Injuries in Collegiate Ladies Gaelic Footballers: A 2-Season Prospective Cohort Study

The epidemiology of hip and groin pain and Femoroacetabular Impingement Syndrome (FAIS) in male and female Gaelic games players

OBJECTIVES

Hip and groin pain is common in Gaelic games players, but data are limited to elite males with poor representation of females. The aim of this study was to examine the prevalence, severity and factors associated with hip and groin pain and Femoroacetabular Impingement Syndrome (FAIS) in male and female Gaelic games players.

METHODS

A representative national sample of Gaelic games players completed a survey providing demographic information and details related to self-reported episodes of hip and groin pain and FAIS diagnosis within the last year. Players from multiple age grades, codes (Football/Hurling/Camogie) and levels of Gaelic games were included.

RESULTS

A total of 775 players responded to the survey. The annual prevalence of hip and groin pain was 54.8%. Almost half of players (48.8%) continued to participate in sport, while 18.7% ceased participation and 32.5% reported reduced participation. Although 40% of episodes lasted no longer than 3 weeks, there was a high recurrence rate (33.5%). FAIS was reported by eight players, representing 1.9% of hip and groin complaints. Logistic regression models indicate male sex, playing both codes of Gaelic games and participating in additional sport were significant factors in predicting hip and groin pain.

CONCLUSION

Hip and groin pain is prevalent in Gaelic Games with FAIS accounting for a small proportion of cases. However, consideration of indicators of severity (participation impact/symptom duration/medical attention) is essential in understanding the context and magnitude of these hip and groin issues. Male players and players engaging in multiple sports are more likely to experience hip and groin pain.

A qualitative exploration of perceived challenges and opportunities in the implementation of injury prevention and management in amateur female sport

Introduction

Coaches, practitioners, and leadership in amateur female sport must navigate many obstacles in the pursuit of athlete availability and optimal performance. The present study aims to evaluate opportunities and challenges to both injury prevention and management in amateur female sport, as experienced by mixed-gender coaches, allied healthcare professionals, and general practitioners.

Methods

Semi-structured virtual interviews of coaches, allied healthcare professionals, and general practitioners (N = 25), recruited via convenience snowball sample. Data transcribed verbatim with reflexive thematic analysis through a critical realism framework.

Results

Female-specific issues, education, and resource capital were challenges to the implementation of injury prevention and management in amateur female sport, thus negatively impacting on performance, prevention, and rehabilitation. Opportunities for improved care for female athletes were developing communication and relationships, outsourcing responsibility, and providing greater education, in response to desires for such, and lastly exposure to elite sport and national governing bodies' protocols.

Discussion

In amateur female sport, developing communication pathways and relationships, along with upskilling coaches, can help better support female athletes, coaches, and healthcare professionals. Leaders and stakeholders must advocate for and support greater education, resourcing, and an understanding of female-specific issues in amateur female sport. It is intended that these findings will provide evidence and opportunities for discourse between stakeholders in amateur female sport to improve standard of supports for female athletes, coaches, and healthcare professionals. These findings may also help practitioners better exploit opportunities and circumvent challenges to improve the welfare and performance of amateur female athletes.

The relationship between hamstring strength tests and sprint performance in female Gaelic footballers: A correlation and linear regression analysis

OBJECTIVES

To investigate the relationships between handheld dynamometer (HHD), isokinetic and Nordic hamstrings exercise (NHE) measurements of knee flexor strength and their association with sprinting performance.

DESIGN

Cross-sectional.

METHODS

The relationships between HHD (prone isometric, prone break and supine break knee flexor strength tests), isokinetic and NHE peak knee flexor strength measures were examined using Pearson product correlations on 38 female footballers. A linear regression analysis was also performed for each pair of dependent variables (10 and 30 metre sprint times) and independent predictor variables (average relative peak torque for HHD, isokinetic and NHE testing).

RESULTS

There were good correlations between HHD tests (r = 0.81-0.90, p < 0.001, R2 = 0.65-0.82), moderate correlations between HHD and isokinetic peak torque, (r = 0.61-0.67, p < 0.001, R2 = 0.37-0.44) and poor association between the HHD peak torques and isokinetic work (r = 0.44-0.46, p = 0.005-0.007, R2 = 0.20-0.21) and average power (r = 0.39-0.45, n = 36, p = 0.006-0.019, R2 = 0.15-0.22). There was a poor association between NHE peak torque and isokinetic total work (r = 0.34, p = 0.04, R2 = 0.12). No associations between knee flexor strength and sprint times were observed (p = 0.12-0.79, r2 = 0.002-0.086).

