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Injury Time Episode 4, Runs of Injuries, bad luck or something deeper?
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In this episode, we talk initially about "runs" or clusters of injuries at a football club. WHat do we think is the cause? What can be done about it? We also talk about the decision to opt for surgery. Who make the call? Is surgery always the best option?
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Transcript
Introduction to Episode 4
00:00:02
Jonathan Bird
oh Welcome everybody to episode 4 of Injury Time. I'm Jonathan Bird I've got here as ever Ian Beasley and Shemaz Mugl.
00:00:13
Shabaaz Mughal
I hope...
00:00:15
Ian
Evening.
Liverpool vs. Arsenal: Injury Highlights
00:00:16
Jonathan Bird
So we're recording Sunday evening, Sunday 31st of August. um We've had the sort of big game the weekend, Liverpool Arsenal. um and we thought we'd dig just I just wanted to kick off with with you two guys to talk about sort of runs of injuries.
00:00:33
Jonathan Bird
um i mean Within Arsenal, there's been Habert-Saka, Odegaard, Norgaard, Ben White, and then today, Saliba injured his ankle apparently in warm-up and then injured it again three or four minutes in and had to come off. but There's been has been um ah Kunye and Mount into United in the same game. um We've had delamited his hamstring. Colwell's done his ACL.
00:01:00
Jonathan Bird
Cole Palmer injured in warm-up last week. um you know is this You know, Spurs had a real run of injuries last season. That did Arsenal as well. um And so the the first thing I would really wanted to ask both of you from your sort of insight of being Premier League and England medics,
00:01:18
Jonathan Bird
is when there is a run of injuries like that within your club, is that is does it just assumed to be run of bad luck?
Understanding Injury Thresholds
00:01:28
Jonathan Bird
Is it about the strength and conditioning coaches?
00:01:31
Jonathan Bird
um Is there an internal sort of look in the and at the medical setup? Is there something that they they could be doing better? I mean, what what kind of thing happens? Ian?
00:01:44
Ian
Oh, well, thank you, Jonathan. It's a slightly long story. I mean, I think that the one thing you've got to remember is you've got a team of 25 professional footballers, and they've all got their their own sort of injury threshold.
00:02:00
Ian
The trouble is, most of the time, we don't know where the threshold is until they get injured. Then we realise, looking back on the stats, often GPS stats and everything else and how many minutes they've played,
00:02:11
Ian
how many accelerations and decelerations they've done over the last two weeks. All this sort of stuff is collated and then people realise that, hey, maybe this player was on the edge.
00:02:22
Ian
The real trouble is, if you say to a manager, this player's on the edge, the manager may say, well, you know, we'll just, we'll put him on the subs bench and perhaps use him the last half hour.
00:02:34
Ian
But the manager may also say, he's our most important player. He cost ยฃ100 million. He's got play. So even though you know that it's coming or you know there's a risk, it's not always possible to do much about it.
Club Audits and Injury Causes
00:02:50
Jonathan Bird
But then when you do have that kind of run of injuries, is that is there sometimes does the managers say, look, what's going on? why Why are we as a club getting such a horrendous run of injuries?
00:03:01
Ian
Yeah, I mean, I think everybody says that. The owners certainly will come and say, what's going on? And often, you know, there's a small audit that goes on.
00:03:13
Ian
I've done audits for clubs that have had loads and loads of injuries all at once. And you try and find out exactly what's happening and why. And it's often very, very difficult.
00:03:25
Ian
If you think about Chelsea, they had the Club World Cup. Their players didn't have very much rest because they got to the final and won it, which is fantastic. But they're into a heavy Premier League season where they are expected to do very well.
00:03:39
Ian
So their tip-top players, they have to play every game. It doesn't surprise me if they do suffer a run of injuries just because it's hard to keep everybody at the right level.
Impact of Fixture Congestion
00:03:57
Jonathan Bird
So, Schmaas, what's your perspective on
00:03:59
Shabaaz Mughal
think I think over the last sort of, since the inception of the Premier League, really, the game's changed a lot. You used to have a first team, they'd play the majority of the games, the subs would come on, maybe do a little bit, but there wasn't too much rotation.
