Problems afoot for England’s young playmaker?

Wilshere played 49 games in 2010/11, more than any other Arsenal player.

Arsenal’s former player of the season has suffered a frustrating year, being side-lined with a string of ankle, heel and knee problems. The lack of competitive games for Alex Oxlade-Chamberlain this season is perhaps admission from Arsene Wenger himself that focusing on developing young talent can be a delicate process.

The mixed messages given by the club doctors and Arsenal’s press team have no doubt infuriated Gunners fans. One minute Wilshere is a ‘medical miracle’, the next his rehabilitation has suffered a major setback.

He was injured while on England duty in June 2011, Wenger seeing a month’s holiday as sufficient recovery time. At the end of July, during Arsenal’s Far East tour, he limped off seven minutes into the game with “ankle inflammation”. Scans suggested it was a short-term issue, however, upon further investigation a stress fracture was revealed, with the subsequent operation ruling him out for 4-5 months. Toward the end of the recovery process he suffered another stress fracture, this time in his calcaneus (heel bone) in late January of this year.

So has Jack been burned out by Wenger? Mismanaged by the club doctors? Or is it just a case of bad luck?

Some sporting injuries are just unlucky; take Djibril Cisse’s broken leg in 2004 whilst playing for Liverpool against Blackburn. In Wilshere’s case luck doesn’t come in to it. A combination of playing too many games (Wilshere was the most played player for the Gunners in 2010/2011), and poor management on the physicians part is to blame.

Diagnosis and Treatment

Before a return date can be set, any injury must be thoroughly investigated and X-rays and MRI scans are non-invasive methods that are used most frequently. The issue with sending a player for scans is that they are never 100% reliable.

Despite the initial diagnosis being inflammation around his ankle, secondary x-rays will have been taken 7-10 days later (standard medical protocol). The acute inactivity will have led to decalcification of the rested bones and a minor reduction in inflammation, leading to a clearer x-ray and revealing the stress fracture. This was the source of the initial confusion.

Wilshere has suffered a string of ankle injuries, keeping him out of action all season.

When doctors talk about ankle fractures they are usually referring to a broken tibia or fibula. The tibia (shin bone) is the larger, weight bearing bone, transferring roughly 90% of weight through the leg. Wilshere’s fracture is likely to have been here. Successful surgery was performed on the stress fracture under the care of two-world renowned surgeons. An estimated 4-5 months rehabilitation was prescribed, with no weight to be put on the ankle for the first 12 weeks.

During a lengthy recuperation period such as this, the body undergoes a process called atrophy. This is a gradual wasting of muscle, leading to a reduction in strength and conditioning. When an athlete returns to training they must be wary of pushing themselves too hard as this is when the body is most at risk.

Lessons learned?

Ambitious and eager to prove himself at the highest level, Wilshere could be forgiven for being too keen to play again. The first question on any players mind when injured is “when can I play again”? On top of that Wenger will have been keen to get the boy playing again as the Gunners pushed for a Champions League spot. The medical staff should be able to overrule the manager in these cases as the player’s welfare is arguably more important. Such is the pressure of the modern game though, the manager usually gets what he demands.

Low and behold, Wilshere suffered another stress fracture, this time in his heel, a notoriously difficult bone to mend. The club described the second fracture as “a recognised complication of a complex rehabilitation process”, i.e. they knew full well it was a risk rushing him back.

The club doctors will be keen to stamp out any adaptations in Wilshere’s walking / running style to accommodate for the pain; much of his ankles dexterity could be lost if not treated.

One thing Arsenal, and indeed every other Premier League team, can take from this situation is a need for clarity. Naturally the press want immediate answers, but being patient and delivering an accurate assessment is what fans really want.

Wilshere is a technically gifted player, his style of play very much influenced by his former teammate Cesc Fabregas. The intricate turns, close control and short, sharp bursts are integral to his game. Wilshere has already stated he does not want to put any timescale on his return and wishes to be given time. Without this he may well be plagued with ankle trouble throughout his career.

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• Arsenal’s Jack Wilshere faces knee operation after latest injury setback (guardian.co.uk)
• Arsenal call in lawyers over Jack Wilshere Twitter rumours (theweek.co.uk)