Injuries, misinformation, and the probable cause

[LHarper]

Apologies for another (long winded) thread about our injury problems, however, reading through a lot of posts on the other threads and articles published in the mass media it's apparent that not many people know what the number one major contributing factor is for the number of soft tissue injuries:

The coach/manager.

People continue to state that we have some of the best medical/sport science facilities and staff in the world and we do. However, they are only left to cure instead of intervene if the data they produce from monitoring players is not used by the manager. It's my opinion that Pellegrini does not integrate the sport science and fitness and conditioning staff enough at City.

The majority of teams competing in the Champions League don't perform hamstring intervention programmes (http://www.ncbi.nlm.nih.gov/pubmed/25995308, http://goo.gl/jrT6fy) and are therefore unlikely to have many other types of intervention programmes in place as hamstring injuries are the most common injury type. This paper (http://bjsm.bmj.com/content/49/9/603.full) found that 69% of practitioners feel that coaches could be more compliant with injury prevention strategies (albeit in international teams) so it seems to be endemic in the modern game and I believe it to be the case at City.

Leicester City and Swansea City have the lowest number of injuries this season in the Premier League. Of course fixture congestion plays somewhat of a role, however, their sport science and medical departments are very much integrated within the management and are a huge part of the culture (recent podcast with Matt Reeves, head of fitness and conditioning at Leicester: http://www.historicperformance.net/podcast-episodes//historic-performance-podcast-30-matt-reeves).

With the physical demands in the Premier League increasing year on year (http://www.ncbi.nlm.nih.gov/pubmed/25009969, https://pbs.twimg.com/media/B9RyXr3CUAE2ctJ.png) and the number of hamstring injuries increasing (http://goo.gl/lTA9qE) the problem is only going to worsen. Especially when Guardiola joins as injuries tend to increase when a new manager joins a club (see Klopp at Liverpool for a recent example), and also Guardiola's players tend to suffer a high rate of injuries anyway.

I could be wrong and it's just been bad luck.

However, there is no such thing as bad luck when it comes to soft tissue injuries.

 

[Higor Douglas]

Brazil's sports medicine is very good.
But here in Brazil, things are different, the training is more intense.
Alexandre Pato, who always had constant injuries in Milan, was "cured" in Corinthians, which is a worldwide reference in sports medicine.

And all teams usually have 75 games a year.

 

[Centurions]

Swansea have played 28 games, Leicester 30 and we've played 38 and you think 'Of course fixture congestion plays somewhat of a role'. 'Somewhat'. really?

 

[taleofbluehalves]

Half way through Pep Confidential and its constant injuries not particularly Peps fault though he tends to trust a smaller squad of senior pros. He tends to focus on fitness with the ball and around tactics than long runs. Keen on nutrition and how it affects fitness.
When I look back at the players in 2011-12 the likes of Silva look a bit quicker and I just wonder of the intensity of the Premiership and getting kicked around takes its toll.

 

[LHarper]

Swansea have played 28 games, Leicester 30 and we've played 38 and you think 'Of course fixture congestion plays somewhat of a role'. 'Somewhat'. really?

The disproportionate number of injuries between ourselves and those two teams cannot be explained by fixture congestion.

 

[Corky]

Most injuries at all clubs are soft tissue, as the body is mainly soft tissue. It has always been the case, but at least there are not as many serious ones like Quinn, Edghill, Tskhadadze, Shelia, Lake. Bojinov, Sun etc

 

[LHarper]

Most injuries at all clubs are soft tissue, as the body is mainly soft tissue. It has always been the case, but at least there are not as many serious ones like Quinn, Edghill, Tskhadadze, Shelia, Lake. Bojinov, Sun etc

The point is is that they are becoming more frequent every year and we seem to be getting way more than the league average, particularly this season.

The way these injuries are treated has improved greatly since the 90s and early 00s, hence why the severity might not seem as bad (i.e., reduced recovery time).

 

[Marvin]

Apologies for another (long winded) thread about our injury problems, however, reading through a lot of posts on the other threads and articles published in the mass media it's apparent that not many people know what the number one major contributing factor is for the number of soft tissue injuries:

The coach/manager.

People continue to state that we have some of the best medical/sport science facilities and staff in the world and we do. However, they are only left to cure instead of intervene if the data they produce from monitoring players is not used by the manager. It's my opinion that Pellegrini does not integrate the sport science and fitness and conditioning staff enough at City.

The majority of teams competing in the Champions League don't perform hamstring intervention programmes (http://www.ncbi.nlm.nih.gov/pubmed/25995308, http://goo.gl/jrT6fy) and are therefore unlikely to have many other types of intervention programmes in place as hamstring injuries are the most common injury type. This paper (http://bjsm.bmj.com/content/49/9/603.full) found that 69% of practitioners feel that coaches could be more compliant with injury prevention strategies (albeit in international teams) so it seems to be endemic in the modern game and I believe it to be the case at City.

