Was there an increase in La Liga injuries after the restart?

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La Liga injuries and the restart of the competition 

Based on the lack of preparation time given to the clubs, would the restart of La Liga in June lead to an increase in the number of players' injuries?  

When the restart of La Liga was announced after the end of the coronavirus lockdown, interest was high over whether or not this would lead to a surge in injuries.  

Concern centred on the lack of preparation time given to clubs in the rush to get La Liga playing again.  It seemed that football just had to restart, and all the indications were that the number of injuries would increase accordingly.

This was based on the short 'pre-season' period allowed by the football authorities plus the fact that each club would play eleven games; all of which would be condensed into thirty days. 

Not surprisingly, discussions in football circles were all about what the restart would bring in terms of injuries.  Colleagues agreed that it would be an interesting exercise to look at this in detail and collect as much information as possible.    

The findings could then be assessed at the end of the season.  

Planning and strategy

In terms of planning and strategy, therefore, the first thing to do was to differentiate between existing injuries that had been sustained by players pre-lockdown and new injuries occurring after the restart.  Existing injuries are important from a recurrence aspect so these were identified and are included in the summary pages below.

The drawback was that two sets of data were needed.  But without having the advantage of 100% access to official sources, this didn't turn out to be as easy as it sounded.  Existing injuries had to be separated from new injuries, and the main problem was that in most cases the injury lists released by the clubs did not differentiate between these. 

Players undergoing post-operative rehabilitation for long-term injuries such as anterior cruciate ligament (ACL) tears, for example, were regularly included in weekly injury lists alongside relatively short-term injuries such as thigh bruising or muscular overload.  

Another problem was the accuracy of the information, which varied depending on the source, and in some cases, it was impossible to obtain a proper diagnosis.  It tended to be that players were simply classified as just being unavailable through injury, therefore each injury report had to be double-checked.  

There are several clubs across La Liga whose injury information is impeccable, accurate, up-to-date and easy to find.  By contrast, some require a little more work! 

So for this exercise, then, the baseline was set as the 11th of June, 2020.  This was the start date for the resumption of La Liga and the Betis - Sevilla derby.   Any injuries recorded before then counted as ''existing pre-restart'' and anything on or after the 11th classified as ''post-restart'' injuries.  

It's worth mentioning at this point that Rayo Vallecano's match against Albacete on the 10th June, 2020, to complete the game that had been abandoned at half-time on the 15th December, 2019 is included in this exercise as this was technically the first game post-lockdown.

An increase in the number of injuries was anticipated

It was anticipated that the number of injuries would increase in proportion to the number of games played in addition to the training injuries, and of this the clubs were well aware.  

Measures were immediately put in place to minimise the risk of avoidable injury but in real terms, football and injuries don't always sit nicely in one basket and some things quickly became obvious. 

Where existing injuries were concerned, most clubs simply picked up where they left off.

For those players who were already injured before the lockdown, face-to-face rehabilitation effectively ended when the clubs closed in March and didn't happen again until early May when everyone returned to training.

This was a concern.  Several clubs had players with ACL injuries sustained before the break, and when these players returned along with everyone else to pick up their rehab schedules under close supervision again, the immediate focus was on whether any of those would be able to play in any of the forthcoming fixtures.

Some players, like Marco Asensio at Real Madrid and Alexander Szymanowski at Leganés, reported for rehab and were subsequently discharged by the medical teams to resume full training again.  

Others were not anywhere near that stage, and these players simply continued their rehabilitation as directed by the medical teams.  With the best will in the world, at club level, the main focus is always on the next game.  

During the lockdown that preceded the restart, guidance and customised rehab schedules were provided by the clubs.  The medical and fitness teams across the divisions excelled themselves in terms of providing new and innovative methods of assessment which included remote consultations and supervised exercises via video calls etc. 

The difficulty for the medical teams was to monitor injury responses without being able to take a ''hands-on" approach.  Despite all their efforts in a virtual sense, it's still hard for club medical staff to assess the ''end-feel'' of a knee joint if they can't perform a proper physical examination.

