Round 23 Injury Wrap-up

Our resident rugby league injury expert, the NRL Physio is back with a wrap-up of the injuries and recoveries after Round 23.

 

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Tohu Harris

Tohu will face a fitness test on his injured shoulder this week. He’s listed as #18 this week so keep an eye on the late mail on Saturday.

 

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Ben Hunt

After an incident during wrestling drill at training this week, scans cleared Ben Hunt of fracture to arm. He should be fit to play this week

 

Joey Leilua

Leilua’s knee injury is believed to be minor and he has been cleared to play this week for the Raiders.

 

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Jarryd Hayne

Hayne has been confirmed to miss this week’s game against his former club with minor lateral ankle sprain. It shouldn’t cause him to miss multiple weeks. Expect him to be back next week.

 

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Michael Gordon

After narrowly avoiding surgery on his pec injury, Michael Gordon will return this wk. It will be a six week return to play whereas surgery would’ve been 10 plus weeks.

 

Nathan Ross

As expected Nathan Ross is aiming to return before end of the season for the Knights. Great news in recovery from transverse process fracture.

 

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Peter Wallace

Wallace has had a plate inserted in his broken hand and is hopeful of only missing one week. It’s more likely a two week absence, but surgery does shorten recovery.

 

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Josh Reynolds

Reynolds is sidelined this week with a minor calf strain – likely grade 1. It is usually a one to three week recovery, which means he should play for Bulldogs again this season.

 

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Josh McCrone

McCrone has been dealing with bilateral (both sides) groin issues for the past six weeks. Hopefully it’s not the dreaded osteitis pubis.

 

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Gavin Cooper and Antonio Winterstein

Cooper and Winterstein are not expected back for at least another two weeks for the Cowboys.

 

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Kaysa Pritchard

In other surprising news, Kaysa Pritchard is back training for the Eels despite his initial prognosis of PCL/LCL surgery/season over. Pritchard has avoided surgery thus far which would assume damage to his LCL not as bad as first feared. It’s a relief as PCL/LCL surgery is a long recovery.

 

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Moses Suli

Suli will be unavailable this week for the Tigers as he is managing stress fractures in his ankle. This explains his prolonged absence from the top grade.

 

Others:

  • Beau Scott has returned to training. He will see surgeon at the end of this month and the earliest he could return likely mid September.
  • Sam Kasiano will miss this week with sternum injury. It is usually a pain management issue in guiding return to play.
  • Tim Glasby will not make the trip to Newcastle due to a minor shoulder complaint.
  • Brad Parker suffered a lateral meniscus tear and not ACL as reported. It is usually four to six weeks recovery. Injury video didn’t suggest ACL and this is great news for Parker.

 

 

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook.

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

Round 22 Injury Wrap-up

Our resident rugby league injury expert, the NRL Physio is back with a wrap-up of the injuries and recoveries after Round 22.

 

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Bevan French

Bevan French is likely to be rested as a precautionary measure for Friday night’s clash against the Knights. It would be a smart call as I have seen with Moylan recently how troublesome lingering hamstring issues can be.

 

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Jack Bird

Bird’s shoulder injury is not as bad as first feared. He is expected to miss one to two weeks of football. He will see a specialist this week for expected recovery details.

 

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Nathan Ross

Talk of Nathan Ross’ season being over may be premature. It is possible to return from transverse process fractures in as little as two to three weeks. It is an extremely painful injury but structurally not as debilitating. I have seen some people refer to this specific fracture as a pain tolerance issue.

 

Daniel Tupou

It is a groin tear for the Roosters tall timber. He will have up to six weeks recovery according to the Roosters. With that timeline it is likely a grade 2-3 injury and he would be aiming for four to six weeks.

 

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Sio Siua Taukeiaho

Great news for SST and the Roosters as his open dislocation only pierced the skin and he could play this week. If fractured it would have been four to six weeks recovery.

 

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Josh Dugan

Dugan has been confirmed with a lateral ligament sprain and no syndesmosis injury. He is a chance to play this week but it is usually a one to three week recovery.

 

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Gavin Cooper and Antonio Winterstein

The best case for both Cooper (calf) and Winterstein (hamstring) is to only miss two games each. Both of them likely suffered grade 1 strains. A grade 1 calf is approximately one to three weeks recovery for Cooper and a grade 1 hamstring strain is likely two to four weeks for Winterstein.

 

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Jayden Brailey

After breaking his jaw in Round 16, Brailey is still two to three weeks away from returning.

