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Home » Exercise Programs » Coach and Player Views Toward Injury Prevention Exercise Programs in Camogie: A Cross-sectional Survey – Healio

Camogie is one of the most popular team sports played by adolescent and adult females in Ireland and is governed by the Camogie Association.1,2 It is one of Ireland's Gaelic games and is the female equivalent to the sport of hurling, varying only by minor rule differences.3 Camogie has a mix of actions similar to field hockey and lacrosse2 and is a multi-directional, high-speed contact field sport.1 Players hit a small leather ball (sliotar) with a stick called a hurley.4 Mandatory equipment consists of a helmet with a faceguard.5 Injuries are common in camogie, with 88% of adult camogie players sustaining an injury in the previous season, 60% reporting more than one injury, and 33% attending a hospital due to the injury.2 Most reported injuries are to the lower limb (primarily the knee, ankle, and hamstring).2 These injuries in particular have been the target injuries of many injury prevention exercise programs (IPEPs).6,7

The governing bodies for Gaelic games, including the Camogie Association, have several strategies to counter the high number of injuries experienced by its participants. Alongside rules on wearing protective equipment and injury management principles, resources have also been put toward the development of exercise-based warm-up activities specific for Gaelic sports.8 Similar to other IPEPs designed for soccer, Australian football, lacrosse, and rugby union, the Gaelic Athletic Association's (GAA) GAA 15 and Activate GAA programs consist of several exercises designed to target the muscles and movements required to participate safely in the sport. These similar programs were designed based on the FIFA 11+ program and are recommended to be conducted during the warm-up for all training sessions and games.8,9 Both programs involve exercises that target lower limb running, cutting, landing mechanics, and strength, balance, agility, and power. Information on these programs and resources such as videos and handouts for use by coaches are available on the GAA and Camogie Association websites. The GAA15+ has been reported to reduce injuries in male adolescent hurlers10 and collegiate Gaelic games players.11

However, as with other sports and settings,12,13 up-take of and adherence to IPEPs outside of dedicated research studies are anecdotally considered to be low. Although GAA-specific programs have been designed and offered, like many programs, they have potentially had inadequate focus and resourcing on how they can best be promoted, taught, shared, integrated, and maintained. Previous research in male Gaelic football coaches reported that, although 96% of coaches believed that an IPP would reduce injuries for their players, only 2 of 26 coaches reported using a specific IPP.14 IPEP effectiveness is unlikely to reach its full potential and injuries will continue to be a problem unless program implementation to maximize adoption and compliance is considered and completed.15,16

The adoption and implementation of IPEPs in camogie has yet to be established. Establishing the current success or lack of success of the GAA IPEPs in camogie and identifying areas where further development on program implementation may have the most impact is important. Thus, this study aimed to: (1) identify the awareness and use of IPEPs by camogie coaches and players; (2) compare player and coach attitudes to IPEPs; and (3) explore the willingness and perceived ability of coaches to implement an IPEP within their teams, as reported by coaches and players.

This study was designed as an anonymous cross-sectional survey of adult camogie coaches' and players' views toward IPEPs. Ethical approval was granted by the Dublin City University's Human Research Ethics Committee.

Adult camogie coaches and registered adult camogie players aged 18 years or older who took part in camogie the previous season were eligible to complete the survey. Camogie players could be elite (represent their county and club team) or non-elite (represent their club team only). Participants were excluded if they were younger than 18 years or did not coach or play camogie the previous season. Participants were requested to read a plain language statement and provide informed consent before proceeding to the survey questions.

The survey was delivered online using SurveyMonkey (SVMK Inc) and was open for responses from July 13 to August 15, 2018. An invitation to participate was sent by email from the Camogie Association to all 572 camogie club secretaries in Ireland, and the survey was promoted through social media and word of mouth. In total, a 56% completion rate was noted; 482 people opened the survey and 297 surveys with at least 80% of the survey completed were received. Twelve surveys were removed because participants reported that they were younger than 18 years, leaving a total sample of 285 participants.

