Arsenal fitness part 2: Second opinion

One of the cliches you see in all the medical shows is "get a second opinion". Got cancer? Second opinion! Need a facelift? Second opinion! Need a kidney transplant? Well, OK, some things may not NEED a second opinion. Anyway.

We reached out to a couple doctors for this initial round of questions, and today we'll be chatting with TSF reader Chillbro69.  As with last week's talk with HoodRiverDuck, the standard caveats apply:

Caveat the first: Our first guest is, in fact, a doctor, but in his own words:

I'm an MD/PhD in the first year of a neurology residency in NYC. My PhD is in bioinformatics (basically the crossroads of genetics and statistics), and will be trying to establish a research practice when this residency is done, which means a lot of tenure committee ass kissing for the next decade.

Caveat the second: We are not attempting to diagnose or solve any specific problem with any specific player.

Caveat the third, and probably most important: We are not attempting to reach a Grand Unified Conclusion about what is wrong with Arsenal's overall fitness/physio regime, nor are we trying to find where to pin blame when things don't go as planned. This is a 10,000 foot overview of medical science, if you will, in an attempt to clear up some of the general misconceptions around sports teams and health issues.

With all that in mind, then, here are the questions (SPOILER ALERT: they're the same questions) and Chillbro's answers, lightly edited (adding a few commas) for clarity.

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TSF: In general, how much do muscular injuries stem from overuse and how much can be attributed to bad luck and/or genetics?

CB: The smuggest answer I can give is that all injuries are due to bad luck. Whether that's getting the wrong end of a tackle (McNair on Jack), hyperextending your knee (Debuchy), or having a gaggle of Everton players perform on-field rhinoplasty (Coquelin), injuries are always the result of just the wrong thing happening. What you're getting at, though, is what lies beneath. Overuse is the simplest explanation because it doesn't allow an individual's muscles to fully heal, making them more susceptible to injury. Part of Shad Forsythe's job as I understand it is to reform some of the older training methods so that they accord with current sports science. In particular, he develops individual training regimens for each player according to their needs at the time. It's unbelievable that this is a recent advance, but hey, baby steps I guess.

Now, there is a strong genetic component to muscular development and function, but, short of known musculoskeletal conditions (which would likely preclude a player from youth), we're coming to understand that genetics is not as deterministic as previously thought, particularly since professional athletes spend so much time doing extensive conditioning to prevent these sorts of injuries. This all being said, we're only just starting to see how genetics and environment interplay, so I think it's a multifaceted issue, which is why we have a medical team instead of one witch doctor.

TSF: Is it possible to determine if a person is more predisposed to chronic injuries than another person, or is that something that only reveals itself over time as injuries keep happening?

CB: If something doesn't reveal itself on a medical, it's not especially predictable. There's a lot of feeling in the dark here regardless, and thankfully I don't think teams are sequencing their players' genomes to look for certain disease markers, but figuring out how to predict these things is the first step to figuring out how to prevent them and I don't think we're nearly there.

TSF: It was mentioned once in TSF's comment section that traumatic injuries can cause muscle injuries later on, as in Aaron Ramsey's case. Is this true, and if so, why is that?

CB: This may have been me who initially said this (Here's the original comment).  Find a scar on your body and feel it - notice how much stiffer that tissue is than the surrounding area. Extrapolate this to, say, Aaron's pulled hamstring, and try to imagine how much less functional the scarified muscle would be. Without actually examining him (and also not being that type of doctor), I can't diagnosis it, but orthopedists I've talked to say it's fairly common for athletes to have range of motion issues following muscle trauma and then re-aggravate the muscle by trying to make the same movements they used to.

TSF: s there any way to reduce the likelihood of recurring injuries, or is that pursuit nothing but a long game of medical whack-a-mole?

CB: Something I keep harping on in comments is that athletes are pretty much in a perpetual state of disrepair, so preventing injury is down to identifying just how dilapidated they're getting, on a scale from shiny new Williamsburg condo to Boo Radley's house. Also essential is ensuring they get enough minerals in their diet (I eat a lot of spinach; shout out to all the spinach). Another big thing is not letting players be the masters of their own destiny (looking at you, Alexis). These are all very obvious overarching prophylactic measures and short of this, a lot of treatments, supplements, and procedures performed to enhance fitness and prevent injury are slightly less effective than Haitian voodoo.

When a player returns from injury, their physical ability will usually be limited for a time as the totality of the trauma heals and they regain muscle strength. With this in mind, I think the best way to prevent recurrent injuries is to A. allow enough time for proper healing and reconditioning in the first place and B. allow enough time to familiarize themselves with the new limits of their body before throwing them back into the fray. People have been sweating bullets about Walcott's participation, but I think that's Wenger making the conscious decision to ease Walcott back to avoid new injury, which'd be smart considering the type of injury and length of his absence.

TSF: If there was one misconception you'd love to clear up around how medical issues in soccer are reported or perceived, what would that be?

CB: Haha, where to begin. First, I will say that I don't think any Arsenal player is "injury-prone" [the readership boos and hisses] in the sense that no one seems to have a genetic predisposition to injury. Diaby's IHOP menu injury list is the result of a horror challenge that never completely healed, opening him up to the possibility of further trauma. Same for others. Second, the club's medical approach has quite recently, particularly with the arrival of Forsythe, but these are longterm, systematic changes and we cannot expect overnight results. I think we're beginning to see the Shadster's philosophy settling into the club, and will watch it unfurl before our eyes in the next season or so.

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Thanks to Chillbro69, and to HoodRiverDuck, for being willing to participate in our little roundtable. Again, if you're a doctor, particularly a sports medicine or orthopedic doctor, and would like us to ask you some questions about medical things, let us know - we may even come up with some different questions!