All the research about football injuries reports that the pre-season period carries a high injury rate, and most of this is simply down to the intensity of training and the number of matches played. Another common but less-researched factor is when injuries sustained in the latter part of the previous season are not addressed during the break; with many of these often unreported by the players and medical staff unaware that the injuries exist.
Often these injuries, although not necessarily serious at the time, can have an effect on a player's biomechanics through making them susceptible to other injuries. This happens as a result of muscle imbalances which often accompany adapted running styles in an attempt to compensate for the underlying problem.
This is particularly true of those ‘niggling' injuries throughout the season that don't really result in players missing any matches as such, but frequently result in training days lost on a regular basis. Players in this category will regularly miss group training sessions on the days after a game in favour of working out in the gym or having a massage. At the end of the season, these players will go off for the summer hoping that time away from training and playing will allow these niggles to clear.
If these injuries are of a minor nature they will resolve given time; but any resultant muscle imbalances won't; and then you return to training with a slightly stronger thigh and a slightly weaker hamstring for example. This immediately leads to a predisposition to further injury as the intensity of training increases because the loading isn't evenly distributed, and this in turn can then lead to injuries in other areas of the body.
The last couple of weeks have seen Cristiano Ronaldo, Fabio Coentrau, and latterly Pepe, miss game time due to injury. Additionally, it's been well publicised in between talk of a potential move to Arsenal, that Karim Benzema has also missed the past couple of weeks with a thigh injury. It's interesting to note that all four players have had injuries last season that has caused them to missed game time.
It can be a tricky for the management to correctly find that delicate balance between taking players out of training and playing, such as Rafa did the other day with Gareth Bale, and pushing to get the most out of the pre-season period in terms of fitness, match time, and the continuity that comes with keeping the group together in training.
None of the players mentioned above are strangers to injury; but how many players at that level can honestly say that they've been injury-free over the past two years? Injuries are part and parcel of the game as we all know, but with the general reluctance of football clubs to release injury information unless it's absolutely obvious what's happened such as with Luka Modric for example, we often don't really get to know the ins and outs of the injury details.
Part of that will be due to medical confidentiality, and the other part will be not alerting the opposition to the fact that player X has missed a few days with a hamstring strain and therefore it might be worthwhile making sure that he has to sprint at every opportunity.
Cristiano's not had the best of pre-seasons so far with his recent back injury forcing both him and Karim Benzema to miss the German trip in midweek. The media has been full of stories about how he's been putting in four hour sessions to try to make the Norwegian match this weekend, but in truth Rafa Benitez probably won't be too bothered if he doesn't. In addition to the pre-season being important in terms of fitness and game time, it's also a vital period for getting the injuries resolved before the real games start.
Cristiano's knee problems became particularly obvious towards the back-end of last season, and this recent setback won't have helped from a fitness aspect. However, by all accounts this doesn't appear to be too serious a problem, but nevertheless presents another ‘niggle' to be wary of flaring up again in future weeks if his eagerness to play overrides the emphasis that needs to be placed on his recovery.
Similarly, Karim Benzema has struggled for a while with injuries and it's a concern that he's having to miss more training days so early in the season. Whether he goes to Arsenal or not the fact remains that the pre-season period is almost over and that there's not a lot of time now before the opening league games are due. Decisions to be taken on injury matters between now and the 23rd August are going to be even more vital; since by having already missed an important part of the pre-season Karim can't risk the scenario of coming back too early to play and risking a recurrence of the injury that could put him out for another few weeks. Although media reports indicate that Karim won't play against Sporting; it remains to be seen whether his estimated return against Betis is a realistic target or not.
Pepe's also had injury problems last season and the recent strain that forced him to come off against Tottenham is reported to be serious enough to put his appearance in doubt against Sporting Gijon later in in the month as well. Muscle injuries are always difficult for the medical teams to deal with since players have a tendency to underplay the true extent of these injuries; so the accepted practise now of having injuries scanned using either Magnetic Resonance Imaging (MRI) or diagnostic ultrasound allows a clearer prognosis of how long the recovery time is likely to be.
Previous research carried out by the new Real Madrid coaching team at previous clubs indicated that another part of the season when injuries are at their premium is in late October and into November. At that time the games are coming thick and fast; and there's also the European involvement to consider. So injuries sustained in the early part of the actual playing season could potentially have knock-on effects on players' physical fitness as the build up to that period approaches.
This makes it essential that the management of injuries sustained at the moment - i.e. pre-season and into late August - September will have to be carefully considered with the European games in mind. Although November seems a long way off at the moment, research indicates that the high-risk period for injury recurrence is during the first three weeks after returning to play. This emphasises the importance of managing the current injuries correctly with later in the season in mind.
So Pepe, Cristiano, Karim et al will need to take care to make sure that they come back at the right time and not try to return too soon. I'm sure we needn't worry about this, though, as it looks as though Rafa and his support team take quite a research-based approach to injuries and fitness. Accordingly the likelihood of players playing with injuries is remote; and this approach will no doubt extend to making return-to-play decisions.
We often read in the media about the situation at other clubs where players take their own decisions on when they feel ready to return to play, and these are often made without any scientific basis. I'm always amazed how often we read about players carefully going through each and every stage of their rehab under strict supervision until it gets to the last part and suddenly they've made their own decision that they're fit and they're back in the team; only to come off injured again in keeping with the three-week window.
The early indications are that all of the new training schedules and injury management strategies introduced this season by the new coaching team at Madrid are based on fact and previous experiences backed up by researched evidence. On that basis alone there should be no risk of reading about Real Madrid players "defying medical opinion in order to play"!