It was easy to forget.
After the interview, speak to BT Sport Liverpool’s 3-0 win against Ajax in the Champions LeagueJurgen Klopp was highly praised on Wednesday night Darwin Nunez’s performance at both ends of the pitch and recognised the “big heart” the Uruguayan showed during the 63 minutes he was on the pitch.
Then came the sign-off: “Hopefully we took him off early enough.”
Some might have dismissed it as a little joke — Klopp finding humour in the fact that Nunez was removed after 57 minutes in their 1-0 win over West Ham United a week ago but still missed Liverpool’s game against Nottingham ForestThree days later. Others might have felt a little more heat emanating from the Liverpool manager’s words, given his recent comments about the club’s injury situation overall.
However Klopp intended the comment, and whatever the guidance coming from Liverpool’s medical department, what lies beneath it is a 23-year-old who has already experienced the depths of despair due to serious injury. In recent weeks, it has been nothing more serious than a “tight hamstring” limiting Nunez’s minutes on the pitch, but to understand more about the approach that Liverpool are taking with their summer signing it’s worth going back six years, to a bobbly pitch in Uruguay.
Nunez was just 17 when he injured his anterior cruciate (ACL), while playing for Penarol, a Uruguayan club. Nunez was enjoying a great season and was close to being called up to the first team. However, in a match against Sud America on a pitch in poor condition, he attempted a header but landed awkwardly. This caused his knee to bend severely.
“There are two central ligaments in the knee: the posterior cruciate ligament (PCL) and the ACL,” explains knee surgeon Andy Williams, who has worked in professional sport since 1999 and operated on approximately 4,500 ACLs (around half of which have been in professional sportspeople).
“The ACL is key for athletes who need to change direction, as it allows control of rotation. Imagine the ligament as a rope made up of multiple fibres. When it ruptures, all those fibres break and it’s like a rope that has become two pieces of rope.”
Players fear the injury the most. They know that it will mean spending time rehabilitating the entire musculature around the knee. Even if they are able to return to play, the possibility of a rerupture could be a concern and the entire process will start over again.
We’ve seen the journey played out countless times among established professionals, though rarely do we hear of it happening to young players. However, it is not actually less common among young players, says Williams, who calls it “natural selection — anybody with a weakness gets found out”.
“His might have just been bad luck, but of course, as they go from boy to man or girl to woman, they’re suddenly doing things they’re perhaps not quite yet physically capable of.”
We hear fewer stories of young players suffering partly because they are less likely to be high profile but also, when they are less established before the injury, it’s even harder for them to find their way back.
“For a serious young footballer, the big problem is they miss a season and never catch up with their colleagues,” says Williams. “When I operate on them, they all get back to playing just about, and everyone is happy with the surgery and with me, but they rarely get a contract.
“So he (Nunez) is extraordinary to have got a contract having had an ACL so young. It’s a testament to his surgery and also to his talents.”
Darwin Nunez, who sustained an injury while playing for Benfica in December 2021 against Porto (Photo: Jose Manuel Alvarez/Quality Sport Images/Getty Images).
A footballer who ruptures their ACL can return to playing in around eight months. However, it may take longer if other structures have been damaged. Williams claims that younger players can have a longer recovery time due to research he did last year about 232 professional footballers who had their ACLs repaired.
“We found the under-25s had a couple of months longer recovery. Maybe that’s because it’s a shock to them — there’s a big psychological element to it and they are frightened, while the older players have had more injuries so are more ‘get up and go’.
“Or it might partly be because medical staff are worried about them because there is a much higher re-rupture rate, particularly in the under-20s. Re-rupture is dangerous. If you miss a second season at that age, that’s probably the end of your career. If you’re really senior, a club will wait for you — they’ve invested so much in you, everyone knows you’re good and proven.
“If you’re a young kid who’s got talent, there are so many others that they’re not going to wait.”
There is one potential plus-point for getting such a brutal injury so young, says performance consultant and Liverpool’s former head of physiotherapy Andy Renshaw: “It might have alerted him as a young player to how important it is for him to keep himself in good shape, listen to the support staff he has around him and focus on work in the gym work before games.
“It might have pushed him into thinking, ‘I need to take care of myself and think about what I’m doing, what I’m eating, my sleep…’.
“But it’s certainly not something you’d wish on any player, especially a young one, because he’s got another 15 or potentially 20 years of playing time ahead of him. During which, because he’s had that injury before, he’s at a greater risk of injuring it again and/or on his contralateral side.”
Nunez’s route back from the injury was a difficult one. When he returned to training after the best part of a year out, he was still in pain and Penarol’s youth coaches couldn’t find a solution.
Nunez in pre-season training with knee strappings (Photo by Andrew Powell/Liverpool FC via Getty Images).
In November 2017, the club’s first-team coach Leonardo Ramos called him up to the senior squad in a bid to get him back to fitness. “You could see he was an interesting player, but he wasn’t able to show all of his potential due to that knee injury,” Ramos tells The Athletic “We spoke to him and started a process of strengthening his muscles and knee. He began to gain muscle mass which was a big help in his recovery.
“But even when he was training with the rest of the squad, his knee hurt every time he went for the ball.”
After months of painstaking work, Ramos says that many people cry during training sessions.Nunez finally reached breaking point and told Ramos that he was ready to quit playing. It was then that the coach and the player’s agent decided to send him for a more detailed scan of his knee. It showed an exostosis — extra bone growth in his knee — which was the cause of his pain.
Nunez had another operation in December 2017 to remove the excess bone. The second operation required Nunez to continue rehabilitation for six months before he was able to return to play in June. But, it did not take long for the players to recognize the talents of Nunez who had been suffering pain and injury for 18 years.
