Will Benzema and Cristiano Ronaldo be ready for Manchester City?

Real Madrid as a club have said very little in these past few days about the fitness levels of Cristiano Ronaldo and Karim Benzema.  Although frustrating for the supporters, on this occasion that's maybe not a bad thing.  Manchester City are going to be scrutinising every sentence written in the Spanish media between now and Wednesday to see if they can find any clues as to whether Real Madrid's injured duo are likely to play in the second leg of the Champions League semi-final.

City will be scheduled to train in Madrid on Tuesday as part of their preparations for the tie; and it's usually traditional that the visiting club get to do a light workout on the pitch they'll be playing on. From City's point of view, their session will be designed to give away as little as possible to anyone watching from Madrid; but they'll have one ear to the ground for any available updates about Cristiano Ronaldo and Karim Benzema.  Just like last week when Zidane announced Cristiano would play when Real trained in Manchester, he's likely to keep them guessing once again.

Real Madrid have come in for a lot of criticism this season with regards to injury reporting and in particular for the statements normally released via the club website detailing the situation when players are injured.  Releasing the usual statements saying that Karim Benzema has "been diagnosed with a muscle injury in his right hamstring and his recovery will continue to be assessed" tells us absolutely nothing in real terms; but it tells Manchester City nothing either.

The trouble is that the information coming from outside sources is conflicting; and there's a lot of it.  We all know that Cristiano's been to see another doctor and physiotherapist about his injury who are not connected to Real Madrid but who are optimistic of his chances of being fit for the City game.  On the other hand, current and former members of the Portuguese National Team's medical services are less confident and suggest that Cristiano could be out of action a lot longer than he would like to think.

Real Madrid's medical team, however, maintain a dignified silence.  You can't blame Zinedine Zidane for wanting to keep his cards close to his chest before Wednesday's big game although I don't think he's going to be amused with all the present media hype.  Everyone, it seems, is having their say but as several observers are now rightly pointing out, it's impossible to give a realistic answer to the question of whether either of the duo will be fit without having all the facts.

In Cristiano's case, it appears as though the reported diagnosis of a small tear in one of the hamstring muscles is correct; and that tests including an MRI scan have confirmed this.  If so, and if such a partial tear is present, then the odds are against him being fit at the present time.  If the injury is not allowed to heal correctly and he plays, then he runs the risk of sustaining further damage.  However, only Cristiano himself and those closely involved with his injury will be able to comment on this with any degree of accuracy.

On the other hand, as opposed to reporting his injury as a muscular strain or partial tear of the affected hamstring, Karim Benzema is now talking about suffering with myofascial pain in the muscles instead.  Myofascial pain is a condition where sensitive areas in a muscle lead to pain and these are usually referred to as ‘trigger points.'  Myofascial pain typically presents as a cramp-like contraction in a muscle that is used to being repetitively loaded such as the thigh, hamstrings or calf muscles in a footballer or the shoulder muscles of a cricketer or baseball player.

It's interesting to note that Karim Benzema is reported to be considering having a pain-killing injection (or injections) in order to play against City.  Although there are no definitive protocols for the exact treatment of the condition, most clinicians find myofascial pain responds to regular treatment involving a form of acupuncture known as dry needling together with electrotherapy and appropriate exercise management.

Straight-forward pain-killing injections comprising local anaesthetic are now legal in football but are only effective in cases where no further significant damage can be done to an injury as a result (Orchard, 2004); hence they are not usually considered appropriate in cases of muscular tears.

Myofascial pain, however, often acts as a warning sign and can precede an actual strain or partial tear if the condition is not appropriately addressed.  Use of pain-killing injections in cases of myofascial pain has been trialled; mainly in the general public but requires further study.  The concept of pain-killing injections has been around for years and research to date is scarce with reference to their use in football.   Studies in other sports, however, have shown that pain-killing injections can be effective if ultrasound guided (James et al, 2010).  As with Sergio Ramos earlier in the season, the benefits of these need to be weighed up against the risks.

As ever, the key lies in establishing an accurate diagnosis.  We can all speculate but in the end only Zinedine Zidane and his team, the medical people, and of course the two players themselves will know the true situation.  There's a lot of psychology involved in sport nowadays and keeping your own counsel has always been part of the build up to the big matches.  I don't expect Real Madrid to give too much away before the teams are finally announced and probably nor does Manuel Pellegrini either.

By breakfast time on Tuesday though Zinedine Zidane will have made his mind up over who is likely to play.  We all know that's it's going to be a late decision for both of them but the onus is on everyone involved to make sure that if either Cristiano or Karim do turn out to face City then they're actually fit enough to do so.  The last thing we need is somebody bravely "defying medical advice" in order to play and then having to come off after twenty minutes.

References:

James P, Barbour T, Stone I (2010).  The match day use of ultrasound during professional football finals matches.  British Journal of Sports Medicine. Vol. 44 (16); 1149 - 1152.

Orchard JW (2004).  Is it safe to use local anaesthetic painkilling injections in professional football?  Sports Medicine Australia. Vol. 34 (4); 209 - 219.