It is certainly one of the most frustrating and yet often inescapable facts of a footballer’s career that at some point they will be injured, and unfortunately sometimes for a considerable length of time. At Wolves, the medical and sports science staff combine to run an extensive preventative rehabilitation programme designed to reduce the risk of soft tissue injuries and ensure players are regularly assessed so that precautions can be taken when they are more prone to picking up problems, for example when fatigued. But of course no preventative action can completely rule out injuries, and certainly not the sort of impact injuries which have affected several members of the Wolves squad so far this season.
Wolves Official Website caught up with Head of the Medical Department Phil Hayward to find out just what happens when a player get injured and the detail which goes in to the road to recovery.
On a matchday if a player suffers an injury the first thing to decide is whether they can continue to play or not. In some cases, after treatment players are fine to continue. If the injury is deemed too severe then they are taken off the pitch and straight into the medical room. Once in there, either myself or first team physio Carl Howarth and one of our Doctors will then assess the player and usually make an immediate start on anti-inflammatory treatment. For example, someone who has suffered a ligament injury to the ankle would immediately receive treatment via one of the Game Ready ice machines which is a mixture of ice and compression to limit the initial bleeding in the tissues. Then they would usually get off home with compression strapping and the Game Ready machine to carry on the treatment that evening. The general rules in those early stages are protect, rest, ice, compression and elevation to try and reduce the amount of inflammation that will naturally occur.
The player would then come in on the following day for further assessment. At this point we can see how serious the injury is as the amount of inflammation gives you an initial indication as to the severity of the problem. If it is something that we are concerned could be a serious injury then the player will go off for an MRI scan. This is particularly the case if we believe that more than one structure is involved, for example an ankle injury where different ligaments are affected. In these cases there are risks that the cartilage on the surface of the joint is also damaged and this would be scanned as it might affect our treatment further down the line. And so a scan would be arranged for that day or the following day. At this point you have enough information to decide whether it’s going to be a short term injury or something more long term. Then we are able to give the manager some more guidance as to how long it will be before he can expect to get the player back.
SHORT TERM INJURIES
With the short term injuries, say for example an expected two to three weeks, the first few days will be focused on reducing the inflammation. Once this has happened we can start the rehabilitation process, focusing both on the particular area affected, restoring normal movement and also on the rest of the biomechanical chain which could also potentially be affected by the injury. If there is any loss of strength there will be some work specifically tailored to that. We use a lot of different techniques and have lots of electrotherapy devices which speed up both the reduction of the inflammation and then regaining strength. With a short term injury we would normally get the player back doing as much exercise as they can within their limits of pain fairly early on. For a two or three week injury you want the player to maintain their fitness levels as much as possible. If they are unable to walk or run, perhaps with it being an ankle injury, we will get them doing a lot of upper body cardio work to keep the heart rate up. They may not be able to do any weight-bearing activity but you want them to stretch their cardio-vascular system enough to fatigue them and reduce the risk of de-conditioning.
LONG TERM INJURIES
With a more long-term injury the focus first of all is whether it is something that can be dealt with in-house or whether it requires external intervention. If it is a particularly nasty injury we would use a consultant who would look at our scans and may decide that surgery is the best option. If this is the case we would then look to book the player in for surgery as soon as possible after which the rehabilitation process can start. If it is a fairly ‘routine’ injury requiring surgery the consultant doing the operation would know the relevant timescales in terms of recovery. Take for example a cruciate ligament injury. Each of the consultants doing an operation would have their own protocols and their own ideas as to how long it would take a player to return. They have lots of benchmarks as the rehabilitation goes along that the player needs to hit to progress to the next level. We are given this information by the consultants and then help the player to work towards those benchmarks to try and hit the pre-set targets. This may for example involve range of movement and how long it takes to reach a joint angle. With the surgery Wayne Hennessey has had the consultant was keen for him to keep the knee at nought to 90 degrees for the first six weeks and, once he has done that and everything is settled and healing as it should, he steps up his work and extends his range of movement. He moves towards a full range of movement and once that is re-established we can then start on some more functional work. Some of this advice can be received via telephone calls or other consultants are keen to see the players at various stages on a regular basis. All that depends on the particular consultant who has been involved with the player.
FINDING THE BALANCE
Our main focus is always trying to get the player doing as much as they can in order to load the injured tissues optimally. There can be a fine line between pushing the player to help their recovery without pushing too much and risking further tissue damage. That is always what we want to avoid. We do a lot of monitoring to ensure the players are at the right level for them without going beyond a certain parameter and taking risks. We will always be talking to the player about their levels of pain and how they have felt during a specific exercise or treatment. We have GPS data and Heart Rate information which we can look at during rehabilitation to measure their progress. Once they have reached a certain stage indoors, generally using our Alter-G anti-gravity treadmill, we will then always move on to straight line running outdoors. Once that box is ticked with no issues it will be side to side work and once that is achieved then on to ball work. From there it’s all about progressing towards end-stage real functional work which is also specific to the player. With a winger the drills we do at this stage would be very different to that of a centre half. There would be lots of explosive work, twisting and turning and finishing whereas a centre half would do more linear work including heading, tackling and playing long passes. We monitor along the way doing tests at the beginning of the rehabilitation process to get a baseline and then re-testing at the different stages to assess the progress. We have a test called the T-test which is a test of agility and would look at how well the player can move left and right. An iso-kinetic device would be used to look at specific leg strength. Anything we are doing that is rehabilitation-based – whether in the gym or out on the field – is constantly re-evaluated to see how progress is going and whether we need to alter the programme at any stage if problems arise.
BACK TO FULL TRAINING
At the back-end of the outdoor rehabilitation process the physios will then hand the player over to the conditioning guys who will look at doing more specific bits and pieces and introducing some contact work as well. Once they have achieved all the necessary goals then they will go back into full training, although this will usually take place on a gradual basis. They may not do the full session at first and just do part of the session, avoiding any parts of training which may still aggravate them. Or sometimes they might not do any contact work initially. Slawomir Peszko for example in his first week back training earlier this year wore a bib to show he shouldn’t be tackled just to minimise the risk before he got to his full fitness.
We speak to the manager every morning to let him know how things are progressing with the different players and will keep the other staff informed. The sports science and medical team also have regular morning meetings where we look at the plan for the week for every player.