GAA injuries: The Tipping Point
The ‘professional amateur predicament’. This is a term coined by the leading Irish physiotherapist, John Murphy. Murphy, a member of the GAA Medical Scientific and Player Welfare Committee, believes no player can expect to train to extreme intensity for a prolonged period of time within the constrains of a second professional life, ie your day job.
Cork footballers John Miskella and Anthony Lynch both retired from inter-county GAA last month. Even though they were amateurs in the strictest sense, they would have been the two of the most professional athletes I would have trained or played with.
They would also have been the most difficult opponents I’ve faced. Even at 33 and 34 years of age respectively, fitness levels and pace were not actually the reasons for hanging up the boots. In the case of both players, recurring injuries caused by years of wear and tear to the joints finished them. Currently, neither player is sure of even being able to play club football going forward.
Frankie Sheahan retired from professional rugby two years ago, having played more than 200 professional games for both Ireland and Munster during a 16-year adult career. Having started his playing career as an amateur, he saw how the fitness and training intensity between the amateur and professional era were broadly similar. It was the recovery and rest period afforded to the professional athlete that was the key difference.
“As professionals, the morning after a game, we would have a later-than-usual start and would always do a recovery session, just to get the blood flowing back into the muscles,” he said. “We’d have always got in an hour’s sleep in the middle of the day too and the evenings were our down time.”
Corkman Damien Delaney spent the last 10 years as a professional footballer in England in both the Championship and the Premier League. He is
currently with Ipswich Town, having been bought by Roy Keane. He played minor Gaelic football for Cork in 1999, winning a Munster Championship and believes the average inter-county GAA session is equal if not more intense than professional football sessions in England.
“Given that you may only be together three times a week on average, it seems as if you try to fit as much as possible into the sessions.”
During his summer break, Delaney was in gyms in Cork and gasped at GAA players, whose main requirements for the game are ball skill, squatting huge weights on bar bells. As a professional, he is never allowed to compromise technique for weight. The squats he will do are multidirectional and more often than not weightless.
For the amateur GAA player, the journey from injury or niggle to fully recovered stage is a process they fumble their way through. In the first instance, the majority of players will be unable to pinpoint any reason for the injury. Training logs and their analysis for spikes and troughs that may have caused the injury is a relatively new phenomenon being implemented by some of the more pioneering inter-county coaches, like Aiden O’Connell in Cork and Liam Moffat with Mayo.
For the majority of players however, cause and effect is seldom studied. The GAA player will then set about the rehab of the injury without clearly defined structures. The professional will have access to and be treated by a sequential series of rehab experts and with every occurrence of the injury, they will not return to action until they are 100% fit.
Many GAA players have a different approach. The short-term solution is the priority with a “can you get me right for Sunday” approach. Even at inter-county level with a good physio on board, there will be over 30 players to look after. A root and branch assessment is impossible with each player and if the problem is not straightforward, it can be almost impossible to find the right path in sufficient time.
The pattern is a familiar one. A niggle is followed by pain or a tear. Physiotherapist A is followed by Physiotherapist B.
A consultation with a specialist results in you being sent for a scan. Physical therapists, osteopaths, chiropractors, orthotics, etc.
In April 2009, I noticed my right hamstring getting unusually tight high up my leg.
Massage and stretching gave immediate relief but it got worse over time. As part of an inter-county panel in mid-season chasing an All-Ireland, you do what you can to get right.
From June to September, the maintenance schedule became almost round the clock. Hot water bottles, tiger balm, massage and stretching before sessions, followed by ice packs after each session with heavy massage, pool work, and endless further stretching before the next one. Sometimes an injection was chosen. You will tell management you are getting it sorted but you won’t let them think it’s a major problem, for obvious reasons. Just go away and get it right in your own time, somehow. By the time the season ended in September, scans confirmed the tendon to be severely damaged by playing through.
