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FAN ARTICLES

Vaughan, Arteta, Jagielka Simply Bad Luck? Maybe Not.

By Mick Wrende :  27/04/2009 :  Comments (58) :

Could these catastrophic injuries have been avoided? Is anyone to blame?

When Tim Cahill arrived in Sydney for the World Cup qualifier 3 weeks ago, the Australian medical team was very scathing of the treatment he had been given for his calf injury by the physiotherapists at Everton. They commented he was hardly able to walk off the plane and that Everton should be grateful for the therapy he received in Australia to heal his injury. He was indeed not fit to play in the international.

I was over in Melbourne at the time for a short visit and as a lifelong Evertonian, my initial reaction was to react by thinking how dare they criticise our beloved club. But there was a niggle in my mind as, being in the medical profession myself, I have thought on several occasions, that our players do seem to take a long time to recover. Take, for example Cahill?s metatarsal relapse and more recently Saha?s hamstring that seemed to take forever. Furthermore, we do seem to be ?unlucky? with injuries compared to other clubs.

Now we are faced with yet another serious injury with Jags and not only that but our third major anterior cruciate ligament in recent times and our second within two months.

There is no doubt that this type of injury is becoming more common but nonetheless three such injuries is too much of a coincidence. Some people blame the modern pitches, others tiredness from playing so many games. Both of these may be true as over 80% of cruciate tears are non-contact. They happen when there is a sudden change of direction or when a player jumps for a header and lands awkwardly.

The cruciate ligament is a tough structure, rather like a coiled piece of rope in the knee, and it needs considerable force to rupture it. When it does rupture, because it is so tough, it needs major surgery to repair it and a long time to recover. The impact on the player and club can be devastating. In Everton?s case the difference in the loss of these players may be failing to finish in the top four and the possibility of losing the cup final. So can these injuries be prevented? Not surprisingly a great deal of time and money has been spent in seeing whether this is possible. Studies in both Italy and America have shown that by increasing proprioceptive training, cruciate ligament tears can be greatly reduced. In fact, players who had done this training were ten times less likely to rupture the ligament then those who had not.

Proprioception put simply is the ability to feel when your foot touches the floor so you immediately transfer your weight on to it. In normal walking this is done automatically but there is still a slight time delay. So if you put your foot down awkwardly you are at risk, for example, of turning over your ankle before you react. If you do intensive proprioceptive exercises you can reduce your reaction time and thus prevent the turning over of your ankle or in relation to your cruciate ligament, prevent the sudden shearing force on the knee.

Now it may still be that it has been simply bad luck with our players but three sounds too many to me. Do you think that our players are doing these exercises? I don?t know but I suspect not as, the top physiotherapists, for various reasons, do not go into football clubs. Maybe with the best training either Mikel or Jags or both would still be running out on that Wembley turf at the end of May. Surely, after Vaughan?s injury the medical team at our club should have looked at this. We are the best club in the world bar none and our players deserve the best. But are they getting it? If they cannot treat Cahill?s calf strain properly then what confidence can we have in them. The doctors and physiotherapists at Everton need to stand up and be counted over this. Their Australian counterparts may indeed have had good reason for their criticism.

The cup final will be a great day out. To see the boys in blue at Wembley again will be brilliant. But how much greater it would be to have both Mikel and Jags there as well.

Reader Comments

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Martin Cutler
1   Posted 27/04/2009 at 17:16:59

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I doubt if anybody reading your post could comment as to whether the club are doing what you are saying or would have any specific knowledge about the quality or lack thereof in EFC’s medical department.

Although I do find it difficult to comprehend why Cahill would arrive in Australia "hardly able to walk". Surely if that were the case then he simply wouldn’t have gone?

However, I would suggest that you contact EFC directly and put the question to them.
Michael Hunt
2   Posted 27/04/2009 at 17:16:56

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I understand the frustration 100%, it is gutting that Jags (and Mikky, Vic, Yak etc before him) have suffered such bad injuries. However, it is a fact of the game that injuries are commonplace, I feel we have just been especially unlucky this season. Here's hoping for the rest of this season, and nexrt season onwards, the players of Everton have much better luck.

Everton?s physio and medical team is top notch, without them the squad would be far worse off. To suggest otherwise seems churlish to me. Onwards and upwards Evertonians, the glass is still at least half full: Come season?s end there can be Cup as fitting reward for the real togtherness and teamwork that the Everton family have demonstrated in adversity by depleted resources.

It is 11 v 11 and our TEAM shall remain greater than the sum of its parts and forge onwards to achieve glory on 30th May. Coz were the TEAM that's gonna WIN THE FA CUP, WE SHALL NOT BE MOVED.
COYB!<

Steve Edwards
3   Posted 27/04/2009 at 17:23:56

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Very interesting, it certainly gets you wondering. On the other hand I’ve always thought of Everton as a very unlucky club.
Anthony Dyer
4   Posted 27/04/2009 at 17:22:23

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Everton have indeed suffered from bad luck with injuries, not just this season, but for as long as I can remember. Although I don?t remember a time when so many important players received such bad injuries in such a relatively short period.

I would be suprised if David Moyes neglects to oversee the medical department as it has such importance on his planning and preparation for matches. On the other hand, when a club is struggling for cash it may be seen as an area where savings could be made.

Whilst the injuries have had a detrimental effect on the current season, I am more concerned with how it will effect the start of next season and the ramifications that it will have on our results. Obviously, we want all our players who are out injured to receive the best care possible and wish to see them back in the team asap; however, there may well be a requirement for a review of how we prepare and react to so many serious injuries to senior players.

