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What's happening with Real Madrid's injuries?

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Is this usual?

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The number of injuries sustained by Real Madrid players this season has been well documented and regularly discussed.  Viewed as separate events, these aren't really too much of an issue.  The real problem comes when you get several players injured at the same time.  I know it sounds like stating the obvious, but most clubs are able to carry one or two players with injuries and have adequate replacements available to step in as cover; but it's when it gets to five or six missing through injury that the situation quickly leads to a different story.

In particular, the topic most regularly debated on these forums concerns the number of muscle injuries suffered by Madrid players this season.  There's been a fair number of studies carried out on football injuries in the past few years and I know I've referred to these before; but they do set bench marks in terms of what can be expected over a season and what constitutes an excessive amount of injuries at a club of Real Madrid's level.  The study I've tended to refer to in the past has been the UEFA injury study headed up by Jan Ekstrand (2011); but again all this does is enable rough comparisons to be drawn.

Ekstrand (2011) found that lower limb injuries accounted for 87% of all football injuries recorded in the UEFA study of 2011 with the most common of these being muscular strains of the thigh(17%); and with the hamstrings the most commonly-injured muscle within that group.  The basic information provided by that particular study was that a team of Madrid's level would expect to record around 50 injuries per season; at an average of 2 injuries per player based on squad of 25 players.  Injury recurrences were given as 12%; but out of an average of 50 injuries a season that seems quite a high rate.

However, in a later study, Ueblacker et al (2015) gave the figure for thigh muscle injuries as 25% of all injuries; claiming that the incidence of thigh muscle injuries is higher than previously thought.  Of the injuries recorded (collated from stats provided by elite football clubs including Real Madrid) the incidence was eight times higher for non-contact injuries such as hamstring and thigh strains when compared to injuries sustained by direct contact.  Muscle strains were noted to take twice as long on average to recover (18.5 days) as injuries caused by direct blows.

The drawback with such stats is that they don't generally include minor knocks, bruises and strains that only result in players missing the odd day of training.  Although most studies define an injury as any event or incident that results in a player being absent from training or playing for a period of 48 hours or more,  some studies at lower levels only record injuries that cause players to miss matches; while others will focus on the number of training days lost.  Where I think injury studies fail is that they don't always record the seemingly irritating, niggling injuries that if left unaddressed can turn into serious problems further down the line.  Additionally, most clubs give their players the day off after a game, so somebody having treatment for an injury picked up the night before may not be recorded for study purposes if they're able to train the next day.

For example, in the earlier part of this season Cristiano Ronaldo, Sergio Ramos, and Raphael Varane had all been out injured for various reasons; but although all three returned to training at different stages this was offset by media suggestions that they weren't really fit.  In fact what had happened was that they joined the main group for part of the sessions but followed their own individual routines as opposed to taking part in the same work-outs as everyone else.  To all intents and purposes the trio didn't really return to training at all; but as they took part in some of the group sessions it's hard to know whether they were classified as injured or not at that time.  If their injuries prevented them from playing then they should have been listed as injured; but if not then they still didn't make a full return to training, hence the difficulty in correctly interpreting injury statistics.

To date, Real Madrid players have suffered 15 muscle injuries based on data taken from the official club website.  One of the online sports dailies actually quoted 15 injuries this time last month so there's room for a bit of leeway with the figures.  In practice, 15 is likely to be an understatement since neither source will have included the injuries sustained in pre-season or the various niggles that have forced players to sit out of the odd session.  However, without the exact injury data being available from the Real Madrid medical team to relate to in terms of training days lost, the estimate of 15 muscle injuries could well vary.  For example, plantar fasciitis (Danilo) and peroneal tendinopathy (Dani Carvajal) wouldn't really be classified as muscle injuries in any study but could be included if the stats were applicable to lower limb injuries across the board.

We also know that Sergio Ramos had a muscle injury earlier in the season (well before the shoulder issue) and that Cristiano Ronaldo missed several training days at different times due to a back problem; as did Marcelo during the early part of the pre-season.  Pepe missed some of the pre-season preparations as well with a thigh strain picked up against Tottenham in a friendly.  With the exception of Fabio Coentrao's injury in July, most of the strains and sprains sustained around that time are unlikely to be recorded in any studies since most won't fit into one single category.  If Gareth Bale sits a session out because his calf is tight then that's probably not going to appear on the official stats since missing a single session doesn't fit into the 48 hours template favoured by most football statisticians.  Additionally, such time lost is often deemed to be "precautionary", but to all intents and purposes he'll have missed the session because he was carrying an injury on the day.

It's true that the majority of injuries recorded so far this season are to muscles but these are the type of injuries that are the most common in football.  The hamstring strains certainly occur regularly enough and putting aside the injury studies that say these are the most common, the situation is likely to be the same in most clubs and the physios won't need to reach for the stats to comment on that.  AS reported on Wednesday that it's 16 muscle injuries.  I wonder if the exact numbers really matter as long as they are within reason for the type of injuries sustained.

It's an old and recurring theme but the main issue with all the injuries is how to avoid recurrences.  I think with any injury study it's great being able to say that club X sustained Y amount of thigh strains or ankle sprains but we probably don't need to do a huge study to conclude that 87% of football injuries are to the lower limb.  Where these studies do come in useful though is in identifying trends such as training injuries versus match injuries or in highlighting the number of injury recurrences.  Both of these are useful exercises since the results may lead to addressing important issues such as whether players are coming back from injury too early or before complete healing has taken place.

Recurrences of muscle injuries this season have been few by comparison and only really occurred with James Rodriguez and Gareth Bale; although the information available from Real Madrid isn't going to include the daily niggles that cause players to miss the odd session.  However, if missing the odd session then becomes a habit for the same few players then it's pretty obvious that these are more than just niggles.  Real have also had players injured while on international duty and again it's been unfortunate that these were all sustained at the same time.  However, the internationals in the squad are obviously going to play more games than the rest so their chances of getting injured will naturally be higher.

Based on the stats to date being compared with the findings of Ekstrand's and later Ueblacker's studies, it's certainly looking likely at this stage that Madrid are going to record an above average number of injuries this season if the current trend continues.  However, the majority of injuries so far have been recorded as originating in match play and injuries from matches don't tend to have too much of a pattern.  Again, though, it's the minor injuries that are going to slip through the net.  The situation may well be above average for Real Madrid but ‘normal' for any other club who doesn't have the variety of players Real do together with the international commitments on top.  It's true that the vast majority of the injuries this season have been muscular, but as the stats (appear to) prove, that's the nature of football injuries.

References:

Ekstrand J, Hagglund M, Walden M (2011).  Injury incidence and injury patterns in professional football -  the UEFA injury study.  British Journal of Sports Medicine. Vol 45 (7); 553 - 558.

Ueblacker P, Mueller-Wohlfahrt, Ekstrand J (2015).  Epidemiological and clinical outcome comparison of indirect (strain) versus direct (contusion) anterior and posterior thigh muscle injuries in elite male football players: UEFA Elite League study of 2287 thigh injuries (2001 - 2013).  British Journal of Sports Medicine. Bjsports - 2014-094285 Published Online First: 9 March 2015.