Epidemiology and moderators of injury in Gaelic football: A systematic review and meta-analysis

"Martyr or Moaner:" A Qualitative Study of Elite Ladies Gaelic Football and Camogie Players' Perceptions of Injury Surveillance

CONTEXT

Ladies Gaelic Football (LGF) is the fastest growing female sport in Europe and camogie is among the most popular female team sports in Ireland. Intercounty is considered the elite level, with high physical and technical demands that inevitably involve a risk of injury. At the elite level, an injury incidence as high or higher as professional sports such as rugby and soccer has been reported. Inadequate injury surveillance (IS) can be a barrier to effective injury prevention. This study aimed to (i) explore perspectives on IS and (ii) examine perceived barriers and facilitators to injury reporting of elite LGF and camogie players.

DESIGN

Qualitative descriptive study.

METHODS

Six focus groups were conducted with elite LGF (n = 11) and camogie (n = 10) players representing a range of divisions and intercounty panels. Participants outlined their understanding of IS and described IS practices within their teams. Participants completed a written task, noting and discussing perceived barriers and facilitators to injury reporting. Focus groups were audio recorded, transcribed, and analyzed using reflexive thematic analysis.

RESULTS

Participants' report of current IS practices for their team echoed closely their interpretation of IS, as the reporting of injury to health care professionals (HCPs) and broader team personnel. Injury reporting was influenced by factors related to the player, the organization, and the environment including player mindset, access to HCPs and club culture.

CONCLUSION

Enhanced and consistent access to appropriate HCPs is deemed key to monitoring and managing injuries. HCPs are central to fostering a culture of openness and trust, critical to facilitate the timely reporting and management of injuries in elite LGF and camogie. The influence of HCPs is powerful in players' perceptions of barriers and facilitators to reporting and future work should capture their thoughts.

What do coaches want? Exploring the preferences of youth rugby union coaches for education in the implementation of injury prevention programmes

OBJECTIVE

To explore youth Rugby Union coaches' preferences for education and support in the implementation of injury prevention programmes (IPPs).

METHODS

Twelve Rugby Union coaches involved with youth teams participated in five online focus groups. Conventional content analysis was used to determine preferences initially from transcripts, and thereafter main categories, generic categories and sub-categories.

RESULTS

Coach preferences were organised into three main categories: 'formal/non-formal learning', 'informal learning', and 'intrapersonal considerations'. The generic categories of 'logistics', 'content' and 'resources' featured substantially in coach preferences for education. Coaches prefer live structured group workshops in the pre-season period, which focus on the development of implicit knowledge. To do this, coaches prefer practical opportunities for coaching within the education session. In support of this education, coaches want resources (both physical and video) which assist in session planning.

CONCLUSIONS

The preferences of youth Rugby Union coaches towards IPP education and support are similar to that of other coaching domains. A live practical workshop held in the pre-season is preferred, although facilitator preferences varied. A mismatch is evident between coach preferences for IPP education and what is currently being offered through NGB coach education therefore further exploration of NGB perspectives is warranted.

Incidence and Risk Factors for Sport-Related Concussion in Female Youth Athletes Participating in Contact and Collision Invasion Sports: A Systematic Review

BACKGROUND

The incidence and risk factors for sport-related concussion (SRC) associated with contact and collision invasion sports (CCIS) in female youth are unclear.

OBJECTIVES

This systematic review aimed to identify (i) the incidence of and (ii) risk factors for SRC in female youth athletes playing CCIS.

METHODS

A systematic search of PubMed, CINAHL, Embase, SPORTDiscus and ProQuest to 8 May, 2024 was conducted. Two reviewers independently screened articles against eligibility criteria and assessed risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Aetiological or intervention studies reporting on SRC incidence or risk factors in female youth athletes (aged 13-19 years and under) participating in CCIS were included. Meta-analyses were conducted to explore SRC incidence and risk factors. For each meta-analysis of SRC incidence rate, sub-group analyses were conducted by sport. Where heterogeneity was above 60% for the meta-analysis of SRC risk/protective factors, sensitivity analyses were conducted.

