Factors influencing performance and injury risk in elite female Gaelic team sport players and future research directions: a narrative review

Camogie [kuh mow gee] and ladies Gaelic football are two of the most popular female participation-based sports in Ireland. Furthermore, as the Irish diaspora settle around the world and the increasing globalization of sport, both games are now played in every corner of the globe. Despite the amateur ethos of Gaelic games, inter-county (elite) female Gaelic team sport players complete up to six tactical, technical and physical training sessions per week, consisting of combination of both pitch and resistance training-based sessions [1, 2]. During the competitive season, elite inter-county female Gaelic team sport players compete in two major competitions, the National League, and the All-Ireland Championship. The National League runs from January to April, whilst the All-Ireland Championship runs from May to July each year. From a competition/training perspective, during the peak competitive phases of the National League and All-Ireland, female athletes may partake in games on a weekly/fortnightly basis depending on progress through each of the major competitions.

In both female Gaelic team sports, the game model of both sports is similar [3]. A team consists of 15 players, with the possibility of using five substitutes [4]. Each team includes a goalkeeper, two lines of three defensive players (full-back and half-back), two midfielders, and two lines of attacking players (half forward and full forward). Games at elite inter-county level comprise of two 30-min halves played on a rectangular pitch, 145 m in length and 90 m in width [5]. The principles of play of both female Gaelic team sports are to disrupt and unbalance the defense by striking the Gaelic football or the solid leather slíotar [slit er] (camogie) through the oppositions goalposts (similar to rugby goalposts), either below the cross bar for a goal (three points) or above for a point [1]. In ladies Gaelic football (similar principles of play to Australian Rules Football and basketball), the ball (diameter 680 mm, mass 480 g) is spherical, and heavier than the ball used in soccer. The skills of the ladies Gaelic football include high catching/fielding, handling the ball, kicking the football over a range of distances, solo running with the ball, passing the ball by hand, and blocking and intercepting [4]. Successful ladies Gaelic football teams were observed to have significantly superior ability to gain and use possession [6]. In camogie, (similar principles of play to field hockey & Lacrosse), an ash stick (hurley) is used to strike the slíotar (diameter 69–72 mm, mass 110–120 g) over variable distances. The skills of camogie include high catching/fielding, aerial duels, striking the sliotar over short and long distances, passing the slíotar by hand, solo running with the slíotar balanced on the hurley, blocking opponents using the hurley and intercepting the slíotar with the hurley or by hand [1, 4].

There has been an increase in both participation and professionalization of female team sports in the past decade [6, 7]. Despite this, there appears to be an underrepresentation of sports science research focused on female athletes [8, 9]. It has been reported that only 4% of research conducted in sport science and medicine includes female-only cohorts [10, 11]. This disparity influences practitioners to apply evidence developed in male team athletes’ environments to the female team sport domain, which has the potential to lead to erroneous assumptions [9, 12]. Progressively, there has been recent research efforts to compile evidence on the match demands, physiological characteristics and health and performance considerations of female athletes including soccer [13, 14], rugby 7 s [15] and AFL [16]. However, no such source exists for female Gaelic team sports. Therefore, the primary aim of this review is to summarize existing literature relating to elite female Gaelic team sports athletes including physical and physiological demands, anthropometric and performance characteristics, injury risk, nutritional considerations, and female physiology. In doing so, the authors aim to highlight what is currently known on these specific topics and identify gaps in the research. The review will focus on research conducted in elite female and sub elite Gaelic team sports athletes with comparisons made to other female team sports and male Gaelic team sport athletes when appropriate.

The use of microtechnology devices such as global positioning systems (GPS) has become ubiquitous in team sports settings to enable sports practitioners to collect comprehensive and real-time data during training and competition [17]. The GPS data can aid practitioners to objectively quantify the physical demands of competition, examine individual positional workloads and establish training intensities [18]. Despite the growing number of GPS research in the male versions of Gaelic team sports [19–23], research in elite female Gaelic team sports is still at the emergent stage.

