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Player Welfare & Injury Prevention:
What now?
Marty Loughran
Physiotherapist
Making Headlines
• GAAInjuries:Thetippingpoint
ConorMcCarthy,IrishExaminerJanuary28th2012
• 'Rugbyplayersdon'tknowhowtheydoit'
MarieCrowe,SundayIndependentJanuary29th2012
• “GAAplayerspushedbeyondbreakingpoint."
DrTadhgMacIntyre,BelfastTelegraphFebruary9th2012
• “RebelragesthatCorkGAAlefthimwith€7000medicalbill”
FintanO’Toole,IrishExaminerFebruary20th2012
Still making headlines…
• “KneeInjuriestoplistasGAAshellout€8mininsuranceclaims”
IrishIndependentFeb2014
• “Pleasestopthisabuse”
SundayWorldJan2014
• “Arehipinjuriesjustthepricewepayforastronger,faster,morepowerfulgame”
IrishTimesJan2014
• “Moynawarnsoftraininghealthrisks”
Groundhog Day….
• What’s the point?
Joe Brolly, Gaelic Life, 11th
January 2015
• Saving the GAA
Joe Brolly, Gaelic Life, 19th
January 2015
• Enough words, now its time for action
Joe Brolly, Gaelic Life, 26th
January 2015
• Treat the lifeblood with respect
Joe Brolly, Gaelic Life, 8th
February 2015
• Paraic Duffy says GAA to tackle
fixtures and welfare issues
Irish Times 28th
January 2015
• Its not dark yet, but it’s getting
there
Eamon Sweeney, Sunday Independent
18th
January 2015
• Earley pays price for playing through
pain
Irish News, 19th
February 2015
How big is the problem really?
• What is the reality?
• How has this come about?
• What can we do about it?
What Percentage of players in a senior inter
county squad will get injured each year?
67%
Some players get injured more
than others
34 players = 40 injuries
1.2injuriesperplayerperseason
More likely to get injured during
matches or training?
Matches
15timesmorelikelytogetinjuredinmatches
Biggerthematchthemorelikelyyouaretogetinjured
25% of all injuries are recurrent
injuries
Previous injury is the No. 1 risk
factor for future injury
What are the most common
injuries in GAA?
•Hamstrings20%
•Pelvis/hip/groin13%
•Knee11%
•Ankle10%
Hamstrings
• 2007-13 average 18%
• 2014 season 26%
• Why the surge?
ACL
• 1% of total
• Large time loss
• 1/squad/biannually
• Knee OA unavoidable
• Significant changes in 10-15
yrs
• Financial Loss
• QOL
How do GAA injuries
happen?
Contact v Non contact
32% v 68%
•Sprinting 27%
•Turning 12%
•Landing 7%
•Kicking 5%
Why do injuries happen?
Oslo Sports Trauma Research Group
Unfortunately its not as simple as that…
Oslo Sports Trauma Research Group
Summary
• High injury rate in GAA (2/3 of squad)
• 68% of all injuries are non-contact injuries (?preventable)
• 25% of all injuries will reoccur
• Previous injury, decreased flexibility, strength and control
can cause future injury
• Big 4 - Hamstring, groin, knee, ankle
• Potentially large number of undocumented overuse
injuries
• Some Injuries are catastrophic and having wider ranging
effect beyond sporting life
Why are we so injury prone?
• Previous injury, decreased flexibility, strength and
control can cause future injury
• Fixture calendar
• Decreased recovery / Overtraining / Non-
application of sports science
• Early specialisation
• Developing S&C culture
What can we do about it?
