Milan's Injury Nightmares

After years of Milan struggling with injuries, the latest surge of players getting injured has finally got people looking at the numbers. And those numbers are staggering. Milan have had 24 injuries already this season, more than Juventus and Inter combined, and 21 of those 24 injuries have been muscle-related injuries. A shocking more than 500 days out injured as a squad. And, as Pioli pointed out postmatch on Saturday, these cannot all be due to just bad luck. While the players are all at Milanello injured or on national team duty, everyone is speculating about Milan's injury nightmares.

Pioli's recurring nightmares.

Contrary to popular belief, the growing number of injuries actually has been addressed by the Club in recent years. In 2021, for example, they hired Andrea Azzalin to be the Head of Performance, a new position for athletics and injury prevention. He had previously worked with Shevchenko in Ukraine and also Claudio Ranieri, including his fairy tale season at Leicester City. However, he only stayed at Milan for about four months, and currently works for Sassuolo.

Milan have consistently brought in new specialists, such as Andrea Riboli, PhD.

At the beginning of last season, Milan announced that they were re-opening the famous MilanLab, which had been a groundbreaking sports medicine facility based on research, data and preventative medicine founded by Jean-Pierre Meersseman in 2002. Now headed up by the team doctor and director, Stefano Mazzoni, it features a staff of about 15 people. That includes Andrea Riboli, who was also brought in last summer, and has a PhD in Sports Sciences. His research specialized in elite footballers and fatigue, and he formerly worked with Atalanta.

All of the injuries of the season, from La Gazzetta dello Sport
Players, date injured, their injuries, number of days out per injury - yellow indicates players still unavailable

Still, for all of these and other proactive measures the Club has taken in recent years in an attempt to lower the injury toll, the number of injuries has only continued to increase. Many have called for the sacking of Pioli, obviously. But, particularly with a lack of suitable replacements at this point, his job is reportedly still safe for now. Others want to sack Matteo Osti, Pioli's Head Athletic Trainer, but Pioli refuses to allow that to happen without definitively knowing the reason for the injuries. Osti was actually chosen by his colleagues as the best Serie A fitness coach for 2021-22, however, his job is definitely at risk now. Real Madrid recently sacked the head of their medical staff due to excessive and continued injuries at their club, and some are looking to that example for Milan as well. A complete list of the first team's coaching and medical staff this season is posted here.

Last summer, Pioli had the team casually biking through Austria later in the summer preparations.
This year, they almost immediately were training/playing matches in 100°F (38°C)+ weather in the U.S.
(But think of the money! And the hot air balloon advertising!)

Speculation on the reasons for so many increasing injuries includes:

• Milan's summer USA trip, which rushed preseason preparation and included excessive travel and other engagements that took a physical toll on players and staff
• Daily training methods at Milanello, which are supervised by athletic and coaching staff, and may be too little in quantity or require too much in strength training, or any number of other variables
• Management of physical recovery after matches, which is supervised by athletic and coaching staff and monitored by Milan Labs as well
• Pioli's playing style, which requires more quick sprints than other teams, as well as more physical stamina due to the higher demands throughout the entire 90 minutes.
• The training pitches at Milanello, which are reported to be too firm after being replaced in 2021. Or other pitches, like the case of Pellegrino's injury, for example, where a hole in the Stadio Maradona pitch caused a compound fracture in his foot, or the San Siro pitch, which often suffers damage due to overscheduling.
• Predisposition for injuries, as some players have physical or genetic issues that cause them to be injured more frequently or severely than others
• Overscheduling, including international breaks, with more players traveling further more often
• Psychological stress, which has increased for Milan players with changes at the club and changes of personnel

Kalulu missed 40 days with a lesion, now he'll miss 4 months after surgery to repair a ruptured tendon.

Pioli is reportedly sitting down with investment banker Furlani to discuss these issues this week, so I am sure that brain trust will be able to come up with the right solutions going forward. (In case you do not speak sarcasm, that was like caps lock sarcasm.) There are many things that can be looked at and adjusted, such as training methods, playing style, management of physical recovery postmatch, and even the pitches, which we have seen replaced before when there was an injury crisis. 

