Curse of the cruciate
It’s the injury that strikes fear into every athlete and, with a growing number of GAA players affected, Colm Keys looks at some recent prominent cases and talks to the medics trying to find ways of combating it
The first time it happened he couldn't have been sure. The second time? The diagnosis was carried out in his own mind before anyone came to his assistance.
Mark Davoren knew when he collapsed to the ground that the same cruciate ligament in his knee, which he had painstakingly rebuilt over an eight-month period following surgery, had torn again.
It was April last year and Davoren admits now he was a man in a hurry.
Too much of a hurry.
Kilmacud Crokes had organised a challenge against a club side from Meath and Davoren, with one eye on a championship campaign with Dublin, took a deep breath and jumped back into action.
Hindsight tells him now it wasn't the right move. He had initially torn the ligament in a collision with an opponent in the previous year's championship against Meath.
"My foot planted into the ground, I went to turn, but my leg stayed and only my body moved," recalled Davoren.
"I heard the snap and knew it was something serious. When it happens the first time you always hope for the best. The second time you instantly fear the worst. You know.
"Clearly it wasn't ready to go. I wanted to get back for a shot at the championship (with Dublin), but it didn't pay off. I wasn't ready."
The experience has shaped his recovery this time round. Davoren describes his routine now as being cloaked with "ultra caution".
In his own mind he has some time in September with Kilmacud Crokes in his mind as a comeback date. No reason why, just an instinct. The Dubs? They're for another year. At 26 he still feels he has time. But will he have healthy knees?
"There'll be no risks this time. If it happened again then I don't think I'd be able to come back. Mentally you can get quite disillusioned the second time. I stopped at it for a while. But there is light at the end of the tunnel."
Davoren may feel alone as he continues his rehabilitation, but the number of inter-county players in the same position is staggering.
Between Dublin hurling and football alone, there are seven players who have either recently suffered or recently recovered from the injury.
Moreover, the numbers who, like Davoren, are experiencing cruciate tears almost as soon as they recover, is an even more worrying development.
David Connole, Clare's exciting football prodigy, came back for last year's county junior final having recovered from cruciate surgery the previous year, but suffered a recurrence and has been out of action since.
Two weeks ago, Meath's David Bray turned awkwardly in training and within a year of his initial tear he is also back to square one again.
Two years ago, Paul Brogan had just completed his first rehabilitation process when he was back under the knife again with the same problem.
Of the victorious 2006 Roscommon minor team, two members, Darren McDermott and Eamonn Kenny, sustained cruciate tears in a particular knee around the same and within months of their respective comebacks, they sustained the same damage to their other knees.
Even the elite can't avoid recurrence.
It was also the two knees for Henry Shefflin, but the gap between his first (2007) and second tears (2010) was less than three years.
Shefflin's troubles in advance of last year's All-Ireland final are well documented -- he was able to start the final three weeks after sustaining the damage.
The range of inter-county footballers and hurlers who have either torn or recovered from cruciate ligament injuries over the last 15 months is in excess of 30.
That figure may be quite small, but the very word cruciate strikes fear into just about every sportsman.
In the last seven days, two of Gaelic football's rising stars, Cork's Colm O'Neill and Kerry's David Moran, have succumbed to the dreaded injury.
Their seasons are over.
The phenomenon of recurrence is one that has experts with strong GAA backgrounds concerned.
Dr Pat O'Neill, the last man to manage Dublin to an All-Ireland football title in 1995 and a prominent sports injury specialist, acknowledges that there seems to be a higher incidence of cruciate injuries at present than there has been at any stage in the past.
"I don't think there is any factual explanation, but my supposition is that there may be three reasons -- all unproven, it must be said -- artificial pitches, footwear and the type of training teams are doing," said O'Neill.
"The footwear-surface interface seems to be an issue. There was always a bit of give on GAA pitches that acted as a natural buffer, but now there are different surfaces and different footwear.
"High-agility training may also be contributing, but again there are more questions than answers, questions that we don't have ready-made answers for."
O'Neill now believes that resources should be put into prevention of the injury rather than repair and recuperation.
When the GAA's Medical, Scientific and Welfare Committee convened for their last meeting, Dr Pat Duggan, who chairs the group, recalled a long discussion about the dreaded injury.
"The question was put out there," said Duggan. "What was the biomechanical reason for a cruciate ligament? And there was a difference of opinion about what the key factor was. For me, it's all about rotation."
Like O'Neill, Duggan admits that artificial pitches "bother" him. And he shares the view that the GAA have to put more time and energy into preventative measures.
"I'd share the view that cruciate damage appears to be on the increase, which is why we as a committee are proposing extensive research into it over the next few years."
Duggan references a Santa Monica PEP study in 2000, which discovered that occurrence of cruciate ligament damage among women soccer players was eight times higher than their male counterparts.
"There was an explosion of interest in women's soccer after the (1999) Women's World Cup and this is what they came up with.
"They devised a prehab warm-up routine which took 10 minutes before training sessions three times a week," recalled Duggan.
"They were able to reduce cruciate damage by an incredible 80pc as a consequence."
Duggan said plans are in the pipeline to introduce a similar routine to a series of club GAA teams over the next few years.
"We intend to pilot it with clubs first," he said.
"Inter-county squads generally do their own thing. Some of them are very sophisticated in their approach, but that hasn't stopped the number of cruciate injuries stacking up."
Neither specialist can agree with a commonly held view that excessive leg work in the gym is a cause of increased incidence of cruciate injuries.
"Strengthening the muscles in the legs should be a help. After all, the purpose of the cruciate ligaments is stability," said O'Neill.
Cruciate ligament injuries are nothing new to Gaelic footballers and hurlers. From Pat Spillane to Kieran McGeeney; from JJ Delaney to Bernard Brogan, the best have all had to endure a recuperation process that can last between six and 12 months.
But the occurrence has never been more noticeable than over the last few weeks.