Individual Intervention
or
Group Intervention
Group Intervention
Contact v Non contact
32% v 68%
•Sprinting 27%
•Turning 12%
•Landing 7%
•Kicking 5%
The Sequence of injury prevention
Implementation Stage
• Launched at 2014 conference by Mario Bizzini
(FIFA) to 400 Delegates
• SINI launch to sports medicine community (100+)
• 50 Workshops
• Rolled out to over 1000 coaches
• 4/5 workshops in each of the 9 counties
Website
• 54,000 hits
• Over 8000 unique users
• Viewed from 11 countries GB,
USA, Canada, Australia,
Scandinavia & Spain
Individual Intervention
Predicting who is at risk
Screening
The Big 4
Screening for Hamstring Injury
1. Previous Injury
2. Hamstring Strength
(Single leg hamstring bridge test)
Screening for Hip/Groin Injuries
1. Previous Injury
2. Hip ROM tests (FADIR, IR ROM)
3. Provocation Tests (squeeze
test)
Knee Screening Tests
1. Previous Injury
2. Landing/cutting technique
Tuck Jumps
LESS
Ankle Screening Test
1. Previous Injury
2. Balance Deficit
Star Excursion Balance Test
(SEBT)
ONGOING PROCESS
Why are we so injury prone?
• Previous injury, decreased flexibility, strength and
control can cause future injury
• Fixture calendar
• Decreased recovery / Overtraining / Dearth of
sports science
• Early specialisation
• Developing S&C culture
Early Specialisation
• Cam Deformity
• Link to hip pathology, loss
of ROM & Hip/Groin pain
• Form pre PHV
• Unlikely to form after 14
• Dose related
Early Specialisation
• Playing 4 times a week at 12/13 increases
likelihood of hip pathology
• Relevance to elite u-14 squad
• Overlapping seasons of school, club and county
Why are we so injury prone?
• Previous injury, decreased flexibility, strength and
control can cause future injury
• Fixture calendar
• Decreased recovery / Overtraining / Dearth of
sports science
• Early specialisation
• Developing S&C culture
Training Response
Insufficient RECOVERY
Body adapts to the exercise load during the RECOVERY process.
Overtraining Symptoms
Oslo Sports Trauma Research Group
Overuse
Gaelic Groin
Report - Gaelic Groin
Recovery Days
FIFA >2 d
Why are we so injury prone?
• Previous injury, decreased flexibility, strength and
control can cause future injury
• Fixture calendar
• Decreased recovery / Overtraining / Dearth of
sports science
• Early specialisation
• Developing S&C culture
Strength & Conditioning
• KISS
• Train movements not
muscles
Qualifications
• UKSCA, CSCS, BSc, MSc, EXOS
Summary
• High Injury Rate
• High Re-Injury Rate
• Many of these preventable
• Good evidence for group and individual injury
prevention strategies
• Fixture calendar as it stands makes it difficult to
prevent overuse injuries and overtraining
Key Recommendations
• Activate (www.activategaa.sini.co.uk)
• Group mobility, stability and prehab sessions
• Individual interventions for identified at risk
players
• Train smarter, optimal recovery
• Adoption of Gaelic Groin Recommendations
Major overhaul of fixture calendar
required
“Being against GAA player burnout is like being
against racism or for free speech. It offers us all the
chance to deliver a few pious platitudes while doing
absolutely nothing to mitigate the actual problems
involved.”
Eamonn Sweeney,
Sunday Independent
18/1/15
Responsibilities
What are we going to do?
Joe is right, Enough words, now it’s time for action

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Player welfare; injury prevention 2015 2-1 2-2

  • 1. Player Welfare & Injury Prevention: What now? Marty Loughran Physiotherapist
  • 2. Making Headlines • GAAInjuries:Thetippingpoint ConorMcCarthy,IrishExaminerJanuary28th2012 • 'Rugbyplayersdon'tknowhowtheydoit' MarieCrowe,SundayIndependentJanuary29th2012 • “GAAplayerspushedbeyondbreakingpoint." DrTadhgMacIntyre,BelfastTelegraphFebruary9th2012 • “RebelragesthatCorkGAAlefthimwith€7000medicalbill” FintanO’Toole,IrishExaminerFebruary20th2012
  • 3. Still making headlines… • “KneeInjuriestoplistasGAAshellout€8mininsuranceclaims” IrishIndependentFeb2014 • “Pleasestopthisabuse” SundayWorldJan2014 • “Arehipinjuriesjustthepricewepayforastronger,faster,morepowerfulgame” IrishTimesJan2014 • “Moynawarnsoftraininghealthrisks”
  • 4. Groundhog Day…. • What’s the point? Joe Brolly, Gaelic Life, 11th January 2015 • Saving the GAA Joe Brolly, Gaelic Life, 19th January 2015 • Enough words, now its time for action Joe Brolly, Gaelic Life, 26th January 2015 • Treat the lifeblood with respect Joe Brolly, Gaelic Life, 8th February 2015 • Paraic Duffy says GAA to tackle fixtures and welfare issues Irish Times 28th January 2015 • Its not dark yet, but it’s getting there Eamon Sweeney, Sunday Independent 18th January 2015 • Earley pays price for playing through pain Irish News, 19th February 2015
  • 5. How big is the problem really? • What is the reality? • How has this come about? • What can we do about it?
