The lights and shadows of a legend
On June 5th we were once again moved by Rafa Nadal’s game, which led him to achieve victory again on the slopes of Roland Garros.
With this, there would be 14 trophies that he has lifted in the French competition and 22 the total number of grand slams with which he has built the highest track record that any tennis player has ever achieved, remaining ahead of Roger Fereder and Novak Djokovic, both with 20.
There is no doubt that Rafa Nadal is a sporting benchmark and a source of pride for Spanish sport. But it is also an example of physical and mental resistance that he displays every time he jumps onto the court to play his game. “I don’t remember what the feeling of playing without pain is” he confessed on the well-known Bertín Osborne program and that is why from TRAK we wanted to analyze a topic that has been the talk every time the tennis player wins a new match. competition.
Rafael Nadal’s injuries
Added to this injury suffered by the Spaniard are various serious pathologies that accompany him in every game:
- Fissures in elbow and ribs.
- Problems in the sheaths of both wrists.
- Abdominal tears.
- Rupture and/or inflammation of the tendons in both knees.
- An injury to the iliopsoas.
- Arthroscopy in the right ankle.
- Left foot fracture.
- Inflammation in the peroneal tendons.
- Muller Weiss syndrome in the left foot.
Exactly, a whopping 23 serious injuries in 19 years of professional career.
The truth is that, specifically, this last pathology was one of the first to manifest itself and one of those that has been tormenting the Balearic Islands for the longest time, which he assures almost made him retire at the beginning of his career. But what is Muller Weiss syndrome? Let’s see it.
Muller-Weiss disease is a dysplasia of the tarsal scaphoid that develops in childhood but does not cause symptoms until adulthood. Often, this diagnosis goes unnoticed by radiologists, implying a delay in the diagnosis of the pathology.
It was the surgeon Walter Müller who first described this syndrome at the beginning of the 20th century, identifying a congenital defect as its etiopathogenesis. Another radiologist, Konrad Weiss, described osteonecrosis as the cause. Finally it was Schmidt, the first to report a case in a patient with endocrinopathy. Currently, the etiopathogenesis is under discussion. (Pantoja AG, 2018)
The pathophysiology is reduced to a compression suffered by the navicular in an anteroposterior direction in its lateral area. It is like a failure of the “acetabulum pedis”, a lateral acetabular protrusion, which forces the head of the talus, to occupy a position of lateralization with respect to the ideal.
The lateralization of the head of the talus is necessarily associated with a subtalar varization; the two columns of the foot are blocked one on the other, turning it into a rigid structure, with the consequent loss of cushioning in the upper segments. The knee will suffer the consequences of this loss of distal cushioning in the medium and long term. (Núñez-Samper et al, 2007)
The evolutionary stages of the lesion can be correlated with degrees of structural failure, from the slightest, almost negligible compression (stage 1) to the medial extrusion of the bone, allowing the lateral cuneiforms and the head of the talus to articulate with each other (stage 5). ).
Treatment of Muller Weiss. Rehabilitation or surgery?
Conservative treatment begins by redistributing the loads and improving the heel varus, as in the case of Nadal’s injury, which, according to the press, “had been helped by special insoles that deviated his point of support.”
In the advanced stages of the disease there is usually significant stiffness, so it is not advisable to try to correct the support position. Weight control, avoiding overloads and the use of suitable footwear should also be advised in the initial treatment. Magnetotherapy is often used in rehabilitation services.
When conservative treatment fails, surgical treatment is performed. The purpose of the treatment is threefold:
1. Suppress pain.
2. Restore the integrity of the medial column.
3. Correct heel deviation.
Although several procedures have been proposed to achieve these objectives, no technique is considered ideal because the published works do not provide great results. In addition, the low incidence with which these patients are operated does not allow obtaining homogeneous series to draw definitive conclusions.
So what is the solution for Nadal’s injury?
“I have been able to compete this fortnight because my doctor has given me nerve anesthesia injections to put my foot to sleep, but it is a risk. In the current conditions, I cannot and do not want to continue playing until a solution is found.” These were the statements made by the tennis player from Manacor after winning his 14th Roland Garros.
Until now, specialists had discouraged athletes from surgical treatment, opting for the use of orthopedic insoles and infiltrations of analgesics and/or hyaluronic acid to reduce their pain.
However, he revealed that next week he will try a new treatment to try to alleviate the pathology that has been with him for years and that causes severe chronic pain. “An intervention in the nerves with pulsatile radiofrequency that could help me decrease the sensation in my foot,” he explained. “So that through this treatment, leave the nerve touched, half asleep and have that more permanent sensation, which leaves my foot with less sensitivity, but the goal is to reduce the pain a lot.”
In the event that this treatment does not work, Nadal admitted that it would be time to make a life plan, but that everything will depend on the result of this new method.