One-stop shop that tackles scourge of groin injuries
HAD severe groin pain not ended Alan Brogan's involvement in last year's All-Ireland semi-final after just 18 minutes, Dublin football's fate in 2012 might have been different.
Tyrone fans could make the same argument after losing Kyle Coney to the same problem for the entire summer. Numerous other counties have counted the cost of recurring groin injuries in the past year and will do so again before the end of 2013.
Sports medicine has now identified that there can often be a correlation between groin and hip problems, with the latter increasingly a recurring problem among top players.
Dublin's Eoghan O'Gara is among the Gaelic footballers who has had hip surgery recently, but the most high-profile is undoubtedly Donegal's Footballer of the Year Karl Lacey, whose return to action in 2013 will be delayed for months after his pre-Christmas hip injury.
But one Irish sports medicine centre is now pioneering a ground-breaking groin treatment system which even uses iPads to accelerate recovery rates from one of the most problematic injury areas in sport. Eanna Falvey is not only director of sport and exercise medicine at the Sports Surgery Clinic (SSC) in Santry but the team doctor for the IRFU and Ireland's top boxers.
He is a former Irish superheavyweight boxing champion who started out hurling ("at a very low level," he stresses) with his native Cloyne, so he knows well the high incidence of groin problems among inter-county GAA players and regularly treats them.
On the fourth floor at the SSC is an Astroturfed performance analysis lab that they have turned into a high-tech one-stop shop for groin injuries which they hope will make them world leaders in the field. The Santry clinic is pioneering an individualised, fast, multi-disciplinary and movement-based approach to the problem.
When Falvey worked with Mick Molloy's sports clinic in Cork in 2006, he was amazed at the level of groin pain – "riddling the place" – and went to the University of Melbourne and the local Olympic Park Sports Medicine Centre to learn more.
Before he left for Australia, they diagnosed a tear in a Cork senior hurler's hip. At the time, there was a surgeon in the country who could have operated on it but there was no suitable equipment.
In Australia, Falvey quickly met a specialist in Geelong who had already done 3,500 hip arthroscopies. Irish sports medicine has since caught up but – despite all the money and research sloshing through professional sport – why do chronic conditions like Gilmore's Groin and osteitis pubis (inflammation of the pubic joint resulting in groin pain) remain such a recurring problem?
"For one, because there's no off-season anymore," Falvey notes. "Players don't stop playing in most sports and, if their game does stop, they go off playing something else. Secondly, a fella who played inter-county football 20 years ago didn't train as much as some club players train nowadays.
"We've got bigger players now, training harder, making bigger demands on their bodies and the game is significantly faster too. If you watch '80s Gold' on TG4, it was a different sport."
Significantly, groin injuries have become far less an issue in professional rugby "because the (training) load is all managed," Falvey stresses.
That improvement is also related to the amount of stretching professional sportsmen do, yet rugby, conversely, is now noticing a rise in hip problems.
There is one – as yet unproven – theory linking this to weight-training and, in particular, to players' foot placement when they're performing squat-lifts. Falvey says 25 to 30pc of the groin problems he treats are hip-related.
"Osteitis pubis is just a symptom, it's because there's too much stress across the pubic synthesis because of lack of range of motion either in the hip joint or gluteal muscles (backside) or the hip flexors."
But he stresses that a significant number of the population also have hip abnormalities that never cause them groin problems. He feels proper longitudinal research still needs to be done on hip injuries, like the 3,000 groin reviews the SSC has done since 2007.
"We've always had fantastic imaging, the expertise to read it and the clinical expertise for examining it, but our big issue was how to treat it," he says.
"Traditionally, the treatment for groin problems was to strengthen up the muscles by something like static squeeze testing but, clinically, that's not any use because you don't run around playing football squeezing your adductors."
He has similar reservations about groin rehab that emphasises static core exercises.
"Fellas are lying down doing a plank (exercise) but you don't play football lying down. A plank is of very limited use. Yes, it's very good for getting started, but to go from that to running around is a huge step given the demand on your groin muscles."
The SSC is pioneering and validating dynamic (moving) groin tests and rehab exercises, using 3D movement analysis and technology like iPads to customise recovery.
"Osteitis pubis treatment, traditionally, was 'go away and rest for six months' but you still haven't corrected the problem," Falvey says. "People return to training and are often back to square one in a couple of months. If I'd a fiver for every patient who's come into me like that, I wouldn't have to work anymore.
"Time is of the essence. Players are often told to rest but it doesn't necessarily need to be rested. It may need that, yes, but you can't have a 'one size fits all' approach. You're bound to fail if you don't individualise it and our philosophy is 'treat the man, not the scan'."
Falvey says groin injuries are particularly problematic because of the mental toll they also take.
"One of the biggest things is the psychological impact," he says. "If you tear your cruciate, I'll say, 'listen, you're out for six to eight months, take it on the chin,' and players do.
"But with groin pain, it could be anything from three months to a lot longer, so that's a killer for a start.
"Secondly, you don't have any crutches or a cast. So you're down at the GAA club three weeks later and they're saying, 'sure there's eff all wrong with that fella, he's only bluffing'.
"Someone who has had groin pain for six to 12 months is often damaged goods psychologically and needs help to cope with the mental aspect of it as well."