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Physiotherapy Corner: Tom’s Injury of the Week – Abou Diaby

Dec 212011

Tom Goom is a physiotherapist and Gooner. He loves Arsenal, cheese and shooting thirty yards over the bar. He hate grass munching, racist centre halves, and former Manchester United strikers who look like Black Beauty’s ugly diving younger brother.

This week, the grisly details of Abou Diaby’s ankle injury:

May 1st 2006. Injury time at the Stadium of Light. Arsenal lead Sunderland 3-0. Dan Smith hits Abou Diaby hard with an over-the-ball challenge, studs down onto his right shin, just above the ankle. It is immediately obvious something is wrong but somehow Diaby manages to limp off, his right foot hanging at an odd angle as the physio helps him to the sidelines.

In the media furore that follows, the usual dialogue takes place; one side deplores the “horrendous” tackle, the other insists “he’s not that kind of player“. That’s all been debated ad nauseum, and my aim isn’t to go into that but rather to look at the impact this has had on what was a blossoming career.

Diaby suffered a fracture dislocation of his right ankle. It is common in these injuries for both tibia and fibula to break, sometimes in several areas. We don’t know the exact details, as football clubs rarely release them – it is, after all, confidential patient information. When the ankle dislocates there is trauma to the surrounding ligaments as well as the bone and ankle joint. The pictures below show normal anatomy (A and B) and potential effects of a fracture dislocation (C and D).

A) Normal X-ray

B) Ankle bones and ligaments

C) Ankle Dislocation

D) Fracture of tibia and fibula

In Diaby’s case, he had three separate surgeries to repair his injury. It is likely that this included an ORIF (Open Reduction Internal Fixation) of some description, depending on the nature of his injury.

I see these fractures regularly where I work as a physiotherapist, and they can be challenging to rehab. The nature of the trauma causes a lot of swelling and stiffness in the ankle joint. It is quite rare for a patient to recover 100% range of movement in the ankle, even with intensive treatment. The fact that Diaby was able to return to action nine months later is a great credit to Arsenal’s excellent medical team. He made 28 appearances in all competitions in 2007-2008 and by 2009-2010 that number rose to 40, before he featured for France in their disappointing 2010 World Cup. But that doesn’t tell the whole story. Diaby has reportedly had 29 injuries since 2006. On average a player would expect two injuries per season. He has, on average, had around five per year and faced lengthy layoffs, playing just 20 times in 2010-2011 and featuring just twice this season.

Diaby’s most recent absence has been down to the surgery he had on his ankle this summer. Again few details have been released by the club, but it is possible he had the original metalwork removed, as this can cause problems. That said, professional footballers often have this removed at a much earlier stage. On returning to action Diaby has picked up a hamstring problem that has ruled him out again. I can only imagine how frustrating that must be for him.

It is easy for us as Arsenal fans to criticise Diaby or the Arsenal medical team for his repeated injuries. Many have the attitude that we should “get rid“. I think though that the blame lays clearly at the severity of the initial injury and not its management or Diaby’s ineptitude. Or blame John Terry. Maybe Diaby re-injured his ankle when he volleyed Terry’s hideous concrete block of head?

Kicking racism out of football

Dorsiflexion

More likely though is the long term effect Diaby’s injury will have had on his ankle and how that affects other areas. One of the most important movements of the ankle is dorsiflexion (see picture for details). We need this for so many functional movements; walking, running, squatting, lunging and many activities that involve impact. Unfortunately it’s very hard to fully restore after this type of injury. Side to side movement (inversion and eversion) is also essential. When we balance on one leg the ankle can adapt by moving one way or the other allowing fine control of balance.

Without these movements it becomes harder to balance and the body often adapts by placing more stress on the knees or surrounding muscles. This may be why Diaby has had knee, calf, hamstring and groin problems since his injury. In addition, if the ankle is forced into a position where it is stiff, during a tackle or striking a ball for example, there can be further injury to the ankle.

So, what does the future hold for Abou Diaby? My hope is that with a gradual return to first team action Diaby will be able to reach the level he did in 2009-2010 where he made 35 starts for Arsenal. Five years of persistent injuries though makes me wonder if this will ever be a realistic outcome. For his sake I really hope he can make it. At 25 he still has time on his side to fulfil some of the potential we’ve seen from him at his best.