The survey (Tables AB, available in the online version of this article) was adapted from a survey developed for Ladies Gaelic Football coaches and players that had been validated using a three-round Delphi review process with a panel of five international injury prevention experts.17 The original survey was developed based on the Theory of Planned Behavior.18,19 One screening question was included at the beginning of the survey to ensure that coaches or players had participated in camogie last season. Subsequently, the survey consisted of four parts with 16 questions for players and 22 questions for coaches, with a greater number of demographic questions included for coaches than players. IPEPs were defined in the questionnaire for the participations as specifically designed programs that aim to provide strength and movement control to players in order to prevent injury occurrence.

Survey Part A. Coaches and players were asked to report their age, years spent coaching/playing camogie, and their main team (the team they spend most of their time with, or more than 50% of their time playing/coaching). Coaches were additionally asked to report their sex, previous coaching qualifications, and the estimated number of injuries sustained by their team last season (defined as injuries that resulted in a player being unable to participate in training or games for a minimum of 24 hours).

Survey Part B. Coaches' and players' awareness of IPEPs, both GAA-specific and those from other sports, were examined. Respondents who were aware of an IPEP were asked to name it. Coaches and players were also asked whether they were currently using an IPEP. If so, they were further asked to report what encouraged them to choose this IPEP, who delivers the IPEP, how often it is completed, how long is allocated to complete the IPEP, and the broad contents of the IPEP. Coaches were also requested to report where they sourced their IPEP from.

Survey Part C. Three themes, each containing several statements, were presented for which respondents indicated their agreement using a Likert scale response consisting of 5 levels from strongly agree to strongly disagree. There were 8 statements on attitudes toward IPEPs, 8 statements on willingness to use an IPEP, and 11 statements on current perceived ability to deliver an IPEP. Response options were presented in reverse for some items to reduce automated responses.

Survey Part D. An open-ended question identifying anything further that respondents believed would reduce previously identified barriers to the use of IPEPs in camogie was also included. Their interest in further education on IPEPs was examined and participants were asked to rank (from very likely to very unlikely) whether they would participate in seven differing formats of future injury prevention education and training (Table 1).

Table 1:

Likeliness to Take Part in Different Education Formats for Injury Prevention, % (n)

Data were downloaded from SurveyMonkey in Microsoft Excel (Microsoft Corporation) format and were then imported to SPSS Statistics for Windows (version 23.0; IBM Corporation). Data were cleaned and checked for missing or erroneous responses. Frequencies and descriptive statistics were generated from responses by coaches and players on awareness and current use of IPEPs, attitudes to IPEPs, willingness and perceived ability to conduct IPEPs, and views on coach education around injury prevention. The open-ended question was coded into any prevailing themes. A total attitudes scale was created by assigning a score from 1 to 5 for each response to the 8 statements examined, with a score of 1 assigned to strongly disagree and 5 to strongly agree. Negative statements were reversed (as indicated in the results tables) so that a higher score was provided for each statement representing a more positive attitude toward IPEPs. All responses were then summed to create an attitudes scale with a maximum score of 50. This process was repeated to create a willingness scale (maximum score of 40) and perceived ability scale (maximum score of 55). The more positive the attitudes toward IPEP, willingness to use an IPEP, or perceived ability in using an IPEP, the greater the total score for each scale. Normality tests were conducted and the data were not normal. Therefore, Mann-Whitney U tests were conducted to examine whether attitudes, willingness to complete IPEPs, and perceived ability to conduct IPEPs differed between (1) coaches and players, (2) elite or non-elite coaches and players, (3) male and female coaches, and (4) underage and adult team coaches. Statistical significance was set a priori at 0.05. Effect sizes were classified as small (0.1), medium (0.3), and large (0.5).20

A total of 285 participants (98 coaches and 187 players) were included. Table 2 displays the demographic information of coaches. Many coaches had completed a previous coaching qualification (92.7%). Players reported a mean of 15.6 7.1 years playing camogie, mostly with non-elite teams (78.5%).