Let?s just hope it is down to plain bad luck and not bad practice.

John Nolan
5   Posted 27/04/2009 at 17:55:10

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I think the problem is down to the small squad. As more players get injured we are relying on the same player week in week out and as such these players do not get a chance to rest and fix minor knocks and injuries. If not treated minor problems become big problems. If we had suffient depth to our squad we would be able to rest players from time to time to allow players to fully recover.
Steve Hopkins
6   Posted 27/04/2009 at 17:35:54

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Good article and certainly food for thought, I must admit it was something that had crossed my mind before. Although in these days of extreme player power I struggle to believe that international footballers, of which many of our squad are, wouldn’t complain about any substandard facilities or care that they had received!
Si Kirwan
7   Posted 27/04/2009 at 18:21:12

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Tired muscles and bodies are more susceptible to injuries - this and bad luck are the reasons for our injuries.

Interesting point, however...
Ken Buckley
8   Posted 27/04/2009 at 18:21:21

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I reckon just too many games at this level with a small squad. Man U rotate pretty well except for the back four and that's where most of their injuries have been this season. I suppose the more games played the more wear and tear leaving a small squad like ours at high risk.
David Alexander
9   Posted 27/04/2009 at 18:41:35

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I think this is a little critical for several reasons:

Saha takes for ever to recover cause he’s not been fit in years and so isnt a good example

Cahil’s metatersal break was treated by an oz based surgeon not the Everton medical staff - that sugeon kept him on the sidelines for so long, pluss it was his third such break in three years so you would want that extra caution.

Cahill probably hobbled of the plane because he wasn’t fit to be on it in the first place - flying for 20+ hours injured is going to leave a player struggleing - maybe the australian FA shouldn’t have asked him to fly and should have let him have rest and treatment here.

On the Proprioception question, I remember after Cahill’s 2nd metatersal break reading that the club felt the injury was caused by the way he was landing after jumping for headers. The answer was aparently special training so that he learned to land diferently and not stress that part of his foot so much - which might suggest that the club do think of these things.

All in all I think the medical staff deserve some credit, most injuries do just happen.
Andy Crooks
10   Posted 27/04/2009 at 18:58:31

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An interesting article, Mick. I know certain players are injury prone but so, it seems, are certain clubs. We are one of them and it is something the club need to look at closely. Especially with regard to how long our players seem to take to recover.
Dan Brough
11   Posted 27/04/2009 at 18:51:24

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Maybe it’s the club’s new method for keeping it’s top stars...no-one’s gonna buy a crock, cept maybe the barcodes :-)
Dave Gommery
12   Posted 27/04/2009 at 19:18:44

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Its an interesting point but I don’t think it is the reason. With medical experience myself I know what you mean about the cruciate, tough little thing. Wonder if any of the top clubs do this training?
Andy Morden
13   Posted 27/04/2009 at 19:59:19

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I’m not sure about this argument that we have terrible luck with injuries every season. Under Walter Smith we were crock central, but with the swift removal of Smith, Knox and the infamous ’baseball bat’ our injury record under Moyes was fairly good. Last season I think we were very, very lucky with only Baines being out of action for any serious length of time. We just couldn’t get a decision from refs! This year we have had hideous luck with injuries, yet have been getting some decisions go our way. As they say, "it’s a funny old game"...
Mike Oates
14   Posted 27/04/2009 at 20:11:39

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Mick, I wrote an e.mail about 12-18 months ago regarding the extended recovery periods for our players. At the time I very roughly compared similar knocks as reported ie strains, pulls, etc vs some other teams and we seemed at least 30% longer.
Nick Entwistle
15   Posted 27/04/2009 at 20:19:42

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I remember when we finished 4th, we had next to no injuries and Liverpool had a bucket load...
Peter Roberts
16   Posted 27/04/2009 at 20:29:30

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Can’t really comment as I have no medical knowledge but as far as I know the cruciate can go with any sudden movement of the knee, and sometimes cannot be prepared for. A work colleague of mine did her cruciate ligament about 6-7 months ago playing tennis. All she says she did was turn sharply during the game and snap, it went. Cue many weeks off work before returning to work at home (one advantage of working for a major corporation) and at least two operations, one exploratory, one to repair the ligament.

Your point though about the return to fitness is interesting, though I think it’s partially due to the mindset of the club. We have one of the most stringent medicals in the league, and are well known for it. Andy Gray mentions this in his autobiography when he was at Wolves - he literally spent the night before going up burning several pieces of paper detailing his knee surgery from early on in his career because he was so sure if he went with the full truth they would not pass him fit. Maybe it’s for this reason we return players longer than everyone - because our fitness tests are so thorough that players passed fit at other clubs may not pass fit for Everton. A trait of the Moyes, perhaps?
Alan Clarke
17   Posted 27/04/2009 at 20:51:12

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I am currently 4 weeks on from an ACL repair so can speak from 1st hand experience regarding what it is like to tear it. 1st of all it is incredibly fucking painful. Most cruciate tears occur when the knee is fully extended and an excessive twisting force is applied to the knee. In my case it was in a tackle on the rugby pitch. Most of us remember Michael Owen in the world cup - you could see his knee take up the slack of his ligament then ’pop’ as he crumpled to the floor.

It is obviously very difficult to prove whether such injuries are avoidable. I think it is more bad luck that these injuries occur rather than bad training methods. One of the best ways of improving proprioception is functional training i.e. training of the action that you are most likely to perform. You can’t doubt that football players don’t train hardest on their essentials such as kicking and jumping.

