Reece James hamstring injuries why does this keep happening?

It was the news everyone connected to Chelsea expected but still did not want to hear.

On Tuesday morning, the club released a statement confirming that Reece James was facing a spell on the sidelines with the hamstring injury he sustained during the loss at Everton two days earlier.

It read: “Captain Reece James has undergone medical assessment following Sunday’s 2-0 defeat at Everton. The defender was withdrawn during the first half at Goodison Park and scan results have confirmed a hamstring injury. Reece will now begin his rehabilitation programme at Cobham.”

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There have already been some reports that James will be unavailable for a minimum of three months. One source connected to the club, who was speaking anonymously to The Athletic to protect relationships, believes he faces a challenge to get back to his best before the end of the season in late May.

This is the seventh time James has suffered a hamstring injury in his senior career at Stamford Bridge. According to trusted website Transfermarkt, the problem, which he has suffered with at different times in both legs, has caused him to sit out 35 games and 175 days since December 2020, including nine fixtures between August and October of the current season.

It is a bitter blow for the 24-year-old, who is regarded as one of the best full-backs in the world. With two knee injuries curtailing his contribution in 2022-23, fans are left wondering why James keeps suffering these setbacks. The many changes to fitness and medical staff at Stamford Bridge since the club’s change of ownership in May 2022 are regularly highlighted by supporters as a possible factor.

To get more clarity, The Athletic decided to talk to Newcastle United’s former head of sports science Callum Walsh for some insight into hamstring injuries…

How does a hamstring injury occur?

That is a million-dollar question. There are three different hamstring muscles and some strains are more common in footballers than others. Usually, there are two main mechanisms that can go wrong. One can occur while they are sprinting, which is the most common, and the other occurs when the player overstretches. They go to plant their foot and maybe it slips an extra five or six inches in the turf. It might not be in their range or it might just be they have reached a certain level of fatigue and their body says ‘no thanks’.

What exactly happens to your hamstring?

It will be a tear of the muscle fibres, and the severity can vary. It can get a little complicated. After a hamstring, or any soft tissue, injury, you go for a scan and get a grading comprising of a number and a letter. It reflects the length and the depth of the tear. So a grade 1A in your calf means you might miss 10 to 14 days, but when you get a 3C, you are in trouble. If you get one with tendon involvement, those are nasty. Research has just come out that indicates that they have higher incidents of re-injury.

What makes them so hard to recover from?

There are always myriad factors and what works in rehab for one player will not necessarily work for another. Unless you understand the athlete in-depth, it is really hard to see the signs.

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I have worked with people for four, five years, so you know that for Player X, when October/November comes around and the pitches change (as the weather gets worse), they will be vulnerable to calf issues. So you are wary of that. You begin to understand what their red flags are. So, for example, you could do testing the day after the game and they are 50 per cent down on everything, but you know for them it is normal. You know their habits, what discomforts them.

When I was at Huddersfield, we had a player who was an absolute machine, putting up physical numbers I had not seen from anyone else. As soon as he went to left-back, he had a problem with his calves, because he was not used to backpedalling.

When it comes to Reece James, you have to remember he has been played at right wing-back, right-back, right-sided centre-back and even in midfield. These positions are slightly different profiles.

Also, you have to bear in mind how a change in coach makes a difference. Chelsea have had a lot of different managers in the space of two years. They have gone from Thomas Tuchel to Graham Potter to Frank Lampard and now Mauricio Pochettino. All have different demands and different methods, as well as systems.

I know of a manager who instructed his players to do 30 accelerations and decelerations across a six-day period. Then another coach came in and he wanted players to do 100 a day. A player has to get used to that change.

Chelsea will have been getting all of Reece’s data. There is a testing system called the NordBord and you get all the data on the hamstrings. Chelsea will be asking where his aerobic fitness is at and what his peak power output is. It is a bit like trying to get a Formula One car to go fast. You try different strategies, only to find out that when the car goes out on track it does not work, so you try something else.

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When it comes to hamstrings, there are four quadrants of profile you can be in. Let’s say weak and short is group one. You do not want players to be in that, you want them to be in group four, which is strong and long. A player may get to group four but still break down. Maybe it is a capacity issue, a running issue, the way he runs is different, the recovery after games. Some have slower recoveries, while for some, the games have a greater impact.

Isn’t prevention better than cure?

At clubs, you will test groin and hamstrings two or three times a week. You look to see where they are at compared to their norm, so you see a pattern of them being down by 20 per cent three days before matchday but one day before matchday they are back to zero. But if that is a little bit delayed, that is one signal.

