Injury screening practices and risk perceptions in intercounty Gaelic Games in Ireland: A cross-sectional survey of players,coaches,and medical staff

Abstract

The aim of this study was to investigate current injury screening practices and injury risk perceptions among medical staff, coaches, and players in elite Gaelic Games. A cross-sectional online survey of elite Gaelic Games stakeholders was used, that included sections on participants’ demographics, and injury risk perceptions; medical staff also completed an individual injury risk assessment section. Medical staff (n=19), coaches (n=22), and players (n=244) were recruited using a multipronged sampling approach. Over half (53%, n=10) of medical staff implemented individualised injury risk assessments; all used maximal strength tests. Most participants (77%, n=218) believed it was possible to identify through screening players at a higher risk of sustaining a musculoskeletal injury, although both the value and limitations of injury screening tests were highlighted. Stakeholders identified previous injury, sleep, and wellness scores as important intrinsic risk factors. Training load, fixture congestion, and internal communication were identified as extrinsic risk factors. This study highlights the absence of standardised injury screening protocols across elite Gaelic Games, with current approaches implemented inconsistently, and little agreement on the most effective strategies to identify high-risk players. These findings highlight the need for a more coordinated and collaborative injury risk management approach that considers the views and experiences of player, coaches, and medical staff, within the unique context and demands of amateur elite Gaelic Games.

Keywords

Communication fixture congestion musculoskeletal injury sleep training load wellness

Introduction

Gaelic Games in Ireland represents four primary codes: Gaelic Football and Hurling played by males under the governance of the Gaelic Athletic Association (GAA), and Camogie and Ladies Football played by females, governed by the Camogie Association and the Ladies Gaelic Football Association (LGFA), respectively. Despite its amateur status, there is a large time commitment,¹ and the physical demands and training loads of elite Gaelic Games are comparable to professional sports such as football (soccer),^2,3 and Australian Football League / Australian Football League Women's.^4,5 Different levels of competitions exist within Gaelic Games, where local club teams compete in respective county regional competitions, and inter-county teams, comprising a selection of the best club players in that county, represent the elite level. The increasing professionalism and employment of specialists within backroom teams in inter-county GAA is evident, with €43m in total spent preparing Gaelic Football and Hurling teams in 2024, doubling within the last decade,⁶ and €2.6m of government funding allocated to Ladies Gaelic Football and Camogie teams to help with training and player expenses.⁷

Despite this, a significant burden of injury still exists within Gaelic Games.^8,9 The most prominent injuries reported in Gaelic Games are lower limb injuries, accounting for 68 to 72% of all injuries,^9–12 with lower limb muscle injuries being the most common (47–70%).^9,10,12 The incidence of injury has been reported to be 38.4/1000 h in Gaelic Football,⁹ 61.2/1000 h in Hurling,¹⁰ and 26.4/1000 h in Camogie¹¹ which is comparable to professional field based contact sports.^13–15 A proportion of these injuries may be preventable by identifying ‘high risk’ athletes through injury screening tests and developing programmes that address these risks. These tests are typically devised based on perceived important intrinsic (i.e., previous injury, strength, flexibility)^16–19 and extrinsic (training load) injury risk factors.²⁰ While these tests have limited predictive accuracy,²¹ athletes continue to be tested in pre-season with the purpose of estimating risk.^16,17

The perceptions of injury risk factors of field-based sports based on screening practices have been investigated previously.^22–25 In elite soccer, the majority of perceptions and practices have a low level of evidence and low graded recommendation for implementation.²⁶ Despite a positive attitude towards injury prevention in Gaelic Games, and the existence of effective injury prevention programmes,^27,28 adoption of injury prevention programmes at subelite levels remains low.²⁹ However, it is not clear if this is the case at the elite level of Gaelic Games. Previous authors have emphasised the need to better understand injuries from the athlete's context.^30,31 Giving a voice to the athlete, opening a communication channel between the staff and athlete, and a shared responsibility in the decision making process should be included in the development of injury prevention strategies.³² Indeed, in Ladies Gaelic Football, it has been highlighted that for successful adoption (including uptake and adherence) of injury prevention programmes, the preferences of end-user stakeholders must be addressed.^33,34 Given the complexities of Gaelic Games across multiple codes, regions, and competition levels, questions over adherence to injury prevention programmes, and lack of involvement of different stakeholders, it is apparent that the factors affecting injury prevention perceptions and practices require further exploration. Therefore, the aim of this study is to investigate the current injury screening practices, and injury risk perceptions of players, coaches, and medical staff within elite Gaelic Games across the four codes.

