Thursday 16 August 2018

GAA stars need new hips by their mid-20s

Players are wearing themselves out and slapdash injury record-keeping means they are left on the scrapheap

Retired: Chronic hip injury forced former Meath player Kevin Reilly to bow out of GAA at age 29
Retired: Chronic hip injury forced former Meath player Kevin Reilly to bow out of GAA at age 29

Joanna Kiernan and Jerome Reilly

Talented GAA players, who from their late teens have endured an endless regime of training and playing for club, college and county, are suffering irreparable hip damage by their mid 20s, one of the country's leading orthopaedic surgeons says.

Too much training and ignorance are to blame for many GAA players needing hip replacements in their early 20s and 30s. And part of the blame may be the ever-changing roster of medics who are treating players as they move from under-age to senior grades for their clubs, county and college.

It means there may be no proper recording of injuries suffered and care received, so underlying issues are identified too late. There is a generation of former players in all sports, now middle-aged, who are enduring a life of pain, only relieved by surgery.

"My main concern is the number of young sportsmen, who are coming through our clinic with evidence of irreversible damage to their hip joints - early arthritis - that in many cases is too advanced to treat.

"These players are advised to give up their sports completely," Patrick Carton, a consultant at Whitfield Clinic in Waterford, said.

"Every single week, I see players in their 20s and 30s, who are hoping to have hip- repair surgery and, unfortunately, their hip has deteriorated to such an extent that we cannot repair it.

"The story is the same every time - they've had regular rest periods, a number of different physiotherapy programmes, injections of steroids, but eventually after a number of years, the symptoms get to the stage where the players cannot train or play without pain and are advised to see me, and by this time, it is much too late," Mr Carton added.

"I have been working and operating in this environment for over 10 years now and, at this stage, I would have hoped that things might have changed and that the physiotherapists and doctors, who are looking after these players on a weekly basis, would be picking these things up at an earlier stage so we can actually treat them properly.

"I think one thing that is missing in GAA that you see in other sports, is the ability for the physiotherapist or the doctor, who looks after the team, to have logs of their injuries, or times they train and play, to see the workload. Nobody knows from one week to the next, or even one year to the next, what injuries a player has had and the physiotherapists and physical therapists change every year, so there is no continuity or ability to see if someone is getting progressively worse."

Mr Carton, who developed the pioneering keyhole 'sports hip repair' procedure, has helped hundreds of elite sportsmen and sportswomen - from GAA, professional soccer, rugby and Olympic athletes - to continue with their sport. He operates on between 200 to 300 athletes per year and has performed this 'sports hip repair' surgery on 1,500 sports people. However, many more young sportsmen and women are still being diagnosed too late.

"There is no doubt that the earlier you play sports and the more intensively you train, especially if you are involved in playing hurling and football - and if you are one of the better players, you would be required for your club, for your school or college and for your county - all of that training takes its toll on the hip," Mr Carton said. "We regularly see guys who were aged 16, 17, 18 when the hip impingement began and unfortunately, a lot of the time they are unaware of the symptoms and thought the stiffness, loss of flexibility or tight hamstrings after training they were feeling was normal."

Hurling and football are equally hard on the hips.

"The only difference is geographical - more footballers in Dublin, Meath, Louth and Kerry, for example, and more hurlers in Waterford and Kilkenny. In Cork, Galway and Tipperary, it's balanced between the two codes," he said.

Mr Carton said that Gaelic games require twisting, turning and sprinting, which stress the hips. The neck of the femur makes regular contact with the rim of the socket.

This leads to progressive flattening of the femoral head (ball) and reactive prominence of the rim of the socket. As this continues, the range of movement decreases but continued abnormal contact begins to damage the cartilage in the hip joint.

The younger you begin playing and the more intense and frequent the training, the higher chance that 'hip impingement' will develop.

Mr Carton said there remains a lack of awareness of the importance of early diagnosis and referral at a time when effective treatment can be undertaken.

Many physiotherapists and doctors believe hip impingement can be treated with physical therapy and that surgery should be avoided.

"However, there is little or no evidence to support this view. There is an enormous body of evidence that hip impingement will lead to arthritis and that surgical correction is very successful if it is performed before irreversible damage occurs," he said.

Mr Carton said it is now accepted that hip replacements, being performed in men in early middle age, are primarily as a result of hip impingement, and most patients have a clearly documented sporting past.

"We are looking at performing a research study," he told the Sunday Independent.

Meath full back Kevin Reilly was just 29 when he retired from inter-county football last October. He said chronic hip injury forced him to stop playing for the county and that he will need a hip replacement within five to 10 years.

He also sustained other injuries while playing at the highest level.

"Three surgeries, my back, hip and Achilles tendon, bulging discs, frequent hamstring, quad and hip flexor tears, broken arm, foot, nose, fingers and vertebrae, chronic tendonitis and cartilage damage in knees, shoulders and Achilles tendons have all taken their toll on my body," he said at the time.

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