Journal of Science and Medicine in Sport 16 (2013) 307311

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Journal of Science and Medicine in Sport

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Original research

The relationship between pre-season tness testing and injury in elite junior
Australian football players
Samuel Chalmers a, , Mary E. Magarey a , Adrian Esterman b , Melinda Speechley c ,
Ebonie Scase d , Michael Heynen e,c
a
Exercise for Health and Human Performance Research Group, Sansom Institute, School of Health Sciences, University of South Australia, Australia
b
School of Nursing and Midwifery, University of South Australia, Australia
c
International Centre for Allied Health Evidence, University of South Australia, Australia
d
School of Primary Health Care, Monash University, Australia
e
Port Adelaide Football Club

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: Australian Football (AF) is a collision sport containing high injury rates in junior competition.
Received 1 May 2012 Successful performance at the elite junior level not only requires superior specic football knowledge
Received in revised form 27 August 2012 and skills, but also well developed tness qualities. However, no studies have examined the link between
Accepted 21 September 2012
physical tness qualities and injury in AF.
Design: Prospective cohort.
Methods: Injury data were collected through the use of a Player Movement Record (PMR) and a standard-
Keywords:
ized Injury Report Form (IRF). Fitness test data was collected during the pre-season of the 2010 and 2011
Physical tness
Football
seasons.
Injuries Results: 382 players consented to participate in the study. The cohort experienced an injury incidence
Trauma rate of 24.29/standardized club (40 players/club). A faster 5-m sprint was associated with injury sta-
Sport tus (p = 0.016) and a knee region (p 0.001) injury. A faster planned agility score was associated
Adolescent with an increased risk of a hip/groin/thigh region (p = 0.010) injury, and specically a quadriceps
strain (p = 0.005). A lower 20-m shuttle run was associated with an increased risk of a shin/ankle/foot
(p = 0.045) injury. Increased injury severity was associated with a higher left foot running vertical jump
(VJ) (p = 0.040), and faster 5-m sprint (p = 0.043).
Conclusions: Lower aerobic endurance, faster 5-m acceleration and greater planned agility were associated
with an increased risk of various injury types in elite junior AF players. Furthermore, a higher left foot
running VJ and faster 5-m acceleration were associated with injury severity. These results may largely
relate to a greater work capacity placing a higher load upon the musculoskeletal system in contact and
non-contact situations.
2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

1. Introduction U18 competitions act as primary feeder leagues to the professional

Australian Football (AF) is a collision sport containing high injury
rates in senior1,2 and junior1,3 competition. The game is primarily
played in Australia on a large sized eld involving strenuous run-
ning and cutting combined with ball handling and body contact.
Elite junior players complete an average total distance of 13.6 km
and 140 high intensity efforts (running and sprinting) per match.4
The South Australian National Football League (SANFL) is the state
competition for South Australia in which nine teams participate
in the elite Under 18 (U18) league. Nation-wide, the elite state
Corresponding author.
E-mail address: samuel.chalmers@mymail.unisa.edu.au (S. Chalmers).
Australian Football League (AFL) competition.
Successful performance at the elite junior and senior level not
only requires superior specic football knowledge and skills, but
also well-developed tness qualities of muscular power, strength,
speed, acceleration, agility and aerobic endurance.57 However, no
studies have examined the link between physical tness qualities
and injury in AF.
The testing of physical tness qualities provides an accessible
means to potentially predict injury risk. The AFL currently recom-
mends a standard battery of tness tests that includes standing and
running vertical jumps (VJ), sprinting, planned agility and 20-m
multi stage shuttle run tests.
The use of physical tness qualities to predict injury has had
mixed success in the similar sports of soccer810 and rugby.11,12