If the rehab stage were to take longer or players struggle to regain fitness following the injury then you can question the physio or medical team. My concern with ’Baz’ Rathbone is that he got his job through being an ex-pro and a mate of Moyes rather than being the best qualified physio. But on the other hand both Chelsea and Blackburn have excellent medical and physio set ups and both have players out with ACL injuries - Steven Reid, Michael Essien and Joe Cole.

And Saha couldn’t keep fit at Man U who must have all the mdecial resources any club could wish for so how the fuck Everton thought he’d stay fit is beyond me.

If you remember the season we finished 4th we had fantastic luck with our team not getting injured. I think this season the injuries are just bad luck.
Pat Ahern
18   Posted 27/04/2009 at 21:21:24

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I like this post as it asks questions about the training and experience of the physios at Everton without being critical. I would assume that given the value of Premiership players that we would not have unqualified people treating their injuries I would therefore assume that they are all qualified with their respective medical organisations and be state registered, e.g Chartered Society of Physiotherapists and use the MCSP letters after their name. Lets look at it another way, if we owned racehorses then we would let unqualified vets look after them. With regards to the lack of qualified physios not wanting to get into the game, after talking to a Scottish Womans Team physio who takes annual leave from her day job to attend matches, she points out that football is the only sport she knows that does not insist on fully qualified and state registered physotherapists being employed.

From a historic point, then we are hopefully just having an unlucky year because compared to pre-Moyes times when we appeared to lose people with career ending injuries, that does not seem to happen as often.

On a final point about pitches, I would also raise the point about blades and studs on the boots. Apparently, there is evidence that the blades on hard ground does not allow the foot to turn like a pair of studded boots therefore transferring the turn into the knee. Does anyone know what type of boots Arteta and Jags wear?

Its run all over the place this post but I think its important that players get the right advice to ensure they can deliver for the Blues but also to ensure they have less problems when their careers are over.

Let shout for Jags and Arteta at Wembley COYB
john sreet
19   Posted 27/04/2009 at 22:41:48

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pretty ridiculous if you ask me..............so Fabregas and Arsenal also have a poor medical staff etc etc.
The Aussie management have a hate relationship with everton, do you not think that Tim Cahill might just have a thing to say if he felt he did not get the best of ttreatment at everton.....................besides what do a bunch of aussies know about football
Russell Buckley
20   Posted 27/04/2009 at 23:19:31

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I know he played for the shite, but Harry Kewell had ongoing groin problems that Liverpool?s medical staff couldn?t fix. He ended up going through surgery again in Australia and is now playing the house down and getting regular football with Galatasaray. Its a big reason why Australian national teams do so well for a country of our size. We have some of the best sports science programs and facilities in the world.

Despite their money I think football clubs don?t always look after a player's health as the number one priority. That will always be results.
Dick Fearon
21   Posted 27/04/2009 at 23:25:59

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John Sreet, to quote an old Aussie saying: ?You?ll keep!? Anyhow, back to the ligament of contention, eh... Bodies that are always punching above their weight must be more than usually susceptable injury.
Richy Jenkins
22   Posted 27/04/2009 at 23:31:35

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Sorry Mick but I do struggle with the concerns you?ve expressed. You say you are ?medical? ? may I ask in what capacity?

As a chartered sports injury physiotherapist and as someone who suffered a cruciate ligament rupture (and underwent reconstruction last year) playing football 2 seasons ago, I have some experience in this area and am struggling to see what you feel is so lacking in the treatment and training of our players at Everton?!

Do you really think they don?t carry out proprioceptive, plyometrics and stability work along with all the other fitness, agility and skill training, not to mention nutritions and constant medical review? Is any football club in the league that naive?! I doubt it!

Phil Jagielka has played more football this season than any other Everton player and certainly fatigue ?may? have played a part in his ACL injury, but sometimes you?ve just got to accept that in any sport you risk injury. Is it the fault of the physios and trainers that so many Everton players have suffered injury this season?

What about West Ham's injury woes, or Arsenal?s ever growing list of walking wounded? You?ve just got to accept that some seasons you get the ?breaks? (please excuse the pun!) and others you don?t!

Let?s not try and find scapegoats for an unlucky run of injuries, rather just get behind Everton FC, and that includes the back room staff who are always professional and do a great job as well as players and manager.

Stewart Littler
23   Posted 28/04/2009 at 02:44:06

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The only reason for an ACL going that could be avoided would be if the knee had been injured previously, and therefore weakened. As you yourself stated, the ACL is tough and designed to withstand all sorts of pressure.

It does however have a weakness, namely when a twisting motion is applied to the joint at the same time as pressure from top or bottom. To suggest an ACL rupture could be avoided is ridiculous ? it is bad luck, simple as. The fact that it?s happened three times is just more bad luck.

I?m not medically specialised in this area, but I have experience, having torn my right ACL playing football. I didn?t play for two years and have ongoing issues with my knee. The fact that pros are able to play at all again is thanks to the advances in medical science. Three cruciates in one season may be seen as suspicious, but it is simply bad luck, end of.

Paul Hennessey
24   Posted 28/04/2009 at 05:06:18

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If the injuries are down to the intensity and nature of the training that the players are doing or the then how come then that each of the injuries have occured during a match?

We have just been unlucky and unfortunately the players that have been playing the most are more likely to get these injuries.