Materials and methods

Study design and setting

This cross-sectional survey was conducted online using Qualtrics (Provo, UT, USA), between May 1^st, 2023, and June 31^st, 2024. The survey is reported following the Checklist for reporting Results of Internet E-Surveys (CHERRIES)³⁵ (Supplementary file 5). The survey questions were informed by previous research,^23,36 adapted to include Gaelic Games specific context, and input from the author team. The survey was piloted with eight stakeholders (medical staff n=2, coaches n=4, players n=2), and based on these results, minor edits were made to five questions. Pilot data was not included in the final data analysis.

Ethics and consent

Ethical approval was granted by University College Dublin's Human Research Ethics Committee (Approval number LS-E-22-100). The first page of the survey described the study and its voluntary nature. Electronic informed consent was obtained from all participants before completing the survey. Participation was anonymous, and responses were reviewed and any potentially identifiable information de-identified prior to analysis.

Participants

Medical staff, coaches, and players, (≥18 years old) from elite inter-county Gaelic Games, defined as “A team competing at adult inter-county level in Gaelic Football, Hurling, Ladies Football, or Camogie”. Participants were from the 2020–2024 seasons, with medical staff currently working at the elite level at time of survey completion. Typically, 132 adult inter-county teams, and 4000 players, compete nationally across the four codes every year, with some counties fielding more than one team per code in the female competitions. Due to the absence of a single-source database for all three stakeholder groups, a multipronged sampling approach was used. Invitations were distributed via email to official county secretaries, social media (X and LinkedIn), and to organisations to distribute to members; Athletic Rehabilitation Therapy Ireland (ARTI), Irish Society of Chartered Physiotherapists (ISCP), and the Gaelic Players Association (GPA). An active snowballing approach was encouraged, for participants to share the invitation within their own network. No incentives were offered for completing survey.

Survey administration

The survey for medical staff (See Supplementary File 4 for Survey Questions) was conducted in English and consisted of 12 to 15 questions, across 11 pages, with adaptive questioning implemented for whether individual injury risk assessments were used, or not. The survey for players and coaches was 9 to 10 questions total, across six pages. The survey typically took between 8–15 min, a password or login was not required, and participants could review answers before final submission.

Survey outcomes

All surveys included Section A: Personal Background, and Section B: Injury Risk Perceptions. The medical staff survey additionally included a Section C: Individual Injury Risk Assessments. Section A consisted of closed questions on the playing/working experience within elite Gaelic Games, qualifications, and the competition level(s) of the teams that players and coaches have played/coached with, and the current team(s) that medical staff work with. Section B asked open-ended questions on their definition of injury, and their opinion on the possibility to identify players at a higher risk of musculoskeletal injury. A five-point Likert scale of importance was used to determine the importance of a list of 14 intrinsic and 19 extrinsic injury risk factors.²³ Participants were then asked to rank the top five most common injury locations (all stakeholders), and injury types (medical staff only). Section C opened with a closed question, “did you perform an individual injury risk assessment(s) with players this season?”. If answered “yes”, there was four follow up closed questions; 1) The stage(s) of the season when implemented, from a list of five stages, 2) The screening tests used from a list of ten commonly used tests (both objective and subjective), how often each was implemented, with the option to provide more details and/or other tests not included on the list, 3) The perceived effectiveness of their assessments from a list of five, with an ‘other’ option if none of the provided answers were applicable, and 4) The feedback strategy used to deliver results of the injury risk assessments to players, from a list of six. If “no” was answered, there was one follow up closed question on the factors that contributed to this decision, from a list of six factors, with the option to provide more details and/or other factors not included on the list.

Data analysis

Data were exported from Qualtrics to Microsoft Excel (Microsoft Excel, Microsoft Corporation, Redmond, WA, USA) for analysis. Only fully completed surveys were included. This study reports the findings related to participants team competition level, code, years of experience, definition of injury, perception of injury risk identification, and injury risk factors. Medical staff practices and perceptions of individual injury risk assessments were also reported. Other survey items are available upon request. Categorical and Likert scale data were reported using the median values, frequencies and percentages, and confidence intervals. Likert responses were assigned a numerical value 1–5: very important = 5, important = 4, neutral = 3, unimportant = 2, very unimportant = 1, and summed to calculate overall importance and rankings. Open-ended questions were analysed using qualitative content analysis,³⁷ informed by the principles of reflexive thematic analysis,^38,39 to identify common responses from the structured nature of the survey responses, typically brief and narrow focused, but also explore the deeper meaning and context of the participants views. The primary author (DB) coded all responses in NVivo (QSR International Pty Ltd, 2020) and grouped into descriptive categories. Categories were discussed and refined iteratively between authors (DB and NVD) but not further developed into interpretative themes. The researcher's reflexivity was acknowledged but not emphasised during analysis given the descriptive focus.