 

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook.

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

Round 21 Injury Wrap-up

Our resident rugby league injury expert, the NRL Physio is back with a wrap-up of the injuries and recoveries after Round 21.

 

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Cameron Munster

Cameron Munster has been ruled out of this weekend’s clash with the Cowboys with low grade high ankle sprain. It can be one to four weeks recovery as he returns to play but Storm seem confident he won’t miss much footy.

 

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Angus Crichton

Great news for CEOs! Angus Crichton is confident to play out season. His foot wasn’t sore after last game and he’s no longer wearing a boot. Still one to watch due to nature of injury but Coach Maguire seems set on playing him out for the rest of the season.

 

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Dylan Walker

Dylan Walker has a foot injury with bone bruising after being stood on. This is a good example of a boot being precaution to help it settle. He is fit to play this week.

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Nathan Brown

Nathan Brown trained and will play after a nasty head knock last week.

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Boyd Cordner and Tohu Harris

Boyd Cordner (knee) and Tohu Harris (shoulder) were both not named to play this week and it is still unclear on their return dates. There is almost no info at all on Harris which is a concern for CEOs leading into finals.

 

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Brett Morris

Brett Morris missed last week’s game with a fever, but has recovered well and is fit for selection this week.

 

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Matt Moylan

Matt Moylan ran for first time today since re-aggravating hamstring strain. How he pulls up big indicator for availability this week.

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Corey Oates

Corey Oates trained on the wing today for the Broncos and is likely to return this week. Great news in his recovery from a staph infection.

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Karl Lawton

Karl Lawton is out for the year to have shoulder surgery to repair damage caused by dislocation and re-injury this season. This is a three to six month recovery.

 

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook.

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

Round 18 Injury Wrap-up

Angus Crichton

It’s not uncommon for players to manage and play with certain types of injury throughout the year. Fractures are usually not included in this category, as continuing to stress/place pressure on a fracture can have detrimental short and long term effects. The mildest form of bone injury is a stress reaction, which if played on can become a stress fracture and then a formal fracture. Usually either a stress or formal fracture will result in 6-12 weeks on the sidelines.

It has been reported that Angus Crichton is playing with a “small break” in his foot, and is wearing a moon boot to manage the inflammation throughout the week. There have been no details reported on the location of the fracture in the foot (which bone) which would give a lot more clarity to his prognosis for the rest of the season. This is still a surprising report, and hopefully Crichton is only dealing with a bone injury that poses as little risk as possible to his long term foot health. This would likely be a small fracture of middle/distal phalanx (end of toe, common “stubbed toe” injury).

Pain killing injections are not really an option for bone injuries like this, as removing the pain and pushing through puts Crichton at a high risk of the fracture becoming more severe and a considerably longer recovery time. Other risks include the development of arthritis due to chronic inflammation, and impaired function or permanent foot deformity if the fracture becomes severe enough.

If the reports of a break are confirmed and he is still safe to play, it would not be surprising if the plan for Crichton was to play each week until Souths are out of finals contention. If/once this occurs hopefully Crichton has suffered no further damage and at this point he will no doubt be given adequate time to recover.

 

Anthony Milford

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Milford has been named on an extended bench and if not this week he is likely to return at some point in the next few weeks. Whilst this is great news for the Broncos and Milford unfortunately he will not be in the clear at that point. Milford will require surgery at some stage to repair likely labral/ligamentous damage he suffered when he dislocated his shoulder.  Damage to these structures causes instability in the shoulder joint.

For the past six weeks Milford has been attempting to strengthen the muscles around his shoulder (particularly the rotator cuff) in an attempt to stabilise the joint and allow for a safe return to footy. However, if he gets back to full contact and there is still instability present in his shoulder he will require surgery to tighten up loose/damaged ligaments or repair damaged cartilage. Hopefully Milford’s shoulder is stable enough to delay this surgery until the post-season, but it will be a fluid situation week to week for the remainder of 2017.

 

Michael Gordon and Curtis Sironen

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Usually tears of the pec tendon will result in surgical repair and 10-16 weeks on the sidelines, whereas pec muscle injuries are conservatively managed and can be anywhere from 3-8 weeks’ recovery. Sironen and Gordon both suffered pectoral injuries recently, with Sironen undergoing surgery (likely tendon) and Gordon opting for conservative management/rehab (likely muscle). Sironen is reportedly aiming to return in 8 weeks after repair of his pectoral tendon, and whilst this is possible, 10 weeks is a more common time frame. Gordon is aiming for 7-8 weeks’ recovery, but this timeline is less predictable as rehab progress for pec muscle strains can be quite varied.