  • 6. What Percentage of players in a senior inter county squad will get injured each year? 67%
  • 7.
  • 8. Some players get injured more than others 34 players = 40 injuries 1.2injuriesperplayerperseason
  • 9. More likely to get injured during matches or training? Matches 15timesmorelikelytogetinjuredinmatches Biggerthematchthemorelikelyyouaretogetinjured
  • 10. 25% of all injuries are recurrent injuries Previous injury is the No. 1 risk factor for future injury
  • 11. What are the most common injuries in GAA? •Hamstrings20% •Pelvis/hip/groin13% •Knee11% •Ankle10%
  • 12. Hamstrings • 2007-13 average 18% • 2014 season 26% • Why the surge?
  • 13. ACL • 1% of total • Large time loss • 1/squad/biannually • Knee OA unavoidable • Significant changes in 10-15 yrs • Financial Loss • QOL
  • 14. How do GAA injuries happen?
  • 15. Contact v Non contact 32% v 68% •Sprinting 27% •Turning 12% •Landing 7% •Kicking 5%
  • 16. Why do injuries happen?
  • 17. Oslo Sports Trauma Research Group
  • 18. Unfortunately its not as simple as that…
  • 19. Oslo Sports Trauma Research Group
  • 20. Summary • High injury rate in GAA (2/3 of squad) • 68% of all injuries are non-contact injuries (?preventable) • 25% of all injuries will reoccur • Previous injury, decreased flexibility, strength and control can cause future injury • Big 4 - Hamstring, groin, knee, ankle • Potentially large number of undocumented overuse injuries • Some Injuries are catastrophic and having wider ranging effect beyond sporting life
  • 21. Why are we so injury prone? • Previous injury, decreased flexibility, strength and control can cause future injury • Fixture calendar • Decreased recovery / Overtraining / Non- application of sports science • Early specialisation • Developing S&C culture
  • 22. What can we do about it?
  • 23.
  • 26. Contact v Non contact 32% v 68% •Sprinting 27% •Turning 12% •Landing 7% •Kicking 5%
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32. The Sequence of injury prevention
  • 33. Implementation Stage • Launched at 2014 conference by Mario Bizzini (FIFA) to 400 Delegates • SINI launch to sports medicine community (100+) • 50 Workshops • Rolled out to over 1000 coaches • 4/5 workshops in each of the 9 counties
  • 34. Website • 54,000 hits • Over 8000 unique users • Viewed from 11 countries GB, USA, Canada, Australia, Scandinavia & Spain
  • 36.
