Sports njures n School Gaelc Football: A Study Over One Season A. W. S. Watson Sports njures Research Centre, Unversty of Lmerck, Lmerck, reland. Abstract School football njures were studed over the seven months of one season on 150 males aged 16.94_+0.82 years. Tranng averaged 4.13+J.47 hours per week and matches 1.84_+0.60 hours per week. Mean tme njured was: 0.51+1.7 days n hosptal, 34.27+_37.08 days offsport and 13.98+_5.22 days of restrcted actvty. There were 136 match and 63 tranng njures gvng 175.98 njures per 10000 hours of matches and 31.06 njures per 10000 hours of tranng. njures were treated as follows: hosptal 83, general practtoners 51, physotherapsts 28, no treatment 38. The most common njures were: ankle spran (11.6 % of the total), hamstrng stran (6.5 %), contuson (6.5 %) back stran (6 % ) knee spran (5.0 %), fnger spran (5.0 %), other muscle strans (5.0 %), fracture of the wrst (5.0 % ), dslocaton of the fnger (4.5 %), overuse njury of the back (4.0 % ), tenosynovts (3.5%), fracture of the ankle (3.0%). Thrteen njures were to goal-keepers, 85 to hacks, 31 to md-feld players and 70 to forwards. n 34.83% of the njures foul play was gven as the major cause. Ths was followed by "Lack of ftness", "Poor kt or boots" and "Prevous njury" (all 11.24 %). The most common mnor cause was "Poor state of the ptch" (17.42% of njures). ntroducton There have been few prevous studes of njures n Gaelc football and none have specfcally consdered trauma n the game at school level. Earler nvestgatons nto football njures have tended to be examnatons of hosptal accdent and emergency records 1,2,3,4. Many of these analyses have suggested that sprans are the most common njury: strans, back problems and overuse njures have not been consdered problems n Gaelc football. However, t s well known that the njures seen n hosptal accdent and emergency departments do not adequately reflect the totalty of njures n a partcular sport, snce they are strongly based towards the more serous knds of njury and those that requre surgcal repar. Two other studes have brefly consdered football njures n the context of school sports accdents as a whole 5'6. But none of these nvestgatons attempted to quantfy the rsk of njury n Gaelc football or to examne the causes of njury. The present paper s a report of the frst study of the njures occurrng n school Gaelc football durng the course of one school year. Subjects and Methods Data concernng partcpaton rates and sports njures were collected over one season on 150 members of nne successful senor school football squads. Schools were recruted nto the study because of personal contact wth the researcher. Data were collected over the seven month perod that corresponded wth the school football season. Respondents kept records of ther partcpaton n football and of the njures that were sustaned by them durng tranng or competton. Data were recorded on specally desgned forms by the subjects after the detals of the survey had been explaned to them by the author or an assstant. The recordng took place under the supervson of the football coach, who n all cases was a physcal educaton graduate and had experence of the collecton and analyss of sports njury data. The effect of each njury was recorded: f the condton resulted n restrcted actvty the nature of the restrcton was noted. Only njures sustaned by the subject durng tranng for, or partcpaton n, the game of Gaelc football were consdered n ths study..the majorty of the subjects were nvolved at a compettve level only n football. Where ths was not the case, njures arsng from partcpaton n other actvtes were gnored. The followng nformaton was collected on each subject:- age, level of partcpaton, poston played, number of years of experence of the game of Gaelc football, hours of tranng for football per week, hours of matches per week, the nature of any protectve equpment used for football. The followng nformaton was collected wth respect to each njury sustaned: the type and ste of the njury, days of hosptalsaton (f any), days off from matches or tranng due to the njury, days of restrcted performance due to the njury, the source of treatment receved for the njury (f any), protectve tems used, the cause of the njury, weather condtons at the tme of the njury, state of the ptch at the tme of the njury, tme after the start of the practce or match, tme before the end of the practce or match, any other factor relevant to the njury. The nvestgaton was not restrcted to njures that requred medcal treatment or that prevented partcpaton ;n football completely. t ncludec! njures that restrcted actvty to any sgnfcant, specfed, extent. The justfcaton for ths approach s gven n full n Watson 7. 12
