Marco Asensio made a welcome return from injury against Dortmund

Marco Asensio made a welcome return for Real Madrid last night after missing the last few matches with a deep muscle strain of the right hip.

Marco has only just come back into full training this week; and joined the game as a substitute against the German side. Based on the schedule ahead for Real Madrid over the next fortnight his return will be welcomed by Zinedine Zidane as another hectic period approaches.

With the FIFA Club World Cup sandwiched between league games against Sevilla on Saturday and Barça in a fortnight, Zidane will need as many fit players as he can muster.

Marco’s injury, diagnosed by the Real Madrid medical team as an injury to the obturator externus muscle, can be a difficult injury to manage due to its location.

As one of the deep stabiliser muscles of the hip, strains of the obturator externus (OE) are thought to be rare in athletes (Khodaee et al, 2015) and are not reported to be common in football. But like most injuries that doesn’t mean that they don’t happen; perhaps only less frequently compared to the usual strains and sprains of the knees and ankles.

Where the hip joint is concerned, the more superficial gluteal muscles and the deep stabilisers and rotators are all thought to have an influence on injuries of biomechanical origin and are often linked to the presence of lower back and knee pain.

Sometimes the cause of injury can be uncertain; and from a purely medical aspect, information about the exact function of the OE muscle is thought to be limited (Gudena et al., 2015).

As a muscle with similar functions to the OE, the commonly-referred to ‘piriformis syndrome’ which is often seen in runners falls into this category. Symptoms in this region are often confused with an injury to a lumbar inter-vertebral disc, and this is due to the presence of pain in the buttock and in the back of the thigh.

Willick et al, (2002) noted that injuries to the deep muscles of the hip are often thought to be commonly misdiagnosed as hamstring or gluteal strains; therefore accurate diagnosis of the exact structure injured is essential as always.

Due to its deep location, MRI is recommended as the method of choice when identifying soft-tissue structures injured in and around the hip (Vellman et al, 2014).

And as Marco will have discovered, injuries in this area can take time to recover. Often the pain is of a general nature and difficult for a clinician to accurately pinpoint in a physical examination; hence the reliance on MRI.

Inflamed bursae and nerve irritations can also confuse the issue if the injury hasn’t occurred as the result of one single specific incident. The differential diagnosis for buttock pain in athletes can be extensive as reported by Vasudevan et al (2012).

If the symptoms have occurred by gradual development, then these injuries can be notoriously frustrating to deal with, both from the player’s aspect in addition to that of the treating clinician.

So it’s good to see that Marco appears to have completed his short stint against Dortmund without any reported adverse reaction; and Zinedine Zidane will be pleased to have him back.

Putting aside the FIFA World Club Cup for the moment, the talk is now all about Sevilla this coming weekend; and it will be hard to separate that game from the Barça match when the team return from the Emirates.

In recent times neither of the games involving Real Madrid and their immediate League opponents have been low-key encounters played in friendly spirits - as Sergio Ramos for one will testify.

Although the Champions League tie against Dortmund on Wednesday wasn’t be an easy fixture, at least it wasn’t played with the same level of animosity evident between the teams as is likely to be the case with the two league matches that follow.

And with Rafaël Varane and Jesús Vallejo now reported to be carrying injuries it looks as though further changes will be on the cards for Real Madrid.

As part of Zidane’s forced reshuffle, perhaps some of those who are playing less frequently at first team level will be given the chance to stake their claim for a regular position in the side.

Coming from the green half of Sevilla, Dani Ceballos for one will relish playing against old rivals from his Betis days. It all depends on who Zidane decides to go with in midfield; and whether the returning Marco Asensio starts the game or has a place on the bench.

With Sergio Ramos unavailable there will be changes anyway; we’ll just have to wait and see how many of these Zidane actually makes. At least he’s got Marco Asensio to call on once again.

References:

Gudena R, Alzahrani A, Railton P, Powell J, Ganz R (2015). The anatomy and function of the obturator externus. Hip International. Vol. 25 (5); 424 – 427.

Khodaee M, Jones D, Spittler J (2015). Obturator Internus and Obturator Externus strain in a high school quarterback. Asian Journal of Sports Medicine. Vol. 6 (3); e23481.

Vasudevan JM, Smuck M, Fredericson M (2012). Evaluation of the athlete with buttock pain. Current Sports Medicine Reports. Vol. 11 (1); 35 – 42.

Vellman MD, Jansen van Rensburg A, Jansen van Rensburg DC, Strauss O (2014). Acute obturator internus muscle strain in a rugby player - A case study. Journal of Sports Medicine and Physical Fitness. Vol. 55 (12); 1544 – 1546.

Willick SE, Lazarus M, Press JM (2002). Quadratis femoris strain. Clinical Journal of Sports Medicine. Vol. 12 (2); 130 – 131.