Explaining Jozy Altidore’s Injury

Zenit Saint Petersburg’s physiotherapist answers our questions about muscle ailments at the World Cup

The first ten days of the World Cup have been filled with high-scoring games—and a spate of muscle injuries. Eduardo Santos is a biomedical engineer and physiotherapist from Brazil. He taught for several years at the Universidade Estácio de Sá in Rio de Janiero and worked as the head physiotherapist at Dutch club Vitesse Arnhem from January 2012 until earlier this year when Andre Vilas-Boas hired him at Zenit Saint Petersburg in March as the head physiotherapist. Santos has helped Younès Kaboul and Sandro overcome career-threatening injuries and has also helped players like Mousa Dembélé, Alex, and Heurelho Gomes successfully rehab from injuries. Fusion Soccer asked Santos about the best way for players to remain fit during the World Cup.

Fusion Soccer: A European team has never won the World Cup in South America. While I’m sure a lot of it has to do with the sheer quality of South American teams, I would think that it also has something to do with the climate, which Europeans aren’t used to. Is the heat and humidity just something the body adjusts to over time or are there certain techniques or methods that can combat the conditions?

Eduardo Santos: The climate is something the body will adapt to over time. Normally in Brazil, the players have been used to the climate since they were young. For the European players, it’s more difficult to play [in these] temperatures. Latin players who have played in Europe for extended periods of time often have problems adapting to the climate again when they come back to play in Brazil.

Is it a problem for the players going from Manaus and then to a cooler climate for a game four or five days later? Is it a shock to the system? For example, the U.S. team traveled from Natal on the northern coast, then deep into the interior in Manaus, where it tied Portugal on Sunday, and will travel clear across the country back to Recife on the coast. How much of a toll does this take?

It’s not ideal, for sure. Such drastic contrasts in climate can not only have an adverse affect on performance, but it can also make the athlete more vulnerable to respiratory issues.What we have to point out is that with the stadiums so far away and with most teams having to take long trips to different climates, this change of temperature becomes standard for all teams in the tournament.

What are some of the things players can do to make sure they don’t overextend themselves and make sure bodies don’t get too run down as the tournament progresses?

The most important thing is really take care of your body. Pay attention to the signals your body is giving you. If the player feels any kind of discomfort or any kind of pain he needs to treat it immediately, even if it is just a small pain or discomfort. Some players need extra supplementation like protein shakes and vitamins, and some players just need some nutritional education and tips on what to eat and drink.

Players have been experiencing muscle cramps: Have you noticed more cramping than usual in this tournament, and if so, why? What are some of the things that can be done to prevent it? Are there stretches and exercises that players can do or is it more of a matter of nutrition and fluid intake?

Cramps are involuntary contractions and usually affect the lower limbs, but a player’s arms, hands, and neck could also be affected. Normally, treating cramps is about taking care of nutrition and hydration. Coconut water, drinks with electrolytes, bananas, and oranges can help to avoid cramping. Given that a lack of potassium, calcium, or magnesium in the diet may explain these contractions, it is important to pay special attention to nutrition. However, there are several things that can cause cramps, and dehydration is just one of the theories. The lack of water can create spasms, which would explain the cramps. During excessive perspiration, in addition to losing water, a certain amount of electrolytes are also lost. The lack of electrolytes may compromise the proper balance of bodily fluids, which is another way cramps can be triggered. In addition to playing in high temperatures, playing in cold temperatures could also lead to cramps, as the muscles can tense up. Cramping can also be caused by the compression of the nerve roots, the lack of minerals in the diet, and excessive use of diuretics that cause people to lose greater amounts of potassium.

Is there an increased risk of pulled muscles and/or pulled hamstrings? If so, what can be done with regards to prevention, and if the injury does end up occurring, what is the best treatment?

Yes, when your muscles aren’t getting what they need, you increase the possibility of get injured. However, it’s a complex question because every athlete is unique. We need to identify and try to control all of the causes that can create muscle damage (lack of hydration, weak muscles, bad posture, imbalanced muscles, over training). The best treatment is always to treat the cause and not the symptom.

How would you advise a coach whose team is lucky enough to go deep in the tournament: There will be less rest days they further a team goes. How does a team handle this in terms of training schedule, diet, sleep, relaxation time?

You need to be very disciplined. Proper nutrition, hydration, and sleep schedules are all important, as is taking care not to overtrain your players. Each player is different, and the best thing to do is to continually evaluate each individual player and make sure he and his specific medical needs are taken care of.