School of hard knocks

Ireland's rugby players have been educating themselves about their health, with some help from their doctors, writes Shane Hegarty…

Ireland's rugby players have been educating themselves about their health, with some help from their doctors, writes Shane Hegarty.

When Brian O'Driscoll limped off at the end of Ireland's Grand Slam decider against England, Leinster fans holding their breath in case he would be out of Saturday's Heineken Cup quarter-final, it was into the hands of the team's medical officer that he hobbled.

Luckily, O'Driscoll was suffering only a dead leg, one of the soft-tissue injuries that take up much of the medical officer's time. O'Driscoll returned to his provincial team a few days after the match, and he is due to play in the quarter-final.

He is not out of sight of the medical officer, however, who will keep track of that injury and any other until he rejoins the national squad in a couple of months.

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As the structure of Irish rugby has developed over the past few years, so has that of the medical team. At the crucial match against England, it was Dr Jim McShane repairing the team.

He became a medical officer with the side this year, temporarily replacing Dr Michael Griffin, who has been working with it for three years and will return later in the year, to work with Dr McShane as Ireland prepare for the World Cup, which starts in Australia in October.

Both are practising GPs who work part time within a structure that lies halfway between that of England, which has a full-time team doctor, and Wales, whose doctor is drafted in the week leading up to international matches.

"We're responsible for the holistic 24-hour care of the players when they are with the Irish team and with their provinces," says Dr Griffin.

"We would work in partnership with the provincial team doctors, although the ultimate responsibility would be with the Irish doctor."

Much of their work with the players is, in fact, typical GP work. "We have a responsibility for all medical matters. It's split about 50/50 between sports injuries and medical matters such as rashes, colds, flus, viruses and dental problems.

"It's also an important part of our job to keep them fully educated on doping and drugs. For example, they could accidentally take cough medicine that may contain ephedrine, which is a banned drug. We would also advise them on nutritional supplements, to let them know what's safe for their health or what might be on the doping list."

The doctor is the first port of call for players gathering with the squad. "I have a travelling hospital in the back of my car, and when I get to a hotel I'd generally take a large room and turn it into a private surgery," says Dr Griffin.

"Each player will come in to me for screening as they arrive for the session. Some of them we will have been keeping an eye on any way, through their provinces, but some of them are contracted to English clubs, and we wouldn't have seen them for a while.

"So on day one we get through everyone, make sure that they're fully healthy and fit to take part."

Steeped in rugby tradition although never a player, Dr Griffin has a master's degree in sports medicine and "stitched" for Young Munster for 22 years. He worked with the Ireland A team and Munster before graduating to the senior squad. Spending 23 weeks with the team last year, he had worked solo for three years before taking time out to attend to his Limerick practice.

Dr McShane, who cared for the team during the Six Nations campaign, played with St Mary's, the Dublin club. When he moved into coaching, he also doubled as unofficial team doctor, before joining the Leinster medical team and, this year, the Irish set-up. He still maintains a practice in Glasthule, Co Dublin.

"For a GP with an interest in sports medicine it's a fascinating job," says Dr McShane, who became involved in time for a truncated and physically stressful campaign.

"The big thing about this year's Six Nations was that it was so compressed. There was no time to rehab injuries, especially in the first week, when there was only a six-day gap between internationals.

"It was an intense campaign. These guys were knocking lumps out of each other, and there was no time even for bruises to recover. It's stressful for the doctors to make the call on these players, as well as for the physio and the masseur."

The most common injury is bruising, although increasing numbers of players have serious shoulder injuries and face major reconstructive surgery.

"There might be a lot of arthritic shoulders in the future," he points out. "In the old days, props generally had arthritic hips. But that was in the time of hard scrums that seemed to go for minutes."

Is there a danger that more players will retire early under the strain? "The English pack was such an aged one but were still incredibly fit. Many of them were in their 30s. As professional players, they don't have to work the next day, and they are not played when they are injured. The impacts might be bigger now than before, but the rehabilitation is more sophisticated than ever, too."

Attitudes to injury have changed, he says. "The way the IRFU has structured the season has protected the players. In England, the Zurich Premiership players are flogged week in and week out, and there are commercial pressures and television pressures that have now affected the Six Nations. Here, they just wouldn't be allowed play."

Dr Griffin adds: "These players are our assets. Their health is put first. A few years ago, there would have been only four internationals a year, and they would have played the match come hell or high water. They would think, I've got nine months to get over it.

"Now we would put a rehab programme in place immediately. We would put a time on it, two or four or six weeks, and the player would not be allowed move on until he is fit to do so."

The doctors are there, they both say, to protect players as much from themselves as from anybody else, although they have found them both aware and honest about their health.

"Three years ago, and in the amateur days, I suppose that you wouldn't have had the same level of professionalism," says Dr Griffin.

"These players have educated themselves. The amount of food that they go through is incredible. They need 6,000 to 7,000 calories a day, but it's all healthy. Their diets would be rich in carbohydrates and protein, with a little vegetable oil used for cooking. But it would be very well balanced."

This health awareness has had obvious effects on the players. "I've never had to pull a player because of injury. They have always pulled themselves out rather than risk damaging themselves further."

As the players return to their provincial and club sides, those based in Ireland will be monitored regularly with an eye to a tour of Australia in June, before the World Cup, where the challenge will be to keep the team fit during weeks of intensive rugby against the world's best teams.

"Our main challenge is to help them recover as quickly as possible," says Dr Griffin. "You have to remember that as long as they're injured, these players are losing their livelihood and losing their chance with the team. This is where the pressure is."