CONCLUSIONS

Moderate to good correlations within HHD testing and poor to moderate correlations between HHD and isokinetic testing were observed. HHD knee flexor torque assessment may be useful to regularly chart the progress of hamstring rehabilitation for female footballers. Knee flexor strength assessments were not associated with sprint times in female footballers. Other aspects of knee flexor strength and sprint performance should be investigated to assist clinicians in making return to running and sprinting decisions in this population.

The Use of Recovery Strategies in Gaelic Games: A Mixed-Methods Analysis

PURPOSE

This study investigated Gaelic games players' (1) use of postexercise recovery strategies; (2) recovery strategies according to sport, biological sex, and playing standard; and (3) recovery strategy periodization.

METHODS

Participants were a total of 1178 Gaelic players (n = 574 female), age 24.6 (6.6) years. These players completed a questionnaire investigating postexercise recovery strategies. Participants were further dichotomized by playing standard into developmental (club/collegiate; n = 869) and national (intercounty; n = 309) levels and by sporting codes: Gaelic football (n = 813), Camogie/hurling (n = 342), and handball (n = 23).

RESULTS

Active recovery (90.4%), cold temperature exposure (79.5%), regular sleep routine (79.1%), strategic nutritional intake (72.3%), and massage (68.8%) were the most commonly used recovery strategies. Recovery strategy use was periodized by 30% of players. A significantly larger proportion of national-level players apply cold temperatures (86.7% vs 73.1%; P = .001) and nutritional strategies (80.1% vs 69.2%; P = .012) when compared with developmental players. A significantly larger proportion of female players have a regular sleep routine (82.6% vs 75.1%; P = .037), apply external heat (63.4% vs 48.5%; P = .002), and perform stretching (76.5% vs 66.4%; P = .002) postexercise when compared with male players. A significantly larger proportion of male players employ nutritional strategies (77.6% vs 67.5%; P = .007) and consume a combination of protein and carbohydrate (62.1% vs 28.0%; P < .001) postexercise when compared with female players.

CONCLUSION

Gaelic games players regularly implement a range of postexercise recovery strategies in an attempt to expediate the return of performance capacity and psychophysiological status to preexercise levels. The current findings may support practitioners who seek to prescribe effective and periodized recovery interventions targeting optimized preference/compliance.

The architectural characteristics of the hamstring muscles do not differ between male and female elite-level rugby union players

Purpose: To determine whether differences exist in the architectural characteristics of the hamstring muscles of elite-level male and female rugby union players. Methods: Forty elite-level rugby union players (male n = 20, female n = 20) participated in this cross-sectional study. A sonographer acquired static ultrasound images using a 92 mm linear transducer to quantify (via a semi-automated tracing software tool) the architectural characteristics (muscle length, fascicle length, pennation angle, and muscle thickness) of the biceps femoris long head and semimembranosus muscles of participants' left limb. Muscle length and muscle thickness of the biceps femoris short head and semitendinosus muscles of participants' left limb were also quantified. Bonferroni adjusted independent samples t-tests were performed to evaluate whether differences exist in the architectural characteristics of the hamstring muscles of elite-level male and female rugby union players. Results: There were no significant differences in fascicle length or pennation angle of the hamstring muscles of elite-level male and female rugby union players. Some significant differences in muscle thickness (biceps femoris short head, and semimembranosus) and muscle length (biceps femoris short head, biceps femoris long head, semitendinosus, and semimembranosus) were observed; in all cases the male players had thicker and longer muscles. Conclusion: At a group level, hamstring muscle fascicle length and pennation angle are unlikely to be a sex-specific intrinsic risk factor for Hamstring strain injuries.

Hamstring Injury Rehabilitation and Prevention in the Female Athlete

Hamstring injuries (HSIs) are common in female athletes and are associated with a lengthy recovery period and a high rate of reinjury. Currently, the majority of existing literature investigating HSI rehabilitation has been conducted using male participants. However, female athletes display intrinsic anatomical and biomechanical differences compared to males that influences the way this population experiences HSIs and HSI rehabilitation. HSI rehabilitation and injury prevention guidelines for female athletes must take these differences into account. Female athletes display anatomical differences such as increased anterior pelvic tilting, gluteus maximus weakness, an increased pelvic width-to-femoral length ratio, and an increased degree of femoral anteversion, all of which can predispose females to HSIs. Maneuvers designed to strengthen the gluteal musculature and transverse abdominis can overcome these risk factors. Females show increased joint laxity and a greater range of motion of hip flexion and internal rotation compared to males. Females have lower passive hamstring stiffness than males, therefore hamstring flexibility exercises may not be as necessary during rehabilitation for females as in the male athlete population. Female athletes may instead benefit from trunk stabilization exercises and agility training due to neuromuscular control deficits that arise from the maturation and growth of the female pelvis. Existing literature on hamstring injury prevention shows consistent use of the Nordic Hamstring Exercise and balance exercises may reduce the risk of sustaining an HSI in both males and females, though more studies are needed to ascertain the optimal regimen for injury prevention in the female athlete population specifically. The goal of this clinical commentary is to discuss sex-specific anatomic and biomechanical differences of the lumbar, pelvic, and hip regions with the aim of providing guidelines for rehabilitation and injury prevention of HSIs in female athletes.