 

Boyd Cordner, Josh Hodgson and Paul Vaughan

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A trio of calf strains; with Cordner returning after a three week recovery for Origin 3, Hodgson named to start this weekend after missing one game for Canberra, and Vaughan is a chance to return this weekend (but more likely Round 20) after straining his calf in Round 16. As I have indicated in the past, a calf strain is one of the most likely soft tissue injuries to linger. There is a much increased risk of re-injury and prolonged recovery time if a player returns too soon. Cordner is of particular note as he only ran for the first time at 100% four days before Origin 3. Usually this signifies the point where a player feels no lingering symptoms in the calf, but will often be followed by 7-10 days of running/rehab before a return to play. Hopefully Cordner pulls up from Origin unscathed and the plays out the rest of the season with the Roosters.

 

Euan Aitken

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Aitken is out this week with hamstring soreness which the Dragons believe has come from a minor fascia tear. Fascia is the tough layer of connective tissue that surrounds muscles and is some of the most pain sensitive tissue in the body. Unfortunately, it does not show up well on scans such as MRI or ultrasound. Aitken is rightly taking a conservative approach seeing he has only just returned from a hamstring tendon tear, but provided his pain settles well he should only miss 1-2 weeks.

 

Jake Friend

Friend unfortunately had surgery on a fractured bone in his hand on Wednesday. Depending on the severity of the fracture and location, surgery will often speed up the recovery and result in a sooner return to play. Friend should be expected to miss 3-4 weeks.

 

Corey Oates

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A bit outside a physio’s scope of practice, Oates has been out of action the past two weeks with a staph infection. Staph bacteria lives on the skin and in the nose and is mostly harmless, however it can become a problem if it enters the body and multiplies. Oates was suffering from weakness in his lower limbs and said to be extremely lethargic, both common symptoms of this type of infection. Whilst medical issues like this can be greatly unpredictable in terms of return to play, the Broncos have indicated they expect him to miss the next two games.

 

Rory Kostjasyn

Very unfortunate to hear Nathan Brown say it was highly unlikely Kostjasyn will ever play for the Knights, suggesting retirement is on the cards. Kostjasyn copped a stray elbow at preseason training which fractured his cricoid cartilage and dislocated his vocal cords, and whilst initially was expected to return early in the season this is looking to be too dangerous in such a heavy contact sport. Thoughts go out to him

 

Greg Inglis and Matt Scott

Great to see both Inglis and Scott start running in the past few weeks as they both rehab from ACL reconstructions. Both are at around four months’ post-surgery, and whilst there is a small chance they could return for the World Cup I would say they will be aiming to be fit and ready for the start of the 2018 season.

 

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook.

 

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

 

Round 11 Injury Wrap-up

Returning from injury

Johnathan Thurston

Determining whether Johnathan Thurston is fit to return from injury in Origin 1 is one of the most challenging issues any medical staff would have to face. It is obviously of vital importance to get this right, as a return too early can result in further/more severe damage and a much longer stint on the sidelines. As Thurston himself has indicated, if he returns too soon his partial tear (grade 2) can quickly turn into a complete rupture (grade 3) and result in a 6-month recovery process, effectively ending his season. Whilst it can’t be guaranteed that he will not injure or re-injure himself when he does step out onto the field, there are a number of factors and guidelines that can ensure the risk of returning to footy is acceptable. These are often assessed in 2 main categories; physical and functional.

The number one priority in this whole process is the health of the player. There may be external pressures coming from the coach and even from Thurston himself, but it is the job of the medical staff in consultation with these parties to indicate when an injury is sufficiently healed and stable for a safe return. This is part of the physical assessment. Pain would seem to be the most obvious indicator; this is not always the case. The absence of pain does not always signify adequate healing of an injury, which is why it is important for the medical staff to be aware of the expected healing and recovery times of all tissues and structures affected by an injury. Pain is also a subjective measure, meaning what Thurston deems as “painful” can be extremely variable when compared to other players. As well as pain other physical factors such as muscular strength, tissue/bone healing, joint stiffness, swelling and range of movement need to be assessed and compared to pre-injury measures. Thurston has indicated in interviews this week he is still suffering pain and does not have full range of movement or strength, but with his history of shoulder problems this may not be far from normal. Individualised assessment and management is key, and another indication of the challenging nature of the return to play decision.

