Women in sport: adding insult to injury

“Those were some of the scariest times of my life. I remember sitting at home thinking am I ever going to get better? Is this going to be me for the rest of my life?”

Róisín McCafferty, a Donegal footballer, was 18 years old when she suffered a serious concussion during a county challenge match in 2010.

Over the following weeks and months she lost the power in her hands and the sensation in her feet. Her eyesight was cloudy, she suffered severe and constant headaches and for a time she could not stand on her own.

“It was like going back to being a child again, where your mother had to help you do everything. I couldn’t go to the bathroom on my own . . . I literally couldn’t stand on my own.”

McCafferty was in and out of hospital for three weeks, missed 10 weeks of school during her Leaving Cert year, and neither MRI scans nor neurologists could provide any answers.

She eventually regained full mobility and returned to football before the year was out, but describes those times as being distressing, lonely and upsetting: feelings many players who have suffered serious injury are familiar with.

Broken bones, ligament tears, tendon strains and concussions are all part and parcel of our national amateur sport.

These injuries are not only physically devastating but can also prove mentally and financially difficult to overcome.

Players often have to take unpaid leave from work, miss out on school or college and suffer the added stress of claiming insurance for medical expenses from management boards.

For most players, though, missing out on a game that has become an intrinsic part of who they are is the most difficult part.

Cruciate tear

Una Leacy

returned home from Australia in 2014 so she could play camogie for her native Wexford again, as well as her club Oulart the Ballagh.

She had suffered chronic pain in her right knee from a lack of cartilage between her bones and made the decision to have surgery on it in May 2014.

That resulted in a three-month absence from play, which she describes as being “heartbreaking”. “One of the main reasons I came back was to play camogie again, so that was really tough.”

She managed to return for the All-Ireland semifinal against Cork in August and went on to win an All-Ireland final with her club in March 2015.

However, just 10 months after getting back playing again, Leacy suffered what is probably the most dreaded injury within the GAA: a torn anterior cruciate ligament.

She remembers going for a goal in a club game against St Ibars in June, saying, “I went to go one way, but I went the other. Next thing I knew I was on the ground and I thought I had a broken leg.

“When I heard the word cruciate I was just heartbroken. I didn’t know what to say. I haven’t played properly for Wexford since 2012, and I was really looking forward to getting back.

“But with the ACL [anterior cruciate ligament] I knew there is no quick recovery. You have to do your rehab and that’s it: there is no quick way of getting back. You just have to give it time.”

A torn ACL usually means surgery to tie the knee ligament back together and a rehabilitation period of between six and 12 months, according to Enda King, head of performance rehabilitation at Santry Sports Clinic in Dublin.

A number of studies have shown that women are up to six times more likely to suffer an ACL injury than men.

“Women generally have wider pelvises and their knee collapses inwards easier than it does for men.

“They aren’t as strong around the hip area and that contributes to the risk movements associated with the ACL injury”, says King.

The surgery usually involves taking a portion of a tendon from the hamstring area to reconstruct the snapped ACL, a procedure Leacy describes as “the worst surgery you could go through”.

“Preparing for surgery mentally, you don’t know what to expect. I was after having surgery on my right knee the year before so I thought, Oh, it’ll be sore for a little while but it’ll be grand.

“But no one told me how painful getting your ACL done is.”

‘Roaring in pain’

Ann Marie Starr

can empathise with Leacy’s experience of severe pain through injury.

Starr suffered a compound arm fracture – where the bone pierces the skin – while playing camogie with Galway last July.

"As I was going to pick the ball our corner forward, Jessica Gill, went to strike and the heel of her hurdle with full force caught my upper arm and snapped my humerus in half.

“I was roaring in pain . . . the bone had pierced the skin and made a hole. The muscle also contracted to try to hold on to the bone.”

The following day she had surgery at Tullamore General Hospital to clean out the hole in her arm and make it safe before a metal plate was inserted and secured with six screws.

The team doctor, who also works for the men’s hurling team, told her he had never seen an injury so bad on the pitch.

Her surgeon told her it would be at least three months until she returned to play, but Starr was determined to be back for the All-Ireland final against Cork in September.

Her consultant was sceptical. "He told me: 'I don't care if you're Dan Carter, you're not going to be back for that final.' "

She continued going to training sessions with Galway, where she worked with a physiotherapist and ran with the team. She went to chirotherapy and took vitamins and calcium to build up her strength.

When the consultant saw her X-ray the week before the final he was stunned by the progress she had made.

“The arm had healed over 90 per cent, which was as good as it was ever going to get.