Level of Evidence

5.

Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type

BACKGROUND

Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts.

OBJECTIVE

To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports.

METHODS

Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included.

RESULTS

Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48-62, I2 = 82%; females: 63%, 95% CI 53-71, I2 = 84%; males: 50%, 95% CI 42-58, I2 = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05-0.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03-0.07, I2 = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10-0.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03-0.07, I2 = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32-0.72, I2 = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15-0.70, I2 = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02-0.07, I2 = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01-0.05, I2 = 86%) and these differences were significant. Heterogeneity across studies was generally high.

CONCLUSION

This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.

Epidemiology of sport-related concussion rates in female contact/collision sport: a systematic review

Objectives

To determine sport-related concussion (SRC) incidence rates in female contact/collision sport.

Design

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Data sources

Four databases (PubMed, SportsDiscus, Web of Science, CINAHL) were searched for data from 2012 to 2021.

Eligibility criteria

Studies reporting SRC incidence rates or the number of concussions and athletic exposures (AEs) per 1000 participating events or hours in healthy female contact and collision sport athletes of any age were included.

Results

The search yielded 8438 non-duplicate articles. Following screening, 19 were included in the analysis (median quality score=70%), with 8 reporting match or training incidence rates. Studies were primarily from US high school and collegiate populations; data are reported for eight sports. Rugby union reported the highest match SRC rates (8.2-16.11 per 1000 AE hours), followed by Gaelic football (5.21 per 1000 AE hours) and soccer (2.08-4.04 per 1000 AE events). Where available, match SRC rates were substantially higher than training and overall SRC rates.

Conclusion

Female sports such as rugby union, Gaelic football and soccer present the highest risk for SRCs within the available data. Previous research indicates a potentially greater injury burden for female athletes experiencing SRCs than their male counterparts. Thus, future research should analyse concussion knowledge and return-to-play protocols in these sports. Future research should also prioritise exploration of the gap in SRC rates within amateur sports, and data should be presented specifically in the context of athletic exposures (match vs training).

Trial registration number

CRD42021281569.

Factors influencing performance and injury risk in elite female Gaelic team sport players and future research directions: a narrative review

BACKGROUND

Sports science research in elite female Gaelic team sports has increased in recent years, but still a large disparity exists between the volume of studies involving male and female players. As a consequence of this, it is difficult for practitioners to develop an evidence-based approach when working with female players.

MAIN BODY

In this review, we discuss the current research available in elite female Gaelic team sports with focus on seven specific areas including physical and physiological demands, anthropometric and performance characteristics, injury risk, nutritional considerations, and female physiology. There appears to be unique physical demands data in match play across positions in Camogie, however, there is currently no comparative data available in ladies Gaelic football. Similarly, there is no research available on the physiological demands of both elite female Gaelic team sports. According to existing literature, performance characteristics such as speed and power are lower in this population compared to other elite female team sports. Although data is limited, the anthropometric characteristics of elite female Gaelic team sport players appear homogenous with some positional differences observed at a sub-elite level. Previous research has demonstrated a high prevalence of lower limb injuries in female elite Gaelic team sports and the provision of quality, evidence-based strength & conditioning could help mitigate these injury risks. Female Gaelic team sport players have been shown to have poor nutrition knowledge and inadequate intakes of micronutrients. Finally, although menstrual cycle phase and oral contraceptives have been shown to influence performance in other female intermittent sports, to date there has not been any research carried out in elite female Gaelic team sport players.

CONCLUSIONS

It is evident that limited research has been carried out on elite female Gaelic sport players. More up-to-date, high-quality investigations are needed to address the research gaps, which in turn should enable practitioners in the field to apply sound, evidence-based practice/theory when working with this population.

Descriptive Epidemiology of Injuries in Professional Speedball Athletes

CONTEXT

Speedball is an increasingly popular racquet sport played in more than 25 countries. Our objective was to describe injury incidence and patterns among Egyptian national-level speedball athletes.

DESIGN

Descriptive epidemiological.

METHODS

We conducted a survey of athletes who were registered with the Egyptian Speedball Federation during the 2018-2019 professional season. The survey inquired about injury types and athlete exposures (AEs). The response rate was 63% (100/160 athletes). Respondent ages ranged from 18 to 41 years. We analyzed demographic characteristics; number, location, and mechanism of injuries; treatment; and speedball participation time lost because of injury.