Players and staff up and down the country had no choice other than to adapt to the circumstances dictated by the coronavirus lockdown and the weeks spent in isolation tested everyone's imagination.  I'm sure I wasn't the only medical anorak to look forward to the daily round of training videos released on social media by imaginative players and coaches!

Individual sessions conducted from home soon became the normal, but once the lockdown was relaxed, the individual stage was over and the group training began, the inevitable happened and several clubs began to report injuries.  The majority of these were routine but as the build-up to the 11th June continued, these became more frequent. 

Most of these injuries were nothing more than minor niggles, but there were some incidences of players carrying-over injuries from the pre-lockdown days into the return to group training.  Some players in this category quickly discovered that they were not quite ready to make a full return at that stage and consequently dropped out of training.

Once the fixtures began, the difference was obvious

Once the fixtures began, it became a different story to that of the preparation period.  The quick turnaround between one game and the next meant that players picking up new injuries were faced with limited recovery times.  As a result, routine injuries that were likely to last several weeks effectively finished the season for several players.

In the early stages of the return to La Liga, games were played every three or four days on average, but then stretched to four or five days towards the end of the season.  

Although the longer periods between matches allowed more recovery time, which could be argued was more in keeping with the regular season, it still didn't help in terms of minimising injury risk.  

Nor did it change the fact that anyone carrying an injury over from one game to the next ran the risk of turning what might have started as a minor niggle into a longer-term problem that could potentially carry-over into the summer months.

There are always a few grey areas where injuries are concerned though and the restart was no exception with several players playing through niggling and chronic injuries.  

At Real Sociedad, for example, Martin Ødegaard played with a patella tendinopathy in some of the restart fixtures.   Mid-way through the programme, Martin travelled to Barcelona to take another opinion on his injury, and played a few days later.  He will now use the official close season to recuperate.  

Also at Real Sociedad, Asier Illarramendi was forced to drop out of training after only a few days of the restart due to a niggling adductor problem notable on kicking.  He later underwent surgery in London in early July and this is likely to keep Asier out of action until around October.  

It's interesting to note though that Asier had sustained a serious ankle injury during the earlier part of the season and was out of action for a considerable length of time with this.  The injury comprised of a fractured left fibula bone, deltoid ligament tear and injury to the syndesmosis of the ankle.  

It's always debatable whether injuries like these can lead indirectly to other injuries in the future, such as Asier subsequently sustaining the adductor injury, due to the potential for altered biomechanics associated with lengthy absences from training and playing.  

Players frequently return to play after long-term injuries then pick up further (potentially) non-related injuries.  Anecdotal evidence would suggest that the enforced break in training could also contribute to this; with players confined to home-based training during the lockdown, the potential for this is likely to have increased.

Both Eden Hazard and Marco Asensio at Real Madrid began the lockdown at varying stages of rehabilitation for long-term injuries.  Marco had knee surgery after tearing an ACL in America during Real's pre-season tour last summer while Eden underwent an ankle operation earlier this year.  

Upon being given the all-clear to return to the club in May, both players reported to Real Madrid's training centre in Valdebebas to continue what had then become the final stages of their rehabilitation.  Both were deemed fit to play on the official restart date on Thursday 11th June, although Real didn't play their opening game until Sunday 14th against Eibar.

Unfortunately, Nacho Fernández sustained a rectus femoris thigh muscle injury in the week leading up to that opening game with Eibar.  But Nacho wasn't the only player to miss the restart with a new injury.  

João Félix at Atlético Madrid also struggled with a thigh injury during most of Atlético Madrid's return to training period and missed a lot of the preparation period as a result.   Joao was technically fit to play from the restart date of the 11th June onwards, though, albeit suspended for Atlético's opening fixture against Athletic Bilbao.   

Gabriel Paulista at Valencia was one of several players across La Liga who didn't make the restart due to a niggling hamstring injury but returned to play at a later date.  The complete lists of existing injuries pre-restart and those sustained on the resumption of competition are provided in the web pages below this article.

Some injuries are impossible to legislate for

There were also the inevitable injuries that are impossible to legislate for.  Celta goalkeeper Rubén Blanco will be out for the next four months following a tendon rupture of his rectus femoris muscle in his thigh during the game against Atlético and his Celta teammate David Juncá dislocated his shoulder in training.

