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How long will Carvajal be out?

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Even though he still has time on his side when it comes to playing for Spain, Dani Carvajal must have been disappointed beyond belief on Saturday night when he came off injured against Atlético.

Shaun Botterill/Getty Images

Hip and groin injuries are not known for healing quickly and can become complicated in so many ways if you try to play through them.  At least Dani came off the pitch right away.  Despite being visibly upset, there wouldn't have been a lot he could have done at the time about the injury.  Understandably concerned about missing Spain's European campaign, Dani couldn't help but share his emotions with everyone watching.  Our thoughts are with him.

Real Madrid's report on the club website gives the basic details of the injury and indicates that Dani's recovery will continue to be assessed.  At this stage, that's about as much as can be done.  In all honesty, any injury to the hip and groin area needs to be monitored as there are so many various possibilities when it comes to injuries in this area of the body.  From a minor strain through to a full-blown muscle herniation, injuries to the hip and groin can fall into more than one single category.

With Dani's injury reported to be a grade 2 injury to the iliopsoas muscle, he's going to be in the middle range which is essentially a moderate injury as opposed to being severe.  Grade 2 injuries, involving the tearing of a substantial number of muscle fibres, are normally expected to take around four to six weeks; but in reality these can take a long longer if the healing process is slow.

Ekberg et al (2009) reported that groin injuries often present with diffuse and vague symptoms; and in referring to this in a UEFA study, Werner et al (2010) found that 41% of groin injuries in football were classified as moderate and 12% as severe, which supported earlier work by the same authors in the 2001 -€” 02 season.  For the purposes of both studies, Werner et al defined a hip/groin injury as an injury located to the hip (hip joint or surrounding soft tissues) or groin (junction between the anteromedial part of the thigh, including the adductor muscle belly and lower abdomen), resulting from playing football and leading to a player being unable to fully participate in future training or match play.

Additionally, Hölmich et al (2010) showed that having had a previous groin injury almost doubles the risk of developing a new groin injury and playing at a higher level almost triples the risk of sustaining a groin injury.

In their later study, Werner et al (2010) found that the incidences of recurrence of hip and groin injuries had dropped to only 15% as opposed to the previously reported and relatively high recurrence rate of 31% - 50% noted by Hawkins and Fuller (1999) and by Árnason et al (1996) in earlier studies.  This they attributed to the rather small number of subjects included in the earlier studies, together with increased and updated knowledge among the medical staff of elite clubs about treating groin injuries cautiously in order to minimise the risk of re-injury.

I know it can be a recurrent and obvious theme in these articles, but having been diagnosed with a Grade 2 injury means that this is more than just a minor irritation and Dani is going to have to be patient and allow the injury to heal properly in order to avoid the risk of recurrence.

For the record, anatomically the iliopsoas muscle is part of a group of muscles that function as the primary flexors of the thigh and trunk and is actually a fusion of the iliacus and psoas major muscles arising from the pelvis and inserting into the femur via the psoas tendon (Torres et al, 1995).  The psoas muscles are essentially hip flexors and as such these form part of the kicking action in addition to assisting the abdominals to contribute towards the stability required for the upper body when standing on one leg.

In football, stresses on the hip and groin occur largely as repetitive loads through the natural twisting, turning, and changes of direction associated with the game.  Hip and groin injuries are frequently incurred therefore by these unavoidable mechanisms.

From a diagnostic aspect, muscular injuries to the hip and groin require accurate clinical examination and medical imaging such as MRI scanning to differentiate between the structures involved.  However, due to the close proximity of the psoas muscle to the underlying inguinal ligament, the potential for the associated condition of groin disruption often exists.  Frequently referred to as "sportsman's hernia", groin disruption can accompany most soft-tissue injuries to this region.  The plus side to this is that the condition referred to as sportsman's hernia isn't an actual hernia as such; but is more of a disruption to the tendons of the muscles found in that region, hence the confusion that often exists over the terminology.

At first glance it might not be what Dani would want to read at this particular moment, but although it's not always easy to identify in the early stages, this common if often misunderstood and exaggerated condition invariably responds to treatment once diagnosed.

It can be seen, therefore, that injuries to this region of the body are not always as clear-cut as a simple muscle injury in the thigh for example; and this is due to the complex movements involved in the hip and groin which are many and variable.  Since the muscles and tendons of the hip also affect the groin and vice versa as indicated earlier, they are inextricably linked; with twisting and turning the trigger for creating further disruption to this extremely vulnerable area.

Dani was seen to point to the injured area at one point during Sunday's official presentation in the Bernabéu; and although nobody had said much about the injury at that stage, you could see that he was clearly struggling.  Injuries to the hip and groin are impossible to disguise and you rarely hear of anyone trying to play on with an injury to this region of the body.  There was no possibility of Dani trying to grit his teeth against Atlético and continue in the same way you would do with a kick to the shin for example.

Hopefully, by coming off when he did, Dani will have limited the damage.  As he's now having to miss the Euro 16 campaign, the next few days will allow the injury to settle and then the treatment and rehabilitation will begin in earnest.  With the estimated recovery time for this injury being around four to six weeks, the positive aspect of this will be that Dani should be fit in time for pre-season training; and he'll likely be allowed to report at the later date along with his colleagues who will be away on international duty.

He might even manage to fit in a short holiday somewhere along the line; although I'd be tempted to hold back on the booking until he sees how the injury responds in these early days.  Either way, Dani should be back fit and well in time for the pre-season period and the forthcoming tournament in the USA.  Ánimo Dani!!!

References

Árnason Á, Gudmundsson Á, Dahl HA, Jóhansson E (1996).  Soccer injuries in Iceland.  Scandinavian Journal of Medicine and Science in Sports. Vol. 6; 40 - 45.

Ekberg O, Persson N, Abrahamsson P, Westlin N, Lilja B (1988).  Longstanding groin pain in athletes: a multidisciplinary approach.  Sports Medicine. Vol. 6; 56 -€” 61.

Hawkins RD, Fuller CW (1999). A prospective epidemiological study of injuries in four English professional football clubs.  British Journal of Sports Medicine. Vol. 33; 196 -€” 203.

Hölmich P, Larsen K, Krogsgaard K, Gluud C (2010).  Exercise program for prevention of groin pain in football players: a cluster-randomized trial.  Scandinavian Journal of Medicine & Science in Sports. Vol. 20 (6); 814 -€” 821.

Torres GM, Cernigliaro JG, Abbitt PL (1995). Iliopsoas compartment: normal anatomy and pathologic processes.  Radiographics. Vol.15 (6); 1285 - 1297.

Werner J, Hägglund M, Waldén M, Ekstrand J (2010).  UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. British Journal of Sports Medicine. Vol 43 (13); 1036 -€” 1040.