This latest thigh injury to Jesús Vallejo won’t do much for his confidence

You have to feel for Jesús Vallejo. I know I've said this before but his latest setback has again come at a time when Real Madrid already have several players injured. Sadly he’s missed another opportunity to get a few more games in; this time under Santiago Solari’s management.

Jesús’ latest injury has been reported by the club as a grade 2 injury to the biceps femoris muscle of the left thigh - aka one of the hamstrings. It doesn’t look as though he’ll be back ready and available outside the four to six week mark based on the diagnosis provided.

At this stage it’s hard to be more specific; and this is where the problem lies for Jesús and the Real Madrid medical team. Grading injuries on the 1 / 2 / 3 scale isn’t always 100% accurate and often only provides an estimate of the recovery times based on an average presentation (Grassi et al., 2016).

Academics now agree that the commonly used muscle injury grading systems based on three grades of injury, representing minor, moderate and complete injuries to the muscle, are lacking in diagnostic accuracy and provide limited prognostic information to the clinician (Pollock et al, 2014).

This is because of the extent that soft-tissue injuries can vary within the grades. And with repeated or recurrent injuries you can always add a bit more time to the recovery period.

Broadly speaking, under the accepted grading system a grade 1 injury is defined as a minor strain involving only a few fibres of the affected muscle tissue; with a grade 3 injury normally classified as a complete rupture.

At opposite ends of the scale, the diagnosis is relatively easy to make since a grade one injury is usually minor and often involves only a few training days lost. 7 - 10 days is a good average for grade 1 injuries but dealing with a complete rupture for example will obviously take a lot longer; often several months.

The problem comes when injuries are classified as ‘Grade 2’; which indicates a moderate injury on the accepted grading scale. In reality these can vary from something just a little more serious than a minor strain to an injury not too far off a complete rupture.

Although several authors have considered the need for a more accurate system of grading injuries (Mueller-Wohlfahrt et al., 2013; Hamiilton et al., 2015), we still seem to rely on using the old system.

This can lead to confusion. Since most injuries in football appear to fall into the minor-moderate or moderate-severe categories, it’s hard to be more accurate with an estimation of how long Jesús Vallejo will need to recover.

This will be the fifth muscular injury that Jesús has suffered in the last 18 months; albeit at varying levels. And just because not all of these have been sustained in game situations, it doesn’t make them any less serious.

Injuries in training are generally reported to have a lower incidence rate than injuries that occur in matches (Ekstrand et al., 2011); but the end result is the same. And each will have had its own impact on Jesús in terms of confidence.

Once the same type of injuries start to repeat themselves then players’ morale can quickly become affected.

They become wary of pushing themselves in training, recovery times take longer due to the cautious approach adopted both by the medical staff and the players themselves, and understandably progress will often be slower than anticipated.

Returning to actual play can be just as difficult. They often appear to be a few seconds behind everyone else where reaction time is concerned in game situations and that too can affect a players’ confidence.

This is especially true when their direct opponent appears to look sharper in one-to-one situations and that only highlights the lack of recent playing time; often making things appear a lot worse than they actually are.

There’s a huge emphasis placed nowadays on the psychological aspect of football. Medical staff factor this into their approach to rehabilitation, particularly where longer term injuries are concerned.

The same applies to recurrent and repetitive injuries. Hour by hour, players will spend far more time in training than they do in matches; especially the fringe members of the squad who don’t get as much playing time as Sergio Ramos et al.

This then leads to the potential for an increase in training injuries based on the regular starters performing fewer drills of a repetitive nature.

If some players have biomechanical issues or muscular imbalances then they will be at a higher risk of sustaining injuries in training based on the time spent overall working to maintain their fitness levels.

Frequent injuries to the same areas of the body such as the hamstrings or thigh muscles could easily lead to muscle imbalances; and this could well predispose players like Jesús Vallejo to further injury through repeated movements, altered techniques or running / gait anomalies.

Whatever the reason, he needs support at the moment, not criticism. No player likes to be injured and Jesús certainly won’t be happy about the current situation.

You have to feel for him; and at the same time hope that whatever the trigger is that’s causing him to suffer so many muscular injuries can quickly be identified and addressed.

Ánimo Jesús; one day less until your return!

References:

Ekstrand J, Hagglund M, Walde M (2011). Epidemiology of muscle injuries in professional football (soccer). American Journal of Sports Medicine. Vol 39; 1226 -1232.

Grassi A, Quaglia A, Canata GL, Zaffagnini S (2016). An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints. Vol. 4 (1); 39 – 46.

Hamilton B, Valle X, Rodas G, Til L, Grive RP, Rincon JAC, Tol JL (2015). Classification and grading of muscle injuries: a narrative review. British Journal of Sports Medicine. Vol. 49: 306 doi:10.1136/bjsports-2014-093551

Mueller-Wohlfahrt H-W, Haensel L, Mithoefer K, Ekstand J, English B, McNally S, Orchard J, Niek van Dijk N, Kerkhoffs GM, Schamasch P, Blottner D, Swaerd L, Goedhart E, Ueblacker P (2013). Terminology and classification of muscle injuries in sport: the Munich consensus statement. British Journal of Sports Medicine. Vol. 47; 342 - 350.

Pollock N, James SLJ, Lee JC, Chakraverty R (2014). British Athletics muscle injury classification: a new grading system. British Journal of Sports Medicine. Vol. 48 (18); 1347 – 1351.