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Is soccer's injury, burnout crisis caused by national teams?

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Why Carvajal's ACL injury is 'massive blow' for Real Madrid (0:45)

Luis García speaks about the impact of Dani Carvajal's ACL injury on Real Madrid. (0:45)

The men who raised the alarm were the first to fall, an extra cruelty to it all. But at least this way, they were heard.

"If this carries on we will have no option but to go on strike: we're worried it's too much," said the Manchester City and Spain midfielder Rodrigo Hernandez; at the end of September; six days later, he tore an anterior cruciate knee ligament. The European champion, Ballon d'Or candidate and arguably the best player in the world will not play for a year.

A week or so after that, Dani Carvajal was stretchered off at the Santiago Bernabeu, hiding his head in his shirt and sobbing, the screams heard in the silence of the stadium. He had torn two ligaments and a tendon in his right knee. A season that had started with the Real Madrid and Spain defender insisting "it's not chance that there are so many injuries" and telling anyone who would listen that "we can't play 72 games ... the authorities have to analyse this," was over already. Another Ballon d'Or candidate who won't be seen again for many months.

This was not the first time Spain's captains had warned that football risked destroying footballers, and with them, the game itself.

Carvajal was asked during the Euros whether he feared for Lamine Yamal, a 16-year-old who had already played 58 professional games since the previous August and was preparing for the semifinals at the time. Could Lamine be another prodigious Barcelona kid exposed early like Ansu Fati, Pedri and Gavi, all of whom had suffered serious injuries that cut them down young? Carvajal replied that yes, but no ... he feared for every player.

"Personally, I have more energy than ever," Carvajal said. "But looking at what is coming next year: a preseason, a Super Cup outside Spain, an entire month for the Club World Cup, at least two more games in the Champions League, maybe four, the calendar is unviable. And the quality of the games will drop because it is impossible that players keep up that level all year, playing every three days."

Just before Spain's Euros quarterfinal in Stuttgart, Rodri had said: "I sincerely think that something needs to be done. Because there are more and more [games], and it looks like it isn't about to stop. In the end, you have to take care of the player and I am very conscious of that because I reached a point where I can't [do it] anymore, you can't do it anymore."

Rodri was on 61 games for the season and still had two left. As Man City reached the spring, he had already admitted that he was exhausted. In the end, he would reach 185 games over three campaigns. One hundred and eighty-five. In the last of them, the Euro 2024 final in Berlin, he had to go off after 45 minutes. It was time, he intimated before the quarterfinal, with Spain competing for the euros, for players to take collective action.

"In fact," he said, "there have been situations in which we have spoken ... someone has to put their hand up, the people who have power above all, the big organisations, and say, 'Hey, look, this is all well and good but we have to take care.'"

On Saturday, Spain play their first home game since the Euros and two of their best players -- two of the three captains -- will be missing from what should be a triumphant homecoming. They are not the only ones.

"We got to the table, sat down, and said: bloody hell, Rodri's missing, and Dani, Ferran, Olmo ... we miss them," said defender Dani Vivian, having joined up with the national team at their Las Rozas HQ. Nico Williams pulled out next, then Yeremy Pino.

Pino had been involved in the serious injuries suffered by Carvajal and, a couple of weeks earlier, Marc André ter Stegen, the blameless opponent challenging them in both cases ending up in tears. "Yeremy is affected," said the Villarreal coach, Marcelino Garcia Toral. "It's not long since he came back from a serious knee injury of his own; he knows what it is like."

Too many players do. The Spanish league has never reached the second international break of the season having played so many games -- nine weeks have already been played already -- and they have never seen so many injuries. There were 101 in the opening six weeks alone, 94 in September. Fourteen players have already gone under the knife. By the October break, the injury count was up at 200, with more than 10 clubs in double figures. Between the two international breaks, the European teams had played seven club games.

Nor is it just Spain. The past two seasons in the Premier league has seen injuries increase 11% and 21.93%, respectively. Read Carvajal's words again: "it's not chance."

"The increase in the number of games in the Champions League, the Club World Cup [expanded to a month of competition in the summer] and the expansion of the Nations League has seen players rebel, and that rebellion is understandable from those who are immersed in so many competitions," said Pablo de la Torre, the fitness coach at Bournemouth, whose teams have always been characterised by high energy.

"The number of hours has risen and that has been a reason, albeit not the only one, that we have seen an increase in injuries. Those footballers play in leagues where the metrics show that the demands are increasing in terms of high-intensity effort and sprints."