Vol. 165 No. FRACTURE JAW FRACTURE FNGER FRACTURE RB FRACTURE ARM FRACTURE WRST FRACTURE ANKLE DSLOCATON KNEE DSLOCATON FNGER DSLOCATON OTHER SPRAN WRST SPRAN KNEE SPRAN ANKLE SPRAN FNGER CARTLAGE STRAN HAMSTRNG STRAN QUADS STRAN GRON STRAN BACK STRAN OTHER CONTUSON BACK OVERUSE SHN SPLNTS TENOSYNOVTS FROZEN SHOULDER OTHER OVERUSE WOUND DENTAL NJURY EYE NJURY OTHER NJURY njures n school Gaelc r 13 2 0 12 14 PERCENTAGE OF THE TOTAL NJURES Fgure 1 - Sports njures sustaned by 150 schoolboy Gaelc footballers over one season. The percentage contrbuton of each knd of njury to the total s shown on the axs at the bottom of the graph. Results The average age of the subjects was 16.94 + 0.82 years. Durng the seven month perod of the study they spent a mean of 4.13 -+ 1.47 hours per week tranng and 1.84 + 0.60 hours per week n football matches. The dstrbuton of njures s shown n Fgure. The four most frequent njures were: spran of the ankle (11.6% of the total njures recorded), stran of the hamstrng muscle (6.5%), contuson (also 6.5%) and stran of the back (6%). Together these four njures accounted for almost one thrd of the total njures (30.6%). Other common njures ncluded:- knee spran (5.0%), fnger spran (5.0%), other muscle strans (5.0%), fracture of the wrst (5.0%), dslocaton of the fnger (4.5%), overuse njury of the back (4.0%), tenosynovts (3.5%) and fracture of the ankle (3.5%). Fgure 2 shows that 13 of the njures were to goal keepers, 85 to backs, 31 to md-feld players and 70 to forwards. The major and mnor causes attrbuted to the njures are shown n Fgure 3. n just over one thrd of the njures "Foul or llegal play by another player" was gven as the major cause (62 of the njures or 34.83% of the total). Ths was followed by "Lack of ftness", "Poor kt or boots" and "Prevous njury" (all 20 njures or 11.24 % of the total). The most common mnor cause gven was "Poor state of the ptch" (31 njures or 17.42%). The state of the ptch was strongly, but not exclusvely, nfluenced by the weather condtons at the tme of the njury. Eghty two of the njures receved hosptal treatment, 51 were treated by general practtoners, 28 by regstered physotherapsts and 38 njures receved no professonal medcal treatment (Fgure 4). The more serous njures, whch requred one or more days as a hosptal n-patent, conssted of the tbllowng: fractures (20 cases), concusson (10 cases), menscus njury (3 cases), dslocaton (3 cases), njury to back (3 cases), eye njury (2 cases), other njury (5 cases). Ankle spran, the most common njury, resulted n a mean of 13.42 + 4.73 days off sport and a further 12.38 + 11.90 days of restrcted actvty. Ths s slghtly less than the mean tme the subjects were affected by the other njures reported n ths study whch resulted n 25.83 + 24.34 days off sport and 10.54 + 12.54 days of restrcted actvty. The subjects averaged 1.33 njures over the 7 months of the study and durng ths perod spent a mean of 0.51 +_ 1.7 days as a hosptal n-patent, 34.27 + 37.08 days off sport and 13.98 +.+- 15.22 days of restrcted actvty. One hundred and thrty sx of the 199 njures occurred durng competton and the other 63 happened durng tranng. Snce 4.83 hours were spent n tranng each week compared to 1.84 hours of matches t follows that the rsk of njury s 175.98 njures per 10000 hours of matches and 31.06 njures per 10000 hours of tranng. n other words, the njury rate durng matches s 5.6 tmes that durng tranng. The mean rate s 71.(14 njures per 10000 hours of partcpaton. When the njury rate s expressed as days of njury per 1000 hours of partcpaton, the ndex s 260.71. Expressed another way, four man-hours of football partcpaton results n about one man-day of njury.
14 Watson.J.M.S. January, February, March, 1996,oo- NUMBER OF NJURES 8O 60 40 20 GOAL KEEPER BACK MDFE.LD FORWARD Fgure 2 - The number of njures sustaned n four dfferent playng postons. POOR PTCH WEATHER TOO MANY MATCHES //////////////,2//////,2,,t ~ " POOR KT OR BOOTS LACK OF FTNESS REFEREENG m ///////4"//// POOR WARM-UP LLEGAL PLAY PREVOUS NJURY /////////~ [ m MAJOR ~,~ M~NOR ~ NO GUM SHELD 0 10 20 30 40 50 60 NUMBER OF NJURES 70 Fgure 3 - Major and mnor causes attrbuted to the njures.