Table 2:

Demographic Information for Coaches

Thirty-two percent of coaches (n = 31) were aware of and could name an IPEP (either one specific for Gaelic games or more generally). Of the 32%, two-thirds (66.7%, n = 16) specified the GAA 15+ and one-third (33.3%, n = 8) named the Activate GAA warm-up. Thirty-four percent of coaches (n = 33) are currently using an IPEP with their teams. The main factors that encouraged coaches to use an IPEP were the following: it doubles as a warm-up (64.1%, n = 25), research shows it is beneficial (48.7%, n = 19), it improves team performance (41.0%, n = 16), and having observed elite teams using an IPEP (38.5%, n = 15). Coaches were largely responsible for delivering the IPEP (77.8%, n = 28), followed by the strength and conditioning coach (16.7%, n = 6). Of those coaches using an IPEP, the main actions included were: muscular activation (86.1%, n = 31), jumping and landing (80.6%, n = 29), change of direction (80.6%, n = 29), running (80.6%, n = 29), dynamic balance (75.0%, n = 27), and neuromuscular control (41.7%, n = 15).

Coaches stated they used the IPEP during every training session and match (47.2%, n = 17), during every training session (30.6%, n = 11), during one training session a week (8.3%, n = 3), during every match (5.6%, n = 2), player self-administration outside of training and matches (2.8%, n = 1), or as an one-off session (2.8%, n = 1). Most coaches allocated 6 to 10 minutes for IPEP completion (41.7%, n = 15), followed by 11 to 15 minutes (27.8%, n = 10). Coaches sourced their IPEPs from a strength and conditioning coach (50.0%, n = 18), current research (41.7%, n = 15), a course/presentation (25.0%, n = 9), designed it themselves (25.0%, n = 9), saw it online or on social media (22.2%, n = 8), or it was provided by a medical or allied health care professional (11.1%, n = 4).

For players, 13.9% reported they were aware of a specific IPEP, and 11.8% (n = 22) of players indicated that they currently use an IPEP at their club. Players reported that a strength and conditioning coach (47.8%, n = 11) or their regular coach (26.1%, n = 6) led the IPEP during training sessions and/or warm-ups. For the players who reported using an IPEP, 52.2% (n = 12) used it at every training session and match and 26.1% (n = 6) used it as a self-administered session. Players who used an IPEP commonly reported completing muscular activation (87.0%, n = 20), jumping and landing (82.6%, n = 19), and dynamic balance (72.7%, n = 16) as part of their IPEP, whereas running (59.1%, n = 13), neuromuscular control (27.3%, n = 6), and change of direction (27.3%, n = 6) were less common.

Coaches and players agreed and/or strongly agreed that it was important for coaches (95.9%, 96.7%) and players (95.9%, 97.8%) to have current knowledge of IPEPs and that injury prevention is important during training sessions (96.9%, 95.2%, respectively) (Table 3). However, 64.6% of coaches and 67.2% of players disagreed and/or strongly disagreed that an IPEP takes up too much training time. No significant difference in attitude scores was noted between coaches and players (P > .05). However, elite coaches and players had significantly higher scores (median = 34, range = 23 to 39) than non-elite coaches and players (median = 32, range = 24 to 40, P = .01) with a small effect size (r = 0.17). No significant differences were noted between women and men who were coaching or between individuals who coached junior or adult teams.

Table 3:

Coach and Player Attitudes Toward Injury Prevention Exercise Programs

Coaches and players primarily believed that education (90.3%, n = 28; 75.9%, n = 41), more funding (3.2%, n = 1; 20.4%, n = 11), and time (6.5%, n = 2; 3.7%, n = 2) would reduce the barriers to conducting injury prevention programs. Coaches (92.2%, n = 83) and players (82.9%, n = 107) would like further education on injury prevention programs. Table 1 displays players' likeliness to take part in future injury prevention education and training formats.

Coaches and players were willing to complete an IPEP if it was shown to significantly lower the chance of injury (97.8%, 97.8%) and improve player performance (95.7%, 97.1%), respectively (Table 4). Fewer than half of coaches reported that they had sufficient knowledge (30.8%), experience (22.6%), and skills (43.1%) to implement an IPEP (Table 5). Coaches (46.3%) also reported insufficient educational resources available to them to assist with implementing an IPEP.

Table 4:

Willingness of Coaches to Conduct an IPEP as Reported by Coaches and Players

Table 5:

Perceived Ability of Coaches to Conduct an IPEP as Reported by Coaches and Players

Willingness and perceived ability to implement an IPEP did not differ between players and coaches, elite and non-elite players and coaches, and those who coached junior or adult teams (P > .05). However, whereas willingness did not differ between female and male coaches (P >.05), female coaches reported a lower perceived ability score (median = 33.5) than male coaches (median = 39.5, P = .004), with a medium effect size (0.31).