Results

Participants

A total of 555 participants opened the survey, but only responses with 100% completion (51.4%) were used for analysis (n=285) including 244 players, 22 coaches, and 19 medical staff. Medical staff consisted of chartered physiotherapists (n=9), certified athletic therapists (n=9), physical therapists (n=2), and medical doctors (n=2). Two of the participants had dual certified athletic therapist and chartered physiotherapist qualifications (Table 1).

Table 1.

Demographic characteristics of players, coaches, and medical staff surveyed. Data provided as frequencies, percentages, mean ± standard deviation, and medians.

Team Role (*)
	Players (n=244)	Coaches (n=22)	Medical Staff (n=19)
Gaelic Football	100	15	7
Hurling	66	9	8
Ladies Gaelic Football	95	8	7
Camogie	69	4	6
Years of Experience (n, %)
0–2	34 (13.9)	2 (9.1)	10 (52.6)
2–4	66 (27)	5 (22.7)	5 (26.3)
4–6	36 (14.8)	3 (13.6)	1 (5.3)
6–8	33 (13.5)	5 (22.7)	1(5.3)
8–10	24 (9.8)	2 (9.1)	1 (5.3)
10+	51 (20.9)	5 (22.7)	1 (5.3)
Mean (SD)	5.8 (±3.5)	6.4 (±3.4)	3 (±2.98)
Median	4–6	6–8	0–2

*The 19 medical staff surveyed represents the 28 teams they currently work with. The 22 coaches represented 36 teams, and the 244 players, represented 330 teams across the career of coaches and players.

Definition of injury

The players, coaches, and medical staff reported a variety of factors when describing what defines an injury. Five main categories emerged from analysis; participation affected, damage, presence of pain, performance limitation, and altered function (Table 2). The most commonly used definition of injury, with 159 references, described participation in team activities being negatively affected, either partially or completely. Damage, particularly physical injury or harm to the body was also frequently used (134 references) when defining injury. The presence of pain, and or discomfort was recognised as another contributor, with 73 references, to defining when a player is injured. Decrements in performance capacity, was another category identified for the definition of injury, on 68 occasions. Finally, several players mentioned in their definition of injury that daily activities or tasks external to training and matches could be affected.

Table 2.

Categories and related quotes for defining injury.

Categories	Role	Quote
Participation Affected	Medical Staff 18	“Something that prevents a player from partaking in normal training/games/gym”
	Medical Staff 3	“Something that prevents an athlete from participating in training/matches for 48 h”
	Coach 2	“Something incurred as part of matches/training that precipitates a modification/absence from training/matches”
	Player 212	“An injury is something that prohibits you from playing sport at all or to your maximum potential”
Damage	Medical Staff 11	“Physiological damage to musculoskeletal tissue that is either acute, chronic or from overuse”
	Player 113	“Damage to muscle tissue or connective tissue (musculoskeletal) that is too painful to participate in sport without more damage occurring and takes longer than a week to recover from”
	Coach 7	“Physical damage to someone's body caused by trauma (contact or non-contact)”
Presence of Pain	Player 63	“No matter how severe, if a body is experiencing pain either playing/exercising, or pain filtering into everyday tasks, you are injured”
	Medical Staff 15	“Any structural tissue damage, inflammatory or perceived pain that leads to reduced or inability to perform sport or daily function”
	Player 56	“Acute or chronic pain preventing you from training or playing sport and affecting your day-to-day life”
Performance Limitation	Coach 17	“Anything that inhibits a players ability to perform”
	Medical Staff 8	“Any physical issue which causes pain and a decrease in performance”
	Player 125	“An issue that is preventing/stopping you from doing what you want to be able to do”
Altered Function	Player 87	“Unable to perform daily tasks or unable to perform on the field”
	Medical Staff 19	“A disruption to tissues that brings about pain and movement dysfunction”
	Player 132	“Physical harm to a person's body that usually causes pain and affects a person's mobility to perform daily tasks to the best of their ability / restricting their movements”