1440-2440/$ see front matter 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jsams.2012.09.005
308 S. Chalmers et al. / Journal of Science and Medicine in Sport 16 (2013) 307311
Studies have failed to demonstrate a relationship between phys-
ical tness qualities and within-season injury.8 However, other
studies have demonstrated a link, for example, in soccer, Engebret-
sen et al.10 identied slower speed to increase the risk of acute
groin injury in amateur players. In rugby, Gabbett and Domrow12
identied reduced speed and aerobic endurance to be linked with
increased injury rates in sub-elite players.
The aim of the research was to investigate the relationship
between physical tness qualities and injury in elite junior AF play-
ers. Based upon results from previous research, we hypothesized
that players with lower physical tness qualities would be at an
increased risk of injury.
2. Methods
The SANFL was approached to give their approval and consent
for participation of their players in this prospective cohort study.
All players registered for the SANFL U18 competition over the 2010
and 2011 competitive seasons were then approached for inclusion
within the study. Informed consent was obtained from individual
players, or their parent/guardian if under 18 years old. All players
were de-identied when placed in the injury database by assigning
each player a study number. Ethical clearance for the research was
obtained from the University of South Australia Human Research
Ethics Committee.
An injury was dened as an injury or medical condition which
causes a player to miss a match, maintaining consistency with the
AFL injury Report.2
Each team in the U18 SANFL league competes in 20 regular sea-
son matches from March to September. Data were not collected
during the pre-season period or the end of season nals series. The
instruments used in the study included a Player Movement Record
(PMR) and a standardized Injury Report Form (IRF), as used in sim-
ilar studies by Scase et al.3,13 with similar elite junior cohorts and
comparable medical facilities. The PMR was a coded spreadsheet
that recorded player participation data. The possible participation
options were:
1. Competing for their SANFL club, local club or school team, or
2. Not competing because of injury, illness, suspension or other
reasons.
Following a competitive match, a hard copy or electronic PMR and
IRF were submitted to the principal investigator by a designated
person at each club (e.g. physiotherapist or head trainer).
Through the combined use of the PMR and IRF, the injury
status of a player could be determined. For the purpose of data
analysis, injury status was dened as a count variable, which
identied whether a player had been injured (yes/no), irrespective
of injury type. Injury status was inclusive of upper and lower limb
injuries. Next, the IRF enabled classication of an injury into sev-
eral categories: the injury region category enabled classication
of all lower limb injuries (comprising hip/groin/thigh, knee and
shin/ankle/foot), whilst the specic injury type category com-
prised four injuries (ankle sprains, hamstring strain, quadriceps
strain and groin strains). The four specic injuries have been iden-
tied to be highly common injuries in junior AF players3 and were
representative of the main muscle groups that are utilized during
game conditions and the tness tests.
In addition, injury severity was reported on the IRF. Injury
severity was dened as the number of games a player missed per
injury.
During the 2010 and 2011 pre-season periods, players partic-
ipated in an AFL recommended standard battery of tness tests.
The sum of seven skinfolds, consistent with the protocol of the
International Society of Kinanthropometry14 was used to estab-
lish the body fat percentage of a player. The skinfold sites included
the triceps, biceps, subscapular, supraspinale, abdominal, medial
calf and front thigh. The measurement was recorded to the nearest
0.1 mm. The maximal muscular power of the lower limb was evalu-
ated using VJ tests. VJ was measured by a jump and reach protocol
from a standing start and running jumps (within 5 m) from the
left and right foot. A Vertec yardstick device (Swift Performance
Equipment, New South Wales, Australia) measured the height to
the closest 0.1 cm. The acceleration of a player was evaluated using
a maximal high intensity run over a 5- and 20-m distance from
a stationary start. Players were timed to the closest 0.01 s using
a dual beam electronic timing system (Swift Performance Equip-
ment, New South Wales, Australia). Planned agility was evaluated
using the protocol termed AFL unique agility test. The test consists
of a series of ve pre-planned changes of direction each greater
than 90 . The changes of direction are marked with cones that the
players run around. Players began from a standing start and perfor-
mance was timed to the closest 0.01 s using a dual beam electronic
timing system (Swift Performance Equipment, New South Wales,
Australia) positioned at the end of the course. Aerobic endurance
was estimated using the standard protocol for the 20-m multi stage
shuttle run, as outlined in a recent reliability re-appraisal of the test
by Lamb and Rogers.15 The nal stage achieved was recorded rather
than a calculated estimate of V O2max . Error and reliability data were
not available for the planned agility and 20-m shuttle run tests.
Injury data were standardized to a 40 player club to maintain
consistency with the established protocol of the AFL.2 No recur-
rent injuries were included in the data. The injury status of each
player was only examined against tness test results from the cur-
rent year. Thus, if a player participated in the rst year of the study,
and were eligible and consented to participate for the second year,
they participated in another round of pre-season tness testing.
Statistical analysis was performed in Stata version 11. To deter-
mine the impact of confounding variables, the relationship between
demographic variables and injury was rst established. A log bino-
mial generalized linear model (GLM) was used which modeled the
risk ratios (RRs) with 95% condence intervals (CIs), to determine
which factors increased or decreased the risk of injury. In cases
where the log binomial GLM failed to converge, a robust Poisson
regression model was used instead.
Secondly, to examine the relationship between tness test
results and injury status, injury region and specic injury types, a
log binomial GLM was again used. RRs were calculated in the model,
combined with 95% CIs. If two or more factors were identied
to be statistically signicant (p 0.05) in the adjusted univariate
analysis, a multivariate analysis was performed using backward
elimination.
Thirdly, a negative binomial regression equation that accounted
for player clustering was used to examine the relationship between
injury severity and tness test results. RRs with 95% condence
intervals were established. If two or more factors were identied
to be statistically signicant (p 0.05) in the adjusted univariate
analysis, a multivariate analysis was performed.
3. Results
Over the course of the two seasons, 382 males aged between 14
and 19 years consented to participate in the study. The average age
was 17.1 0.8 years. Injury incidence for the cohort is described in
Table 1. The average injury severity was 2.8 missed matches/injury.
The average tness test scores are recorded in Table 2.
The rst aim of the study was to determine whether any of
the physical tness variables were related to injury status. A
univariate analysis determined whether any of the demographic
 S. Chalmers et al. / Journal of Science and Medicine in Sport 16 (2013) 307311 309

