Keeping the Wolves from the physio's door

Saturday, January 26 2019

 

Injuries had a “significant influence” on team performance in professional football an 11-year UEFA Champions League study concluded back in 2012. The main finding was a correlation between low season injury rates and increased performance domestically.

Wolverhampton Wanderers had been tipped for a top half finish in the Premier League following an impressive 2017/18 Championship campaign. A season which saw Nuno Espírito Santo benefit from a squad largely unaffected by injury.

"We do a full screen on all the players when they come back from pre-season," Head of Medical Phil Hayward explained during a behind-the-scenes tour undertaken by 5 Live Sport in 2018. "We'll get a clear picture of how each player moves, what happens to each of their joints, and according to that we'll have a clearer idea of areas which may be exposed to certain injuries. We'll then put some programmes in place to help prevent those injuries."

And a quick look at the injury table tells you everything you need to know about how the squad is faring currently. Wolves boast a clean bill of health and haven’t reported any fresh absences for over six weeks – Diogo Jota (hamstring) in December being the last.

They have suffered only 4 significant injuries (9+ days) this term, the fewest of any top-flight side and almost a third of the next best. To give some perspective - Manchester United have eight-times as many reported problems (32) although they are involved in European competition which has resulted in five additional competitive games.

Increased exposure to game play = higher risk of injury incidence.

A valid point, until you consider that United suffer on average 1 injury for every game played compared to that of Wolves which is around 1 in every 607 minutes.

Of those four injuries, one was muscular – hamstring – and another occurred whilst on international duty – Jonny MCL knee. Having lost 76 days in total to injury, Wolves not only suffer less, but those sidelined return to play quicker on average (19 days) - almost a week faster than their league counterparts (25.7 days).

In recognition of their success during 2017/18, Wolverhampton Wanderers were awarded the ‘Medicine and Performance Team Award’ by the Football Medicine and Performance Association. An accolade which could be bestowed upon them once again come May.


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Opinion: What happened to Hector Bellerin....

Monday, January 21 2019

 

Hector Bellerin suffered what is thought to be a serious knee injury during Arsenal’s Premier League encounter with Chelsea on Saturday. A setback which came only a week after his return to play from a calf strain that he suffered in mid-December to the same leg.

Initial thoughts from leaders within Sports Medicine have speculated that he may have torn his anterior cruciate ligament.

By examining the mechanism of his injury from video analysis, there is a clear shift of the tibia (shin bone) in a backwards direction. This type of movement is usually more indicative of a PCL injury, rather than an ACL, given that the posterior cruciate is the main restraining ligament which prevents excessive movement of the tibia in a backwards direction.

 

 

However, what if….

We assume that the femur (thigh bone) has moved forwards at the same time as the shin bone moved backwards, that would indicate that Bellerin has in fact damaged his ACL and will almost certainly need reconstructive surgery which is likely to mean around 9 months on the sidelines.

Why did it happen?

There are of course a range of risk factors which will have played a role in this non-contact injury, but for the purposes of this blog will stick to some of the more generally recognised risk factors.

Fatigue

Bellerin is a modern-day attacking wing back and carries out a lot of explosive sprints and lung bursting high-intensity runs up and down the pitch repeatedly over a period of 90 minutes – no mean feat at all -you try it!!!! This type of high-intensity exercise can predispose the player to early onset of fatigue. Furthermore, if we examine the sports medicine literature, there are a number of influential papers on this matter which suggest that fatigue is a major risk factor for injury and therefore, given the demands of playing this position on the pitch and the fact that he has just returned from an injury, it could certainly have played a role, especially given it occurred in the latter stages of the game.

Previous Injury

This then brings us on the second risk factor for future injury – that is previous injury. Previous injury is a well-known and accepted risk factor for increasing the risk of injury. Bellerin suffered a calf injury to the same leg on the 16th of December and had just returned to play - against West Ham (GW22) – in a brief 21-minute run out. It has been well-documented in leading research papers in this field that the first 4 weeks of a RTP carries significant risk for a recurrence of injury, not just from the initial problem but from any injury in general.

Graded Return to Play

Therefore, the question could be asked, was it too much of a jump to go from playing 21 minutes to starting a Premier League game in just seven days. If Bellerin was still on a restricted minutes plan – i.e. only allowed to play for 45 minutes against Chelsea, then 60 minutes for the next game, and 75 for the following and then a full 90 minutes on his fourth week following a return to play, this would certainly have mitigated the risk of injury from the two aforementioned risk factors: Fatigue and Previous Injury.

Incomplete Rehab

Bellerin suffered his calf injury in December and returned to play against West Ham 26 days later. If we break down this time period it would be reasonable to suggest that he did not have enough time to A) recover from the calf injury itself. B) regain his pre-injury strength, aerobic and anaerobic fitness levels.

For example, let’s assume that the first 5 days following the injury were spent convalescing from the injury: protecting the injured area, relative rest to promote optimum healing, ice to help reduce pain levels, compression and elevation to reduce excess inflammation to the area and gentle pain free movement to encourage normal mechanics of the lower limb, the player is now only left with three weeks before he enters the fray against West Ham.