Currently, just four peer reviewed studies have been conducted on the physical demands of elite female camogie players. The first study demonstrated that in 60 min of camogie match-play, elite players covered 5881 ± 906 m in total, 546 ± 259 m in high-speed running, and 183 ± 130 m sprinting [24]. A second study reported that players covered 5800 ± 900 m in total distance, 733 ± 245 m in high-speed running and 206 ± 93 m in sprinting [25]. Positional and running temporal demands measured during 5 min time epochs in elite camogie suggested that midfielders had the greater total and sprint distance decrements and defenders also exhibited total and relative decrements in match-play [26]. However, caution is warranted using this approach, as it may underprepare athletes for competition and not be representative of the complex demands of match play [27]. This data is comparable to other female team sports including elite female AFL where players, across the range of positions covered 6.0–7.0 km at 95.0–126.0 m min⁻¹ during 80 min of match-play [16]. However, the very-high speed running (> 18 km h⁻¹) and sprint distances (> 20 km h⁻¹) were marginally less for these AFL players when compared to camogie, ~ 417 m and ~ 159 m respectively. Furthermore, it has been shown in camogie that full backs cover less total distance (m) and relative distance (m min⁻¹) compared to other positions, whilst half backs and half forwards had higher sprint distances when compared to other playing positions [24]. This is similar to data in elite female field hockey where forwards were reported to have the highest peak output for relative high-speed distance (119.3 ± 19.7 m min⁻¹) in comparison to the defenders (100.7 ± 19.7 m min⁻¹) [28]. The maximal velocity reported in elite camogie players has been previously reported as 24.9 ± 1.6 km h⁻¹ [24], 24.7 ± 1.26 km h⁻¹ [20] and most recently 25.4 ± 1.5 km h⁻¹ [29], respectively. These values are slightly higher in comparison to elite Irish female rugby players where maximal velocity has been reported as 23.4 ± 2.52 km h⁻¹ [30].

Currently, there appears to be no peer-reviewed GPS data for elite female Gaelic football. An early study using time motion analysis investigated player locomotion in elite female Gaelic football and concluded that players spend more time standing still with less time in high intensity activities in comparison to males, with no performance decrements observed across halves of play [31]. However, this method has since been described as outdated. As a result of the paucity of data in ladies Gaelic football, practitioners and coaches rely heavily on data from other female team sports and from the male game, which has received criticism [32]. The use of absolute thresholds is a common example of this, as values from men's Gaelic football have been adopted and applied in the female game [24]. It has previously been suggested that employing male-related speed velocity zones thresholds to the female team sports context could result in an underestimation of workloads [33, 34], and as such female specific high-speed running velocity thresholds have been recommended due to the physiological sex differences in physical fitness/capacity [29, 33–37]. Therefore, an up-to-date analysis of physical demands of elite female Gaelic football using GPS is needed. This information would aid practitioners to design sport and position specific training programs which mimic the unique demands of the game.

The use of heart rate (HR) measurement has been suggested previously as an indirect measure of exercise intensity and has become a widespread practice in female team sports [13, 38]. However, despite this there has been no research on HR indices in either elite female Gaelic team sports. The application of HR measures during training and match-play within female Gaelic team sports would ensure that athletes receive an adequate internal training load stimulus and can provide useful feedback in maintaining or improving fitness capacities in preparing for the demands of match-play [32]. HR monitoring could also enable practitioners to design training units to potentially replicate the demands of the game and provide an individualized aerobic stimulus [39, 40]. In elite female soccer, small-sided games elicited a higher HR response (> 85 HR_max) when compared to medium- and large-conditioned games [39]. This information could be used by Gaelic game practitioners to manipulate the constraints within a modified game to elicit a specific physiological adaptation whilst continually developing the technical and tactical elements of the game [41]. It has previously been shown in elite female soccer players the average HR during competitive games ranged between 152 and 186 b min⁻¹, the equivalent ~ 80 and 90% of HR_peak [35, 38], with no differences across positions. In contrast, during competitive match play in elite female hockey players, HR_peak was reported at 199 ± 1 b min⁻¹, with an average HR intensity of 86 ± 7.8 of HR_peak. Positional differences were also reported with defenders spending more time at > 85% HR_peak when compared to forwards (p ≤ 0.001) [39]. There is a dearth of the research available on the physiological demands in elite female Gaelic team sports. Further research is needed to examine if HR values are similar and/or if positional differences exist in female Gaelic team sports.