Man City 1-0 Arsenal: Sometimes you don’t get what you deserve

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Dec 192011

Man City 1 (Silva 53) Arsenal 0
(Premiership)

Rarely do you feel so positive after a defeat. Improved form, a greater sense of team spirit and unity, and perhaps a slight readjustment of fan expectation has mended a lot of the bridges between the club and the supporters since our last trip to Manchester, and despite tasting defeat in the league again there yesterday, none of that will have been sullied thanks to a terrific performance that deserved more than it got.

Most of the recent clashes between the clubs have been dull affairs, and even the Carling Cup tie a few weeks back was devoid of real entertainment. But yesterday was entirely different – a basketball match played out between two teams attacking at will, and with an intensity that ensures that both should end the season in decent positions. City again came out on top, but they had to work far harder for it than in the majority of their games this season – remember this is the team that put six past United and five past Spurs. They average around three a game, but despite our patched up defence, packed with centre halves, we held them at bay valiantly.

They had chances of course – aside from Silva’s winning goal, Zabaleta struck the post, Szczesny saved superbly from Balotelli and Aguero missed a great chance early on. And with the chance to seal the game with a simple pass for a Balotelli tap in, Nasri woefully overhit an assist even Eddie McGoldrick wouldn’t have got wrong. Thanks for the millions, fellas.

But we caused plenty of problems too – Hart was forced into a couple of terrific saves from Gervinho and Ramsey, and later Walcott and Van Persie stung his fingers. Late on, Vermaelen had two terrific efforts that could easily have seen us snatch the point we probably deserved, and were it not for a marginal (but correct) offside flag, Van Persie would have levelled.

We also had a strong penalty appeal when Richards handled in the box, but to be honest I didn’t think it warranted a spot kick. The rule these days seems to be all about arm position, and his were firmly down by his side, so despite the phrase ‘seen them given‘ being tailor made for the incident, I think it would have been a soft one. The trouble is that the handball rule has become a little like the offside rule – the laws keep changing, no-one knows what they are and every referee applies them differently.

Phil Dowd, as ever, had a mixed game. His yellow cards were often bizarre, both in their presence and how he followed one up by ignoring the exact same foul by someone else, but in fairness the big decisions were correct. He also resisted City’s attempts to get Song and Arteta sent off when first Richards and then Barry realised they were going into challenges with carded players and flung themselves to the ground. It was a tactic that does City no favours – an excellent side they are turning out to be, and a club that I’ve always had a bit of a soft spot for (largely because of a good mate who suffered through every moment of their yo-yoing through divisions), but since gaining riches they have also developed a cynical side. Not pleasant, but perhaps inevitable.

But credit where it is due – not many teams would have kept a clean sheet against us yesterday, or indeed beaten us, and if they continue that form they could well lift the league title at the end of the season, no matter what that means for the soul of football.

As for us, we still have some work to do – Djourou’s injury means we’re struggling even more for fit defenders, and with Arshavin and Chamakh continuing their struggles, our options from the bench are sadly limited at the moment – but we should take an enormous amount of encouragement from what was a terrific display.

Continue in that vein, and we’ll be absolutely fine.

Arseblog Book Launch: A great night at the Tollington

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Dec 092011

A little over seven years ago, Tom Goom, a good friend of mine, fellow Gooner and all round good egg, told me about this ‘great fansite he’d come across‘, and that I should check it out. At the time, I’d grown bored of gossip sites, as well as the majority of the printed press, such was the dearth of accuracy and logic on offer, so I was naturally a little cynical.

“Seriously mate, this one’s different. The bloke makes sense, cuts the bullshit, and is hilarious.”

“Actually hilarious? Or Soccer AM ‘hilarious’?”

“He’s giving away prizes on his site. The question you have to answer is: Is Didier Drogba a) a cunt or b) a cunt”

My curiosity was piqued.

The next day was a slow one at work, and I thought back to the night before, and the site Tom had mentioned. Why not, I thought, and typed ‘arseblog‘ into Google. Arseblog – it’s fuckin’ excellent appeared as the first result. My thoughts switched to Freddie Ljungberg and I chuckled inwardly at the reference. It was the be the first of many.

