Cole Palmer’s ‘chronic’ injury explained – should Man Utd consider it a huge risk?

Chelsea have had to get used to life without Cole Palmer this season. While still one of the most influential figures at the club, a true ‘untouchable’ at Stamford Bridge, injury problems have been a recurring theme.

Between the opening weekend of the season and the first weekend of December, the 23-year-old started just three matches – with one of those against Manchester United in September coming to an end after just 21 minutes.

In October, the decision was made to pull Palmer out of the team so he could focus on rehabilitation with former Blues boss Enzo Maresca insisting the club must protect their talisman ‘as much as they can.’

The England international got his season back on track leading up to Christmas and started eight straight league matches across December and January, competing the full 90 minutes in two of those.

Palmer sat out of four of Liam Rosenior’s first five matches in charge but was fit enough to come off the bench for the second half of last night’s crucial Champions League clash with Napoli, turning the game around with two assists for Joao Pedro.

While his most recent absences have been attributed to a thigh issue with a freak toe injury also delaying his return in November, the vast majority of Palmer’s problems this season have been with the groin.

The specific condition Palmer has been battling with is called pubalgia, a chronic groin and lower abdomen issue that Barcelona sensation Lamine Yamal also deals with.

What exactly is causing Palmer’s problems?

Stephen Smith, CEO and founder of Kitman Labs which specialises in injury welfare and performance analytics, explained it as a ‘catch all terminology’ for a set of chronic conditions afflicting some of the most creative players in the game.

‘You can have a couple of different things at play,’ Smith told Metro. ‘Your abdominal wall which goes all the way down to your pubis bone, your groin or adductors which cross over the lower part of your pelvis and you also have the ligaments and tendons around the two sides of your pelvis. Pubalgia is a type of dysfunction there.

‘That dysfunction could be you have some sort of weakness in the muscle strength on one side of your groin or adductors. It could be that you have an irritation of the tendons on the adductors or it could be, due to a muscular weakness or imbalance, that you have inflammation of the pelvis itself or the actual pubic joint. The source can be from any of those things.’

It is a complex injury and, as Palmer’s stop-start season demonstrates, can be highly disruptive. But with the right game management and rehabilitation programme, it is something that can be managed.   

‘The challenge for a professional footballer is they are running, kicking, tackling, turning and jumping all the time so their pelvis is going through lots of movement. Everything comes through there. All their force comes through there so everything you do is going to cause some level of friction or irritation.

‘It is not like a hamstring where that is torn and you can’t run, you can manage through something like this at certain grades or levels. But then it can get irritated. So it comes down to  how you treat it and, giving it enough rest. We know with Cole Palmer this is something they [Chelsea] have been managing throughout the season. It always depends on the severity of it but I think we can surmise from how much he has played recently that it is working.’

Is surgery the answer for Palmer?

Pubalgia is not a condition that disappears overnight and while surgery may once have been deemed a solution, modern approaches tend to favour alternative methods on the training ground and in the gym. Treating the condition relies on a huge amount of work for players like Palmer and the medical staff working around them, with managing their workload central to keeping them fit for as long and as frequently as possible.

‘Depending on the source, we have seen surgical interventions,’ Smith said. That was a more traditional approach but a more modern approach would be to continue to treat it conservatively with a lot of rehab. It is all about trying to find the right balance.’

When it comes to week-to-week treatment, Smith continued: ‘Managing workload is a big part of it. Rest, recovery, strength conditioning and trying to not cause too much irritation is one aspect. But they will be looking at the source of why this is happening.

‘If it is a tendon issue, there would be specific rehab measures to take. If it’s a muscular imbalance, they would be assessing those imbalances and have a strengthening programme in place to assess improvement. If it’s a joint related issue they might have something different. But in every one of those cases it will involve rest and some kind of manual therapy or treatment and rehabilitation.’

Why Man Utd will be wary of Palmer’s record

Palmer’s most challenging season at Chelsea yet has seen him linked with a sensational move to Manchester United, with reports suggesting the Mancunian is unsettled in west London. With a return to Manchester City not currently an option for him, Old Trafford could offer him the home comforts he misses.

United could soon have a vacancy to fill in their no10 role. Bruno Fernandes, restored to his best position under Michael Carrick, has cast doubt over his long-term future at the club and it may need an eye-watering new contract to retain his services.

Aside from his outstanding goal and assists output, Fernandes’ biggest value is his relentless fitness levels and match availability.

The United captain missed three games with a hamstring injury at the turn of the year before making a quicker than expected return against Burnley – typically marking it with an assist. Discounting suspensions and illness, Fernandes did not miss a single Premier League game through injury during his first four years at the club. In 312 appearances, he has missed five games through injury.

Only a small number of players can match that robust availability and when the time does come to replace Fernandes, United will want someone who can be ever-present.

Palmer may or may not be that man – it would take a colossal fee to prise him away from Stamford Bridge, not to mention United’s priorities lie elsewhere this summer.

Bis record over the last six months may suggest Palmer would struggle to be that omnipresent figure at Old Trafford. His condition has required plenty of game management but it does not automatically restrict how often he can play. And in an age where squad rotation is so fundamental for every player, not every player will be like Fernandes.

Asked whether players with Palmer’s condition can expect to play twice or even three times a week, Smith said: ‘It’s hard for us to guess. It depends on how severe it is. But modern expectations have become, regardless if they are injured are not, that not everyone is going to be playing three times a week.

‘The levels of performance that teams want to maintain sees managers and their coaching staff rotating their players regardless. So for players dealing with this, there will be a smart strategy in place to get the right performance level out of them and balance that specific issue. And with Palmer, Chelsea have done a very good job with that.’