00:04:17
Shabaaz Mughal
Now you need a squad, really, to sort of challenge on all fronts. So the bigger picture is there's a lot more football being played at club level, at international level. There's a lot less recovery time, there's a lot less in terms of off-season um and that can be even you know commercial commitments.
00:04:39
Shabaaz Mughal
So you have post-season tours as well as pre-season tours. And pre-season isn't necessarily just, you working on the fitness, working on your tactics.
00:04:50
Shabaaz Mughal
You could be travelling halfway around the world that disrupts your sleep patterns. you've to think, think if we think of ourselves, if we're not sleeping well, um we're doing a lot of long haul travel.
00:05:04
Shabaaz Mughal
um Even for games playing in Europe, you're traveling, you're coming back. All of this affects how you recover and how you perform in your normal day day activities.
Optimizing Player Availability
00:05:15
Shabaaz Mughal
And then you you put that into a sort of professional athlete.
00:05:19
Shabaaz Mughal
So they're having the normal stresses and strains of life. They may have young children. They may have interrupted sleep, I should say. ah So all of that's going on. Plus they've got this heavy physical workload and It's, you know, they they're human beings, so they they are inevitably going to break. They can't just keep going and going and going.
00:05:44
Shabaaz Mughal
And I think that's why clubs are building squads and trying to make sure there's rotation. um But there's that side. And then the question that you're asking, Jonathan, about do clubs look internally or medical departments?
00:05:56
Shabaaz Mughal
I think that's always an ongoing process. You're always looking for best practice. What you doing? Are doing everything possible? Is every stone left unturned? So, you know, the things you you would look at, you look at the training volumes, the training load, the the acute on chronic training changes that Ian talked about.
00:06:19
Shabaaz Mughal
You look at things like nutrition, you look at their sleep quality, you even look at the pitch and the quality of your training pitches and whether they're too firm, too soft, are they taking too much um you know sapping energy out of the legs.
00:06:35
Shabaaz Mughal
And really one of the key things is working with your coaching staff, the medical staff. or the medical and performance staff and the coaching staff have got to be so well aligned that there's this mutual trust and respect that, you know, working both ways, really, that we think this player may be on the edge or, you know, Doc, do you think this players, you know, I can see they're not performing quite as they should be.
00:06:43
Ian
Thank you.
00:07:02
Shabaaz Mughal
What do you think? Shall we you know give them an extra recovery day in terms of their weekly training load? Shall we alter their training? So it's all about communication, trust, respect, try and optimise availability and and all being on the same page. and And that's what you want to be doing, really.
00:07:22
Jonathan Bird
But sou do you think, sorry, go on here.
00:07:22
Ian
Yeah.
Focus on Recovery vs. Conditioning
00:07:25
Ian
ah I was just going to say, you know, during a season when there's three games in a week often, it is about recovery.
00:07:33
Shabaaz Mughal
Mm-hmm.
00:07:33
Ian
You know, your pre-season and and preparation games, that's getting you to a certain stage.
00:07:33
Shabaaz Mughal
Mm-hmm.
00:07:41
Ian
It's like being at tournaments. At tournaments and international get-togethers, it's about recovery. It's not about conditioning. So, you know, you can look at the strength and conditioning coach. Their job is to maintain during the season a lot of the time.
00:07:55
Ian
There's actually often not enough time during the week to do a a hamstring strength session when you're you're doing some preventative work on the hamstring to stop them tearing.
00:08:07
Ian
If you make them stronger, then it helps. Trouble is, it's quite a hard session. You can't fit it in around training. If there's a match day minus one, a match day, a match day plus one, you know, a match day minus two, minus one, another match.
00:08:22
Ian
It's very, very difficult. So, you know, it it's really about... minimizing overstress whilst trying to get the best out of each player and to recover them after, you know, what's, i mean, it's very, very tough.
00:08:39
Ian
You know, they run what a midfielder will run perhaps 12 kilometers in a game.
