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Luka Modric's experimental treatment explained

Valerio Pennicino/Getty Images

There's always an exception to every rule and in Real Madrid's case this is Luka Modrić.  After writing a few weeks ago about how Madrid players rarely seem to 'go outside of the club' for diagnosis or treatment, Modrić made a trip to Vitoria in the Basque Country for a consultation with Dr Mikel Sánchez, an orthopedic consultant specializing in Stem Cell and Platelet Rich Plasma treatment. Additionally, it had been reported that Modrić made an earlier trip to Germany for a consultation with Dr. Hans-Wilhelm Müller-Wohlfahrt; the Bayern Munich and German national team doctor. Dr. Müller-Wohlfahrt is well-known in football thanks to his speciality in homeopathic medicine, but particularly for pioneering a treatment involving the injection of calf blood into injured tissues.

As I understand it, the trip to Munich was made at the request of the Croatian Football Association, who were represented at the meeting with Dr. Müller-Wohlfahrt, along with a delegate from the Real Madrid medical services. The whole episode started back in late 2014 when Modrić sustained a partial tear of his thigh muscle while playing for Croatia against Italy in a Euro 2016 qualifying game. The Croatian national team coach Niko Kovač blamed Real Madrid for the injury, stating at the time that Madrid players were playing too many games and being worked too hard.   As a result, an opinion was sought from Dr. Müller-Wohlfahrt, although it remains unclear who actually initiated the decision to take an opinion from the German doctor.

It is not unusual for national federations to request an input into the medical care at club level of national team players, and some pressure may well have been brought to bear on Real Madrid by the Croatian FA. In the past, the high-profile doctor has been visited regularly by a host of elite footballers and has become renowned for his treatment techniques which centre on administering injections of a serum derived from calves' blood, to the extent that club doctors in other countries have also attempted to imitate and practice this technique.  In addition to top players, athletes including Usain Bolt, Kelly Holmes, Linford Christie, and U2 musician Bono have all visited the Bayern club doctor over the past few years.

Players in general are always happy to try any forms of treatment - unusual or otherwise - if they feel that these treatments might have the potential to get them back on the pitch faster than the normal time-scale for injury.  The horse placenta treatment tried unsuccessfully by Diego Costa is a classic example of how players will try anything if they are desperate enough to play. If a few weeks here or a few days there can be saved through utilizing these 'alternative' methods then it is generally accepted within the game that most players will be prepared to give these methods a try.

Dr Mikel Sánchez in Vitoria has specialized for several years in the development of stem cell therapy involving Platelet-Rich Plasma (PRP).  This form of treatment has a scientific foundation and although trials are continuing into it's effectiveness, the techniques of PRP /stem cell therapy are becoming more and more used in modern medicine, particularly with top level athletes.  Dr. Sánchez counts the tennis legend Rafael Nadal - a massive Real Madrid fan - among his many clients, and Nadal himself has undergone this form of treatment not too long ago. In other sports, Canadian Olympic figure skater Kaetlyn Osmond and several American Football players are also reported to have benefited from having this particular treatment in recent years as the concept has become acceptable and is readily available worldwide.

Basically, PRP treatment involves taking a certain amount of blood from the athlete concerned and spinning it in a centrifuge.  Human blood consists of red and white blood cells, platelets, and plasma.  The centrifuge enables separation of the blood into the different components which allows for the red and white blood cells to be removed, leaving the platelets and plasma.  After separating the blood cells initially, a second separation is then required to concentrate as many platelets as possible into the plasma, and this is then injected back into the athlete at the injury site.  This in turn accelerates the healing process for musculoskeletal injuries.

Damaged muscle tissue begins with clotting in the early stages and once that stage has passed, growth factors are then released which stimulate the synthesis of collagen, which is the matrix of connective tissue such as muscles, ligaments and tendons. PRP includes additional growth factors which are believed to stimulate tissue repair and have been shown in various studies to enhance the different phases of healing.  Because the platelet-rich plasma is derived from the athlete's own metabolism, no additional substances are injected and the treatment is designed to enhance the body's own healing process.

With a severe musculoskeletal injury involving a partial tear of soft-tissue structures likely to take an average healing time of 12-16 weeks, Modrić will have been desperate to get back to playing without delay, and will no doubt have explored the ins and outs of the procedures involved before committing himself to the care of Dr. Sánchez.  It is not completely clear who actually made the final decision before proceeding with the treatment: if the decision was taken purely between Real Madrid and Luka Modrić, or whether the Croatian FA had any influence on Modrić's thinking.

As with all injuries, though, once the medical input from the doctor has been completed, the onus then falls on the rehab staff to deliver in a practical sense.    A torn muscle, ligament or tendon needs adequate healing time in the early stages before rehabilitative techniques can be employed which stress the injured structures, in this case the thigh, and it is has been during this early stage that the PRP treatment has been applied.   All injuries need proper healing time and by going down the PRP route, Luka Modrić will have been hoping to minimize this healing period in order to allow for the more active rehab to take place as the injury recovers and the thigh becomes stronger.

Having passed through the early and recovery stages, Modrić is now reported to be running well and has returned to Valdebebas, where a recent MRI scan is reported to have shown good progress.   However, a part of his rehab has also been taken outside of Madrid in addition to the stem cell treatment.  Modrić has just spent a couple of weeks in Antwerp, progressing his running under the watchful eye of physical therapist Lieven Maesschalck, a rehabilitation specialist well known to Dr. Sánchez.  The doctor and Maesschalck have worked together before and he is obviously a trusted member of Dr. Sánchez' medical network.  I understand that the invitation for Luka Modrić to spend a couple of weeks supervised training at Maesschalck's clinic in Antwerp came as part of the overall package included in Dr. Sánchez' treatment, and that this aspect of the rehab has taken place once again with the knowledge of the Real Madrid medical team.

The key period for Modrić is now approaching as he progresses towards the football-related aspect of his injury rehabilitation.  In order to reach a level of fitness appropriate to play at first team level, he will need to satisfy Madrid's medical staff (not to mention Carlo Ancelotti and the coaches) that his recovery is complete.  People keep talking about this date and that date for a return to play, but the harsh reality is that Luka Modrić must be able to be 100% confident of his ability to perform repeated sprints time and time again in simulated match situations in training before a return to play can even be considered.  In addition to the fitness element of the game, working with the football is an even greater priority.

Kicking the ball, running and shooting all have a nasty habit of resulting in further injuries during the return to play stage if the leg muscles aren't strong enough and the evidence shows that the risk of repeated or recurrent injury is greatly increased during the first two weeks back in action.  There is nothing worse than a recurrence of the same injury following a long lay off so the most important thing is to ensure that the risks of this happening to Luka Modrić are kept to an absolute minimum through careful planning.

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