“He reckoned it was the movement from physio and training and all the extra bits I was trying to do that caused a bone callus to grow outside of the break, which made it heal.”

Starr did not make it on to the field for the final she so longed for, but she went on to captain her club Killimor to a county title.

“I know it was sore and sudden and a very bad injury, but a bone will heal.

“I was looking at two other girls who had done their cruciates at the start of the year and that’s nine months out. It could have been much worse.”

Added stress

Leacy is now five months into her ACL rehab programme and says she feels like she is “nearly at the end of the tunnel”.

She credits the support she received from her club Oulart the Ballagh, as well as friends and family, as helping her through the frustrating stages of her recovery.

“When it came to insurance, surgery or physio they were always so good: they couldn’t do enough for you.”

For other players, getting expensive surgeries and physiotherapy sessions paid for can become “a real added stress on top of already being injured”, says McCafferty.

“I know from other people with injuries that require surgeries or long-term physio it’s more hassle than it’s worth really, because they can be out of a lot of money.”

If the injury happens during a club game, the process can be delayed even further given management does not have the same funds at their disposal as larger county boards.

“If you’re not in a county set up where the claims are being dealt with, you’re waiting on money for physio and it’s harder to get back quickly. You’re paying first and then getting the money back,” says Starr.

Sustaining an injury while playing on a county panel can bring its own difficulties.

Leacy was injured the week before championship started with Galway, and felt “isolated from the county . . . I just didn’t feel part of it any more. That was tough.

“When anyone hears that someone has done their ACL, they know you’re no good to them for the year.”

For others, there can often be a lot of pressure from management to go back into contact before being 100 per cent ready.

“I don’t know if player welfare always goes first. The better players are definitely put under severe pressure to get back playing . . . people want their best team out,” says McCafferty.

Why me?

Mentally, the prospect of a long period of rehab can be tough to come to terms with. Leacy remembers a woman from her club whose daughter had also suffered a cruciate tear giving her some warning.

“She knew it wasn’t going to be easy for me. She said, ‘You’re going lose sleep over it, wondering, why me?’ ”

McCafferty sums it up, saying: “Whenever you’re training so hard and trying to be the best that you can be, and then you get a setback like that from injury, you put yourself through such mental torment. It can be a very lonely place.”

Painful, lonely, stressful, devastating, frustrating, disappointing, scary, distressing: those are among the words used by these women to describe their experience of injury.

But despite all that, heartbreak at missing out on the game they love was the word they used most often, followed by “lucky” for getting the chance to return to it.

If that doesn’t demonstrate the immense commitment and sacrifice of the GAA players who we hear so little about, I don’t know what does.

Róisín McCafferty on concussion

I first got concussed five years ago, at a time when there were no clear cut guidelines of when to return to training. The only advice I had from doctors was to go back whenever I felt up to it, and managers didn’t realise how serious it was. There are a lot more guidelines now, like the graded return to play. We could learn a lot from rugby, which I would say is about five to 10 years ahead of the GAA in that sense. Managers need to be more educated about it, but players also need to take ownership of their injury – you only get one head and you have to be smart with it. I rushed back to playing too soon after the first concussion. You put pressure on yourself, especially at county level where you really want to impress. You’re at the top of your game and you don’t want anything holding you back, but getting concussed again after not taking enough recovery time the first time around is so dangerous. After my second concussion in March of this year I was bed bound for about a week afterwards. I went straight back to county training five weeks later and I’d say I nearly killed myself that night. So I took it easy then and graded myself back in properly – that is what you are supposed to do . . . Take responsibility yourself, because nobody else will.

Roisin McCafferty plays football for Donegal and her club Termon

Enda King on the cruciate injury

The ACL injury gets quite a lot of exposure through the media because of the consequences of it, which are quite severe. There is a significant amount of time lost to playing sport after the injury – anywhere between six to 12 months – and an increased incidence of longer term wear and tear in the knee afterwards. It is usually a single leg injury whereby the knees collapse or twist. There’s any amount of research to prove that women suffer significantly more ACL injuries than males do, primarily because they have wider pelvises and are not as strong around the hip area, meaning their knees collapse in easier. Hormonal cycles and the anatomy of the knee joint are also a factor. Some people think they can get back playing after six months when they hear of professionals doing it, but the reality is they are probably in the gym three times a day under a professional eye for six to seven months, as opposed to amateurs who are in the gym twice a week on their own. The hardest bit is definitely between being told you have injured the ACL and surgery – after that the weeks run into each other because there is a very set structure towards your rehabilitation. Although it sounds like a long period of time, you’re always reaching for that next goal.

Enda King is head of performance rehabilitation at Santry Sports Clinic