Why injury comebacks are far from scientific
In this article, published by Mike Davison, Football Medicine Specialist at Return to Play, he discusses the recuperation and rehabilitation of a selection of Premier League footballers, and the difficulty associated with predicting a date for their return.
For Daniel Sturridge and Jack Wilshere, this season has been one of painful setbacks and missed deadlines.
On an almost weekly basis, we have heard when they were stepping up training and which game had been targeted for a return. Then, as sure as night follows day, a more pessimistic bulletin would emerge in which it became clear that their “imminent” return was not quite so imminent after all.
In contrast, we were told Diego Costa would miss six weeks of Chelsea’s run-in only for him to return after just a fortnight, suffer a recurrence of the injury and embark on a long trudge to the medical room.
These are just three of many examples, but they raise a simple question: is estimating when a footballer will return to play a science, or just guesswork?
The football world is certainly obsessed with timescales, with news of an injury swiftly followed by the question of when he or she will return to action. That is hardly surprising. On that news depends the player’s future, the media agenda, the obsession of the fan, the livelihood of the manager, and the owner’s investment. Everyone is looking for a number, measurable in weeks or months.
Neuroscientists even suggest it reduces the threat response in the player concerned as it removes an unknown, even if the figure is not accurate.
What that means, however, is that the responsibility and risk to their reputation lies solely with the medical team. Indeed, the Return to Play (RTP) process is such a complex and emotional issue that there is really no way to give an accurate prediction.
Recent studies on RTP in the British Journal of Sports Medicine state that full healing of a similar injury can differ between two players. Recovery is individual to each player, and the progression depends not only on physiological criteria (tissues healing) but also psychological factors, including their professionalism and attitude to the often dull and arduous nature of rehabilitation through to their fear of aggravating the injury. Research indicates that if you are under 25 years old, male, and psychologically ready, then the likelihood of returning to a pre-injury level of sport after a major knee injury, such as an anterior cruciate ligament reconstruction, is up to 50 per cent higher than other players. Ultimately, RTP criteria should be based upon functional assessment rather than time-based considerations.
While there is so much secrecy in other areas of football, it seems strange, therefore, there is always a rush to broadcast details of injuries and timescales for a player’s comeback.
Yet there are a number of interested parties who have a role to play in this process and the discussion of when a player will return.
The club’s manager, for example, often feels the need to take control of injury situations. That could be to take the emphasis away from a poor result and towards the absence of an important player, or the desire to protect their medical team by overestimating the length of time a player will miss and then heaping praise on them when they return early.
Alternatively they may want to shift the focus of blame on to their medical staff, or simply misrepresent the facts in order to keep their next opponents in the dark.
There is also a grey area in the numbers they do divulge. When a manager says a player will return in three weeks, it is often not made clear if that is to training or to full match fitness.
Players and their advisers also like to put out their own updates on social media, while club medical staff will obviously have a key part to play in the process.
If the time frame is overly conservative, some staff will end up delaying a return until the nominated date anyway, as the risk on them if they are seen to accelerate the process and then the player breaks down is too great.
Alternatively, if the time frame is overly aggressive, they will be under huge pressure to have the player back on the field on schedule, so there are some in football’s medicinal fraternity who operate under the mantra of “under-promise and over-deliver”.
There is no easy solution, although in Australian sport they have attempted to introduce some clarity to proceedings by bringing the team doctor into press conferences. This is enhanced by managers simply saying injuries are being treated on a day-to-day basis.
There are no signs that such a move is imminent. So until the goalposts are moved, we will have to settle for regular updates that are little more than rough guides – and we will know players such as Sturridge, Wilshere and Costa have fully recovered only when you see them on the pitch, fully free of injury.
With the Return to Play, Football Medicine Strategies Conference kicking-off this saturday make sure you book your place now.
Online registrations will close on the 6th April 2016, but it will be possible to register directly at the Conference Venue: the registration desk will be open from Saturday 9th April 2016 from 8am onwards.
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