A well-developed aerobic system is required for team sport athletes to adequately recover between periods of play and between periods of maximal and submaximal work [42]. Limited data exists on the performance profile of elite female Gaelic team sports athletes. The estimated aerobic power values for successful elite female Gaelic footballers tend to be high, supporting the belief that there is a large aerobic contribution to playing the game. Keane et al. [43] reported a mean value of 49.9 ± 4.2 mL kg⁻¹ min⁻¹ for elite female Gaelic footballers. The values compare favorably to elite female soccer (51.9 ± 5.1 mL kg⁻¹ min⁻¹) and female Australian football (50.4 ± 6.9 mL kg⁻¹ min⁻¹) players [13, 44]. Tucker and Reilly [45] reported that the mean of female sub-elite Gaelic football players were slightly lower at 42.0 ± 6.8 mL kg⁻¹ min⁻¹. At present, there is no comparative data for elite camogie players.

In addition to a well-developed aerobic system, strength, speed and power are all essential bio-motor qualities of female Gaelic team sports [46]. The development of muscular strength and power is an important attribute in elite female Gaelic games athletes to enable them to tolerate the physical demands of the games [43]. Recently isometric strength, using an isometric mid-thigh pull (IMTP) test reported the average peak force was 1938.46 ± 300.17 N and average relative force as 28.72 ± 3.11 N/kg in elite camogie athletes [47]. This is in comparison to IMTP results in elite female rugby union in which the backs and forwards average peak force as 2560.8 N and 2729.8 N respectively [48]. The average relative force was 36.4 N/kg for the forwards and 31.8 N/kg for backs. This could be due to the superior training age of the elite female rugby union athletes and the unique physical characteristics of the game. There is a myriad of research to suggest the importance of resistance training for female athletes to enhance performance and mitigate injury risks [49–55]. Furthermore, enhanced muscular strength for athletic performance has been advocated by Suchomel et al. [49, 50] who suggests that it correlated with rate of force development (RFD), mechanical power output, and sports specific movements (running, jumping, striking) as well as enhanced ability to perform on-field sports specific skills.

Strength training programs for female Gaelic team sports athletes, which includes weightlifting, ballistic, complex training and plyometric movements enhances neural drive, neural activation rates and inter-muscular coordination [1]. It was demonstrated that females who engaged in a 20-week, multi-joint, strength-based training improved strength (neural adaptations, (p < 0.05) with no change in muscle cross sectional area [56]. Advanced training methods such as complex training have been shown to improve athletic capabilities in female athletes with a high training age [57]. From a training specificity perspective, complex training has been demonstrated to improve running economy in division 1 female soccer player [57]. Further research is needed to ascertain the efficacy of specific strength training modalities in elite female Gaelic team sports athletes.

To embed successful injury management strategies in elite female Gaelic team sports, firstly one must understand the epidemiology of injury incidence and burden. Due to the high velocity, multi-directional, contact nature of Gaelic team sports, female athletes who participate in these sports, especially at an elite level, are inherently at risk of injury [73, 74]. In a self-reported participant injury survey across all levels of camogie, indicated that the most traumatic injury that occurred in the game/training activities was knee ligament damage (21% of all injuries) with over 60.8% of correspondences reporting lower limb injuries [3]. Furthermore, 85% of female correspondents felt obliged to continue playing whilst injured, reporting that they did not want to let their teammates down or believed they could manage the injury themselves [3]. Similarly, it was reported that lower limb injuries were the most frequent in elite camogie (71.4%), with 23.8% of injuries occurring to thigh, knee (19%) and ankle (9.5%) [75]. This study reported that 19% of injuries were a result of sprinting, 14.3% resulting from a change of direction, 9.5% occurring from overloading and 4.8% occurring from a push off [75]. Although there is currently no data on injury rates in elite female Gaelic football, lower limb injuries were the most prevalent (67.09%) and caused the greatest injury burden (276.17 days absent per 1000 h) at a collegiate, sub-elite level [76]. Additionally, hamstring injuries were the most common (21.52%) followed by knee (12.66%), quadriceps (11.39%) and ankle (10.31%). It was reported that knee injuries cause the greatest injury burden (106.46 days absent per 1000 h) [76].

