Paris Saint-Germain FC Neymar Jr. Injury Discussion

*****Update Update Update*****

I am updating my article that was previously written about Neymar Junior’s injury following new information. It turns out not only did he suffer a sprained ankle but he also suffered a fracture in his fifth metatarsal. 

He has not been reported where the “crack” in his metatarsal is. It is also not known where the fracture has occurred: head, neck, shaft or if it’s an avulsion fracture or if a Jones’ fracture has occurred. 

While conflicting reports have said he is getting surgery or not getting surgery. Surgery would put him back three months, while a non-surgical option of: physical therapy, manual care, *chiropractic, and “rest” will be utilized. 

Treatment now, not only will included rehabilitation for the ankle, but also foot strengthening exercises and another focus on foot mobility and great toe mobility. 

He is going to miss the match against Real Madrid. But more importantly for him is his recovery in preparation for this year’s FIFA World Cup in Russia. The world wide tournament begins in June. Which will be plenty of time for him to recover. If he goes through with surgery, he won’t be playing until May, which only gives him a month to get into soccer shape needed to play well. By all accounts, he is hoping to avoid surgery. We’ll see him in the World Cup. He won’t miss that. 

So I was all set to release an injury discussion on Minnesota Timberwolves’ Jimmy Butler and his knee, but since Neymar Jr. sprained his ankle only 9 days out from a clash against Real Madrid this injury is a bit more relevant. They play Real Madrid in the Second Leg of the Champions League Round of 16.

From the game footage, Neymar injured his ankle. He suffered an acute inversion ankle sprain. Given his reaction, there was an opportunity for something to have torn (muscles, ligaments, tendons) or break (fibula, tibia, talus). He was carted off and unable to bear weight.

Inversion ankle injuries occur when the foot turns outward and the bones of the lower leg (tibia and fibula) turn inward and it results in a tension twist motion on the ligaments.

https://www.instagram.com/p/Bfoq0QpFtq7/?taken-by=njr48

But imaging as been able to rule out a fracture, avulsion fracture, torn muscles or ligaments.

Quick Recap:

Sprains – damage to ligament or other connective tissue
Strains – damage to muscle belly or muscle tendon

Anatomy Review:

The lateral ankle is held together by many small ligaments. Which is one of reasons why it is more common to sprain the lateral ligaments of the ankle. When it becomes a “High Ankle Sprain” is when the ligament (anterior tibiofibular ligament) is torn. I would consider a high ankle sprain, severe.

The ligaments to consider:

Anterior talofibular ligament
Calcaneofibular ligament
Psterior talofibular ligament

What I Could Do:

Well he’s going to be booted up for protection whenever he travels. As a part of a treatment team, the manual component to help with decreasing pain, decrease inflammation, creating ankle stabilization will be important.

While many would want to think just resting and icing are the primary treatment modalities, I would say that’s wrong. Getting Neymar involved with his treatment, he’ll start off with real basic ankle strengthening exercises that you would see at a generic rehab clinic. The purpose for him is to just move the ankle and help get the blood moving and help flush out the swelling that has occurred.

The goal will be for him to be able to bear weight to be able to walk without pain and bear weight on a single leg without pain. Most of my role, for now, is to just decrease pain and swelling. An exercise I like using in the clinic to help with ankle injuries are weighted shifts to help loading the injured ankle.

Once he’s able to bear weight without pain, that is when you can take a variety of paths to continue this rehab. The goal by the end of the week is that he is able run and change directions without pain.

As long as he is able to stand on his ankle without pain, have no pinpoint pain, able to jump on his ankle without pain those are very good standards for him to pass to be cleared to play.

Another standard progression that I like to use in the office are:

• Jog without pain and proper mechancis
• Sprint without pain and proper mechancis
• Cut left and right (50%) without pain
• Cut left and right (90%) without pain
• Multi-directional cutting and movement at half speed without pain
• Multi-directional cutting and movement at full speed without pain
• Jumping and landing on  two feet without pain
• Jumpion and landing on one foot without pain

My Take:

With round the clock treatment and access to top notch medical care I think he will play against Real Madrid. Also it’s an important game for PSG if they want to have a chance to move on in the Round of 16. There’s no doubt the next 9 days will be grueling to make sure he hits all the different clearances and checkpoints, but I think he will end up playing. His ankle is going to be heavily taped, you can bet Nike will have a different soccer cleat for him to wear as well. He may not be up to form when he plays, but he will play. He plays but PSG doesn’t move past Real Madrid.