Susceptibility to Recurring Injuries
00:08:44
Ian
um You know, their metabolic strain is is high. And as Shabazz rightly says, you know, in the end,
00:08:52
Ian
You know, some players will will not cope very well with it. And we all we all know as well, there are some players who keep getting injured. and No matter what you do, they just do seem to keep getting injured.
00:09:04
Ian
And it may be that metabolically and from a structural point of view, you know, perhaps professional football isn't for them.
Luck vs. Medical Shortcomings in Injury Streaks
00:09:12
Jonathan Bird
but So when there is a run though, So would your feeling be, neither of were involved, well Ian wasn't involved at Arsenal, you're not involved at Arsenal anymore, but particularly that club that's had this run of injuries, is your feeling that probably it's just bad luck for that club that they've had a run of these particular injuries?
00:09:31
Jonathan Bird
There's been a bunch of hamstrings gone and there's been injuries at the start of this season. Is that particularly, with the but you know, people's fans will say, what's wrong with our medical team?
00:09:45
Jonathan Bird
Is that is is there's not just, you know, they don't really understand what goes on behind a closed door and it's just that's just is just bad luck? I mean, surely each individual club, the medical setup can't be that different to each other.
00:10:01
Ian
Yeah, well, it's not. I think Shavaz is right. It is about you can't see departments in a
Importance of Medical-Coach Communication
00:10:07
Ian
football club as separate entities. You know, silo thinking in football clubs does happen and should happen.
00:10:13
Ian
And what you should be able to do is to talk freely with your coaches. If you're in the medical team, everybody will look at the medical team and say, you know Why have we got so many injuries?
00:10:24
Ian
I've never seen ah physio or a doctor or any strength and conditioning person, or certainly not intentionally, injure a player.
00:10:33
Ian
Players get injured on the field of play. And the medical and performance team's job is to advise the coaching staff where their team is in the scheme of things.
00:10:45
Ian
If that, and there there is research evidence to show that good communication equals better availability um for games in football clubs and better availability equals better results.
00:10:58
Ian
So, you know, there's quite a lot to be said for that. It doesn't always happen.
00:11:03
Jonathan Bird
How do you mean better availability?
00:11:06
Ian
You know, how many players are you available to pick this weekend?
00:11:10
Shabaaz Mughal
Mm-hmm.
00:11:10
Jonathan Bird
So it's just ah is is um as simple as just having a bigger score, more players to...
00:11:15
Ian
No, well, the squads are fixed. You know, it's it's having the number of players fit.
00:11:18
Jonathan Bird
Well, not a bigger score, but having a having a...
00:11:23
Ian
Yeah.
00:11:23
Jonathan Bird
Yeah, you've got to...
00:11:23
Ian
So better, if yeah. If they're available and fit, um the more the players are available and fit, the better the outcome at the end of the season.
00:11:25
Jonathan Bird
Yes. Yeah.
00:11:33
Ian
And there's a fair bit of evidence to show that good communication between coaches and medical and performance staff equals better availability.
Injury Bias and Club Strategies
00:11:43
Jonathan Bird
So if the.
00:11:43
Shabaaz Mughal
I think I'd add to what Ian's saying in that there's a few things that happens.
00:11:43
Jonathan Bird
Yeah.
00:11:49
Shabaaz Mughal
One is when fans always sort of concentrate on their own team and feel their team is having excessive injuries or having lots of injuries or having a bad run.
00:11:59
Shabaaz Mughal
But generally, if you look across the board, it tends to be quite similar. And it tends to follow, think it was a couple of years ago where the World Cup was during the season.
00:12:11
Shabaaz Mughal
And I think that's had a quite a big knock on effect over the last two seasons and the number of injuries across the board have really gone up and especially the number of muscle injuries or sort of intrinsic injuries.
00:12:26
Shabaaz Mughal
and And then the other thing is your players like Ian said as well. So biggest predictor of injury, especially any muscle injury is a past history of muscle injury.
00:12:38
Shabaaz Mughal
Once your star striker or star winger who relies on pace gets a bad muscle, e.g. hamstring injury, unfortunately that's now a big predisposition.