I clicked, and read. And then I read some more, scrolling back through older pieces, laughing at the highlighted jokes that appeared when you hovered over links, at the biting comments made towards unsavoury opposition, and the general tone of light hearted merriment, clearly written by someone used to cutting through the crap he read everywhere else. I loved it.

The next day, I read again. And the next day, and the one after that. In fact, over 2500 days have passed since then, which represents a ridiculous number of articles, yet I, along with many others, have lapped up every one. After a few days, I started to wonder if there were others like it, and came across another few blogs of quality, notably Goodplaya, Gunnerblog, Goonerholic and East Lower, or Man From East Lower as he was then. Remarkably, that select group still produces quality content to this day, and have since been joined by many others.

I was hooked. More blogs began to spring up, and I kept adding them to my list. Some began to irritate me, and tempt me into writing responses in the comments, but I’ve never really been one to write scathing replies to obviously antagonistic content. I’m not a biter, I suppose, so instead they dropped off my list, and I returned to the tried and tested group. I started to interact with them, commenting and debating where I could, and as the months passed, I realised it would be far easier if I just wrote my own opinions in one place. Perhaps, blogging would be for me?

My wife was all for the idea, but I suspect that had more to do with the fact that if I had somewhere to write, I would spend less time boring her with my opinions (she doesn’t care much for the game, her desire to see Arsenal win is driven more by wanting me to be in a good mood). She also named the site – coming up with what I thought was a clever play on ‘the beautiful game‘ and my constant rants about it. Since then, others have told me that The Beautiful Groan actually sounds like a bad porn film. You win some, you lose some.

And so this site was born (or at least, a previous incarnation of it). For nearly five years I’ve been penning my thoughts here, and like many other bloggers, there have been times of regular articles, and lean periods. In fact, my current count of 713 pieces means that there have been over 1000 days on which I’ve written nothing. Meanwhile, in nearly ten years Arseblog has barely skipped a beat, which no matter what the man himself modestly says, is an extraordinary display of commitment.

On Wednesday night, the crowds were out in full to celebrate that commitment, arriving in droves to get their hands on his new book, So Paddy Got Up, complete with contributions from a veritable who’s who of journalists, bloggers and passionate fans. The sight of queues winding round the pub and out the door was one to behold, but at the other end of the line was a shiny new hardback anthology, a group of contributors willing to spend hours signing each copy, and of course the man himself, whose arm probably wanted to drop off after hundreds of handshakes and scribbles.

What made the evening particularly great was that the characters there were exactly as you would imagine them to be if, like me, you had never met the majority. From the professionals – Philippe Auclair, whose passion for the game soaked every one of his words, and Amy Lawrence, whose inability to hide her love of Arsenal was touching to listen to – to the bloggers – Tim Stillman (handsome bastard – Arseblog columnist), Siân Ranscombe (smiley, sharply dressed, blogs here) and the cheerful legend that is the ‘holic – they were all friendly, warm and genuine, even when meeting their hundredth stranger of the evening.

I remember at one point shooting the breeze with the ‘holic, Amy Lawrence and Tayo Popoola, blogging/writing/podcasting royalty all, and despite me feeling like a Fiesta parked between a Jaguar and an Aston Martin, they were wonderfully engaging and as entertaining as you would expect and hope. It genuinely was a pleasure to meet every single one of you. There were many more I missed, but it was a superb evening overall, not even spoilt when some arsehole decided to swipe my book after I put it down for a matter of seconds at the bar. To lose a few of the signatures was annoying, but some were willing to ink the second copy I soon replaced it with. And even Tom, who pointed me towards Arseblog all those years ago, came along for a few jars and a catch up.

If all this sounds a bit overly sycophantic, then I apologise, but frankly, we support the best club in the world, and have the best fans in the world, so it was inevitable I was going to love the lot of them. Of course, with both Manchester clubs adding to the occasion by crashing out of the Champions League on the big screens, a multitude of cheers rang round the pub at regular intervals, complete with a variety of entertaining chants, some more repeatable than others. ‘You’re getting Stoke in the next round’ was my personal favourite, even if technically incorrect as English sides will be kept apart for another round. Accuracy is overrated, though, when there are so many laughs on offer. Suffice to say Samir Nasri was the recipient of a few ditties, too.

