Discussing West Ham’s Current Injuries at the International Break

Just when it looked as though things were improving on the injury front, three further casualties have now added to the work of the medical team led by West Ham’s head of Sports Science and Medicine, Stijn Vandenbroucke.

However, with the reported improvements in the conditions of those players carrying longer-term injuries, it’s now back to basics for Stijn et al with some of the most frequent injury presentations in football demanding the full attention of the medical staff. There’s no doubt that they’re all earning their salaries this season; having had a wide and varied caseload to manage over the past few months!

Winston Reid (adductor), Michail Antonio (hamstring) and Pedro Obiang (ankle) all joined the Hammer’s injury list after the defeat to Leicester City. Now that all the injuries have had the chance to settle, this is a good time to take a deeper look at these and see how things have progressed in the past week.

Winston Reid came off against Leicester with a groin injury. Initial fears were that Winston had torn the adductor tendon from the bone although scans have since reported that the injury is confined to the actual muscle itself. Adductor / groin injuries are difficult to treat anyway and recovery can be awkward in terms of rehabilitation.

As we know from discussing Andy Carroll’s injury in earlier columns, the rehabilitation period can be lengthy if these become chronic and patience is often required. Any injury sustained in the hip and groin region can be sensitive when it comes to the changing of direction element associated with football; so it’s vital to know that you are at the correct stage of healing before returning to play.

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However, it’s early days yet for Winston. According to Stijn Vandenbroucke on the club website in midweek, the initial prognosis is that Winston is likely to be out for around five weeks so we’ll wait for further updates from the club as and when these become available.

Winston should have been away this week on international duty with New Zealand but since that’s obviously not going to happen, he’ll remain in London for treatment.

Like his Kiwi colleague, Michail Antonio should have been involved in the internationals but a hamstring injury also sustained against Leicester has put paid to his England call-up. Return to play times for hamstring muscle injuries vary according to their severity and nature; but early reports indicate that the club medical people are anticipating Michail’s absence from the first team to be around three to four weeks.

That estimation could well vary as the treatment period progresses. Since it is not always possible to determine the full extent of an injury by clinical examination alone in the very early stages, clubs will often use medical imaging to assist with the working diagnosis of an injury. Michail’s now reported to have had a scan earlier in the week so hopefully things won’t be as bad as initially feared.

At professional level, different sorts of imaging are used to enhance the quality of the diagnosis with MRI scans having been validated for the diagnosis and prognosis of acute hamstring injury (Ekstrand et al, 2012); Kerkhoffs et al, 2013). Since previous studies have shown that MRI scanning of fresh hamstring injuries have diagnostic and prognostic value (Reurink et al, 2014), a reasonable estimation of the extent of the injury can therefore be made in conjunction with the clinical impression.

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Hamstring injuries are the most frequently occurring of all the lower limb muscles injuries sustained in football; a fact that has been researched and proven time and time again. There’s no doubt that these injuries can be debilitating to the players in question. As referred to in previous injury updates throughout this web, the incidence of hamstring injuries in football is reported to be 37% according to Ekstrand et al (2011), making these by far the most commonly injured muscle group where the lower limbs are concerned.

The third injury from the Hammer’s game against Leicester was to Pedro Obiang. This was a nasty-looking ankle injury which has since required surgery. Pedro’s injury was reported as a “high ankle sprain” and injuries in this category differ from the routine ankle sprains and generally take longer to heal. As the term implies, high ankle sprains involve damage being sustained to the ligamentous and bony structures immediately above (but also including) the ankle joint itself. Complications can occur as a result and surgery is often required as was the case with Pedro.

Although perhaps less frequent in football as opposed to American football and / or rugby league, these injuries can and do occur regularly in soccer. This is particularly true in contact situations where a player is tackled around the fixed foot. Early diagnosis of these injuries is essential in order for the correct injury management to follow so well done again to the medical team for being so prompt with their actions.

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In football it’s impossible to legislate for every eventuality and sometimes injuries occur that just can’t be prevented. The key lies in dealing with the regular injuries while being prepared for the unexpected; and this season several of the injuries sustained have been difficult if not impossible to allow for.

So even though that’s another three players out of the side for the time being it’s important to remember that of the latest injuries sustained, two of these are common injuries which are always likely to occur; and Pedro’s injury isn’t all that unusual although perhaps less frequent in nature.

Finally, in looking at the longer term impact of these injuries, the fact that we’re almost into April already doesn’t help. Since Pedro went on to have surgery his rehabilitation period is likely to extend well into the summer. That’s also the reason why the odds are now reported to be against Diafro Sakho featuring again for West Ham this term.

Sadly, the international break isn’t going to make a lot of difference to the players we’ve discussed above; but hopefully it will give some of those who are carrying minor or irritating injuries the chance to recover without having the added worry of a Premier League match to think about as well.

References:

Ekstrand J, Hagglund M, Walden M (2011). Epidemiology of muscle injuries in professional football (soccer). American Journal of Sports Medicine. Vol 39; 1226 -1232.

Ekstrand J, Healy JC, Walden M, Lee JC, English B, Hagglund M (2012). Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play. British Journal of Sports Medicine. Vol. 46; 112 – 117.

Kerkhoffs GMMJ, van Es N, Wieldraaijer T, Siervelt IN, Ekstrand J, van Dijk CN (2013). Diagnosis and prognosis of acute hamstring injuries in athletes. Knee Surgery, Sports Traumatology and Arthroscopy. Vol. 21 (2); 500 – 509.

Reurink G, Goudswaard GJ, Tol Jl, Almusa E, Moen MH, Weir A, Verhaar JAN, Hamilton B, Maas M (2014). MRI observations at return to play of clinically recovered hamstring injuries. British Journal of Sports Medicine. Vol. 48 (18); 1370 – 1376.