide a higher level of care than a paramedic. Private ambulance providers are not a viable option as they cannot undertake emergency transportation. In every other state it remains policy to have a static state ambulance at the venue for a match.