RESULTS

The search yielded 4509 articles; 66 were included. Sport-related concussion incidence or risk factor data for nine CCIS were extracted. Pooled estimates revealed SRC incidence for female youth athletes in CCIS combined was 0.50/1000 match and practice hours (95% confidence interval [CI] 0.34-0.66). When examined by sport classification, SRC incidence in contact invasion sports was 0.12/1000 match and practice hours (95% CI 0.03-0.21), and in collision invasion sports was 2.08/1000 match and practice hours (95% CI 0.90-3.25). Sub-group analysis by individual sport revealed female youth soccer players had the highest overall SRC incidence rate (0.89/1000 match and practice hours, 95% CI - 0.19 to 1.97) amongst contact sports, and rugby union players had the highest overall SRC incidence rate (4.04/1000 match and practice hours, 95% CI 3.03-5.05) among collision sports. Forty-five studies (68%) reported SRC risk factor data, investigating 12 different potential risk factors. Female youth sustained over 7.5 times the rate of SRC in matches compared with practice (incidence rate ratio 7.52, 95% CI 6.32-8.95, p < 0.01) when competing in CCIS; however, considerable heterogeneity existed (I2 = 84.98%). When exploring potential risk factors, no significant difference was found in SRC rate between female youth lacrosse players wearing versus not wearing headgear (p = 0.07). No significant difference was found in SRC rates between female youth athletes competing in younger versus older age groups (incidence rate ratio 0.91, 95% CI 0.52-1.61, p = 0.48, I2 = 0.00%). Insufficient evidence was available to examine remaining risk factors.

CONCLUSIONS

This meta-analysis revealed SRC in female youth playing CCIS was higher than previously reported, with SRC rates higher in matches than practice. Soccer had the highest SRC incidence rate for female youth athletes competing in contact invasion sports, whilst rugby union demonstrated the highest SRC incidence rates for collision invasion sports. The results of this review should be interpreted with caution given the lack of representation from some common CCIS codes. Further research is required to examine SRC risk factors in female youth athletes participating in CCIS.

CLINICAL TRIAL REGISTRATION

OSF Registration: osf.io/s573v.

Predictors of Risk of Muscle Injury in Non-Professional Soccer Players: An Ambispective Cohort Study

(1) Background: Soccer accounts for 30% of all sports injuries. Muscle injuries in soccer, not caused by trauma or contact, are the most common. The objective was to assess the risk of injury based on the footwear used by soccer players and the playing field and to identify the best predictive model of muscle injuries; (2) Methods: An ambispective cohort study. The primary variable was the number of muscle injuries in the last three seasons. The secondary variables were age, body mass index, type of soccer shoes and turf, training load and position on the field. The possible confounding variables were motivation for the choice of footwear, date of injuries, time playing and regular first-team player status; (3) Results: 156 players were recruited. The risk of injury is 1.03 (95% CI: 0.83; 1.27) times more frequent in players competing on artificial turf. The risk of injury is slightly higher in first-team players than in substitutes (RR = 1.02; 95% CI: 0.79; 1.32). There was no statistically significant relationship between the position on the field (p = 0.91), the type of shoe (p = 0.69) and the motivation to buy the shoes (p = 0.82), regarding the risk of muscle injury in these athletes. The best model to estimate risk of injury includes age, training load and soccer shoe type as confounding variables (AIC = 190.5; p = 0.10; χ2(3) = 10.14; p = 0.02); (4) Conclusions: The risk of muscle injury is higher in non-professional soccer players competing on artificial pitches and in those who are regular starters on their teams. Field position, soccer shoe and motivation to purchase the soccer shoe are variables that do not increase the risk of muscle injury in these athletes. The best predictive model of injury includes age, training load and shoe type.

Concussion management and concussion recovery in Gaelic games: a qualitative analysis

Background

The purpose of this qualitative research study was to interview current and retired Gaelic games athletes to understand the current landscape of concussion recovery in Gaelic sports from the athlete perspective.

Methods

A grounded theory methodology was employed to explore the experiences of a cohort of Gaelic games athletes (n = 22) regarding recovery from concussion, the levels of concussion awareness in Gaelic sports and their opinions on current concussion identification protocols. The study's data were gathered through semi-structured interviews.