Despite an intense four-month rehab, I still couldn’t take the field the following March without the pain and tightening of the hamstring. At 29 and a now peripheral member of the Cork squad, I was in no position to continue even at club level.
To be fair, the physio team with Cork were excellent but playing at the top level and rehabbing at the same time was impossible. Injuries will linger and bigger problems will follow.
Derek Kavanagh experienced the same torturous regime in 2010. His was a hip problem: “From the start of the year, I adopted a strict recovery regime [particularly aqua jogging/pool sessions] to counteract my symptoms.
“I did two pool sessions for every one pitch session and limited impact by missing club sessions when I could. I also got three cortisone injections in hospital throughout the year… the schedule just wasn’t sustainable for more than a few months. At 31, I am now retired from everything.”
At 28, Diarmuid Duggan was man of the match in the Munster final for Cork against Kerry in 2008. By the time he was 30, his club and county career was also finished, again due to restricted hip mobility. Between them, Kavanagh and Duggan explored all the available rehab solutions both in Ireland and Britain. Injections, operations, specialist followed by specialist. All said the same thing. It was too late. Years of doing too much and doing the wrong thing. The damage was done. Kavanagh looks back and sees two distinct periods in his career.
“It seems as if I spent the first half of my career pushing my body’s limits on the pitch and in the gym, without fully understanding all the exercises and the effects they would have on my body, while the second half was spent mostly on treatment tables and gym mats trying to stretch out and undo much of the damage done.”
Mike McGurn uses the term ‘periodisation’. This is an important point. How many college or U21 players are required to merge the end of their championship seasons into the start of another one at senior level for two if not three years in a row? Of course, many conscientious coaches will make allowances but many just do not realise that, unlike professional sport where the physical limits can be pushed further, an amateur sport has to have a tipping point and if you pass it, you are left with diminishing returns over time.
The injuries resulting from the load factor — in layman’s terms, doing too much — are one side of the coin. Of equal concern, are doing the wrong things.
McGurn makes the point that many GAA players are all too willing to do what is prescribed, but when that’s incorrectly shown to the players on day one, or incorrectly monitored for execution in the training regime thereafter, it can be just as dangerous.
“Squat, power clean, dead lift are all exercises being prescribed to players who are executing them wrongly,” says McGurn. “I feel anybody prescribing any type of training programme has a duty of care to ensure the work being done in the gym and on the training pitch is suitable, appropriate and properly periodised and includes proper warm ups and recovery strategies.”
McGurn’s duty of care sentiments are admirable but the tragic upshot of this is that, for as long as success is measured by progress within a given season or two, the long-term problems will always be second priority on an organisation-wide basis. Absolving responsibility to individual coaches and managers is a fool’s errand (one friend of mine played with 13 different teams in one season when in first year of college).
Real change is always more effective when it is accepted and implemented from a top down structural point of view.
In a redeveloped Páirc Uí Chaoimh with its Centre of Excellence, would it be beneficial to have a fully staffed 8am to 10pm gym where every member of any Cork panel from minor upwards would be afforded the flexibility to swipe in/swipe out and go about programmes under watchful eye of fully qualified staff?
Then again, this is a cost and worse still, could be perceived as stepping too close to the dark side of professionalism, as opposed to protecting players!
From my own experience, I travelled to what seemed like the entire country in 2010 trying to find a solution to my hamstring issue (including 16 trips to another ‘specialist’ in Galway).
Eventually, I was referred by a friend to John Murphy at the Carysfort Clinic in Dublin. Unlike the physiotherapist attached to every GAA team up and down the country, Murphy is not answerable to any coach or trainer with a matchday deadline. He was able to take time and explain to me the basics of free movement and sequence of movement through the joints. He tasked me with taking a step back and opening up all the major joints down through the body.
Once these were freed up, the muscles followed suit and began firing in sequence once more. When a therapist is able to spend time diagnosing a problem and later explaining that solution, it becomes very easy to buy into, especially when it makes sense to the player himself.
