West Ham United's immediate injury focus is on the Hull City game

After a relatively-quiet international break that didn't affect the squad too much, West Ham United continued with full training in the build-up to the Hull City game. Doubts remained on Thursday over the fitness of club captain Mark Noble and indeed over the future of coach Slaven Bilić as the squad prepared for the trip to East Yorkshire this coming Saturday.

Even though the club are currrently in a respectable position in the league table, the longer-term injuries sustained to key players have limited the choices available to Slaven Bilic.

With these, it can often be a never-ending loop. As Angelo Ogbonna, Gökhan Töre and Diafra Sakho approach the latter stages of their recovery period, Pedro Obiang is only just starting out on his.

Although we're not going to see Pedro for a while, it is encouraging to hear that both Michail Antonio (hamstring) and Winston Reid (adductor) remain on schedule. The suggestion from Slaven Bilić himself in midweek was that Michail Antonio might well be in contention for a first team return a lot sooner than perhaps originally expected.

Hopefully, there will be an update on both players shortly.

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As Diafra Sakho continues his own rehab and fitness work in London, it is interesting to note the variations in some reports which appear to indicate he is a lot nearer reaching full fitness than in others.

Reporting on injury progressions can be difficult; since clubs tend not to give too much away when it comes to defining exact stages of injury progressions. You will always get conflicting opinions where players and medical staff are concerned and this is seen on numerous occasions where players are reported to have played through the pain; as Robert Snodgrass recently stated after the Leicester game.

Clearly,the medical teams aren't going to sanction players turning out with injuries that could be easily aggravated and lead to further or more serious damage.

West Ham's medical people are advising caution with Diafra as the Senegalese international attempts to return to the squad following a back operation. There are some injuries that you can shake off and there are some you can't; an operation being one of them and attempting to make too early a return often only ends in tears.

With apologies for the repetition, if you try to come back before you are ready, then the potential for repeat or recurrence of injury is ever-present; and that is backed by fact as opposed to opinion.

Hagglund et al.,(2006) stated that the biggest single risk for recurrent or repeat injury is having had a previous injury to the same area already; yet with the best of intentions players will often insist their recovery is complete.

With the evidence in many cases pointing to the opposite, it doesn't actually matter whether a player tells you or the coach / manager that he feels fine and will be ready to play on whatever Saturday it is in question. This is often unsupported factually and the risk of recurrence will follow.

This will almost certainly be the point that West Ham's Head of Sports Medicine Stijn Vandenbroucke and the West Ham medical team are making at the moment over Diafra Sakho’s intended return to the team. It's still very early days yet and although Diaf is reported to have stepped up his fitness work and actually trained with the squad this week, the medical and fitness people obviously feel that ample scope for further improvement exists.

In a nutshell, then, they feel that he's simply not ready to return to the first team at the moment.

This doesn't mean that Diafra is not making progress; just that there are certain fitness targets that need to be met before a player can be considered to have recovered from injury sufficiently in order to return safely to the team with the minimal risk of injury recurrence present.

It's the same when it comes to 'playing through the pain' as Robert Snodgrass mentioned after the Leicester match, sometimes as a player you do just play on. However, in these situations you just can’t win. There are no allowances made for carrying an injury once the game starts; you are either fit or you aren’t in the eyes of the management and indeed your team-mates.

If you’re not fit then you shouldn’t be playing; and if you are fit there can be no excuses for not making tackles and runs so Diafra needs to choose his moment of return with care.

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Finally, hopes are high that Mark Noble will return to the team at Hull City following a bruised thigh muscle. This true extent of this type of injury can often be understated and there are certain kinds of 'dead legs' that take longer to recover than others.

If Mark's injury falls into the latter category, then the risk of recurrence is high; so once again there will be careful thought going into whether he is fit enough to return at the weekend or not.

No doubt he'll be in Hull anyway even if he isn't playing; and encouraging his team mates. Off the field, Mark has had an up and down period with the Hammers' supporters of late and having a go at them sometimes only makes matters worse.

There's bound to be a lot of tension around the club right now and things can be said in the heat of the moment that are difficult to retract once the situation has passed. With more pressure on the players and management to deliver, the game in Hull takes on a new meaning.

Reference:

Hagglund M, Walden M, Ekstrand J (2006). Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. British Journal of Sports Medicine. Vol. 40; 767 – 772.