It has been reported that female team sports athletes are 3–6 times more likely to obtain an anterior cruciate ligament (ACL) injury than their male counterparts [77]. This high incidence has been largely attributed to anatomical and hormonal aspects including joint laxity, limb alignment, intercondylar notch proportions, ligament size and hormonal fluctuations [78]. Although there is no existing research on ACL injury rates in elite female Gaelic team sports athletes it is imperative that practitioners use different training modalities (resistance training, plyometrics, development of athletic motor skill competencies etc.) to support structural components and improve neuromuscular control of the knee joint and reduce the incidence of non-contact ACL injuries in field-based sports [54, 79]. It is reported during side cutting maneuvers in which internal tibia rotation occurs in < 50 ms after initial contact in conjunction with reduced semitendinosus pre-activation, is associated with an increased risk of ACL injury [80]. Therefore, it may be worthwhile for elite Gaelic practitioners to consider specific training modalities to replicate forces produced < 100 ms such as strength-speed, speed strength and velocity-based modalities [1, 2].

Developing stronger, resilient elite female Gaelic team sports athletes will enable them to master complex, athletic movements innate to the games and cope with the increased demands of training and competition without injury [2, 81]. An INT approach, which combines strength training, plyometrics and movement skill competencies to maximize female athletic performance [54, 55] has been recommended. This multifaceted training system can assist in the strengthening of tendons, ligaments and bones, enhanced balance and coordination between agonist and antagonist muscle groups and an improved capability to withstand training load from specific sports training and competition [53, 54]. It has been demonstrated that integrative neuromuscular training (INT) designed for female soccer players injury prevention simultaneously improved lower body performance measures and improved movement mechanics [54, 55]. This accentuates the importance of a systematic IPP to decrease the severity of injuries [82]. An applied, minimally invasive example of an INT is the Gaelic specific injury prevention program (IPP) (GAA 15) [83–85]. Both LGFA and the Camogie Association have introduced the GAA specific GAA 15 IPP [84, 85]. The implementation of the GAA 15 IPP led to a 66% (p = 0.001) reduction in training injuries, hamstring injuries, and non-contact injuries in a collegiate Gaelic team sports specific IPP intervention group [83]. A survey conducted on Camogie coaches and players reported that only 34% of coaches and 11.8% of players were using the GAA 15 and the Camogie Association should include a mandatory Camogie specific IPP concurrently with coach education programs [85]. The development of enhanced performance characteristics in conjunction with greater compliance of IPP’s could mitigate against the injury risks associated with both elite female Gaelic team sports.

The anthropometric characteristics of athletes are an important health and performance variable [86]. The information is beneficial for coaches and practitioners to inform training practices and nutritional strategies as well as potentially guide playing positions. Currently, there is a paucity of anthropometric data on elite female Gaelic footballers compared to camogie players, as demonstrated in Table 1. Players ranged between 18–29 years of age, 1.58–1.74 m in stature, 56.4–75.9 kg in body mass and had a body fat percentage of 21–26%. The age, stature and mass range of female Gaelic footballers are comparable to other female team sports such as rugby, handball, and hockey [86–88], however, the range observed in female soccer players is far greater and this highlights the heterogeneity among top level soccer players [14]. When comparing the data from earlier studies [43] to the most recent [24, 25, 29, 89] players’ stature and body mass have remained similar despite the sport evolving in recent years and the advent of strength and conditioning programs. Positional differences of female Gaelic footballers have been assessed in one study however, this was carried out on sub-elite players [90]. The authors reported similarities between positions for both body mass and body mass index (BMI), but a ~ 3–7 cm mean difference in stature was observed between midfielders and other positions. However, it is unclear if these positional differences exist at an elite level.