Vo[. 165 No. njures n school Gaelc football 15 NUMBER OF NJURES 100 80 60 40 20 HOSPTAL DOCTOR Fgure 4 - The number of njures treated: n hosptal, by whch receved no professonal medcal treatment. PHYSOTHERAPST OTHER physcans n general practce, by physotherapsts and No relatonshp was noted between type or ste of njury and the followng factors:- weather condtons, the protectve tems used by the subjects, the age or playng experence of the subjects, mnutes after the start of the match, mnutes before the end of the match. Ths does not necessarly mean that such relatonshps do not exst. However, a larger study, or one of a dfferent desgn, would be requred n order to detect them. Dscusson The 150 schoolboy Gaelc footballers followed n ths study sustaned 199 football njures over a seven month perod - an average njury rate of 2.27 njures per player over a 12 month perod. Ths s smlar to the 2.10 njures per year reported for a cross-secton of rsh sportsmen and sports women by Watson 7. The total tme that the school-footballers were affected by njury (48.64 days over a 7 month perod or 83.47 days over a 12 month perod) was sgnfcantly hgher than the fgure for the crosssecton of rsh sports persons from the same study (51.78 days over a 12 month perod). The rato of"days off sport" to "Days of restrcted actvty" was 71:29 for the present subjects as aganst 50:50 for the cross secton of rsh sports persons. Ths analyss ndcates that n comparson to the other rsh sports that have so far been examned, the ncdence of njures n school Gaelc football s hgh and the njures are relatvely serous. Ths suggeston s confrmed by the fact that over 41% of the njures receved hosptal treatment. The tour most frequent njures were: spran of the ankle (11.6% of the total), stran of the hamstrng muscle (6.5%), contuson (also 6.5%) and stran of the back (6%). Together these four njures accounted for almost one thrd of the total njures (30.6%). Ankle spran s the most common njury found n schools, both n reland 5,6 and abroad 9'1~ so that the hgh ncdence n schoolboy football s not unusual. Procedures recommended for the preventon of ankle njures nclude: tapng, the use of hgh topped boots, proproceptv~ tranng of the ankle jont and better rehabltaton from prevous njury 11. The hgh ncdence of ankle sprans found n the present Subjects suggest that t would be desrable to nvestgate the effectveness of such procedures n young Gaelc footballers. Hamstrng strans and back njures are not tradtonally assocated wth school Gaelc football but were found to be very common. Such njures are attrbuted to poor levels of flexblty, poor posture and body mechancs and muscle mbalance 12A3,14'lS'tr,17. n vew of the hgh ncdence of such njures n the present group of subjects t seems necessary to encourage the ntroducton of better condtonng procedures for schoolboy Gaelc tootballers; or better stll, to conduct an evaluaton of the effectveness of such procedures n school Gaelc football. Ths concluson seems to concur wth the vews of players and coaches snce lack of ftness was cted as the second most common cause of njury n these subjects (20 njures or 11.24% of the total njures). Foul or llegal play was gven as the most common cause (n more than one thrd of all njures). Ths s a very hgh percentage and suggests that a much strcter enforcement of the rules s requred. ncomplete recovery from a prevous njury and defects
16 Watson n the ptch were other factors frequently cted as the cause of njury9 The rsk of njury per 10000 hours of partcpaton (106.8 njures per 10000 hours) s hgh n comparson wth other school athletc actvtes where the rsk s reported to be between 10 and 30 njures per 10000 hours 9A~ However, t s less than njury rates recorded n ce hockey s, hgh-school Amercan football 19 and senor hurlng (Watson, unpublshed study). t has been argued that days of njury per 1000 hours of partcpaton s a better measure of the problem of njures n a partcular sport than the number of njures per 10000 hours Watson 7. Ths s because recovery tme - and therefore the dsrupton caused - vares consderably wth dfferent types of njury. The mportance of ths statstc has not been apprecated n the past but would be a valuable contrbuton to future studes of sports njures earred out n ths country9 The number of njures that were attrbuted to foul play was consderably hgher than those recorded n a recent rsh study nto soccer and rugby trauma by Stokes and hs colleagues a. t s the present