Rashford: This is just the tip of the Iceberg

Monday, January 20 2020

 

A new Era for the Type of Injuries Seen in the Premier League

Not so long ago the expectation on professional footballers was to be able to “play week in week out” now it's every three days. The rising intensity of the physical demands of the sport and the frequency of games are toxic ingredients when combined. The outcome of this venom could signal the onset of a new era for the type of injury seen in the Premier League. A Pars stress fracture (spondylolysis) is an injury to the vertebrae in the spine. It is thought to be an overuse injury in which the lumbar spine is exposed to repetitive stresses which over time exceed its physiological limits and cause the bones of the spine to fracture, and, in extreme cases can cause a segment of the spine to slip from its position and significantly increase the chance of suffering from degenerative back conditions, disc herniations, and nerve impingement.


A Strange Occurrence

This type of injury is traditionally seen in youth athletes in and around their pubertal years when they undergo rapid increases in height when their bones have not fully developed to tolerate the demands of playing so much football at such a volatile age for growth and development. However, Rashford is far from pubertal. At 22 years of age, he is a young man, commanding a first-team position at Manchester United. He has started every game this season and is undeniably integral to United’s success. So how could this happen to him?


Practice makes perfect, but it can also fracture

I won’t bore you with the details of how a Pars Stress Fractures occur in general; you can google it. But I will speculate on how it might have reared its venomous head for Marcus Rashford. It is well documented in the media and by Rashford himself that he has had a longstanding history of low back pain, dating right back to his early teen years. Rashford is an explosive athlete, who week after week, month after month and year upon year, since the age of 13, has been making the same repetitive runs into the box to hone his craft of scoring goals for one of the greatest teams on the planet: Manchester United. Practice makes perfect they say, but it can also lead to a stress fracture of the lumbar spine. The repetitive action of turning, sprinting, kicking, jumping and landing hundreds of thousands of times during training and playing can cause a stress reaction in one of the vertebrae of the spine, usually the lowest lumbar segment, commonly known as L5.


The stealth-like qualities of a Pars Stress Fracture

This stress reaction has James Bond-like qualities; it can develop for months on end without being detected. It is stealth in its infancy. As Rashford continued to pursue his dream of playing for United and rise from prospect to hero, so too did his stress reaction; it fractured. And just like Rashford learned how to make clever raiding runs into the opponent's box to fracture their defence by attacking areas where they were most vulnerable, so too did the stress reaction: it learned where best it could become a fracture. It learned to strike the part of the spinal segment where it is most vulnerable: the pars interarticularis (pars for short), a known weak spot.


Where now for Rashford?

Now that the spy-like stress fracture has been detected and diagnosed, the return to play stopwatch has already begun. Twelve weeks is a general rule of thumb to allow pain to subside, the bone to heal, physical activity to be resumed and progressed to a standard where he can start banging them in for club and country again. The rehab journey is by no means a simple walk in the park, setbacks can be potentially pretty serious and, in some instances, may require surgery. Along his rehab travels, Rashford is likely to undertake work on the Wattbike, engage in hydrotherapy and aim to restore function on an anti-gravity treadmill to ensure he returns to play as quickly and as safely as possible. Core strength, endurance and control play a significant role in the recovery process, and his rehab progress will be based on his ability to carry out tasks in a pain-free manner. If he reports pain on a particular task, let's say jogging for example, then the rehab journey will not progress to running until he is able to jog pain-free.


Who’s to blame?

I’ve read all the speculation in relation to the performance of the Manchester United Sports Medicine Team on social media; however, he is in fact in the very best of hands. From the outside looking in, it is very easy to criticise and let’s face it everyone has a PHD in “hindsight”. Not knowing all the facts pertaining to this specific case, I do not doubt that the medical team at United always acted in the best interests of the player. Injuries happen and if one were to lay blame anywhere, then the rising nature of fixture overload would be a reasonable place to start.


I hope you enjoyed this short piece. I will write a more in-depth review on the rehab process for this type of injury over the coming few weeks.

 

Johnny Wilson


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What we learned | Week Twenty-three

Monday, January 20 2020

 

Another curious weekend in the Premier League. Glad I’m not a tipster (anymore). Only the most optimistic – or maybe just mystic – Palace fans would’ve backed their team before kick-off. And not even the bench would’ve fancied it at 2-1 down in the 87th minute.

Likewise, Sheffield United and Newcastle pulled late – and really late – rabbits out of the hat. Goal scorers Fleck and Hayden feature in just 3.4% and 3.8% of FPL teams. But that’s Fleck’s 5th in 11. Better than Son (TOT), Willian, Mount (CHE) and Silva (MCL) among others.

And Wolves didn’t look like ending their 3-match winless run – and Saints’ 5-match unbeaten one – after 35 mins. Not being 2-0 down so much, but when Shane Long scores against you, the omens can’t be good. Remarkably 1.9% of you have on the books.

Even more remarkably, only double that figure have Liverpool’s now nailed-on central defensive stalwart Gomez in their team. At £5.2m he looks a snip. Act accordingly. It’s only a matter of time before he completes the clean sweep in the Form XI.