Results

Two major themes were identified, (1) Male and female athletes experience a range of acute and chronic symptoms post-SRC and (2) Gaelic sports athletes are expected to demonstrate constant allegiance and commitment to the GAA. These themes were further divided into categories and subcategories.

Conclusion

Based on the experiences of the cohort of Gaelic sports athletes, there exists a wide variation of SRC symptomology in the acute, and chronic (post-concussion syndrome) phases. In many cases, there are reports of long-term side effects associated with the perceived mismanagement or misdiagnosis of SRC in Gaelic sports. Gaelic sports athletes require a more robust SRC management system to support and manage SRC in the acute, chronic and long-term phases.

Descriptive epidemiology study of hand injuries sustained in Gaelic football referred to a hand therapy service over 1 year

Objectives

Gaelic football requires ball handling, such as bouncing, fist passing and catching. To date, no research has examined the types of injuries sustained to the hand in this sport. This study aims to establish the types of orthopaedic hand injuries sustained in Gaelic football.

Methods

This was a retrospective descriptive epidemiology study of Gaelic football-related hand injuries treated at a hand therapy unit. The nature of injuries was categorised along with collated variables on player demographics and injury profiles. Potential correlations between injury and continuous demographic data were analysed using the Mann-Whitney U and Kruskal-Wallis tests. Pearson's χ2 test was used for categorical data (p<0.05).

Results

287 referrals were identified. Most players were men (n=189; 65.9%), and the average age was 17 (IQR 14-25). Most fractures were to the volar base of the middle phalanx (n=110; 42.8%). Significant differences were found between the age of male and female players with fractures under 18 (p<0.05), the distribution of left and right-hand fractures by age (p<0.05), the distribution of fractures by bone type (p<0.05) and also between sex and affected ray (p<0.05), bone type (p<0.05) and mechanism of injury (p=0.05).

Conclusion

This study established the types of musculoskeletal hand injuries sustained by players in Gaelic football. Considering developmental, anthropometric and rule differences between male and female players across the age range may explain variations in injuries. This data can help devise injury prevention and management strategies for Gaelic football.

Training Load Monitoring Practices Used by Strength and Conditioning Coaches in Hurling, Gaelic Football, Camogie, and Ladies Gaelic Football

BACKGROUND

No research has investigated the training load (TL) monitoring practices currently used by strength and conditioning (S&C) coaches in Gaelic games. The purpose of this study was to investigate the TL monitoring practices used by S&C coaches across senior intercounty male and female Gaelic game sports.

STUDY DESIGN

Cross-sectional.

HYPOTHESES

It was hypothesized that (1) TL is commonly monitored, (2) various methods are used by S&C coaches to monitor TL, and (3) the level of qualifications of the S&C coach is of a professional standard.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 33 (n = 32 male and n = 1 female) S&C coaches participated in the study by completing an online questionnaire that investigated coach biography, coach education, team biography, monitoring practices, rating of perceived exertion, acute:chronic workload ratio, and data implementation.

RESULTS

The results showed that S&C coaches had varying levels of experience and education. All 33 coaches (100%) stated they monitored the TL of the players. The most common method used to monitor TL was session rating of perceived exertion, which was used by 91% of coaches. Analysis of an open-ended question afforded each participant the opportunity to share additional information, highlighting 3 themes: (1) communication with players, (2) performance testing, and (3) clarity and support among other coaching staff.

CONCLUSION

Multiple methods are used to monitor TL in Gaelic games. Despite multiple forms of technology available, communication with players provides essential information regarding an athlete's state.

CLINICAL RELEVANCE

As this is the first study to explore TL monitoring practices used by S&C coaches in Gaelic games, the results may inform the development of educational resources for the guidance of coaches working in Gaelic games in best practice TL monitoring.

Hamstring Stiffness and Strength Responses to Repeated Sprints in Healthy Nonathletes and Soccer Players With Versus Without Previous Injury

BACKGROUND

The effect of 10 × 30 m repeated sprints on passive and active stiffness of semitendinosus (ST) and biceps femoris long head (BFlh), and knee flexor maximal voluntary isometric contraction (MVIC) and rate of force development (RFD), and whether athletes with previous hamstring injury have a different response, is unknown.