And what of the man himself, and his book? All I can say is that I hope the turnout and the chants of ‘we’ve only come to see the blogger‘ made him realise the beast he has created, if he hadn’t already. It is surely no coincidence that the club with the earliest top level blogger has ended up as the club with the most online writers. One drives and inspires the other. I’ll be interested to know how many new blogs spring up over the next couple of weeks – it was the sort of evening that makes you want to raise your writing game a little. I’m not claiming for a moment that I’ll suddenly switch to writing every day – I have no idea how he does that, but you can expect a little more regularity.

The book itself is spellbindingly brilliant, with each contributor having their own angle, their own story, and their own writing style. If you weren’t at the launch night, I seriously urge you to pick up a copy, either this weekend, or online. You won’t regret it, trust me.

But overall, I just want to tip my hat to the man who started one hell of a movement. From one blogger to another, from one fan to another, congratulations to the one and only Arseblogger. You deserve it, my friend.

Put the knives away + see you at the Tollington

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Dec 072011

Olympiakos 3 (Djebbour 16, Fuster 36, Modesto 89) Arsenal 1 (Benayoun 57)
(Champions League Group Stage)

It seems the knives are out again. Described as Euro flops in some quarters, and a laughing stock in others, it seems many of the press are finally able to pull the trigger on the negative stories they’ve been unable to run over the past month, thanks to our improved form. Never mind the fact that we qualified on matchday five, as group winners, and never mind the fact that our second string was up against a motivated Olympiakos who knew that victory was their only chance of progression, it was time to sharpen the knives and mention the C word. Crisis.

Some crisis.

Last night’s display was, for the most part, pretty abject – there’s no getting away from that. But the Greeks are a tough nut to crack even if you face them at full strength, so to take a mixture of kids and out of favour squad players, and expect them to breeze through, was optimistic in the extreme. Having said that, it is certainly fair to ask for a little more than we got last night, particularly from some of the more experienced figures. Arshavin cannot seem to shake himself out of his current stupor, but his misplaced passes are now being combined with a sulky demeanour which doesn’t inspire confidence that he will improve anytime soon. That could be important – with Gervinho absent in January, he is likely to play a decent number of games, and we cannot afford passengers. Concerning.

Going forward, we generally looked fairly impotent. A few decent chances were carved, but we weren’t seriously threatening. At the other end, we seemed determined to concede at times, and unfortunately, we have to focus yet again on the goalkeeping. Fabianski was erratic, to say the very least, and imbued the rest of the defence (even the normally ice cool Vermaelen) with uncertainty, and hardly covered himself in glory for the opening goal. But worse was to follow after he went off injured. Mannone replaced him, and suffered a moment that will be replayed indefinitely – having done well to come out of his area and head the ball away, the resultant pot shot could have been caught, but sadly he completely lost his bearings, failing to realise he was back in his area, and instead attempted an ambitious scissor kick that hit nothing but air. The ball trickled slowly into the net, and his confidence visibly sapped.

Despite Benayoun’s excellent goal, we never really looked like getting back on terms, and their late third was deserved, even if their celebrations were soon cut short by Marseille’s late double in Dortmund. It wasn’t a performance that will live long in the memory, at least for the right reasons, but you can at least hope that some of the younger players will learn from the experience.

Of greater concern were the performances of the seniors, for whom such a lesson should be unnecessary. Squillaci looked like a man previously frozen out, while Chamakh still looks as impotent in and around the area as he looks decent in the build up (his hold up play is actually pretty good). Chamakh in particular may yet be an important cog in the season, but on current form he is a rusty one at best.

But it is easy to forget that we had already won the group. Sky Sports certainly managed it, claiming we were ‘lucky we had already qualified’. Perhaps they should consider that we might have fielded a stronger team had we not? Morons.

In any case, through we go, although so far our group winning achievement isn’t guaranteed to give us an easy draw. Zenit, AC Milan and Bayer Leverkusen are potential opponents, with more to arrive tonight. But for now, forget the criticism. We’re through.

——

In other news, tonight sees the launch of the Arseblog Book – So Paddy Got Up, which has a long and distinguished list of contributors. I’ll be going along to the launch itself, which is in the Tollington Pub on Hornsey Road, at 7 tonight, so if you are heading along, say hi.