In La Segunda, Numancia defender Alex Sola, on loan from Real Sociedad, tore his ACL against Extremadura and faces lengthy rehab well into 2021; as does Liusmi Quezada who tore his ACL, collateral ligament and meniscus in Cádiz's opening game against Rayo Vallecano.  Details of the injuries sustained in La Segunda aka La Liga Smartbank will follow.

And as we also know, some clubs suffered more than others.  Granada, Osasuna, and Mallorca restarted the competition with an already-high number of pre-existing injuries, while Málaga suffered more than most in La Segunda.

Real Valladolid, in particular, picked up more injuries than most after the restart on the 11th June, but except for Valladolid, most injuries were evenly spread across the league.  Most clubs had at least a couple of players out at any particular time.  

Levante appeared to show the least number of injuries overall.  This wasn't lost on coach Iván López who praised the medical team for their efforts in minimising the risk of avoidable muscle injuries.

Of note, however, was the number of muscular injuries reported across the clubs in general, which could potentially be explained by the short preparation time allowed.  Some were described as 'overload', which is a loose term frequently used to explain muscular discomfort after excessive training or a particularly physical game.

This often precedes an injury proper and can be a problem in football where players are in that intermediate stage between showing initial symptoms of muscular injury and sustaining a graded soft-tissue tear.  

With careful management these early symptoms can be identified; but only if players make the medical staff aware of their existence.  Sometimes the latter doesn't happen as often as it should!  

The key, as always, lies in making that early diagnosis.  This was complicated during the match phase post-restart by the crossover between recovery and recuperation from one match and beginning preparations for the next.

Additionally, we saw an unusual pattern of injuries.  Players were seemingly recovering from injuries that would normally be expected to rule them out for several weeks returning in half that time; in the early stages at least. 

Towards the end of the fixture list, we had the opposite effect.  Players sustaining injuries in the last few weeks of the competition inevitably had their season ended prematurely.  With most soft-tissue injuries taking roughly 10 – 14 days to recover, the season was effectively over for anyone unfortunate enough to pick up an injury with just over a week or two to go. 

So, did we answer the question and did the number of injuries increase?

It would be easy to say yes and that there did appear to be an increase in injuries based on the number of muscular injuries recorded, but an increase in injuries compared to what?  

In order to provide a true reflection of the injury situation following the post-COVID restart, comparisons would need to be drawn between the injuries occurring after the lockdown and the injuries recorded from the beginning of the true pre-season period in July 2019 until March 2020.

But in order for this to be effective, a complete injury audit would need to be undertaken across the league that involves all the clubs and maintains medical confidentiality, with only the actual injuries being analysed and where the methodology chosen would guarantee the anonymity of the players who consent to participate in such a study.

Access to players' medical records would be required, so this could only be done properly with the agreement and involvement of the clubs.

Additionally, since there are so many factors involved in injury management, each particular injury sustained post-restart would need to be assessed on an individual basis.  This would include the player's age and history of previous injuries, whether the injury being assessed was new or recurrent, relevant underlying factors, plus ground and weather conditions etc.

Bahr and Holme (2003) stated that injuries occur through a complex interaction of multiple risk factors and events, hence today's emphasis on using the term injury risk management instead of injury prevention, since the question is always whether the latter can realistically be applied to certain injuries that are unavoidable.

The true answer, therefore, is not without previous data to compare with.  

In keeping with the current interest in this topic, Drs Ripoll and Da Prado in Elche have researched the injuries occurring in La Primera since the restart and it will be good to see their findings in due course.

For this site, though, information will continue to be added to that provided in the pages below and once La Segunda is added, it will be interesting to see how both divisions compare.  No doubt the discussions will continue as the weeks go on, and now it's started, I'll continually keep this site updated.  

Happy to discuss further at any time!

Reference:  Bahr R, Holme I (2003).  Risk factors for sports injuries: a methodological approach.  British Journal of Sports Medicine.  Vol. 37; 384 – 392.