And after that seamless segue (that’s Segway to you), here’s the rest…

Player

Club

Price

Selection %

Alisson

LIV

£6.1m

9.6%

D

E

F

 

Alexander-Arnold

LIV

£7.5m

39.6%

Robertson

LIV

£7.0m

20.1%

Van Dijk

LIV

£6.4m

40.7%

Azpilicueta

CHE

£5.8m

5.7%

M

I

D

 

Grealish

AVL

£6.5m

20.2%

Mahrez

MCL

£8.5m

9.2%

Mane

LIV

£12.4m

40.5%

A

T

T

 

Aguero

MCL

£11.9m

39.6%

Ings

SOU

£6.9m

27.9%

Jimenez

WOL

£7.5m

16.7%

 

 

 

 

 

 

 

 

 

 

 


Back shufflers…

There’s only so much champions-elect Liverpool to be spread through the team, of course. And there are cut-price alternatives on offer in Enda Stephens (SHU) at £4.4m and Digne (EVE) at £5.7m. And his mate Holgate (EVE) is developing into a sub £4.5m bargain.


Middle-men…

A little gentleman’s Grealish (AVL) is essential these days. And Duda (NOR) is no dud. Despite the fact that currently NONE of the FPL universe has taken the plunge. I appeal to the 3.1% of you that still have Ceballos (ARS) in your team to have a little word with yourselves.


Forward thinkers…

So, what to do in the absence of Kane (TOT), Rashford (MUN) and Aubameyang (ARS) for a couple, perhaps several weeks and the rest of season (in reverse order)…? Jimenez (WOL) is the obvious pick. But outside him, it’s tricky. Jesus (MCI) and Firmino (LIV) don’t deliver the minutes or end product they should. So then you’re in the straw-clutching territory of Calvert-Lewin (EVE) and Ayew (CRY). Let’s just hope rat boy Vardy (LEI) gets through his sticky patch sharpish.


That’s how it looks from here.

Matt


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View from the Boot Room

Monday, January 13 2020

 

Old skoolers like me will say the Premier League table doesn’t mean a thing until after Christmas. And it has certainly taken shape over the holiday period.

Liverpool are now permitted a ‘meep meep’ stretching their advantage to 14pts and it looks a straight fight between loving it Leicester and mithering Man City for second place. And then there is a skip full of oiled-up beauties ready to wrestle for the last Champions League spot.

Chelsea have looked a bit young and exposed in the last couple of months, but their grubby Russian money could talk in January. Mourinho’s transition at Tottenham hasn’t been a smooth as his talking. And Kane’s pinged hamstring won’t make them any more able.

Ole is still struggling to get to grips with that big, stiff steering wheel at Man United. The backseat drivers probably don’t help either.

And what about them Blades, eh? Personally, I think they’re starting to look a bit leggy. But I’ve been wrong before. So, let’s see what you think shall we?

Here’s the Most Selected XI…

Player

Club

Price

Selection %

Ryan

BHA

£4.8m

17.6%

D

E

F

 

Alexander-Arnold

LIV

£7.5m

38.4%

Van Dijk

LIV

£6.4m

40%

Kelly (DEF)

CRY

£4.4m

31.5%

Lundstram (SHU)

SHU

£5.1m

47.2%

M

I

D

 

Mane

LIV

£12.3m

40%

De Bruyne

MCI

£10.6m

51.7%

Maddison

LEI

£7.7m

27%

A

T

T

 

Abraham

CHE

£7.8m

33.7%

Rashford

MUN

£9.2m

29.9%

Vardy

LEI

£10.m

50%

S

U

B

 

Soyuncu (DEF)

LEI

£5.1m

19.9%

Cantwell (MID)

NOR

£4.9m

23.9%

Salah (MID)

LIV

£12.3m

25.1%

Ings (FOR)

SOU

£6.7m

21.2%

Jimenez (FOR)

WOL

£7.5m

19.2%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

At the back…

There is a glut full of decent keepers available in the January sales – even though 19.9% of you are sticking with Brighton’s second choice Button. Eyes roll. Schmeichel heads the list, but Foster (WAT), Guaita (CRY), Henderson (SHU) and Ramsdale (BOU) are all Top Six performers for around £5.0m.

Half the back four has a predictable look. No reason to end your membership of the T-A-A. and VVD is hard to get rid of. But there are also bargains to be had…

Don’t ditch your Sheffield United steel just yet. Equal cases can be made for Baldock and Lundstram. And Arsenal defenders are suddenly back in the frame. Sokratis and Luiz have shot up the form and at £4.9m and £5.7m might be worth a look.

In the middle…

Alli has shuffled his way into reckoning – and could be a major player in the efforts to overcome the loss of Kane. You might also want to consider Man United’s moody Martial. He’s 4 in four starts, allows you £0.8m more leverage and plays upfront. Sterling has lost some ground to teammate De Bruyne – featuring in 22.6% of teams v 51.7%. But it’s not impossible to cater for both, if you box clever…

Midlander’s Grealish (AVL) and Traore (WOL) can be snapped up for £6.5m and £5.5m respectively. There’s Willian (CHE) if you’re feeling flush. Or Fleck (SHU) if you’re not.

Up top…

Three Englishmen lead the way at the sharp end. Faith in Vardy has wobbled a tad. Rashford is approaching undroppable status – 9 in eleven must be his best run ever. And Abraham (CHE) is back in favour – offering value and threat in equal measures.

Elsewhere, at £6.6m Ings is the outstanding third choice (10 in eleven by the way).

Keep Aubameyang (ARS) on ice following his dismissal. And Jimenez (WOL), Jesus (MCI) and Calvert-Lewin (EVE) head the form table.

That’s how it looks from here.


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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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