Injuries in football: No smoke without fire?

There was little sign on Monday of Martin O'Neill giving any ground in his war of words with Ronald Koeman, and the Ireland manager seemed, in truth, to be revelling in it all a little.

O’Neill’s bottom line remains the same; that McCarthy’s injury was picked up at the club and so the medical staff there should be looking at themselves rather than their opposite numbers in Abbotstown. It all sounds fair enough until we come to the question of the player having apparently declared himself fit for the game.

If he carries it off and plays with a problem then that is one thing but clearly a club is going to be unhappy if their player pushes himself in an attempt to participate then has to pull out in the pre-match warm up, as McCarthy did against Wales. It’s hard to avoid the sense that Everton are entitled to feel a little aggrieved here even if they have overstated their case.

Everton have had other injuries problems this year, not least the loss to a double lower leg fracture of Seamus Coleman, while he was also on international duty, and both will have contributed to their slightly high mid-table ranking for injuries based on data provided by premierinjuries.com.

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In basic terms, the table provides a sense of which clubs have been best and worse at keeping their players injury free and on the pitch and what is most striking is that two of this season’s relegated clubs, Sunderland an Hull City, are right up at the top, in first and second place, for the numbers of games missed by squad members while Chelsea are second only to West Brom for ensuring the manager’s selection options are maximised.

There is clearly some element of fortune, good and bad, about this with Coleman’s injury entirely out of the hands of anyone on his club or country’s medical staff. But at a conference run here last year by the Beacon Clinic, Professor Jan Ekstrand, a former team doctor with the Swedish federation and a leading light in Uefa’s sports medicine programme, was utterly dismissive of managers who try to blame bad luck when an injury crisis strikes. In all but exceptional circumstances, he insisted, coaches and clubs make their own luck and misfortune has a habit of associating itself with the same managers regardless of how many times they change employer.

Just now, premierinjuries lists Everton as having nine players ruled out, although three are on international duty with the English Under-20s. Manchester United are not far behind and it seems safe to assume that Ekstrand would not have a huge amount of sympathy for Jose Mourinho when the Portuguese comes out to complain after games about how handicapped he is these days by limited numbers.

The Swede’s arguments are primarily based on data gathered from clubs participating in the Champions League over a period of 15 years or so. Some 55 clubs from 18 countries participated in Uefa’s Elite Club Injury Study up until 2016, registering around 22,000 injuries and the recovery outcomes that followed and the most startling conclusion those behind it seemed to reach was that injury rates are essentially unchanged over time at the top end of the game with every advance in prevention and treatment cancelled out by growing external pressures on players.

When it came to the very top clubs, Ekstrand suggested, there is no limit to how much might be spent on getting a player fit again after an injury but managers at some clubs routinely rushed the return of team members they felt were needed. Meanwhile club chairmen placed additional strain on entire squads by, amongst other things, packing them off around the world to play friendlies in emerging international markets with long periods of air travel and frequent moves between major cities complicating and undermining pre-season programmes.

There is some encouraging data with the study finding that 100 per cent of those elite players to suffer a cruciate ligament injury at clubs participating in the study got back to play top level football. But even outside of the Real Madrids etc, the scale of the expense involved can be astronomical. At Shaktar Donetsk, they put the total cost to an average Champions League side of a player being sidelined at €583,000 per month and Uefa’s statistics on total injuries suggests that that translates into a €20 million per season bill at club below the very top level.

Perhaps unsurprisingly, Ekstrand reckons the solution is more resources for medical departments and, he says, better communications with them, although neither will make much difference in the end if a manager decides to throw a player in on the basis, say, that he has declared himself fit.

Clearly at Everton, they believe McCarthy could have been better handled here in March in the most basic terms, the number point to O’Neill having a point too. Coleman’s absence might count as bad luck but Koeman and co. are not, the evidence seems to suggest, in the wrong half of this particular table for nothing.