The Bundesliga’s return saw a sharp rise in injuries, with a study by sports scientist Joel Mason showing that the first
weekend had 0.88 injuries per game, up from 0.27 per game in pre-lockdown 2019/20 fixtures.
There are caveats to this. The sample size is small. Injuries could be discovered only
after games had finished. And teams were probably more likely to be over-cautious in bringing
players off after a lay-off: some of these injuries were likely severe cramp rather than
soft tissue problems.
But it’s clear that returning to competitive football after a period away increases the
likelihood of injury. In 2011, the NFL lockout saw athletes unable to train properly for
136 days, and pre-season training was cut from the normal 14 weeks to 17 days. In the
first twelve days once training restarted, 10 players ruptured their Achilles tendon,
and injury levels in the first month of competition were twice what would normally be expected.
Soft tissue injuries affect muscles, ligaments, and tendons. Injuries can be explosive – where
the intensity level increases, such as during a sprint – or endurance – where the tissue
is fatigued and trying to deal with more overall load than it should have to.
There are three fundamental reasons why such injuries increase after a period of lockdown.
Increased training load ramped up over a short period
Inability to train properly prior to removal of lockdown, due to lesser facilities and
monitoring Loss of fitness that helps protect against
injury
There is also a tendency to prioritise technical and tactical training over physical preparation,
although this may vary from club to club.
Dr Raj Brar, an expert in sports medicine and physiotherapy, says that there is nothing
unexpected about the upsurge in injuries seen in the Bundesliga.
“The reason why you tend to see an increase during these periods after a delay is that
the body de-acclimates to the stress.” It is the sudden increase in stress levels to
get players match-fit that makes injuries far more likely.
This brings into play something called the acute:chronic workload ratio.
Acute workload is the effort put in over a week, often measured in distance run. Chronic
workload is the four-week rolling average of effort. While neither of these factors
correlates strongly to injury in isolation, and higher chronic levels can actually reduce
injury risk as players get their bodies used to doing a lot, the ratio is key.
A study by Billy Hulin and others showed that a ratio of over 2.11 meant injury risk was
almost 17%. And a lower ratio, but with a significantly increased acute level, meant
almost a 29% risk of injury. Spikes in acute workload pose the greatest risk. In layman’s
terms, doing too much, too soon can increase soft tissue injury risk by upwards of two
and a half times.
As Dr Brar puts it, “The real injury risk is from the ramp-up period. Even during a
normal season, when you go from training camp to pre-season to season there is an increased
risk.”
And this, when the other factors of lockdown are brought into play, poses a real risk to
athletes.
Clubs have seen their plans disrupted. They build their fitness programs to anticipate
the ebb and flow of competition across the season. Such a significant break will have
not just created its own issues in terms of ramp-up, but will also have thrown these plans
into disarray.
As Dr Brar says, “It will have disrupted a whole year’s planning, especially ones
who are planning to play deep into the season, to stay competitive across one or more competitions”.
Research shows that the higher the competitive level, the higher the risk. This is partly
intensity level: better competitions have better athletes, and so other athletes have
to push themselves harder. But there is also a psychological component: maybe it’s the
opportunity to succeed at a higher level, to advertise oneself to suitor clubs, to rectify
league form in the Champions League. Clubs must also deal with other psychological factors,
including the mental stress caused by lockdown, or players desperate to get back to playing
and therefore hiding injuries.
And social distancing has also been a factor. While some clubs have, according to Dr Brar,
provided their players with gym equipment, it’s obviously not to the standard found
at clubs. Clubs can and do, according to Dr Brar, collect some medical data, while video
calling has also made it easier to stay in touch, but athletes at physical distance are
harder to monitor and motivate. And distancing also affects treatment – doctors and physios
will have found it harder to work with athletes while respecting rules around contact, especially
where something as physical as soft tissue injuries are concerned.
Five substitutes per game should help, but it’s unlikely that clubs will instruct their
players to work less hard on the pitch. The balance of managing a ramping-up of workload
in a short time with getting players ready to compete is almost impossible to achieve
without injuries occurring, whatever steps clubs take to mitigate the risk.