In the latest of our interview series on player welfare in the GAA, we speak to the Director of Medicine at the Irish Institute of Sport Dr. Rod McLoughlin about the issue of concussion in Gaelic Games and the challenges facing the GAA in the area of anti-doping.
By Brian Murphy
Having served on the GAA's Medical and Scientific Committee from 2006 to 2012 and as the Medical Officer for the Wicklow Senior football team from 1998 to 2006, Dr. McLoughlin is one of the most respected authorities on these matters within the GAA.
As well as wealth of GAA experience, Dr McLoughlin has worked with many teams across various sports including rugby and soccer. As the Irish Olympic Medical Officer, he works with the Irish Sports Council anti-doping unit in providing athletes, coaches and medical personnel with information on the regulations and procedures relevant to doping in sport.
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GAA.ie: Given GAA players are now bigger, faster and stronger than ever before, are more high-impact collisions and, as a result, increased instances of head injuries an inevitability?
Dr. Rod McLoughlin: The statistics from the national study show that head injuries are about three per cent of total injuries – 3.6 per cent in football and 2.6 per cent in hurling. Of those, one per cent are concussion so one per cent of the three per cent are concussion so it is a very small but very important part because of the critical nature of the potential outcome. If you get a serious injury to your knee it might end your career, but an injury to your head might be much more significant in terms of your health and your future.
Time will tell us if this is increasing. It makes logical sense that bigger people hitting at greater speeds are producing greater forces and they are more likely to cause injuries and some of these will obviously be concussion. The other side of the coin though, is that because the players’ strength and conditioning has improved, they are becoming better able to take the greater force. If you or I got hit by one of these players it would have a greater impact on me and potentially to my head than somebody else. We are very early in our data collection figures - the GAA have been collecting figures since about 2007.
If you look at other sports, certainly it appears that it is a bigger issue in rugby now. Concussion appears to be happening more where the bigger players are hitting harder, but the nature of the game – the tackle and the impact – is different.
GAA.ie: Acquired Brain Injury Ireland (ABI Ireland) in association with the GPA and the GAA ran a campaign last year about educating players on the signs and symptoms of concussion, but from a medical perspective can you explain why it is so important for players to learn about concussion and about dealing with the consequences of head injuries?
RM: It’s vital. Players and coaches, medics, we are all involved in this. If we don’t understand the significance of a head injury then they don’t know why they are doing something. You need to understand the logic behind something before you buy into it. The education needs, from a player’s perspective, has to be around recognising that they may be injured. When someone comes out of a tackle a bit dazed they may not realise that actually they need to take a bit of time out.
We need to educate people around the symptoms of a potential concussion and then educating the people who are involved in their care, be it trainers, coaches, doctors and physios in terms of trying to recognise this. Once diagnosed, it’s about educating them on how to manage it, removing them from the play, keeping an eye on someone and monitoring them and making sure their care is handed over.
If you have somebody who is concussed, of which part of that might involve some memory loss, there is no point in giving them a series of instructions and sending them home because by the time they will have gotten home they may have forgotten what they said and the person they go home to doesn’t understand what has happened.
Obviously one of the key things at the moment is then the return to play. Is it safe to return to play? If I as a player don’t understand the reasons why I wouldn't go back onto the field of play – and they are essentially that I may get further injury and another much more significant injury – if they don’t understand that it is essentially for the players’ well-being, they are less inclined to buy into it.
GAA.ie: Can you outline some of the potential risks of returning to play with a concussion?
RM: The ultimate risk is called second impact syndrome. That is very rare but it is where the player goes back on and gets another minor injury which causes a catastrophic brain swelling and death. That is incredibly rare, but that’s the ultimate risk.
The more immediate risk is that if I play on and I am not mentally alert and not functioning well and therefore not coordinated – you see people staggering and all sorts of things to the point that they are clearly uncomfortable – I increase the risk of another injury, any other injury. Be it I twist my knee, be it I enter a tackle badly and I come out at the wrong end of another collision and I damage something else.
I think for players, managers and coaches the thing I would say is why return to play when you are not going to perform to your level? For many people performance is the thing that drives them. ‘Ah look, I think I’m fine’. That’s not right. What we need to do is educate coaches that are driven only by performances, these people will not perform as well, they will not be the player they normally are if they are not coordinated, if they are not thinking clearly.
