Cruciate - GAA must act
17:40, 10 May 2012
Cruciate injuries are a recurring nightmare in sport.
Previously they were career-ending but while modern treatment means a player is now more likely to lose a season, they are still a massive issue.
Those at Parnell Park on Wednesday night would have seen Stephen Hiney and Conal Keaney play their second club championship match for Ballyboden St Enda’s in the space of 10 days. These two men, along with Na Fianna’s Tomás Brady, comprise what has been known as Dublin's ‘cruciate trio’ - a disturbing trivialisation of a chronic problem in the GAA.
Former Munster and current Tipperary hurling physio John Casey deals with all kinds of injuries at his sports clinic in Nenagh, including the dreaded cruciate. He insists that prevention is better than cure, but is concerned that this is not as likely at club level as it is at inter-county.
“They are very prevalent but they do appear to strike in pockets,” says Casey. “It’s very well documented among inter-county players but it’s not at club level. The inter-county guys are at least doing some kind of preventative stuff but at club level they seem to miss that.
“And some clubs seem to go way beyond the normal ranges of cruciates compared to other clubs and you’d think there’d have to be trends there. It’s very, very high in camogie as well: females are fives time more predisposed to cruciates tears than males.”
That begs the question of why that is, whether a person’s make-up puts them more at risk. Casey explains that it is a complicated, multi-factoral area but that footwear specific to conditions is key.
“You’d prepare for it. We’re lucky enough at inter-county level (in Tipp) that our guys would have a couple of pairs of boots in their bags or I could talk with the fitness coach (Ross Dunphy) and we could modify what we’d do on an evening. Depending on the surfaces we find, we can tailor it.
“Unfortunately at club level, you’re looking at guys going out with a plan to do a session and they have to do that session; hail, rain or snow, it’s going to be done. I suppose the thing as well is tailoring sessions to how players are performing during the sessions. Peak-setting a thing like that, you don’t want to predispose players to getting injured and getting tired and fatiguing fellas.
“Ligament injuries are much more prevalent at that stage towards the end of sessions and matches when fatigue is a factor.”
There were 470 cruciate injuries claimed for under the Players' Injury Scheme in 2011, with only other knee (1305) and shoulder (525) issues more prevalent in the table. There seems to be no apparent reason why one county would be more risk than others but perhaps it’s a case of player welfare.
“You do have to modify activity; you can’t afford to play fatigued,” says Casey. “The injury incidence is raised much higher when you’re playing with a fatigued body. A lot of time the problem is communication on injuries in general between club and county. Or even with younger players who are playing club, county and school or club, county and colleges in the case of Fitzgibbon. Things tend to fall between communication.
“Players want to play and it’s up to people guiding these players to educate them and to be talking among themselves. I’ve seen players leaving county sessions to go to Fitzgibbon training sessions and vice versa and it’s criminal because something has to give eventually.”
Kilkenny had two cruciate injuries in 2010 to John Tennyson and Henry Shefflin and both tried to play through it - with Tennyson only back this season. Recently, Brian Cody was made to sweat over whether Richie Power had sustained the same injury playing for Carrickshock, but the forward will return in a matter of weeks.
While Dublin’s trio look set to return to inter-county action in the near future, Anthony Daly was fortunate not to lose another member of his panel, Paul Schutte, for a full season. Initially they feared it was a cruciate tear but scans revealed it is still 80% intact. The Cuala man, who has done a cruciate before, picked up his injury in a challenge game against Limerick less than 24 hours after playing a club championship match.
It seems reckless for Daly to have played a man whom he knew would be key this summer in a match of such little importance. Indeed every player who took part for Dublin in that game had already played a club game that weekend - and many who lined out in blue the next day won’t be in the reckoning this summer. What was the point? For a county that had three cruciates last year - albeit Keaney’s in a road accident - and another the year before, the idea of exposing fatigued players in a nothing match beggars belief.
Particularly as Schutte, who had been exceptional in his club’s win over Lucan Sarsfields, seems somewhat prone to injury. Of the seven games he has started for Dublin from 2011 onwards, he has completed just three. Muscle fatigue often an issue.
Casey of course would not presume to comment on another county’s affairs but gives an insight into the Premier County’s set-up. “I’m in my fifth year with Tipp and thankfully we haven’t had any so I don’t know is it our prehab or have we just been lucky or is it placation or is it a combination of everything.
“It’s very difficult to say. Anecdotally, I would say definitely rates are reduced if you take the right preventative measure, and it’s all about prevention. Because injuries do occur in sport, you can’t prevent them completely but you can certainly minimise and that would be the aim with cruciates.
“Various studies around the world have shown that you can reduce injuries rate through particular strategies to minimise injuries. And I’d love to see the GAA take a stance and develop a generic warm-up or a generic injury prevention programme that they would give to clubs and say: right guys, you should stick to this for eight weeks to dramatically reduce your cruciate injury. Okay, they can do whatever they like in training but every club would be doing a standard warm-up that would incorporate all the aspects of injury prevention. And I think that would be a real step towards reducing it.”
Would this be difficult to implement?
“Not at all. It would be just developing one hurling or sports-specific warm-up and meeting a coach from each club and going through it with them. You could do divisions at a time and go through it over an hour. I think you’d see a dramatic reduction in costs. I don’t think surgeons would be too happy but insurance companies and clubs certainly would.”
(Table of injuries by category for which payments, totalling €8m, made under the Players' Injury Scheme in 2011)
Knee (cruciate ligament excluded) 1,305, Shoulder 525, Cruciate 470, Thigh 419, Ankle 416, Teeth 377, Leg 333, Finger 258, Back 214, Hand 189, Thumb 138, Nose 121, Rib 111, Hip 105, Abdominal 104, Wrist 103, Foot 102, Toe 101, Arm 96, Jaw 77, Groin 68, Neck 66, Head 58, Collar bone 46, Facial 46, Bleeding 32, Elbow 31, Internal organ 20, Eye 16, Chest 15, Ear 9, Heart/respiratory 8, Testicle 7, Muscular 3, Death 3 - Total 5,992
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