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Pepe's injury brings back the controversy around International games

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At the end of every international week the old club v country argument invariably rears its head. The call of duty for players to fulfill individual commitments to their respective countries can often have both a positive and a negative effect.  This time around, in Real Madrid's case at least, Gareth Bale and Pepe are two contrasting examples of this with Gareth scoring a perfect free-kick for Wales and Pepe returning injured.

By all accounts Pepe suffered a bruised thigh and was originally not expected to be a doubt for Sunday's La Liga fixture against Granada but you never can tell.  It's easy to say at this stage that injuries are not serious but it only takes a few days of slow recovery and before you know it the league game is only 48 hrs away and if the injured guys still haven't been able to train that's when the doubt sets in.  Indications are that the injury is a bruised thigh muscle which he actually sustained against Barca, and Pepe returned to Madrid as he was clearly unfit to take part in either of Portugal's recent games.

There's a common misconception in most sports that bruised thigh muscles, also known as ‘dead legs' due to the numbness that accompanies these injuries, are straight-forward and easy to run off.  In most cases they are, but a few of these so-called ‘dead-legs' don't respond in this way and activity / exercise actually makes the injury worse and can be potentially serious.

When a direct blow is sustained to a muscle, the injured muscle will bleed.  The difference then lies in whether the actual site of the injury is on the periphery of the muscle - in which case any bleeding can drain away from the injury site as a result of gravity - or whether the bruising is contained within the actual muscle itself; in which case it cannot.  In most injuries of this type, the bruising is to the outside of the muscle and can easily drain away towards the knee as a result of gravity.  You can often see surface bruising well below the area of injury and this often appears behind the knee if the injury is to the hamstring region.  However, with the less common type of muscle contusion injury, the injury bleeds into the actual muscle itself and therefore becomes contained within the belly of the muscle and in this case becomes trapped and therefore unable to drain away in the usual manner.

With this kind of injury any attempt to "run it off" will only result in further bleeding due to increased body temperature, and the same applies if any form of deep massage or heat treatments are delivered.  With the usual kind of dead leg / thigh bruising the bleeding is able to drain between adjacent muscle planes as detailed, and these usually respond very well to active exercise.  However, if the bleeding is into the muscle itself then this requires enforced rest to avoid the risk of increased intra-muscular pressure which can ultimately require surgery to release.

So if the injury has been sustained a few days ago and the thigh continues to swell and feels warm, looks swollen and it's painful to try to bend the knee, then the injury needs to be left alone and should be seen by the club doctor if this continues.

It's not only the risk of injury, however, that affects players when they go away on international duty. Guillem Balague was speaking in the media the other day and without mentioning any names, said that he had been talking to a coach from a La Liga club about the negative side of the internationals.  This coach had said that it wasn't the injury risk that made him dislike the international weeks, but rather the fact that players become out of tune with their club tactics if they are away for a while and playing in a team with a different style.  Things they would normally do in their own team at club level are often different when they turn out for the national sides, and when they return to their clubs to pick up the league  games once again, these differences become obvious.

Both Guillem and this particular coach felt that this goes a long way towards explaining why clubs who have a lot of international players in their team frequently do badly on the first weekend of league games after the break. I know this applies to a lot of clubs and without having the exact statistics to hand, it would be interesting to see how most of the clubs fare this coming weekend and whether there is indeed a pattern as they both suggest.

On a much brighter note, though, Gareth Bale's goal from the free-kick for Wales was more like the player Madrid signed in what seems like an eternity ago.  Hopefully this will increase his confidence and help to get him back to form in the coming weeks.  As has been mentioned in other articles by numerous authors, Gareth is becoming a bit of a scapegoat at the moment for everything that goes wrong on the field and it will be good to see if he comes back from international duty feeling more relaxed and better form.  I know most of us enjoy the internationals but it's good to get back to league business again, and hopefully without the negative effects to match.

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