It was previously thought that the uptake of IPEPs in camogie was low, which was similar to what has been reported in other sports such as association football, where the uptake is between 6% and 22% in youth professional male teams12 and 20% in youth community female coaches.13 Our study confirmed this for camogie with 1 in 3 coaches and approximately 1 in 10 players using an IPEP with their current team. This presents multiple questions regarding why some coaches use an IPEP when others do not. This study sought to understand these reasons to improve future iterations of similar programs.

More players (69.5%) than coaches (40.2%) agreed and/or strongly agreed that injuries were an issue with their team. Therefore, educating coaches on camogie injury incidence and the future negative consequences due to injury could demonstrate the importance of IPEPs and encourage IPEP use. As noted above, the use of IPEPs was generally low, with approximately one-third of coaches aware of a specific IPEP and currently using an IPEP. Fewer players indicated they knew of or used an IPEP in their clubs. Similarly low awareness of a specific IPEP (FIFA 11+) has been noted in professional soccer players (9%)22 and Nigerian youth soccer players (21%).23 Without widespread awareness of specific IPEPs, the chances of adoption by camogie teams are low. Thus, it is important that pervasive dissemination of IPEPs is prioritized with this population, particularly with those most likely to deliver these injury prevention strategies. We found that coaches primarily delivered the IPEPs (77%), highlighting the important role coach education can play in improving IPEP knowledge and uptake. Current camogie coach education courses do not contain information on injury prevention, and the Camogie Association should consider introducing injury prevention education into the course program.

A greater understanding of athlete's willingness and motivation to implement an IPEP is important to ensure strategies capitalize on these facilitators and emphasize them during education. Camogie coaches and players in this study demonstrated high willingness to complete an IPEP if it could reduce injury risk and/or improve player performance. This result of strong willingness to complete an IPEP if it reduces injury risk has previously been reported in female adolescent athletes.24 However, improving their sporting performance did not affect their willingness to conduct an IPEP.24 Coaches and players also agreed that it was important to have current knowledge of IPEPs and that injury prevention is an important component in training sessions. This has been similarly noted by high school coaches25 and high acceptance of an IPEP has been highlighted as a key facilitator by both players and team staff in professional youth soccer.12 The overall idea of an IPEP was supported by most players and coaches, with positive responses to statements of the activities included in IPEPs are relevant and beneficial to players and I believe that using an IPEP will reduce the number of injuries with my team. Similarly, when these statements were reversed, respondents disagreed that IPEPs take up too much training time away from necessary tasks or that IPEPs cost too much money. This suggests that an IPEP, if designed and delivered appropriately for a community sport like camogie, has potential to be well received. This is important because attitudes to a behavior can have a strong affect on uptake and compliance.19,26 Elite coaches and players displayed better attitude scores toward injury prevention and IPEPs in particular, compared to coaches and players of non-elite teams. Thus, the Camogie Association should focus on educating those involved in camogie at the non-elite level on the importance of injury prevention in the sport.

Understanding and addressing potential barriers and challenges to the implementation of IPEP specific to the population and setting can improve their success, particularly in community-based sports,12,27,28 such as camogie. Approximately 3 of 5 camogie players reported that they believed poor training attendance would offset the benefits of implementing an IPEP. This issue unique to amateur community sports like camogie may affect the reach of the IPEP, because those not at training will not undertake the IPEP if delivered in that format. In community Australian football, the IPEP only reached 50% to 60% of targeted players due to missed training sessions.29 If some players are missing training sessions, the exercise intensity and progressions within the IPEP should be modified for them to ensure they are appropriate for their level.28

