And Now a Word on Soft Tissue Injuries From the Arsenal Medical Department

If you read twitter regularly you know the idea of soft-tissue injuries has been thrown out there. The talk is that they are avoidable and we shouldn’t be having so many. But is that really the case.

Now before we go further, I am not an expert. In real life, I am a Medical Marketing Strategist. I do spend a lot of time reading and getting to know clinical data and my particular area of focus is metabolic syndromes, specifically diabetes. So I have spent some time mulling over clinical data on soft tissue injuries to better understand them.

Just because I have done that doesn’t make an expert, it makes me informed. The experts are the physios, physicians and other practitioners who work on this every day. Reading a clinical study only provides insight, it does not make you an expert.

Sorry for that digression.

As for soft tissue injuries; these are injuries that occur through direct or indirect trauma to the muscles, ligaments and joint capsules. Direct trauma is exactly as you would expect it, injury from blunt trauma or sudden overload – e.g. a ball slamming into a foot or a defender crunching someone. This is clinically known as a macrotrauma – a true muscle tear or ligament sprain.

The other kind of trauma is indirect or trauma from repeated submaximal loading of the ligaments. In layman’s terms – overuse.

Regardless of the type of trauma, the end result is the same, tissue dysfunction characterized by pain, inflammation and tissue stress. Soft tissue injuries often result in functional disability, where the injured person can carry on with normal day-to-day activities but my experience limitations in their capacity to train or compete.

Tendons out of all the tissues are the least elastic. Injuries we often hear of are sprains or partial tears. Sprains are essentially abnormal stress on the tendon that result in inflammation. Of all the injuries we hear about these require the shortest time to recover. Tears or partial tears are macroscopic events. Most require surgical management.

Healing depends on the severity of the injury and the individual themselves. Soft tissue injuries heal in three distinct phases.

• First phase: The Inflammatory Phase. Duration up to 72 hours.  Often manifested by pain, swelling, redness and increased temperature at the injury location.
• Second phase: Regeneration and Repair (Fibro-elastic/Collagen-forming Phase). Duration from 48 hours to 6 weeks. Typically this is when the injured structures are rebuilt and regeneration occurs.
• Final phase: Remodelling phase. Duration from 3 weeks to 12 months.The collagen regeneration here is working to increase functional capabilities of the muscle and tendon.  However, its important to note that when this phase is over the injured tendon is not fully restored to its prior levels (this is important) – Two healing processes are competing with each other and impair the process of total healing. The question here is whether or not physios and/or physicians are taking steps to help the healing and offset the competing processes.

Rehabilitation should be designed with the individual in mind, specifically the athlete’s short- and long-term goals. The key here is that regardless of team needs, rehab should progress slowly, safely and effectively.  In the end the therapist is working to get back to normal anatomical and physiological function. Like the healing process the rehabilitation process is also categorized in phases. I won’t go into them in detail but they are, Management and Rehabilitation Stages 1-3. Each of these stages occurs in after the phases listed above.

The end goal obviously is the return of the player to the team in form and able to participate in the competition. However, several criteria should be met – the absence of symptoms, normal flexibility, adequate strength (90% of uninjured side) and the ability to perform. Finally, conditioning needs to be set and maintained post-injury to avoid the recurrence of injury.

So now you’ve gotten a fair amount of physio mumbo jumbo in a short span you can consider yourself educated but why bother?

These injuries as we are well aware are the bane of the Arsenal medical team and the bane of the club in it’s entirety. We’ve had our fair share of direct trauma injuries – mainly broken ankles and such. There is not a lot you can do for that. They happen in the course of a game. Additionally, soft-tissue injuries incurred during a game due to as we mentioned earlier – direct trauma – are also unavoidable. You simply can’t prepare for the errant tackle that causes you suffer some sort of damage to the tissue. No amount of physical training will prevent that. The best you can hope is that your strength and tone in the affected area is enough that the deep lying damage isn’t enough to force a long stay on the sidelines.

So that leaves those injuries that occur from indirect trauma or submaximal loading – as we said earlier – overuse.

Can overuse injuries to soft tissue be avoided?

