Maestro out: The trio of injuries that sidelined Jack Wilshere for a year

July 31st 2011 – Arsenal faced NY Red Bulls in the Emirates Cup. It was the highlight of the pre-season games with Thierry Henry returning to his old stomping ground where he will always be a legend. 7 minutes in and Jack Wilshere hobbles off nursing what appeared to be a minor ankle injury. It turned out to be the start of an injury problem that has seen him miss a year of football.

Early signs suggested nothing serious and on August 6th Jack Wilshere was even called up to Capello’s England squad for a midweek friendly against Holland. Sadly two days later he was withdrawn from the team as his ankle was still causing him problems.

By September 9th Jack is still out and Arséne Wenger reveals he has an ‘inflamed bone’ which he first felt back in June playing for England against Switzerland. He’s put in a protective boot for a month, but scans in late September reveal a fracture that hasn’t healed and he undergoes surgery on September 26th.

So what actually happened? It’s hard to tell exactly with Arsenal players. Injury information is confidential and the club rarely release any more information than they have to. What we have been told is that there was a ‘stress fracture’ to part of the ankle with a poor blood supply.

My theory is this; Jack developed a stress fracture to a bone in the foot called the navicular. It heals slowly due to this poor blood supply, and as a result when it hadn’t healed with a month in a protective boot, it was fixed surgically. Bone healing usually takes 6-8 weeks. In this case we were told to expect around a 4 month lay-off, I think this will have been because the navicular is slow healing. Navicular stress fractures are considered ‘high risk’ due to their tendency to progress to complete fracture, delayed union or non-union (failure to heal).

I wonder if this situation could have been avoided. Jack was omitted from the England Under 21 squad because they were aware of his sports science data and the risk of injury due to playing 49 times for Arsenal in 2010-2011. Stress fractures develop over time and usually go through 3 stages; bone marrow oedema, periosteal reaction (inflammation in the surface of the bone) and then eventually progress to fracture.

It is likely he would have had some symptoms prior to the fracture and perhaps should have been rested more. A stress fracture is usually an overuse injury. With sports science data showing he was at risk and him feeling symptoms as far back as June you have to wonder why he was included in pre-season fixtures. But hind sight is a wonderful thing.

The story continues with Wilshere’s development of a second injury. His healing was progressing well and he was pencilled in for a late January return when he picked up a second stress fracture, this time to his calcaneum (heel bone).

Again I can’t help wondering whether he was rushed back, stress fractures are a typical ‘too much too soon injury’. Wenger acknowledged this; “we tried to push him back quicker and we had a setback.” That said, once you’ve had one stress fracture it’s fairly common to pick up a second one.

As the season progressed Wenger’s words became less and less optimistic until Wilshere was eventually ruled out for the rest of the season and Euros on April 16th. It was news none of us were surprised by but I think we all fully expected him to be fit for the start of the 2012-2013 season. That is of course until injury number three…

May 22th Wilshere had to have surgery on his left patella tendon for a problem that had flared up during his rehab. This is as much a worry for me as the stress fractures. The patella tendon connects the knee cap to the tibia. The tendon can suffer from a buildup of ‘micro-trauma’ tiny tears and structural change within the tendon. It becomes painful and scar tissue develops.

I think it’s most likely he has had surgery to remove this scar tissue. The worry is that this problem can become a persistent issue – it was what sidelined Owen Hargreaves. That said, it is usually treatable and Hargreaves was an unusual case in that it doesn’t usually restrict a footballer as much as that.

Our most recent update on Wilshere is that all is ok but Wenger won’t set a date for his return. After a year’s absence from the game he will need time to regain fitness. I have heard a few voices on Twitter suggesting eight weeks as a timeframe but I have no idea what that’s based on.

My concern is the pattern that has developed here. Stress fractures and tendon problems can be caused by a number of things, in most cases in athletes though they are from overuse.

On each of Wilshere’s attempts to return he appears to have overdone his rehab and created a new issue, this may be why Wenger is so reluctant to set a date and place pressure on him.

Another possibility is that Jack has some underlying biomechanical issues – this means that perhaps he has poor foot posture (such as ‘flat feet’) or some kind of strength and conditioning problem that has lead him to develop these issues. Undoubtedly Arsenal will have identified this and attempted to rectify it.

My final thought here is for Jack. It must be so frustrating for him to miss a year of football just when he was emerging in the Arsenal side and onto the international scene. I think hoping for a return in eight weeks may be a little optimistic, but for his sake, let’s hope he’s donning the red and white as soon as possible.