00:12:52
Jonathan Bird
you
00:12:53
Shabaaz Mughal
No matter what you do, no matter how well it's treated, how much rehab, how much strengthening work, but they're going to be at a higher risk of getting a hamstring injury again in comparison to have not had one previously.
00:13:06
Shabaaz Mughal
And it's kind of the nature of the game, of their game, where it's very explosive, short, sharp, speed, that it puts that stress on the muscles.
00:13:18
Shabaaz Mughal
And I think once you get a number of players in your squad who have had recurrent injuries or have had a big injury and have come back, so say for instance, and we'll talk about ACLs in the future, but One of the big things you see with ACLs is when the player comes back, they'll pick up other injuries.
00:13:35
Shabaaz Mughal
It's just inevitable. Again, no matter how good the rehab. So that I think once you've got three or four of those in your squad, you're almost, you know, your baseline of number of injuries in the squad goes higher.
00:13:52
Shabaaz Mughal
So it kind of depends on your model as well and the type players you're buying. Are you buying players? are sort young, injury-free, no past significant history of injury? Or are you buying a squad of older players who've had a lot of injuries in the past?
00:14:06
Shabaaz Mughal
And you've then got to sort of balance that up and expect some of it as well.
00:14:11
Jonathan Bird
So would you flag that up in, I mean, the entrance of windows open to another another
Complexities of Surgical Decisions
00:14:17
Jonathan Bird
day, isn't it? If you looked at a player's medical history, would you flag it up as you say, look, this player, it might be an issue, he's got a history of muscular injuries.
00:14:29
Shabaaz Mughal
Yeah, we we talked about that, didn't we, last week? Yeah, definitely.
00:14:32
Jonathan Bird
Yeah.
00:14:32
Shabaaz Mughal
It's one of the big things you flag up and then that can influence a lot of the decision and negotiation in the transfer.
00:14:42
Ian
Yeah, I mean, it's risk mitigation, isn't it? You know, if sign a 31-year-old player with had a few injuries because they've all had a few injuries by that time you know you've got to say to your manager yeah you know he's fine now but blah blah blah if you sign a 21 year old superstar who as as shabazz said doesn't have much of an injury history then it makes life a lot easier But, you know, know that Alan Hansen said you can't win anything with kids, but I mean, you know, not everybody has hundreds of millions to pay for players in any transfer window.
00:15:26
Ian
So there's always a mixture, you know, you're buying. Jordan Hent, you know, who did Sunderland buy? They bought Zanuck Grecker, Granit Shaka back from Bayer Leverkusen.
00:15:39
Jonathan Bird
Jaka, yeah.
00:15:42
Ian
I don't think it was a lot of money, but great experience. So, you know, managers do that sort of thing. That's what they want. Thomas Tuchel picks Jordan Henderson for the national team.
00:15:54
Ian
Probably if another manager were there, that wouldn't have happened. But he picked him for a certain reason. Nothing to do with injury or to do with experience and attitude.
00:16:04
Shabaaz Mughal
Another thing I'd add though, I think you can build robustness and I think the more you train and dedicate, the more you can become robust.
00:16:15
Shabaaz Mughal
I think the greatest example is Cristiano Ronaldo. So this player throughout his career, I can't think of many instances where he's been out with any sort long-term muscle injury and yet he's a very explosive player.
00:16:32
Shabaaz Mughal
I think when he was younger, he had a bad ankle problem and had an operation for the ankle. That was probably his only major injury. So it makes you think, unless he is, mean, he is clearly built different, it may well be he is metabolically blessed as well and genetically blessed.
00:16:52
Shabaaz Mughal
But when you hear about his dedication and his routine and how much he puts in, you you know it is possible maybe to add to your robustness with that sort of routine
00:17:05
Ian
Yeah, i think you're right. James Milner's the same.
00:17:08
Shabaaz Mughal
um
00:17:09
Ian
I think he's playing in his 20-plus... I think he's 40 this year. um Scored, didn't he, for Brighton yesterday? Scored a penalty.
00:17:17
Jonathan Bird
Mm-hmm.