author's vew, and those of expert colleagues, that the play n Gaelc football s generally less tghtly controlled than t s n rugby and soccer and that n Gaelc football the penaltes for llegal play are generally less severe. However, re!lance upon the optons of players and coaches as to the cause of njury s not entrely satsfactory and n future studes the use of more objectve crtera should be consdered. The type of actvty beng undertaken at the tme of njury was not consdered n the present study. Also the use made by players of varous types of protectve equpment was not examned n suffcent detal for any conclusons to be drawn9 Both these matters are of nterest and should be nvestgated n future research on football njures. t would be better not to rely upon the recollectons of players or coaches but to base the analyss on some knd of objectve record such as vdeo recordngs of matches and tranng. The results of the present study ndcate that the ncdence of njures n school Gaelc football s hgh n relaton to other actvtes and that the tme loss from sport due to these njures s consderable9 These results suggest that some form of nterventon should be undertaken to reduce the rsk. Ths would be n lne wth ntatves already n progress n other European countres and n some other sports9 Other results of the present nvestgaton suggest that the most effectve preventatve measures mght perhaps nvolve: (1) Strcter applcaton of the rules n order to reduce the ncdence of foul play. (2) Better condt!onng programmes to mprove posture, flexblty, jont stablty and muscle balance n schoolage Gaelc footballers. (3) Measures to mprove the stablty and strength of the ankle jont9 (4) More effectve l J.M S. January: February, March, 1996 rehabltaton from prevous njury. (5) Greater attenton to the state of ptches, partcularly n bad weather. References 1. Flood, H. D., Mna, A. G. A revew of njures seen n the Casualty Department. rsh Journal of Medcal Scence. 1985; 154: 270-39 2. O'Sullvan, M. E., Curtn, J. Hand njures n Gaelc games9 rsh Journal of Medcal Scence 1989; 58: 79-81. 3. Cuddhy, B., Hurley, M. Contact Sports and njures. rsh Medcal Journal 1990; 83: 98-100. 4. Stokes, M. A., McKeever, J. A., McQullan, R. F., O' Hggns, N. J. A season of football njures. rsh Journal of Medcal Scence 1994; 163: 290-93. 5. Watson, A. W. S. Sports njures durng one academc year n 6799 rsh school chldren. Amercan Journal of Sports Medcne 1984; 12: 65-71. 6. Watson, A. W. S. Sports njures n rsh Second-Level Schools durng the School Year 1984-5. Dubln: Department of Educaton, 1986. 7. Watson, A. W. S. ncdence and nature of sports njures n reland: analyss of four types of sport. Amercan journal of Sports Medcne 1993; 21: 137-439 8. McLennan,. G., McLennan, J. E. njury patterns n Scottsh heavy athletes. Amercan Journal of Sports Medcne 1990; 18: 529-329 9. Garrck, J. G., Requa, R. A. Grls sports njures n hgh school athletcs. Journal of the Amercan Medcal Assocaton 1978; 239: 2245-89 10. Backx, F. J. G. Sports njures n youth. MD Thess Unversty of Utrecht9 Publshed by nsttute of Sports Health Care, Oosterbeek, Netherlands, 1991. 11. Renstrom, P. The Preventon of njury n Sport. The Olympc Encylopaeda of Sports Medcne9 Oxford: Blackwell, 1992. 12. Burkett, L. N. Causatve factors n hamstrng strans9 Medcne and Scence n Sports 1970; 2: 39-42. 13. Ekstrand, J~., Gllqust, J. Soccer njures and ther mechansms. A prospectve study. Medcne and Scence n Sports and Exercse 1983; 15: 26770. 14. Watson, A. W. S. Lumbar lordoss and'stran of the lopsoas. Brtsh Journal of Sports Medcne 1974; 8: 203-5. 15. Watson, A. W. S. Physcal Ftness and Athletc Performance; a gude for students, athletes and coaches9 London, Longrnans, 1983 (second edton 1995, n press)9 16. Watson, A. W. S. Sports njures - relatonshp to defcences of flexblty and body mechancs and the effectveness of dfferent nterventon strateges. n: Sports njures and ther Preventon9 Proceedngs of Councl of Europe 3rd meetng. Papendal, Netherlands, 1989. 17. Hennessy, L., Watson, A. W. S. Flexblty and posture assessment n relaton to hamstrng njury. Brtsh Journal of Sports Medcne 1993; 27: 243-6. 18. Lorentzon, R., Wedren, H., Petla, T., Gustavsson,B. njures n nternatonal cc hockey. Amercan Journal of Sports Medcne 1988; 16: 389-91. 19. Halpern, B., Thomson, N., Curl, W. W, Andrews, J. R., Hunter, S. C., Borng, J. R. Hgh school football njures: dentfyng the rsk factors9 Amercan Journal of Sports Medcne 1987; 15: 316-20.