By Doctor Liam Hennessey. Let’s face it… A GAA player will never go through a season without sustaining some type of injury. Indeed, you are twice as likely to get injured playing a Gaelic football match than playing soccer. And why is it that a rugby player is three times as unlikely to get injured in training than a Gaelic player but twice as likely to be hurt in a match?
The answers lie ultimately in the amount of physical pressure we put on our bodies but also on the methods we employ to ensure our bodies can handle that pressure. So why is the attrition rate is so high in Gaelic games and what measures can be taken to prevent injury?
There are two types of study that have been made in Ireland into injury in Gaelic games.
Retrospective study uses various methods to recall injuries that have already taken place. For example, many researchers send questionnaires to players, physiotherapists or doctors. In it they are asked to recall the incidence, severity and duration of an injury that may have occurred in a training session or playing season. This method of data gathering is an accepted form of gaining information on injuries in sport but its accuracy is questionable. The retrospective study is highly dependent on the accurate record keeping and indeed the memory of the respondent. Thus the retrospective injury study is often prone to imprecise detail.
In contrast a prospective study is considered to be a more reliable and accurate representation of the nature of sport injuries. The injury is recorded as it happens. It is recorded and reported by a qualified and experienced individual. It is not prone to the vagaries of memory to recall the injury detail.
Unfortunately there are few prospective studies examining injuries in Gaelic games. Having this type of study and information would help the coach to identify the most common types of injury and the factors associated with the injury occurrence. Therefore a programme could be tailor made for players to prevent suffering from that type of injury. Several studies have been conducted into player injury in Gaelic games. The main facts are as follows.
Rates of Injury
Injury studies report injury in terms of hours out due to injury in 1000 hours of participation (both training and playing in matches). Some studies report the rates for each activity (training and playing) separately. Training can include all physical and practice units. However let us try and make some common sense comparisons.
The injury rate of 51.2 per 1000 hours for Gaelic football can be put into perspective when compared to injuries in other team sports.
For example, an injury rate of 26 per 1000 hours of playing has been reported in elite soccer players. In professional rugby it has been reported that an injury rate of 91 per 1000 hours playing occurs. However, other studies show that injury rates in rugby at international level are as high as 218 injuries per 1000 hours match play. Compared to Aussie Rules the injury rate for playing Gaelic football is virtually double that for Aussie Rules. Thus comparing Gaelic football to elite soccer players, professional rugby and Aussie Rules injury rates, there seems to be more game related injuries in rugby compared to the three other popular field games (See Figure 1).
When training and practice injury rates are compared however, it seems that Gaelic football has the highest injury at 5.8 injuries per 1000 hours training. In contrast a rate of 2 per 1000 hours training for rugby players and 5.2 injuries for soccer players proves that GAA training could be adapted to prevent unnecessary injury.
TYPES OF INJURY
There are some common trends evident in the studies that have been completed to date. For example the most common types of injury in both Gaelic football and hurling are bruises and contusions, strains and sprains. It does appear that hamstring strain is a common type of injury between both codes. It accounts for approximately 26% and 20.5% of injuries in Gaelic football and hurling.
Knee, ankle and groin injuries in addition to hamstring injuries account for the majority of soft tissue injuries found in both codes – in all between 70% and 78% of injuries are soft tissue in nature. Thus lower limb injuries predominant in Gaelic games.
However, a recent collaborative study# reports that 86.7% of senior inter county hurling players received head and facial injuries during their career. This suggests that while head and facial injuries are not the predominant injury they nevertheless occur and most demand hospitalisation or a visit to an A&E department
·Injury by playing position
There is no difference between playing positions in terms of injury incidence in either football or hurling.
·Time of Injury
Studies tend to agree that most injuries occur later in the game and later in training. This suggests that fatigue is directly related to injury and that there may be a lack of conditioning for players to cope with the physical demands of the game.