00:17:19
Ian
You know, I think that... And having known him a bit, he's dedicated, meticulous in preparation. And you know you see some of these players come through the ranks.
00:17:31
Ian
And you can imagine that these players were like exactly like this, meticulous about preparation, eating and everything else when they were 20, as they are when they're 35 or 40.
00:17:43
Ian
These are the players that come through. And I know what i was in when i was at Aspatar and we used to screen everybody every year, I could tell the players that looked after themselves straight away just because how they looked, their demeanour when you examined them.
00:18:00
Ian
it It was just all completely different. And yeah I'd say to them, yeah you look after yourself, they go, yeah, I do everything right, Doc, because they know they're going to get more out of their career.
00:18:11
Ian
it's It's very interesting. I think you're right, though. I think genetics plays a big part. um I think Danny Welbeck mentioned that a couple of months ago in an interview, said that his you know something must have come down from his parents because he's done very well, really.
00:18:25
Ian
Despite injuries, he's still playing first-team football.
00:18:31
Jonathan Bird
um Okay, look, so let's let's move a little bit. We'll try and cover just at least one other topic. um We were going to talk, we've been talking a little about about the decision to operate on someone.
00:18:46
Jonathan Bird
and that kind of joint decision between um the player, the medical staff and the secondary care, so so the surgeon. You know, we've had, um Madison's recently done as ACL at Spurs.
00:19:01
Jonathan Bird
um
00:19:04
Jonathan Bird
Havertz has been just recently had surgery last week, and but they kind of waited a week or so, didn't they? And we were trying to speculate exactly why that was. So how how does that kind of whole process works in terms of when you have when you have an injury which it's not obvious is going to need surgery. So someone who snapped their ACL, professional footballer, pretty much 100% of the time gets a reconstruction. But there are many injuries, and not just around the knee, around the shoulder. We talked um about Wokes, didn't we, about his shoulder injury. And we, in fact, we all predicted that he he may go for rehab rather than surgery, and and that and that's what's happened.
00:19:42
Jonathan Bird
So how how does that process work um when you have a player who has, when it's questionable whether they do or do do don't go for surgery?
00:19:52
Jonathan Bird
So a Shabash, let us know your feelings on that.
00:19:55
Shabaaz Mughal
Yeah, I think it's always a decision that you've got to, I think everyone's got to be on board with it. So everyone's got to sort of, again, it's the big thing is communication. So And I mean, when I say everyone, I mean, obviously the player, the medical staff, the coaching staff, but the club as a whole as well.
00:20:15
Shabaaz Mughal
They need to be informed and understand because in a way, everyone thinks of surgery as being the answer almost instantly. And to put that, you know, almost the surgeon's view of that, and you can tell us, John, surgery...
00:20:33
Shabaaz Mughal
It's not 100% and there are pros and cons and you've got to give them the whole side effect and risk profile. And I think sometimes in sort of football clubs, maybe in sport in general, of the the yeah it's almost like Should he have an op?
00:20:49
Shabaaz Mughal
Does he need an op? Etc. And sometimes that decision isn't, or that answer isn't clear. So when we're in a clinic setting, a patient may come to us and they've already spent six weeks trying to do some rehab, trying to get back to what they were doing and and they can't.
00:21:07
Shabaaz Mughal
And then it's quite a clear of decision then. But even then, sometimes we give them the option of an injection. So it's not... I think it's not as straightforward as, you know, he needs an op, he has to have an op.
00:21:21
Shabaaz Mughal
I think it's got to be a sort joint discussion. often injuries are managed in-house. there You know, it doesn't mean every single injury goes to see a surgeon because when you go and see a surgeon, the ultimate solution is surgery.
00:21:38
Shabaaz Mughal
So that's what the sports physician's role is, is to sort of, essentially be making those decisions and deciding do we think this is a surgical case or can it be managed conservatively? Are we going to trial conservative management?
00:21:53
Shabaaz Mughal
What the pros and cons? And ultimately comes down to time. Ian, what do you think?
Collaborative Approach to Surgery
00:21:59
Shabaaz Mughal
it alwayss Time is the thing in football, so that's what it comes down to.