Having worked as physio to the Dublin footballers, Murphy is convinced that damage is nearly always just the symptom in non-contact injuries such as strains and tears. The cause is inevitably mobility and range of movement being restricted by years of overly heavy and incorrect training. This is cumulative. What’s worse is the reason is far more obvious.
“Take the 24-hour or 48-hour period between training sessions for the amateur GAA player. Most sessions end with an inadequate (cool down). A token lap of the field with a few half-hearted stretches. The player will drive home, likely sit on the couch for an hour and then go to bed. The following morning, that player will get up, drive to work and sit at a desk [hips locked] for the majority of the day.
“Over time, range of motion is eroded and resultant stiffness, soreness and tears emerge.
“Compare that to the life of a professional athlete. The professional will be disciplined into the warm-down phase after a session but more importantly, he will be able to get up the next morning and do his mobility work and rest appropriately. Range of motion is retained.”
Murphy explained that as we all age, our lumbar spine and hip joints begin to wear, stiffen, work incorrectly and become less functional. High-intensity exercise will accelerate this process so it is vital that training regimes are changed for players as they age. With chronic injuries, Murphy stresses that only corrective/preventative exercises addressing the entire Kinetic Chain (and more rest) of the body can lead to longer and safer careers.
So what are the solutions that can be rolled out on a macro level?
If anything, intensity appears to be actually increasing. Dublin’s well publicised twice a day regime (before and after work) took things to a new level. The fact they were successful will inevitably lead to copy-cat regimes amongst many inter-county panels in 2012. After all, the evidence suggests that clocking up the man hours is the easiest and fastest way to further injuries (79.3 injuries on average per thousand hours).
Accepting fate and turning inter-county teams semi or fully professional across the board is not viable without jeopardising the club and many of the structures that are so important to the GAA. On the other hand, placing a leash on teams and trying to police training levels in such a fiercely competitive environment is practically impossible, especially when one considers that the closed season is now a pseudonym for boxing, basketball, circuits and gym work.
To be fair to the GAA hierarchy, an ambitious project was established in 2006 to put a system in place to understand GAA field sport injuries. Its aim is to initially measure the incidence and nature of injuries sustained in GAA field sports. This information is essential as it provides a baseline of injury data, from which the GAA and its Medical Scientific and Player Welfare Committee can strategically plan and place player welfare at a premium. The next stage is to begin testing the intervention training methods.
All this needs to take place before they can try to implement a more focused training schedule, where less injury is the focus. One of these is currently at the pilot stage. Needless to say, this will all take time.
The uneasy feeling is that intensity levels will continue towards their tipping point for some years yet. Those in charge of inter-county panels will be judged on games won and not avoidance of hip replacements 10 years down the line.
One thing is clear: the players themselves are in no position to row back. Even with the prospect of a hip replacement before the age of 40, would they swap their sporting careers for a body less wrecked?
Derek Kavanagh, Bernard Flynn, Diarmuid Duggan, John Miskella, Anthony Lynch all had a one word response — no.
* The author is a former Cork inter-county footballer
“My quality of life at 39 years of age, before I had my hip replaced, was truly appalling.”
Bernard Flynn, Meath inter-county footballer 1986 to 1995.
“I played in an the All-Ireland final just over 12 months ago. Now I can’t go for a light jog without suffering extreme inhibited movement and substantial pain.”
Derek Kavanagh, Cork inter-county panel 2002 to 2010.
“A lot of GAA training prescription does not follow any sensible periodisation of loading and unloading. Not every training session can be done at 100% intensity especially when the player has to get up and go to work for the next two days before the next flogging session.”
Mike McGurn, former strength and conditioning coach to the Ireland rugby team, and Compromise Rules squad. Current Performance Director with Armagh.
“I often hear retired players saying that hamstrings were not around in their day. Well, I remember those days and it often involved meeting up three weeks before championship to see what the team might be! There was no training in the league. There was no load factor!”
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