Liverpool FC Forum

by **kazza** » Wed Mar 09, 2005 3:33 pm

DR WALLER ON INJURIES, CISSE, XABI AND MORE
Paul Eaton 07 March 2005
We speak exclusively to Liverpool's club doctor Mark Waller about a freak season of injuries at Anfield.
Nobody at Anfield can remember a campaign as bad as this in terms of injury problems, with nine players having undergone operations and several more having spent weeks on the sidelines with a variety of problems.

Dr Mark Waller has been with the Reds since 1993 and so is well qualified to label this season as being the busiest he has known since he arrived at the club.

In this exclusive interview with Liverpoolfc.tv, Dr Waller talks about a season decimated by injuries and speaks in detail about some of the problems the medical team have had to deal with this year.

Liverpoolfc.tv: Have you ever known a season like this one in terms of injuries at the club?

Dr Mark Waller: The simple answer is no. We've collected statistics from over the last eight years and this has undoubtedly been our worst season in terms of injuries.

Is there any reason why we've had so many injuries or has it just been really bad luck?

We obviously look at trends of injuries so that if something is going wrong in the club then we can pick it up fairly early and make alterations in either training or in how we are dealing with the general well-being of the players. This season we've had a lot of injuries which you wouldn't ordinarily expect to see in the club.
This time we've had four times our normal meniscal tear incidents and we've had three times our normal fracture incidents. Also, we normally get two chondral lesions (the lining at the back of the cartilage) every three years and yet we've had three this season alone.
We've had particularly nasty injuries this season and certainly far more than you would expect at a football club like this.

Have you been busier than usual then this season?

One of the differences this year is we haven't been dealing with only muscle strains or sprains, injuries which are relatively straightforward. We've had nasty fractures to deal with this season and injuries which don't just require physiotherapy. That hasbeen particularly unusual.

How closely do the medical team need to work together to discuss injuries and plan rehab programmes?

We have to speak regularly about what's going on. In the medical team there's myself, two chartered physiotherapists and two full time masseurs and we speak every day about individual players' injuries and we speak with the manager and coaching staff as well. It's important that everyone knows each situation because if an injured player can do a small amount but not full training then the coaching staff need to know what we think the particular player should be doing. Communication is extremely important.

As the club doctor, are you involved with the injured players from the moment they get injured to the moment they are back playing again?

I wouldn't say so. The actual hands-on rehab work is best done by those who have the experience and in our case that's our physiotherapists. I'm someone who is there as a resource and who will co-ordinate everything but the physios are the ones who will do the running outside.

Let's talk about some specific incidents from the season then. What were your immediate thoughts when you saw Djibril Cisse lying on the pitch at Blackburn?

It was a strange one because when a player suffers a nasty fracture like Djibril did they usually lie still on the pitch. Djibril rolled over, then got up onto his knees as though he was going to try and stand up, then he sat up and then started rolling around again. From the position we had, although we saw the incident, it looked fairly innocuous and not too bad.

Then some of the players started to summon us over and that's when we realised something was wrong. When we got there he was obviously in some distress and it was clear very quickly that he had done something serious.

From our point of view there were then two things to do. Firstly we had to alleviate the pain which we managed to do with entinox and the other was to try and immobilise the fracture so that we could then transport him properly to an area where we could examine the injury properly. We took him to the treatment room where it was clean, warm and with good lighting so we could cut off his boot and sock to get to the leg and make a formal assessment

Djibril has said that your actions saved his leg. What did you do?

One of the things you look for when you see an injury as bad as Djibril's is whether he has suffered either any nerve injury or any vascular injury. I found that he had lost the blood supply to his foot. He had a shortened, slightly angulated lower leg with no pulses in his foot. There are a couple of reasons why that could have happened, he could either have severed the artery or the broken bone could have been pressing against the artery.

We were left with two options in the treatment room. We could spend an hour or two getting to the hospital and have the leg x-rayed or we could grab the leg and manipulate it. We took the second option and if we'd taken the first and gone to hospital then he wouldn't have done as well as he has since because in the time spent getting to the hospital he would have suffered even more damage.

In order to manipulate the leg we had to give him a good analgaesic which almost put him to sleep and he honestly has no recollection whatsoever of what we did to him in that room. Fortunately, with one pull of the leg we managed to get it in a good position and at the same time return the blood flow to his foot. It meant he only had a lack of blood going to his foot for three or four minutes, which is not a big problem.

Everything was done very quickly. The doctor at Blackburn and Dave Galley our physiotherapist were excellent and we worked as a team with one doing one thing and one doing another.