00:22:02
Ian
yeah Yeah, I mean, thanks. I mean, i look, the surgeon and and his team are part of what I call the extended multidisciplinary team. So you've got your MDT, multidisciplinary team in the club, and your extended, they they're the people you you send the scans to and say, will you have a look at these? What do you think? Would you like to see this player?
00:22:25
Ian
Do you think that he might need surgery? What's your view? And you present that view back to the player, his agent, of course, and and and the the wider team in the club.
00:22:38
Ian
And you have ah you know you have some discussion. it's In a way, it's easy if it's an ACL injury because, yeah, you're right, Jonathan, they're going to get surgery. In the professional game, they're probably almost certainly going to get surgery.
00:22:51
Ian
The real difficulty is this thing about, well look, got a meniscal tear, do you think it's going to heal? Well it might heal. You know, this is a 19 year old professional footballer, it's got a good chance of it healing.
00:23:02
Ian
Is it going to heal? We don't know. You know, if it if it doesn't heal, what does that mean? Well it might need surgery, might need a repair. Well, why don't we do that now? So, and this is now the crux of the discussion that you're going to have.
00:23:17
Ian
Should we do it now or should we wait? Should we spare him an operation? As I always say to patients, surgery nearly always really good. Not always. Nothing is always.
00:23:28
Ian
So yeah, small chance of things going wrong. But if you do nothing, there's no chance of things going wrong. But, you know, you may be, we may be two months down the line and suddenly your knee all flares up again.
00:23:41
Ian
You're going to need surgery. That two months has gone. We've wasted that in a short season. You know, so if you're another three months out for a repair, plus the two months you've wasted, that's five months.
00:23:56
Ian
It's going to take you another six to eight weeks to get fit. enough to perform it's two-thirds three-quarters of the season so that's the discussion and that's always you know you're always at the back of your mind i'm saying you don't i don't think you need surgery but there's a part of me that's always thinking trouble is they might trouble is they might
00:24:02
Jonathan Bird
That's the whole season.
00:24:18
Shabaaz Mughal
What do you think Jonathan from the viewpoint they come to see you with the sports physician, the medical team with the player and you know what's your sort of way of working your way through that?
00:24:35
Jonathan Bird
So yes, I think there there are a lot of injuries where it's pretty clear that they need surgery. But there is so much nuance in it and exactly as Ian said, that it it doesn't the the perception for fans outside of the medical world is that you know the surgery is just is the fix, and why are we hanging around, why aren't we just doing said surgery?
00:24:57
Jonathan Bird
and therere ah We are doing less and less operations for a meniscus tear. It used to be over the age of 35, slash 40, that was the point that you you treated a meniscus tear without surgery.
00:25:12
Jonathan Bird
But that's changed now that it's kind of anybody. Anybody over o the age of 18, and sometimes even children, with a meniscus tear, you don't you don't have to have surgery every time.
00:25:24
Jonathan Bird
But when it comes to the professional player, is they are they their patients, but they're also commodities. And time as a time as ah is an issue as well, as you say.
00:25:39
Jonathan Bird
for instance, ACL, you know that the player's going to need their ACL doing. you know that you that you know that the the player's going to need their acl doing They also injure the MCO, which is the medial, which is the inside ligament, which is the most commonly injured ligament in the knee. It's the one on the on the is one of those sort of left-hand side of your right knee. It's
00:26:03
Jonathan Bird
the most commonly injured, but it's the one that you that that you that you don't operate on that often. because it because it heals itself. Even terrible grade three injuries where the whole thing snapped in half, you can still get away with your brace for six, eight weeks and it gets better. And then and then if you so if you've got an ACL and an MCL, it would make sense to leave the player in a brace, have the MCL heal, and then it's a much better, it much quicker, straightforward rehab with just an ACL.
00:26:37
Jonathan Bird
But there has been a bit little bit of a move in the professional game, the heightpe higher Premier League players, that they're getting the ACL and MCL done early because then they get straight into the rehab.
00:26:49
Jonathan Bird
think that's pretty controversial. But it does just demonstrate how, I think, with a Sunday League player who had an ACL-MCL and you decide to operate that week on both ligaments, that's that's quite controversial.
