Sergio Ramos, Rafa Benitez set to walk the injury tightrope

Rafa Benitez is not a manager normally associated with taking unnecessary risks. The Real Madrid coach has waged a personal media campaign to shake off his cautious tactical reputation since his summer arrival at the Bernabeu but Sergio Ramos' recurring injury problem present Benitez with a treatment room balancing act as delicate as his captain's shoulder.

After undergoing tests on Tuesday in Madrid, Ramos is weighing up one of two options: surgery, or a period of rehabilitation. The defender was ruled out of Spain's upcoming friendly matches against England and Belgium in advance, but was nonetheless named in Real's starting line-up for the loss to Sevilla on Sunday night, during which he bagged a goal with an overhead kick but landed awkwardly. He was substituted within 10 minutes, with half an hour played. The score then was 1-0 to the visitors. When the final whistle sounded, Sevilla had put three past Madrid in Ramos' absence.

There were many reasons for the turnaround -- not least Sevilla, and Yevhen Konoplyanka in particular -- playing extremely well, but that Benitez's team disintegrated in the absence of their captain was not pure coincidence.

With the Clasico on the horizon, the Real manager, and Ramos himself, seem intent on another patch-up job. Ramos has been playing with pain-killing injections for weeks since dislocating his shoulder against Shakhtar on Sept. 15. He missed six games after that but was pumped full of cortisone to lead the team out against Atletico, Celta, Paris Saint-Germain and Sevilla. On balance, the gamble has paid off. But the uncomfortable truth about pain-killers is that under their numbing influence, the amount of punishment an injury is taking cannot be reliably gauged.

As Ramos said after the Sevilla game: "The priority is to recover because it is another relapse. I have played four or five games with injections and this is the type of injury that if you are not careful can cause a lot more problems."

Benitez should be very wary of being the source of an unnecessarily prolonged Ramos absence. The Real club doctor, Jesus Olmo, does not fill the squad with confidence and it is telling that Ramos is apparently being left to decide his own course of action in this case.

If he opts for surgery, it will be postponed until after the Clasico. Both Benitez and Ramos know what is riding on that encounter: lose, and Real will be six points behind the eternal foe and, from the manager's point of view, back-to-back defeats will not sit comfortably with Florentino Perez in the boardroom.

But Benitez has to weigh up the long-term implications of wheeling Ramos out for one final round before he seeks medical treatment. Ramos is a fighter -- even his detractors cannot deny that -- but as with pugilists in the ring, one last scrap can always become one too many.

For some time, Ramos has been Real's on-field leader. Iker Casillas may have ruled the roost in the dressing room before his departure for Porto, but it was his vice-captain who led from the back, front and everywhere in between during matches. Real lack similar leadership almost across the board. Marcelo has matured considerably over the course of recent seasons and has eased into his role as vice-captain but the Brazilian also faces a race to be fit for the Clasico.

That will certainly have a bearing on Benitez's mindset. Real have an enviable bench but lack genuine replacements in the grabbing-teammates-by-the-scruff-of-the-neck department. Nobody in midfield has sufficient personality or seniority to gee up the side. Up front, shoulders have a tendency to sag when the team goes behind, or the ball becomes a fond memory.

There is no doubt that Benitez needs Ramos on the pitch on Nov. 21. Equally certain is that Ramos would say he was fine to play if he'd been hit by a car instead of Taras Stepanenko. It is also reasonable to assume that Luis Enrique, if asked to pick one player to remove from the Real starting 11 based on form, influence and commitment to the cause, might deselect Ramos. However, the Liga season is played over 38 games and Barcelona's visit to the capital comes in week 12.

A loss to Barcelona, at home, after throwing away a lead in Seville will not be high on Benitez's wish list. But losing Ramos for longer than necessary will be more damaging in the long-term.

If the Real manager tunes in to any friendlies during the international break, they will probably feature Spain, France and Portugal. As long as Nacho, Raphael Varane and Pepe return unscathed, at the very least he will have a choice.