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Are players ever 100% fit?

Reading the reports earlier this morning about Gareth Bale leads me to ask whether or not players are ever 100% fit after an injury?

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It's generally accepted that recovery times are estimated and that some injuries take longer than others to respond to treatment, but determining return-to-play fitness is a constant no matter what the injury is.  Added to that the fact that all the evidence states that the biggest risk of repeat or recurrent injury is having sustained an injury in the first place, makes this a difficult call to make for any manager, coach or physiotherapist having that responsibility.

By all accounts Gareth Bale played the latter part of the game at Sevilla although still not quite 100% totally fit; but is anyone?  Physiologically, injured tissues never heal like with like and the body will repair damaged tissue with a poor substitute.  So technically, therefore, an injury never really does heal 100%; but taken in context the debate about players returning to match fitness is usually over what percentage of fitness they are actually at when they do return to play.

At the level of football we are talking about with Real Madrid, players will need to prove that they are at the stage where there is the minimal risk of an injury recurring before they will be allowed to return.  The reports over Gareth Bale's fitness in midweek indicated that he was indeed fit enough to be considered to participate in the Sevilla game for some of the time, and as we all know that's exactly what happened; Carlo Ancelotti gave him the latter part of the game.

The big question, though, is how fine is the line between safely returning to play when still carrying an injury and setting yourself up to make it worse?

At that level, there is no way that any player can be selective about what he does on the field, or which ball he challenges for, what runs to make etc., since if they have to think about whether to sprint / challenge or whatever, then clearly they shouldn't be playing.  Changing direction, performing sharp and sudden movements, and being able to perform repeated sprints interspersed with frequent periods of relative inactivity are a few of the demands of football which demand a high level of fitness together with the ability to adapt to changing situations during a game.

Gareth Bale will have been under constant scrutiny over the past few days with regards to his fitness and only he is going to be able to say with all honesty whether he feels that he has recovered to the point where his recent injury is unlikely to recur.  In these situations, any decisions taken over return-to-play fitness will be made jointly between everyone concerned and Gareth himself will have had a lot to say about whether he felt up to playing at Sevilla or not.  However, that hard part will have been in proving this on the training ground beforehand.

For Carlo Ancelotti to have selected Gareth Bale against Sevilla may or may not have been a gamble with regards to his calf injury depending on what stage of the healing process he had reached.  To be playing at that level, though, Gareth's injury will have had to have been in the high percentages of the recovery process and although this almost certainly would not have been at 100% he wouldn't have been too far off this in order to be selected.

One problem for Gareth, though, could be the fact that this wasn't his first injury of the season and that means having already had a period away from training and playing earlier in the campaign will result in an overall reduction in his physical fitness.  Although one of the main priorities for any injured player is to maintain general body fitness whilst unable to train, this is easier said than done.  There are few alternatives to running that work the muscles in exactly the way they need to be worked and although swimming and cycling are great for general aerobic fitness they don't provide the stresses that the body needs to re-develop the correct running patterns.

So although the players are able to keep generally fit, they aren't always able to address that specific part of fitness required without potentially disturbing the healing process.  That's where the problem lies in the later stages when working towards a return to the team.  Players may feel as though the injury has healed but they are never going to be able to reach that magic 100% without being out of the team a bit longer and the risk of recurrence subsequently becomes that much higher as a result.

An overall loss in general fitness can lead to a higher risk of injury and if you've been out for periods with two or three injuries at different times in the season then it's difficult to get back to the level of fitness required.  Although Gareth Bale will be the first to acknowledge that he has struggled with injury this season he will be desperate to get back into the team for the final run in.  Having already had previous muscle injuries, he's bound to be a bit wary with regards to how much he can actually do and whether a full ninety minutes is realistic or not at this point.

By the same token, both Luka Modric and Karim Benzema are also reported to be working as hard as they can to regain fitness and Karim Benzema frequently posts images of him going through his exercise routines on his various social media accounts.  They're also going to be asking themselves the same questions, since neither wants to come back too soon and find themselves on the sidelines again.  Although neither of these are out with recurrences of recent injuries, the same principles are going to apply in terms of appropriate return-to-play percentages.

From a management aspect, Carlo Ancelotti will be looking to have as many fit players available as possible now that we are coming into this vital stage of the season, but it's highly unlikely that those returning from injury are going to be 100% fit.  Hopefully, though, everyone will have reached a level of recovery where the risks of recurrences are minimal.  With only a few weeks left nobody can afford to gamble on fitness unless, as the manager says, it's in the last game of the season and even then that's taking a huge risk.

The key will not only be in how close to full fitness the players coming back from injury actually are when they return to the team, but also in the timing.

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