In this 21-day period, it would be reasonable to suggest that he had 3 to 4 rest days to optimise any gains in strength and/fitness levels - which then leave him only 16 or 17 days to return to full fitness levels to tolerate the brutal demands of the Premier League.

Now let’s, complicate things even a little more. It is normal practice for a player to be expected to take part in a full week of squad training before bringing declared fit for selection for competitive games. Therefore, his return to train date was probably on the Monday before the WEST HAM game, which now means that he would only have spent 11 days building up his strength, speed and fitness levels.

During this 11-day period; 4 to 5 days would have been spent progressing from running in the pool, to the AlterG (Anti-Gravity Treadmill), to a soft surface and then onto grass. His running pace would have progressed from a slow steady jog to all out sprinting possibly over a 6-day period, if all went well. Then for the remaining few days, he would have had to complete some repeated short sprints similar to match pace, some maximal jumping and kicking before being declared fit to return to squad training on the Monday prior to West Ham. Fine margins and an all too tight timeframe - certainly not enough time to regain strength and fitness levels comparable to pre-injury levels.

Therefore, given all of this, he probably wasn’t afforded the time needed to complete a full recovery from his calf injury – but this is normal in professional sport and is generally accepted by all those who work in elite a professional sport as an industry hazard.

Risk Management

The player, coaching staff, manager and sports medicine team will all have inputted into whether or not they felt it was the right decision for the player to return to train and play so early following his calf injury. At the time these domain experts made the best decision they could with the available information they had at hand, which will of course include the wishes of the player. They will have used - GPS data, strength profile tests and aerobic/anaerobic tests to gauge his progress. However, all these tests have limited utility in isolation and in reality, maybe the player just needed a bit more time to make a full return to play with unrestricted minutes following injury – a lesson for all of us, I think. No matter how robust you think your battery of testing is or how eager the player is to return to play, the better decision would have been to be more cautious in his return to full play strategy.

So, in summary, I can imagine that the Arsenal sports medicine and coaching staff are reflecting on this latest injury and hypothesising what risk factors may have played a role in this injury and what they could do to mitigate a similar injury in the future: injury sport related growth for everyone.


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View from the BaDMaN Boot Room - GW 23

Friday, January 18 2019

 

I read today that Aaron Ramsey has signed a £300k-a-week pre-contract deal with Juve, so will leave Arsenal in the summer. For fuck all. 

Precisely the same fee they negotiated for Alexis Sanchez. 

Well, at least they are losing their reputation for being a ‘selling’ club. 

Eyes down, ladies.

Goalkeeper

Total Pts

GW 22 Pts

Alisson (LIV)

107

6

Defenders

 

 

Robertson (LIV)

124

9

Alonso (CHE)

119

2

van Dijk (LIV)

113

7

Luis (CHE)

105

8

Midfielders

 

 

Salah (LIV)

162

11

Hazard (CHE)

144

5

Sterling (MC)

133

6

Sane (MC)

115

8

Forwards

 

 

Aubameyang (ARS)

134

2

Kane (TOT)

132

2

 

Hmm. Here we are in GW 23 and it looks like we might be looking at nine of the FPL Dream Team X1 already in situ.  

Take it as Red…

Liverpool’s No 1 (actually No 13) Alisson is going nowhere. He’s parried challenges from the best that Man City and Chelsea have got to offer – and your best alternative is actually Cardiff’s Etheridge as it stands. He’ll save you £1.3m each week – and could be worth an investment this week (away to Newcastle).

There’s only Wan-Bissaka…

A slight shuffle in the defensive four, but the Liverpool and Chelsea pairings look away and clear. Doherty (WOL), Digne (EV) and Trippier (TOT) are still decent investments – at least as far as 23%, 15.8% and 18.3% of the FPL universe are concerned. But just don’t get the clean sheets to back up their assist appeal. Oh and there’s been a 33% swell for the £4.5m Wan-Bissaka (CP). He’s a bargain and might just get a big move this month. Possibly. Maybe.   

You’re in Sane! 

Sane (MC) has clambered over Fraser (BOU) this week, but there’s only one big performance between those two, Mane (LIV), Anderson (WH) and even Pogba (MU) if you’re buying the ‘United are back’ hoopla.

But the big three Salah (LIV), Hazard (CHE) and Sterling (MC) look to have their spots in the locker room nailed down.

A Rash you won’t mind getting…

Now then… there could be a bit of headway at the sharp end. No change yet, but it’s a-coming. Kane (TOT) is crocked for probably ten matches, so choose your replacements wisely. Wilson (BOU) and Firmino (LIV) are next on the list, but Aguero (MC) will outscore both on the run-in. £9.3m Lacazette (ARS) will save you a bit, £6.4m Jimenez (WOL) will save you a lot. But the mob has already spoken – with born-again £7.5m Rashford (MU) now accounting for 32.2% of the vote. 

The Watch List: I got five on it.

