EXCLUSIVE TJ – Pogba case, the physiotherapist Gianluca Palmas: “The Frenchman chose Rasputin’s way”

It is making the choice of Paul Pogba and Juventus not to resort to surgery but to conservative therapy to recover from the injury to the meniscus. To investigate the situation, the editorial staff of TuttoJuve.com consulted one of the leading Italian experts in knee care, as well as the author of books on meniscus rehabilitation, the physiotherapist Gianluca Palmaswhich provides a particular point of view on the case of the French ace:

“After about ten days in which the French talent held Juventus and overseas fans in suspense, and catalyzed the media attention of the football world, the Juventus 10 dissolved all reservations – explains Palmas -. In the thinning of the curtain that has wrapped the future of his knee, it was possible to guess what the new priorities of the player are, and, unfortunately for the Juventini fans, despite the long courtship that resulted in a new marriage, the Juventus team no longer seems to be at the top of his priorities. Yes, because reading between the lines of his choice, which he seems to have taken together with the faithful rehabilitator rather than with the Juventus management, this route would distance the return to the field of the Allianz Stadium rather than bring it closer “.

Palmas retraces “the stages that led the” octopus “to re-establish a silent ranking of (his) priorities even before the 2022-23 season has begun and undermining it (perhaps) irremediably.

Each knee has two menisci (lateral and medial) and these perform different tasks both in the correct functioning of the joint and in protecting the cartilages that cover it. They are very strong and dynamic structures, but they can still be damaged during sports practice, making it impractical. Consequently, it is necessary to intervene when this happens.

The Pogba case is no exception, he suffered the lesion of the lateral meniscus of his left knee and so, in recent days, he flew to Lyon to be evaluated by the luminary Dr Sonnery-Cottet, and to receive the only two surgical proposals, diametrically opposed to each other. .

The French doctor is the same one who operated on Ibrahimovic only a few months ago, opting, on that occasion, for the repair of the lateral meniscus of the Swedish champion’s left knee. He also strongly recommended the meniscus suture surgery to the Juventus talent, because it is more logical and because the scientific evidence has shown, in a future perspective, to ensure an almost normal football life for those who undergo such surgery. But the price to pay was too high for the 29-year-old Frenchman. Give up the warmth of the Juventus audience for several months, but, above all, the specter of having to skip the World Cup in Qatar which will start on November 21st this year, to follow a slow and long rehabilitation path (at least 4-5 months) , such as to protect the suture, allow the best tissue healing and restore the mechanical and cartilage protection functions. In short, too much for those who want to present themselves to the world as reigning champion “.

“But he didn’t even choose the alternative – observes Palmas -, the shortest route, meniscectomy, that is the partial resection of the meniscus with consequent rapid recovery path (5-7 weeks), which would have allowed him to participate regularly in the World Championship. Same path taken by our Italian captain, Franco Baresi, at the 1994 World Cup in the USA.

This path also involved a sacrifice that Paul would have paid in installments over the years: giving up an anatomical structure that performs, among others, the task of protecting the articular cartilages, exposing the joint to a high risk of deterioration and functional incapacity. Thus, the more than real risk of a shortened remaining career and the risk of new knee injuries. But there is more, if for Baresi it was a medial meniscus lesion, less prone to immediate complications, for the French sample it was a lateral meniscus lesion, more prone to having complications already in the first postoperative months ( eg pain, swelling, cartilage injury, but also new surgery and even career risk) “.

“And here, faced with the choice to repair the meniscus, and” save “the knee from a possible early arthrosis, or to remove the damaged part, exposing the articular cartilages to (highly) probable premature injuries, the Juventus ace pulled out from the deck the joker of the third way, at the suggestion of his trusty physiotherapist, what we can define – adds Palmas – the “way of Rasputin”.

The advice of Dr Sonnery-Cottet (and of all the professionals who have spoken in the newspapers of half of Europe) in favor of a repair and in the interest of the player himself, have thus become waste paper. There are those who even speculated that the trip to Lyon was only a formal “obligation” towards the Old Lady, because Paul had already made the decision within himself. The opinion of Juventus is not known, even if it is legitimate to think of a Juventus management in favor of an intervention that would save the knee of his client. Speech super partes that linked to the French national team, which has probably endorsed the decision of its midfield lighthouse, thinking about their immediate future interests, without worrying about the football future of the footballer, having so many talents who could replace him at the American World Cup in 2026. In short, it seems clear that Juventus and the Juventus fans have lost positions in the Pogba priority list.

But what is the route suggested by Rasputin of the Pogba house? “It is, in fact, the least known and also the most risky of all, the one that involves not undergoing any surgery, repair or removal of the meniscus, but to leave everything as it is in its current state (broken ) and, probably, to postpone the repair work, to the beginning of the new year – continues dr. Palmas -. Another element that would strengthen the idea that for the “octopus” the World Cup counts more than Juve and the warmth of its fans, giving up the second half of the season in Serie A and returning to Allegri only for the 2023-24 season.

More than a recovery path, it seems to be a minefield full of pitfalls. The guru’s advice is probably based on the great (excessive?) Trust placed in the muscle strength of the octopus, which could compensate for the degree of instability given by the meniscal injury, and on the rather optimistic reading of the UEFA statistics regarding the players participating in the major series. The latter suggest that 70% of players who suffered a meniscal tear returned to playing at pre-injury levels. They suggest that those who underwent surgery had a 40% better chance of returning to those levels, that the surgery could be postponed to a later date, that the risk of re-injury was 5%. But there are also other data, a little hidden, in the UEFA statistics and which have an important relevance in the Pogba case. Two out of all, players in their thirties and those who perform the defensive pressing phase, have a worse prognosis of returning to their performance levels they had before the injury. Part of the octopus identikit.

For those who decide to follow this conservative path, as the Juventus talent will do, there is no shortage of unknowns related to the lack of studies that have evaluated the results of a conservative treatment on high-level players. As is, precisely, Pogba.

Not only that, there is an even more marked shortage of high-level studies describing the “what” and “how” to do in the case of isolated meniscal tears, that is, those lesions that occur without affecting other knee ligaments. Because lateral meniscus tears usually occur concurrently with the anterior cruciate. But that’s not the case with Pogba. The only randomized and controlled study (to be clear, one of those that will make history) and which has given positive results for isolated meniscal tears in young and active patients, but not of high sports level, has just been published. The champion cannot be reflected in this population of sportsmen, who is an elite footballer, who faces frenetic and intense game rhythms, who expends much more energy than a non-elitist athlete. For players like them, the goal cannot be a return to the pitch but a return to pre-injury performance levels.

But what is even more perplexing – continues the physiotherapist – is the (under) estimate that has been made about the duration of the conservative treatment to which he will have to undergo. In the high-level study the program was carried out for 12 weeks, for French only 5 were planned! In short, in spite of the luminaries and scientific studies, the French ace is preparing to embark on a recovery path that is anything but easy and linear, which should take him to the fields in a short time.

The final question is how will he return to play? With what intensity, with what determination, with what incisiveness in Allegri’s game plots? Without being great fortune-tellers it can be assumed that we will see a Pogba far from the performances that one might expect, so as to preserve the knee for the World Championship, provided that there are no other hitches, and then undergo the repair operation at the beginning of 2023 and return to the fields only at the end of the season. A little far from what was the dream of the millions of Juventus fans scattered around the boot, but, above all, divergent from the idea that the Juventus managers had, having staked everything on the figure of Pogba for the umpteenth year of the relaunch in Europe”, concludes dr. Gianluca Palmas.

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About David Martin

David Martin is the lead editor for Spark Chronicles. David has been working as a freelance journalist.

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