Dualtach Mac Colgáin is a UPMC sports medicine physician at the Sports Medicine Clinic at Waterford Institute of Technology (WIT) Arena, Meath Gaelic football team doctor and lead clinician with the Dundalk Football Club. He gets down to business quickly.
“Anyone who has an injury should seek medical advice,” he says.
“Don’t just leave it. If you have an injury, no matter how you got it – through walking, climbing, dancing, playing sport or whatever – seek medical advice if you are in pain.
“Going to your doctor or chartered physiotherapist will hopefully improve things for you and prevent further injury. Flag it early and treat it early for a good outcome.”
Lockdown due to the COVID-19 pandemic has led to many recent injuries, he says.
“There were the 5km restrictions and it was winter and the weather was cold and this kept people home and more sedentary – then, all of a sudden, restrictions are lifted, the weather is good, everyone wants to get out and move and shake off the cobwebs of winter and of the lockdown, as well. Some people would have put on a bit of weight, too, and wanted to get out and exercise and try and get back to their pre-lockdown wellbeing, but they overdid it and developed injuries.
“Prevention is about controlling the amount of exercise or the amount of sport you do relative to what you were doing in the period prior to that,” he adds.
Most common injuries
What are the three most common types of injuries Dualtach is seeing at the moment?
“Since lockdown we have noticed a lot more soft tissue injuries,” he says. “That means muscle tears. We’ve seen more tendon injuries, too.
“Tendons are what connect the bone to the muscle. A lot of joint injuries have happened, as well – injuries of the ligaments around the joints (ligaments attach bone to bone) and cartilage issues also. Cartilage is the rubbery tissue that acts as a cushion between joints.”
Injuries don’t just occur in field sports, either.
“It’s recreational as well,” Dualtach says. “We would treat a lot of walkers, also – male and female – but because GAA club seasons are kicking off at the moment we see a lot of injuries there. We also see Irish dancers, jockeys, swimmers – all sports, really, now that lockdown is over, as people take more exercise but their bodies aren’t quite ready for it.”
Soft tissue injuries
There are a lot of muscle injuries happening – particularly in GAA players, he states.
“During the lockdown many were given strengthening and conditioning programmes to do and they were all working by themselves, as they should have been. That brought them out running but it was a lot of running in straight lines. Doing that, they had no injury issues. When they returned to play with their teams, however, and went from running in a straight line to making sharp turns as they ran (in the context of team training or games) their bodies just weren’t used to these movements. That resulted in muscle tears. We saw it first with the county GAA players and now we are seeing it with the club GAA players and soccer players – any sport, really, where they’re suddenly back to this new change of direction movement.”
Treatment for soft tissue injuries
So, what happens if a person presents with a soft tissue injury?
“Like all health professionals, we would take a detailed history, asking about factors around the injury,” Dualtach says. “We would want to know if it is purely a sport-related injury or is there a medical history involved – and has it happened before. Nutrition, for example, as well as other factors would be discussed so that we can get a full picture.”
A treatment plan is decided on after a physical examination.
“From here it could be a straightforward referral to a chartered physiotherapist colleague in the building or a referral on to a strengthening and conditioning coach,” he says. “Sometimes an MRI scan or X-ray might be needed to get a clearer picture and enable how we manage the injuries. A small percentage could be referred for surgery.”
It is difficult to say exactly how long it will take for anyone to recover from a soft tissue injury.
“It could be from two weeks up to 12 weeks,” he says. “It very much depends on the injury and on the individual. Some people might respond very well to treatment and get back (to sport or exercise) a bit sooner. Others, for whatever reasons, perhaps because of underlying medical conditions, might take a bit longer. It can depend on motivation, too. Some might be more motivated to do the rehab exercises but some people are too motivated – and do too much – and, as a result, they might add a few weeks on to their recovery.”
Pressure to resume play
Dualtach admits that there may be too much pressure on team sport players to resume play, at times, and that this can have adverse effects.
“What we find is that a player could be seen doing their rehab (exercises) on the side line and the manager sees them and says, ‘He’s fine – we’ll get him back in.’ He might look fine and feel 80% fine, but what happens is that these players often return to play too soon. They take the risk and re-injure themselves, so it’s a case of managing expectations of the players and the managers and the wider approach of staff on various teams.”
The long term implications must always be considered, he adds.
“There is a welfare issue there. You have to make sure that players return to sport pain free and more importantly, injury free.”
Tendinopathy or tendonitis
Sudden overuse is also leading to tendinopathy or tendonitis, he says.
“This is inflammation around the tendons. We are seeing this issue right across the board from recreational exercisers to professional athletes. During the Level 5 restrictions from January up to April or May, people were obviously limited in what they could do and where they could go. They became relatively sedentary and then suddenly went from being quite sedentary to exercising a lot in a short space of time and vastly increasing what we call ‘load’.
Zero to hero too quickly
“Getting out and moving was the right thing to do, but sometimes they went from ‘zero to hero’ too quickly – whether it was running or cycling or field training or whatever,” he continues. “This caused a lot of tendinopathy, which is a massive amount of load placed on the body or tendons in a short space of time, and they developed a lot of pain – usually around the Achilles or hamstring tendons.”
Dualtach’s advice is to take return to increased exercise slowly.
“A gradual build up to getting back to your pre-lockdown types of exercise is best. Easing yourself gradually into it should prevent these types of issues happening. The increased load on a part of the body – if you, say, walk around the upper lake in Glendalough with its inclines and declines and so on after only doing 5km straight walking for months – that can cause the tendon to become inflamed and cause pain.”
Treatment for tendinopathy can be managed using rehabilitation that is best guided by a chartered physiotherapist.
These include ligament and cartilage type of injuries and are mostly seen in field athletes.
“Again, this goes back to the players running in straight lines then suddenly bringing in a lot of turning movements,” Dualtach says. “They do a quick turn and they hear or feel a pop in their knee and all of a sudden they have a cruciate (ACL) injury. Tears in ligaments and cartilage can happen in all joints, but we are particularly seeing more around the knee joint.
“Cruciate ligament injuries would be the more serious type of injury and these would be referred for surgery, in our case to UPMC Whitfield,” he adds. “The cartilage injuries would also be referred on to our surgical colleagues.”
Cartilage injuries can occur because of all sorts of movements – jumping, landing, movements people haven’t been doing during lockdown period. So how can joint injuries be prevented?
“Again, it’s all about a nice, gradual return to play. Instead of going from straight running to match play situations you slowly bring in those change of direction drills.”
Stress fractures have been common recently, also.
A stress fracture can involve inflammation or a tiny crack in a bone often caused by repetitive force or overuse.
“We’d see these in recreational exercisers where they might have walked 5k during lockdown but are suddenly doing 10km or 15km walks and developing stress fractures. Again, that’s down to a massive amount of load in a very short space of time. Stress fractures can occur as the body isn’t able to cope with the increased load.”
“In general, it’s all about prevention and looking after your body and listening to your body. If injury occurs seek help early. If you flag it late it can mean a more severe injury and more time on the sidelines.”
In relation to prevention, Dualtach points out that there are excellent injury prevention programmes, the GAA 15 in Gaelic games – a standardised warm up programme and the FIFA 11+ in soccer.
“Both of these are very good to do prior to going out for a training session or playing a match.”
He also advises taking your health professional’s rehab advice on board.
“Make sure that whoever is going through the rehab with you is a chartered physiotherapist,” he says, “and things will tend to work out very well with a good return to sport.”