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De la Torre is keen not to oversimplify complex questions of cause and effect. But, he added: "There is very recent scientific evidence to show that tissues -- in this case in the hamstring, which is the most commonly occurring injury -- are not fully recovered, ready to compete again every three days, and that shows how those players with international commitments, especially at the end of the season, experience a drop in their output compared to the 10 weeks prior to international competition.

"Other studies suggest that players over 2,500-3,000 minutes have an increased risk of injury, and perhaps that is the human cost of a saturated calendar for star players."

Said Edu Alvarez, a physio who worked at Manchester City and Real Sociedad: "It's not so much that the difference in the number of games is so significant for most players. If you take the GPS figures from 20 years ago, the total distance is similar. Where does it change? In the intensity. We have never run 36 km/h before. Never done so many high intensity repetitions. The duels are not what they were. Football is more physical now. There are many factors, but one of them is that we haven't adapted the calendar, the rest and games to the intensity demanded by modern football."

"There's another thing I think is important," Alvarez added. "Look at NBA, NFL. They have a lot of games but in the summer, the break is bigger. In football, you get guys who can't clear out their system, rest properly and have a good preseason. The rests we are seeing are short."

Brian Moore called it the "perfect storm." A bio-analyst quoted in Marca, Moore said "we have a calendar that is always expanding with more international competitions and preseasons held around the world that bring us ever closer to a season that never ends. In football there have never been so many injuries, and this is going to be another brutal year."

Something must shift, everyone seems to agree. But what? There is a kind of simplistic consensus that the number of games should be reduced. That some of them have to be taken off the calendar. But which ones?

The short answer is: someone else's, and that's the problem.

Getting rid of national teams will fix this. Ditching the cups will fix this. Reducing the leagues will fix this.

A Super league will fix this.

Choose the one that suits you. Everyone else does.

Maheta Molango, the head of the English Professional Footballers' Association (PFA), has suggested three basic measures: (1) to fix a max number of games per season, probably somewhere between 50 and 60; (2) to agree on a maximum of six matches back to back, such as every three days, in any one stretch; and (3) to protect a summer break of at least three to four weeks.

His opposite number at the Spanish players' union, David Aganzo, said, "The footballing authorities need to protect football more, but they look more at the economic side of it than the footballing side." And that's the thing. Follow the money. It's the economy, stupid. "We're the protagonists of this sport or this business, whatever you want to call it," Rodri said.

"We have to adapt the structure, fixtures, rest and games to the actual demands made on players these days," Alvarez said. "How? That's complex, because there are economic questions, issues beyond the football itself."

The number of games keeps expanding because it's a business, the revenue growing all the time. European football generates 38% more than it did five years ago, according to AS, the game squeezed ever more tightly. Everyone has a vested interest, and arguments are so often conditioned by those, responsibility and blame apportioned elsewhere. With that there often comes a proprietorial, entitled tone.

When players say there are too many games, the classic retort -- which when you think about it, when you contemplate players as employees and workers, is an old favourite across all industries -- is to say: earn less. They might be the only ones whose interests are not solely financial, which is not to say their interests are not also financial. "They say drop your salary, then; we have never said we wouldn't," Carvajal said.

"Maybe the commercialisation of the product has taken us closer to burnout for the main actors; the players are exposed physically and mentally and may come to feel they are in a golden cage," De la Torre said.

It should be noted that for a lot of players, this is not a problem, and that is a factor to take into account when considering where to cut games from, if indeed anyone is willing to do so: a footballer in primera, not playing in Europe and not an international, won't play much more than 40 games a season in any season. This is an elite issue, which leads to another familiar, and often facile target, especially at this time of year: the national teams.

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In the media in Spain and among fans, a phrase is always applied: they call it the "FIFA virus," referring to the damage during the international break, and it is something that afflicts clubs and players. It is said as if only international teams play irrelevant games, as if players only get injured when they are with their countries. For many supporters, the international breaks outside of summer tournament season are just periods during which to pray your players come back fit or better still one for them to avoid already.

Which, actually, they sometimes do. This break, with the number of games that lie ahead present in everyone's minds, with what you could almost call a psychosis around injury now as it becomes a subject that dominates everything, the number of international pull-outs has been high. Perhaps even suspiciously high: one Spanish paper called it a "hidden strike," and some in France have put speech marks around the injury that kept Kylian Mbappé out of the latest get-together, preserving him for club commitments.