GAA.ie: The GAA published a set of guidelines in their Position Statement on Concussion in Gaelic Games in 2007, but as a medical professional do you think there is a need for a protocol in relation to some of these areas, as is the case in some other sports?
RM: I think what you are getting at is removing the decision-making process from the time and removing pressure from individuals – that a protocol will direct, with certain criteria meaning a player is automatically taken off. There are a number of issues that need to be discussed around that.
When I was involved in the past with rugby, they had a situation whereby any player who came off in the All-Ireland league with a diagnosis of concussion had to have a specific time period out. What actually happened then was that the diagnosis was changed to something else. The trouble with this is that if people want to get around it they will get around it. That’s back to education, but if it’s something we are enforcing on people, I'm not saying it isn't of value, but it’s of limited value because people just get around it.
The other challenge with a protocol is that with concussion is the diagnosis – it’s a real hard thing to diagnose. Concussion, essentially, is where someone has some impairment of their brain function. I could go and assess someone who I have never met before, and somebody else could say, ‘Wait, that’s their normal self. They’re normally that slow or they normally respond like that’. Or I might know the person, and without knowing them terribly well, just be able to tell that they are off, they are concussed, so I am getting them off the pitch. There is a lot of subjectiveness to the diagnosis.
The challenge is the diagnosis. There is a pressure on me as a doctor: ‘Yeah, I think he’s concussed’. But then there is a pressure from everyone else saying that they need him on then you can see why I might say, ‘Well maybe he’s not as concussed as I think.
Speaking from a personal point of view, I remember years ago assessing a player who was involved in a tackle. I went out, did my assessment and thought he was fine. He got another bang five minutes later and I went on thinking two bangs in a row, this guy is off. But in between the two bangs he had played brilliantly and scored a goal. I talked to him about it and he had no memory of it. So, I had clearly mismanaged the first concussion. That is the difficulty – the challenge of diagnosing.
GAA.ie: Broadly speaking, what do you think the main challenges are for the GAA around the area of anti-doping?
RM: We touched on it at the beginning of the conversation when you said players are now three to four kgs on average bigger than five or six years ago and you can see that with inter-county teams that have size right across the pitch. It’s the culture to bulk up. Now we have bigger players going just as fast and faster than players in the past. With that culture comes more use of gyms and a gym culture. Within certain gyms – whether we like it or not – there is a culture where they sell you supplements that help you bulk up, and I think that is potentially a challenge for the GAA and for doctors in the future in terms of the risk that somebody may take a supplement, knowingly or not, that may cause them to have a positive test.
GAA.ie: Would it be naïve to believe that there is no potential for such a culture to grow at some point in the GAA?
RM: Thankfully to date we have no evidence to believe that this culture exists and we should start at this point. What we always need to be is cautious and vigilant about the possibility because I think where the benefits of being successful in sport become greater, where gain comes to the competitor, be that financial or through recognition or a standing in society that opens doors for me, in that setting other sports show that there is pressure on players to do whatever it takes to make that happen. We have to be vigilant, keep it in mind and wait and see. But, yes, it may be something that becomes a bigger issue and a bigger concern, but thankfully to date we don’t have positive tests.
GAA.ie: You were on the Irish Sports Council committee (Irish Sports Council food and Supplements subcommittee) that recommended sportspeople avoid supplements completely. Can you explain the rationale behind that recommendation and explain why that stance has since changed?
RM: What we did was we understood the reality of what happens within elite sport, and obviously this is an area that I now work in as Director of Medicine of the Irish Institute of Sport. We realised that stance was a hard one to stand over when the reality was somewhat different – that people took supplements. What has happened now is that they have produced guidelines on the do's and don'tsto lessen the likelihood that you will take a supplement, that you will take a banned substance.
The bottom line still is that you are responsible for whatever you take. That is one of the concerns in the sense that sometimes what you can have is other players recommending stuff, but what each player needs to understand is that no matter who recommends, you are still responsible again to check out the product as best you can.