To date, only one study [43] has reported body fat percentage values for elite female Gaelic footballers using a 4-site skinfold assessment method. The body fat percentage values reported by Keane et al. [43] were less than the non-exercising controls in the study but are also comparable to elite female handball [87] and hockey players [88] In contrast, female soccer players tend to have a lower body fat percentage with ranges of 15–22% reported [14] whilst elite rugby league players have slightly higher values typically ranging from 23–39% depending on playing position [91]. Body composition data pertaining to female GAA players requires updating before positional differences can be explored. Although not Gaelic team sports specific, there are best practice recommendations in terms of assessing body composition although this will be dependent on what equipment is available. Where feasible, DEXA or skinfolds (ISAK accredited) should be used [92].

Nutrition plays a significant role in athletic performance, achieved through the dietary influence on body composition, training adaptation, and recovery [93, 94]. There has been growing interest in the nutritional requirements of Gaelic team sport athletes and subsequently, a number of recent nutritional studies have been conducted. However, to date many of these studies and subsequent recommendations are based on male athletes and as such there is an absence of sex specific nutrition guidelines. This is a vital first step in promoting the health and performance of elite female Gaelic team sport athletes.

Interest in female athletes has grown exponentially over the past decade, with recent research efforts focusing on the match demands, physiological characteristics as well as specific health and performance considerations in female intermittent team-based sports. To the best of the authors knowledge, this is the first review summarizing the current research available in elite female Gaelic team sports, with a focus on seven specific areas including: physical and physiological demands, anthropometric and performance characteristics, injury risk, nutritional considerations, and female physiology.

In summary, there appears to be unique physical demands data in match play across positions in camogie with midfielders having greater total and sprint distance decrements. There is currently no comparative data available in ladies Gaelic football. Similarly, there is no research available on the physiological demands of both elite female Gaelic team sports. According to existing literature, performance characteristics such as speed and power are lower in this population compared to other elite female team sports. Based on the research available, the anthropometric characteristics of elite female Gaelic team sport players appear homogenous with some positional differences in stature observed at a sub-elite level. Previous research has demonstrated a high prevalence of lower limb injuries in female elite Gaelic team sports with 85% of players reporting they felt obliged to continue playing whilst injured. The provision of quality, evidence-based strength & conditioning such as the Gaelic specific IPP could help mitigate these injury risks with positive results already observed at a sub-elite level. With regards to nutrition, female Gaelic team sport players have been shown to have inadequate nutrition knowledge which may put them at a higher risk of LEA. In addition, previous research has shown sub-optimal intakes of certain micronutrients including vitamin D, iron, and calcium in this population. Positively, it would appear female Gaelic team sport players adopt appropriate hydration practices. Finally, although menstrual cycle phase and oral contraceptives have been shown to influence performance in other female intermittent sports, to date there has not been any research carried out in elite female Gaelic team sport players.

To conclude, the current work has summarized the existing literature in the area and created a roadmap for researchers in highlighting the existing knowledge gaps that need to be addressed in this field. Addressing these, would help inform future recommendations and make it easier for practitioners to adopt an evidence-based approach when working with elite female Gaelic team sport players.

Not applicable.

JD, KC & KK: conceived the manuscript idea. JD: performed the initial search and data extraction, drafted the article and made critical revisions, read and approved the final manuscript. KC: drafted the article and made revisions, read and approved the final manuscript. KK: drafted the article and made critical revisions, read and approved the final manuscript. All authors read and approved the final manuscript.

No funding was obtained for this project.

Not applicable.