Injury report: Real's injuries after the Derby

Following the Madrid derby against Atletico, Dani Carvajal was added to the list; joining Pepe, James, and Danilo in the treatment room.  Additionally, Castilla's Abner Felipe is reported to have suffered another ACL rupture to the same knee that required surgery a year ago.  This is on top of a previous ACL tear the year before that; so the young Brazilian faces an uphill struggle and his recovery is likely to take the remainder of the season.

The latest addition to the injured rota was Dani Carvajal; who came off against Atletico with an ankle injury.  According to Real Madrid's official web, this was diagnosed as a peroneal injury but further details have not been released as yet other than to say that Dani will not be taking part in either of Spain's two forthcoming European games.  It remains to be seen whether the actual diagnosis refers to either a strained or torn peroneal tendon or a ligamentous injury to the ankle; but often the two are linked.  Injury to the peroneal tendons frequently accompany a lateral ankle sprain and can be one of the most common causes of recurrence of injury if not rehabbed correctly.

The lateral ankle ligamentous complex is made up of the major ligaments that provide the static stability of the ankle; while the dynamic stability is controlled by the peroneal muscles.  These are a small but vitally important group of three muscles situated on the outside of the lower leg, whose function is to turn the foot outwards at the same time as pointing the toes downwards.  The peroneal muscles effectively provide the main stabilisers to the outside of the ankle, and a large part of post-ankle injury rehab concentrates on strengthening these.  Strong peroneal muscles are thought to help prevent the rolling-over movement that is normally associated with lateral ankle injuries, hence their importance in rehab.  Additionally, and just to confuse matters, one of the peroneal muscles also helps to lift the ankle upwards; so a thorough examination is always required in order to identify the correct tendons injured in order to ensure that the rehab is properly targeted.  It is generally thought that developing strong peroneal muscles can help in the prevention of ankle injuries by assisting in providing joint stability.

However, like all muscles, the peroneals are joined to the bones by tendons; and it's more common for the peroneal tendons to be injured as opposed to the muscles.  The downside to this is that tendon injuries are slower to heal than injuries to the actual muscles, and this can lead to a longer recovery as a result.  The information released by Real Madrid on the official web doesn't go into any great detail and as such makes it difficult to accurately discuss the injury in more depth.  However, if Dani is going to be out for two to three weeks then this would suggest that the injury may be more than a relatively minor one; particularly as very little time was wasted in bringing him off the field on the night.

Pepe continues to recover from a thigh injury sustained a few weeks ago, which was unfortunate considering he's had a thigh injury last season and it looks as though the timing of this one couldn't have been any worse.  With Sergio Ramos also recently unavailable, injuries have affected Madrid's central defence making it difficult to have a settled defensive line.  Not only has Pepe now missed important league games, he's also out of the international matches for Portugal since the injury has taken it's time to respond.  On the bright side for Madrid, though, missing the internationals will allow him to remain in Valdebebas and continue his rehab; which by all accounts seems to be going well.

James Rodrigues' injury has been a little more controversial however; diagnosed as a muscular tear in the left thigh.  The Columbian FA aren't reported to be too happy about the fact that the indications are that the injury may have been aggravated lately and this is likely to keep James out of action for a while longer.  It's a fact of footballing life that not all injury rehab goes 100% according to plan and relapses / recurrences of injuries do happen and however much we dislike these, they do occur despite the best efforts of all concerned.  The obvious disadvantage is that players suffering relapses tend to take longer to return simply because everyone then becomes far more cautious about progressing; and sometimes erring on the side of caution can add a week or two to the total time out.  That said, although the time sounds a lot, when viewed as part of the bigger picture over a whole season, maybe an additional couple of weeks to minimise the risks of further aggravating the injury isn't so bad.

Whilst most of the muscular and ligamentous / tendinous injuries are relatively easy to categorise in terms of predicting an approximate recovery time, the injury sustained by Danilo doesn't fall into this category.  Reported to be an injury to the plantar fascia, once again there are several possibilities with regards to the extent and even the diagnosis of the actual injury.  The plantar fascia is a strong band of fibrous tissue running along the sole of the foot and is frequently inflamed in runners and also in players returning from slightly longer-term foot and ankle injuries.  When inflammation is present the condition is known as plantar fasciitis and this affects players predominately in the pre-season period or during the early part of the playing season and can be very painful indeed.  Plantar fasciitis is nearly always mechanically induced; meaning that too much running can lead to the condition arising in the first place, and for a footballer who needs to run, that's not good.

Occasionally, the fascia can tear, and the rehab period then becomes that bit longer.  This appears to be the situation as far as Danilo is concerned, and the healing time for a torn plantar fascia is difficult to estimate.  Like tendons, the plantar fascia tissue differs from muscles in that a reduced blood supply leads to longer healing so recovery tends to be on the slow side.  Reports indicate that Danilo is now back running; and since the plantar fascia is mainly affected by running, the fact that he's now able to join the others on the training field is encouraging and could indicate that his return might not be too far away.

Of those players recently returned from injury, Gareth Bale reckons he's fit enough now to turn out for Wales in their next two matches; while Sergio Ramos won't be in the Spain team although he's joined up with the squad for the games against Luxembourg on Friday and the Ukraine next week.  Reports indicate that he played against Atletico after an injection, and is going to need some recovery time now to ensure the shoulder settles.  The next week is going to be a worry for Rafa Benitez with Real Madrid having so many players away representing their respective countries; and with Champions League matches due after the internationals everyone will be hoping that they all come back without any further problems.