The overscheduling is something that affects all footballers now, and I am not sure what has to happen before governing bodies such as FIFA, UEFA, and the FIGC will put the health and safety of players ahead of the almighty dollar. Especially when they can further exploit said players to give themselves more of those dollars.

Calabria shut down Kvara, then kept Mbappé quiet, but is now injured, so can't represent Italy.

But the one thing that is not being discussed is the stress levels of the players. Studies have shown that psychological stress and mental well being in general are definitely a factor in physical sports injuries, and can impact injury recovery as well. Are Milan players under more stress than their peers? Look at the pattern at this point in the season in each of the last four seasons:

2020/21: 4 muscle injuries
2021/22: 11 muscle injuries
2022/23: 17 muscle injuries
2023/24: 21 muscle injuries

Maignan missed 5 months and the World Cup the season following the Scudetto win.

There was a big jump in 2021-22, during the Scudetto-winning season, when Milan were under a lot of pressure to win. This was also when Milan were looking for reinforcements and clearly lacked a proper bench, and Pioli probably did not rotate enough because of that fact. Also notable was Milan's return to the Champions League after such a long absence, which created even more intensity and psychological stress, as well as more matches.

The next big jump was the following year, in which major stressors occurred but were overlooked. Already under pressure to repeat their title, the Club was sold immediately following the win. While Cardinale now claims he laid low and did not do much at this time, his first act was to dramatically cut the transfer budget, then haggle with Maldini and Massara about their own contract extensions until literally 11:59pm on June 30th. 

This tension was felt by the players long before Cardinale sacked Maldini.

That changed the entire transfer market that summer, and thus the fate of the squad, and also seemed to influence Gazidis' decision to step down at the end of his contract, as well. Cardinale brought in the completely inexperienced portfolio manager, Giorgio Furlani, midseason to run his two billion dollar investment. While all of these changes were happening behind the scenes and impacting the club at every level, Maldini was very much the face of Milan, absorbing the stress and much of the blame for anything going wrong at the Club, while doing his best to protect Pioli and the players. 

But there is only so much one person can do, and the Italian media were particularly toxic, having never given Milan or Pioli the credit they deserved since returning from the COVID lockdown (yes, even after winning the Scudetto.) This led to further pressure from fans on social media, too, which even more directly impacts the players, especially those who are active online. The mentality suffered, the performances suffered, and the players quite literally suffered, as injuries increased.

There is no doubt that Ibrahimović's mentality helped Pioli and the team, he is missed.

Then Ibrahimović, a force in the dressing room, retired. The next day, Cardinale fired Maldini and Massara. The players were shocked, but were told by Furlani that they had contracts and they should do what was best for the team. He then proceeded to sell lifelong Milanista and warrior teammate, Tonali. Then Milan saw the exit of a total 17 players throughout the summer transfer window. Most of these players who were left at Milan had been previously quoted about Maldini being the reason they came to Milan, the reason they agreed to the project, the reason they accepted lower wages, and the reason they renewed last year. Now he was gone. So was Ibrahimović. So was Tonali. And 15 other players. 

Bennacer looks to finally be returning in a month, after over 7 months out.

Yes, these are professional footballers. Yes, transfers happen. Changes in management happen. But these players felt betrayed, and probably still do. Leão agreed to his new contract on a Friday, and Cardinale fired Maldini on Monday. Leão flat out said he would not have renewed if he had known Maldini was leaving. Now nearly two-thirds of their teammates were gone, and they had to get to know all of the new players, too, who were brought in throughout the summer, including during the very hectic USA tour. Additionally, management clearly did not know what they were doing and changed directions on how to proceed with the sporting sector. They also shopped a very attack-heavy transfer window, without finding a suitable backup for Giroud or properly reinforcing the defense.

Pioli once had a full team supporting him and his squad, but now he is all alone.

