Injury updates: It’s been all about surgery this week at West Ham United

It’s all been about operations in the last couple of weeks with another three West Ham United players going under the knife.

It’s been reported that Mark Noble was the latest to have surgery; this time on a double hernia which has troubled him for some time. Slaven Bilić indicated that Mark wanted to keep this quiet until the potential threat of relegation had been removed and the club have obviously respected his wishes.

Although reported as a hernia, use of this terminology when referring to footballers can sometimes be confusing. The “sportsman’s hernia” as it is known, normally refers not to an actual hernia as such but more of a chronic disruption of the tissues in or around the groin area.

Symptoms of groin pain on exercise are common in football and the condition has been referred to by several different names over the years. A detailed review of the condition which typically affects the lower abdominal / inguinal region and refers into the adductor (or groin) tendons was published by Dimitrakopoulou and Schilders (2016).

Groin pain on exercise can be either unilateral or bilateral.

The classic symptoms are of chronic exercise or activity-related groin pain typically aggravated by increased activity such as twisting and turning, running and changing direction, together with sprinting.

In other words, all the movements associated with football!

Photo by Mike Hewitt/Getty Images

Hammer’s Head of Sports Medicine Stijin Vandenbroucke also revealed this week that Cheik Kouyate has undergone surgery on a painful wrist injury that has troubled him for the last two years.

Seen here wearing a strong wrist brace, playing with such an injury can’t have been easy. Although wrist injuries in football to outfield players are generally less troublesome than they are to goalkeepers, the same risks apply in terms of falling on the outstretched hand or overuse mechanisms.

In the UK, injuries to the wrist are common in rugby league football and in tennis amongst other sports including of course rugby union, but as far as football is concerned, injuries to this region are relatively rare with the exception of those sustained by goalkeepers.

Outfield players tend to be more susceptible to upper limb / shoulder /wrist and hand injuries since these are almost always the result of landing after a fall and they are often unprepared for the impact (Volpi, 2006).

Goalkeepers, however, tend to ‘roll’ with the landing and learn how to hit the ground safely, thus giving themselves the minimal risk of ground-contact injuries.

That’s not going to make Cheik feel any better though as he’s going to be out of action now for several weeks. He will be able to train to a certain extent in a few weeks’ time as the healing process continues but will need to avoid any bodily contact during the early stages of his return.

According to club co-chairman David Gold in midweek, Cheik will be in plaster for the next eight weeks before removing this in order to begin his specific exercises.

Cheik will be able to exercise aerobically in the meantime under the supervision of the medical team and will be able to keep himself fit though gym and water-based exercises in addition to circuits designed to maintain his fitness levels as much as possible pending removal of the cast and concentrated rehab.

Photo by Bryn Lennon/Getty Images

The third recipient of corrective surgery was Michail Antonio.

Operative surgery to the hamstring muscles is indicated exclusively in cases where massive muscle tears are present leading to functional impairment or where the resulting haematoma is accompanied by significant blood loss (Järvinen et al, 2007).

Most injuries heal without the need for surgery unless either of these factors are present; with physiotherapy treatment the main focus throughout beginning with standard cryotherapy and following a progressive regime leading to a return to play.

However, based on current research it appears that good or even excellent results are obtained in cases where surgery is indicated and this has been noted to facilitate a return to play (Lempainen et al, 2006).

As always, the hard part for Michail will come with the rehabilitation process which is likely to take several weeks.

In terms of making a full recovery and returning to fitness, the same applies to Mark and Cheik as well.

The body needs to heal; and although it can be tempting to make predictions these can often come back to haunt you in the future if things don’t work out as planned, even if the reasons are unavoidable.

It is sometimes better just to assess progress on a daily or even a weekly basis in the case of the longer-term injuries, and simply work around a return to fitness date based purely on physiological as opposed to theoretical time scales.

References:

Dimitrakopoulou A, Schilders E (2016). Sportsman’s Hernia? An ambiguous term. Journal of Hip Preservation Surgery. Vol. 3 (1); 16 – 22.

Järvinen TA, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M (2007). Muscle injuries: optimising recovery. Best practice & research: Clinical rheumatology. Vol. 21 (2); 317 – 331.

Lempainen L, Sarimo J, Heikkilä J, Mattila K, Orava S (2006). Surgical treatment of partial tears of the proximal origin of the hamstring muscles. British Journal of Sports Medicine. Vol. 40 (8); 688 – 691.

Volpi P (2006). Football Traumatology; Current Concepts from Prevention to Treatment. Milan, Springer.