The pain game: What’s the solution to the growing injury lists in top level football?

After a World Cup summer, perhaps it was always inevitable the topic of injuries would overshadow the first three and a half months of the Premier League season.

Many clubs can complain of genuine crises. Manchester United were already struggling to cope before the recent international break added a few more bruised and battered bodies to their ranks.

Since the campaign began, Arsenal players have suffered close to 30 injuries. Liverpool have experienced well- documented problems too — most notably with Daniel Sturridge while Everton and Newcastle can both point to casualty-lists that stretch into double-figures.

Is there a scientific reason or is it merely bad luck? Are training regimes too strenuous? Is there a lack of communication between managers and clubs’ medical departments?

Dave Hancock has been involved in elite-level sport for over two decades and is the CEO of Atherapy, which has over 20 physical therapy practices in the UK. He’s also served as the head physio at Chelsea, Leeds, Blackburn and Wolves and acted as first-team physio for the England national team. In 2008, he moved to the USA and spent six years as Director of Training and Performance with the New York Knicks.

He feels that such a dramatic increase in the pace and tempo of the game was always likely to lead to more injuries.

“When you look at Opta and Prozone stats, the speed of football has increased massively over the last 12 years. The distance these guys are now covering and the speed they’re playing at far outweighs what they were doing in the late 1990s, early 2000s. Whenever you ask a human body to excel at more speeds, you’re pushing the boundaries of the athlete. The more you push, the more you’re leaving yourself open to injury.”

Then, there’s the volume of matches. Southampton manager Ronald Koeman recently voiced his concerns about the congested Christmas schedule saying that one day- off between games is ‘crazy’. United boss Louis van Gaal expressed similar sentiments. With the top-six teams already playing twice a week since September, scheduling demands reduce recovery time and make players vulnerable.

“Injury is stress to the body, to a joint, to a muscle. There can be psychological stress — which would be hormonal or biochemical and mechanical stress – which would be from running or jumping, heading and contact. You put that into an equation with the number of games that’s asked of a professional Premier League footballer, especially in the top clubs, and it’s a hell of a lot of stress and load. The more load you have, the more chance you’re going to have of injury.”

A quick glance at the injury stats will tell you that Newcastle currently have the busiest treatment room in the top- flight. Runaway league leaders Chelsea have the quietest.

Hancock spent 18 months at Stamford Bridge as head physiotherapist and observed Jose Mourinho’s coaching methods closely.

“There are a few people that injure an athlete. One is the athlete themselves (or another athlete through contact). The other is the coach. More emphasis can be placed on periodisation and looking at what’s happening on a daily basis in training. With the information we now have, we’re starting to get a better understanding of that. But the optimisation is dependent on the head coach or manager. It’s dependent on his style of play, his tactics and his psychology. With my experience of working with 14 top managers over 16 years, that was something I really admired about Jose. He had a system, which was very short, sharp and intense.

“He could periodise his sessions, he allowed players to recover, psychologically he knew what buttons to press with each individual. He used to pride himself on not having any injuries in training. I think he had studied it when he was at Barcelona and then with Rui Faria, his assistant coach. They had a philosophy and understood what was necessary to play to that game, the speed and intensity of it. The training techniques they put in place were high-intensity, very game-specific.”

Hancock believes that in order to maximise players’ performances more coaches need to step away from tradition and acknowledge that even though football is a team sport, the group contains very different individuals.

“One of the biggest things I learned from working for Jose was that his periodisation of training was very, very good. If you have a game where you’re travelling, where you’re coming in late, then you need to let the body recover and sleep. I’ve learned from working in the NBA that sleep is a massive recovery strategy. Things in football have been very traditional — like players training at 11am. But if you’re optimising sleep, 11 o’clock training after coming in at 2 or 3 in the morning after a game is not the way to go.

Bring players in at a later time to make sure the recovery is adequate. And then it’s the intensity of the training. It’s like peaking for an Olympics but unfortunately in football, you have to peak twice a week. It’s having that balance of stress and knowing which players need to be stressed and which players don’t because every individual footballer is different. So you have to look at what a player has to go through on a daily, weekly and monthly basis and you can then gear your optimisation for that individual within the team environment.”

There’s a fine-line. Coaches want to push players hard in training to try and rectify game environments. But, stretch the players too much and they’ll break down or simply burn-out.

“For an athlete to be at their optimum level, they need to push their body. Injuries are always going to happen no matter how careful you are. And on the flip-side, if you’re too careful, you’re not going to be at your optimum fitness or strength to cope with playing twice a week. It’s a very fine balance between over-training – if you want to use that terminology, and under-training.

It’s tough to keep it at the seesaw level, without tipping it one way or the other.”

In the sports science world, injury prevention is the next big thing. Last season, Daniel Sturridge’s goals were worth 20 Premier League points to Liverpool. Because of injury, he’s played just three games this term and Liverpool are adrift in mid-table. There’s a correlation and it’s becoming increasingly damaging and costly for various clubs when they lose key players for long periods.

“Preventing injury is high up the ladder of what a modern-day coach needs to understand. It’s getting better with the additions of sports scientists and the various software and hardware.”

“The non-contact injuries – the ones connected to muscle and tendons – they’re the ones that you can try and prevent. From a medical point of view, there are two key indicators for injury – one is age and the other is past medical history. So if someone has had an injury, they have more of a chance to reinjure that injury or more of a chance to injure something else because of a biomechanical issue.”

In Sturridge’s case, Liverpool manager Brendan Rodgers has admitted the club’s medical team are now investigating a potentially deeper problem after the attacker suffered what’s believed to be the ninth thigh-related injury of his career.

“Many teams do a lot of screening now to look for biomechanical deficiencies and then working on them. That might be weakness with stability or balance or it might be something from a previous injury that’s caused the current problem. Hamstring is the classic injury that occurs. But the numbers have reduced over the last decade because we have a better understanding of what causes them, what other issues can cause them and what’s referred.

For instance, your spine is commonly associated with hamstring injuries so we can do work on that while rehabilitating the hamstring so you don’t keep getting the reoccurence.”

Still based in New York, Hancock oversees the network of Atherapy facilities and consults with a variety of sports clients.

His time in the US has allowed him observe the contrast in how elite athletes are perceived on both sides of the Atlantic.

“These guys are human beings. They have all the same strains as everyone else. Whether it’s relationships, stress from outside sources or people wanting a piece of them. And some players can go over the edge. Joe Public and the media don’t understand what it takes to do what these guys do. They don’t understand the ins and outs of training and the rigours of performance and the stress and the media attention that’s placed on these guys. And if you don’t understand, it’s very easy to criticise. The mentality in England would be ‘Well, we pay him ‘X amount of money’ so they should be able to do that every single week’. It’s a lot easier said than done. They get pushed and pushed and then end up with an injury. There’s a lot of negativity from the British press where they’re always looking to point the finger whereas when you come to America, the athletes are put more on a pedestal.”