World Cup Injury Analysis on Ronaldo, Costa, Suarez, Neuer and More

Will Carroll@injuryexpertSports Injuries Lead WriterJune 11, 2014

World Cup Injury Analysis on Ronaldo, Costa, Suarez, Neuer and More

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    Clint Hughes/Associated Press

    The biggest sporting event in the world should be decided by the best players in the world. Unfortunately, that's not always the case with the World Cup. Injuries are already taking their toll, leaving some of the likely stars on the sidelines watching like the rest of us. Players like Cristiano Ronaldo, Luis Suarez and Manuel Neuer enter Brazil with big question marks.

    The long club season always takes a toll, but this time around it seems like it's struck bigger names. Physios and doctors will be working long hours, before and after every match, to keep their teams as close to full fitness as possible.

    While the teams flew in the players over the last few days in order to establish a base in Brazil, the teams also brought along case after case filled with everything from cold lasers to tape stations. Training rooms in the new stadiums spread around the country will be well-equipped, but don't expect anyone to come empty-handed either. There's always a trick in the pocket of a team's belt. 

    Here are several of the biggest stars with injury question marks as we head to Brazil for the 2014 World Cup. We'll see which teams have the best answers soon...

Cristiano Ronaldo, Portugal

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    Francisco Seco/Associated Press

    Cristiano Ronaldo's tendinosis is a real problem for Portugal. If the speedy winger isn't able to be out there for every match, the team's chances in the "Group of Death" go down.

    Tendinosis is a physical change in the tendon, in this case the patellar tendon. This doesn't happen overnight, so we know Ronaldo has been dealing with this for a while. The Real Madrid medical staff has been able to manage this, keeping him productive throughout a long La Liga and European season. Javier Santamaria of Real has been working closely with his Portuguese counterparts in hopes of keeping some continuity, sharing the plan that's worked so well for Los Merengues.

    He's shown no issue with burst or long runs and little issue with stamina. The worry instead is that the tendinosis will act up and with only a few days between games that he'll be unavailable or hobbled. Aside from the recent rest, there's been no sign of that being a problem for Ronaldo, and his fitness level and work ethic should keep that from being a problem.

    Ronaldo may miss a training day here or there, but with no real rest or offseason to speak of, buying him a bit of extra time off is the smart play. The drop-off at forward is pretty steep for Portugal, and without its captain, this team can't go far. 

    For more info on the injury itself, click here

Diego Costa, Spain

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    USA TODAY Sports

    Horse placenta didn't help Diego Costa get ready for the Champions League final, so he's returned to more normal therapies in hopes of being ready for the World Cup. The Brazilian-born star has shifted his citizenship to Spain for 2014, so the Atletico Madrid star gets some of the world's best treatment leading up to the Cup.

    Costa has been dealing with a significant hamstring strain since early in the spring. He's had several re-injuries, which is common. The muscle fiber simply wasn't given enough time to heal up, and as it scars over, it is weakened. Costa's strong push overtaxes the fibers and puts him back at square one—or worse.

    Costa has had a few more weeks since his short appearance in Porto, which should be enough to get him ready, and he says this is the case, according to Yahoo. He was close when he took the field, though there's still a question of how close (and Diego Simeone isn't telling!).

    Since there's no noted re-injury, it's reasonable to think that a few more weeks of rest and treatment should have him significantly closer to function. Costa showed a good burst in his appearance in a friendly last week as well.

    Whether he's able to go the entire 90 minutes is in question, as is his recovery in between games. Managing his fatigue and recovery will be key to Spain, but there is depth that would allow the team to cover his absences if Vicente del Bosque is willing to be creative. 

    He should, since the depth of the Spanish squad is not up front. If Costa can't go (or can't go the entire game), then David Villa and Fernando Torres likely get pushed into the role. Francisco Minano will have his work cut out for him keeping Costa ready and functional. 

Luis Suarez, Uruguay

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    Alberto Tao/Associated Press

    Luis Suarez is racing against time. His knee surgery was minor—a cleanup that normally takes just a few weeks to recover from—but he only has about exactly that amount of time before the World Cup kicks off. How close Suarez can get to 100 percent may decide how far plucky Uruguay goes in this tournament.

    Suarez's "keyhole surgery," the European term for arthroscopic, has him with a chance to come back and play. The question now is less about whether he'll play but when and how well. The knee will still be tender, so questions of physicality and burst will be there. The Uruguayans can test it to some extent in training, but it will be nothing like what Costa Rica and England will do in the first two matches.