What I worry about is that everyone is expecting all three to return as if nothing happened, I would be very suprised if all three are able to come back the same players as before the injuries.

Let?s keep our fingers crossed we see the three back and that there are no further complications, it must be said though, that is a massive ask...

Paul Columb
25   Posted 28/04/2009 at 05:08:56

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Mick; interesting point. I?m an orthopaedic physio in the States where the Sportsmetrics program (the proprioceptive program in the US to which you refer) is routinely used, particularly with female athletes who are more at risk of ACL injury. Custom orthotics are often employed where foot anomoly can predispose the athlete to injury or sub-par performance. Theses stratagies are routine in the profession at this point and where there is a multi-million pound patient on the treatment table my hunch is that the latest in sports medicine is employed in injury treat ment AND prevention.

The nature of the beast is such that these traumatic injuries will occur and when fatigue is a factor, non-contact ACL injury is more likley. Never had the chance to see what goes on at FF but it?s food for thought .........I?m sure Mike Rathbone & Co are well on top of it. COYB

Richard Parker
26   Posted 28/04/2009 at 07:36:33

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This training sounds like a good suggestion to me, you?d hope that the people at Everton are aware of it and use all of the tools at their disposal.

Maybe this is something they can do in-between practicing hitting Mo?s Fro.
Gary Hegarty
27   Posted 28/04/2009 at 07:54:20

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In simple terms it happens. As a former semi-pro footballer I had my fair share of injuries including the ACL and patella tendon tear (my kneecap disappeared half way up my thigh). Despite very intense physiotherapy by John Swires (Man United physio) it didn?t stop it happening again.

The reason I was largely given was too much football as a kid ? wear and tear takes it?s toll and it?s no coincidence that until Chelsea Jags had played every single minute in the league. I just hope he gets back to his best ? and Mikel for that matter. They are fighters and are clearly Blue so I?m sure there are no ifs!!!!

Wes Coles
28   Posted 28/04/2009 at 08:24:48

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A fantastic article and very thought provoking judging by the responses. Isn’t it reassuring that we have Evertonians from all areas of the globe with the passion and the knowledge in the finer details, such as the scientific elements concerning the injury to Jags.

The incredible depth of sports medicine available in Australia makes me wonder if Everton could employ an absolutely brilliant sports doctor to work alongside our current team. Seriously the Aussies have something special when it comes to injury and prevention!

Come on Everton!!!
Ben Rostron
29   Posted 28/04/2009 at 08:57:56

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I seem to remember one game where Walter Smith fielded 9 defenders with Watson and Rhino upfront.... so things maybe bad at the moment, but they?ve got better over the years!!!!
Iain Love
30   Posted 28/04/2009 at 09:12:55

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As stated before a small squad = more games = more injuries. I don't think Everton's backroom staff are any worse or better than other teams.

I was in a health club in Wilmslow and saw probably the richest player in the country, Owen, there. I asked one of the staff how come he was there? I was told he had come for treatment from one of the guys there, it seems he?s better than any Newcastle can afford. I was told a lot of City players see him as well...?

Alan Clarke
31   Posted 28/04/2009 at 09:26:21

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Rich Jenkins, yours is a typical 'know it all' sports physio response and I?ve met a few in my time. Mick is right to ask the question without being criticised. By all means put your opinion forward, but don?t think your qualification puts you in the right all the time. For all you know, Mick might be head of the sports medicine council!
Tim Wardrop
32   Posted 28/04/2009 at 09:21:29

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Very good article.

My thoughts are as follows: a lot of people believe that players (all pros, not just Everton?s) suffer more injuries because of the amount of football that is played and the lack of rest / recovery time. I think it?s more to do with the "tuning" of players.

To explain this I use the comparison of a formula 1 car, or a top race horse, with a Premier League footballer. Ferrari, McLaren, Team Brawn etc.....they push their cars to the absolute acceptable limit they possibly can in testing. They work every sinew to tune the performance of the car up, get extra bhp from the car, increase aerodynamics etc, so that the cars are always on a knife edge and close to breaking point. Similarly, Paul Nicholls, Mick Channon, Henrietta Knight.....all the top race horse trainers train their throughbreds to the highest possible level of performance they can. These animals are as lean as they can be, as sharp as they can be and as agile as they can be.

What is the result of all this? Put simply, formula 1 cars and race horses are more likely to break down, or pick up an injury than my VW Golf, or a horse that is cantered around a paddock three times a week., which aren?t tuned to the same degree and therefore have more scope, or range of reliability. Road cars are built with longevity in mind and aren?t pushed to the threshold of their capabilities in the same way as an F1 car is.

So - in comparison to footballers: modern Premier League players (as a result of increased sports science, better diet and fitness, attempts by clubs to get even more out of their players) are simply higher tuned than they were 20 years ago. This means that ligaments such as the ACL, or calf and hamstring muscles, are constantly on that thin dividing line between being able to function at absolute maximum and breaking down. For me this explains why modern professional footballers suffer more of these types of injuries than ex-pros. As if to emphasise the point, I play a lot of Sunday League football and almost all the injuries I?ve ever witnessed have been impact injuries, caused in the tackle. I?ve only ever witnessed one ACL being done, which (ironically) was done by a team mate who was previously a youth team footballer at a number of professional clubs and had been exposed to professional standard football training.