That’s one of the other troubles with supplements: if I prescribe a medicine, it comes through a regulated industry and each medicine gets a licence number which essentially says that it is what it says on the label. In the supplement world, there isn't the same ability to regulate. We have supplements that contain things that they don’t say they contain. They might contain something that is banned but they use a different name and players don’t realise this.
The term that is misleading is the word ‘natural’, which suggests they are fine. But they are meaningless terms in the industry; I’m not aware of what is ‘natural’ and what’s a ‘sports supplement’. Those terms can give people a false sense of security, but in reality they are meaningless terms.
GAA.ie: What advice would you give to a player who is considering taking a supplement?
RM: The supplements that are at the highest risk of causing you a problem are ones that are designed to increase energy or aid weight loss. I think if somebody is taking a supplement that they claim has made a huge difference to their performance, always be wary. That’s what has happened in the past.
Supplements gotten from the internet are more likely to be positive than supplements that aren't. Supplements that have come from a company that has already been associated with producing products that contain banned substances I wouldn't go near. These things suggest there is a risk.
Some products you can check on websites like Eirpharm or the Irish Sports Council website. The problem is that often they don’t look too closely at supplements because often all they can stand over are things that have product licences.
It’s also about doing the basics properly. It’s about getting proper dietary advice and forming a dietary plan. We see people who are eating poorly wanting supplements, but what they need to do is do the basics well. You need to seek advice on that from a professional.
You also need to be aware of or talk to somebody that has some understanding of the WADA (World Anti-Doping Agency) anti-doping rules. We forget to do the basics sometimes because we are always looking for an edge. Companies are aware of that, and that’s what they make their profit on – the idea that you or I will believe that some tablet or something will give me an edge. At times there is appropriate supplementation.
GAA.ie: Given the huge levels of training inter-county players do, and the additional stresses they are under with work that professional sportspeople may not have to worry about, is it realistic to expect GAA players to reach those performance levels without using supplements?
RM: I certainly think there are many players who need to be doing all that as a first line before they add supplements on top of that. What makes me a top inter-county player is not just the amount of training that I do and the fuel I take in – although they are hugely important parts – it is exactly balancing all the things that you have talked about.
The big area in other professional sports they are looking more and more at at the moment is recovery. It’s not that I am doing more and more training. When I train, I get the benefit of that training by my act of recovery afterwards. If I keep training and never give my body the time to recover after I will get overtrained.
I’m trying to broaden the answer to the question. It’s about having a good work-life balance, getting appropriate sleep, resting and relaxing and having other outlets. All those things contribute to being a top GAA player. There is a saying, ‘Those that recover best perform best’. We’re all into training, but recovery is something in time we will see more and more emphasis on. We see people who are starting to see the negative side of all the training, like mood changes and sleep changes, so if I am not taking appropriate rest then I will not feel the benefit of all the training.
GAA.ie: What advice would you give to players around taking medication for common illnesses?
RM: I would suggest every player who is in the testing pool and therefore runs the risk of being tested that whenever they go to anyone for advice and a person talks to them about giving them any sort of medication, that they tell them they can be tested to make sure it is alright under the WADA rules. That’s the advice I give everyone.
There are certain cough and ‘flu medications that are allowed, but there are certain other products that are not allowed. Tell whoever it is who may give you a product that you could be tested and secondly you then go and check the product on the Eirpharm website if you bought it in the Republic of Ireland and on Global DRO if the product was purchased in the UK, USA or Canada.
The other caution that may apply less to GAA players than other sports but is beginning to apply a little bit more now is travel abroad. When you have teams going to places like New York, be aware that a product with the exact same name abroad may contain different substances. We have had that happen in other sports, where an athlete has gone abroad, taken the same product name as in Ireland but in another country it’s slightly different.
Dr. Rod McLoughlin
Medical CV
Director of Medicine, IIS
Olympic Medical Officer
London 2012 Technical Group
Sports Management Lecturer, UCD
Medical & Scientific Comm:2006-'12
Wicklow Senior Footballers:1998-'06
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Dr. Rod McLoughlin was speaking in an exclusive interview with GAA.ie. GAA.ie will continue to feature interviews with a wide range of people involved in safeguarding and ensuring the welfare of GAA players.