Top players Donnelly and Hughes warn of concussion crisis threatening GAA
Gaelic footballers are not dealing with some of the concussions they suffer, or else they are ignoring them in order to play on, believe two of Ulster's foremost players.
The available evidence in the Allianz League so far is that footballers have become much more cautious in their approach to concussions this season, but there is a belief out there that the assessments are not fool-proof.
Tyrone's Matthew Donnelly and Monaghan's Darren Hughes have spoken of the dangers of concussion and how they have struggled to function in the workplace, or even had to stay off work for a time, after picking up a head injury.
So far it has become commonplace for players suffering from a blow to the head to skip the following weekend's fixture.
The first weekend of the league claimed three concussions - Kerry's Shane Enright, along with Donnelly and David Murray in Tyrone's clash with Roscommon, with all three men sitting out the next game. For Donnelly, that meant the glamour fixture against Dublin in Croke Park when Tyrone nabbed a draw.
Hughes got an early blow in the back and a further knock on the head against Kerry and did not reappear for the second half, sitting out the subsequent game against Tyrone.
It is not the first head injury Donnelly has had. Last year, at the height of summer and only a fortnight before Tyrone took on Mayo in the All-Ireland quarter-final, he suffered a clash while playing for Trillick against Errigal Ciaran in the club league.
"I would have been chattering gibberish that evening," reveals the two-time All-Star.
"I was sitting at home and I didn't go to work for a few days after it.
"I never felt nauseous from either of them, but definitely any form of exercise or even concentrating, you get a dead ache in the centre of your head, just between your eyes. That would have been the case."
Hughes has a similar tale to tell. He says: "I would have played on myself in matches and I would have had team mates who were sitting out training around peak championship time (with concussion).
"You would have been telling them, 'sure you're alright, it's not that bad, it's not going to kill you', that sort of thing. But it is dangerous."
Against Kerry, Hughes was initially hit in the back when he wasn't expecting it. A small knock on the side of the head triggered a bigger reaction, he feels.
"It wasn't a heavy injury the first one. I just got a shoulder in the back, and it probably did make my head go back because I wasn't expecting it. The second one just completely triggered the concussion.
"If you get another bang, it might only take something minor to trigger it being one hundred times worse," he says.
"They asked me at half-time was I alright and I said I was. But I went to go out for the second half and I was feeling a bit off with what was going on around me. So I said, 'I'm out here'."
Hughes is a dairy farmer and operating heavy machinery would only have placed himself and others in danger during the following days.
He admits: "I felt dizzy that week and it was difficult to concentrate. It is a busy time at home too. It did have an effect and I knew that I had to sit out a week. I was in no condition to be playing."
There are a number of set protocols in relation to returning to play.
Here on the page is one from the Sports Concussion Institute that states if an injury is sustained on a Sunday, then the recovery process is too tight for a player to play a competitive match six days later. Managers have recognised that.
Despite the clear guidelines, Donnelly feels there is a danger players may not be entirely aware of their progress through the various stages, or may not fully declare their symptoms as they seek to hold down a place in the team.
"The tricky thing about it is that the symptoms are so acute that you mightn't even be able to distinguish if there are symptoms there. You could be over-thinking it too much and nearly looking for the symptoms. There is no real way of measuring what level of concussion you are at, what stage you are at," he explains.
"The only thing you have is your word to the doctor, or his assessment. That was the trickiest part of it.
"I would have a fair idea that a lot of players would be going through the next stages and you mightn't be sure they are fit to get to that next stage of the protocol. They are nearly just telling the doctor that to get to the next stage."
Since his injury against Kerry, Hughes made two aborted attempts to return to training and had to pull out twice. With Monaghan's team medic Dr McGinnity, the minimum period before returning to full contact is longer.
"Ten days would be the protocol Dr McGinnity would be going on," states Hughes.
"It's based on how I am feeling. I suppose sleep is a big thing and there are different levels in it. They ask you these questions about your sleep, and that ticks one box. Then they go into light running without exerting yourself, that ticks another box, whereas I wasn't getting through that last week (the week of the Tyrone game).
"I was building up the lungs, but I could find myself getting a bit dizzy and finding myself go. But it is 10 days for a reason."
The 2013 All-Ireland final was pockmarked by head injuries. Dublin defender Rory O'Carroll clashed with Mayo's Enda Varley and was knocked out cold, but insisted on playing the closing stages.
Despite being "spaced" for the last 15 minutes, according to Dublin doctor David Hickey, he remained on the pitch as Dublin had used up all their substitutes.
In 2015, O'Carroll vowed that one more head injury would finish him with football and he has not been seen in a Dublin shirt since the end of that season.
As well as the initial affect of a head injury, Donnelly believes there is the possibility for an overall physiological effect on the body.
"Last year (when he was injured for Trillick) the next game I was playing was the Mayo game and I pulled up at the end with an injury, which would never ever happen to me," he says.
"I just started picking up wee injuries after it so I don't know if there is a correlation, but I do think there is an impact on your whole body," he added.