Modern football means players are fitter and therefore suffer less fatigue and fewer injuries caused by poor conditioning, but the flip side is that they are so highly tuned that they will inevitably break down with muscle snaps when sprinting, or ligament damage from landing. In my opinion it?s just unavoidable, as no club worth its salt will not want to push its players to the limit as this will ultimately result in poorer results.
Mick Wrende
33   Posted 28/04/2009 at 09:57:18

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Many very interesting comments and I am sorry not to be able to discuss them individually. Some reacted the way I did initially when the Aussies criticised our clubs treatment of Cahill. How dare anyone say those things! But then how do we know how good the treatment our players get? We shouln?t assume it is automatically the best just because we are a Premier League club and just because we are Everton.

We know the best physios do not go to football clubs ? in fact, better ones can often be found in your local hospital. Rathbone was not appointed on merit but because Moyes got on with him well at Preston. Until the regulations changed 6 years ago, Aston Villa did not have a qualified physio looking after the first team. Richard Steadman is considered the world?s best knee surgeon but Mikel and Jags are not going to him. So don't simply assume our players get the best.

I am sure that bad luck plays a part as well as tiredness and I suspect Tim?s comments above are spot on in that anything / anyone playing at the limits is more prone to damage. But I still wonder if, even accepting all these factors whether we are doing all we can.

After Vaughan and Arteta, did the club look inwards and do everything possible to prevent it happening again? Two such injuries in 2 months is too much of a coincidence for me ? and what if, God forbid, we get a third. Would your views change then?

Karl Masters
34   Posted 28/04/2009 at 10:11:24

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Tim Wardrop: You have pretty much nailed the point I think.

Our players are giving 100% all the time, they are finely tuned athletes these days and sometimes the body fails you.

I had a succession of knee problems when I was younger and while no way was I a finely tuned athlete, I was the fittest, quickest and had the highest stamina levels that I have ever had in my life and yet I was more injury prone.

One thing that I do think needs looking at though is pitches. They are undeniably better playing surfaces these days, but at what cost? They are better drained and therefore firmer. Over a season of playing and training on these surfacs the extra pounding the joints are taking must have an effect. On the other hand, softer pitches cause more slips and possibly more tears and strains.

It’s an important issue you have raised though, Mick. Well done.
Karl Sega
35   Posted 28/04/2009 at 12:18:45

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A very interesting article but I doubt that our medical team is inferior to the training regimes mentioned. However, I point that i’ve always thought about is the studs on those boots. The ’plate’ type studs seem to grip the pitch better than the normal round studs but also contribute to the foot being caught. Its just my tought but on the other hand, fatigue could have played a big part. When you’re tired, you do tend to switch off. It could be a case of the players being too relaxed when coming down after a jump hence forgeting to feel the landing. Anyways, I just feel so sad for the boys. I hope and pray that they will come back stronger than ever.
Kevin Quinn
36   Posted 28/04/2009 at 13:02:24

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I'm in no position to say whether or not the club do these training techniques, but we have a history of bad feeling between Moyes and the Australian medical team. So them saying Cahill was not fit when we went to Australia is no suprise to me.

Personally, I think it is rotten luck, nothing more. Robert Pires suffered the injury under Arsene Wenger and he definitely would do these training techniques as he brought in sports science to English football.

Mike Owen
37   Posted 28/04/2009 at 13:25:43

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Thing that struck me on Saturday was that Jags stretched (slipped?) at a part of the pitch that ? I think I?m right in saying ? had had the sprinklers wetting it at half-time. But then the wetting of pitches is a common practice. Whether it could have been a factor to some extent I don?t know. But, as I say, it crossed my mind at the time.

I must add I get the impression Everton?s players are much better looked after than in the past, although I have wondered once or twice if players have been back playing before they ideally should have been.

Our money is going on quality of players rather than quantity of players. I am not going to argue against that. But with Europe assured, I wish we had a few big, wily old grogs to throw in the team to mix it with the likes of Sunderland and rest some of the "first XI".

Marcus Choo
38   Posted 28/04/2009 at 15:07:22

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I tore my ACL in 2002 playing football. Horrible, horrible pain. Never want to ever feel that kind of pain again. I thought I had just bruised it as I could still run a bit. I rested for a couple of weeks, but in the next match I played, I tried to turn and my knee just gave way... cue horrible, horrible pain all over again. Went to the specialist who confirmed the ACL tear.

Went for surgery a few months after the accident. Spent close to one year in physiotherapy (thank the Lord for company insurance). Treatment consisted of passing small amounts of electricity through the injured area via suction cups (I think to stimulate the muscles and tendons), then some kind of vibrating or heat-application machine (couldn’t tell except through feeling) over the knee that had been applied with some kind of cream/vaseline... Lastly would be massages and knee stretches/flexions/extensions. Unfortunately, I never recovered 100%. The specialist said I had missed a crucial 2-week window during post-surgery where I should have stressed my knee to the max. Apparently, if you don’t stress the reconstructed ligament during that period, your knee won’t be able to bend or extend to its maximum in the future. And it’s true... now, I can’t straighten or bend my right knee as much as my left :-(

Jags, if you’re reading this, DON’T MISS THAT 2-WEEK WINDOW! Hope you get better real soon...
Mark Stone
39   Posted 28/04/2009 at 15:04:29

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Mick,

I would assume that like most physio’s, Baz Rathbone’s responsibilities are largely limited to post injury treatment and rehabilitation. I would be very suprised if balance board and other joint stability exercises targetting the knee joint to increase strength of the ACL and joint capsule (which I assume are the exercises you are talking about) were not a part of Rathbone’s arsenal in the treatment of these players.

