Are hip injuries just the price paid for stronger, faster, more powerful players?

Is the type of training teams do contributing to the level of hip injuries?

Clare’s Conor McGrath: a hip surgery success story. From surgery Christmas 2012 to the best goal of the All-Ireland final nine months later. Photograph: James Crombie/Inpho

Clare’s Conor McGrath: a hip surgery success story. From surgery Christmas 2012 to the best goal of the All-Ireland final nine months later. Photograph: James Crombie/Inpho

 

The first answer is that there is no answer. As is so often the case when we start casting around for a through line connecting a spate of injuries of one type, it’s impossible to nail a satisfying head to the wall. There is no single reason why hip injuries are more common in GAA players now than before but they are. On that there is little argument.

In a way, hip injuries have suffered for their modesty. Torn cruciates, broken bones, snapped hamstrings, even concussions get all the press. There’s no mystery there, since those are injuries that end seasons or, at the very least, keep players out of games.

Issue for all
A hip is a niggle, an irritation, rarely enough to keep you on the sideline. In most cases, you won’t make it significantly worse by playing on it. Hips get fixed in the off-season while few in the outside world are interested and fewer still are watching on. An unlucky county panel might lose one player to a cruciate every couple of seasons but very few squads winter without someone needing a hip sorted out. As Cork football physiotherapist Colin Lane puts it, “I actually don’t know of any county that has escaped it. It is an issue for everyone.”

The roll-call of high-profile players in football and hurling whose hips have gone under the knife in the past 18 months is eye-popping.

The scorers of Clare’s final two goals in 2013 Conor McGrath and Darach Honan. Richie Power, Richie Doyle and Cillian Buckley in Kilkenny. Liam Rushe, Maurice Shanahan, Jamie Coghlan. Donnchadh Walsh started last year in recovery for Kerry, just as Darran O’Sullivan has begun this. Karl Lacey was never right last year, while hip surgery was just another log thrown on the pile for Michael Fitzsimons and Eoghan O’Gara.

The list goes on. Kildare face into the league without Niall Kelly, Eoin Doyle and Eamon Callaghan, Cork have to do without Damien Cahalane, Paddy Kelly and Jamie O’Sullivan.

The Tipp hurlers are down three and Louth have to plan without Shane Lennon, who misses his second league in three seasons while he ploughs on through another recovery. And on and on and ever on.

More hip surgeries than ever doesn’t necessarily mean there are more hip injuries. Dr Pat O’Neill, the former All-Ireland winning manager with Dublin and an orthopaedic consultant, recently had a former colleague visit him with an arthritic hip. O’Neill could only wonder at how much better off his friend would be now if medicine, physiotherapy and technology had been as advanced as it is now in that man’s time.

“It doesn’t surprise me,” he says when asked about the increased prevalence. “There are three main factors. One, the increase in intensity and frequency of high-agility training. Two, the improved diagnostic parameters. And three, the availability of interventional treatment procedures. Put those together and it’s no surprise at all.”

The point about diagnostic parameters is essentially that there are more hip surgeries now because there is a greater ability to find problems. Advancements in arthroscopy, such as MRI and magnetic resonance imaging, allow doctors to see their way around the hip joint and to identify issues to fix where they couldn’t before.

Major procedure
“Arthroscopy is keyhole inspection of the joint and it has evolved significantly in the last five to 10 years,” says O’Neill. “It just wasn’t available before that. It isn’t a major procedure but it’s very high-tech and it takes major skill required to carry it out. When something becomes available, it tends to be used.

“These advances mean that it has become a lot more obvious to see what the problem is and to discover smaller problems that would have gone unnoticed in years gone by.

“Before it was there, it’s perfectly likely that some of these conditions were there but there was nothing we could do about it because we didn’t have the technology to find them.”

Hip problems have always existed in people playing field sports and are likely to well into the future. One reason, says Lane, is that in many cases the problem comes pre-cooked.

If you look at the illustration in a school science book, you will see the ball-and-socket joints consist of perfectly rounded orbs fitting neatly into one another. Nature’s jigsaw doesn’t always snap into place so readily however.

“If you just take one common problem, foroacetabular impingement or FAI as we call it, the crucial thing that stands out there is that it’s a congenital problem with the hip. You’re born with it. There are plenty of players out there who will never have a problem with FAI impingements. But some players are just born with a small abnormality – I use that term very loosely now.

“If you look at a hip joint as being a simple ball and socket joint, some of these guys will be born with an extra prominence on the bumpy ball part of the joint. Or there might be a small bit of over-coverage of the socket part. So what happens is that when he flexes the hip up, one part bounces off another prematurely and it causes this kind of damage.”

So there will always be a certain percentage of hip injuries that are inevitable. And there have always been hip injuries in the past that just haven’t got the attention modern science is affording them now. But what of the rest?

Simply over-training?
Again, everyone has their theories. Some say the so-called cruciate curse of the past few seasons has changed the way some train, that in an effort to build up muscle stability around the knee, some of the muscles around the pelvis aren’t getting the attention they need.

Others hold that it’s over-training, plain and simple. The brouhaha in Wexford before Christmas got a little hysterical at times but the basic point about the amount and intensity of training regimens stands.

Nobody is having hip replacements because of over-training but there is little doubt that the type of training teams are doing is a contributing factor.

“One influence on the prevalence of these injuries that could be looked at,” offers Lane, “would be the strength and conditioning programmes that have become quite prominent in GAA teams over the past decade. No serious GAA team is without a strength and conditioning programme and there are huge benefits to it. It’s undeniable: you’re stronger, you’re faster, you’re more powerful. But there’s a price to pay.

“Take an exercise like the squat, where you’re holding a sizeable weight on your shoulders and you’re squatting down with it. The compressional forces through your hips and for that matter through your knees are huge.

“Going down into a 90-degree squat with an extra 150kgs weighing down on you, you can imagine the compressional forces that are at play there. We don’t do that exercise in Cork any more for that reason.”

The one upside is that most players recovery reasonably well in pretty short order. Conor McGrath had a sliver shaved of his hip socket four day before Christmas 2012.

By the end of last March he was back playing in the league. By the end of the year, he had the best goal of the All Ireland final to his name, along with an All-Ireland medal and an All Star. No niggle to be found.

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