The Club, The Player, The Person. They’re not the same!!!
Everything is great until it isn’t
It’s impossible to truly define what football is. Sure you can referee it and score it, but can you really define it? It has the ability to help us forget the mundane of the 9 to 5, stir up hopes, dreams, aspirations and creativity. It can simultaneously tear apart and bring together families, neighbours, communities, cities and countries. It is the matriarch of a Friday night in the pub with your mates when speculating your starting XI for your fantasy team. But the name on everyone’s tongue at the moment is that of Andre Gomes, the Everton midfielder who suffered a fracture-dislocation of his ankle at the weekend and had surgery on Monday. Thankfully, Everton FC have stated that the procedure was a success and Andre is expected to make a “full recovery”. In this piece I’m going to discuss the nuance between making a full recovery and returning to play and how the two are not necessarily the same. I’ll touch upon what success looks like for club and player and what the duty of care Everton and their medical staff have for Gomes.
Return to Play Speculation from the “Experts”
A fracture-dislocation of the ankle can certainly cause chaos within the joint. There are plenty of so-called “medical experts” touting on social media their expected return to play timeframes, what damage the ligaments, cartilage and bones may be subjected to and the contents and legitimacy of surgical intervention to maximise Gomes chances of making a speedy return to play. A lot of nonsensical speculation: something I’m not going to cover. I’ll let the “experts” take the lead on this aspect rather than adding my own “mystic meg” return to play predictions into the mix.
Return to play is possible, but is full recovery a reality?
Injury analyst Ben Dinnery posted return to play timeframes for this type of injury. Firstly, this data proves that this injury is not always career-ending and that it is possible to return from a fracture-dislocation within as little as 138 days (Aymeric Laporte). However, when you analyse the data a little more, it would appear that this number is an optimistic outlier and that it is more likely that Gomes will return next season rather than this, as the average return to play timeframe is 225 days. Be warned though; this data is merely a documentation of when players have returned from this type of injury in the past, that does not mean that it was the right, it also doesn’t mean it was wrong either. It is a return to play date not a definitive indicator that any of these players had made a full recovery following injury.
What exactly do Everton mean by a “full recovery?”
Were Everton FC referring to Gomes’ ankle joint? Is the club stating that his ankle will function the same as the other one? Or are Everton FC commenting on his psychological status? Does it mean that psychologically, Gomes will contest every ball in the same manner as he did before this injury for the Toffees? Are the club stating that this injury will not cut short his career in professional football? Are they stating that his ankle joint will be able to tolerate the toll of training and playing week in week out in the Premier League for the next ten years? Does a “full recovery” mean that he won’t suffer from post-traumatic osteoarthritis of his ankle joint in 15 to 20 years time (still a young man) and need further surgical intervention to manage pain, stiffness and decreasing function? Or are they speaking out to the Everton fans that Gomes will make a “full recovery” to play for the club again? There are many factors which can influence whether a player makes a “full recovery” or not. The figure below from the Clinical Journal of Sports Medicine depicts beautifully the complexity of return to play decisions.
We are not the only ones playing Fantasy Football
The reality of playing professional sport is that players are a commodity; they are the product on the pitch in which the club have invested. In terms of Everton and Gomes, or any other player for that manner: will the primary concern be with the long term health and well-being of the player or is the outcome measure for success how many days it takes for Gomes to return to play?. Let’s say he returns in 225 days, the average for this type of injury, and this is recognised as a successful return to play by the club. However, let’s play devil’s advocate for a moment and fast forward five years and imagine that Gomes is forced to retire due to ongoing ankle issues. Should this be defined as a “full recovery” just because he played football again or is it more factual that we term it a “return to play” date?
The Duty of Care
The duty of care is on the surgeon and the medical staff to keep in mind the long term sequelae of such an injury rather than focusing on a return to play date. Injuries of this nature (joint-related especially) shouldn’t be rushed. We shouldn’t be looking to put in place an accelerated protocol to hasten a return to play. The ankle joint and the player need time to recover from this traumatic event. The expectations of the player, manager, stakeholders and fans need to be addressed early on, and the big picture needs to be taken into consideration. What might look like a successful return to play for Everton FC might be far removed from what success looks like for Andre Gomes as a person.
I Doff My Hat
The consequences of serious injury in sport are far-reaching and complex. And although it is encouraging that surgery went well, the real work begins now with the medical team. The months ahead in the gym, on the bike, in the pool, on the treatment table, one to one with the physio will be the true determinant of what success looks like for Gomes and Everton. In fairness to Everton FC they stated that Gomes is expected to make a “full recovery”, they never commented on a return to play date, therefore, it would be reasonable to suggest that the club is ensuring everything is done so that Gomes’ health and well-being is at the foremost rather than when he will next play for the Toffees. I would expect nothing less from a such great club with a super bunch of fans. With that said I doff my hat to Everton Football Club: Take a bow.
Football Physio Columnist