Footballers, managers and coaches alike will all be doing everything they can to avoid injuries in the run-up to the UEFA European Championships in the summer of this year. For many players, the chance to play in a Euro tournament represents a dream come true, and marks the high point in their careers.
Focusing on England, manager Roy Hodgson has already ruled out a number of players who have recently suffered injuries. These de-selections include Arsenal mid-fielder Alex Oxlade-Chamberlain, out since February with a knee injury; Jack Butland, keeper for Stoke currently recovering from a fractured ankle; and Liverpool forward Danny Ings, who during training suffered a ruptured anterior cruciate ligament.
Despite the best efforts of footballers and coaches, the Euro 2016 qualifying stages were a time of potentially unavoidable injuries. In this article, we will examine the following questions, answers to which are vital for coaches, sports physiotherapists and players, as well as being interesting for fans. Which teams suffered the most injuries? Which injuries were most common? And, perhaps most importantly, did a higher rate of injuries affect a team’s chances of qualification?
A UEFA study of injuries among the elite clubs during the 2013-14 season found, as perhaps expected, that 87 percent of injuries sustained during football affected the lower extremities of the body below the waist. The ankle, knee, thigh and hip constituted the most common locations of injury. Continuing this trend in the Euro 2016 qualifiers, the most common form of injury was damage to the hamstring.
Former Schalke midfielder and potential German team member Julian Draxler didn’t make an appearance during his nation’s qualifier against Scotland, having been pulled out of an earlier friendly match with Argentina. 20 year-old Draxler limped off the pitch 33 minutes into the game suspecting a hamstring injury, with scans confirming a slight strain which would have been made significantly worse had he kept playing.
That was back in September, but in April of this year Draxler, now signed as an attacking midfielder with Wolfsburg, sustained a torn muscle in his left thigh during a Champions League play-off against Real Madrid. Wolfsburg went on to lose 3-0, but Draxler again departed at the 30-minute mark with a muscle tear, despite putting on a strong performance up to that point. After medical examination, Wolfsburg announced that Draxler will be sitting on the sidelines for a long time to come.
Hamstring recovery and re-injuries
The British Journal of Sports Medicine recently published a study examining injury incidence and patterns in professional football. Among their many findings was that, while re-injuries only made up 12 percent of all injuries, they did lead to significantly longer periods of absence - almost 50 percent longer on average. Whether or not Draxler’s second injury was related to his first is not clear, but this is the case with another footballer who has battled recurrent injuries: Spaniard Diego Costa.
A striker for Chelsea, Costa limped off the pitch during an international friendly against France, complaining of thigh pain. An MRI scan shortly afterwards confirmed that he had sustained myofascial damage to his left hamstring. Myofascial tissue is the tough lining over the muscle, the damage to which led to Costa's absence from the Euro 2016 qualifier match for Spain against Macedonia. Previously, Diego Costa has suffered repeated injuries to his right hamstring - perhaps not surprising, given that hamstring trauma is reportedly the most common injury for professional footballers according to the British Journal of Sports Medicine.
Returning to England, hamstring injuries may shatter the Euro dreams of Liverpool striker Daniel Sturridge, who missed the qualifier against Switzerland after suffering an injury during training. The UEFA elite club injury report mentioned above found that 43 percent of all injuries occur in training - a sizeable amount, and an extra worry for players gearing up for a big championship tournament and wanting to train as hard as they can.
Sturridge reported “thigh pain and discomfort” during the training session, and was removed from the pitch for a medical imaging scan. Sturridge has suffered 14 thigh-related injuries since signing with Liverpool in 2013, and has racked up 33 injuries throughout his career, the details of which have become a regular topic for discussion among fans, many of whom think the club should cut their losses and drop him. While it is unlikely that he will appear in the England squad, Sturridge remains on the Liverpool roster.
Further evidence for the problem of re-injuries and continuing weakness can be seen in the case of Fiorentina striker Giuseppe Rossi. Rossi’s right knee has been injured numerous times since 2011, starting with a series of injuries to his anterior cruciate ligament. This caused Rossi to take over a year out of the game in order to recover. In 2014, a notoriously aggressive tackle from Leandro Rinaudo delivered an injury to the medial collateral ligament of his right knee, leading to another six month absence, despite Rossi being the top goal scorer in the Serie A Italian league at that point.
Just a few months after returning to the game, Rossi sustained yet more right knee damage, this time to the medial meniscus. As a result of the recurrent injury, Rossi had exploratory surgery carried out by leading knee specialist Dr Richard Steadman in London. Specialists have recommended a five or six month recovery window, dashing any hopes of his joining the Italian squad in the UEFA European Championships this time around.
Other injuries which affected team line-ups for qualifying games included Villa striker and Belgium team candidate Christian Benteke’s ruptured Achilles tendon. A particularly severe injury, the player was out of the game for six months, but did continue to travel with the club and participate in light pre-warm-up sessions alongside his teammates.
Riccardo Montolivo, AC Milan midfielder, similarly had to undergo surgery for a fractured tibia in his leg that occurred during a warm-up game for the World Cup against the Republic of Ireland. A broken leg generally takes around six months to heal, but Montolivo returned to training earlier than expected, and re-appeared in competitive play on the pitch after the six months were up.
Across the board, hamstring injuries were the most common - a fact seen in professional football as a whole, and demonstrated by the research mentioned above. The study published in the British Journal of Sports Medicine found that, on average, football players in European tournaments sustained 2 injuries each per season, and thus a team with the usual 25 players should expect to have to deal with around 50 injuries every season.
The severity of injuries can be reduced with plenty of attention paid to careful warm-ups, and the incidence of re-injury - a vital factor that all teams need to minimise, due its long-lasting and potentially career-ending effects - can be reduced by allowing for generous amounts of recovery time, alongside the usual physio that teams employ.
Overall, injuries most likely did affect the scores of individual matches, but none of the teams seems to have failed to qualify as a result of a high incidence of injuries. Indeed, all of the teams mentioned above did qualify. It remains to be seen how far they will get in the actual championship, however.