‘Most people would prefer an operation than four months in rehab’

Anyone picking up a newspaper recently has seen that GAA players seem to be undergoing hip operations more often now than ever before.

Dr Eanna Falvey, of the Sports Surgery Clinic and the IRFU, warns, however, that surgery may not be the silver bullet that will solve every problem in this area.

“There are a couple of factors here,” he says. “In 2005 I was asked to review an elite intercounty player and we diagnosed hip impingement — basically he’d had groin trouble for years — but there was no-one to operate on him in Ireland at the time.

“Professor Kevin Mulhall in Dublin had trained in it but didn’t have the equipment at the time. Nowadays there are lots of guys to do it.

“When I came back from Australia in 2008 people were still talking about Gilmore’s Groin as the cause of groin problems, but I’d say that in our practice 25-30% of groin trouble is hip-derived.

“That has to be taken in context. If you went out into the general population and scanned an asymptomatic population, there’s an awful lot of abnormal hip morphology, or hip shape, and labral tears which aren’t symptomatic.

“I think we may now be where we were in the early 90s with knees, when I had my first arthroscopy on my knee and the doctor said, ‘you had a big tear but I got it all out and you’ll be grand’.

“Now I have arthritis in my knee.

“I’m worried that we’re very active in doing something about this now that we might regret in 15, 20 years time — that we’re operating on hips that won’t be operated on then.”

He has sobering hard statistics on hip operations: “When I in Australia I observed John O’Donnell and in 2008 he had done 5,000 hip scopes, nobody in Ireland had done any.

“But they’re coming full circle away from that in Australia now, just as we’re heading into that. We’re doing scopes now at a time that they’re moving away from it.”

Falvey breaks down the realities of hip injury: “Where you have abnormal hip shape and an abnormal range of motion, you’re more predisposed to groin pain and labral tear.

“The issue relates to the shape of the hip, a socket and a ball. The junction between the socket and the stem is the neck, and if the neck is prominent or the wrong shape it impacts against the edge of the hip socket and you develop labral tears.

“You can have the abnormal shape without a tear, but it makes the mechanics of your hip abnormal, resulting in a tear. The problem is that if a player has a sore groin then he’ll have 25 hurlers on the ditch will tell him he’s got a Gilmore’s Groin — and because there’s an operation for that, people see a quick fix.”

The attraction of that quick fix can be dangerous, he warns.

“The prospect of an operation and ‘it’ll all be okay’, well, that appeals to our psychology. Most people would rather an operation to four months of rehab with an ill-defined end point: you’re not sure when that rehab will be over, or whether the injury will be alright afterwards. But there’s a tacit agreement with an operation that you’ll be ‘better’ afterwards.

“The other factor is that if you have established wear and tear of your hip joints, doing a scope (operation) is not a good idea. Not only will it not make you better, it can potentially make you worse, so you have to be careful about who gets this done.

“There’s also a touch of bandwagoning going on about this, and there seems to be a fashion for guys going abroad now. Remember if you seek an opinion abroad you’ll get an operation abroad, but if your operation doesn’t work then it’s no skin off that surgeon’s nose.

“If you have an operation in Ireland that doesn’t go well, then it affects that surgeon’s trade: this would logically mean you are more likely to get an opinion that may be better for you in the long term.”

There are also issues relating to training, he says.

“There are people who’ll say, ‘well, isn’t this just an anatomical variant’, and it may be, but stack seven-days-a-week training on top, and it becomes a problem very quickly.

“Second, what hip changes do, they change the biomechanics of how your groin and pelvis work. If you’re loading, loading, loading in training, then you’re getting groin pain or hip problems.

“And finally, if you have biomechanical problems the heavy weights, particularly heavy weights with poor technique, tend to make those worse.

“There’s nothing wrong with heavy weights, they’re a very important part of conditioning, but if you have a labral tear or bad hip impingement, you shouldn’t be doing heavy squatting. That’ll make it worse.

“Now, we don’t know for sure, but if 30% of the population has hip problems, then 30% of the exercising population has that problem. And if the exercise load of that exercising population has doubled in the ten years, which would be a fair estimate, then bingo. You have a problem.”

Another problem is the ‘one size fits all’ approach to training teams.

“I was recently consulted on an intercounty GAA player who has a hip problem, and I recommended that he could manage — but that he should do his conditioning off-feet.

“He should leave his running for football, but he could do intensive interval work on a rowing machine, bike, in the pool, etc. Word came back from the squad, though, that he had to do the same strength and conditioning as everyone else.

“Why? You’re just going to break the guy.”

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