Limitations of MRI and Comprehensive Evaluations
00:27:05
Jonathan Bird
and I think you would be and if they ended up with problems of persistent laxity you know persistently like the MCL bit the side ligament ended up still being a bit unstable and you had decided to operate early and most other people wouldn't I mean you could be really heavily criticized so it does become slightly different world when you're dealing with elite athletes
00:27:29
Ian
Yeah, I mean, I think it's a slightly different thing before I forget to say it. The other thing is, is that we rely on MRI now. MRI is God.
00:27:40
Ian
How many times have both of you, ah you know, we've either ahve ah either referred someone for surgery or Jonathan, you would have been there and eyeballed what's inside the knee, that it's a more significant injury or a different, you know, there's something else going on as well as what you can see on the scan.
00:27:55
Shabaaz Mughal
yeah
00:27:57
Ian
and And actually, you've been rehabilitating someone who was never going to rehabilitate because they got something else there that wasn't evident on the scan.
00:28:09
Jonathan Bird
Yeah, and I think part of it also that is the is the examination. The examination is incredibly important and um if the if the examination is not fitting with what's on the scan and what's the history of the injury, then you need to go back and read and and recheck.
00:28:28
Jonathan Bird
um
00:28:29
Shabaaz Mughal
yeah I also think, especially in professional football, you've got all the resources and I think there's an over-reliance on just MRI and having access to ultrasound, whether in-house or a good radiologist that you trust is a more dynamic test and it can add so much more to your MRI findings as well, maybe even an x-ray. So this is where it's really important, to I think,
00:28:59
Shabaaz Mughal
it's more than just, Claire gets injured,
Focus Beyond Scan Results
00:29:02
Shabaaz Mughal
get a scan, get scan. You know, you've got to really look at it properly, look at all the things that need to be done, and then you're more informed to make that decision, really.
00:29:14
Jonathan Bird
Because if click like you know and an MRI can pick up all sorts of stuff. Not all it's relevant.
00:29:18
Ian
but What but exactly? and Sometimes it's not relevant. i So my recent experience with this is um a player I was dealing with um from abroad had,
00:29:35
Ian
and a um in the truck clear groove, had a which is the sort of dip in, in yeah,
00:29:40
Jonathan Bird
which is the bit which the kneecap sits in, the kneecap sits in a kind of groove at the end of the thigh bone.
00:29:47
Ian
And, you know, this player on the um MRI, it all settled down. He was rehabbing, rehabbing, rehabbing. And eventually it blew up again, had surgery. And it was, the the lesion was much more extensive than it had appeared ever.
00:30:02
Ian
And, you know, I'd like to tell you he'd only had one MRI, but he'd had multiple MRIs. So, you know, it's, it's ah you and Shabazz is right, really. I think, look,
00:30:17
Ian
Anyone that gets injured, they're going to get scanned. yeah ah I think that ship has sailed and that's a, you know, you're trying to swim against the rapids, trying to swim against that. But what you've got to do then is is be circumspect about what you're doing and why.
00:30:32
Ian
no you know With that knowledge, and and as you're you're right, in Jonathan, you sometimes you think, yeah, but it's only got this on the scan, but i can find that I can find this on examination. Why is that?
00:30:42
Shabaaz Mughal
Yeah.
00:30:43
Ian
So I think you do have to be circumspect, and sometimes you have to go back and get another type of scan or another imaging. um and And that's difficult sometimes because there are lots of people at the club saying, oh yeah, the Scansers got this, well what are we going to do then?
00:30:58
Shabaaz Mughal
yeah
00:30:59
Ian
ah you know We need a plan, we need a plan tomorrow but if because it's got hamstring tear.
00:30:59
Shabaaz Mughal
yeah
00:31:04
Ian
And you'll say, yeah, but think his knee's a bit lax or his knee's hyperextending. Why is that? What's this?
00:31:12
Ian
you know what's this um And I think we've all been there, we've all gone through this, and it's very difficult to to hold back, to rein that impetus in from the rest of the ah the club.
