A critical review of injury distribution in elite Gaelic football and the presentation of a holistic management model.
As one of the national games, Gaelic football (GF) is one of the most popular sports in Ireland. Players represent their clubs (their town of birth) and if deemed good enough are selected to play for their counties, the “elite” level within the sport. Although an amateur sport, the demands on elite players are akin to professional athletes as not only do they effectively play with 2 teams, the level for preparation at the elite level is highly demanding, (Kelly, Banks, McGuinness, & Watson, 2018).
The nature of the GF season schedule requires elite players to peak over a 37-week period. Typically, the elite season lasts 9 months divided into four cycles: preseason (weeks 1- 7), competitive cycle one (the National League, weeks 8-16), mid-season (weeks 17-22), and competitive cycle two (encompassing the Provincial and National Championships, weeks 23-34), (Roe, Murphy, Gissane, & Blake, 2018 a). Once finished playing with their counties, players then return to their clubs to participate in the competitive county championships, (Figure 1).
Figure 1 outlines two competitive cycles in which a typical elite player must peak for competition (Competitive Cycle 1 & 2). Additionally, during the midseason and the intercounty offseason the player will play Championship Games with his club. The results in substantial periods at which the elite player must peak for competition.
This schedule places huge demands on the elite players and with higher demands comes longer periods of match play, higher training volumes, gruelling travel schedules and less down time than their club counterparts (Kelly, Banks, McGuinness, & Watson, 2018). The aim of this blog is to identify the injury rates and risk factors in elite GF in an attempt to identify highly susceptible players so that holistic injury risk management strategy can be implemented.
Injury Analysis
Research into GF injury epidemiology has identified that most injuries occur in the lower extremity (76.0 %), with muscle tissue reported as being the most frequently injured tissue (42.6 %), (Murphy et al., 2012), see Figure 2.
These findings are supported by Roe, Murphy, Gissane, & Blake (2018 a) and taken together suggest a very stable four site injury pattern in GF distributed between the hamstrings, quadriceps, the ankle joint and the groin/adductor sites. This is not to suggest that upper body injuries do not occur in GF, however only 11 % of reported injuries occur in the upper extremity (Figure 2).
Given the high reported distribution of lower limb injuries (see Figure 3) it seems prudent to prioritize these areas (see Figure 4) in an injury risk management strategy. A screening process to establish the players current capacity in these areas would inform the coach when developing a strength training program.
Figure 4- Stable 4 site injury pattern in Gaelic Football.
Factors such as knee flexor strength, adductor squeeze score, the Copenhagen Hip and Groin Outcome Score (HAGOS), single-leg drop landing and jump performance, Star Excursion Balance test in the posterior direction, hamstring strength and aerobic fitness have been shown to modify primary and secondary lower limb injury risk, (Malone, Roe, Doran, Gabbett, & Collins, 2016; Delahunt, Fitzpatrick, & Blake, 2017; Doherty, Bleakley, Hertel, Caulfield, Ryan, & Delahunt, 2016). Therefore the testing protocol to screen such factors is outlined below.
1) Adductor Groin Squeeze Test
2) Single Leg Hamstring Bridge Test
3) Single Leg Drop Landing Test
4) Star Excursion Balance Test
5) 30-15 Intermittent Fitness Test
Risk Factors
Each player is unique biomechanically and structurally Therefore each player has unique injury risks and even though we cannot predict injuries, we can assess the risk factors and apply interventions where appropriate.
Previous Injury History & Age
In a 7 year prospective investigation of lower limb injuries in elite GF, a total of 56.8% of players with a previous lower limb injury sustained another (Roe, Murphy, Gissane, & Blake, 2018 a). Such findings suggests factors making these players susceptible to initial injury may
not have been adequately addressed during rehabilitation or in training following return to play. Additionally, injury rates were greatest for players aged >25 years, as well as those in the forward playing position; suggesting that tailored interventions may need to be targeted at these sub-groups of players.
Matchplay demands pose highest risks.
Lower limb injuries occurred 10-times more frequently in match-play than in training (Roe, Murphy, Gissane, & Blake, 2018 a). In field sports with similar match-play movement profiles, force production, postural control, and sprinting performance are known to be impaired following simulated match-play (Small, McNaughton, Greig, & Lovell, 2010). Such adverse responses may also be more pronounced during congested competition periods. Therefore, adjustments in training volume during these periods should be considered, (Roe et al., 2018 a ).