HYPOTHESIS

Repeated sprints would (1) increase BFlh stiffness and decrease ST stiffness and knee flexors MVIC and RFD in healthy participants; and (2) greater magnitude of response would be seen in athletes with previous hamstring injury.

STUDY DESIGN

Case series (experiment I) and case control (experiment II) study designs.

LEVEL OF EVIDENCE

Level 3.

METHODS

Healthy nonathletes attended 2 replicated sessions (experiment I, n = 18), while soccer players with (n = 38) and without (n = 67) previous hamstring injury attended 1 testing session (experiment II).

RESULTS

In both experiments, the knee flexors MVIC and RFD decreased after the sprints (P < 0.05). In experiment I, the ST and BFlh passive stiffness reduced after the sprints (P < 0.02), while a small BFlh active stiffness increase was noted (P = 0.02); however, no correlation was observed between the 2 testing sessions for the postsprint muscle stiffness responses (r = -0.07-0.44; P > 0.07). In experiment II, only an ST passive stiffness reduction was observed after the sprints (P < 0.01). No differences were noted between injured and noninjured lower limbs for any variable (P > 0.10).

CONCLUSION

Repeated sprints are likely to decrease the knee flexor's maximal and rapid strength, and to alter the hamstring stiffness in the nonathlete population. Previous hamstring injury does not apparently affect the footballer's hamstring functional and mechanical responses to repeated sprints.

CLINICAL RELEVANCE

The responses of hamstring stiffness and knee flexor strength to repeated sprints are unlikely to be associated with hamstring injury.

Epidemiology of Injuries in Men's Professional and Amateur Football (Part I)

Background (1): Football is the most popular sport among men, associated with a certain risk of injury, which leads to short- and long-term health consequences. While the injury profile of professional footballers is known, little is known about the injury profile of amateur footballers; amateur football is a major and diverse area, the development of which should be a priority for football associations around the world and UEFA. The aim of this study was to perform a systematic review of epidemiological literature data on injuries in professional and amateur football players belonging to certain leagues. Methods (2): A systematic review according to the PRISMA guidelines was performed until June 2023 in the databases PubMed, Web of Science, Google Academic, Google Scholar, and Diva portal. Forty-six studies reporting injury incidence in professional and amateur men's football were selected and analyzed. Two reviewers independently extracted data and assessed study quality using an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): The overall incidence of injuries in professional male football players was 7.75 ± 2.28, 95% confidence interval, injuries/1000 h of exposure and that of amateur football players was 7.98 ± 2.95, 95% confidence interval, injuries/1000 h of exposure. The incidence of match injuries (30.64 ± 10.28, 95% confidence interval, injuries/1000 exposure hours) was 7.71 times higher than the training injury incidence rate (3.97 ± 1.35, 95% confidence interval, injuries/1000 h) in professional football players and 5.45 times higher in amateurs (17.56 ± 6.15 vs. 3.22 ± 1.4, 95% confidence interval, injuries/1000 h). Aggregate lower extremity injuries had the highest prevalence in both categories of footballers, being 83.32 ± 4.85% in professional footballers and 80.4 ± 7.04% in amateur footballers: thigh, ankle, and knee injuries predominated. Conclusions (4): Professional and amateur football players are at substantial risk of injury, especially during matches that require the highest level of performance. Injury rates have implications for players, coaches, and sports medicine practitioners. Therefore, information on football injuries can help develop personalized injury risk mitigation strategies that could make football safer for both categories of football players. The current findings have implications for the management, monitoring, and design of training, competition, injury prevention, especially severe injury, and education programs for amateur football players.

A systematic literature review of injury epidemiology and surveillance practices in elite adult female field-based team sport

OBJECTIVES

To describe injury incidence and surveillance practices in elite adult female field-based team sports.

DESIGN

Systematic literature review.

METHODS

This review was prospectively registered (PROSPERO CRD42022318642). CINAHL, PubMed, MEDLINE, Scopus, SPORTDiscus, Web of Science, Open Grey and Google Scholar were searched from inception to 30th June inclusive. Peer reviewed original research articles that reported the incidence of injury sustained by females aged ≥18 years in elite field-based team sports were included. The Newcastle Ottawa Scale was used to assess the risk of bias.

