There is a clear scientific link between injuries and performance across all sports. This improved performance is both in domestic league play and in international cup competitions. History also tells us that injuries make and break the careers of players, and can often signal the end of a manager’s tenure or a team’s run for a title; it seems that Manchester City’s Premier League title charge will in all likelihood rest on the speedy and prolonged return of Aguero. Therefore football’s richest prize depends upon fast and effective hamstring rehabilitation.
Uefa’s Elite Club injury survey has reviewed the last ten seasons of the top 18 teams in Europe from an injury epidemiology perspective. Their figures show that in a squad of between 25-28 players, there are on average 50 injuries per season. This means 1.8 injuries per player per season, and at most points in the season 12 per cent of the squad unavailable due to injury. The RFU’s recent injury audit for the 2012/13 season showed teams suffer, on average, 49 match injuries and 28 training injuries.This means a similar number of injuries per player per season.
What are the common injuries that challenge teams? Hamstring injury is the single most common injury in elite football and rugby. This translates to a professional male team with 25 players suffering about five hamstring injuries each season. Whilst hamstring injuries, and re-injuries, are common, it is longer term injuries such as ruptured ACLs and Achilles that can have the most significant economic cost. The Uefa study identified a mean return to play of 194 days (with a standard deviation of +/- 75 days and maximum of 580 days) for ACL injuries, and a mean of 169 days (with a standard deviation of +/- 65 days) for ruptured Achilles. Overall, when we speak about injuries, we should talk about match days lost.
It is this availability index of players which is often the primary focus for managers and owners alike. They have a pre-occupation of what “money is on the bench”, as the New York Times coins it. Considering baseball, one of the highest paying sports in the world, it is estimated that teams such as the New York Yankees have up to 34 per cent of their payroll (US$77 million per year) on the so-called disabled list. This is talent that can deliver no return on investment.
In the Premier League, the 21st Club’s Costly Injuries Table estimates that Arsenal currently have UK£96 million of value inactive, sidelined by injury. It is therefore so critical for all stakeholders in the game (owners, agents, fans, investors, TV companies, sponsors) that when a player gets injured they are rehabilitated as fast as possible.
Moreover the rehabilitation needs to be effective; in other words the risk of re-injury is minimised and the player returns to play at the same pre-injury level. The prize and upside is the opportunity to earn more from final league standings (the RFU study concluded that three additional league points can be gained by a reduction in the return to play by an average of six days) and associated sponsorship deals. Teams can also mitigate against additional costs arising from the need to potentially dip into the transfer window to replace the injured player.
But what can teams do to speed up the process of rehabilitation? Most teams have invested over the past five years in their player care structures with increased numbers of in-house doctors, physiotherapists and sports science staff. I would argue, though, that the primary function of these departments should be to look after the fit players, maximise their performance and deal with the small, inevitable niggles. What we know is that in the total equation, the actual cost of treating the injury pales in comparison with the direct and indirect economic costs. There are outside options that can help.
Specialist Sports Medicine and Orthopaedic Rehabilitation centres such as ours can work well with teams and players to return players back to play quickly and effectively. Such centres can dedicate more time to players, often up to 5-6 hours per day, and they have more cumulative experience of different injury types. For example, last year we looked after 570 sporting ACL injuries, whereas a normal professional team may suffer one per every second season. This type of volume provides for the ever-enhancing design of accelerated rehabilitation protocols.
Michael Davison, Managing Director, Isokinetic London