The big burnout question remains as serious as ever for GAA's brightest talent
'Overuse' injuries among 16-23-year-old players are all too prevalent, warns Dr Pat O'Neill
Seven years ago last January, Dr Pat O'Neill showed some disturbing images to a specially-convened GAA Congress in Croke Park.
Delegates watched intently as he took them through a detailed 30-minute presentation on a range of injuries suffered by young players.
It made grim viewing, but as chairman of the Task Force on Burnout, which had been established by then president Nickey Brennan, he was determined to leave the GAA's ultimate decision-making body in no doubt that the situation was serious. It wasn't as if he had disguised his intentions.
"There is accumulating anecdotal and empirical evidence to suggest that burnout in talented young players is a serious issue that needs to be urgently addressed by the Association.
"Preventing burnout and associated overuse injuries is of paramount importance in protecting young players. This will require limiting training and playing activity and incorporating an official closed season in the GAA calendar," wrote Dr O'Neill in his introduction.
One of the key recommendations was to replace the minor and U-21 grades with a U-19 championship. The Task Force contended that it would have a two-fold benefit, reducing the physical strain on players while also easing the other pressures minor panellists experience in their Leaving Cert year.
"The teachers in the group were very strong on that. They felt that by going for a U-19 competition, it would take most players outside the Leaving Cert cycle. There was a lot of sense in that view from a number of viewpoints," said Dr O'Neill.
It was a very experienced committee, which apart from Dr O'Neill, included Paraic Duffy, who was incoming director-general at the time, having previously been player welfare manager, Colm O'Rourke, John Tobin, Niall Moyna, Davy Fitzgerald, Seamus Qualter, Mickey Moran, Eugene Young, Jack Devaney, Pat Daly and Michael Reynolds.
The Task Force travelled around the country, trying to sell their message to provincial councils and county boards in advance of the special Congress. They felt they were dealing with a serious issue which needed to be tackled head on - hence the extensive briefings.
They were well-received personally but their proposal to restructure underage championships was not.
"Hurling people, in particular, didn't buy the U-19 idea at all," said Dr O'Neill this week.
On Congress day, Dublin, Cavan, Antrim, Roscommon and Louth spoke for the proposal while Galway, Tyrone, Mayo, Tipperary and Kilkenny led the anti-side. Many other counties didn't publicly commit themselves but were obviously embedded in the 'no' camp.
A simple majority would have been enough to introduce the U-19 grade for two years, but the proposal was well beaten (115-58). The fact that so many weren't even prepared to try it out on an experimental basis said it all about the general attitude to young player welfare.
The Task Force never claimed that replacing minor and U-21 with U-19 would solve all the burnout and overuse issues but they did see it as an important part of wider suite of measures.
All the delegates were impressed by Dr O'Neill's presentation, but when it came to interfering with grades, they were not prepared to move. It was as if they saw it as a case of right diagnosis, wrong remedy.
Sorry, doctor, but we're not taking that medicine - it might do us more harm than good.
Dr O'Neill, a double All-Ireland medal winner with Dublin in the 1970s and All-Ireland-winning manager in 1995, was using his vast experience as an expert in the medical field to underpin the case for change but, on the grades issue at least, the majority were not for turning.
Seven years on, Dr O'Neill is still dealing with the impact of overuse injuries in his rooms in Eccles Street opposite the Mater Private Hospital. Depressingly, the pattern has remained the same in the intervening years.
"No, I wouldn't see any significant change for the better in the 16-23-year age group, which is what we're talking about here. I'm not involved with any of the groups in the GAA who are dealing with it at present but, from my own observations, it's the same as it has been.
"Overuse injuries are still very common. We have nicer pictures of them, more sophisticated diagnostic images but the underlying problem is the same," he said.
There are several occasions when he has to swing the computer screen around to a youngster, often accompanied by his parents, and explain the injury, knowing that it's the result of overuse and/or over-training. In either case, it could have been avoided.
Apart from the physical discomfort, the knock-on impact on the injured player can be severe in a psychological sense, especially at a time when he has so much else going on in life.
"People like me are at the end of the line in terms of dealing with this. The damage is done by the time players arrive here. They're sore; they're unhappy; they're tired of the injury; they're generally fed up with it all. They're dealing with all the various issues, physical, social, psychological, academic. It's very tough on them," he said.
