Sports injury forecast in a blood test… coming soon to a footy team near you?

Port Adelaide footy players are rightly feeling pretty good. They are sitting in fifth position on the AFL ladder, have had a few decent wins (including a nail-biter against Collingwood), rested up through a bye weekend, and gave Geelong a proper shake before the Cats got away from them in a fourth-quarter blitz.

Behind the team’s power performances is a science program that is revealing new information about how the body and brain communicate. Dr Ian McKeown, Head of High Performance at the Port Adelaide Football Club (PAFC), says the players have been part of a discovery that their blood carries signals that potentially predict whether or not they’ll have a good game. Sugar decorations on proteins in the blood of stars like Robbie Gray, Sam Powell-Pepper, Travis Boak and Ollie Wines could also indicate if they are becoming susceptible to injury – vital information that players, coaches and support staff would love to have.

The research was undertaken by the ARC Centre of Excellence for Nanoscale BioPhotonics (CNBP), in collaboration with PAFC.

McKeown says he is always on the lookout for research projects that might give his players an advantage, either now or down the track. While most clubs would have someone in his position focus on sports science and sports medicine, PAFC tends to be a bit more leading edge.

“I’ve striven to make sure that we are not just following what’s published out there, but going after the world’s best thinking and practice before it gets published,” McKeown says. “Our playing group are quite abnormal and special in that they really embrace this stuff. They’re feeling like they get information that no other AFL athlete has.”

At a sports medicine conference a couple of years ago, Professor Mark Hutchinson – also of the CNBP – met McKeown and told him about the Centre’s research into blood biomarkers.

“My research team were looking at how the brain and body were connected, and that what occurs in our blood immunology reflects what happens in our brain,” Hutchinson says.

“We had applied that to pain research – sort of a blood test for pain.”

“By the time you have a player with a foot that’s sore to touch, it’s too late.”

This greatly interested McKeown at PAFC. “One of the biggest questions we’ve got is around bone stress,” he says. “For example, by the time you have a player with a foot that’s sore to touch, it’s too late – you have maladapted bones and you have to take weeks off. Once these things are happening, they creep up on you like a silent killer. So the question was, is there something in our blood or in our markers that is an early warning system that we can look out for?”

Hutchinson had received funding from the Australian Defence Science Technology Group, which was interested in how to ensure military personnel perform at the highest levels possible.

“Much of the work in this area has been done on university students, not elite physical people at the edge of their physical abilities,” he says. “It’s rarely done in…hardened, active individuals of a military age… Meanwhile, Port Adelaide are trying to maintain a baseline of operational readiness at an elite level and operate them almost at the threshold of their physical capability. The players are ready on the sports field to undertake a profound amount of cognitive processing on a high-stress, high-demand physical baseline.”

A partnership was formed to develop the research. Although the initial phase finished last year, the research is ongoing.

Before and immediately after their vigorous training sessions, Port Adelaide players were taken to a room under the stairs called The Dungeon, where they gave a small blood sample and undertook concentration, focus and speed tests on computers. Their blood markers were then analysed and compared with the results of the tests.

A total of 26 markers were shown to be significantly related to players’ immediate performance. Of these, 22 were types of soluble plasma glycans (the sugar decorations on proteins) and the others were proteins.

“The morning sample we took was almost predictive of the day.”

The results suggest that not only can these blood markers show how a player is currently performing, but they can also predict how players will perform, with nine markers taken pre-training correlating with cognitive performance tests done after the completion of training. “The morning sample we took was almost predictive of the day, which is almost like saying, ‘Am I going to have a good day or not today?’” Hutchinson says. “Milliseconds can be the difference between taking a mark, making the kick or making a good decision on a battlefield.”

Dr Daniel Barratt, a researcher at the University of Adelaide who was involved in the initial analyses, says the biomarkers could be causing the change in performance, or they could be produced as a result of the change in performance.

“There’s definitely enough that we want to investigate it further,” he says. “When one player was injured, we saw they had a lot of proteins in their plasma that were extremely high for that player. We also saw similar protein spikes in other players, who hadn’t incurred serious injuries at the time, but who missed trainings in subsequent weeks, raising the possibility of an early warning system.”

“We think the physiology is telling their body that ‘you’ve got an injury, you’ve got to adapt,’ but the brain isn’t telling them that,” Hutchinson adds.

McKeown says the results were “pretty damn cool. It’s early in the process but it’s very exciting stuff.”

He says it is extremely difficult to obtain data on injury prevention research in AFL players and other elite athletes. “The reason why injury prevention work is so hard to get a handle on is that we’re trying to stop these things from happening in the first place, so the numbers are so low. We don’t have as much information as we’d like from a mathematics or data analytics point of view.”

During the whole study, only two serious training injuries coincided with study days.

For footy players’ biomarkers to be regularly read and the information applied in a useful way, an easy-to-measure system would need to be created, targeting fewer than 10 markers. McKeown says such a tool would help the coaches with the quality control of training for individual players.

“Maybe something like mindfulness will be reflected at a cellular level better than we think.”

“There are times in the pre-season when we don’t want total recovery because we need to create a training effect for the body to adapt to stress… And this could be a great way for us to be able to quantify that. Maybe we learn this player can go even further, or we need to take him back a step.

“And because we [run] a holistic program, maybe something like mindfulness will be reflected at a cellular level better than we think, so we can say to a player, ‘This actually will help you when you run out on to the MCG at the end of September’.”

Hutchinson says when they can understand the different signals being sent in the blood, the information might lead to solutions such as giving a player an ice bath, extra nutrition, anti-inflammatory medicine or a physical stimulus. The ultimate end goal for the Defence project is a “Tom Cruise-esque patch on the skin attached to electronics to allow for real-time measuring and application of fluids”, which would ensure military personnel continue performing at their peak.

In the meantime, the men in teal, silver, black and white will keep using science to remain at the top of their game.

“At the moment we’re looking at questions around how do we create the best learning environment for our players so they can impart what they can do in a game,” McKeown says. “We’re trying to reproduce the stresses in a game and giving them the tools to solve them, so on game day not only will the players be capable of executing a laser-guided 40-metre kick through traffic, they will have made the correct decision with the time and space provided to them.”