Under Recovery – Managing training loads
Malone, Roe, Doran, Gabbett, & Collins, (2016) examined the association between combined session-rate of perceived exertion (RPE) workload measures and injury risk in elite GF. Session-RPE in arbitrary units (AU) for each player is derived by multiplying RPE and session duration (min). For example if a player reported an RPE of 6 for a 100 minute session then it would equate to a 600 AU. They found that high weekly workloads (≥2770 AU) were associated with significantly higher risk of injury compared to a low training load reference group (<1250 AU). These findings highlight an increased risk of injury for elite GF players with high (>2.0) acute: chronic workload ratios and high weekly workloads. Furthermore previous investigations in elite GF reported no differences in weekly workloads between preseason and competitive cycles, however, spikes in weekly workload were associated with greater injury risk during late-in season compared with other cycles, (Malone, et al., 2016 b). This suggests that players tolerate similar workloads differently throughout the season, possibly due to differences in fitness levels and the specific demands of match play exposure. This highlights the importance of clear communication between coaching personnel when discussing and managing weekly workloads for players. Weekly monitoring of training loads and implementing moderate workloads, coupled with moderate-high changes in the acute: chronic workload ratio appear to be protective for GF players. Special consideration must be given to players who are competing for multiple teams, who have additional lifestyle stresses, a higher training age and/or previous injury history.
Training Methodology
Injury is never a fault, it is a responsibility.
Training design, behaviours and methodologies play a key part in the player welfare process. Outlining and adhering to predetermined weekly schedules allows players to organise their lives outside of the sport and reduce social and emotional stress. On field practice design where fatigue is monitored & mitigated by adjusting volume and intensity through subjective and objective data allows coaches and players to make training interventions when necessary.
Successful interventions are anchored on successful communication.
Finally and possibly most importantly, fostering an environment where players feel safe to express themselves to coaching staff is a key variable in the injury management model. Each player is a puzzle of needs, wants, drives and insecurities and it is our role as coaches to augment relationships and trust so that the player feels safe to express themselves. If a player is feeling tired or run down, is dealing with relationship/work stress or has any other additional stress in their lives, all the scientific models in the world will not work unless he communicates with management. The coaches eyes and ears are by far the most reliable monitoring and communication tools available to him. Flexible communication is a must. Everything we do as coaches is a screen of some sort, which should provide us with data (both objective and subjective) that we can use to enhance the quality of care we provide to our athletes.
We spend so much time learning about the history of an athlete’s body, but far too little time learning about their mind and as coaches in the team environment we sometimes forget that there is just one player at the centre of the coaching process thus, elite GF players need an individualised holistic management model that puts the player at the centre of the process as outlined in figure 6 .
Figure 6- 12 point holistic management model placing the individual athlete at the centre of the process.
References
Doherty, C., Bleakley, C., Hertel, J., Caulfield, B., Ryan, J., & Delahunt, E. (2016). Recovery from a first-time lateral ankle sprain and the predictors of chronic ankle instability: a prospective cohort analysis. The American journal of sports medicine, 44(4), 995-1003.
Delahunt, E., Fitzpatrick, H., & Blake, C. (2017). Pre-season adductor squeeze test and HAGOS function sport and recreation subscale scores predict groin injury in Gaelic football players. Physical therapy in sport, 23, 1-6.
Kelly, E., Banks, J., McGuinness, S., & Watson, D. (2018). Playing senior intercounty Gaelic games: experiences, realities and consequences. ESRI research series number 76 September 2018.
Malone, S., Roe, M., Doran, D. A., Gabbett, T. J., & Collins, K. D. (2016). Aerobic fitness and playing experience protect against spikes in workload: the role of the acute: chronic workload ratio on injury risk in elite Gaelic football. International journal of sports physiology and performance.
Murphy, J. C., O’Malley, E., Gissane, C., & Blake, C. (2012). Incidence of injury in Gaelic football: a 4-year prospective study. The American journal of sports medicine, 40(9), 2113-2120.
Roe, M., Murphy, J. C., Gissane, C., & Blake, C. (2018 a). Lower limb injuries in men’s elite Gaelic football: A prospective investigation among division one teams from 2008 to 2015. Journal of science and medicine in sport, 21(2), 155-159.
Roe, M., Murphy, J. C., Gissane, C., & Blake, C. (2018 b). Hamstring injuries in elite Gaelic football: an 8-year investigation to identify injury rates, time-loss patterns and players at increased risk. British journal of sports medicine, 52(15), 982-988.
Small, K., McNaughton, L., Greig, M., & Lovell, R. (2010). The effects of multidirectional soccer-specific fatigue on markers of hamstring injury risk. Journal of Science and Medicine in Sport, 13(1), 120-125.
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