1. The Rehabilitation Specialists
Surveillance of Injuries in Gaelic Games & the Implications for Insurance. Different Rehabilitation Approaches for the Active versus the Inactive.
John C Murphy
B Physio MSc GDBS SMISCP
Clinical Director Medfit
Dublin. Ireland

2. Translating Research into Injury Prevention Practice TRIPP Model
Injury surveillance
Establish cause and mechanisms of injury
Develop preventative measures
Scientific evaluation in ‘ideal conditions’
Examine the context and environment to guide implementation
Evaluate effectiveness of preventative measures in real world

3. Assess Programme Effectiveness by Repeating Step 1 Step 2
Identify Injury
Risk Factors
Step 3
Implement a Prevention Programme
Step 1
Identify & Quantify the Injury
Adapted from van Mechelen et al., 1992

4. Healthcare Nudging Improving Choices Thaler/ Sunstein
A healthcare Nudge, deliberate process which leads to positive behavioural changes, thereby addressing multiple healthcare issues
(“nudging” refers to steering individual decision making so as to make choosers better off without breaching their free choice. If successful, this may offer an ideal synthesis between the duty to respect patient autonomy and that of beneficence)
Tackling obesity post Total Hip replacement
In sport changing the variables which cause injuries is called prehabilitation

5. Society Nudging

6. Nudging a system or a patient

7. Rehabilitation within the active & less active population
Rehabilitation is a treatment or treatments designed to facilitate the process of recovery from injury, illness, or disease to as normal a condition as possible.
In sporting patients, motivation is very high
In patients with lower back pain, depression , T2DM & cardiac issues a very complex, multi-factorial approach is required. At what stage in their lives do they take the illness seriously to facilitate a complete or partial rehabilitation process?

8. National GAA Injury Surveillance Database
A Review of 2008 to 2014 Seasons

9. 55 37 1788 1192 1909 1399 Teams Enrolled Players Enrolled
The National GAA injury database was established in 2007 by the John C Murphy of GAA Medical, Scientific and Player Welfare Committee in collaboration with Dr Catherine Blake of UCD. The catalyst for this initiative was the prioritisation of player welfare and injury prevention. 55
Gaelic Football 37
Hurling
Teams Enrolled
1788
Gaelic Football
1192
Hurling
Players Enrolled
1909
Gaelic Football
1399
Hurling
Reviewed Injuries

19. Rate Per Injured Player
1.7 in Gaelic Football

20. Rate Per Injured Player
1.6 in Hurling

21. Team Injury Rate Per Season - Intercounty Gaelic Football

22. Team Injury Rate Per Season - Intercounty Hurling

23. Match-Play to Training Ratio of Rate Per 1000 Exposure Hours
15.6
in Gaelic Football
4.6
in Gaelic Football
Knee Injury Risk Ratio
Match-Play to Training Ratio
of Rate Per 1000 Exposure Hours
Rate Per Team
Per Season
11.5%
Proportion of All Injuries
9.2%
Proportion of All Training Injuries
12.8%
Proportion of All Match-Play Injuries

24. Match-Play to Training Ratio of Rate Per 1000 Exposure Hours
17.7
in Hurling
4.7
in Hurling
Knee Injury Risk Ratio
Match-Play to Training Ratio
of Rate Per 1000 Exposure Hours
Rate Per Team
Per Season
11.3%
Proportion of All Injuries
9.7%
Proportion of All Training Injuries
12.7%
Proportion of All Match-Play Injuries

25. Fracture and Bone Stress 12.1% 13.4% Fracture 0.6% 2.4% Bony Bruising
Gaelic Football
Hurling
Total
157
127
Fracture and Bone Stress
12.1%
13.4%
Fracture
0.6%
2.4%
Bony Bruising
11.5%
11.0%
Anterior Cruciate Ligament
ACL Sprain
4.5%
4.7%
ACL Rupture
7.6%
8.7%
Posterior Cruciate Ligament
2.5%
1.6%
PCL Sprain
Lateral Collateral Ligament
5.7%
LCL Sprain
5.1%
LCL Rupture -
Medial Collateral Ligament
17.3%
MCL Sprain
10.8%
MCL Rupture
Meniscus
Lateral Meniscus
3.8%
3.1%
Medial Meniscus
5.5%
Unspecified Meniscus
Joint (General)
9.6%
10.2%
Loose Body
Synovitis
Cartilage
1.9% %
Contusion
1.3%
0.8%
Muscular and Tendinous
15.9%
Muscular
Patellofemoral Tendonopathy
14.6%
Other
6.3%
Unspecified Structure
8.9%
3.9%