  • 37. Predicting who is at risk
  • 40. Screening for Hamstring Injury 1. Previous Injury 2. Hamstring Strength (Single leg hamstring bridge test)
  • 41. Screening for Hip/Groin Injuries 1. Previous Injury 2. Hip ROM tests (FADIR, IR ROM) 3. Provocation Tests (squeeze test)
  • 42. Knee Screening Tests 1. Previous Injury 2. Landing/cutting technique Tuck Jumps LESS
  • 43. Ankle Screening Test 1. Previous Injury 2. Balance Deficit Star Excursion Balance Test (SEBT)
  • 45. Why are we so injury prone? • Previous injury, decreased flexibility, strength and control can cause future injury • Fixture calendar • Decreased recovery / Overtraining / Dearth of sports science • Early specialisation • Developing S&C culture
  • 46. Early Specialisation • Cam Deformity • Link to hip pathology, loss of ROM & Hip/Groin pain • Form pre PHV • Unlikely to form after 14 • Dose related
  • 47. Early Specialisation • Playing 4 times a week at 12/13 increases likelihood of hip pathology • Relevance to elite u-14 squad • Overlapping seasons of school, club and county
  • 48. Why are we so injury prone? • Previous injury, decreased flexibility, strength and control can cause future injury • Fixture calendar • Decreased recovery / Overtraining / Dearth of sports science • Early specialisation • Developing S&C culture
  • 50. Insufficient RECOVERY Body adapts to the exercise load during the RECOVERY process.
  • 52. Oslo Sports Trauma Research Group
  • 57. Why are we so injury prone? • Previous injury, decreased flexibility, strength and control can cause future injury • Fixture calendar • Decreased recovery / Overtraining / Dearth of sports science • Early specialisation • Developing S&C culture
  • 58. Strength & Conditioning • KISS • Train movements not muscles
  • 60. Summary • High Injury Rate • High Re-Injury Rate • Many of these preventable • Good evidence for group and individual injury prevention strategies • Fixture calendar as it stands makes it difficult to prevent overuse injuries and overtraining
  • 61. Key Recommendations • Activate (www.activategaa.sini.co.uk) • Group mobility, stability and prehab sessions • Individual interventions for identified at risk players • Train smarter, optimal recovery • Adoption of Gaelic Groin Recommendations Major overhaul of fixture calendar required
  • 62. “Being against GAA player burnout is like being against racism or for free speech. It offers us all the chance to deliver a few pious platitudes while doing absolutely nothing to mitigate the actual problems involved.” Eamonn Sweeney, Sunday Independent 18/1/15
  • 63.
  • 65. What are we going to do?
  • 66. Joe is right, Enough words, now it’s time for action

Editor's Notes

  1. Introduction Physio for tyrone minors, lTAD role, physio at UUJ sigerson SINI role with other sports Still playing and coaching Evidence and opinion from my experience in the sport
  2. Define injury
  3. spot the difference
  4. http://roadcyclinguk.com/riding/training-for-results-train-hard-recover-stronger.html#77busiawAXl0SSmg.97 These next slides illustrate some of the basic training science.
  5. The most common goal of training athletes is to provide training loads that will improve performance. The process of training will generally lead to athletes progressing through various stages such as ‘undertraining’, overreaching’ and ‘overtraining’. When prolonged, excessive training occurs concurrent with other stressors and insufficient recovery, performance decrements can result in chronic maladaptations that can lead to ‘overtraining syndrome’ (OTS) (Meeusen et al., 2014). It’s important to note that whilst intensified training can result in a decline in performance, when tempered with appropriate periods of recovery, athletes may exhibit enhanced performance compared to baseline levels e.g. training camps often lead players to ‘functional overreaching’ which leads to temporary performance decrements that disappear after a taper period. However, when intensified training continues without appropriate rest, players can evolve into a state of extreme overreaching or ‘non-functional overreaching’ (NFO) that will lead to decrease in performance which will not resolve for several weeks or months. Definition When prolonged, excessive training occurs concurrent with other stressors and insufficient recovery, performance decrements can result in chronic maladaptations that can lead to ‘overtraining syndrome’ (OTS) (Meeusen et al., 2014).
  6. Chronic fatigue, feeling drained all of the time, lacking energy Decreased ability to achieve performance goals Lacking motivation to practice Irritability and unwillingness to cooperate with team-mates Reduction in strength, speed, or power Deterioration in execution of skills Mild soreness in the legs or “heavy legs” that does not resolve for long periods Increased prevalence of injury Ongoing aches/pains in muscles and joints Loss of appetite Elevated resting/morning heart rate Picking up illness easily Decreased concentration
  7. The more common signs of overuse injury include:
  8. 2011