The club that loves the spine, that loves the club

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Dec 062011

Over the past few years Arsenal have had some exceptional players. For all the bemoaning of the lack of trophies, there has remained a bountiful supply of top talent strutting their stuff at the Emirates – Cesc Fabregas remains the best young midfielder in Europe, one we kept for seven years, and we have more that could be labelled ‘amongst the best in their position, or for their age‘ – the likes of Vermaelen, Van Persie and Wilshere can certainly be counted in those categories, with others knocking on the door. Even the likes of Nasri and Adebayor had golden patches with us, even if they may end up joining the long line of those who wished they’d never left (hello, Hleb!).

When you reel off the names, the six year trophy hunt is a little baffling. We aren’t Liverpool – look at their teamsheet and ‘mediocre’ is the word that pops out. Against Fulham, their midfield contained the less than inspiring names of Adam, Spearing and Henderson – hardly a frightening force, even when you take their respective visages into account. We genuinely have had world class players, but for whatever reason something hasn’t clicked since the Invincibles disbanded.

This year, a case could be made that the overall quality of our squad is down – it is certainly an argument the pundits make. Personally, I’m not convinced – we may have lost Cesc and a bottler, but we’ve gained in other areas, particularly defensively, and the added experience of many of the younger players bridges that particular gap. However, it is probably fair to say that man for man, our individuals may not scare teams as they used to.

Yet something feels more positive. The atmosphere around the club is much improved from the poisonous nature of a couple of months ago (of course we are winning, which helps, but something more fundamental seems to have changed), there is a greater unity within the club, and the players are less inclined to wallow in the more negative moments – we’ve conceded the first goal a few times of late, only to come back impressively, a trait that we lacked up until recently.

I’ve been trying to put my finger on what has made the players seem more driven, more positive and more willing to fight, and also why the fans are suddenly so much calmer and able to forgive the bad moments. Six weeks ago, the Fulham draw would have resulted in a cacophony of boos, but was instead met with an understanding shrug. Quite the contrast. And I think I know why.

For all the talent in the club, there has been a feeling over the last few years that some players haven’t known the value of pulling on the Arsenal shirt, or at least they haven’t always shown it on the field. They may be motivated players, talented players, but that stops a little way short of what we have now – fans playing for the club.

Consider our spine. Szczesny hadn’t made his Premiership debut this time last season, yet is now a firm favourite with every one of us. Antics such as leading the crowd in a song last weekend, and his constant Chelsea and Spurs baiting on Twitter certainly help, but you can also see the pride he takes from being Arsenal’s number one, and how it hurts him personally when we’re struggling. He cares. It makes him feel like one of us, because in a way he is like one of us. Only better at football.

In front of him you have Vermaelen, who is furious when we concede a late goal in a 5-1 victory, and passionate enough to be determined to haul us back into the game after he scores an own goal. He simply refuses to lose, to give up, or to give anything less than his maximum for the club. And he doesn’t tolerate excuses, from himself or anyone else.

Further forward, and you find more of the young players who grew up with Arsenal in their blood. Jack Wilshere has been with the club from the age of eight, and without wishing to coin a painful phrase, has Arsenal DNA coursing through his veins. He also happens to be the brightest English prospect of a generation. And ours. But you don’t have to be English to be emotionally tied – for evidence of that, take one Emmanuel Frimpong. Ghana-born he may be, but he is Arsenal through and through – he joined the club when he was nine, and has progressed all the way through the youth ranks, determined to represent the club he loves. His anger at Nasri’s behaviour shows where his loyalties lie.

At the tip of the spine, we have Robin Van Persie, the most freescoring forward outside the unbalanced Spanish league. Feyenoord may be his first love, but Arsenal is his second, and unlike the Cesc situation, a return to his homeland would not be the final step to the top of the mountain. Right now, he is adored by the fans of a club he fights tooth and nail for, and one he is proud captain of. It still annoys me that many doubt his commitment, despite every one of his actions countering that assertion.

When fans get the feeling that the players do not care, or are going through the motions, we get angry. We yell at them and cannot understand why anyone in such a privileged position would give anything less than their all. But it is different with the current crop – for many of these players, success would be less sweet if tasted anywhere other than at home. And their home is the same as our home. The Arsenal.

We love them. They love us. The ties are stronger.