How altitude chambers, anti-gravity treadmills and dogged determination helped Andriy Yarmolenko recover from serious injury to become one of the Premier League's star players…
Andriy Yarmolenko is lighting up the Premier League and has been instrumental in West Ham's rise to fifth in the table.
His manager, Manuel Pellegrini, described him as a "special player" after he followed goals against Norwich and Manchester United with a classy finish against Bournemouth last weekend. "He's carrying us at times," said team-mate Ryan Fredericks, who plays behind him on the right flank.
But this fine form has been hard fought for.
A little under 12 months ago, Yarmolenko, 29, suffered a ruptured Achilles as he tried to make a turn against Tottenham. It's a rare but serious injury for a footballer. For Yarmolenko it was a cruel blow. Just a couple of months after a high-profile move to West Ham and the Premier League he was facing months on the sidelines.
Here, with the help of Richard Collinge, Head of Medical at West Ham, we tell the story of Yarmolenko's long battle back to fitness…
"I think you know straight away when someone goes down with an injury like that, that it's a nasty one. As soon as we got on the pitch we knew he was in a great deal of discomfort and the player, in that scenario, is in a great deal of shock."
While Yarmolenko clutched at his right leg, the expression on the face of his team-mates underlined the seriousness of the injury, even before Collinge and his medical team arrived on the scene.
"You don't see a ruptured Achilles that often," Collinge told Sky Sports. "I've been in and around football for 20 years now and I think I've seen two in my career. They are infrequent but they're big injuries."
Aware of the gravity of the injury, the West Ham medical team knew they had to act quickly.
"His wife was at the game, so we brought her down to the medical room and explained the significance of the injury. Andriy was shocked and disappointed. He'd come to a new team in the Premier League and wanted to make a great first impression. It was only October and that opportunity had been taken away from him.
"We put him in a protective boot, gave him crutches and sent him straight off for an MRI scan, which confirmed our fears that he'd ruptured his Achilles. With those ruptures you want to operate as quickly as possible. That was a Saturday and by first-thing Monday morning Andriy had undergone surgery in London to repair the tendon."
After the whirlwind hours following the injury, Yarmolenko had to face up to the prospect of many long months of recovery work.
The early days
Following the operation, Yarmolenko's injured right leg was kept in a protective boot which only came off for light stretching exercises. During this frustratingly slow period, his morale was just as important as his physical recovery.
"Watching the other players go out training every day was hard for him," said Collinge. "To get him through that initial 10 week period after the injury, we were trying to be really positive around him. Andriy is a very positive character anyway, so that helped, but the players, the manager and the coaching staff were great around him.
"We have a player care team at the club as well who ensured Andriy and his family knew we were here as a staff and club to give him every support possible, from chatting to a psychologist to reaching out to staff he's used previously in the Ukraine. The 'team-behind-the-team' ethic helped to get Andriy back to where he is now."
Collinge and the coaching staff were keen to keep Yarmolenko as active as possible to maintain his condition. There was gym work for his upper body and to raise his heart rate and hydrotherapy to keep him in shape.
Yarmolenko was also set a series of targets. "The most important thing I've learnt over the years is you give the player realistic markers of how the rehab programme is going to look and set them goals within that period," said Collinge. "You have to make sure the player buys into that."
Technology and tenacity
Buy into it he did. There were early starts and long hours at West Ham's Rush Green training base but Yarmolenko's attitude remained steadfast. Even at the end of the season, when his team-mates had gone off on holiday, Yarmolenko still arrived each day to continue his battle back to fitness.
His treatment was wide-ranging and employed modern technology. Inside an altitude chamber, Yarmolenko rode static bikes, exercised on a cross-trainer and ran on an anti-gravity treadmill.
"Andriy was doing work in a simulated environment of 3000m altitude," explained Collinge. "That worked his heart and lungs harder, so when he came back to the pitch his fitness wasn't depleted too much. He'd do high-intensity work on the bike and, from December, we gradually increased the weight his body was bearing as he ran on the treadmill."
Regular weigh-ins and body fat checks monitored Yarmolenko's condition, meetings with the club nutritionist tweaked his diet, while massage and muscle stimulators helped strengthen muscles around the healing Achilles.
After a morning in the altitude chamber, extra work with the strength and conditioning coaches followed in the afternoon and weekly Pilates classes helped with flexibility.
"Every player wants to get back as quickly as possible and we want to facilitate that safely," said Collinge. "Altitude chambers, cryotherapy chambers, muscle stimulators, shockwave machines, you name it, there's a lot of information and equipment out there. We're always trying to find these gains to get the player back on the pitch quicker and safer and in a more effective manner."
Pellegrini's keen interest
West Ham boss Pellegrini kept a close eye on the process. Yarmolenko may have been ruled out for the season but, as with all injured players at the club, Pellegrini insisted on him still being involved in team meetings and made to feel part of the group.
"Mr Pellegrini likes to be kept abreast of what's happening with the injured players," said Collinge. "I meet with him each morning and talk through every player, whether they're fit or not. The manager also sees the players in the treatment room, he'll come in and ask how they're getting on.
"He keeps communication open with injured players because the player still needs to feel part of the club and involved. Mr Pellegrini and his staff are great at doing that. The players don't feel left out or moved to the side because they're injured."
Back on the grass
Yarmolenko's work on the treadmill increased his strength through December and come January he was ready to get back to running on grass.
The approach was again slow, steady, methodical. Straight line running evolved into agility work and by April he was able to join his team-mates for some non-contact sessions before, eventually, in May, contact training. But that wasn't the end of the road.
"When you put a player back into contact sessions, you have to build up his confidence," said Collinge. "There's nothing like training to do that. There's only so much we can do in a rehab setting before you unleash the player into a full-contact session and he has to be exposed to the stresses and strains that training exerts on that tendon."
Yarmolenko responded well and, had the Premier League season stretched into June, he'd have been back in action for West Ham. However, given the timing of his recovery, Pellegrini and the medical staff agreed it would be best to go easy and ensure Yarmolenko was 100 per cent for July 1, the start of pre-season.
That meant that, with West Ham's first team heading off for their holidays after achieving a top-half finish in the league, Yarmolenko needed to find others to train with.
"We kept an U23s training group back later specifically to help Andriy, so he could do extra training with them," said Collinge. "He also went back to Ukraine and did some training with the national team, although we were very much controlling that training to make sure he didn't do too much too soon."
With his own holidays reduced to just a short break away with his family, Yarmolenko's summer continued to focus on his rehabilitation.
"They're the sacrifices you have to make," said Collinge. "People think the season finishes mid-May, but certainly for the medical team, the sports science team we provide a service throughout the summer and Andriy was in for most of the summer."
When July 1 arrived Yarmolenko was ready for action - and now he is reaping the rewards for all his hard work.
"The rehab shouldn't be taken lightly because it's a process that takes an awful lot of buy-in, and it's testament to Andriy he came through it so well," said Collinge. "It takes a huge amount of mental robustness and positivity to get back playing at that level again.
"The hard work still continues. We don't get complacent. The demands of the Premier League are huge these days, physically and psychologically, and when a player like Andriy has been injured they need to do extra work that helps keeps him on the pitch.
"But he's a good professional. He's been a sponge over the past 12 months and taken on board the information my staff have given him and it's extremely satisfying to see him back, playing the way he is."
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