At least on twitter the so-called experts believe they can. Let’s be clear on one thing – the normal human mechanics weren’t designed for the type of load and activity that we do today. So any athlete is walking a fine line between health and ruin. What we can do today is train players and their bodies to better bare those loads and hopefully reduce the likelihood of injury.

Now I am sure there are people that are out there that are more in tune with what Arsenal are doing at London Colney on a daily basis. Suffice it to say we can probably surmise that the physical training – NOT the technical and tactical training – may not have been optimal to helping Arsenal on the field.

Let’s be clear on the disctinctions I’ve just made above:

• Physical training:  the training done for the body to physically prepare it for the rigors of the season
• Technical training: developing a player’s technical attributes, like passing, touch, finishing, etc
• Tactical training: functional training that helps develop each player’s understanding of their role within the team’s system of play

Clearly we can deduce that the first training is the area where Arsenal likely have been deficient for some time. Or have they? Yes, Arsenal have an inordinate amount of injuries to their players of the “overuse” type. But as you dig deeper the term “overuse” may be bit misleading. Yes, you’d have to be daft not to admit that some of the injuries come from our small squad and lack of rotation of certain players. Additionally, I think Mesut Özil’s injury has more to do with the fact that he played through the summer with a minimal break and no proper pre-season.  You ask why hasn’t it happened to the likes of Per Mertesacker and or Chelsea’s Andre Schurrle? Neither played the minutes that Özil did in Brazil.

Overuse is also a category where you could drop in the likes of Mikel Arteta an older player who may still have something in the tank but really shouldn’t be playing as much as he is. He needs to be managed better unfortunately he hasn’t. But how does overuse cover a player like Abou Diaby – who never seemed to ever recover from his original injury? Remember in the final phase of healing we talked about the fact that your body doesn’t actually get back to it’s pre-injury performance. It doesn’t take an expert to determine that the likelihood of reinjuring oneself either at the original injury site or supporting muscular areas is enhanced.  I’ve always felt that Diaby’s injuries have been a result of a.) his original injury b.) the rush to get him back and c.) the player’s own desire to prove his worth.

Again, I don’t have the foresight to know what Arsenal were doing in terms of physical training prior to the hiring of Shad Forsythe. I think it’s safe to say that it didn’t really seem to be effective. On one level Wenger has to bare some of the blame because he allowed what ever training routine to go on. But he also has to be given credit for seeing the error of his ways and in reaching out to some like Forsythe and having them come in to change things.

I am not sure we should expect immediate returns on this investment. In our piece on Forsythe last week, we mentioned it took nearly 6-10 years for the program they developed to take hold at the German National Team. Unfortunately Arsenal don’t have 6-10 years. But given that the team is together on a regular basis and no every 2-3 months for a couple weeks, there may be an easier transition. I fear the rash of strains and whatnot are a direct result of the transition in physical training styles. When the body is not in tune with a certain physical load, it increases the likelihood of injury (duh) and I think that during the transition to Forsythe’s individual technique we could see certain players respond well and other suffer annoying niggly injuries that keep them out a couple weeks at a time.

In the end, the hope is that the transition is enough to cut out the common occurrence of these types of injuries. Let’s be clear – you will never eradicate them completely. Simple human mechanics will see to that. The hope is though that we will have done enough to make sure we don’t see the annual parade to the physio room.

SIDE NOTE:

A word about this change in training theories. I personally think the delay in getting Theo back and yesterday’s news that Giroud can come back sooner are a direct result of the change to the training staff. Earlier we heard that Theo would be back by the Spurs match but even before that we started to hear very little about his progress. I personally think that he was kept out longer to improve the healing process and get him fit.  I think in years past Theo would’ve come back when it was first targeted – and likely would’ve been injured soon thereafter. I think this was a concerted effort to give Theo to heal to that 90% threshold and give him the best opportunity for success.

I think Giroud is merely a case of the surgery going better than expected and the training team having a plan in place that can get him back in shape. We’ll see if his return is accelerated – I doubt it – but  I wouldn’t be surprised if he is back a couple weeks earlier than originally projected.