It was a great start to the season for Real Madrid on Sunday night with the win away at Real Sociedad setting the scene for the season to come. Particularly pleasing for Zinedene Zidane would have been the performance of the players he brought in due to the unavailability of the regulars. With Pepe, Keylor Navas, Karim Benzema and Cristiano Ronaldo of course all currently unfit and Luka Modric suspended; three points away are always welcome.
It’s looking as though Gareth Bale managed to survive an injury scare in the second half; jumping for the ball and coming down heavily on his ankle. With two of the ‘BBC’ already missing from the line-up, Zinedene Zidane could ill afford Gareth making up the trio. Madrid hearts were in their mouths for a moment or two until he got up and started hobbling; a little to begin with and then the injury appeared to settle thereafter.
With Cristiano still unavailable following his recent knee injury in Euro 16, Karim Benzema also missed the Real Sociedad game. The official diagnosis in a statement by the club explained that the condition was reported to be sacroiliitis. Any condition ending in ‘itis’ means that inflammation is present so Karim’s condition is basically an inflammation of the sacro-iliac joint (SIJ). This can be an extremely painful condition. Often linked to non-specific lower back pain (LBP), sacroiliac pain comes in various guises but the main symptom is one of pain; frequently of that ‘nagging’ type that just won’t go away. No matter what you do or what position you try to get into, the symptoms are still present and constant, with varying degrees of discomfort ranging from a minor irritation right through to downright excruciating pain.
The sacro-iliac joint (SIJ) is the joint that connects the lower back to the pelvis, highlighted by the arrow in the illustration below.
In medical terms, the lower part of the lumbar spine is called the sacrum, while the anatomical name for the pelvic bone is the ilium. The area where the two meet is called the sacro-iliac joint (SIJ) and it is a joint where very little movement actually occurs. Movements in this area of the body take place at the hip joint or in the lumbar spine; with true movement at the SIJ minimal and limited to a few degrees only.
Several factors can affect the SIJ, including impact running - which is common in pre-season training, and leg length discrepancies where one leg is shorter than the other. Other biomechanical factors can affect the condition such as muscular imbalances and / or carrying an injury to other areas such as the knee for example. Often, SIJ pain accompanies LBP and the causes can be insidious, frequently without single specific incident or injury leading to symptoms. SIJ pain can often result from lower back pain and vice versa. With sit-ups generally thought to aggravate the condition, exercises of this type should be avoided and the abdominal region should be trained in conjunction with specific back exercises targeting the ‘core’ as a whole while not over-training one particular aspect of it.
Karim’s not had to look too far for his injuries in the past year or so. He’s a big lad and his game is a physical one; and he uses his upper body strength to his own advantage in match situations, screening the ball and holding people off. Because of his robust style of play and position on the field, he often takes a battering from the opposition. His core strength will have been developed through intensive training; and it’s possible that his current injury occurred through gradual onset added to an accumulation of months of physical play compounded by previous injuries. It was reported initially that Karim was suffering from a hip injury and in another report a back injury was mentioned.
An injury to the SIJ would cover both of those complaints; particularly if the origin is of a non-specific nature which has gradually worsened. Either way, a short period of rest should help and hopefully things won’t take too long to settle. When using term ‘rest’ we are talking more of an ‘active rest’ with the emphasis being placed on resting from the activities which flare up the symptoms. So you wouldn’t expect to see Karim pounding the track for example; but you would expect to see him doing plenty of gym work, using the anti-gravity treadmill a lot and in particular, placing a big emphasis on swimming.
By avoiding the known aggravating factors, Karim will be able to maintain his general aerobic fitness while at the same time giving the inflammation a chance to run it’s course until the condition finally settles. It’s always difficult to put a time on injuries or conditions of this nature but he shouldn’t be expected to be out for longer than a few weeks. The key, as always, is in making sure that he has recovered to the full extent before trying to bring him back into the team before he’s fully ready.