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AFL Medical Sub – Can it work?

Another year, another set of new rules from the AFL. The new man on the mark rule, quarters back up to 20 minutes, both have been met with both warm and critical reception. However, one rule drew most of the decision going into Round 1 of the 2021 AFL Season, and during the weekend: the medical sub.

For the uninitiated, the medical sub allows teams to name a 23rd player to the matchday team, but this 23rd player can only be called upon should a player be deemed ‘medically unfit’ to continue, such as in the case of an injury, or if a player has received a concussion. It follows calls for the AFL to do better when protecting players, particularly from head knocks, as well as allowing teams to better facilitate an injury crisis mid-game, which was all too common in the 2020 season given the hastiness and uncertainty that COVID-19 brought on all. The rule was already used to effect across multiple games, with it being both praised and maligned in its first showing.

What we want to ask is – can it work? That depends on how you look at it. As with any new rule or element being introduced, it’s best to weigh the pros and cons and figure out what will work going forward and improve the game and won’t work and should be scrapped or altered.


What Works?


Let’s start with what is most obvious: the need for the rule itself. For years, experts and the footballing community have called upon the AFL to do more on head knocks and concussions. Medical studies and their advances have shown the severe long-term damage that even one concussion can lead to in a player, with the worst cases often forming into cases of CTE. Sports across the world have worked to address this, with soccer being an example of forward thinking on concussions and head injuries. For example, the Premier League has trialled extra substitutes for concussed players, recognising that they’re special cases relative to other injuries. The AFL has seemingly followed this model, by allowing for an extra interchange – or sub – for a concussed player, but this time extending it to any type of injury that puts a player out of action. It’s a step in the right direction for the AFL, who are finally demonstrating that they are taking concussions seriously, and not penalising teams for being unfortunate with injuries in one of the most high-octane and contact-heavy sports in the world.

The AFL have also done well to introduce a rule whereby the injured player cannot return to action for a total of 12 days from the injury. As far as concussions are concerned, the skull and brain are delicate and need to be protected at all costs, so holding a player back and allowing their head time to heal and return to full function is necessary in preventing repeated trauma and associated conditions. The 12-day rule was already in place for concussions going into 2021, before it got absorbed as part of the medical sub rule as a whole, thus preventing players from also doing further damage to soft and hard tissue injuries. Player protection has been thrust right at the forefront by the AFL and we are all for it.


What Doesn’t Work?


Although well-intentioned, the requirement for a club doctor to deem them ‘medically unfit’, and then to submit a medical certificate to the AFL, can be subject to abuse by teams looking to game the season. Punishments for cheating the rule can be hefty, but that has never stopped teams from looking to gain a competitive edge in a win. Teams may instruct their club doctor to forge a medical certificate on behalf of a subbed player, who was never really injured and simply made way as a tactical substitution. It’s a hypothetical situation, but it can happen, and would be the equivalent of a family doctor helping their patient get a sickie from work. It can be easily manipulated.

On the flip side, an important player for a club may go down injured at a crucial point in the season, but rather than risk having that player mandatorily out for 12 days (potentially with a concussion, heavens forbid), coaches may opt to use a standard interchange for that player, play with a shorter rotation and not instruct the club doctor to assess the injury and rule them out for 12 days. It’s very touch and go, similar to the above point regarding medical certificates. Club doctors do fantastic work, but they may be forced into manipulating the rules at the hands of competitive coaches, willing to risk anything for a win. Thus is the nature of sport.

A way around this would be for the AFL to post independent doctors, who deem the medical fitness of players, and who write up the medical certificates. Independent doctors won’t have an agenda and won’t be subject to pressure from coaches and teams, so will only act in the best interests of the players. They will only be subject to the whims of the AFL, whom we are sure would rather not have a cheating scandal or a medical negligence case on their hands.


So, Is It Here to Stay?

Going forward, we think it is ultimately here to stay. The prevailing trend across all sports is leaning towards player safety, particularly around head clashes. The AFL are notoriously stubborn with their new rules and ideas, so we definitely do not see them budging on this one.

Granted, should they iron out the few kinks that the rule has, it will be a welcome addition to the AFL and something we could potentially look back on and realise its importance to improving the health and wellbeing of the players we love to watch.

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