With the Premier League season about to hit its famous festive period, player injuries are set to take on an even greater spotlight and significance.
The games come thick and fast in December as we head into the New Year with increasing intensity, with the race for the top four, European competitions and the fight against relegation heating up. But that brings more attention into player fitness, whether it’s due to the importance of such stars, exposing a lack of depth in the squad or just knock-on effects of fatigue.
But before we get into the major injury issues for the Premier League, there’s a potentially significant injury to a superstar that occurred during Paris Saint-Germain’s 3-1 win over St-Etienne.
Neymar’s left ankle injury
Neymar suffered a left ankle injury at the weekend, with his ankle turning inwards, and had to be taken off on a stretcher. Following the match, he was seen leaving on crutches and in a boot, not putting any weight onto the ankle.
PSG have since released an official medical update on the Brazilian, stating he has suffered “lesions to the ligaments” in his ankle and will miss six to eight weeks. Based on that timeline and phrasing, and in combination with his mechanism of injury (how it happened), this is at minimum very likely a grade 3 full ligament rupture to a lateral ligament of the ankle.
The timeline and wording inclines me to believe there’s potential damage to multiple ligaments as isolated grade 3 lateral ligament ruptures typically come with a four-to-six-week return timeline (for example: Alphonso Davies).
PSG did, however, also state that they’d reassess the player in 72 hours as these can take three or four days for the full extent of the injury to become crystal clear.
Now moving into the Premier League!
Chelsea’s most-notable injury came to left-wing-back Ben Chilwell, who hurt his left knee during their 4-0 win over Juventus in the Champions League last week.
Based on the video mechanism, I was significantly concerned for a season-ending grade 3 anterior cruciate ligament (ACL) injury but the club announced some good news in that Chilwell has only a partial tear of the ligament.
— Squawka News (@SquawkaNews) November 23, 2021
The plan of care, according to the club, is to allow him to rehabilitate for the next six weeks and then make a decision in early January. The key indicator will be the stability of Chilwell’s knee at that point. If physio does not work, then surgery is indicated and he would still likely be ready for the start of the 2022/23 Premier League campaign and 2022 World Cup in Qatar.
Additionally, Chelsea will also be missing two key midfielders in N’Golo Kante and Mateo Kovacic for the foreseeable future. Kante twisted his knee “a little” according to manager Tomas Tuchel and his return timeline is still undecided. Kovacic continues to be out with a thigh strain and it doesn’t sound like he will be back any time soon.
Manchester City and Pep Guardiola have received a double boost of good news on the injury front with two of their premier play-makers, Phil Foden and Jack Grealish, having returned to individual training and progressing well according to the manager.
As is typically the case with Man City, we have received very little information on the injuries outside of general updates on their progressions and photo evidence of what they are and aren’t doing. Keep an eye on their return to team training for a better indicator of when each might be back playing games.
Jurgen Klopp’s side have received positive news on four different fronts. Midfielder Naby Keita – who was in spectacular form prior to a thigh injury – may return soon to team training. Striker Roberto Firmino – another victim of a thigh injury – is progressive positively as well.
Central defender Joe Gomez is still weeks away from returning and I imagine the medical and training staff will be very methodical and conservative with his reintegration as he will have considerable fitness deficits (and thus increased injury risk) coming off an extended rehabilitation from his patellar tendon rupture and compounder by this injury.
Additionally, young midfielder Harvey Elliott continues to progress very well from his ankle-fracture dislocation.
The one item of bad news for the Reds is Curtis Jones, who is out indefinitely with an eye injury that, according Klopp, “cannot be rushed” and simply needs time to heal.
Arsenal washed the bad taste of the 4-0 defeat to Liverpool out of their mouths with a nice bounce-back win against Newcastle at the weekend and have received even more positive news in their quest to return to Europe – and potentially challenge for a top four spot – as key central midfielder Granit Xhaka is nearly a month ahead of his initial schedule in returning from a right knee injury suffered in the closing moments of the club’s 3-1 North London Derby victory over Tottenham.
?? An update on Granit Xhaka
? Looking ahead to Newcastle
Read every word from Mikel Arteta's press conference ?
— Arsenal (@Arsenal) November 25, 2021
The club’s most recent medical update – along with pictures showing Xhaka in team training – states the midfielder is expected to begin full team training in December (he was originally slated for January). The midfielder is not only a key positional and progressive influence on the team but he will be critical as the Gunners’ are set to lose Thomas Partey and Mohammed Elneny during the African Cup of Nations period from January to February. This earlier integration will also allow Xhaka to rebuild his fitness and not be thrust into games too quickly.
Moving onto a concern from the Newcastle match, Bukayo Saka had some discomfort in his left hip flexor region during the match – initially allowed to play on but then taken off – and will be undergoing scans to reveal the full extent of the injury.
New Manchester United interim manager Ralf Rangnick faces a team with some key players out of the lineup.
Central midfielder Paul Pogba may be out as long as 12 weeks with a thigh muscle injury he picked up on international duty. The player is currently rehabbing in Dubai.
Additionally, left-back Luke Shaw is dealing with potentially two concussions in quick succession. These mild traumatic brain injuries are serious enough in isolation and symptoms can linger but two in succession can lead to even greater severity, variability, and lesser threshold for recurrence.
Last but not least, striker Edinson Cavani is dealing with a stubborn tendon injury. We haven’t received much information other than it being a “tendon of the foot” but we do know it hasn’t responded well as he tried to ramp up intensity and no timeline has been given as of yet. Tendon injuries and recovery can be highly variable due to the unique elastic demands placed on tendons.
Tottenham – also dealing with the integration of new manager Antonio Conte – are currently missing key acquisition Cristian Romero. The player picked up a significant hamstring injury that is considered to be at least a grade 2 tear (typically three to four week tear) but based on the indeterminate timelines, may even be a grade 3 rupture that can require at least six weeks to return from.
Even when Romero does get back, a key concern will be re-injury as studies show high prevalence rates of re-injury, with nearly 30% of footballers re-injuring the hamstring within the first two weeks of returning to matches.
Leeds United striker Patrick Bamford continues to miss games due to an ankle injury that, based on video review, looked like a “high ankle sprain” but may also be foot-related. Manager Marcelo Bielsa has been coy with any timeline projection, noting only that the injury hasn’t evolved well so Bamford continues to be held out.
However, the team released an update saying that Bamford is on the path to returning and will be playing with the U23 team. That is a key step for the striker and his return will continue to be dictated based on how the ankle/foot responds to increased activity.
Some good news for manager Brendan Rogers and his Leicester City side who have been battered with injuries. Firstly, young central defender Wesley Fofana looks to be recovering very well from his leg break and could be in line for an early January 2022 return. Furthermore, James Justin continues to recover form an ACL rupture and will soon return to bounce games with the U23s and continued building up of his mental and physical fitness.
Dr. Rajpal Brar, DPT, (@3cbperformance) is a physiotherapist, movement expert, fitness trainer, sports scientist and mindfulness coach. He runs the LA and online based wellness and athletic performance clinic 3CB Performance, and you can subscribe to his Youtube channel (which posts analyses of Lionel Messi and more).