Table 1 faster planned agility to increase the risk of a quadriceps strain

Injury statistics.
(p = 0.005) (see supplementary Table 5).
Classication Injury Incidence Incidence/standardized Finally, physical tness qualities were analyzed against injury
club (40 player club) severity. A faster 5-m sprint (p = 0.018), 20-m sprint (p = 0.024),
Total injury 232 24.29 planned agility (p = 0.013), and a higher left run VJ (p = 0.038) were
incidence found to have a relationship with injury severity (adjusted for age
(including upper and BMI). A multivariate analysis revealed that only a higher left
limb injuries)
foot run VJ (p = 0.040) and a faster 5-m sprint (p = 0.043) were sig-
Hip/groin/thigh 71 7.43 nicantly associated with injury severity (see supplementary Table
Body region Knee 32 3.35
6).
Shin/ankle/foot 54 5.65

Groin strains 32 3.35

Specic injury Quadriceps strain 21 2.20
4. Discussion
types Hamstring strain 16 1.68
Ankle sprain 42 4.40
This study supports ongoing research into elite junior AF
injuries, for which there are limited data available for the develop-
ment of injury prevention programs. The present study is the rst
variables of age, height, mass and BMI were related to any of
in which the relationship between physical tness qualities and
the injury variables. Older age was associated with injury sta-
injury in AF players has been investigated. The main nding of the
tus (p 0.001), a knee region (p = 0.010) injury, a shin/ankle/foot
study was that lower aerobic endurance, faster 5-m acceleration,
region injury (p = 0.003), an ankle sprain (p = 0.004) and injury
and faster agility were associated with an increased risk of various
severity (p = 0.001). Shorter height was associated with a quadri-
injury types. The secondary nding of the study was that a higher
ceps injury (p = 0.025) whilst mass was not associated with any of
left foot running VJ, and faster 5-m acceleration were associated
the injury variables. Larger BMI was associated with injury severity
with a greater severity of injury.
(p = 0.006) (see supplementary Table 1).
Whilst the aetiology of an injury in contact sports is
Once the relationship between injuries and demographic vari-
multifactorial,16 it is possible to identify intrinsic factors which
ables was established, a univariate analysis (adjusted for age)
may increase the injury risk of a player. In this study, the demo-
determined that a faster 5-m sprint (p = 0.003), 20-m sprint
graphic variables of age, height, mass and BMI were included in the
(p = 0.025) and agility (p = 0.015) were linked with injury status.
analysis. Older age was found to be associated with injury status
A multivariate analysis revealed that a faster 5-m sprint (p = 0.016)
(RR = 1.343), knee (RR = 1.906) and shin/ankle/foot (RR = 1.743)
was associated with injury status (see supplementary Table 2).
region injuries, and ankle sprains (RR = 1.843) specically. How-
The physical tness qualities were then compared against
ever, the general homogeneity of the cohort must be acknowledged.
injuries of certain lower limb regions. First, a univariate analysis
Shorter players were found to be at a higher risk of a quadri-
(did not require any adjusting for confounding factors) demon-
ceps injury, a result that replicates ndings from the elite senior
strated that a faster planned agility was associated with a greater
level of AF.17 Larger BMI (RR = 1.14) was associated with increased
risk of a hip/groin/thigh region (p = 0.010). Second, a univariate
injury severity. The increased size and mass of players could place
analysis (adjusted for age) identied that a faster 5-m sprint was
their body at a greater risk of more severe injury resulting from
associated with a greater risk of a knee region injury (p 0.001).
the absorption of larger forces through joints and soft tissue.9
Finally, a univariate analysis (adjusted for age) revealed that a lower
Players with larger BMIs may also have an increased level of repet-
20-m shuttle run resulted in an increased risk of a shin/ankle/foot
