Brazil’s Neymar Suffers Ankle Injury, May Miss Next 2 World Cup Matches

Brazil’s star forward Neymar rolled a joint on Thursday during their 2-0 victory over Serbia in Brazil’s opening match of the 2022 FIFA World Cup in Qatar. No, not that kind of joint. We’re talking about Neymar’s right ankle, you know the joint that connects Neymar’s lower right leg with his right foot. A Serbian player’s knee caused Neymar’s right ankle to roll in the wrong direction. Neymar soon realized that something bad was afoot and checked out of the game at the 80-minute mark. This ankle injury left Neymar in tears and fans of the Brazilian team holding their collective breaths.

Here a FOX Sports video shows how Neymar suffered his ankle injury:

As you can see in the video, Matt Provencher, MD, MBA, an orthopedic surgeon at The Steadman clinic, pointed out the significant swelling seen around Neymar’s ankle. That obviously is not swell for the Brazil team’s prospects.

So how bad is Neymar’s injury? Will this mean that Brazil is no longer the favorite to win the 2022 World Cup? Was it a bad idea to wager your life saving on Brazil and hope that winnings from the bet would pay for your kids’ college tuition? Well, it’s hard to say right now. Saying that you suffered an ankle injury or even an ankle sprain is kind of like saying that you will institute content moderation on a social media platform that you have purchased for $44 billion. No one can tell what that means until more details actually emerge. Ankle injuries can range from a minor tweak to a there-goes-my-career-as-a-professional-shuffle-dancer type of injury with a whole spectrum of possibilities in between.

The Brazilian team’s doctor Rodrigo Lasmar, MD, did provide some more details on Friday. According to Pedro Ivo Almeida and Thiago Cara reporting for ESPN, Lasmar stated that, “The tests showed a lateral ligament injury on Neymar’s right ankle, along with a small bone edema and a medial ligament injury on Danilo’s left ankle.” Edema is a fairly non-specific finding that means fluid accumulation. So a funky cold edema finding alone doesn’t mean a whole lot.

Lasmar mentioned Danilo, who is the right back for the Brazilan team. He was the other Brazilian player to have suffered an ankle injury during the game against Serbia. If you haven’t noticed already, top footballers in Brazil often go by single names sort of like Drake, Usher, Prince, Madonna, and Cher. Lasmar added that “We can already say that we will not have the two players for the next game but they remain in treatment with our goal of trying to get them back in time for this competition.”

That’s not great news but it does suggest that Neymar and Danilo could return to playing at World Cup at some point. The next game for Brazil would be against Switzerland on Monday, followed by a match versus Cameroon on Friday to close out the group stage of the tournament. In order to advance to the next knock-out stage of the World Cup, Brazil would need to finish in the top two of Group G, which consists of Serbia, Cameroon, Switzerland, and Brazil. So should Brazil get past the group stage, you could potentially, possibly, perhaps see Neymar and Danilo again.

Of course, this all depends on how severe Neymar’s lateral ligament injury is. Ligaments are the fibrous tissue that connect one bone in your body to another one, typically across some joint in your body. A sprain is another way of saying ligament tear in case you don’t have enough time to say three more syllables. A ligament is a bit like that Vice-President who tends to go along with most of what you say and do as President. You can get the ligament to go pretty far as long as you gradually coax it. However, when you turn a joint in your body the wrong direction too quickly and too far, the ligament can tear.

Turning your foot inwards, in what’s called an ankle inversion, ends up stretching the ligaments that run along the outside of your ankle. These are the anterior talofibular lateral (ATFL) and calcaneofibular lateral (CFL) ligaments. In medical speak, lateral means outside and medial means inside. So when you tell your date, “you make my medial thighs tremble” that means the inside of your thighs. The ATFL connects the big bone of your lower leg called your fibula, with a bone in the back part of your foot, the talus. The CFL connects another bone in the back of your foot, the calcaneus, with your fibula. Based on what Lasmar has said, Neymar probably tore at least one of these two ligaments.