Leicester City and Swansea City have the lowest number of injuries this season in the Premier League. Of course fixture congestion plays somewhat of a role, however, their sport science and medical departments are very much integrated within the management and are a huge part of the culture (recent podcast with Matt Reeves, head of fitness and conditioning at Leicester: http://www.historicperformance.net/podcast-episodes//historic-performance-podcast-30-matt-reeves).

With the physical demands in the Premier League increasing year on year (http://www.ncbi.nlm.nih.gov/pubmed/25009969, https://pbs.twimg.com/media/B9RyXr3CUAE2ctJ.png) and the number of hamstring injuries increasing (http://goo.gl/lTA9qE) the problem is only going to worsen. Especially when Guardiola joins as injuries tend to increase when a new manager joins a club (see Klopp at Liverpool for a recent example), and also Guardiola's players tend to suffer a high rate of injuries anyway.

I could be wrong and it's just been bad luck.

However, there is no such thing as bad luck when it comes to soft tissue injuries.

I don't have time to read the papers, but that does look like a very well resourced and thought out comment.

How do we know whether Pellegrini and his staff integrate injury prevention routines with their training? Speculative

BBC and Sky both published reports on no of injuries per team and there were several clubs who bucked the correlation between no of injuries and games.

I agree that if you tailor your training regime to the player you can minimise soft tissue injury, but I don't think we will get very far with this discussion as we do not know how City implement this.

 

[Marvin]

The point is is that they are becoming more frequent every year and we seem to be getting way more than the league average, particularly this season.

The way these injuries are treated has improved greatly since the 90s and early 00s, hence why the severity might not seem as bad (i.e., reduced recovery time).

Ligament and tendon injuries (twists) tend to be a product of bad luck eg De Bruyne, Nasri - rather than fatigue / poor conditioning that can lead to muscle strains. The injuries we need to focus on are the muscle strains. There I think training can be a factor - as can too many games. I'm sure city are on the case. I am not sure what we can bring to this debate as we are guessing what City do, but I agree its hugely important. Probably the single biggest factor affecting City's success at the moment.

 

[LHarper]

I don't have time to read the papers, but that does look like a very well resourced and thought out comment.

How do we know whether Pellegrini and his staff integrate injury prevention routines with their training? Speculative

BBC and Sky both published reports on no of injuries per team and there were several clubs who bucked the correlation between no of injuries and games.

I agree that if you tailor your training regime to the player you can minimise soft tissue injury, but I don't think we will get very far with this discussion as we do not know how City implement this.

Yes I agree it is speculative but the evidence (both scientific and the current epidemiology of injuries this season) would suggest we don't.

To me that would suggest those teams are implementing methods that are successfully reducing the risk of players getting injured. Mourinho is apparently very good at periodising training to minimise injury risk.

Essentially, although we don't know exactly what City do behind the scenes, the buck stops with Pellegrini.

Ligament and tendon injuries (twists) tend to be a product of bad luck eg De Bruyne, Nasri - rather than fatigue / poor conditioning that can lead to muscle strains. The injuries we need to focus on are the muscle strains. There I think training can be a factor - as can too many games. I'm sure city are on the case. I am not sure what we can bring to this debate as we are guessing what City do, but I agree its hugely important. Probably the single biggest factor affecting City's success at the moment.

It isn't bad luck, it is due to extraneous factors such as fatigue/poor conditioning as you mentioned. 'Soft tissue injuries' is an all encapsulating term for muscle/ligament/tendon injuries.

To me it would seem Pellegrini either a) doesn't perform the right training at the right time, b) implements a strategy that puts high loads on the players or c) doesn't allow for full recovery between matches (<3 days recovery between games does exacerbate this).

 

[domalino]

Guardiola's players tend to suffer a high rate of injuries anyway.

His Bayern team do, but the Barcelona team were almost invincible, hence the doping accusations, and Guardiola has had many rows with the medical staff at Bayern because he thinks they are in the stone age.

Why assume we're going to be like Bayern and not Barca?

 

[Gordyola]

Swansea have played 28 games, Leicester 30 and we've played 38 and you think 'Of course fixture congestion plays somewhat of a role'. 'Somewhat'. really?

It's not just club games that our players play, most are internationals. Would be interesting to see how many minutes our players are playing compared to Leicester's. There is also the travelling to factor in as well, air travel is not good for injuries and post match recuperating

 

[I'm With Stupid]

Swansea have played 28 games, Leicester 30 and we've played 38 and you think 'Of course fixture congestion plays somewhat of a role'. 'Somewhat'. really?

Well Leicester in particular have been extremely lucky. Not just with a lack of injuries, but none of them happening to their key players. Their season has been remarkably similar to the season where Liverpool "won" the league, or even the last time the rags won the league because Van Persie managed to stay fit for the duration. Sometimes teams just get lucky.