RESULTS

Of 100 respondents, 65 reported having sustained at least one injury during the season for a total of 90 injuries and a rate of 4.7 injuries per 1000 AEs (95% confidence interval, 3.7 to 5.7). More injuries occurred during practice (77%) than during competition (23%). Thirty percent of respondents reported having missed a competition because of injury. The most frequent anatomic locations of injury were the shoulder (50%; 2.4/1000 AEs), elbow (14%; 0.68/1000 AEs), and low back (9%; 0.4/1000 AEs). The most frequently cited causes of injury were increased intensity of training (40%) and lack of warming up (18%). Seventy-seven percent of injured respondents underwent treatment by a health care professional, and 9% of these respondents underwent surgery.

CONCLUSION

The shoulder was the most common anatomic location for injuries in speedball athletes. Our results suggest that attention should be directed toward sport-specific injury prevention and intervention strategies because speedball is a fast-growing sport in several countries.

Fear Avoidance After Injury and Readiness to Return to Sport in Collegiate Male and Female Gaelic Games Players

BACKGROUND

Injuries are common in collegiate Gaelic games, and negative psychological responses to injury, such as fear avoidance and a lack of psychological readiness to return to sport, can affect players during their rehabilitation and their subsequent return to sport. Thus, identifying these responses in players can allow clinicians to address these issues during rehabilitation. This study aimed to examine fear avoidance and psychological readiness to return to sport in collegiate Gaelic games players.

HYPOTHESIS

Collegiate Gaelic games players will experience similar levels of fear avoidance and psychological readiness to return to sport as other adult athletes.

STUDY DESIGN

Cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Male (n = 150) and female (n = 76) players from 1 Irish collegiate institution were recruited. Players that were injured over 1 collegiate season completed the Athlete Fear Avoidance Questionnaire (AFAQ) immediately after the injury and the Injury-Psychological Readiness to Return to Sport (I-PRRS) Scale once cleared to return to sport. An injury report form was also completed. The overall AFAQ (sum of 10 items) and I-PRRS (sum of 6 items/10) scores were calculated.

RESULTS

Seventy-three injuries (n = 73) occurred, and injured players had a mean overall AFAQ and I-PRRS score of 22.6 ± 5.3 and 46.4 ± 8.8, respectively. Just less than half (47.9%) of players were deemed psychologically unready to return to sport when cleared physically. After severe injuries, significantly higher overall AFAQ scores than mild injuries (P = 0.01) and lower overall I-PRRS than moderate injuries (P < 0.0001) was noted. For the overall scores, no gender differences were observed.

CONCLUSION

Fear avoidance and lowered confidence levels before return to sport occurs in collegiate Gaelic games players similar to other student-athletes.

CLINICAL RELEVANCE

Identification of fear avoidance or low readiness to return to sport, particularly after serious injury, is important to implement psychosocial support during their rehabilitation.

Injuries in Irish male and female collegiate athletes

OBJECTIVE

To understand the incidence and burden of injury of student-athletes in four of the most popular collegiate sports.

DESIGN

Prospective cohort study.

SETTING

Collegiate sport.

PARTICIPANTS

Gaelic football, hurling/Camogie, soccer and Rugby (n = 672; male = 416, female = 256) student-athletes.

MAIN OUTCOME MEASURE

Injury incidence, burden of injury and total, match and training injury rates, and their 95% confidence intervals were calculated. The frequencies and proportions were also calculated. An injury was defined as any physical condition that prevents a student-athlete from full participation for a period greater than 24 h.

RESULTS

Over a quarter (0.266) of student-athletes sustained an injury in the academic season. Male student-athletes had a higher injury rate than females (21.6 vs 11.3 injuries/1000 h). Rugby (20.8 injuries/1000 h) had the highest injury rates with hurling/Camogie (6.3 injuries/1000 h) the lowest. Lower extremity injuries were predominant (68.8%) with ankle sprains demonstrating a large burden for all sports (20.6-280.2 days absent/1000 h). Hamstring strains (13.7-118.4 days absent/1000 h) had a large burden for all sports except male Rugby. Knee sprains had a large burden on the female Gaelic footballer (84.8 days absent/1000 h). Sprinting (27.4%) and the tackle (20.1%) were the most common mechanism of injury. Injuries were predominantly moderate (8-28 days) or severe (>28 days) (84.7%).

CONCLUSION

Injury reduction needs to be prioritised in the student-athlete, particularly in males. Specific focus is required on the lower extremity, especially in the hamstring muscles and ankle joint owing to the large burden of injury.