Injury risk identification

Across all participants, 77% (n = 218) believed it was possible to identify players who were at a higher risk of sustaining a musculoskeletal injury, 10% (n = 29) believed it to be impossible, and 13% (n = 37) were unsure or unclear. The opinions of players, coaches, and medical staff could be divided into two main categories: Injury Risk Perceptions, and Injury Risk Practices (Table 3). With regards to injury risk perceptions, there were 485 references, with two main sub-categories identified: Amateur Status and Injury Risk Factors. The presence of job-related activities, playing for multiple teams, and factors unique to amateur status were frequently mentioned as contributors to injury risk. Both intrinsic and extrinsic risk factors were highlighted by all three stakeholders as important to identify players at a higher risk of sustaining a musculoskeletal injury. The effectiveness, utility, and limitations of implemented important risk factors were identified. The most frequently reported intrinsic risk factors were previous injury, strength, biomechanics, and a player's robustness. Extrinsic risk factors were training load, lifestyle, and burnout/stress. Injury risk management practices were referenced 111 times, with four sub-categories identified: Screening Tests / Player Profiling, player monitoring, qualified expertise, and training/other modifications. Strength testing was the most frequently mentioned screening test. Various participants highlighted both current practices and potential future interventions to manage the risk of injury.

Table 3.

Categories, sub-categories and related quotes when asked is it possible to identify players at a higher risk of musculoskeletal injury.

Categories	Role	Quote
Injury Risk Perceptions
Amateur Status	Player 145	“Occupation can also impact the risk of injury… working out of hours can also lead to less sleep which increases the risk of injury”
	Coach 3	“Those who spend more time working in seated positions”
	Player 63	“Players who are dual players, those at uni playing club, county and university sports
	Player 85	Yes. Off pitch input I think can definitely foresee any possible injuries. Tracking players day to day activities at even a basic level could help. Type of job, students, recovery practices, any extra sessions being done, etc.
	Coach 1	“…based on their home circumstances. Are they driving long distances, sitting at a desk all day etc.”
	Player 144	“Underdeveloped players who have many teams to play for uni club county”
Risk Factors	Coach 9	“It is possible to identify factors that are known to put players at higher risk such as strength, asymmetry imbalances, ROM, fatigue etc but it is impossible to predict an injury”
	Player 122	“New lads to a team are taking on a higher work load and an increase in training so more chance of getting injury”
	Medical Staff 18	“Yes, on paper, however these risk factors sometimes don't always result in injury”
	Player 47	“It is possible to identify players at risk for some injuries by identifying weaknesses, altered biomechanics, and players who over train or under train. However, we can identify those at higher risk but that does not mean those at low risk won't sustain an injury”
	Player 154	“Yes, but not all the time. Previous injury is a huge indicator. Consider this with training load, lifestyle factors and overall stress levels and it may be possible to pre-empt some possible injuries”
	Medical Staff 5	“Identifying risk factors does not mean you can identify a player at risk. However, knowing the players’ injury profile and identifying metrics that are sub-optimal in a given situation can assist in preventing an injury”
Injury Risk Practices
Screening Tests / Player Profiling	Player 118	“Performing a thorough individual assessment with each player to assess various aspects of physical fitness/health including muscle strength, muscle length, muscle endurance, joint ROM, exercise endurance, balance, proprioception and body composition. A functional movement screening assessment may also be beneficial in identifying abnormal functional movement patterns. Subjective information from each individual player should also be assessed including injury history, training history, training load, psychological stress, sleep quality, diet and hydration”
	Medical Staff 5	“Knowing the players’ injury profile and identifying metrics that are sub-optimal in a given situation can assist in preventing an injury”
	Medical Staff 4	“Yes, though perhaps, not in all cases. Past history of recurrent injury is one simple way to try to do this. It can be possible to also seek to identify individuals who may have poor biomechanics or asymmetrical muscle group strength deficits, who are thus at higher risk of musculoskeletal injury.
	Player 52	Yes, it is. If someone has had a musculoskeletal injury in the past, they may have a weakness and be a risk of the injury reoccurring. Isokinetic testing can be used to determine someone's muscle strength. I did this after tearing my acl and found out that I had a weakness not only in my quads but also in my hamstrings. I think this type of testing should be available to all intercounty players as it can inform them of weaknesses that may not be obvious and hopefully help to prevent future injuries. I know they are used in male intercounty set ups, but I don't think this kind of testing would be available in most female intercounty set ups. If players did a isokinetic test at the start of the year it would inform them accurately on what areas, they may need to strengthen throughout the year.
Player Monitoring	Medical Staff 4	“Monitoring players in terms of fatigue/sleep disturbance/etc. can also be helpful in trying to identify individuals who may be at higher risk”
Player Monitoring	Player 40	“I think it is possible to identify players who are at higher risk of injury if you monitor players nutrition, hormones, mobility, training load, rest and previous injuries”
Qualified Expertise	Player 14	“Yes sometimes, those at higher risk tend to show deficits in strength and mobility through injury screening, but it's not possible to identify deficits as a player unless you have assessed the individual as a professional”
	Coach 10	“Yes, in majority of cases. Proper regular screening and testing under strict supervision should identify potential problems”
	Coach 7	“Through testing by chartered professional's, individuals can be identified as being more susceptible to injury based on differentials”
Training / Other Modifications	Coach 22	“That athlete would be given personalised and specific mobility/prehab/active recovery strategies that would focus on preventing that particular injury along-side generalised stretching/mobility etc.”
Training / Other Modifications	Player 2	“You can identify by machines or by muscles strength tests and can alter your gym sessions to suit”