    The first match is the most in question right now. While Suarez is looking better in training, as noted by the Daily Mail, he is still not match-ready. It will be a very key decision whether to start Suarez and see how he does, as Atletico Madrid tried with Diego Costa in the Champions League final, or to save him for a sub or perhaps a full rest in the first match.

    Without Suarez, there's a huge drop back on the front line. Diego Forlan may have been the best player at the last World Cup, but he is likely to be just a substitute if Suarez is able to take the start. Abel Hernandez might see more action as well, especially in early games. Edinson Cavani will also see more pressure if Suarez isn't there to take a bite out of the defense.

Robin Van Persie, Netherlands

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    Wong Maye-E/Associated Press

    Robin van Persie had something of an offseason pulled down with the season at Manchester United. He can erase the memories of that, at least for himself, by another successful World Cup. To do so, he'll need to be past a groin strain that has dragged on for a while. Ahead of the tournament, Van Persie says he's as healthy as he's been in years. 

    Van Persie also says he hasn't been healthy for six years, which surely got the attention of Manchester United's physios. While playing through soreness is something athletes of all types learn to do, playing through pain is a far different thing. (I do wonder if something wasn't lost in translation here.) 

    Van Persie has looked good leading up to the tournament, though at times, he's showing some limitations. Those may well be self-imposed and show a good sense of place and self. He won't be able to hold back in the team's opening game against Spain, but the Dutch team will have to watch him closely as well. The Spanish defense is physical enough to cause Van Persie (and anyone with leg issues) some problems.

    On top of all that, Van Persie isn't even safe on the beaches of Brazil. Van Persie and other Dutch teammates were walking along when they were hit by a kitesurfer. They escaped with scratches, but it could have been worse. It's a reminder that even the best rehab and work can all be rendered meaningless by something no one saw coming. Seriously, a kitesurfer?

Manuel Neuer, Germany

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    Associated Press

    Manuel Neuer is one of the top goalies in the world right now, but a shoulder injury could keep him from helping Germany go deep into the World Cup tournament. The German star's prowess in goal has allowed the team to press forward with its attack without too much fear of counter and has offered cover for a less-than-stellar defensive backfield. 

    Neuer first injured his shoulder late in the Bundesliga season, and given the description of symptoms—stiffness, soreness, limited motion—it sounds as if it was a mid-grade shoulder separation or perhaps a strain of one of the larger muscles surrounding the shoulder. Early speculation that it was a fracture does not match with anything following that, though there was no specific diagnosis made public. Neuer did remain in a sling for a couple weeks but is not using any support now.

    Neuer has not taken part in games since the injury, but the team doctor continues to hold him back. While the Germans say this is only a precaution, look for any sign that he'll be ready to go next week. Even in practice, it will be difficult to get a real read on this. He has been seen making dives to both sides, but they were controlled. Without Neuer, it's a big step back to Roman Weidenfeller. 

    Neuer will be tested immediately by Portugal's speedy spread attack. If Cristiano Ronaldo is healthy (and check back a few slides for my opinion on that), then Neuer may be in the unenviable position of trying to stop the world's best scorer with one good arm. 


Andrea Barzagli, Italy

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    Andres Kudacki/Associated Press

    The course of the Italian squad may hinge on Andrea Barzagli's leg. If the Juventus defender can go, the team will likely stick with a 4-3-3 set that has coach Cesare Prandelli under pressure. If he can't go, the injuries that have already forced adjustments may crumble the team under their weight.

    With ankle sprains, the worry is lateral mobility, and that's of key importance to a central defender. If Barzagli, who is often able to make late quick moves in defense to dispossess the opposition, can't make those same moves, he'll become much less of an asset. 

    The Italians will have to make a tough decision in warm-ups. Barzagli won't be able to "fight through" if he's still limited by the ankle, and subbing early would put the team in an even worse position. The physios and coaching staff will be looking for smooth lateral motion and an ability to change directions all the way up to game time. 

    Barzagli missed the tie against tiny Luxembourg but is expected to be ready for the opening match against England. He has a moderate ankle sprain and has also been dealing with a fever. (Europeans tend to use "fever" as Americans use "flu-like symptoms." It could be a range of things but seldom serious.) 

    Without Barzagli, Giorgio Chiellini has seemed lost at times, and the drop-off should be noticeable against England even without Theo Walcott testing the wings. The physical play of the English is a poor matchup for a team that could be missing three key players straight up the middle. 

Mario Balotelli, Italy

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    Antonio Calanni/Associated Press

    Let's just stipulate that we'll stick to the physical when talking about Mario Balotelli. 