“From the moment they fixed it, his progress was impressive,” says Fabian Estoyanoff, who played alongside Nunez at Penarol. “He would beat his marker, beat anyone who came into his path. He was so fast, no one could stop him. He became the Darwin Nunez that everyone had been talking about before.”
Nunez had appeared in 22 games for Penarol and scored in two of these.
David Badia was appointed assistant coach at Almeria, along with new manager Guti, a few months later. The young striker impressed him quickly. “He had amazing speed and he could keep it for a long distance — for 25, 35 metres — which was amazing because it makes a difference with teams that play a high press to the centre-forward. He can find the space and with his amazing speed, he can make a big difference.”
It wasn’t until he had been at the club for a few weeks that Badia even knew about Nunez’s injury history. “Because we arrived in November we didn’t have time to analyse player by player — what he has and what he has. We asked if anyone was injured and they told us, ‘No’. After two or three weeks, I saw his scar and I was really surprised that he’d had this kind of surgery. It was the same procedure that I had as a football player. It stopped me playing football.
“But he was better than the other players who hadn’t had this surgery. The players usually lose some speed. If he is this fast now, it’s hard to imagine how fast he was prior to the operation. So, in the end, we say, ‘OK, it’s not a problem’. Maybe if he has another operation he will be even faster!”
Nunez was Almeria’s top scorer for the first season (16 goals in 30 games), and he missed only two games due to injury. For Badia, that consistency is thanks to Nunez’s intense focus on ensuring he misses nothing in his preparation: “He’s taking care of his body amazing. He’s crazy — like Ronaldo. All day he’s looking after his body and taking care of his nutrition — everything.”
Nunez was able to stand out among his colleagues because of this. While other players would talk their way through sessions that were designed to strengthen core muscles or prevent injuries from occurring, Nunez was relentless in his work. It was not lost on Nunez that while others would perform eight repetitions of a given exercise instead of the 10 required, Nunez never took shortcuts. He was a master of the task and never failed to finish it.
Does it have to do with his injury history? “Maybe,” says Badia, “because he feels what happens when you get this kind of problem, so he understood he should be careful about his nutrition, his rest, about all these important points. Sometimes the other young players who haven’t had these kinds of surgeries or problems, they don’t realise how important their nutrition or rest is.”
Nunez’s performances at Almeria got him noticed and, in September 2020, he signed for Benfica for €24million (£20.3m, $24.6m). A COVID-19-interrupted first season saw him miss just three league games with injury (two of those for a hamstring concern and one classified as “unknown”), but in May 2021, the day after Benfica lost the final of the Portuguese Cup to Braga, Nunez was in hospital for another knee operation.
The operation (which was done by arthroscopy, a form of keyhole surgery), was done on Nunez’s right knee. It wasn’t the one that had been injured or torn ACL. The operation was scheduled for the end, in an effort to resolve a problem that had been ongoing for some time and had already caused Jorge Jesus to disclose that Nunez was physically limited.
Nunez was originally expected to be out for at least four months. However, he returned after only three months and was back in full recovery. A stormer of a yearHe scored 26 times in 28 league matches and was a star in the Champions League. While he missed two league games to continue his recovery, he also missed only one more league match in 2021-22 due to a foot injury.
While we don’t know for certain what the operation was that Nunez had in 2021, Renshaw says it’s possible that he had part of his meniscus removed — a meniscectomy. “It would be about that time frame. If it was a lateral one on the outside of his knee, it would take more towards 14 weeks, but with a medial one he could be rushed back in three months.”
— Darwin Núñez (@Darwinn99) August 5, 2022
Renshaw, who spent eight years working at Liverpool before moving on in November 2017, says: “This young lad’s had surgeries on both his knees. He’s going to have to be managed, but it’s managed from an entire staff perspective. Obviously, there are elements of risk that we can’t mitigate, but we can do our best as a group of staff.
“When any player like that goes into a club it’s not just going to be about physios and strength and conditioning staff, that player will spend the majority of his time on a football pitch and the amount of time he spends on the pitch, the amount of distance he covers at certain paces, that’s all going to have to be managed very carefully. There’s got to be buy-in from the football department with that as well as the medical and sports science department.”
Liverpool fans were concerned when Nunez was seen wearing a brace on his right knee. This is to relieve patellofemoral discomfort, which refers to the area between the patella and the kneecap. However, so far there have not been any signs of knee problems.
Darwin Nunez scored for Liverpool against Manchester City at the Community Shield, July 2022 (Photo: Andrew Powell/Liverpool FC via Getty Images).
Williams, the surgeon, states that Nunez ruptured his ACL in 2005. He is now at a much lower risk of it happening again. “Most re-ruptures occur in the first year. And definitely by two years,” explains Williams. “Basically, they get on the pitch and test it. If there’s something not quite right about it, they’ll find out, unfortunately.”
He says that the “final result” of an ACL reconstruction is probably as long as two years from the time of surgery. “Often the player isn’t right for the first season back. Their sport is what fine-tunes their skills. So their final bit of physio is the playing.”
Nunez’s ACL nightmare is long behind him now. The trials and tribulations he went through left Nunez in a better place mentally and physically to handle any future challenges. Premier League(and Champions League) have to throw at him.
“For his past, his childhood and these kind of operations, if you are at the point he is, you are very strong,” says Badia. “This is not for someone who is soft in his mentality, ambitions or focus because in the end, if you lose a little bit, you are not at this point — it’s impossible.”
(Top image: Getty Images