Injury risk factors

The intrinsic and extrinsic risk factor perceptions from each stakeholder are displayed in Figure 1, and Figure 2, respectively. The top three intrinsic risk factors across all three stakeholder groups were previous injury, sleep, and wellness scores, in varying order (Supplementary File 1). Medical staff ranked previous injury first, followed by sleep, and wellness scores. Coaches ranked previous injury as most important, with sleep and wellness scores tied in second. Sleep was ranked first by players, with previous injury and wellness scores, second and third, respectively. External risk factors were different between the groups (Supplementary File 2) Medical staff perceived congested period of fixtures during season as most important, followed by internal communication between medical and management/coaches, and chronic training load. Coaches ranked internal communication between medical and management/coaches first, with acute training load second, and chronic training load third. Training load was ranked first by players, with congested period of fixtures during season, and acute training load, ranked second and third, respectively.

Figure 1.

The distribution of intrinsic risk factors among coaches, medical staff, and players.

Figure 2.

The distribution of extrinsic risk factors among coaches, medical staff, and players.

Individual injury risk assessment (medical staff only)

In total, 53% (n=10) of the medical staff performed an individual injury risk assessment with players. Half (n=5) of the medical staff performed risk assessments only once, while two (20%) did it twice, and three completed an assessment on three occasions. The most frequently chosen injury screening test category was maximal strength (n=10, 100%) used by all medical staff, and on three occasions across the season. Aerobic endurance was the second most frequently used test (n=7, 70%) used on two occasions, with anaerobic endurance third (n=7, 70%), also on two occasions (Supplementary File 3).

Individualised injury risk assessment – effectiveness (medical staff only)

Half (n=5) of medical staff who performed risk assessments described it as: ‘Effective, areas to improve on, more injuries could have been prevented through risk assessments. The remainder of responses deemed the effectiveness to be ‘Ineffective, did not identify players at risk of injury’ (n=2), ‘Not sure’ (n=1), and ‘Other’ (n=2). For those who answered “other” the following explanations were noted:

“I felt the screening was effective but there are areas we could have improved, but I don't know if more injuries could have been prevented - injuries such hamstring strains, ankle sprains, tendinopathies etc where scarce throughout the year - however there was two ACL ruptures, two lower limb fractures and a clavicle fracture due to trauma (contact with another player / the ground) which I feel could not have been prevented using pre-screening.” – Medical Staff 2

“I don't know how to measure if it worked or not. We still have had several soft tissue i.e., preventable injuries. But some of the athletes which we identified, and acted upon have been injury free thus far, but some have still picked up an injury already pre-championship.” – Medical Staff 9

Individualised injury risk assessment - feedback style (medical staff only)

Feedback on the results of the individual injury risk assessments were delivered to players most frequently through ‘Individualised feedback given through resources i.e., visual or written’ (n=6). ‘Individualised feedback given informally without resources’ (n=3) was the 2^nd most common method of feedback delivery, and no feedback was provided on a single occasion (n=1).

