As Real Madrid trained in Warsaw the night before their UEFA Super Cup victory over Atalanta on August 14, Eduardo Camavinga’s heart-rending scream brought the session to a standstill.
Team-mates gathered around him. Carlo Ancelotti threw down his stopwatch in despair. The worry was clear: had Madrid lost another player to an anterior cruciate ligament (ACL) injury?
In the end, fears were allayed. The injury was still bad — Camavinga was diagnosed with a sprained knee ligament and the lay-off time was estimated at seven weeks — but the worst-case scenario was avoided.
Any player fears a serious injury but at Madrid, a recent run of ACL problems has made the subject more sensitive than ever, which helps explain Ancelotti’s dramatic reaction in Poland.
Goalkeeper Thibaut Courtois missed most of last season after damaging his ACL in training just before the campaign started. In Madrid’s opening game, a 2-0 away victory over Athletic Bilbao, Eder Militao suffered the same fate and also missed most of 2023-24. Then it was the turn of David Alaba, who last December ruptured his ACL in a home match against Villarreal. In May, he had further surgery and it is still unclear when he will return — an initial target of October could be delayed.
That’s not all. Five days before the Camavinga scare, promising central defender Joan Martinez, who turned 17 last week, ruptured his ACL injury in another first-team training match, shortly after returning from the pre-season tour of the United States.
Before that, within the first few minutes of Madrid’s opening tour fixture against AC Milan on August 1, their 19-year-old midfielder Cesar Palacios tore his ACL. In late July, 18-year-old Real Madrid Castilla midfielder Dani Mesonero suffered the same injury.
What is the reason behind this spate of injuries? Do Madrid think they have a particular problem?
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Club sources — who, like all those cited here, preferred to speak anonymously because they did not have permission to comment — do not think so. They believe it would be incorrect to characterise six serious ACL injuries in the past 12 months as evidence of a “generalised problem” at the club.
But that is not to say the situation isn’t causing concern. The club have analysed each injury and believe several factors were at play.
One of these has to do with playing surfaces. Figures at Madrid’s Valdebebas training ground recall how, in the 1990s, there was a theory that non-cylindrical studs on boots were making it more difficult for players to twist on the grass properly, contributing to ACL problems.
Now they believe some modern pitches tend to cause similar problems, with players’ feet digging deeper into the turf, which can be problematic when changing direction. Madrid sources make the obvious point that each pitch is (at least slightly) different at every club, which they also believe might be a contributing factor. For example, they said Mallorca’s pitch (where they played their first fixture of La Liga’s new season last weekend, a 1-1 draw) was much harder than the ones they have at Valdebebas.
Others at the club wonder whether, in the cases of Palacios and Martinez, their comparative lack of physical strength or preparation (as youth players training or playing with the first team) should be considered.
Martinez suffered his ACL injury after Madrid’s pre-season tour (Ira L Black – Corbis/Getty Images)
“We’re not talking about just any team, we’re talking about the Real Madrid first team and here we have animals,” one source said. “Another team can beat us in a match, but in physical terms, these players are something else.”
Sources familiar with Madrid’s training programmes explained how the club carries out preventative work to protect players from potential injury. They said each player’s muscular “balance” is examined and any “imbalance” is addressed because it might contribute to ligament or tendon injuries.
Madrid also see nutrition (beyond eating healthily, collagen and other supplements are prescribed where appropriate to promote muscle-mass growth) as a key factor in the prevention and treatment of ACL injuries. This is an area where much scientific progress is being made. In the future, it should be possible to more accurately identify which supplements are most beneficial for each athlete and why.
In the case of collagen supplements, they are already valued at Madrid as something that improves the health of joints. Collagen acts as a lubricant for cartilage and ligaments, which has a protective effect against mechanical stress.
Management of sleep and muscle fatigue is also considered important. For the past three years, Beniamino Fulco, Ancelotti’s son-in-law, has been in charge of this area at Madrid. This season he will also be serving as another technical and physical assistant to the first team.
Fulco emphasises the importance of good rest for the players. Recovery and sleep time are difficult to manage because of Madrid’s intense fixture schedule, but they help reduce the risk of injury. Staff members recommend players sleep between seven and nine hours a night.
Real Madrid training at Valdebebas last week (Alberto Gardin/NurPhoto via Getty Images)
When a player suffers an ACL problem, Madrid usually call in an external specialist, the most common being Dr Manuel Leyes, head of the orthopaedic surgery and traumatology service at the Olympia Medical-Surgical Center in the Spanish capital.
If there are no further problems requiring immobilisation, the player undergoes surgery a few days after the injury. Once the operation is completed, the club’s physiotherapy department immediately starts treating the player and is with them for the first four months or so. Subsequently, the player completes his recovery process with the help of rehabilitation coaches and physical trainers.
There is plenty of in-house expert rehab help to hand. Antonio Pintus, Real Madrid’s head of physical preparation, wrote a book about recovering from ACL injuries in 1996. He is just one important figure, along with physical training assistants Giuseppe Bellistri and Sebastien Devillaz, and fitness trainer Jose Parrales.
But despite their considerable care and attention to detail, sources also allude to “bad luck” — noting that, whatever work might be done, a risk of injury is always there for elite footballers.
(Top photo: Robbie Jay Barratt – AMA/Getty Images)