It is also reasonable to suggest that plyometric training may increase functional dynamic knee stability. However, I would assume this to be the role of sports scientists/strength and conditioning coaches rather than the club doctors/physio’s. What’s more, I would eat my hat if these people did not utilise plyometric training regimens with the purpose of inducing neuromscular adaptations to the stretch reflex and increasing muscle elasticity to optimise muscle contractile strength. It would be interesting to read the studies which you mention, what are they? I ask because these type of exercises are habitually employed by most professional and even amateur sports coaches for different purposes other than injury prevention, therefore I would be interested to see what the coaches in the experimental group did differently than would be expected - or whether the elevated risk of injury in the control group was due to NOT engaging in such activities which it would be expected are part of everyday life for a footballer.
Dominic Bobadilla
40   Posted 28/04/2009 at 15:43:34

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Hey mate. You forgot to name names. I need scapegoats. WHO’S TO BLAME?!
Patrick Einsmann
41   Posted 28/04/2009 at 16:14:04

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Is anyone else worried that Jags & Arteta might not ever make it back to the players they once were? This is a serious injury!

I really wish them all the best for the long road on recovery.
Keith Glazzard
42   Posted 28/04/2009 at 16:56:05

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Points raised here about the demands on players performing at such a high level dovetail into questions raised in other threads - squad size and the Europa cup.

Any fool knows that we need good cover in case of injury, but this is going to be compounded when we play the extra games - half a season’s worth - which will come with success in this competition. And we will be wanting to retain the FA Cup! Then there’s the Carling Cup.

So, David Moyes will surely have to start doing something he hasn’t done too much of - sharing the load around the available players, just to keep an eye on how much strain is being put on each individual.

All our best players will want to play every game (quite rightly) but there must be times when the boss says ’you’re watching this one from the bench’ - or even the stand. And that’s not rotation - that’s good housekeeping.
jayharris
43   Posted 28/04/2009 at 19:10:37

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INJURIES HAVE ALWAYS BEEN PART AND PARCEL OF THE GAME BUT I DO THINK "SERIOUS INJURIES" ARE BECOMING MORE COMMONPLACE.

It used to be claimed that training on the sand at SOUTHPORT caused injury problems!!

No one can really say otherwise they could be avoided but it’s fair to say modern boots dont help and in Everton’s case the players going the extra mile certainly makes them more prone to injury.

I must also add in defence of BAS I dont believe for one minute that treatment is any better in Oz than at EFC.

All I can say is good luck and thanks to Jags for getting us to the cup final.
Tony Doran
44   Posted 28/04/2009 at 19:27:30

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On reading your post it got me thinking a bit.(which can be dangerous)
So much is now put into preparation of players for games that include training, agility and diet. Also what is very top of the list is stretching before and after the game and warming down before the dreaded ice bath. It gets me thinking back to the 80’s when players were still picking out their horses at 2.30pm and Duncan Mckenzie was on his 18th fag of the day. Everton won the league with a squad of about 16. I know the game is faster but i think were just unlucky this year. If this was in football today the likes of Man-ure would be using it and Red nose fergie would pass it onto his mate Moyse.
Carlos Camacho
45   Posted 29/04/2009 at 04:02:44

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I was tackled from behind last year and ripped my ACL and MCL. It was no fun! Its pretty well known that most sports people come to the US for knee surgery. Someone please tell EFC execs to send our boys to Dr. Veltri (Manchester, CT.) He operated on my leg and is the best. (He worked for a US football team as a trainer.)
Cheers, Carlos
Bob Parrington
46   Posted 29/04/2009 at 05:35:00

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There seems to be heaps of interest in this posting so well done Mike. My sports crazy daughter is doing a PhD in Biomechanics in conjunction with one of the professional football teams here so I thought I’d ask her if she could make any observation to the posting. She provided a few points of her own that she says may or may not be relevant in the specific case and provided abstracts from two references some of you might be interested in. As far as Tim Cahill and comments when he landed here, I think you’ll find that, at times, different methods are adopted in different countries. Sometimes they work better, sometimes not. COYB - enjoy!


1. Are the injuries at Everton occurring more frequently? and to what degree? (i.e.. if there was a proven statistical significance that Everton players were incurring more injuries for a given period than any other club - then there is cause for concern).
2. How many of the injuries are the same? - Calf strain and ACL rupture are two different types of injuries and require different prevention strategies and different management post injury. So while proprioceptive training may help to reduce tears/ sprains or ruptures of the ankle/ knee for example, there are other methods in place for helping to reduce muscle strains and tears etc.
3. Perhaps it would be important to see if other clubs are doing proprioceptive type training. I am aware of some football clubs that utilise balance beams, pyrometric balls, balance boards etc in some training and some athletes may be prescribed training programs that "prehab" - try to increase joint stability in some joints.