Evualation of an ankle sprain includes a physical exam and imaging such as an X-ray and potentially magnetic resonance imaging (MRI). An X-ray can mainly tell whether any of your bones are broken whereas an MRI can help you see the soft tissue along with the actual ligaments and whether any tears are present. Of course, a superstar like Neymar who’s participating in a major billion dollar sporting event like the World Cup has ready access to an MRI machine. Doctors aren’t going to double-check his insurance card and say, “Hmm, your plan seems to cover ice but not much more.” However, if you are deciding whether you will be participating in the upcoming local river dancing competition then maybe your doctor won’t order an MRI and will rely solely on the physical exam and X-ray to decide how severe your injury may be and what you should do.

The Brazil team doctor did not reveal what grade Neymar was in, meaning the grade of Neymar’s ankle sprain. The OrthoInfo website maintained by experts from the American Academy of Orthopaedic Surgery breaks down ankle sprains into three grades:

• Grade 1: This is where slight stretching and microscopic tearing of the ligament fibers have occurred. The result are fairly mild symptoms with some tenderness, bruising, and swelling around the ankle. Typically, you aren’t going to get much pain when standing on the ankle. And the doctor won’t notice any instability on examination. Based on observation from afar, it seems like Neymar’s injury was clearly worse than a Grade 1 ankle sprain.
• Grade 2: This is a partial tear of the ligament, resulting in moderate tenderness, bruising, and swelling around the ankle, mild pain with weightbearing, and slight instability on examination. With Neymar’s ankle clearly swollen on the TV images, this could be where Neymar’s ankle sprain may be falling. The main question is how partial is the partial tear.
• Grade 3: This is the worst situation, a complete tear of the ligament. As you can imagine, completely tearing anything in your body is typically not a good thing. You’ll probably rarely say, “Yeah that part of my body got completely torn apart. But other than that it was a good day.” A complete tear will result in a lot more tenderness, bruising, and swelling around the ankle. You’ll probably have severe pain when trying to stand on your foot. And since the ligament is no longer holder the bones together, your ankle will likely be quite unstable on physical examination. Neymar did play for more than 10 minutes after he had injured his ankle, so perhaps he didn’t suffer a complete tear.

That being said, even a Grade 3 ankle sprain rarely requires surgery. Ultimately, what you need most is Father Time, not to be confused with TikTok, along with non-surgical treatment. This is where a good physical therapist can play a major role. A good physical therapist can be like a Neymar to a football team. He or she can make the difference between a speedy and full recovery versus lots of lingering problems.

Treatment tends to progress via three-phases. The first Phase is a short period of keeping the ankle immobilized, rested, and iced in order to manage the pain and swelling. This can be a removable plastic device (e.g., a walking boot or an aircast brace) for a Grade 2 sprain or a more involved short leg cast or cast-brace for a Grade 3 sprain. For a Grade 2 sprain you may only have to wear the device for a few days whereas a Grade 3 sprain may necessitate being in the device for 10 to 14 days. The pain and swelling typically will go down after a few days.

Phase 2 comes next and is where you no longer should keep your ankle immobilized. Keeping it immobilized too long can actually leave too much stiffness in your ankle. And this isn’t one of the body parts that you want to be stiff. Instead, Phase 2 is where you engage in exercises that aim to increase your range of motion, strengthen the muscles around your ankle, and retrain your ability to balance on your ankle.

The third and final Phase is re-training for you to get back to your pre-injury activities. This may include gradually getting you back to running and eventually cutting. You may have to tape or brace your ankle early on to facilitate such activities. Overall, the fastest you can get through these three phases is about two weeks for minor sprains. It can take up to six to 12 weeks when your ankle sprain is more severe.

So for the next few weeks, Neymar’s right ankle will be among the most watched body parts in the world, taking its place alongside Donald Trump’s hair and Kim Kardashian’s bottom. It may take a few days of getting through Phase 1 and at least some of Phase 2 treatment to tell whether and when Neymar will return for the World Cup. Even if he does return, a big question is how much of Neymar will Neymar be. All of this is unexpected twist for a Brazilian team that has the talent to cut to the winner’s circle in Quatar.