The Diary

27 November 2007: Some Things You Never Knew About Lateral Knee Ligaments! (And Neither Did I!)

Rather than kick off by looking at yesterday?s game, then assessing whom I considered good, or a comparative turkey, tonight, I intend to go about things in a totally different way. Now all that horrible Dingle-dust contaminating our ground has settled down until the next time we meet, the big issue facing our promotion push right now is the extent of the lateral knee-ligament damage to Ish Miller.

An awful lot depends upon the damage sustained being minimal, of course, and as the club aren?t saying anything more today, I thought it a good time to look at such injuries, their cause, assessment, and possible treatment, and by doing so, try and get some sort of handle upon the possible length of time our little wounded soldier will be out for. With Kev Phillips still hors de combat because of a similar problem, and our striking hopes very likely resting upon the slender shoulders of Messrs. Beattie and Bednar, it hardly needs me to say there?s a hell of a lot riding upon what the specialist eventually decides.

But first, a quick anatomy lesson. The human knee-joint is the largest in the body, and is known as a ?modified hinge-joint?, as in common-or-garden doors, etc. and working in similar fashion. The joint, which is in a protective capsule and bathed in lubricating fluid, connects and holds together, by means of cords of tissue called ligaments, the thigh-bone (femur) to the shin-bone (tibia), with the knee-cap (patella) stuck in between the two, at the front. Yes, I know there?s lots more to the human knee than that, but as we?re very much in the business of looking at the basic causes of football injuries, and not A-Level sports science, let?s try and keep it simple, eh?

Attached to both bones are several lots of the aforementioned ligaments, most of them running outside the kneecap, but with one lot (those notorious cruciate ligaments) stuck right inside the joint itself. We?re concerned with the lateral ligaments, which run alongside the bit of the knee facing outwards, from the lower femur, across the end of that bone, over the outer side of the knee, then to the beginning of the tibia, where the ligament again attaches itself, about three or four inches downwards, still staying on the outer side, but to the outer-facing top of the shinbone, this time. A diagram would make things a lot simpler, but I?m not sufficiently well-versed in IT to do it, then add it to this blog, so you?ll just have to make do with my ?word picture?. Sorry.

This ?lateral ligament?, then ? besides cart-wheeling normally-stable football supporters into a state of terminal depression, what does it do? Well, it prevents you from becoming ?bow-legged? for a start, i.e. stops the outside of the knee-joint opening up, and making everything all saggy down there. You can feel for it by sitting cross-legged, then running your finger down the outer bit of the knee, from the femur end to the tibia. What you?ll feel there is a hard cord, running from and to all the places I mentioned above ? that?s what Ish has injured, if what the club says is right. It doesn?t need to be as strong as all the other ligaments providing support, as they tend to do a good job on their own, but if the problem?s a bad one, they can be involved too, in which case, the knee?s rendered unstable, as per my previous comments, and if that happens, you?ve got a big crisis on your hands.

The main cause of lateral ligament injury is, you won?t be too surprised to hear, the football tackle. If a player goes to kick the ball, and his opponent?s foot then simultaneously whacks the poor lad?s upper shinbone, then that kick followed through to the outer side of the knee as well, that can cause the protective case of the outer side of the knee to open up, which, in its turn, can cause the ligament itself to strain, or, worse still, tear. That, basically, is what we?re looking at.

The main issue facing Albion?s medical staff right now is whether or not other tissues are damaged also. Worst-case scenario? Additional damage to one or more of the following: lateral and/or posterior cruciate ligament inside the joint, tendon trouble, damage to the joint capsule itself. As I said, though, that?s looking at the problem through the somewhat murky visage of the Bloke In Front Of Me: chances are that it won?t come to any of that, and the lad will be back in gear come the New Year.

Having never been in the position to sustain such a nasty injury myself, I?m having to go by what my little book of medical words says, but it is a pretty painful one, apparently. Before boning up on all this, I was a tad cynical about the seeming silence of the club on the issue, but I now know that accurate estimation of the true extent of the damage may take some time, owing to the continued presence of any remaining swelling, pain etc.

The main aid to diagnosis is an MRI scan ? in effect, using a thundering great electromagnet to see right inside the offending joint, and its various structures. As I know only too well myself when I injured my back, the images thus produced are quite remarkable. Detailed and astonishingly clear, they are, and represent a significant advance upon the old diagnostic method, which was looking at the problem using X rays: if there?s still swelling around, these can be misinterpreted. Ultrasound, which isn?t just for looking at what Junior?s doing inside mum?s body, by the way, can also be used as a diagnostic aid. Usually, a scan of the uninjured knee is done at the same time, for comparison purposes.

As I intimated before, any treatment plan very much depends upon whether or not other things nearby have been damaged. If that?s the case, then both Ish and the club have problems. Surgical reconstruction of the area may prove necessary, which could keep the lad out for months, not weeks.

If the damage is shown to be minimal, however, then physio and rehabilitation exercises alone should do the trick. The 4 to 6-week timescale mentioned by Mogga and others will be correct. If the knee is found to be unstable due to further injury, then an operation to put everything back together again is required PDQ, before the damaged bits get chance to turn to scar tissue and shrink. A real bummer, make no mistake.

