INJURIES:IN SOME ways a cruciate ligament tear is a bit like a car crash – you know it can happen at any time, you just don't think it will ever happen to you.
The worry for GAA players right now is it seems to be happening to them more often, at least compared to other sports – and given the inevitably long lay- off one wonders can anything more be done to prevent it.
The pictures of Kerry midfielder David Moran lying on the ground towards the end of Sunday’s Allianz League game with Monaghan, one hand holding his left knee, the other stretched across his face to hide the pain, was another reminder of how simple and sudden a cruciate ligament tear can be.
Moran fell awkwardly after a heavy tackle, yet there was nothing to suggest the injury would end his season, and force him into almost a year-long period of rehab.
But an MRI scan at the Santry Sports Clinic on Monday morning confirmed his worst fears, and Moran joins the apparently growing list of intercounty and club players falling victim to the dreaded cruciate ligament tear.
His best hope for now is that it won’t happen again, as several of the other high-profile incidences recently – such as Cork footballer Colm O’Neill and Kilkenny hurler Henry Shefflin – were repeat victims, having already suffered the same injury, on either the same or opposite knee.
Ger Hartmann is certainly no stranger to such injuries, and reckons he sees “between 20 and 25 cruciate ligament victims each year” at his sports injury clinic in Limerick.
“And they are all GAA players,” adds Hartmann, who is renowned for his treatment in the full variety of sports, including athletics, rugby, soccer, cycling, and even multi-discipline sports such as triathlon – and he says there is plenty of evidence GAA players are more at risk when it comes to damaging their anterior cruciate ligament (or the ACL, as they say in medical parlance).
The question for Hartmann, therefore, is why GAA players are more susceptible to a cruciate ligament tear, and if so, can anything be done to help address this – or is it simply one of the inevitable risks of playing Gaelic games?
Is there a greater prevalence of cruciate ligament tears compared to 10 or 15 years ago?
“Well, first of all in my 20 or so years working with athletics I’ve never seen a cruciate tear in an athlete, even with a sprint hurdler like Colin Jackson. When it comes to the GAA, in the past the player would have gone to the team doctor, but they wouldn’t have had the diagnostic tools, such as an MRI scan.
“Go back 10 or 15 years and they’d be depending on an X-ray, but that didn’t show a cruciate, which could be torn, or completely gone.
“Now you have an MRI in every hospital, and places like the Santry Clinic, so diagnostics are way more expedient, within days of the trauma. So as Pat Spillane says, cruciate injuries were always there, but players were told the knee was badly inflamed, arthritis even. You played on if you could, and if you couldn’t you retired. But these injuries were always there, just not as readily diagnosed.”
Why are cruciate injures happening to GAA players more than other sports?
“A few things are at play here. If you damage a cruciate, you can also damage cartilage, or the medial collateral ligament. It’s like crashing a car against a wall. You don’t just damage the front fender. You can damage the chassis as well. So there can be other damage, not just to the anterior cruciate ligament.
“That brings up what happened with Henry Shefflin. He started in the All-Ireland final, three and a half weeks after tearing his cruciate. But he was able to build up the strength of the other ligaments to allow him play. John Tennyson played the full game, after tearing his. Shefflin might have lasted the full game too if he wasn’t unlucky enough to twist it again on the field.
“But the problem here is not just the knee, or the leg quadriceps, but the hamstring. Players are building up the quads with squats, lunges and other press machines, but forgetting about the other muscle which stabilises the knee, which is the hamstring.
“As any sports medic will tell you, the hamstring at the back of the leg is every bit as important as the quad at the front. And I would say 90 per cent of GAA players have imbalance between quad and the hamstring, as in an insufficiency in the quad-hamstring relationship.
“If you’re quad dominant, it’s like pulling up a Venetian blind with one string. The thing goes up crooked. I would say hamstrings across the board are too weak, and players are over-dependent on quad muscles. With that weakness you contribute to instability in the knee.”
Is there anything more the GAA player can do to limit the risk?
“There are other issues here. For years as youngsters we were better conditioned, cycling to school, long walking. We see less of that in society. But the biggest single thing we’re seeing is the imbalance between the quad and hamstring, how that acts as a pre-cursor to weakness in the knee.
“We also know flexibility is vital, but not just the quads and hamstrings, but the hips as well.
“But with football and hurling, the game is about short, repetitive sprints, of 10 to 20 metres, so a fatigue factor comes in too. That shows up the imbalance even more. It’s like the 40 links that make up a bicycle chain. If one link is weak, and there’s big pressure put on a chain, the chain can go.
“But often the foot is grounded, and with the hip and buttock stabilising the back, the knee is in no-man’s land, very vulnerable really, not just to twists, but to bangs, and therefore more likely to buckle, especially on an imbalanced muscular-skeletal system.”
Cruciate ligament tear
Recent casualties– Cork footballer Colm O'Neill, Dublin hurler Stephen Hiney and Kerry midfielder David Moran.
Other recent victims– Meath footballer David Bray, Dublin's Mark Davoren, and Kildare's Mickey Conway and Dermot Earley
Kilkenny hurlers can feel particularly jinxed: Henry Shefflin and John Tennyson both tore their cruciate ligaments twice, as did substitute goalkeeper Richie O'Neill, and JJ Delaney missed the 2006 All-Ireland final against Cork having sustained the cruciate tear in training prior to that game.
