Flapping Pays its Toll on the Vulnerable Shoulder

So finally, what I believe most Gunners have wanted to see, Wojciech Szczesny looks like he is going to have a good run of games as Arsenal's No.1 so we can really see what he is like. This is due to injuries to our previous Number's 1's Almunia, and Fabianski.

Let me firstly make my opinions clear on the latter, Lukasz is a good shop stopper, I believe saves against Wolves and Everton have shown that. But it is clear to see he is vulnerable under the high ball, and his communication isn't the best. So where I think he is a good goalkeeper- Arsenal could do better. I think Szczesny shows all the potential to be a fantastic keeper for many years to come.


Lukasz Fabianski has been out for the last couple of weeks with what Arsene describes as "a little shoulder inflammation". But why has have his chances gone from 50:50 against West Ham- to a couple of weeks out?

My thoughts are based purely on speculation, but I am assuming that the inflammation he has, is probably swelling of one of the rotator cuff tendons- this in turn is causing shoulder impingement, commonly seen in sportsmen and women.

The shoulder is a ball and socket joint. The ball of the joint is called the humeral head (top of the arm), whilst the socket is the glenoid fossa (shoulder blade). The rotator cuff consists of 4 muscles which serve to control the humeral head (ball) within the glenoid fossa (socket). So the rotator cuff basically holds the ball in the socket whilst the larger muscles around the arm move it.

Imagine wrapping 4 rubber bands around a golf ball and placing it on a tee- you would probably find space on the ball to balance it. What sounds like has happened to Lukasz, is that one of the rotator cuff muscles (elastic bands) has become inflamed, and so when he moves his arm, there is a narrowing of the space between the ball and socket, and he feels a pinching sensation - known in the medical world as shoulder impingement. The athlete with shoulder impingement complains of pain with throwing and most overhead activities-not ideal for a keep who is already vulnerable under the high ball!!!

So what is the treatment? Annoyingly it is mainly rest from the aggravating activity- which if is overhead activity- is most of goalkeeping. Following this, Nitric Oxide Donor therapy, corticosteroid injections, strengthening exercises, soft tissue release have all been indicated, but as always- I may be able to hypothesis on the injury-what the Arsenal medical team are doing is beyond me! All I know is if it is this it shouldn't keep Lukasz out of the game for too long- but whilst he is, lets hope Wojciech can impress- penalties would be fun ay?!


Want to know any other injuries? Tweet me @davidbartlett89 or leave a comment. I'm off to work with some of the Arsenal Ladies tomorrow! Keeping it Goonerish!

The All too Recurring Hammy

Thanks for the response to yesterdays blog about Thomas Vermaelen,people have requested, and it seems relevant to write about Arsenal's second injured Centre Back-Sebastien Squillaci-and the all too common hamstring injury.

Of course its not just Squillaci whose out with a hamstring injury. Nedum Onuoha, Danny Wellbeck, Scott Dann and Tom Cleverly are just a few that come to mind who are out at this current time with hamstring injuries. 

But why do we hear "he's pulled his hammy" so much in the world of sport?

Hamstring injuries are common in sports that involve high-speed running and kicking, they are usually a non-contact injury and occur during sprinting. But why? 

Muscles work in pairs, in the leg, the quadriceps (front of the thigh) straighten the knee whilst the hamstrings (back of the thigh) bend it. Kicking a football you would naturally think uses mainly the quadriceps, which contract, to straighten the knee and hence move the foot towards the ball, simples. But what stops the knee from carrying on into space? The hamstrings work to decelerate the knee, and not only in kicking, but walking, sprinting- any lower leg movements.

Now imagine you are a kid with an elastic band. You stretch it, and its fine, but the further and further you pull, it becomes weaker and weaker and till BAM, it snaps. Muscles are similar to elastic bands, the longer they go, the weaker they become. Coincidently, when the knee is straightened, and the hamstring is called into action to deccelerate, its at its weakest-sometimes, it can't cope and BAM, it goes.

So what does Arsene mean when he says "Sebastien has a Grade I hamstring strain"?

Grade I - Mild damage to the muscle. The body responds by by sending chemicals to the damaged area and it causes swelling and pain.

Grade II- Partial tear. The small blood vessels in the hamstring also get damaged. Until these repair themselves, less blood gets to the area. Reduced blood flow = increased healing time.

Grade III- Complete tear of the muscle. Your elastic band snaps in half. Ouch.

When the  hamstring repairs itself it lays down collagen fibre. This collagen fibre isn't as strong as muscle, but its the only thing the body can lay down. Therefore, once injured a hamstring, there is always a weak spot, hence being susceptible to further injuries of the same ..... (Michael Owen walks into the room ) 'Hiya'.

The only preventative measure is to strengthen the hamstring when it is at its longest-but even that may still not be enough to cause the inevitable-especially in a game such as football.

As for you Gooners- Squillaci has a Grade I- unfortunately only 3 weeks out tops - then the clown is back. Other players mentioned earlier-no idea.

Hope its not been too dull - any suggestions on injuries tweet me @davidbartlett89.

Thomas Vermaelen's Achilles Heel

Welcome to The Physio's Opinion. I am a qualified physiotherapist and fanatical sports, and Arsenal F.C fan. This blog will not only be about Arsenal, but any sportsmen's injuries you may want more information on. As for now, I have been fed up of reading blogs criticising the Arsenal medical team over Thomas Vermaelen's ongoing achilles injury, as so the blog begins.....


Vermaelen injured his Achilles back on 28th August against Blackburn Rovers in a 2-1 win at Ewood Park. At first, it was thought to only keep him out for a few weeks tops. Little did we know that 5 months down the line he would still be suffering minor setbacks and having to see world specialists. It has meant, that combined with a grade I hamstring strain to Squillaci, Arsene Wenger has had to look into the transfer market for a new Centre Back (probably a blessing in disguise considering the lack of ability of Squillaci and Koscielny!).


The phrase "achilles heel" was not pulled out of the blue. As the trusted Wikipedia source says  "An Achilles’ heel is a deadly weakness in spite of overall strength, that can actually or potentially lead to downfall".


The achilles region has an extremely limited blood supply and poor metabolism, meaning any injury to it has slow progress any way. Thomas's initial diagnosis of a 'few weeks' was probably based on the thought process that he had pulled it rather than damaged any of the tissue. Now, it seems the injury is most likely to be an Achilles Tendonpathy...and just ask Owen Hargreaves how tedious tendonopathies can be. I'm not saying Vermaelen will be out for as long as Hargreaves, but I am saying be patient.


A Tendopathy refers to damage to the tendon, this is an umbrella term for inflammation or small micro-tears in the fibres. Due to the achilles poor blood supply, the lay down of scar tissue is not always succinct, and often goes across the fibres of the tendon, as opposed to with it. This is a normal healing process, its not ideal, but its not Arsenal's medical staffs fault. This scar tissue can form a thick, hard block in the tendon, hard to break down, meaning that when the Thomas starts to run, the achilles tendon cannot move smoothly, and so he feels slight discomfort (one of what Arsene calls a 'setback'). This scar tissue formation is not always easy to spot, and often can't be seen on scans, and so experts from all over the world can come and assess Thomas, and give their opinions on treatment and management strategies.....


What Arsenal have tried, or are trying? Don't ask me! That's what the experts are for, all I can tell you is that tendopathies and achilles injuries are a slow and patient game....lets not rush Vermaelen back or the weakness might cause a complete rupture....then you'll all be moaning that he's out for 8 months! Oh, and don't worry, we have Djourou.....player of the season for arsenal minus Nasri!