Individualised injury risk assessment – reasons not performed (medical staff only)

The medical staff (n=9), that chose not to perform any individual injury risk assessments, cited staff (n=5), time (n=4), equipment (n=4), team management/coaches (n=4), personal opinion (n=1), and finances (n=1) as contributing factors to this decision. Among the reasons outlined for not performing an individualised injury risk assessment include the time, equipment, and personnel commitments to perform. The goals and priorities of different stakeholders, and the amateur status of players also contributed to the decision not to perform individual assessments.

“Did not plan in, or have time for one-to-one assessments” – Medical Staff 7

“Some coaches don't fully understand the importance of risk assessments and may see them as a waste of a session” – Medical Staff 12

“Not seen as a priority” – Medical Staff 17

“Players travelling to training often arrive close to start of training time” – Medical Staff 2

Discussion

This study explored how medical staff, coaches, and players in elite Gaelic Games perceive injury risks, the medical staff implementation of injury screening, and why. Although no single risk factor stood out, there was substantial overlap in perceived risks across groups, suggesting a shared understanding. While all medical staff who performed injury assessments used pre-season screening, only half used individualised protocols, and overall practices varied widely in injury screening tests, timing, and frequency.

The majority of stakeholders defined injury in terms of time loss or reduced participation in team activities, with some players also noting the impact on daily activities. Support staff tended to focus on the sporting or performance context only, consistent with previous research.⁴⁰ This might suggest that players perceive their injuries, and its effects on daily living differently, and may consider, or prioritise external commitments, over on pitch performance to a greater extent than support staff. External factors, including occupational/school workload, and multiple sports/teams, unique to amateur sports, were highlighted as important for injury risk. The risk of injury and burnout appears greatest for younger squad players given the potential for increased workload across multiple competitions, highlighted previously.^41,42 A large majority of respondents believed higher risk players could be identified, but with no agreement on the most effective methods for identification. Participants recognised both the value and limitations of screening tests to identify who will get injured, reflecting the questionable predictive value of these tests.^{16,18,21,43,44}

Previous injury, sleep, and wellness scores were consistently rated as important intrinsic risk factors by all stakeholders. Previous injury was ranked as the most important injury risk factor by medical staff and coaches and second by players, consistent with current evidence^19,26 and perceptions,³⁶ with the vast majority of medical staff utilising injury history questionnaires. Sleep and wellness scores were viewed as important risk factors, which can both provide information on an athletes ability to recover from their workload,⁴⁵ and the dual external commitments placed on amateur players. A high prevalence of poor sleepers in Gaelic Games has been reported,⁴⁶ although evidence for its influence on injury risk is inconclusive.⁴⁷ Interestingly, although maximal strength testing was used by all medical staff implementing injury risk assessments, and frequently mentioned for identifying high risk players, it ranked in the bottom three risk factors by all stakeholders, similar to findings in soccer.³⁶ This suggests an availability bias, perhaps due to the utility of lower body strength in reducing injury risk in Hurling players.⁴⁸

All stakeholder groups identified workload and contextual factors, including fixture congestion and internal communication, as important risk factors for injury similar to findings in elite soccer.²³ Coaches and medical staff ranked internal communication between medical, and management/coaches as highly important, ranked first and second respectively, in comparison to players, ranked fifth. This suggests a difference in the perceived importance of internal staff communication as an injury risk factor, perhaps reflective of players’ absence in the process, and a more focused mindset on their own training and recovery. Another potential factor might be the players perception of injury reporting to management and/or medical staff. A fear of missing training/game time, unapproachable management, and immediate access to medical staff have been identified as barriers in elite female Gaelic Games players.^49,50 The consistent presence of workload, both acute and chronic indicates that training load monitoring appears to be of high value in managing a player's workload, which has been demonstrated in previous research as an important variable for injury risk.⁵¹ Fixture congestion ranked highly across all groups, similar to findings in other sports.²⁴ A move towards a split-season model in recent years has resulted in a more congested calendar for the elite inter-county season, this may have increased the importance of it as an injury risk factor.

Individualised injury risk assessments were implemented by half of medical staff, compared to 94% in elite soccer,^23,36 perhaps due to the availability of qualified staff which can decrease injury screening practices.⁵² Another potential challenge is the on-going issue of determining a cut-off value to identify high-risk athletes,²¹ and the subjectivity in the perceived effectiveness of preventing injury. The relative number of medical staff that believed their practices were effective was much lower than that reported in elite soccer,^23,36 however the number of medical staff represented in this study is low. Although feedback practices were varied, most provided individualised feedback with resources, suggesting an effort by medical staff to clearly communicate the results to the players, but understanding the reasons may provide valuable insight into implementation of injury risk management practices.