If you haven’t got, or can’t get, or don’t fancy any of the above – this lot are handy alternatives. 

GK: Etheridge (CAR) – this week (Newcastle) yes, next week (Arsenal) no.
DEF: Doherty (WOL) – has a nice little run of games until Chelsea on March 9th.
MID: Fraser (BOU) – don’t let this lad drop out of sight. Bargainous.
FOR: Rashford (MU) – could still make a big push for Young Player of the Year. 
FOR: Aguero (MC) – due a streak. It’ll happen.  

That’s how it looks from here.

Matt Nesbitt

 


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View from the BaDMaN Boot Room - GW 22

Friday, January 11 2019

 

More developments in Wayne Hennessey’s ‘Nazi salute’ story…

The Palace keeper insisted that the picture below captured him ‘waving and shouting’ at the photographer to hurry, with his hand placed over his mouth to make the sound carry.

Two independent sources have since come forward to endorse his explanation. Mr Basil Fawlty, a Torquay hotelier who experienced a similar misunderstanding while hosting a group of international travellers in the 1970s.  

And an anonymous former public servant, who accidentally caused a stir in Nuremburg in 1933 while trying to attract the attention of his girlfriend Eva.

Nasty business.

Goalkeeper

Total Pts

GW 21 Pts

Alisson (LIV)

101

8

Defenders

 

 

Alonso (CHE)

117

6

Robertson (LIV)

115

5

van Dijk (LIV)

106

1

Luis (CHE)

97

6

Midfielders

 

 

Salah (LIV)

151

2

Hazard (CHE)

139

3

Sterling (MC)

127

5

Fraser (BOU)

109

12

Forwards

 

 

Aubameyang (ARS)

132

9

Kane (TOT)

130

12

 

Despite taking a couple of week’s break, the glut of Christmas matches only prompted two changes in the XI.

A settled back four…

Two clean sheets and an assist over Christmas for Luis (CHE) helped him nudge his way into the back four, just ahead of team mate Rudiger and Pereira (LEI). This relegated Doherty (WOL) to the standby list – which won’t do you any harm this weekend (Wolves are away at Man City).  

Mo Salah, no problems…

No change in the engine room, other than Hazard (CHE) slipping past Sterling due to three goals in five matches (to Raheem’s one). Bargain of the season Fraser (BOU) kept his place in the starting line-up thanks to a five-start 12pt goal and assist performance last time out (v Watford). But he will be feeling the hot breath of Sane (MC) on the back of his neck.

Salah (LIV) stays out in front, racking up a hat-trick of goals and assist in the four festive fixtures. 

All about North London up top…

Arsenal’s Aubameyang remains top gun despite Tottenham and England talisman Kane finally living up to his billing, firing in five goals in his last four. Oh, and tickling in a couple of assist too. 

Firmino (LIV) has also joined the 100 Club, thanks largely to the treble he caused against Arsenal. But don’t write off the injury-blighted Aguero (MC) and Wilson (BOU) – the latter could even be due for a PL upgrade if transfer stories are to be believed. 

The Watch List: A bench of fives

If you haven’t got, or can’t get, or don’t fancy any of the above – this lot are handy alternatives. 

GK: Etheridge (CAR) – aw c’mon, now. Let’s hear it for the number two No 1 in FPL.
DEF: Rudiger (CHE) – is racking up the sheets at the Bridge.
DEF: Pereira (LEI) – 30pts in four matches (including City and Chelsea) deserves a fist pump.
MID: Sane (MC) – can get among the goals and assists v Wolves, Huddersfield & Newcastle.
FOR: Firmino (LIV) – has a nice little trip to Brighton this weekend.

And that, my friends, is that.

Matt Nesbitt

 

P.S. I know what you're thinking... 'Who does he think he is, putting his name in a fancy box...'. Well, you're wrong. I don't know why it's happened. It just has. I've tried deleting it and cutting and pasting again, but it's still there. Just ignore it. 

 


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Ben Dinnery

Ben Dinnery

@BenDinnery

Ben is football’s leading injury specialist. The ‘go-to’ guru for big hitters like Sky Sports, ESPN and NBC Sports when they need data. Or the BBC, talkSPORT and the broadsheets when a quote is required. His unique insight has helped provide a better understanding of what is really happening in the treatment rooms.


Johnny Wilson

Johnny Wilson

@johnny_wilson5

Johnny is a respected physiotherapist and sports scientist, specialising in football injuries and rehab. Johnny has headed up the medical departments at Chesterfield, Scunthorpe and Notts County. Overseeing everything from player-specific training loads to pre-signing medicals. He has a proven record working with elite athletes in Private Practice and is regularly called upon throughout Europe to deliver presentations on the latest rehab innovations.


Matt Nesbitt

Matt Nesbitt On TipTV

@MattNesbitt16

Matt's short, unremarkable football career was ended by his own bad driving. His long, distinguished career as a football tipster was ended by his own good advice. Because bookmakers don’t like a winner. First, they closed his accounts. Then his members’ accounts. Then his tipping service. And now they employ him as a consultant. Funny old game.


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