Physio Room Blog: Will Baines & Mirallas make Man City?

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Since the last blog, we’ve seen ‘Hibbo’ and ‘Gibbo’ return to action against Arsenal.  Mirallas is still missing but pictures of him running around with a smile on his face from todays open training session seem encouraging.  However, in the same way other teams are struck down by a cold or flu virus, our team seem to be coming down with hamstring strains as though they’re catching.  The latest news is that Baines may have now injured his and could miss Saturday’s game at Man City.

It does seem I’ve been a little too optimistic with my predictions so far about when our players will be able to play again.  I was disappointed not to see Gibson or Mirallas feature against Norwich.  Without disrespecting Norwich too much, if we’ve any designs on finishing in the top 4, this was a must win game.  Gibson had managed 64 minutes a week earlier with no reaction to his thigh injury and the noises from Everton about Mirallas following a positive scan result suggested he’d be back within 2 weeks.

Mirallas – to play or not to play?

INJURY: Hamstring strain

Unfortunately, the decision about when a player is fit enough to play is not an easy one. From the sounds of it, the scan on Mirallas’ hamstring didn’t show much damage so the decision about whether to play him, will have been based on how his leg felt when running.  If Mirallas reported any tightness Moyes will have then been faced with the dilemma about whether to risk him.  Sometimes, tightness in a muscle is just that and with a few stretches you can run it off.  Tightness can be a warning though, a precursor to a more significant injury.  So do you risk your star player in one game in the hope he has no reaction to his injury but a flare up could see him missing the next 6 games? Many a physio and manager have fallen out in football clubs over the years about when a player is fit to return.  Benitez’s over reliance on Torres at Liverpool is a good example of where I’m sure the medical team will have wanted to give the player more recovery time but the manager knew not playing him greatly reduced their goal threat.

Lets hope the caution shown by Moyes and the extra week’s rest will see Mirallas now go on an extended run in the team and we can get back to winning ways again.

Predicted return: Saturday (Man City away)

Baines

INJURY: Hamstring strain

The Everton site is saying Baines has suffered a slight hamstring injury.  Baines managed to finish the game last night so hopefully this is certainly no more than a grade 1 tear.  If it’s just a bit of tightness then a few days rest and some physio treatment should see him return to action in the next game.  A tough call again for Moyes with the busy Christmas schedule approaching.

Predicted return: Saturday (Man City away)

Neville

INJURY: Knee surgery

Predicted return: 4 to 5 weeks (Swansea home)

Anichebe

INJURY: Hamstring strain

Predicted return: 1 week (Tottenham home)

How to rehab a hamstring strain


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This is just a bit of general advice on how the hamstring strain is managed and treated.  The extent of treatment depends on how bad the strain is.

1-2 days:  When any muscle or soft tissue is torn, there’s an initial acute inflammatory reaction, which lasts about 48 hours.  During this time there’ll be pain, swelling and bruising around the injury site.  Bending the knee will also be very painful.  Initial treatment is following the RICE principal – Rest, Ice, Compression, Elevation.

1-2 weeks:  At a football club, a scan will be done to assess the extent of any damage.  If the damage is minimal, some massage will be done on the hamstring to help reduce the tightness.  Maintaining strength and flexibility is important to protect against further injury so it’s likely the player will perform low resistance non-weightbearing exercises such as the exercise bike or swimming or running in the pool.  If there’s no reaction to this, the player can start to run on dry land in straight lines.  Again if there’s no reaction to this the player can then return to ball work and twisting and turning in normal training.

If a scan shows more significant damage, it’s likely the player will still have to apply the RICE principle during this time and will be given crutches to avoid putting too much weight through the injured leg.

3-4 weeks:  Hopefully if a player has suffered a grade 1 tear, they’ll return to playing in this time. Extra strength work will be done in the gym and regular massage and ultrasound therapy will help limit any scarring in the muscle.

If it’s a grade 2 tear, they can ditch the crutches and start some light rehab in the pool.  Specific physio treatment will include regular massage, ultrasound therapy, hamstring stretches and specific hamstrings strengthening exercises.  It’s important that the muscle length is maintained and scar tissue is limited to prevent further injury.

4-6weeks:  Grade 1 tears should have resolved by this point.  Players with a grade 2 tear will step up their work in the gym to build up strength in the damaged muscle.  Gradually the player can progress from low loading exercises such as the exercise bike and swimming to light jogging.  The physio will monitor the player closely to see whether there’s signs of any further damage or inflammation.  Massage and stretching will continue on a regular basis.

6-8 weeks:  The player can return to running and then normal training.  There is a risk of tearing again as there will be weakness in the muscle at the site of the original tear.  If the hamstrings have been kept strong and flexible during the period of the rehab then the risk is greatly reduced.

Follow Ross @UKPhysiotherapy

New on the blog today: Scout Report – Moyes Tactical Blueprint for Man City

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