-The latest injury for Nacho Fernández to contend with is an injury to the medial collateral ligament (MCL) of his left knee, sustained last week against Club Brugge in the Champions League match; and he’ll miss a fair amount of playing time as a result.
Although he’s not had the best of starts to the season, Nacho for years has been relatively injury-free and it’s only in the last couple of seasons that he’s been picking up injuries on a more regular basis.
Last November an injury to his right knee kept him out for several weeks and like everyone else, he’s had the odd muscular strain as well; notably to his right hamstring which side-lined him for most of April 2018.
He’s had other niggles of course, but apart from missing the occasional training day, Nacho had been relatively injury-free until that hamstring injury 18 months ago.
In many ways, Nacho’s injuries fit the current injury profile of an elite footballer. UEFA injury studies show that players are expected to sustain an average of two injuries per season and that an MCL sprain is one of the most frequently sustained injuries in football (Ekstrand et al, 2011).
The injury mechanisms of Nacho’s injury against Brugge followed a familiar pattern. Injuries to the MCL are frequently sustained via a combination of twisting and placing an excessive force on the inner part of the knee, forcing the joint to move towards its natural end of range and placing an excessive strain on the restraining ligaments.
The MCL is the main structure taking the strain on the medial - or inner - side of the knee and when the joint is forced into an excessive range of movement then it is the MCL that invariably gives.
Previous research has shown that the MCL is the most commonly injured structured in the knee (Wijdicks et al, 2010); usually resulting in an average 6 – 8 weeks absence from sport based on the recovery time for a typical Grade 2 ligamentous sprain.
Although Real Madrid’s medical services haven’t put an estimated return time for Nacho, they’re probably thinking along these lines. The only underlying concern would be the possibility of an associated injury to Nacho’s meniscus and potentially to other structures as well.
It’s become the normal procedure now to evaluate injuries on a continuous basis. As the medical reports published by Real Madrid tend to say, “recovery will continue to be assessed”.
Players like Nacho who can slot into various positions are difficult to cover for due to their own flexibility over where they can play.
The effects of not having to Nacho to cover if anyone gets injured often means a reshuffle in Real Madrid’s defence; and will even influence Zinedine Zidane’s choice of substitutes on the bench.
Nacho’s knee injury comes at a particularly difficult time for Real Madrid even though the majority of injuries that Zidane has recently had to contend with in his team selections have started to resolve.
As always, though, as soon as you get one or two players back to fitness others invariably take their places in the medical room!
The latest players to fall into that category are Marcelo and Toni Kroos. In fact Marcelo only just came back from a bout of cervicalgia - which is a painful syndrome affecting the neck and the upper part of his spine - only to injure a left hamstring muscle.
Again, the medical report states that Marcelo’s progress will be continuously assessed.
Given Marcelo’s history of previous hamstring injuries for which the potential always exists to be linked to recurrent lower back problems, this will be the most sensible approach to take in these early stages.
We’ll find out more about Toni Kroos as the week goes on and the club are in a better position to give a clearer indication about the extent of his injury. At the moment we know that he has injured an adductor muscle in his left thigh but as yet we haven’t got any information about how bad this is.
It all means that Zidane’s continuous headache over losing players with injury has once again carried over into the international break.
Real Madrid’s league programme resumes in a fortnight with an away fixture in Mallorca on the 19th, quickly followed up by a trip to Istanbul to face Galatasaray a few days later.
The obvious effect of not having Nacho available in the foreseeable future means a reshuffle in Real Madrid’s defence; but Nacho’s absence will also influences Zidane’s choices of substitutes on the bench.
What makes it more difficult is that a player like Nacho who can slot into various positions is hard to cover for when he’s the one who’s injured!
Zinedine Zidane will need to utilise the players at his disposal to maximum effect and we’re likely to see his trademark rotational system used once again; particularly if anyone returns injured from the internationals.
Ekstrand J, Hagglund M, Walden M (2011). Injury incidence and injury patterns in professional football - the UEFA injury study. British Journal of Sports Medicine. Vol 45 (7); 553 – 558.
Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, LaPrade RF (2010). Injuries to the medial collateral ligament and associated structures of the knee. Journal of Bone and Joint Surgery of America. Vol. 92 (5); 1266 – 1280.