An Exclusive Doctor’s Insight into the Old and New Bellerin, pre and post ACL

The Heads Up campaign hopes to encourage more men to feel comfortable talking about their mental health, and feel able to support their friends and families through difficult times.

Unfortunately, injuries are part and parcel of sport especially at the elite level, and with the vast majority of them being unavoidable it often triggers a psychological response from the athlete.

Whilst some minor problems can be treated with little to no disturbance on performance, others cause extended periods away from sport while inflicting significant impact on not only a players physical health, but their mental state as well.

The affects can reveal more serious mental health issues including: depression, anxiety, disordered eating, and substance use or abuse if sufficient support isn’t available.

With the issue of mental health prevalent in society at the moment, with one in four people experiencing problems each year, it leads to questions about why coverage of this topic isn’t at the forefront of the sporting world.

Nowadays, when managers are asked about updates on injured players every answer is about how they are developing in a physical sense, with the consideration of the mental toll it takes continuing to be left in the dark.

Just over two years ago, Arsenal lost two of their key defenders to long-term injuries within the space of a month, ruling the pair out for at least 6-9 months.

In an interview after, Holding gave an insight into how he felt by seeing the same happen to his teammate, saying: “Then it literally just hit me, and I just started crying. I’ve got no idea why. I obviously love Hector to pieces and stuff, but I didn’t think I’d cry about another guy’s injury.”

“It’s because it was so recent to my surgery, it was literally four weeks after. I knew everything he was about to go through and I just got overcome with emotion a bit.”

After strenuous rehabilitation programmes, the duo took close on a year before they returned to the pitch, and in the early months struggled with minor setbacks due to persistent muscular strains.

It shows that on the surface, Hector Bellerin and Rob Holding both made their comebacks from their ACL ruptures within 250 days, but have they truly returned yet?

Hector Bellerin and Rob Holding both made their comebacks in a 5-0 win against Nottingham Forest.

Despite fans not being allowed to attend games for nearly a year, players still find themselves at the brunt of vile online abuse, which undoubtedly adds to the predicament.

However, one of the main contributors to the detriment of footballers’ mental wellbeing is injuries, especially if they are long-term due to athletes not knowing how to cope without competing regularly.

This season especially, we’ve seen the unattainable fixture lists take it’s toll on teams, forcing managers to utilise every resource within the squad in order to get results.

Combine that with inadequate rest and the fact many top coaches incorporate high pressing tactics into their philosophies, it comes at no surprise that muscular injuries are up around 15% this campaign.

Arsenal’s track record for injuries has never been impressive, as most seasons our key players tend to be on the sidelines for extended periods of time, missing crucial fixtures in the process.

Whether that’s down to substandard recruitment, our training methods or pressure on the manager to rush players back to fitness to pick up points it’s a problem that needs to be addressed.

Often extended periods on the sidelines gives athletes time to do work in the gym, sometimes coming back even stronger physically, but the mental fatigue it causes can be far more disruptive.

Recently, Bellerin has come under a lot of criticism regarding his performances, as many believe he’s yet to reach the level of consistency he showed prior to his injury just over two years ago.

When a player makes their comeback to competitive action, not many supporters consider the other factors that can affect their form, because even if their bodies are ready to return sometimes their mental state isn’t.

To help give an insight from a professional point of view into some of the problems athletes can face, I reached out to Dr Rajpal Brar, DPT, a physical therapist, sports scientist and data analyst who also specialises in sports medicine and mindfulness.

When first retuning after such a significant injury, it takes players time to get back to the level of performance they showed prior, due to a multitude of different reasons.

Bellerin explained in his documentary that one of the aspects he was nervous about was making his first tackle, therefore I asked Brar to evaluate the impact that fear of being injured again has on a players performance:

“It’s significant. You’re naturally going to be cautious or hesitant following an injury – especially a long-term ACL injury like Hector and Rob (and Calum Chambers) – because that’s an experienced trauma and the brain remembers that episode!”

“Like anything else, it’s going to take time to regain that confidence and the research increasingly shows that kinesiophobia (fear or movement or reinjury) is one of the last things to return following long-term injury, especially ACL ruptures.”

In modern times, it appears that clubs are giving players further support on the mental side during rehabilitation than they used to and Brar believes that by doing this, it can also aid physical recovery.

“It depends on the injury with longer-term or recurring injuries potentially requiring more help on the mental side but I think it needs to be a critical piece of recovery.”

“The physical side will certainly be the priority but there’s more and more research showing that taking care of the mental side further expedites physical healing, which can create a virtuous cycle.”

From rupture to full recovery, rehabilitation programmes can feel like groundhog day for players, draining them both physically and mentally due to their repetitive nature.

Therefore, keeping the player in the right frame of mind throughout can play a pivotal role in the process and one of the ways of doing this is by the player having a change of scenery to be close by to your family for support.

“I’d always advise any patient to have a strong social support system when going through a major injury, especially when it’s an athlete who is so used to being active, may not be used to failing, and often have much of their identity tied into playing that sport.” Brar said when asked about what advice he would give to one his patients.

Bellerin made the decision to have the surgery in his hometown of Barcelona, due to the combination of having his family network there to support him through the hard days, while also having access to one of the leading surgeons in the world Dr Ramon Curgat.

Bellerin chose to have his surgery done by Dr Ramon Curgat in Barcelona.

Ever since the arrival of the Premier League in 1992, football has changed drastically due to the financial implications on missing out on certain targets, almost single-handily enforcing an environment where success is solely measured on results.

Inevitably pressure on managers has increased to meet the boards expectations, thus when key players are ruled out for extend periods of time, they want them back contributing on the pitch as soon as possible.

As we have seen first-hand with Bellerin last season, despite clearing all the necessary medical checks before making his return he still suffered with two separate hamstring injuries, which raises doubts whether he was mentally fit.

In total they ruled him out for a further 49 days and propounds the idea that his body was compensating for his knee, hence putting him at increased risk in other areas.

It’s an issue that seems to be becoming more frequent and leads to speculation about whether players long-term health and wellbeing is being compromised to get results.

Brar has suggested that these type of situations arise more often nowadays: “Absolutely – there’s a constant push-pull between player’s absolute health and safety and having them out on the pitch to contribute, it’s a constant risk-reward tightrope.”

Research also indicates that footballers could be more susceptible to becoming addicted to gambling or painkillers after an injury, as they use it as a coping method or another way recreate the thrill that playing football in front of thousands gives them.

However, Dr Brar isn’t convinced that athletes are more likely to struggle with addiction due to their completive nature, saying: “Honestly I can’t say because there are so many nuances to personality type. Someone can be extremely competitive and committed but not have any addictive tendencies. Generally, clubs are offering more and more social and psychological support.”

The examples used above are only scratching the surface into the affects injuries have on an athletes health and performance, some of which I and many other people have experienced, and will continue to if measures aren’t put in place to suppress it.

With the players’ mental wellbeing being so important and even helping to the extent of physical rehabilitation, the stigma surrounding mental health needs to be abolished and put at the forefront of all football clubs.

Not only clubs, but fans can play their part by being more patient and not taking to social media so quickly to criticise and abuse, without taking into consideration the mental barriers that player may be facing.

James Humphreys

I’m a 20 year-old Arsenal fanatic and aspiring Sports Journalist, who will be studying how to write about the Beautiful Game at Solent University from September in an attempt to make my dream into a reality.

Since the age of 8 I have played academy football, but unfortunately it didn’t quite work out – therefore I decided to pursue the next best career for me.

I am aiming to write honest and interesting articles about the club I love, and to share my opinion (one from the younger generation of Arsenal supporters) with as many other fans as possible!