    Many have watched Italy's mercurial striker for signs of a groin problem. Instead, the team doctor insists that Balotelli does not have an injury but is merely "dealing with an overload," as quoted in the Daily Express. Given Balotelli's movements in his last few games, including the friendly against Luxembourg, that seems odd. 

    That's led to some speculation that there's a split inside Italy's camp, with some hoping that Cesare Prandelli would dump Balotelli for Ciro Immobile, as noted by The Independent and other Italian media. The declaration of fitness from inside Italy's camp would seem to indicate that Balotelli is still the top choice.

    It's never that simple. With rampant speculation of a big-dollar Balotelli transfer back to England going on, Balotelli's management has also received questions about his fitness. In other words, no one really knows!

    If it's simply fatigue, Balotelli should show no issue with movement, especially lateral movements and kick release, in the early part of the game. It would obviously be more of a concern later in the game, but it's seldom that clear. Tracking technology in the game could give a clearer picture on both his total distance and bursts, so we'll have to see just how much of that data is made public. 

Arturo Vidal, Chile

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    Luis Hidalgo/Associated Press

    Style matters. Chile is built on the idea of relentless forward pressure, which can disguise a weak defense. Without Arturo Vidal, who is now out of the opening match and in question for more, Chile has to figure out how to hold its style.

    Similar to Luis Suarez, Vidal had minor knee surgery in early May but has not yet reached full fitness. Juventus' star has been pushing to be ready, but the overall picture is that Vidal is close but simply not ready. The Chile physios have decided that getting him ready for the first game with Australia isn't going to happen and have shifted their goal back. 

    The balance between the very short and only slightly longer-term horizons inside the World Cup are tough to judge sometimes. Adding in the long-term concerns of the player and club make for difficult calculus. With Vidal, the need for his pressing style has to be balanced against the difficulty he will have with burst and lateral movements.

    With Vidal out, the Chileans will have to try and avoid the inevitable counters from their press. Vidal's controlling style and handle will be impossible to replace, but Jean Beausejour will be the likely fill-in. It only gets worse if Vidal isn't back in time for the next couple games, as Spain and the Netherlands offer much tougher challenges in the midfield. 

Franck Ribery, France

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    Francois Mori/Associated Press

    Losing Franck Ribery for the duration of the tournament really puts France in a tough spot. The creative winger pairs well with Karim Benzema and has enough physicality to help on defense as well, but a back injury isn't something Ribery could push through.

    In fact, Ribery's back spasms are worrying Bayern Munich as well. With Ribery ruled out, he'll head back to let the club begin focusing on getting him ready for the upcoming Bundesliga campaign. Ribery has been having recurrent back spasms for several weeks, but there's no known underlying cause. With a short lead up to the Cup, the French physios had focused on symptom management. 

    The French made the decision that they couldn't count on Ribery to be healthy at any point in the tournament and took him off the roster. That indicates there's more than just spasms at work here. Those can break at any point, but if there's an underlying disc problem, it could be very problematic in both the short and long term. 

    Mathieu Valbuena is the likely replacement for Ribery, and he's certainly a good player, but it remains to be seen just how much Ribery's back problems cost France. With the loss of Clement Grenier as well, there are more challenges for Didier Deschamps. After the disaster of 2010, the French were hoping for a much more positive outcome. 

Fatigue Management

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    Uncredited/Associated Press

    Perhaps the key for all teams is a hidden one. Physios, doctors and the technical staff will all be working to manage the recovery and fatigue of their players. It's a very difficult task, especially given that most of these players are very seldom with these staffs. While they certainly know and monitor them, it's hard to think that Chile or even Italy will know more about players from Juventus than Juventus do.

    This is repeated around the tournament as national team staffs are more spread out than ever. Argentina and Brazil's top players are often in Europe, as are some of the U.S. and Mexico's stars. The challenge is also there for the clubs, who often do their best to coordinate care, as we've seen with Cristiano Ronaldo and Luis Suarez. That can get complicated, as it likely has with Diego Costa, who may be transferred in the midst of all this! 

    Just as the challenge is bigger, the tools and science are stronger. National teams are flush with cash and with science. Sports science's advances such as sensors, tracking devices, therapeutic modalities and even "secret weapons" are packed for Brazil or, in some cases, have been staged there for weeks or months. That can be supplemented by teams if they have a player who has a preferred technique or tool.

    In the end however, there's no magic bullet (or magic spray.) Teams will be tracking and managing the fatigue of their players as much on subjective instincts as they are by any objective data. "Looking a player in the eye" will often have as much or more weight than deep muscle stimulators, compression massage units and cold lasers.

    The team that does it best could end up with a funny-looking gold trophy