RESULTS

Twenty prospective cohort studies investigating injury incidence in Australian football, American football, soccer, field hockey, rugby, rugby-7s and cricket were eligible. A higher injury incidence in match play compared to training was reported with the highest match and training incidence (132.7 and 42.1/1000 h of exposure respectively) in Australian football. The majority of the reported injuries were to the lower limb and involved muscle/tendon or joint/ligaments. There was heterogeneity in definitions of injury, severity and exposure, variations in methods of injury data collection and reporting with, not all data being collected/reported optimally, which limited comparison of studies.

CONCLUSIONS

This review highlights the lack of and need for injury data specific to this cohort. Establishing the incidence of injury with a robust injury surveillance system is the first step in the sequence of injury prevention. It requires consistency in definitions and methodologies, providing accurate and useful injury data, to guide targeted injury prevention strategies.

Factors influencing performance and injury risk in elite female Gaelic team sport players and future research directions: a narrative review

BACKGROUND

Sports science research in elite female Gaelic team sports has increased in recent years, but still a large disparity exists between the volume of studies involving male and female players. As a consequence of this, it is difficult for practitioners to develop an evidence-based approach when working with female players.

MAIN BODY

In this review, we discuss the current research available in elite female Gaelic team sports with focus on seven specific areas including physical and physiological demands, anthropometric and performance characteristics, injury risk, nutritional considerations, and female physiology. There appears to be unique physical demands data in match play across positions in Camogie, however, there is currently no comparative data available in ladies Gaelic football. Similarly, there is no research available on the physiological demands of both elite female Gaelic team sports. According to existing literature, performance characteristics such as speed and power are lower in this population compared to other elite female team sports. Although data is limited, the anthropometric characteristics of elite female Gaelic team sport players appear homogenous with some positional differences observed at a sub-elite level. Previous research has demonstrated a high prevalence of lower limb injuries in female elite Gaelic team sports and the provision of quality, evidence-based strength & conditioning could help mitigate these injury risks. Female Gaelic team sport players have been shown to have poor nutrition knowledge and inadequate intakes of micronutrients. Finally, although menstrual cycle phase and oral contraceptives have been shown to influence performance in other female intermittent sports, to date there has not been any research carried out in elite female Gaelic team sport players.

CONCLUSIONS

It is evident that limited research has been carried out on elite female Gaelic sport players. More up-to-date, high-quality investigations are needed to address the research gaps, which in turn should enable practitioners in the field to apply sound, evidence-based practice/theory when working with this population.

The epidemiology of back injuries in elite Gaelic football athletes: An 8-year prospective study

OBJECTIVES

To describe the epidemiology of back injury in elite male Gaelic football athletes between 2008 and 2016.

DESIGN

Prospective cohort study.

SETTING

Injury data from the National GAA Injury Surveillance Database.

PARTICIPANTS

Elite male Gaelic football athletes.

MAIN OUTCOME MEASURES

Incidence of injury as a rate per 1000 h of exposure.

RESULTS

38 datasets were analysed. Out of a total of 1606 time-loss injuries, 76 were back injuries (4.73%, 95% CI 3.80%-5.88%). The incidence of back injuries in match play was 1.72 (CI 95% 1.21 to 2.45) and in training was 0.2 (CI 95% 0.14 to 0.28) injuries per 1000 h of exposure. The majority of back injuries (63.16%, CI 95% 51.93-73.12) were new, as opposed to recurrent (35.53% CI 95% 25.7-46.74). Most back injuries were acute (51.32%, CI 95% 40.29-62.22), compared to chronic (31.58%, CI 95% 22.23-42.7) or overuse (11.84%, CI 95% 6.36-21.00). The majority of back injuries occurred during non-contact player activities (n = 60, 78.94% CI 95% 68.50-86.60).

CONCLUSIONS

Back injury rates in Gaelic football are similar to soccer and Australian football but less than rugby union. Further research is needed to understand the factors leading to the onset and recurrence of back injury in Gaelic football athletes.