Sunday 25 January 2015

Getting hip to beating pain

MARIE CROWE dons her scrubs to witness the surgery that is saving Irish sporting careers


Clare hurler Conor McGrath is lying on a hospital bed at Whitfield Clinic. He's dressed in his Cratloe GAA T-shirt and NUI Galway shorts. The 21-year-old is about to be prepped for hip surgery but he's feeling very calm.

He undergoes a few quick tests before it's time to go into theatre to see the anaesthetist. When he leaves, I talk to surgeon Patrick Carton about what lies ahead. He's a very confident, dedicated man who left a top job in the NHS in Northern Ireland to move to Waterford to focus on pioneering this type of hip surgery.

A Christmas card from the Kilkenny hurlers sits on his desk. The front of the card is decorated with pictures of the current All-Ireland-winning team. It's no surprise the doctor received a personalised card from the team – he's carried out successful hip operations on several of their most prominent players.

Mr Carton is a busy man, operating regularly on the hips of sports stars who are all striving to play at 100 per cent fitness. Just a few days before Christmas he has allowed me to sit in on one such operation. Conor McGrath, inter-county hurler with Clare and dual player with Cratloe. For the surgeon, it's operation number 259 for 2012.

According to Mr Carton, the hip is the underlying problem for many other injuries like groin, back and hamstring and it's only recently that many athletes are being properly diagnosed. Many of his patients will have had groin operations and been fine for six months because of rest but the pain returns when full-on exercise resumes.

Others will have been regularly attending physiotherapists or had frequent rest periods and yet their injuries have persisted. And some will have even quit sport altogether but the pain won't have gone away.

The condition is called 'impingement' and is caused by repetitive abnormal contact between the ball of the hip and the socket. As a result of this contact, the shape of the ball changes from round to flat and the damage is usually done when these athletes are in their early teens and engaging in high volumes of sport.

This is what happened with McGrath. When he was a teenager, he played hurling and football for the club and hurling for the county as well as both sports with his school. He was training or playing nearly every day of the week.

In his case the damage was obvious from the X-ray and the MRI scan: the ball of his hip joint was clearly flattened and there was visible bruising on the socket and the cartilage on the hip was torn. No wonder he wasn't feeling right.

This problem is most commonly associated with sports that involve a lot of twisting and turning such as hurling, football, rugby and soccer but can also be seen in runners, dancers, boxers, martial arts practitioners and many other sports people.

The condition is often hard to diagnose because the symptoms are vague. Most athletes who present themselves to Mr Carton will have complained of progressive stiffness and tightness around the hips and also some lower back pain. More often than not the stiffness occurs after exertion, and usually it takes a while for it to ease.

Pain may eventually develop in the groin and around the hip and also the hamstrings can get tight and clicking can occur. For McGrath, it was constant stiffness that raised the alarm bells. He never felt much pain during training or games but afterwards he knew something wasn't right. His movement felt restricted, even while walking, and it all seemed to stem from his hip.

But that's the nature of the condition. It affects mostly young athletes, males in particular, and worryingly it's a progressive condition that can lead to degenerative arthritis of the hips.

So when the 2012 season finished, McGrath decided to get his problem sorted. Clare had performed well in the championship and had big plans for 2013. McGrath wanted to be as fit as he could be for the new season. Every extra bit counts when you are playing at the top level and he wants that edge. The team physiotherapist screened him and sent him to Barrington's Hospital in Limerick for an MRI and from there he went to Whitfield Clinic in Waterford to Mr Carton for further examination and an operation was scheduled.


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