All of these factors massively affected the mentality of the players and the staff. And, as people are finally realizing, Pioli is now all alone without any support for himself, as well. Cardinale has reportedly been negotiating with Ibrahimović to return to Milan in some role to help support Pioli and/or the players, but those negotiations have been ongoing for two months. Given Cardinale's incredibly narcissistic tendencies and the way he fired Maldini, that may never happen, who knows? But it is clear that something is desperately needed. We lost two more players to injury on Saturday, and there are currently ten players unavailable due to injury. That is over one-third of our squad.

Number of injuries this season by club. (from La Gazzetta dello Sport)

What surprises me is that no one is really talking about the psychology of the injuries. For all of his supposed expertise in the sports industry, one would think that Cardinale would have the best sports psychologist in the industry on the first plane to Milano after the first few injuries to protect his €134 million in summer investments on top of his €2 billion investment in the Club. Not that he would know Milan's history with Sports Psychology as it was used for motivation (back when Milan won all of the trophies he also doesn't really keep up with.) Italy is well behind the curve in mental health for players, but it is a much bigger industry in America. And if Cardinale is truly interested in bringing the American business model to Italy, he should protect his investments by bringing the best in medical treatment as well, which includes mental health.

This picture from this summer in Los Angeles perfectly captures the change of atmosphere at Milan.

Not only are the insane events and the complete changing of the culture of the Club the most obvious cause of the doubling of injuries since Cardinale bought Milan, there is also the fear contagion that can impact teams when a lot of injuries start happening. One player gets injured, then another, and then the other players become fearful and are more likely to get injured themselves. It is completely psychological, too, which means bringing in a Sports Psychologist and/or other mental health professionals should be the first and most obvious answer to Milan's injury nightmares. 

For one, it would help everyone manage the stress of the ten players we currently have out injured and the pressure everyone has to perform well for financial purposes. Secondly, it would help those ten players recover more quickly by helping them recover mentally as well as physically. Even that alone would be a huge help and contribute positively to the mentality of the team. But if addressing the psychological aspect of the injuries could help reduce injuries and the time required to heal from injuries as studies have shown, this is an incredibly low-cost answer to Milan's long-term problem. Not to mention focusing on the fact that Milan have the worst discipline record in Serie A, as well. Addressing mental health is an answer that helps the entire project moving forward, too. 

Giroud was a hero when Maignan was sent off, now who steps up during his 2 match suspension?

This is not just for Milan, this is also the health and well-being of our players. They are not robots, or a commodity, they are human beings. These are their lives and their livelihoods, and these injuries can not only change the trajectory or their careers and their lives, but also their own mental health. But hey, I guess "Moneyball" does not do data for player mental health? And Cardinale probably hasn't thought about a way to monetize a Sports Psychologist, either (although there are plenty of possibilities, actually.) While the injury crisis is definitely a combination of many things, the mental side of it seems to be the only question not being effectively raised in these discussions. 

Leão has a 1st degree lesion on his right hamstring
(and the press will probably still criticize him while he's out for 20 days.)

And if Cardinale was too shortsighted to realize the overall impact that firing Maldini would have on the Club, including the stress and injuries to players, then how would he realize the most obvious answer to this problem? Furlani is Italian, so less likely to consider the mental health option, and is also just an investment banker. Moncada is a scout, and also Italian, as is D'Ottavio. So there probably isn't anyone at the Club who is actually capable of solving Milan's injury nightmares.

This post inspired by the music of twenty one pilots' "Stressed Out"

Elaine has been invited to be a guest on the Keep Going Podcast this Sunday
Talking to Luke, Pat, and Jacqui about ending the stigma surrounding Mental Health
Check out their podcast on Apple, Spotify, and YouTube
and follow them on Instagram and Twitter

For more about mental health, check out my other project, the
Total Football Mentality Podcast on Apple, Spotify, or wherever you get your podcasts
and follow Elaine on Instagram totalfootballmentality and Twitter @TFMentality