00:31:22
Shabaaz Mughal
There is. yeah There's a saying, isn't there? Treat the man, not the scan. And I think that that is always something I keep in in my mind because it's very easy to get you know carried away with the scan
Debating Surgical Decisions
00:31:38
Shabaaz Mughal
findings. And as you say, Jonathan, it can show you a lot of things that almost irrelevant as well.
00:31:45
Jonathan Bird
I often say, like, a patient will come to me who's already had a scan, it's maybe a second opinion or something, and I'll say, you know, how can I help? And they will say, um well, my scan shows is this.
00:31:57
Jonathan Bird
I'll say, no, don't, just forget, just pretend you haven't had the scan, tell me about your knee.
00:31:58
Shabaaz Mughal
Mm-hmm. Mm-hmm.
00:32:03
Jonathan Bird
um and they look almost slightly confused. that that the that it's ah How are you doing? How are you doing and how's your knee? Not that little bit of whatever it is on your scan.
00:32:18
Ian
Yeah, and so, I mean, going back to the original thing about why surgery and when, my guess is that when there's a gap, it's because these sort of deliberations are going on, you know, second opinions, sometimes third opinions.
00:32:32
Ian
you know Everyone has to be sure and everyone has to be okay about surgery if you're going to proceed with it. And if the players from abroad and have a have an agent that has a surgeon that they've used before in another country, you you know you end up sending the ah scans over.
00:32:50
Ian
Sometimes I've certainly been abroad with players and you would have been, Shabazz, to see second opinion surgeons in different countries.
00:32:54
Shabaaz Mughal
Hmm. Hmm.
00:32:58
Ian
And that's fine because at the end of the day, it's the player's career. You must cover all the bases before you charge in. It doesn't mean that the first opinion is wrong.
00:33:10
Ian
It just means that everybody's got to be satisfied that we're doing the right thing and we're all facing the right way. Because if it goes wrong, there's plenty of people to say, I told you so.
00:33:21
Jonathan Bird
Yeah.
00:33:22
Shabaaz Mughal
And the reality is taking a few days or a week at the start, in the grand scheme of things, it's not really going to make a difference if you take that time and make the correct decision.
00:33:29
Ian
No.
Episode Wrap-Up and Listener Engagement
00:33:33
Shabaaz Mughal
Because, you know, the rehab will probably go smoother. Yeah, so I think at the time, people get a bit caught up in it.
00:33:44
Shabaaz Mughal
But the reality is any injury takes time, doesn't it? Unless it's a really minor tweak. So any surgery... There's going to be a period of rehab, whether it's to six weeks or 12 weeks, there's still going to be a period.
00:33:59
Shabaaz Mughal
It's not going to be a quick, you have surgery back the next day.
00:34:03
Ian
True. True.
00:34:05
Jonathan Bird
OK, so look, um we've we've've we've rambled on even longer than we did last time. So um eventually we'll have some kind of structure to this to these podcast, but but just just not yet. Anyway, look, so thanks, guys. um We ah do keep sending in questions. Theinjurytimepod at gmail.com.
00:34:26
Jonathan Bird
I also post these on Blue Sky. um So do let us know if you want to cover anything else. We'll aim for another pod next Sunday in terms of football as the international break.
00:34:40
Jonathan Bird
um but there is cricket going on, there is cycling, there is all sorts of other sports going on, there is American sports so we will try and cover as much as we can.
00:34:49
Shabaaz Mughal
US Open.
00:34:50
Jonathan Bird
we do have a bit of a football bent and as Shabazz often says to myself and Ian, too much of an Arsenal bent which I think is fair. um Hopefully what will happen in the next few months is that there will be no and no Arsenal injuries whatsoever and so we can stop talking about them.
00:35:07
Jonathan Bird
um Anyway, look, thanks guys. It says goodbye from me, Jonathan Bird, Ian Beasley and Shemaz Murgul.
00:35:17
Ian
Thanks all. Thanks, Jonathan.
00:35:19
Shabaaz Mughal
Bye bye. ah by
00:35:20
Jonathan Bird
Cheers.