References;
Here are the abstracts -
Prevention of anterior cruciate ligament injuries in soccer
A prospective controlled study of proprioceptive training
Journal Knee Surgery, Sports Traumatology, Arthroscopy

Publisher Springer Berlin / Heidelberg
ISSN 0942-2056 (Print) 1433-7347 (Online)
Issue Volume 4, Number 1 / March, 1996

Category Knee Injuries
DOI 10.1007/BF01565992
Pages 19-21
Subject Collection Medicine

SpringerLink Date Thursday, May 12, 2005
Prevention of anterior cruciate ligament injuries in soccer
A prospective controlled study of proprioceptive training
A. Caraffa1, G. Cerulli1 , M. Projetti1, G. Aisa1 and A. Rizzo1
(1) Orthopedic Clinic R, S. Maria Hospital, University of Perugia, I-05100 Terni, Italy
Received: 23 May 1995 Accepted: 20 February 1996
Abstract Proprioceptive training has been shown to reduce the incidence of ankle sprains in different sports. It can also improve rehabilitation after anterior cruciate ligament (ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead to long absence from sports and are one of the main causes of permanent sports disability, it is essential to try to prevent them. In a prospective controlled study of 600 soccer players in 40 semiprofessional or amateur teams, we studied the possible preventive effect of a gradually increasing proprioceptive training on four different types of wobble-boards during three soccer seasons. Three hundred players were instructed to train 20 min per day with 5 different phases of increasing difficulty. The first phase consisted of balance training without any balance board; phase 2 of training on a rectangular balance board; phase 3 of training on a round board; phase 4 of training on a combined round and rectangular board; phase 5 of training on a so-called BABS board. A control group of 300 players from other, comparable teams trained normally and received no special balance training. Both groups were observed for three whole soccer seasons, and possible ACL lesions were diagnosed by clinical examination, KT-1000 measurements, magnetic resonance imaging or computed tomography, and arthroscopy. We found an incidence of 1.15 ACL injuries per team per year in the control group and 0.15 injuries per team per year in the proprioceptively trained group (P<0.001). Proprioceptive training can thus significantly reduce the incidence of ACL injuries in soccer players.

Mechanisms of anterior cruciate ligament injury.
Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr.
Uniformed Services University of the Health Sciences, Rockville, MD 20850, USA.
This study examined the mechanisms of anterior cruciate ligament (ACL) injury. In the first part of the study, using a comprehensive, standardized questionnaire, 89 athletes (100 knees) were interviewed about the events surrounding their ACL injury. A noncontact mechanism was reported in 71 (72%) knees and a contact injury in 28 (28%) knees; one patient was unsure if there was any contact. Most of the injuries were sustained at footstrike with the knee close to full extension. Noncontact mechanisms were classified as sudden deceleration prior to a change of direction or landing motion, while contact injuries occurred as a result of valgus collapse of the knee. Hamstring flexibility parameters revealed a statistically higher level of laxity in the injured athletes compared with a matched group of 28 controls. In the second part of the study, videotapes of 27 separate ACL disruptions were reviewed and confirmed that most noncontact injuries occur with the knee close to extension during a sharp deceleration or landing maneuver. Because the knee is in a position to allow the extensor mechanism to strain the ACL and maximum, eccentric muscle force conditions usually apply, the quadriceps may play an important role in ACL disruption. Passive protection of the ACL by the hamstring muscles may be reduced in patients with above-average flexibility.
James Brien
47   Posted 29/04/2009 at 07:22:49

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In my work I have come across a number of sports scentists (incl 1 associated thru consultation work to the Football Fed Aust) and they all say the same thing.

English clubs are miles behind in sports science, physiology, rehab and man management.

There is far more expertise and more money spent by clubs involved in non national sports like Australian Rules and both Rugbys which have club turnovers dwarfed by the EPL. Our ’small’ clubs fly overseas to the US NFL teams to glean the latest methods in technology eg GPS player tracking, personalised prep and recovery, computerised diet analysis, oxygen chambers, hi alt training, video training and match analysis. The Sydney AFL club flew to AC Milan 4-5 yrs ago and went thru their internationally recognised program too.

Aust’s Olympic performances have always owed a lot to sports science so it’s hard to argue when the runs are on the board.

As an example, I was informed that no one within the performance units of the FFA were surprised when Tim Cahill reinjured his foot as he informed them all his recovery work had been straight line with no left/right agility training.

I am too far away to know, but would it be fair to assume the Everton admin don’t do too much to advance themselves in this regard??
Will Leaf
48   Posted 29/04/2009 at 15:24:44

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Good stuff, Bob.

Perhaps your daughter has access to the pertinent research of some questions I have.

I have doubts about the Formula 1 analogy expressed earlier, as it relates to ACL tears. 3/4 of ACL tears seem to result from non contact situations, the rest from contact that usually involves a blow from the side of a fully planted leg. If more finely tuned athletes are more susceptible to ACL tears, I would expect a higher incidence of ACL injuries in the modern game. I do not know if this is the case. I would think athletes trained in the rigours of the modern game would have stronger quads and "hamstrings", the muscle groups that help stabilize the knee, along with the actual knee ligaments. In that case, perhaps there shouid actually be less ACL injuries. Of course, these issues are multi factorial, so perhaps no one knows.

Also, when you have her ear, I was wondering aloud what effect better modern pitch conditions have on such injuries. Perhaps there are less non-contact ACL injuries on the smoother modern surface. The rugby pitch conditions of yesteryear may have protected against contact injuries, as the ground is more likely to give away under a fully planted leg. Then of course there are the issues regarding modern boota/studs.

With regards to the Everton injuries, I put it down to bad luck. However, educative exercise programs for ACL injury prevention have trickled down to the girl High School level in America, so I certainly hope such thought has reached Finch Farm.
Brian Waring
49   Posted 29/04/2009 at 18:37:43

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Maybe we get all our medical done on the NHS, because we are skint.
Bob Parrington
50   Posted 30/04/2009 at 03:35:04

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That’s an interesting question, Will, because she did say the following,
"It may be important to see what type of ground the club is training on and the difference between their training ground and the playing surfaces as this can cause problems changing from one surface to the next."

