Cristiano Ronaldo took his Real Madrid squad to the Champions League title, but it came with a cost. The speedy winger fought a sore knee for much of the season, spending long hours with the Real Madrid medical staff.
The condition has complicated, though, with reports saying that Ronaldo is now dealing with tendinosis, not tendinitis. He's working with his own therapists and doctors as he prepares to play for Portugal in the World Cup.
While tendinitis is a well-known acute condition involving swelling and damage to the tendon, tendinosis is usually the bigger issue. A recent study from 2012 indicates that the cellular-level changes caused by tendinosis are often more problematic than those from tendinitis. Those changes in the tendon, the collagen that rebuilds the fibers again and again after chronic overuse, end up becoming a chronic and degenerative weakness.
I asked Bleacher Report's Dr. Dave Siebert to put this in understandable terms:
"Tendinosis differs from its cousin tendinitis in a few important ways. Tendinosis can indeed produce pain, stiffness and swelling in a tendon. However, it usually develops gradually as a result of long-term overuse—probably many, many microtears over a long period of time, though the area remains a subject of research—rather than a more acute injury.
"It isn't inflammation—like tendinitis—it's degeneration. Initial treatment typically involves rest, physical therapy and other conservative measures all aimed at allowing the body's healing mechanism to catch up with the damage. As such, the greater the extent of cellular changes in the tendon, the longer and more difficult the healing process."
Since tendinosis is a chronic condition, this doesn't have one root cause. Given the way that Ronaldo has played over the past few seasons, it's hard to imagine that this was affecting him or limiting him in any way, which gives us the best information that Portugal and Madrid could get: It's manageable.
With situations like this, when managed properly, the degeneration can be slowed or even stopped. There's still some pain and fiber-level weakness, but there's no discernible loss of function. Watching Ronaldo's burst up the pitch is all you need to see to note "no loss of function." However, sources I spoke with say that this is an "on and off" injury. They told me that at times, Ronaldo will push too much or have consecutive runs, and he'll see some degradation.
In those cases, the maintenance comes in even stronger. Pregame, in-game, halftime and postgame all now have routine maintenance, and on off and practice days, Ronaldo is doing both his own exercises and treatments. It's simply part of his everyday work now, and given his well-known work ethic, it's not likely that he'll let up on it. This kind of "getting religion" often happens with more severe injuries, but the pattern can extend careers.
There is a worry that with no offseason to speak of, Ronaldo will wear down even more. This is one of the reasons that he wasn't taking part in many Portugal games or workouts. Much of the therapy he did was simply rest and trying to let his body rebuild and recharge. There was significant rehab, including some fairly advanced techniques designed to help slow any degeneration in the knee. If hair cells are the cure, Ronaldo should be well set up given his 'do.
Other athletes have overcome this, including Rafael Nadal, who just won the French Open despite struggling with a similar condition several years ago. Since there's not significant pain, just weakness, it's tougher for the athlete to judge his own condition and be honest about how he's feeling. (And remember, athletes seldom give accurate feedback!) There's been an extensive use of tracking in European soccer; those distances and bursts are probably a clearer guide for the physios.
One point of contention appears to be who's doing the therapy at this stage. Normally, there would be a coordination of care between club and country, but it appears that Ronaldo is using his own therapists. For an athlete of his caliber, this is not unusual. Dwyane Wade used an outside therapist this season, as detailed by B/R's Ethan Skolnick.
So much of Ronaldo's value is in his speed, both the short bursts and the long runs, so any degradation in that would take away something of his game. There's enough skill and physicality that he could likely remain at a high level, but maintaining this condition is going to be key to his longevity and durability in the short and long term.
If the Ghanaian witch doctor did this to Ronaldo, he started a long time ago. This chronic condition didn't just start, but neither did Ronaldo and his medical staffs. They've managed the condition well so far, and there's no reason to think that he'll have significant new limitations for the World Cup.