If that happens, it can affect ? and perhaps subsequently blight ? an entire playing career. But with modern day professional clubs all taking advantage of state-of-the-art diagnostic technology, and consulting the best sports-injury and orthopaedic surgeons in the country, it should never come to that.

Hope that?s made things a bit clearer for everyone. Naturally, my other wish is that the news from the front won?t prove too gloomy, and we will have Ish back ere the moon has waxed and waned but twice more. Or even sooner than that, maybe.

Leaving the more obscure realms of the human body for pastures new, at long last, on to other things of note. Will our reserve side do, for starters? Coventry 3, Albion 2 was the final score. Sounds one hell of a game, that. The scorers being a youthful combo of Stefan Morrison and Ricky Nicholls can be considered an offshoot of the injury problems currently affecting the first team squad: the entire starting line-up was very adolescent indeed. In fact, Worral, one first team appearance for Bury only, and Luke Steele apart, I doubt whether any of them had any first-team experience of note under their belts. Did their mothers know they were out?

Coventry were first to draw blood, and that?s the way it stayed until 20 minutes to the end, when the home side managed to double their lead. But that wasn?t ?game, set and match? for these kids by any means. Morrison pulled one back, only for City to quickly restore that two-goal advantage, with young Nicholls adding Albion?s second with but three minute remaining. The scene was then set for a crash-bang-wallop of a finish, but we simply couldn?t grab the equaliser. Oh well ? c?est la vie, and all that.

Funny how things change, though: as recently as 25 years ago, it wasn?t at all unusual to see fringe players remain in reserve football until their mid-twenties, before the club finally decided to cut their losses and move them on. Nowadays, if you haven?t made it to the first team squad by the time you leave your teenage years behind, you?re automatically considered surplus baggage, and told to find another club. I wonder how many late developers have ended their time at the Hawthorns in this sad way?

And therein lies the problem: these days, clubs don?t have the luxury of carrying passengers i.e. kids that show promise, but not quite enough to warrant promotion to the senior side, any more. The game is very much one of instant gratification: if your manager doesn?t give your underperforming first team a mental kick up the fundament, if results don?t improve, you don?t get into the play-offs or an automatic promotion slot, then you?re out, like as not. So daft is this policy becoming, a mere bad run of results can be considered ample cause for the axe to fall. I won?t bother with current examples of such craziness, as you can quite easily name them yourselves.

And the same goes with kids; it may be a three-year process, turning a schoolboy into a half-decent professional footballer, but it?s also very dependent upon you catching the coach?s attention very early on, and for the right reasons, preferably. It?s often been said that a career in football largely stands upon who you know, rather than what you know. Get on the wrong side of the coaching staff, even for trivial misdemeanours, and a future as a ?released scholarship player? beckons.

But it?s not necessarily a total disaster: there are many examples to be found, at both Second Division and Conference level, of top-flight discards becoming established first-teamers. In fact, some might argue that it?s only those discards that keep lower-level football functioning at the standard it does. Some even get a second chance to prove themselves, courtesy inquisitive scouts from higher-placed League clubs recognising latent talent when they see it. Albion examples? Tam Mkandawire and young Carey-Bertram, now strutting their stuff lower down.

So, there you go. Young professionals, please take note. It ain?t over until the fat lady sings. It?s a nasty body-blow, not being kept on, but it?s not the end of the matter, by any means. As for our current crop, what with all the injuries to our first-teamers, and everything, it only takes a good run of performances at reserve level for a player-strapped gaffer to think: ?Hmmm ? I wonder whether young ?X? would be up to a spell on the bench?? As they say in the movies, the rest is entirely up to the kid concerned.

According to the club?s website, Mogga has been nominated for a second Manager Of The Month gong, thanks to us going unbeaten over the last four games and taking eight points from a possible twelve, including the complete and utter stonking we inflicted upon Watford at their place. The competition? Hull?s Phil Brown, Charlton?s Alan Pardew and Sheffield Wednesday?s Brian Laws.

Just one thing, Mogga, old mate. It?s all very nice winning these things, and everything, but if you should find yourself topping the poll a second time for what, in effect, amounts to a kiss of death for the end-of-season hopes of not a few gaffers - for God?s sake, man, REFUSE TO ACCEPT IT!

Back tomorrow evening, when I?ll be having a bit of a look at our prospects of sorting out Plymouth, on Wednesday night. If we?re just depending upon Beattie and Bednar to provide the goals, I can?t say I?m very hopeful, but we do have proven scorers turning out for us in midfield, so it?s not a hopeless cause, by any means.

Tex is quite capable of coming up with the goods, and so is Zoltan Gera ? when he?s not pulling strips of double-glazing sealant off John Homer?s windows, that is! Jonathan Greening has been known to make the air around the goal-line sizzle and boil as well. Oh well ? let?s see what tomorrow brings, then enthuse or panic accordingly!

And Finally?. Anyone else clocked who the ref for our Plymouth Argyle game will be, yet? No? Well, it?s Steve Bennett, whose whistling-and-card-waving habitat is the Premier League, more often than not. His claims to fame ? I leave it to the good sense of all you readers, as to whether it?s considered good, bad or indifferent ? include officiating at last season?s FA Cup Final between Chelski and Man U, plus various World Cup qualifiers and Champions League encounters. Off the top of my head, I can?t think of any recent claims to notoriety involving our lot, but I am amenable to other offers. Thoughts, anyone?

 - Glynis Wright

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