I’ll run your questions past my daughter as you asked.

James makes some pertinent comments. I moved over to Australia from UK in the late 1980’s and was coaching football (soccer!) here at a number of levels for 15 years . Since then I’ve been involved with the Women’s National Ice Hockey team program in admin. I have to say that I’ve noticed a substantial difference in approach to training and player recovery/preparation between the two countries.


COYB!
Damian Scott
51   Posted 30/04/2009 at 10:39:09

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I remember a few years ago when Sam Alderdyce was in charge at Newcastle that he put Newcastle’s injury problems down to the hardness of their training pitch.

They were getting a lot of broken metatarsal injuries, ACLs etc... and if you remember back over the recent premier league years, newcastle have always had a ridiculous amount of players out with injury. Up to 8 or 9 first teamers at any one time....

Anyway, Sam being one of the top managers with regards to the use of sports science put it down to the training pitches being too hard. This was causing serious wear and tear on the players.

Found a couple of articles realating to that particular case:

http://www.nufc.premiumtv.co.uk/page/NewsDetail/0,,10278~1087423,00.html

http://www.pitchcare.com/magazine/article/5682/rangers-stretch-to-new-pitch
Connor Lightfoot
52   Posted 30/04/2009 at 18:35:14

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The injuries have coincided with the appointment of Steve Round as our coach. Could it be anything to do with a change in training methods?
Dave Roberts
53   Posted 30/04/2009 at 22:36:46

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I haven’t got time to read all the responses so apologies if someone else has already suggested this. Is it the boots? I tried to see if Jags’ boots were blades or studs. I don’t know whether Mikel’s and Yak’s were blades, but if they were could it be they simply stick to the turf so well there’s no give? Older boots tended to slip, especially multi studs. The worst you got was a sprained ankle. The blades are very popular, presumably because you can keep your feet better.
Just a thought.
Bob Parrington
54   Posted 01/05/2009 at 02:46:47

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Will Leaf
Here are some suggested "related" works.
Football Cleat Design and Its Effect on Anterior Cruciate Ligament Injuries: A Three-Year Prospective Study - Rick B. Lambson, Bill S. Barnhill,Am J Sports Med March 1996 vol. 24 no. 2 155-159
Peak Torque and Rotational Stiffness Developed at the Shoe-Surface Interface: The Effect of Shoe Type and Playing Surface - Am J Sports Med March 1, 2006 34:415-422
Noncontact Anterior Cruciate Ligament Injuries: Risk Factors and Prevention Strategies - J Am Acad Orthop Surg, Vol 8, No 3, May/June 2000, 141-150.
Rye grass is associated with fewer non-contact anterior cruciate ligament injuries than bermuda grassBr. J. Sports. Med. October 1, 2005 39:704-709


There are some good postings on this whole subject. At least one of the papers mentioned should expand on Dave Roberts’ observation about footwear. Connor might also have a valid point about training routines also.

You might smile at the final sentence in the comment from my daughter (below)
"Football (AFL) ground hardness relating to grass types has been assessed in Australia - with discussions of hardness relating to ACL injury. ACL injuries assessed involved contact and non-contact (remembering that AFL involves tackles). Their analysis demonstrated that the ’bermuda’ grass was an independent risk factor for non-contact ACL injury. Low prior rain fall may also have been a factor.. However, I doubt the hardness of the pitch could be comparable to British soccer pitch conditions with the rainfall there.
I hope this all helps.
COYB!
Will Leaf
55   Posted 01/05/2009 at 10:18:23

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Thank you, Bob, and also thank your daughter for me.

Some great stuff there. I’ll chase up some of that info. I tore my ACL about 10 years ago, and you sort of get inducted into the ACL Club, and feel great sympathy when others suffer the injury. I still grasp my knee whenever I see bad knee injuries on the telly.

The worst surface I ever played footy on was astroturf. That surface was lethal as your foot felt like it was glued to the surface with each step. I wonder if there was a surge of injuries at Loftus Rd when QPR had astroturf for a season or two in the 80’s (they were almost unbeatable at home, and the football bounced about like a giant rubber ball!)
Gary Carter
56   Posted 02/05/2009 at 12:06:55

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I think that quite contrary to this article we are actually on the whole quite lucky with injuries really. If you look at the size of our squad over the last 4 years, we simply can't have had that bad an injury problem or at some point we would not have been able to field a team.

And I fail to see how Jags or Mikki?s injuries could have in any way been prevented by our medical staff!!! Players could fall/land/turn the way they did a hundred times and not injure themselves.

I also think that the 100% manner in which Cahill plays means he is always in danger of hurting himself, Saha is a ridiculous example to use as he has not been fit for years and we sent Vaughan to see Dr Steadman (I think thats his name) in America where ALL the top sports people go that have knee problems so we?re hardly selling our players short on the medical front are we?
harry charles
57   Posted 03/05/2009 at 15:50:05

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Ithink it was just a sarcastic comment by the Astrailia FA, because we always dont like sending cahill that far for friendly games.
John Thompson
58   Posted 04/05/2009 at 12:08:54

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Rathbone was not appointed as a friend of Moyes at Preston, but as a physio who had internal knowledge of the game. He is no real friend of Moyes; instead, he sees him as a tough task master of a boss who heaps plenty of pressure on him and his team to get what is right for EFC.

Moyes however does respect him as he once commented in an interview, when asked who is the best signing you have made? (They were actually expecting him to say Nigel Martyn at the time.) He replied ?Baz Rathbone?.


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