What happened in the hours immediately after the injury?

From the treatment room we made sure he was stable and then took him to hospital for x-rays. We then found that the position we'd got his leg into was acceptable overnight and we then transferred him to a private hospital.

Did you think it could be a career ending injury?

When any player has what's called a commimuted fracture of their tibia and fibula then it's a potentially hazardous injury for them. I don't want to be dramatic about it but a number of players haven't been able to continue their football careers after this injury.

How is he coming along in his rehab work?

He started running last Thursday which is great news. He's doing really well and he should be fit and ready for the start of the new season.

Another player to suffer a bad injury this season is Xabi Alonso. What happened when he came off the field against Chelsea?

Xabi played on for a couple of minutes before leaving the field. Often brave players, like Xabi, want to try and run off injuries if they can and play on but obviously that wasn't possible in this case. When a player insists he wants to continue playing we owe it to him to give him the chance.

We're very fortunate at Anfield because we have a set-up whereby a player can be x-rayed immediately if necessary. After I examined Xabi it was obvious he had a problem and so we took him to the treatment room where the x-ray confirmed he'd picked up a bad injury.

Did you suspect a break before the x-ray?

I did. Xabi had sustained a very unusual fracture. It's unusual for anyone with a broken ankle to walk or run around a football field for more than maybe one or two paces. For him to have done what he did is unusual.

He says he hopes to play again this season, is that realistic?

I hope so too.

Vladimir Smicer was operated on by Dr Steadmanin America during the summer. How important is it to have a network of specialists all over the world who you can refer players to if necessary?

We're very lucky because of the name of this football club and the fact we've built up relationships with a lot of specialists over the years means a lot of very eminent people will fit our lads in the next day if we can get them there.

We have a very good relationship with Dr Steadman and if we wanted him to see one of our players then he would always fit them in and then do whatever is necessary. He has an area of expertise which concentrates only on knee injuries. In England we do have some very reputable surgeons who we use for the majority of our players. We will only send players to America if we feel the particular injury they've got warrants that specialist intervention. If we feel that someone in England can do it just as well then we'll keep them in this country.

It looked fairly innocuous when Florent Sinama-Pongolle fell against Watford. How did he do himself so much damage?

It looked very innocuous in that he was just running and then fell over. But as soon as we got him off the pitch it was very evident what he'd done. Sometimes with anterior cruciate ligament (ACL) injuries it can be a small thing which sets it off. If a player has had a problem before then a slight wrong movement can snap it again. Flo's injury came about in much as the same way as Robert Pires' did a number of years ago. There didn't seem to be any danger and then the player goes down and has done himself a lot of damage.

Do you expect Flo to be fit for the start of the new season?

He's walking. He's in a clinic in France for the rest of this week and is coming back to us next week. Usually this injury takes five or six months torecover from so he should be fit for the start of the season, but whether he'll be fit to take part in the pre-seasonI don't know.

Chris Kirkland has had a number of injury setbacks during his Liverpool career, are you confident the operation he had recently will see an end to his problems?

We certainly hope so. This was a problem he had earlier in the season but he hadn't had it previously. He's a very focused and hard working young man and I hope he'll soon be able to enjoy an injury free run. He deserves it.

Finally, last week we heard Neil Mellor underwent a double knee operation. Tell us more about that.

Neil had his patella tendons operated on in both knees after suffering with tendonitis. It's usually a four month rehab after this sort of operation and so he is out for the rest of the season. The operation went well and, although he'll be a bit sore for the first two or three days after the operation, he'll make a good recovery.

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A bit gory, but usefull info.

by **MilitiaRusher** » Wed Mar 09, 2005 3:42 pm

i dont see how plain text with mostly medical terms would make this gory?

in .tv forums, u would get slated for copy pasting news that comes from the .tv homepage. lol.

by **kazza** » Wed Mar 09, 2005 3:53 pm

MilitiaRusher wrote:i dont see how plain text with mostly medical terms would make this gory?

in .tv forums, u would get slated for copy pasting news that comes from the .tv homepage. lol.

I think what I find gory is remembering some of those injuries that have happened to me (especially the knee ones).

Also copy and pasting is a service. Not everyone goes to all sites. I personally am happy to visit this site and get all the information that is out there. If you have read it already, it is easier to skip it than not.

by **Sean** » Wed Mar 09, 2005 5:36 pm

Thanks fot that kazza. Interesting read......now where did I put my crutch?

by **el_stinger** » Wed Mar 09, 2005 11:35 pm

In your pants?

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