Slaven Bilić will wait for updates following this morning’s training session as to whether Sam Byram and Aaron Cresswell will be available for the Sunderland clash but we already know that Winston Reid (adductor) is still having treatment and won’t travel.
Slaven has also stated that both Andy Carroll and Diafra Sakho will definitely be involved at the Stadium of Light. While there will be a late fitness check on Aaron and Sam, the final decisions on both could even be left until Saturday morning to allow any reactions from training to be assessed.
Sam left the ground on crutches after the Swansea game, creating a bit of a scare for anyone who saw the photo on West Ham United co-owner David Gold’s twitter feed; but this is normal practice following a lower limb injury.
The important stage in treating any injury is in the first 48 hours after the injury, and getting the immediate management right means taking as few chances as possible. Use of crutches in the early stages will help to offload the injury and minimise the risks of making matters worse so it makes perfect sense.
Apart from Sam, most of the talk in the past week has been about Michail Antonio, who suffered a recurrence of his hamstring injury against Swansea. Michail returned to the team briefly for the Arsenal game ten days ago; but a stomach upset limited his time on the field and he was subsequently withdrawn.
At that stage, there was no indication of the problems to come. There’s every chance that Michail felt fine and that the recurrence of the injury was unexpected.
Michail will have trained fully with the rest of the squad both before and after the Arsenal game, and will have been included in the team to meet Swansea on the basis that he had recovered sufficiently to be able to play.
However, injury recurrences can hit at any time and are not solely limited to the first occasion that a player returns to the team. It can take some time to get back to that previous level of match fitness; and as we’ve said before in this column, you just cannot one hundred percent match the intensity of a game situation in training.
It’s acknowledged that football is a sport which requires aerobic and anaerobic power, together with strength, speed, and endurance in order to compete at a high standard (Mohr et al, 2003).
Many decisive phases during a match, however, require a player to be capable of performing repeated sprints with only a short recovery period in between (Bangsbo et al, 2006) and this places a strain on the muscular system, particularly the hamstrings. Repeated sprints occur regularly during matches (Rampinini et al, 2009) and this is often where the overall vulnerability lies.
Most of the research into football injuries shows that players are at their greatest risk of injury in the latter stages of a game when fatigue begins to set-in (Reilly et al, 2008).
In Michail’s case, though, the injury happened towards the end of the first half; but there was no mistaking its severity. Again, there are no hard and fast rules as to what point of the game injuries are likely to occur; it’s all to do with the action performed at the time.
Against Swansea it’s possible that Michail was feeling the pace in what would have been his first proper game at full fitness; since if he was under the weather against Arsenal due to the stomach upset the likelihood is that he wouldn’t have been able to work to his maximum. If he had, then perhaps his susceptibility to re-injury would have been evident that night at the Emirates.
We’ve known for years that hamstring injuries are notorious for their high recurrence rate; and extra care needs taken with rehab in order to make a return to play at the right time (Woods et al, 2004). Average injury times for a hamstring muscle injury are up to ten days for a minor Grade 1 muscular strain, which is the tearing of a few muscle fibres only.
Between ten days and up to four to six weeks represents the typical healing time for a mild to moderate Grade 2 strain; which is your average hamstring strain more often than not and this is the category that Michail’s injury will have fallen into.
Grade 3 tears which involve a complete rupture of the muscle will obviously take a lot longer but thankfully these are few and far between.
Nobody likes recurrences of injuries; but unfortunately these things do happen. Dealing with repeated injuries can be a challenge to club medical teams. Nevertheless, it’s still incredibly frustrating to walk into your clinic or club the day after a game and the first person who limps through the door is the one you thought was doing so well a few days ago.
There is a physiological reason for this; and it’s one that doesn’t tend to be stressed enough to coaches, managers and in particular the players. When dealing with damaged tissue the body doesn’t heal in a like for like manner; and the new tissue provided isn’t an exact substitute for the ligamentous or muscular fibres damaged by the original injury. The replacement tissue produced by the body is of a different quality and thus alters the tissue balance of the injured muscle or ligament.
Additionally, research has shown that the biggest single risk for injury is having had a similar injury to the same structure in the past (Hagglund et al, 2006) and whether that’s been six weeks or six years ago doesn’t matter; the inherent risks of recurrence are there.
Players will also have their own ideas about how long the injury is likely to take to heal based on precedents set by others not involved in the injury management process and that in itself can be a problem.
So although the Hammers medical people will have done everything possible to minimise the risk of Michail having a recurrence of his original injury, often it’s all about what happens on the day.
Injuries frequently recur as the result of a sharp, sudden or unexpected movements, and / or a succession of repeated sprints. When a player ‘pulls-up’ sharply as Michail did against Swansea, that’s the classic presentation of a hamstring tear; either as a first time injury or as a recurrence.
To finish with a reference, it’s the combination of these factors that render an athlete susceptible to injury; but it is the sum of their interaction which prepares for the injury to occur (Bahr and Holmes, 2003).
Often then, once the match kicks-off, circumstances just conspire to lead to an injury. Recurrences are unfortunate; but we have to accept that it’s impossible to exclude these completely. The best we can do is to try to minimise the risk of this happening as much as possible. Sadly, injuries are all part of the game.
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