 

[Centurions]

It's not just club games that our players play, most are internationals. Would be interesting to see how many minutes our players are playing compared to Leicester's. There is also the travelling to factor in as well, air travel is not good for injuries and post match recuperating

Yeah, I realised I'd forgotten that when I was already out of the house with the dogs (although the travelling is a good point too), most of ours play for their national teams. How many do Leicester & Swansea have? A damn sight less that's for sure.

The disproportionate number of injuries between ourselves and those two teams cannot be explained by fixture congestion.

Adding in the above I'd have to disagree, it's very rare that our players get even a mid-week break let alone an international weekend break. Over a season that can really add up.

 

[Walking on the blue moon]

Thanks for the research! Having read some of the articles, I found the point on prevention of hamstring injuries very interesting. Here are some details of the Nordic hamstring exercise programme provided in the article:

Nordic hamstring exercise programme - the complete initial programme includes a 10-week exercise progression, advancing from 1 to 3 weekly training sessions, and with increasing number of sets and repetitions. After the 10-week exercise progression, the maintenance programme of 1 weekly maintenance session follows throughout the rest of the season.

So the programme is actually quite demanding. I wonder if it is playing too many games and not having enough time in between that causes some of the problems in our training regime?

 

[Deleted member 58678]

Thanks for the research! Having read some of the articles, I found the point on prevention of hamstring injuries very interesting. Here are some details of the Nordic hamstring exercise programme provided in the article:

Nordic hamstring exercise programme - the complete initial programme includes a 10-week exercise progression, advancing from 1 to 3 weekly training sessions, and with increasing number of sets and repetitions. After the 10-week exercise progression, the maintenance programme of 1 weekly maintenance session follows throughout the rest of the season.

So the programme is actually quite demanding. I wonder if it is playing too many games and not having enough time in between that causes some of the problems in our training regime?

But look at the Argentine and Brazilian leagues and how many games they play in a season, or NBA basketballers who can play four times a week and if you reach the finals you could play up to 100 games a season.

Upper leg and lower torso injuries are all to do with the pelvis and the balance of the strength and flexibility of the muscles that attach to them. If you have tight hamstrings it might not be a hamstring problem, it might be that the muscles in your lower back aren't strong enough therefore the balance of the pull on your pelvis is out and your hamstrings are in a state of tension too much.

It can also be that they are in a state of tension too often by having your knees bent too much. You could sit watching tele or eating at the dinner table with your knees bent, you could sleep on your side in bed and have your knees bent, you could drive a lot or long distances where your knees are bent too and all of the flexion at the knee doesn't allow the extension of the muscles of the hamstrings often enough. You could do all this and not sit up straight and therefore put your lower back muscles in a state of extension too often which leads back to my previous paragraph; all adding to problems in the hamstrings.

It's not always about the training or exertion of games or resting and how much you get, it's about the balance of your body in the everyday living of your life. We are animals who aren't suited to a sedentary lifestyle yet 75-90% of our lives are spent in a sedentary state. Even full time athletes like footballers spend a surprising amount of their regular life away from playing and training chilling out.

Who even thinks about that, never mind monitors it all?

 

[LHarper]

Thanks for the research! Having read some of the articles, I found the point on prevention of hamstring injuries very interesting. Here are some details of the Nordic hamstring exercise programme provided in the article:

Nordic hamstring exercise programme - the complete initial programme includes a 10-week exercise progression, advancing from 1 to 3 weekly training sessions, and with increasing number of sets and repetitions. After the 10-week exercise progression, the maintenance programme of 1 weekly maintenance session follows throughout the rest of the season.

So the programme is actually quite demanding. I wonder if it is playing too many games and not having enough time in between that causes some of the problems in our training regime?

The way the season is structured it should be possible to implement a Nordic hamstring exercise programme, especially if started in pre-season.

 

[LHarper]

Yeah, I realised I'd forgotten that when I was already out of the house with the dogs (although the travelling is a good point too), most of ours play for their national teams. How many do Leicester & Swansea have? A damn sight less that's for sure.


Adding in the above I'd have to disagree, it's very rare that our players get even a mid-week break let alone an international weekend break. Over a season that can really add up.

It can, but it can be managed effectively by coaches. We've had too many injuries this season in proportion to the number of matches our players have participated in.

 

[LHarper]

Well Leicester in particular have been extremely lucky. Not just with a lack of injuries, but none of them happening to their key players. Their season has been remarkably similar to the season where Liverpool "won" the league, or even the last time the rags won the league because Van Persie managed to stay fit for the duration. Sometimes teams just get lucky.

I created this thread to try and get people to move away from this idea of luck regarding injury.

There is no luck when it comes to soft tissue injury prevention!

 

[pardoeofftomexico]

I created this thread to try and get people to move away from this idea of luck regarding injury.

There is no luck when it comes to soft tissue injury prevention!

If it is not luck then Pellegrini must have worked wonders last year when we had one of the best injury records in the league losing only 630 days compared to 9 clubs who lost over 1,000 with Newcastle at the top of the list with 1,871 days lost. Sounds like good and bad luck to me.