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NEWCASTLE-UPON-TYNE, ENGLAND - Saturday, April 30, 2022: Liverpool's Thiago Alcântara during the FA Premier League match between Newcastle United FC and Liverpool FC at St James' Park. Liverpool won 1-0. (Pic by David Rawcliffe/Propaganda)

Thiago injury: Expert view on race for Champions League final fitness

Will Thiago be fit for Saturday’s Champions League final? Dr Raj is here to explain what will happen this week and the potential for the No.6’s involvement in Paris.

In the late stages of the first half vs. Wolves, Thiago immediately recognised a problem in his leg and called for a substitution, limping off to the sidelines where manager Jurgen Klopp inquired to the problem at hand.

Following the match, there were some unvalidated reports that the Spaniard had potentially done his hamstring – which almost certainly would have ruled him out of Saturday’s Champions League final considering only a six-day turnaround time and Thiago’s ongoing battle with hamstring problems.

Klopp refused to be specific in his post-match press conference, saying: “Yes, lower part of the body. I know it but I actually don’t want to talk now about it.”

However, the following day, more information came out that the injury was in fact an Achilles problem and after imaging (most likely magnetic resonance imaging aka an MRI) it was deemed to be non-serious.

The obvious question at hand becomes – will he be available vs. Real Madrid? That answer depends on a number of factors.

 

Key factors underlying his availability

The first factor is the actual injury itself. The only information we have thus far is that it’s an Achilles problem but that doesn’t distinguish between different diagnoses.

For example, an Achilles tendinopathy (meaning pathology of the tendon) is an injury to the tendon itself and results in disorganised fibres, pain, and dysfunction. These present in varying stages of severity which is going to impact the return timeline and odds of returning as these can be sensitive injuries that require slower and more gradual loading of the tendon.

Additionally, these can occur either at the midcord – known as Achilles midcord tendinopathy – or insertion (where the tendon attaches to the heel) point – known as insertional tendinopathy. The latter takes longer to recover from and can be more sensitive especially when stretched.

Further, there’s the possibility of tenosynovitis which is inflammation of the sheath that surrounds the Achilles tendon.

Achilles tenosynovitis can be painful and cause dysfunction but in mild cases can be treated much easier and quicker than the aforementioned tendinopathy.

Another potential confounder to consider is whether this is an acute (new) issue for Thiago or something he’s been dealing with and managing during the season (and if so, how long he’s been managing it for). The longer this has been going on, the more difficult it can be to dig out of that hole when a flare-up does occur.

 

Day to day management

LIVERPOOL, ENGLAND - Monday, April 4, 2022: Liverpool's Fabio Henrique Tavares 'Fabinho', Mohamed Salah, Thiago Alcantara walk out before a training session at the AXA Training Centre ahead of the UEFA Champions League Quarter-Final 1st Leg match against SL Benfica. (Pic by David Rawcliffe/Propaganda)

The mentioned factors will impact the overall probability that Thiago is able to return, but the most important factor is that the injury is being reported as not serious.

That gives Thiago a chance of being ready for Saturday and the key will be how he responds to treatment – likely a combination of hands-on and modalities to reduce pain – activity progressions that place an increasing load on the tendon, and finally to individual and team training.

These incremental increases in stress on the tendon result in critical feedback and information, particularly after the activity is completed.

How painful is it? How long is that pain response lasting? Is it trending positively? These will be assessed on a daily basis and then a judgement made on whether Thiago is close enough to play.

Additionally, you can use specific taping techniques to limit the load on the Achilles tendon and also – if it’s deemed safe – the use of pain killers to alleviate mild pain symptoms.

 

Risk/Reward

LIVERPOOL, ENGLAND - Sunday, May 22, 2022: Liverpool's Thiago Alcântara and his partner after the FA Premier League match between Liverpool FC and Wolverhampton Wanderers FC at Anfield. (Pic by David Rawcliffe/Propaganda)

The main calculation for the medical and training staff will be one of risk vs. reward.

The risks are, playing a potentially limited player in the biggest match of the season, the potential for re-aggravation which can require an early substitution and change in approach, along with potentially costing Thiago part of his off-season to recover and the potential for compensatory injuries which is particularly relevant for Thiago who has been hit with a multitude of soft tissue injuries since joining Liverpool.

The level of risk depends on the factors previously discussed which we aren’t privy to.

On the other side of the coin, the reward is clear – playing a massive impact player in the biggest match of the season, with a chance not only at a Champions League crown but making amends for the previous final vs. Real Madrid along with winning a cup treble.

Further, although his summer would be impacted some, it is the final match of the season so Thiago would have additional time to recover compared to a match that was mid-season. Albeit, he has just been recalled for the Spain squad, but…

 

All in all

Considering the non-serious nature of the injury, the weight of the match, the quality of the player and how competitive Thiago is – look no further than his body language during the Wolves match, he wanted nothing more to be out there helping his teammates in their pursuit of the league title – if he’s even close to fit (say the 70-75% range), I imagine he and the club will give it a go.

Keep a close eye on training pictures as the week continues and if he’s increasing activity. That will be the best tell for his Saturday prospects.


Dr. Rajpal Brar, DPT, (@3cbperformance) is a physiotherapist, movement mechanics coach, fitness trainer, sports scientist and mindfulness coach. He runs the online & Los Angeles based wellness and athletic performance clinic 3CB Performance, and you can subscribe to his Youtube channel (which posts a variety of Reds’ related content).

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