What is happening with the players’ knees?

Not even a week had passed since those words when the Manchester City international midfielder tore the cruciate ligament in his right knee. It happened practically at the same time as Ter Stegen suffered a complete rupture of the patellar tendon in that same knee. And some dates before Dani Carvajal He screamed in pain on the pitch at the Santiago Bernabéu after breaking the anterior cruciate ligament, the external collateral ligament and the popliteal tendon, also in his right leg. Three world-class footballers out of combat for the rest of the season. Three fewer stars in the show affected in the same part of their anatomy. An evil that spreads like an oil spill in the ocean. What is happening with the knees of footballers?

ABC wanted to ask specialists from different fields to try to shed some light on this apparent bleeding that has affected more than twenty players, in the Spanish League alone, in the last year and a half. Ligament injuries have always been the bane of players, but now there is a perception that they are getting worse. Is it really like that? Is the health of the main actors in this sport being taken care of? Could the risks be minimized?

«In the last two seasons there have been almost twice as many ligament tears in the League as in the previous three. Only since January of last year there have been 24 recorded,” says the doctor. Pedro Luis Ripolldirector of the FIFA Ripoll and De Prado medical center of excellence. From his office he even keeps track of the most affected teams: Real Sociedad, Getafe and Real Madrid. “I believe that in professional football the incidence of this type of injuries has not changed, although they are of greater severity and with high relevance,” he points out. Luis Casaisdoctor in Physical Activity and Sports Sciences and current physical trainer for the Russian national team, who believes that being in a more “sensitive” context gives the impression that they are more numerous.

Researchers from the Department of Physiotherapy of the Faculty of Health Sciences of the University of Malaga put this issue in black and white last year. They carried out a study that identified an average of eleven anterior cruciate ligament ruptures per season in the Spanish First Division, which means that every two seasons any team would be affected at least once by this type of injury. Their research demonstrates several patterns, such as that there is a greater risk of suffering this type of injury in matches than in training (68 times higher), that the predominant injury mechanism is non-contact (56.36%) and that time The average sick leave was 218.8 days, with the highest incidence in the months of September-October and March-April. “In Spain this phenomenon had not been studied as it had been done in other European leagues, and we believe that the conclusions drawn can serve as prevention in the future,” he explains. Chelo Pinedaprofessor of physiotherapy at the University of Malaga and one of the authors of the report, along with Paula Requejo and Iván Medina. The study also reveals that the goalkeeper position is the least affected, despite such well-known cases as those of Sergio Asenjo, Víctor Valdés, Thibaut Courtois and Ter Stegen himself.

Experts say that knee injuries do not only proliferate in the elite. On the contrary, it is in amateur and grassroots football where its recurrence skyrockets. «It can be attributed to a change in lifestyles and physical habits. Decades ago, children spent hours playing in the street, plus time studying Physical Education and training in clubs. Now leisure and the configuration of cities has changed,” says Casais.

External factors

Not only that. There is also a deficit in the quality and design of training in youth football, as reported José Ángel García Redondowho was Atlético’s physical trainer for the double, who for years has observed muscular imbalances in children, with very strong quadriceps and very weakened hamstrings, the perfect cocktail to suffer knee injuries in the future: «For me that is the key Most important: work on coordination and strength with children of eight, ten, twelve years old in a balanced way. In professional football, many technical movements are made, and there have to be muscles that support them.

And there is one last factor: the poor choice of sports shoes. In the elite, players have all the means and it is difficult for them to have inadequate material. But for the rest it is crucial not to make mistakes. “They should not choose their boots due to pressure from fashion or imitation of professionals,” Casais recommends. “There are models that are not suitable because they generate more traction on the ground, make turns and changes of direction difficult, and in less developed muscles they are fatal.”

In professional sports, everything is getting worse due to the competitive demands, which have continued to increase in recent years. The existing tournaments are increasingly longer and with more matches, and the few free spaces that still existed are being filled with new competitions that are equally or more severe. «The players start the seasons almost without training. “They arrive, they do the medical check-up, they take the plane and they go to play games in China or the United States,” says the doctor. Victor Laineztraumatologist and doctor of the Spanish basketball team. And from there, the slope only goes up. “The first factor that predisposes to injuries is fatigue, and that is related to the number of minutes that professionals play,” begins Dr. Ripoll. «The greater the number of games, the greater the risk. That is evident – ​​confirms Dr. Laínez –. “The more you play, the more joint stabilization is reduced.”

For an international footballer it is no longer strange to participate in around seventy games per season. Rodri himself played 66 between September 2022 and September 2023. According to the latest report monitoring the workload of footballers prepared by Fifpro, the main footballers’ union worldwide, 54% of the players analyzed faced an excessive workload, and a significant number of them exceeded the limits recommended by medical experts. And things are getting worse. With the current pace, according to Fifpro, the health of footballers is being attacked.

Without zero risk

Being so clear about the factors that favor the appearance of this type of injuries, it should not be difficult to find solutions. And in reality it is not, although it is difficult to imagine that the specialists’ recipes will be applied. “From a medical point of view, we see three aspects as very urgent,” explains Dr. Ripoll. First, the return to the protection provided by structured training, that there be good preseasons. Second, that the number of minutes given to the players be reduced, because it is impossible to come out unscathed after ten years playing seventy games. And finally, let the calendar be reformed. And I would add a fourth: that the injury recovery times recommended by FIFA’s medical division be respected, which is also not usually done.

“The longer the preseason, the greater the protective effect,” insists Casais. «And perhaps the number of FIFA windows should be limited or the number of teams in events reduced. The question is: do we want to see higher level games or do we simply want to see more games?

The Russian national team coach assures that in professional football the problem is well known, and that from the physical and training side it is addressed to contain it: «Practically everything is already done. Another thing is that there is an inherent risk in certain sporting activities. There will always be a possibility by exposing yourself to each sport. In handball and volleyball there will continue to be shoulder injuries; in tennis, elbow… And in football there will continue to be knee injuries.

And since there is no zero risk, we must try to minimize the damage, which involves caring for and accompanying the injured player “from minute zero”, as Professor Pineda explains: “Physiotherapy has to be present from the beginning. And also psychology. Not everyone knows how to manage an injury, especially athletes who have not gone through that process. Once rehabilitation begins, everything is aimed at that balanced balance of muscle strengthening, to avoid sequelae that later prevent normal movement of knee flexion and extension. And you have to support them on a mental level, because for them it is like going through depression. “The great objective is to avoid relapses, which have also been studied.” 20% of players will go through the same nightmare again.