Does Real Madrid have a problem with cruciate ligament injuries?

As Real Madrid trained in Warsaw on the eve of their UEFA Super Cup victory over Atalanta on 14 August, the session was interrupted by Eduardo Camavinga’s heart-rending scream.

His teammates gathered around him. Carlo Ancelotti threw down his stopwatch in despair. His concern was clear: had Madrid lost another player to a cruciate ligament tear?

In the end, the fears were allayed. The injury was still serious – Camavinga was diagnosed with a strained knee ligament and was expected to be out for seven weeks – but the worst-case scenario was avoided.

Every player fears a serious injury, but in Madrid the issue is more pressing than ever due to a recent series of cruciate ligament tears, which explains Ancelotti's dramatic reaction in Poland.

Goalkeeper Thibaut Courtois missed most of last season after tearing his anterior cruciate ligament in training shortly before the start of the season. In Madrid's opening game, a 2-0 away win against Athletic Bilbao, Eder Militao suffered the same fate and also missed most of the 2023/24 season. Then it was David Alaba's turn, who tore his anterior cruciate ligament in a home game against Villarreal last December. He underwent further surgery in May and it is still unclear when he will return – an originally planned October return could be delayed.

But that's not all. Five days before the Camavinga scare, promising centre-back Joan Martinez, who turned 17 last week, tore his cruciate ligament in another first-team training match, shortly after returning from the pre-season tour of the USA.

Before TheIn the opening minutes of Madrid's first match on tour against AC Milan on August 1, 19-year-old midfielder Cesar Palacios tore his cruciate ligament. At the end of July, 18-year-old Real Madrid Castilla midfielder Dani Mesonero suffered the same injury.

What is the reason for this wave of injuries? Does Madrid think they have a particular problem?

Club sources, who like all those quoted here preferred to remain anonymous because they were not given permission to comment, disagree. They say it would be wrong to describe six serious cruciate ligament injuries in the last 12 months as evidence of a “general problem” at the club.

However, that does not mean the situation is not worrying. The club has analysed each injury and believes several factors have played a role.

One of these has to do with the playing surface. Figures at Madrid's Valdebebas training ground remind us that in the 1990s there was a theory that non-cylindrical studs on the boots made it difficult for players to turn properly on the grass, leading to cruciate ligament problems.

Now they believe some modern pitches cause similar problems, with players' feet digging deeper into the grass, which can be problematic when changing direction. Madrid sources point out that every pitch at every club is (at least slightly) different, which they believe could also be a contributing factor. For example, they said Mallorca's pitch (where they played their first game of the new La Liga season last weekend, a 1-1 draw) is much harder than the pitches at Valdebebas.

Others at the club question whether, in the case of Palacios and Martinez, their comparative lack of physical strength or preparation (as youth players training or playing in the first team) should be taken into account.

Martinez suffered his cruciate ligament tear after Madrid's pre-season tour (Ira L Black – Corbis/Getty Images)

“We are not talking about just any team, we are talking about the Real Madrid first team and here we have animals,” said a source. “Another team can beat us in a game, but physically these players are very special.”

Sources familiar with Madrid's training programs explained how the club does preventive work to protect players from potential injuries. They said each player's muscle balance is examined and any “imbalance” is corrected as it could lead to ligament or tendon injuries.

Madrid also considers nutrition (in addition to a healthy diet, collagen and other supplements are prescribed to promote muscle growth) as a key factor in the prevention and treatment of ACL injuries. This is an area where great scientific advances are being made. In the future, it should be possible to determine more precisely which supplements are most beneficial for which athlete and why.

Collagen supplements are already valued in Madrid as a means of improving joint health. Collagen acts as a lubricant for cartilage and ligaments and thus has a protective effect against mechanical stress.

Controlling sleep and muscle fatigue is also considered important. For the past three years, Beniamino Fulco, Ancelotti's son-in-law, has been in charge of this area at Madrid. This season he will also act as an additional technical and physical assistant to the first team.

Fulco stresses the importance of players getting enough rest. Madrid's intense schedule makes recovery and sleep difficult to manage, but they help reduce the risk of injury. Staff recommend players get between seven and nine hours of sleep a night.

Real Madrid training in Valdebebas last week (Alberto Gardin/NurPhoto via Getty Images)

When a player suffers a cruciate ligament injury, Madrid usually calls in an outside specialist. The most common is Dr. Manuel Leyes, head of the Department of Orthopaedic Surgery and Traumatology at the Olympia Medical-Surgical Center in the Spanish capital.

If no further problems arise that require immobilization, the player will undergo surgery a few days after the injury. Once the operation is completed, the club's physiotherapy department will immediately begin treating the player and will follow him for the first four months or so. The player will then complete his recovery process with the help of rehabilitation coaches and fitness trainers.

There are plenty of in-house rehabilitation experts. Antonio Pintus, Real Madrid's head physical preparation coach, wrote a book on cruciate ligament recovery in 1996. He is just one of many important figures, along with training assistants Giuseppe Bellistri and Sebastien Devillaz and fitness coach Jose Parrales.

But despite all the care and attention to detail, some sources also speak of “bad luck” and point out that top footballers, no matter what work they do, always have a certain risk of injury.

(Top photo: Robbie Jay Barratt – AMA/Getty Images)