26. 7.7 5.9 17.8% 21.9% 13.0% Pelvis/Hip Injury Risk Ratio Rate Per Team
in Gaelic Football
5.9
in Gaelic Football
Pelvis/Hip Injury Risk Ratio
Match-Play to Training Ratio
of Rate Per 1000 Exposure Hours
Rate Per Team
Per Season
17.8%
Proportion of All Injuries
21.9%
Proportion of All Training Injuries
13.0%
Proportion of All Match-Play Injuries

27. 10.3 5.0 13.9% 16.2% 12.4% Pelvis/Hip Injury Risk Ratio Rate Per Team
in Hurling
5.0
in Hurling
Pelvis/Hip Injury Risk Ratio
Match-Play to Training Ratio
of Rate Per 1000 Exposure Hours
Rate Per Team
Per Season
13.9%
Proportion of All Injuries
16.2%
Proportion of All Training Injuries
12.4%
Proportion of All Match-Play Injuries

28. 95% of Pelvis/Hip Injuries Result in Time-Loss Days from Sport
in Gaelic Football
in Hurling
Time-Loss Days from Sport
Total
Mean (SD)
Maximum
95% CI
All Pelvis/Hip Injuries
7226
32.7 (47.1)
323
Adductor Related
1965
22.3 (33.1)
203
Iliopsoas Related
500
16.1 (13.1) 52
Inguinal Related
232
46.4 (44.9)
115
Pubic Related
2243
66.0 (61.8)
Hip Related
1591
48.2 (64.7)
274
Other
695
24.8 (43.8)
230
Defined clinical entities for pelvis/hip injuries adapted from Weir A, et al. Br J Sports Med 2015;49:768–774

29. 8.4 9.7 24.9% 26.2% 23.7% Hamstring Injury Risk Ratio Rate Per Team
in Gaelic Football
9.7
in Gaelic Football
Hamstring Injury Risk Ratio
Match-Play to Training Ratio
of Rate Per 1000 Exposure Hours
Rate Per Team
Per Season
24.9%
Proportion of All Injuries
26.2%
Proportion of All Training Injuries
23.7%
Proportion of All Match-Play Injuries

30. 8.0 6.6 17.7% 25.6% 15.2% Hamstring Injury Risk Ratio Rate Per Team
in Hurling
6.6
in Hurling
Hamstring Injury Risk Ratio
Match-Play to Training Ratio
of Rate Per 1000 Exposure Hours
Rate Per Team
Per Season
17.7%
Proportion of All Injuries
25.6%
Proportion of All Training Injuries
15.2%
Proportion of All Match-Play Injuries

31. 95% of Hamstring Injuries Result in Time-Loss Days from Sport
Gaelic Football
Hurling
All Hamstring Injuries
n=341
n=199
Bruising / Haematoma
1.5%
Biceps Femoris Belly
42.8%
45.2%
Distal Musculotendinous Junction
13.8%
14.1%
Proximal Musculotendinous Junction
15.2%
11.1%
Semimembranosis / Semitendinosis Belly
9.1%
10.1%
Unspecified Hamstring Region
17.6%
18.1%
95% of Hamstring Injuries Result in
in Gaelic Football
in Hurling
Time-Loss Days from Sport
Adapted from Woodlet and Storey, 2015, Review of Hamstring Anatomy, Aspetar Sports Medicine Journal.

32. 11.0 5.4 11.5% 11.6% 11.5% Ankle Injury Risk Ratio Rate Per Team
in Gaelic Football
5.4
in Gaelic Football
Ankle Injury Risk Ratio
Match-Play to Training Ratio
of Rate Per 1000 Exposure Hours
Rate Per Team
Per Season
11.5%
Proportion of All Injuries
11.6%
Proportion of All Training Injuries
11.5%
Proportion of All Match-Play Injuries

33. 10.4 4.9 12.1% 12.5% 9.7% Ankle Injury Risk Ratio Rate Per Team
in Hurling
4.9
in Hurling
Ankle Injury Risk Ratio
Match-Play to Training Ratio
of Rate Per 1000 Exposure Hours
Rate Per Team
Per Season
12.1%
Proportion of All Injuries
12.5%
Proportion of All Training Injuries
9.7%
Proportion of All Match-Play Injuries