itive accumulated physical trauma,12 possibly increasing the risk
region injury (p = 0.045) (see supplementary Table 3).
of severe overuse injuries.
The physical tness qualities were then compared against four
Faster acceleration (5-m sprint) was found to be a predictor of
specic injury types. Univariate analyses indicated that an ankle
injury status (RR = 0.013) and knee (RR 0.001/s; RR = 0.989/ms)
sprain (adjusted for age), hamstring strain or groin strain injury
region injuries. Norton et al.18 proposed that increasing match
were not associated with any physical tness qualities. How-
speed is a central component to an increased injury risk in AF.
ever, a univariate analysis demonstrated that a quadriceps strain
Faster players could be at an increased risk of injury in both contact
(adjusted for height) to be associated with a higher running left
and non-contact situations for a variety of reasons. First, previous
foot VJ (p = 0.034) and faster planned agility (p = 0.001) scores (see
authors have suggested that fast twitch dominated athletes and
supplementary Table 4). A multivariate analysis revealed only a
players with a greater work capacity may compete with a greater
playing intensity (i.e. acceleration and deceleration forces), increas-
ing physiological strain upon the musculoskeletal system.10,12,19
Table 2
The tness test results of the cohort.
Secondly, faster players may be able to place themselves in more
game involvements, increasing their risk of injury. Engebretsen
Fitness quality Average Technical error Intraclass et al.10 demonstrated an increased risk of acute groin injuries in
measurement (TEM) coefcient (ICC)
explosive players.
Height (cm) 181.9 7.2 1.03 0.97 Players who were faster at the planned agility run were at a
Mass (kg) 75.0 8.1 0.59 0.99
greater risk of developing a hip/groin/thigh (RR = 0.341) region
BMI 22.6 1.8 na na
Sum of 7 skinfolds 60.4 18.2 na na injury and more specically, a quadriceps strain (RR = 0.073).
(mm) Hip and groin injuries most commonly occur during movements
Standing VJ (cm) 58.1 5.5 1.98 0.88 that are associated with the planned agility test; side-to-side cut-
Left foot run VJ (cm) 70.7 7.8 1.75 0.93 ting, quick accelerations and decelerations, and sudden directional
Right foot run VJ (cm) 66.4 7.9 3.26 0.86
5-m sprint (s) 1.13 0.05 0.02 0.62
changes.20 Pyne et al.21 identied mideld players to have the
20-m sprint (s) 3.14 0.10 0.04 0.78 greatest levels of agility, indicating that this could be the posi-
Agility (s) 8.63 0.29 na na tional group at the greatest risk. This hypothesis could relate to
20-m shuttle run 12.7 1.1 na na the increased physical capacity of these players to change direc-
(level.lap)
tion, cut and maneuver with higher intensity, placing a greater
310 S. Chalmers et al. / Journal of Science and Medicine in Sport 16 (2013) 307311
level of physiological strain on the lower limb. This observation
is especially relevant for an acute quadriceps strain, because the
quadriceps muscle group plays an important role in force genera-
tion and absorption.22
Players with lower levels of aerobic endurance (20-m multi
stage shuttle run) were at a greater risk of shin/ankle/foot region
injuries (RR = 0.752), possibly due to these players experiencing
higher levels of fatigue at a comparative workload.12 Due to the
greater level of fatigue, those players may struggle to avoid poten-
tially dangerous contact situations in the later stages of quarters.
AF is a sport that is highly demanding on the elite athlete. On
average, elite junior players undertake 34 football training ses-
sions per week and compete in 12 matches per week, covering
a mean distance of 13.62 km per match.4,23 This workload may
expose players with lower aerobic endurance and poorer ability
to cope with the high running workload demands to more shin,
ankle and foot injuries, especially those injuries related to repeti-
tive loading. Increasing the aerobic endurance of players may act
as a viable method to reduce the risk of shin, ankle or foot injuries.