CAUSES AND CURES TO INJURY
Players are most often injured in a tackle. A footballer in possession is more likely to be hurt (17.8%) than the player making the tackle (10%) – which accounts for 27.8% of all injuries. The tackle was also responsible for a significant number of injuries in hurling. Other factors contributing to injury include free running movement including sprinting (14.4%) and turning (13.3%).
Further, it has been reported that a significant number of hurling related injuries were as a result of a recurrence in injury suggesting that players had not recovered completely from a previous injury and following a return to training or playing were more exposed to a recurrence of the initial injury.
Given that being tackled in considered a major cause of injury it is clear that the authorities should examine this element of the game and consider what might be a clear set of rules so as to reduce the risk of injury from being tackled. Further it is not clear from the studies on injuries in Gaelic games, as to what the tackle constitutes!
As stated previously, the fatigue factor plays a big part in the occurrence of the injury. This is a very interesting point as often players have a large volume of training already completed in the build up to key games. In fact it is possible that players may have overworked in training and as such may be fatigued due to an excessive training, practice or indeed playing schedule.
Looking at the high incidence of injuries that occurs (for example 17.7% of injuries occur when sprinting and turning) where no tackle or contact is taking place also supports the possibility that players’ training is not suited to meet the demands of the game. Sprinting and turning are common actions and activities in all field game sports and in particular in Gaelic football and hurling. However, the injury stats may indicate that that these common activities – accelerating, decelerating and sprinting and turning may not be well executed by players. Thus training should address the players’ mechanics of accelerating and decelerating as well as sprinting and turning so as to condition them to be able to complete these basic movements very efficiently.
The aggravation of old injuries and poor posture are considered a greater risk compared to hip flexibility. This has implications for the methods used in conditioning players as attention to such issues as basic stability, balance and general limb strength have been shown to decrease the risk of Gaelic game injuries.
In hurling wearing a helmet is considered important in reducing the exposure to head and facial injuries. Other factors are also associated with a reduced risk of injury and they can be summarised as follows:
- Proper conditioning
- Proper playing surface
- Proper playing footwear
- Progressive warm-up
- Stretching post-training
THE ROLE OF CONDITIONING
Numerous experts suggest that a proper conditioning programme will contribute to a reduction in the risk of injury during team sports. The application of a structured programme, that marries the needs of the players with the demands of the game, is likely to contribute to a reduction in injury risk.
This programme should include a structured and progressive strength-training programme. The starting point for this is with a functional competence screening. Following this a period of anatomical adaptation is required. The duration of this anatomical adaptation period will be dependent on the level of athlete or player in your group. Not only will such a programme reduce the risk of injury it will also assist in performance improvement.
A common debate regarding injury risk often centres on the role of flexibility both in terms of completing flexibility during the warm-up and in the extent of a player’s range of movement capability. There is little evidence to suggest that completing static flexibility exercises during a warm-up will reduce the risk of injury. In fact, there is strong evidence that completing static stretching during a warm-up will reduce the strength and power of the stretched muscles. Performing progressive dynamic stretching during a warm-up is now considered to be a more appropriate means of preparing the body for training or a game.
Interestingly there is good evidence to recommend static stretching following training as a means to reducing the risk of injury in a subsequent training unit or game. This is often an overlooked feature of modern training and is perhaps something that should be addressed by all coaches and players.
Coaches should be aware of the limited yet important studies that are available on injuries in Gaelic games. More importantly the coach needs to know the common types of injury occurring and take steps to implement a sound progressive conditioning programme to reduce the risk of injury. This should influence the methods used in training a team. The needs of an individual programme of functional training also to be catered for.
Studies on injuries in Gaelic games – Wilson et al 2007, Newell 2006, King et al 2005, Hennessy et al 2005, Newell et al 2004, Crummie 2004, Hennessy & Watson 1994, Hennessy 1993.
Abernethy and Bleakley 2007, Brooks et al 2006a and 2005a/b/c, Nelson et al 2005, Hagglund et al 2003, Orchard & Seward 2002, Herbert & Gabriel 2002, Fleck & Kraemer 1997, Bompa 2005, Bangsbo 1994, Ekstrand et al 1983.