Real Madrid won’t rush Sergio Ramos back from his recent injury

Based on the report issued last week by Real Madrid medical services, the expectations are that Sergio Ramos will only be out of action for a very short period.

His current injury, diagnosed as a grade 1 injury to the soleus muscle of the left calf group, wouldn’t normally be associated with a medium to longer term absence.

In practical terms though, this could actually turn out to be longer than the average 10 - 14 days normally associated with grade one muscle injuries.

Soleus injuries tend to present as relatively minor in the early stages; and often it’s only when the injury doesn’t respond to treatment as anticipated or turns out to be worse than originally thought, that the indications suggest a longer absence might be on the cards.

The difficulty in managing soleus muscle injuries is that these often present as a gradual progression in terms of discomfort.

This can be anything from a few days to several weeks as opposed to being the result of an obvious strain arising from one single, specific incident.

The classic presentation of a soleus muscle injury is one of pain and stiffness with gradually worsening symptoms over time; and in the early stages of diagnosing a soleus muscle injury, it may well be that the true extent of the tissue damage isn’t always clear.

The generally sub-acute nature of soleus injuries in their clinical presentation means that these can often be underestimated (Dixon, 2009).

Additionally, the evidence also suggests that due to its deep-seated location and involvement with lower limb posture, the soleus muscle requires longer healing time than other muscles of the calf group (Pedret et al.; 2015) or indeed of the lower limb in general.

Broadly speaking, a Grade 1 muscle strain is simply the tearing of a few muscle fibres and these usually heal relatively quickly.

Grade 2 injuries typically involve a considerable amount of muscle fibres and can vary from anything between two and six to eight weeks depending on the extent of the tissue damage sustained.

Injury grading, though, really just provides a rough estimate of the length of time a player is likely to take to recover; and it is the overlapping period between a high-end grade 1 injury and a lower level grade 2 injury where the problem often arises.

Injuries originally estimated to be grade 1 strains often fall into the category of lower level grade 2 injuries and the player involved finds that this means a longer absence than originally estimated.

Of all the Real Madrid players in the current squad, perhaps Sergio Ramos is the one whom Zinedine Zidane would most expect to return from injury sooner rather than later.

We all remember how Sergio played with the acromio-clavicular joint (ACJ) injury a couple of seasons ago by having pain-killing injections before games; something which seemed to go on for weeks on end.

He’s no stranger to managing his injuries in this way. We also remember how this was scrutinised in the media long after the Champions League final in Cardiff had come and gone - with claims that he had broken WADA anti-doping regulations.

In actual fact the substance Sergio used on that occasion, Dexamethasone, is on the banned list but only in competition - i.e. matches - and Real Madrid complied with anti-doping regulations since the injections were given the day before the game.

UEFA found in Real Madrid's favour over this; but cited an administrative error as the doctor should have informed the authorities that Dexamethasone had been given. Technically, though, these injections were allowed within WADA rules.

But on this occasion the medical team won’t be able to manage Sergio’s present injury in the same way.

This is because muscular strains result in damage to the muscle fibres themselves and injecting this area with an analgesic substance is not going to improve the healing process.

Administering pain killing injections could actually have the opposite effect by masking any symptoms that could indicate the tissue healing process is incomplete; thus delaying his return well beyond that currently anticipated.

It wouldn't be unusual for Sergio Ramos to attempt to come back early, but repeated injuries can take their toll; something of which he is acutely aware of.

He spends hours in the gym working hard in rehabilitation after injuries and building on his already high fitness levels; not only to address older issues in the shoulders and knees but also to focus on prevention of future problems in other areas.

The sheer enthusiasm of players like Sergio Ramos who will attempt to play at the earliest opportunity after a period out of the team due to injury cannot be faulted in terms of competitiveness and desire; but needs a different approach from the management to ensure that they aren't coming back too soon.

It’s all about striking the right balance. Zinedine Zidane won’t want to curb any of Sergio’s enthusiasm to get back into the team but at the same time will be making sure that he only returns to lead Real Madrid when he’s ready.

References:

Dixon BJ (2009). Gastrocnemius v Soleus strain: how to differentiate and deal with calf muscle injuries. Current Reviews in Musculoskeletal Medicine. Vol. 2 (2): 74 – 77.

Pedret C, Rodas G, Balius R, Capdevila L, Bossy M, Vernooij WM, Alomar X (2015). Return to play after soleus muscle injuries. Orthopaedic Journal of Sports Medicine. Vol. 3 (7). Published online 2015 Jul 22; doi: 10.1177/2325967115595802.​​