34. 95% of Ankle Injuries Result in Time-Loss Days from Sport
in Gaelic Football
in Hurling
Time-Loss Days from Sport
Count
Sum
Mean SD
Max
95% CI
Gaelic Football 74
2261
30.6
45.1
295
Hurling 21
703
33.5
209
Count
Total Time-Loss
Mean SD
Max
95% CI
Ligament Sprain injury 47
1020
21.7
18.3 80
Lateral 26
653
25.1 23
Medial 3 51 17
3.6 21

35. Concussion Rate Per Team All Head/Neck Injuries
0.4
Gaelic Football
0.3
Hurling
Concussion Rate Per Team
Per Season
0.9%
0.7%
All Injuries
Gaelic Football
Hurling
44.4%
22.2%
All Head/Neck Injuries

36. Reports of Time-Loss (Days) from Sport Following Concussion
in Gaelic Games
Cases
Sum
Min
Max
Mean SD
95% CI
Gaelic Football 6 38 2 13
6.3
3.8
Hurling 3 37 21
12.3 9

37. Work absenteeism Acute injuries
Knee Injury – minimum of 5 days off manual work
Lower back disc injury - 2 weeks
Concussion -7 days
Ankle Injuries- minimum of 5 days off manual work
Upper limb shoulder/ elbow dislocation – 2 weeks off manual work

38. Work Absenteeism (post surgery)
Knee Injury – 2-6 weeks
Lower back disc injury - 4 weeks minimum
Ankle Injuries weeks off manual work
Upper limb shoulder / elbow dislocation – 12 weeks off manual work

39. Focus on Knee injuries ACL Injuries 1% of total Full tear
Expensive – screening , surgery , rehab, 2 weeks minimum off work
1062 claims covered by GAA Insurance during the 2010,2011,2012 period
Approximate Cost of 1.9 million per year

40. Running, Jumping, Landing, Twisting/Turning

41. Looking at reducing lower limb injuries
GAA 15 V1 –Warm up designed to improve mechanics associated with lower limb injuries
Launched Jan 2014
Designed by directors of Injury Surveillance John C Murphy, Dr Catherine Blake and this project was the PhD for Dr Edwenia O Malley

42. Changing Risks
GAA 15, integrated into training warm up was effective in reducing neuromuscular risk factors for injury.
Based on international research (60% reduction Females, 30% reduction in males)
Implementation is the key to enable community change

43. Implementation Clubs Schools Parents Coaches
Pre injury healthcare nudging strategy
Assuming engagement

44. Applying the lessons of behavioral change from GAA project
Nudging to create behavioral change in those with chronic conditions:
Back pain
Type 2 Diabetes
Cardiac
Metabolic syndrome
Addressing the key conditions for disability / income protection claims – orthopaedic, cancer, cardiac

45. Major opportuity with the non-active group
Changing the behaviours of non-active group creates huge health benefits
Using major incidents as an opportunity to create lifestyle change
For example heart incident, back surgery, T2D diagnosis, etc.

46. Telling these guys to get fit makes no sense

47. Ideal Pathway Rehabilitation Improved function Condition Bariatric
Oncology
Orthopaedic
Cardiology
Spinal
Condition
Surgery
Conservative
Rehabilitation
Maintenance
Behavioural change
Improved function

48. Rehabilitation for 60% of the population (insufficiently active)
Huge behavioural challenge
Multiple barriers
Link medical, rehabilitation , physiotherapeutic, dietetic and sports science consults
Use facilities which create the right environment to target non gym goers
Use MSK screening to avoid creating pain
Measure everything- it gets noticed

49. Spinal issues Passive medical & physiotherapeutic management Screening
Pharmacotherapy
Surgery or conservative
Process to limit recurrence
25% progress to an Active rehab program based on severity of presentation

51. Outcomes 48% improved HR QOL 70 hours measured rehab 70% compliance
Significant Metabolic fitness changes
Sub max Vo2 change of 26% to MET fitness of 9

52. MET FITNESS CHANGES with lower back problems and Type 2 Diabetes

53. Ideal Opportunity Aged 45+

54. Take home What gets measured gets noticed
Associated injury risk in sport
Major, knee, shoulder, hip and lower back surgeries cost a minimum of 6k
Changing injury risk in the active requires implementable strategies
Achieving positive rehabilitation outcomes for the inactive is multifactorial
Different model for the active versus inactive due to behaviours of cohorts

55. www.medfit.ie jmurphy@medfit.ie pogrady@medfit.ie
The Rehabilitation Specialists
John C Murphy B Physio MSc GDBS SMISCP
Clinical Director Medfit, Dublin. Ireland