Santi Cazorla pays heavy price for playing on with Achilles injury

Cazorla hits the long comeback trail on the stationary bike
Santi Cazorla would have suffered a loss of capacity after playing through pain Credit: Pablo García Sacristán

Injuries to the Achilles tendon area are common, especially in professional footballers, although I have never seen one quite like this. 

I was interested to read that Santi Cazorla had been dealing with pain in that area for some years before the surgery and what often happens is that athletes will tend to play on with these problems for quite some time before having to stop. 

It is because you might not get any drop in performance and so, even if you have a pain but are still playing well, there is not enough of a motivation to do anything about it.

Once you are down that road, however, the tendon starts to degenerate, the structure starts to change and you will get a loss of capacity. They obviously found that the changes in this case were so great that surgery was required. 

The complications with surgery are that it is going to further change the structure of the tendon again, as well as the environment. He has also had the infection on top of that.

Keep pushing!! Onedaymoreonedaycloser! @arsenal @premierleague @pumafootball

A post shared by Santi Cazorla (@santicazorla) on

The challenge now is to regain the capacity of the tendon to store and release energy for explosive movement. 

How he is going to get there is with a lot of strength training, beginning with very specific, slow and heavy loading.

Once you have regained the strength and stiffness back within the tendon, then you increase the speed of the movement so that it becomes much more explosive. From there, he will do a lot of plyometrics training.

Cazorla has said that he has lost eight centimetres of the tendon through the infection and, although you would hope it grows back slowly, it usually does not. You would try to compensate by aiming to improve the good bit of the remaining tendon. 

A further issue is that the scar tissue from all the surgeries can impact on the tendon. It needs to be able to slide and glide and have a good healing environment. If you have a lot of scar tissue, it can impede that.

The fluid and swelling can create a negative healing environment preventing good nutrition to the tissue. 

You would tackle that with a lot of massage and movement exercise. You try to remove the scar tissue and create better movement and a positive healing environment.

Could Santi Cazorla still play football again at an elite level? Anything is possible if you take one step at a time and the fact that he is running again is a really good sign. 

If you can get someone back to that level then there is the possibility that he can get back on the field, but tendons are notoriously slow healers. They take a long time, even without surgery and complications.

Robert Brown is a Specialist Musculoskeletal Physiotherapist at the Centre for Health and Human Performance

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