However, it is unclear why the upper leg was not a signicantly
greater risk of injury in players with a lower 20-m shuttle run.
The second part of the study was to identify if severity of injury
was linked with any physical tness qualities. First, a higher left
foot running VJ (RR = 1.022) was associated with increased injury
severity. This increase could be associated with the greater muscu-
lar and joint strain to jump higher and in turn, the increased load
upon landing. Data were not collected on leg dominance; thus, the
reason for a lack of relationship with right foot running jump is
unclear. However, it is feasible that the predominance of athletes
were right foot dominant. As such, the non-dominant left leg would
be loaded in stance at a greater level with high intensity movements
(kicking, sprinting, running, jumping).
Second, a faster 5-m sprint (RR = 0.021) may be related to an
increase in the severity of both contact and non-contact injuries.
Faster players may be prone to greater impact forces upon con-
tact with other players, potentially increasing the risk of long term
contact injuries such as fractures and ruptured ligaments through
being tackled, bumped or in a marking contest. Faster players might
also be at an increased risk of more severe non-contact injuries
during running and sprinting, as a result of the increased forces
absorbed by the lower limb musculature. In relation to the general
trend of an increase in injury incidence and injury severity for play-
ers with superior tness test scores, close physical monitoring of
this high risk group may be the only viable option.
The main limitation of the study was that the time between
tness testing and injury was not considered. Pre-season tness
testing may only be reective of injuries sustained early in the
season, as a result of the natural uctuations of player tness
levels over the course of the season. The limitations of the nar-
row missed match only injury denition and its bias towards
more severe injuries are outlined by Orchard and Hoskins.24 It
may be possible that some of the ndings presented here are as a
result of chance rather than being genuinely causal. Future research
should examine the classication of leg dominance, as this may
be a key component in determining the different results for left
and right foot VJ jump and injury severity. Determination whether
there is a relationship between pre-season tness test scores and
results of musculoskeletal screening may provide a greater level
of understanding of the factors inuencing injury in junior AF
players.
5. Conclusion
Lower aerobic endurance, faster 5-m acceleration and greater
agility were associated with an increased risk of various injury types
in elite junior AF players. Furthermore, a higher left foot running VJ
and faster 5-m acceleration were associated with injury severity.
This result may largely relate to a greater work capacity placing
a higher load upon their musculoskeletal system in contact and
non-contact situations.
Practical implications
Increase the aerobic endurance of players, in an effort to reduce
shin/ankle/foot injuries.
In relation to the general trend of an increase in injury incidence
and injury severity for players with superior tness test scores,
close physical monitoring of this high risk group may be the only
viable option.
This study supports ongoing research into elite junior AF injuries,
for which there are limited data available, for the development
of injury prevention programs.
Acknowledgments
The authors would like to acknowledge the valuable support and
assistance with the research from the SANFL, all nine SANFL clubs
and from the sport science staff at SASI. Furthermore, acknowledg-
ment is made to John Petkov for his valuable statistical advice. No
nancial assistance was obtained for the study.
Appendix A. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at http://dx.doi.org/10.1016/
j.jsams.2012.09.005.
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