There is also a sneaking feeling that because this has become such a live issue, players are prioritising certain games even if it is only at some subconscious level. That they are trying to "dosify" their efforts. Some matches are for getting through, others for actually playing.

For Spain especially, the impact of the international team on players' health and their clubs' fortunes has been a sensitive subject, with accusations aimed at the federation and national team coach Luis de la Fuente of failing in their duty of care.

Aged just 18, Pedri's career was set back by injury at the end of a season in which he played 80 games: he went to the Euros and the Olympics in 2021. This summer, so did Fermín López: there was a sense of inevitability and anger when, having barely taken a break, he got injured. There was fear that Yamal would do the same, and relief when he announced that he had decided against it. Gavi, another teenager, suffered a serious knee injury in November 2023 -- the very day after De la Fuente insisted "good players never rest." That phrase bit him hard.

International demands are also growing: the World Cup was moved to the winter, bigger than ever. The Euros will have an expanded field, too. The Nations League brings another competition not on the calendar before, and it will also grow. Many fans, thanks to a media dominated (in Spain at least) by the big clubs, find it hard to care about the rest of the year all that much. In some cases, players travel a long way, across the Atlantic and back. Sometimes they then don't even play. They train differently, routines are broken. And so, the narrative is built, perhaps a little easily: it's the fault of "pointless" international games and national team coaches. And there is a trump card for this argument here of course, often played: it is the clubs that "own" the players.

But then the Spanish Super Cup is expanded and taken to Saudi Arabia. The Champions League gets bigger at the behest of the clubs (and under threat of a breakaway). The Club World Cup is huge, another Gianni Infantino invention. More and more, played by the same men. And not the men who design the schedules, which are always suited more to TV audiences than to teams.

It's not the international teams that take teams on preseason tours across time zones and territories where the priority is expansion over preparation. (Preseason, De la Torre confirmed, is of vital importance.) While the biggest Spanish clubs have played every 3.1 days over the past month, the international teams will play twice in a 10-day period. Some players confide that it is a welcome break, mentally at least. Clubs too have games that matter less than others, in which they can rotate their team. When there is a small gap in the calendar, what do clubs do? Fly off and play a lucrative friendly somewhere.

"We're not responsible for the fixture list," insisted Santi Denia, Spain's U21 coach. "At the U21 level, the average is that 10% of a player's time is with the national team, 90% with his club, who has to manage this." Next summer, Denia takes his team to the Euros, which happens at the same time as the Club World Cup. And it is his team, not any of the clubs, that will miss out if a player is faced with a clash. And he wants to win too. Everyone does. Competition is paramount; protection, well, that can be someone else's problem. Until the golden goose tears a ligament.

"We are never responsible," De la Fuente told the media, his tone bullish, maybe even irritable. "FIFA did a study: only 3.5% of a player's minutes are with the national team."

There was a sleight of hand there: in tournament years that number is higher, and the demands are too. When Pedri got injured, for example, it was far higher.

"If I was at a club and I had a player for 11 months a year, I would try a different routine in terms of rest and rotation. Here, we have only four get-togethers and we have to choose the best players," De la Fuente continued. "Besides, we have always prioritised players' health. There are some who don't join up with the squad and although we don't say so because it's a private matter, that's why: to look after them. But you have to compete. And when the results are not good, you lot are the first to say so. It's all for the benefit of Spanish football."

The doubt might be whether enough of it -- whether enough of any of it -- is for the benefit of Spanish footballers, the men upon whom the whole thing depends. And in the end, everyone wants the same thing. That's the theory, at least. "The solution I see is dialogue: sit, talk, see," De la Fuente said. "This is a problem that has been identified and has to be discussed. The governing bodies, the clubs, the players, all the interested parties have to sit down. It's evident, but no one takes action."

"There is quantifiable data to show that the demands made on players in the big leagues is going up and the performance level is going in the opposite direction, which maybe diminishes the quality in favour of quantity," De la Torre said, and that is not good for anyone.

And yet if the diagnosis can be shared, if everyone claims to care, then agreeing on a treatment seems to be a different matter.

"I love playing football, but it is true that when you do it so much, so often and so repeatedly there's a point that the body doesn't do what the head wants and that is where the risk is," Mikel Merino said. "We have to look after ourselves and do things the best way possible. We all benefit from players being in the best shape, at 100 percent. That brings more spectacular games, more goals, a higher level. FIFA, UEFA, fans, players, everyone, wants that.

"We don't want to be in a situation where we play more games that are not as good and don't interest anyone. We have to find common ground and get this fixed."