With regard to coaches, one of the identified barriers to IPEP uptake was perceived insufficient coach knowledge, experience, and skills to implement an IPEP. Female coaches also reported a lower perceived ability to implement an IPEP score than male coaches. Further, coaches reported they did not have sufficient educational resources to support them in conducting an IPEP. Previous studies have reported similar findings, with poor perceived capability to implement an IPEP in Australian junior netball coaches30 and a desire for stronger training for providing feedback when supervising IPEPs in soccer.13 Thus, identifying how to support coaches' perceived competence, particularly that of female coaches, is a critical component of any future injury prevention educational strategies. Camogie coaches overwhelmingly displayed a keen interest in further education on injury prevention. Currently, information on IPEP programs available on the GAA and Camogie Association websites include videos and handouts that can be used by coaches. Incorporating practical sessions that improve a coach's ability to communicate skills training and strategies to highlight that specialist coaches are not required for an IPEP to be effective should be explored in future research. Smartphone applications and instructional DVDs were the least preferred format for educational material requested by coaches, despite a growing interest in m-Health or disseminating information via mobile applications to help prevent unintentional31 or sports32 injuries. Thus, the Camogie Association should prioritize developing educational resources in the formats that coaches prefer to maximize engagement, such as by running injury prevention courses, or delivering the information via posted injury prevention packages and website platforms. However, previous research has shown that following education on an anterior cruciate ligament IPEP, despite increased intention to complete the anterior cruciate ligament IPEP, only 58% of coaches actually implemented it.33 Thus, the fidelity of a camogie IPEP education program should also be examined.

This study was the first of its kind to examine IPEP implementation in camogie coaches and players, and there were limitations to this study. Convenience sampling was used for data collection and respondents to this survey elected to complete it on a self-selected basis. Thus, response bias may have impacted the generalizability of the findings because those who may have previous experience or interest in injury prevention may have been more likely to complete the survey. A further limitation was that only survey responses that completed at least 80% of the complete survey were included in the analysis. The survey was also developed for use in Ladies Gaelic football and not specifically validated in the camogie population. However, Ladies Gaelic football is a similar Irish community sport with a sporting structure comparable to camogie. Due to constraints with the length of the survey, intention to conduct IPEPs with their teams was not analyzed in the study and should be included in future similar research. A deeper examination of players' and coaches' reasoning, using qualitative approaches, could identify the reasoning behind barriers and potential strategies to overcome these.

Education strategies to enhance the practical knowledge and skills of camogie coaches in conducting IPEPs, particularly female coaches, in formats they prefer is necessary. Incorporating IPEP education in the mandatory camogie coaching foundation course held by the Camogie Association would ensure all camogie coaches have IPEP education. Players have an important role in the success of an IPEP implementation strategy and enhancing the awareness from players of already developed IPEPs that can be readily used in camogie is essential. Thus, it is imperative that any developed IPEP and education strategy target both players and coaches to maximize adherence to the IPEP. Supporting an IPEP with an implementation plan can improve the adoption and use of IPEPs34 and is a critical next step for a community sport like camogie to achieve a real-world reduction in injuries.

Likeliness to Take Part in Different Education Formats for Injury Prevention, % (n)

Demographic Information for Coaches

Coach and Player Attitudes Toward Injury Prevention Exercise Programs

Willingness of Coaches to Conduct an IPEP as Reported by Coaches and Players

Perceived Ability of Coaches to Conduct an IPEP as Reported by Coaches and Players

Coach Questionnaire

Yes

No (excluded)

Female

Male

Other ________________________

Prefer not to say

Camogie Foundation Course

Camogie Level 1

Camogie Level 2

GAA Foundation Award

GAA Award 1 Coach Education

GAA Award 2 Coach Education

LGFA FUNdamentals Course

LGFA Level 1

FAI Kick Start 1

FAI Kick Start 2

IRFU- Mini Rugby

IRFU- Foundation Level

IRFU- Level 1

IRFU- Level 2

IRFU- Level 3

No

Other ____________

Interprovincial

Adult County

College/University

Adult Club

Underage County

Underage Club

Secondary School

Primary School

Other __________

None

15 players

610 players

1115 players

1620 players

2125 players

25+ players

Not applicable

Exact Number ____________

No

If YES, what injury prevention programmes _________________________________

Yes

No

Unsure

Other___________

Advised to by medical and allied healthcare professionals

It doubles as a warm-up

Current research shows benefits

Players requested it

To improve team performance

Due to high levels of injuries seen in previous seasons

Other teams coaches in the club have found it beneficial

I observed elite/high performance teams participating in injury prevention programmes

Other __________________

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Coach and Player Views Toward Injury Prevention Exercise Programs in Camogie: A Cross-sectional Survey - Healio

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Home » Exercise Programs » Coach and Player Views Toward Injury Prevention Exercise Programs in Camogie: A Cross-sectional Survey – Healio