There is another signal when they fill in questionnaires about muscle soreness. They may say, “My hamstring is a bit tight today”, so then you speak to them. The physio who they have been working with for years may say their range is down.

These are red flags to bring up to the manager, but they may need them for the game and picking them is a risk they are prepared to take.

Chelsea changed a lot of staff in the medical department over the past 18 months. Will that play a role in terms of them not knowing James as well?

Chelsea have hired really, really good guys and I do not say that lightly. Pochettino’s right-hand man, Jesus Perez, is seriously top drawer. Head of performance Bryce Kavanagh is a top operator, too. The club may think they have got people in who are better, but it is still going to take them time to get to know the players.

It is also about the support staff getting to know the manager. Perez knows Pochettino very well, but the physios won’t know what a Pochettino training session is like from the get-go.

Pochettino may say, “I need this player back for a training session two days before matchday and it will be a light session.” Now in Pochettino’s mind it is a light session, but comparatively, it may be a harder session than what Potter put on. You can then get the data through and see it was not a light session, it was carnage.

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It can take five or six months for that understanding of what a coach wants and the impact it has to develop.

You have to also bear in mind this is the first time Pochettino has coached a team that is not playing in Europe since Southampton (who he left for Tottenham in the summer of 2014). He is used to training his players for a weekend-midweek-weekend schedule (of games). Now, there can be weeks with seven or eight days between matches. It is a different skill set.

This is why changing a manager every six months has an impact not just on the players, but on the support staff and the decisions the support staff make. The players on the pitch pay the biggest price.

The days of the week you train can have a massive impact. Some coaches may choose to give days off on a Sunday and Thursday so that when they play on a Saturday, it is just the second day on their feet. But players will inevitably have different preferences and what they can cope with. Some will want a day off earlier.

Is it a case that once you have had a hamstring injury, you are more vulnerable to a recurrence?

It can depend on the severity, but the biggest precursor for injury is a previous injury. So if Reece James flags his hamstrings are tight on the questionnaire, I am going to be more concerned because of what has happened before. I will want to take a closer look straight away. If another player complains who does not have that history, I will keep an eye on it but will be fairly confident they are going to be fine.

Don’t forget, staff have around 25 first-team players to be dealing with who are all reacting differently to each factor.

Can a long absence, like James has suffered before, make it harder to get back to where you were before the injury?

The rehab these guys get now is phenomenal. People do not know how supremely fit they are.

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But sometimes a player will lose confidence in his body. If you are breaking down, you can lose a bit of faith. You start to be a bit more conscious of things.

In my personal opinion, although players can be fit, they may not find their rhythm until they have played 400 or 500 minutes. I always think pre-season gets you fit, but it takes four or five matches to find a groove.

Can it be as simple as having an operation to fix it once and for all?

It is an option but it will depend on the injury. There can be issues above or below the muscle.

You would rather be dealing with a horrendous fibula break or ankle fracture than a grade-three hamstring tear with tendon involvement. A break is not as complicated. With hamstrings, you can come up with a plan and it still does not work. It can happen again.

It is horrendous for these lads because they will think it is fixed only for it to happen again. Reece would have spent a month or two all excited about coming back and now he is back to square one.

If they decide to operate, it will be tough to determine how long he could be missing. I would not like to put a timeframe on it. With or without surgery may be a similar length of time or it could be different. It is yet another indication of how things are not straightforward.

GO DEEPER

What is a hamstring strain?

Is it hard to keep fit when out injured?

Yes, but someone like Reece will be given a three-month plan. Let’s say he is off his feet for six weeks, he will still be building his aerobic capacity in the pool, on the bike, on a rowing machine. They will not have to get him fit as such when he is back on the grass. If he was a 10 out of 10 when he got the injury, he may drop to a seven or eight in this period ahead. So they will only have to top him up when he is back on the pitch.

One of the factors they will look at for his rehab is what a normal week in terms of distance covered is. Say it is 35km (just under 22 miles) in a week, that means in the space of six weeks we have to get him from zero to being able to handle 35km. They will figure out the safest way to get him there. Week one he may do 12km, then 16km, then 22km. The trickier ones are when you are out for just three or four weeks, because you spend two weeks off the grass, one week with the rehab coach, then you are back in training.

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Players get slogged when they are injured. They will do two or three sessions a day, possibly with the physio, changing their strength profile and making you aerobically better than what you were. It is just not very nice. My heart goes out to them. I have had players in leg casts still doing rowing. They literally cannot move their arms the next day because of the pain. It is the only way you can get that physical stimulation in them. Chelsea will have strategies in place to make sure he is topped up.

GO DEEPER

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(Top photo: Michael Regan/Getty Images)

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