The injuries associated with overuse mainly affect the groin, the hip and lower back. They may be individual problems or a mixture of all three. Whatever the unfortunate combination, Dr O'Neill is convinced that many are caused by overuse.
"These types of injuries tend to happen from high agility training, shuttle springs, zig-zags and multiples of them. The type of training is one thing, the quantum is another. One study showed that the ratio between training sessions and games is as high as 13 to 1.
"That's a problem - it's totally out of proportion. Using other areas like Australian football and some American sports, it's reckoned that three activity levels of 90 minutes per week is the optimum. That's three matches - which is a lot - or three training sessions or a combination of both. Some of the injured players I've dealt with had a lot more than that," he said.
In a week in which two third-level colleges were facing the prospect of playing three games in 96 hours in the Fitzgibbon Cup, it's clear that young, elite players continue to experience punishing schedules that are as unfair as they are dangerous.
In addition to the third-level college championships, the provincial U-21 football championships, the closing stages of the All-Ireland club championships and the Allianz League in both codes are shoehorned into February-March-April.
It's by far the busiest time of the year on the GAA calendar and involves a great many players in the 17-22 age bracket.
Dr O'Neill is currently chairman of the IRFU medical advisory committee, a position that gives him an insight into how rugby operates. As with soccer, the big difference hinges on the workload facing young players.
"It's easy to understand why young GAA players encounter problems. They really talented ones are involved with club, county, school or college in various grades.
"In some cases, it's across football and hurling. Rugby and soccer have a better structure to their playing programme. They don't have the multi-layered system the GAA has. It's much more integrated," he said.
The Burnout Task Force that reported in late 2007 used research undertaken by Lynette Hughes as part of her PhD degree to reinforce the case on why corrective action should be taken.
Among the findings were that almost one-third of players played for at least five teams in one competitive season and that U-18s were most affected.
It also discovered that almost one in ten players were in the final stages of burnout and deriving little satisfaction from their involvement. Those in the 22-24-year age group were in the highest category in this group.
Around 30 per cent suffered from physical and emotional exhaustion while one in ten in the 16-18-year age group was questioning their involvement in Gaelic games.
Fast forward to last January and a survey carried out by the Minor Review Workgroup, chaired by Games Development Committee chairman Michael Martin.
It found that 24 per cent of inter-county minors were involved in GAA activity on a daily basis (often more than once), while a further 27 per cent had six-day involvement.
Alarmingly, 62 per cent played while injured; 42 per cent reported chronic fatigue; 35 per cent wanted less training and 81 per cent reported being put under pressure by managers/coaches to play with some other unit of the Association.
The Workgroup have five motions before Congress today, designed to ease the pressure on U-18 players. They include not allowing any U-18 player to play at U-21 or senior inter-county level and increasing to 17 the age limit for playing senior club.
They are also proposing that a player on an inter-county minor panel not play in adult club league competitions until his county team has completed its run in the championship.
While he hasn't studied the proposals, Dr O'Neill (right) favours anything that places less pressure on young players during their developmental years.
"An adult male is not fully mature from a skeletal viewpoint until he's 19 or 20 years of age. In those circumstances, more damage can be done if a player is put under excessive pressure in those formative years."
He is quite happy that most of the training techniques used nowadays at all levels are very good but a problem can arise when a player is on several teams.
Unlike senior players who deal mainly with one inter-county and one club manager, their younger counterparts, especially at elite level, have several masters.
Dr O'Neill would favour the use of a training diary where precise details were kept, making it clear to everybody working with a player how much he had done on an ongoing basis. That applies in some counties but isn't as widespread as it should be.
It's a worrying reflection on how little real progress has been made that more than seven years after Dr O'Neill and his Task Force offered such a stark presentation on the overuse injuries endured by many young players, there's no reduction in the numbers coming through his doors for treatment.
It suggests that despite some adjustments, such as the introduction of the closed season (which was originally proposed by the 2007 Task Force), talented young players are still being driven beyond acceptable limits into painful, disruptive and prolonged injuries.
Dr O'Neill's remedy? "Modifying and moderating the training and getting a better balance between training and playing games would be a great help," he said.
It's much the same solution as his Task Force proposed more than seven years ago.
Question is: why hasn't it been acted upon and will this serious issue be as big a problem in another seven years? Based on the evidence, the signs are ominous.