The medical staff that chose not to perform individual injury risk assessments cited staffing, time constraints, equipment, and team management/coaches as contributing factors. Limited staff, and time were frequently cited barriers, aligning with the challenges already noted in amateur sporting environments. Resources, both financial and equipment, played a role in the implementation of injury risk assessment decision making process, highlighting that budget differences between teams can be factor. Stakeholder dynamics again played a part in decision making with a medical staff respondent who noted: “We weren't ever going to get the opportunity to adjust player/team sessions based off this data due to lack of education on coaches’ part”, emphasising why understanding the different stakeholder perceptions as presented here is important to move injury risk management forward in Gaelic Games.

Future research should explore the contextual factors underpinning the practices and perceptions identified within this study, from the perspectives of each stakeholder group. Previous authors have highlighted the need to consider the complexity of sport injuries.³⁰ Qualitative approaches allow us to collect information to better understand the context, from both the staff, and athletes perspectives.^30,31 Sharing of these perspectives from the different stakeholders, and recognising each other's beliefs and understanding of injury, performance, and health and allows a more collaborative approach to injury risk management and prevention.⁵³ The scope of healthcare practitioners should include proactively promoting a more collaborative, athlete focused approach to managing player health and well-being.⁴⁹ The behaviours and factors that shape how an athlete views injury risk, are not confined to the athlete, but can be influenced by coaches, medical staff, sport associations, and referees.⁵⁴ The unique nature of the Gaelic Games demands, due to its amateur status, needs to be considered when developing any potential injury risk management strategies.

Limitations

As a cross-sectional survey, the findings of this study are representative of the current, or recent injury risk practices and perceptions and may not reflect evolving practices, which may be temporal in nature and beyond the scope of this study. It must also be acknowledged that there is overlap between some of the risk factor categories included in the survey. Subjective measures including wellness and psychological factors were both options, with a potential for overlap between training load and fixture congestion also. Although all codes were reprbesented within each stakeholder role, the sample may not be fully representative of the injury risk practices and perceptions of all counties, levels, or team structures. Although the sample size was small (n=285), there are typically 132 adult inter-county teams who participate annually, and there was representation from medical staff across 28 teams, coaches from 33 teams, and players from 330 teams (stakeholders had multiple representations across teams).

Conclusion

Most stakeholders believed it was possible to identify high-risk players, but there was little agreement on the most effective strategies. Intrinsic risk factors such as previous injury, sleep, and wellness scores were ranked most highly, alongside extrinsic risk factors like high training load, fixture congestion, and internal staff communication. These findings point to the need for a more coordinated and collaborative injury risk management approach – one that incorporates the views and experiences of player, coaches, and medical staff.

Supplemental Material

sj-docx-1-spo-10.1177_17479541261421589 - Supplemental material for Injury screening practices and risk perceptions in intercounty Gaelic Games in Ireland: A cross-sectional survey of players, coaches, and medical staff

Supplemental material, sj-docx-1-spo-10.1177_17479541261421589 for Injury screening practices and risk perceptions in intercounty Gaelic Games in Ireland: A cross-sectional survey of players, coaches, and medical staff by Damien Byrne, Catherine Blake, Clare Lodge, Mary O’Keeffe, Dee McEvoy, James Matthews and Nicol van Dyk in International Journal of Sports Science & Coaching

Footnotes

ORCID iDs

Damien Byrne

Catherine Blake

Clare Lodge

Mary O’Keeffe

Dee McEvoy

James Matthews

Nicol van Dyk

Ethical considerations

This study was approved by the University College Dublin, Dublin, Ireland, Human Research Ethics Committee (Approval number = LS-E-22-100).

Consent to participate

Electronic informed consent was obtained from all participants before completing the online survey.

Participation was anonymous, and responses were reviewed and any potentially identifiable information de-identified prior to analysis.

Consent for publication

Electronic informed consent for scientific publication was obtained from all participants before completing the online survey. Responses were reviewed and any potentially identifiable information de-identified prior to analysis.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data sharing statement

All data analysed relevant to this study are included in this article and supplementary material.

Supplemental material

Supplemental material for this article is available online.

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