This is, and will be in the coming months, a topic for debate. No team is free from injuries and especially teams who play the most games, with a greater physical load, more long trips, more success in different competitions, meaning they will play more and with a higher intensity right to the end of the season.
This then raises the question – Can you avoid injuries? The answer is a clear ‘no’. However, you can work in a way to prevent and reduce the amount of them.
Although, for this to happen, to me it is clear that there must be an open dialogue and constant communication with the whole medical staff and the players. The worst thing that can happen, and I can say this from experience, is that some people want to rock the boat and blame others so they don’t take the responsibility. And of course what suffers is the team, the group…
When I worked with different teams I tried to tackle this thorny problem of injuries and it was mostly successful with just a few exceptions. At Real Madrid, in the youth teams as well as the reserves, I was lucky enough to work with a top doctor Miguel Angel Herrador, an excellent doctor and nice man who went on to be my Professor of Sports Medicine at the University. My own injuries as well, those I got when I was playing, gave me an insight in to this subject, which gives me some authority on how a medical department should work.
At Valencia, the co-ordination between the medical staff and technical staff enabled us to use the famous rotation system when few people were using it and to maximise the players’ performance. But we always based everything on our perception of the player’s state in conjunction with analysis of the data we were getting from the tests the players had to undergo periodically. What is clear is that we had few injuries and the trophies we won were the result of professional work and staff co-operation. The same can be said of our time at Valladolid, Almendralejo (CF Extremadura) and Tenerife. All had a good relationship with the medical staff.
At Liverpool FC, we worked with the same professionalism and co-ordination with the medical staff from the beginning and only during the last season did we have more than the usual number of injuries, and that made us less effective as we couldn’t rotate when we needed to with certain players. We can see this right now as the fixture list shows, the months of October and November are when more injuries occur due to the amount of games in the league, Champions League, matches coming one after another and the conditions of the pitches due to bad weather. Even so, the time spent out due to muscular injuries was for all these teams 10 days less than we had at Inter Milan. Strange.
Without doubt, the way you work in training sessions is something you must take in to account but there are other factors as well, as we will see at the end of this article. Our day to day work was usually distributed as 80% with the ball and 20% without. In the past, teams used to do a lot of work without the ball, but for a few years now, all coaches have worked more with the ball. However, you must always do some work without the ball to compensate for muscular imbalance which the dynamic nature of the game creates.
In my technical staff I have 2 excellent fitness coaches, one specializing in prevention and rehabilitation of injuries but they can’t do it alone. Our way of working to prevent injury can only be done with the co-operation of the medical staff from the outset, to have a clear programme of work, to maximise prevention… The diagnosis when the injury occurs and the treatment afterwards are the key avoiding new injuries. To this end the medical staff must be co-ordinated with the technical staff. They are the ones who design the training sessions, the workload and the extra preventative or compensatory work done by the medical staff and should be taken in to consideration by the fitness coach who also has a workload to organise. I am being serious when I say we were shocked to find a fitness coach from the medical department doing weights with a couple of players on the morning of a big game. This can only result in overload and therefore a risk of injury.
Strangely, it is becoming more common for players to return to their native country for treatment. To stop this it is vital to have absolute confidence in the club medical staff who also have a duty to solve the problem.
To investigate muscular injuries, especially the ischio-tibial ones, it is essential to know the factors involved:
The injury history The fact of having had a previous muscle injury increases the risk of re-injury, and at Inter, 80% of injuries had occurred in the same muscle group during the previous two seasons.
Muscular imbalance between quadriceps and ischio-tibial (anterior and posterior thigh muscles). You have to do specific work without the ball to address this imbalance.
Age The older the player, the more risk of injury there is, especially muscular ones; also there is the biological factor of age, so you must take in to account that older players have had more hours of practice and therefore hundreds of matches and thousands of training sessions in their legs.
Other factors can increase the risk of injury; for example, race (black players are more prone to muscle injury because they generally have more explosive muscles); fatigue (a tired muscle has more chance of being injured because its functionality has changed); inappropriate warm up, or habits like smoking, drinking, not resting or inadequate diet all increase the risk of muscular injury.
An injury, then, will have multiple causes and players exposed to more of these risk factors, like the ones we have mentioned, will be prone to suffering more injuries.
A good working methodology and co-operation between the medical and technical staff is fundamental to reducing the number of injuries. But neither can we forget a basic principle: nowadays football is quicker and more demanding than it was in the past. More games are played and there are more international games. For clubs as well as national teams there is more travelling as an additional factor. The result is that players get more injuries than in the past.So we have to be more meticulous. There is no magic wand to avoid injury, but at least you can work to reduce them as much as possible.
Hägglund, M.; Waldén, M.; Ekstrand, J. (2006): Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. British Journal of Sports Medicine, 40 (9): 767-772.
Meeuwisse, W. H.; Tyreman, H.; Hagel, B.; Emery, C. (2007): A dynamic model of etiology in sport injury: the recursive nature of risk and causation. Clinical Journal of Sport Medicine, 17 (3): 215-219.
Volpi, P.; Melegati, G.; Tornese, D.; Bandi, M. (2004): Muscle strains in soccer: a five-year survey of an Italian major league team. Knee Surgery Sports Traumatology Arthroscopy 12, 482-485.
Woods, C.; Hawkins, R. D.; Maltby, S.; Hulse, M.; Thomas, U.; Hodson, A. (2004): The Football Association Medical Research Programme: an audit of injuries in professional football – analysis of hamstring injuries. British Journal of Sports Medicine, 38: 36-41.
Great to see you putting your knowledge out there like this (we rarely get anywhere near such insight in the press) and I hope you get yourself a good job at a good club soon.
I'd like to know your thoughts on AC Milan's famous background staff and their ability to get players like Paolo Maldini (and before him Franco Baresi), and Clarence Seedorf playing at the highest level, with seemingly very little drop off in performance levels, until their late 30s.
Do you think that such players could have played on for so long if they had played several years in the Premier League? And do you think that Milan's medical and coaching staff would be able to translate their results from Serie A to a Premier League club, or has their success been due mostly to the slower pace of the Italian game and a clutch of highly professional players who have kept themselves in better condition than most?
I think that the MIlan Lab is a good thing with very good professionals, but also it is true that the Italian League is less physical than the Premier League and also there is less intensity in the Serie A.
It is interesting you talk about medical/technical staff doing additional training with players during your time at Inter which was counter-productive. I have read accounts of players who have stated that clubs train their players more heavily than in other European leagues, including double training sessions and more strength/stamina training. Is this the common approach of italian managers and why is this the case?
There is a lot of good professionals (fitness coaches and doctors) in Italy. They use to train hard, but it is the same in other countries. Years ago I was visiting different Italian teams and they were working very well, together and with communication.
We were unlucky.
what do you think is happening with the extremely long injury list at arsenal? they seem to have had a big problem with injuries for a few years now.
Sorry, I can't answer this question, you need to have more information.
Thank you for sharing your opinions (backed by the necessary academic references) on football related injury.
In your opinion, who is the fittest player whom you have coached, with a high level of personal commitment to fitness?
--> Easy, Dirk Kuyt
Great Blog. Where can I find the evidence that black players are more prone to muscle injuries due to composition of muscles?
Is it always possible for a young (17-22) injury-prone player to beat the injuriy prone-ness and become totally fit as he matures under the right medical practitionals n conditions?