Even if a JT is cleared in his physical assessment prior to Origin 1, using this in isolation without including a functional assessment is fraught with unnecessary risk; both of re-injury and poor performance. A functional assessment would be heavily based on the physical nature of rugby league, as well as the position Thurston plays on the field. It will be essential to try and replicate the challenging components of the game Thurston will face when he plays; so tackling as well as being tackled are of great importance. It is the purpose of these tests to put his shoulder under the stresses it will encounter during an in-game situation and see if it handles this without aggravation. Fatigue is also important to assess, as it is often under fatigue muscular injury will occur (his current injury occurred in the final 15 minutes of the Test match 4 weeks ago).

In an ideal world rehab would return a player to equal to or better than preinjury levels in both physical and functional testing. However, it is often unrealistic to expect a player to be at 100+% returning from an injury. For example, many players return from ACL reconstructions in the 6-9-month range, which evidence shows still holds an increased risk of re-injury. Long term health will be considered along with short term benefits, and Thurston must always be fully informed of any risk he is taking by returning before reaching full fitness. Although the decision is ultimately Thurston’s, many cases will still require medical clearance from the team Dr, and with the history and severity of his injury this will likely be the case. Thurston’s return to the field will be a natural progression in his recovery rather than a time-determined event, and hopefully it will involve no further time on the sideline in an already interrupted season for JT.

James Graham

Everyone thought “interchange rort” when Graham came from the field after a tackle with his head in an awkward position caused him to clutch at his right arm. This was likely due to a nerve injury that originated in the right side of his neck (stinger/burner). He was able to stay on the field momentarily before being taken off for a HIA. This was definitely the right call, as the mechanism of injury involved both trauma to the head and whiplash in his neck; both are common causes of concussion. Provided he passes through concussion protocols he should be fine to play this week

 

Bryce Cartwright

Bryce Cartwright suffered a lateral meniscus tear after hyperextending his knee in the Panthers’ game on the weekend. He will be visiting an orthopaedic specialist this week to see if surgery is required. Meniscus is the cartilage that sits between your thigh and shin bone that provides stability and shock absorption to your knee. Blood supply to the meniscus is limited, and to avoid surgery Cartwright’s meniscus tear will need to be minor and preferably located in a section on the outer rim of his lateral meniscus where blood supply exists. In rare cases this could allow for the tear to heal naturally and result in a return over the next 2-3 weeks. However, if the tear is in an inner section of the meniscus, or significant in nature in any location within the meniscus, surgery will be required. There are commonly 2 types of surgery used for meniscus tears:

  • Meniscectomy (trim) – removal of the torn portion of meniscus to decrease symptoms, leaving as much of the normal meniscus as possible. 4-6 week recovery
  • Meniscal repair – stitching the torn meniscus back together, used to preserve as much of the meniscus as possible. Is often said to be a better long term option, but recovery is 4-6 months

We will no doubt hear which option Cartwright has opted for in the coming days.

 

Latrell Mitchell and Nathan Brown

Mitchell was struck in the sternum, which is sensitive and can make it extremely painful to breathe and rotate (turn). Provided there is no structural damage (this appears to be the case with Mitchell) he should be fine to play this week. It will be a pain tolerance issue so he may play with pain relieving injections or padding to assist him. Similarly, Nathan Brown suffered a direct blow to his ribs, which caused severe pain and he was even taken to hospital to assess for further damage. There has been little to no information from the Eels about Brown’s injury (he was not even included on the injury report), so it is likely his injury involved minor damage to his rib cartilage. Like Mitchell’s injury this is often a pain tolerance issue, so he should be able to play this week.

 

Peter Wallace

Wallace suffered a grade 2 abductor (groin) strain and has been given a 4-6 week return date by the Panthers. He has been undergoing treatment in a hyperbaric chamber over the past 48 hours, which is used in an effort to increase the supply of oxygen to the injured tissue and speed up recovery. Some players have returned from this injury having only missed 2 weeks of footy, so I am confident Wallace’s goal of a 4-week recovery is achievable.

 

Michael Jennings

Jennings has been ruled out for the next 4 weeks with a quadriceps strain. With that timeline he is likely looking at a grade 2 injury which usually falls in the 4-6 week range for return to play.

 

Andrew McCullough

After quite significant trauma to his head, McCullough seemingly lost consciousness and was seen gasping for air. This was quite confronting, and it took quite a while for him to leave the field on a medicab. As he left the field he was not put in a neck brace, but rather his neck was manually stabilised by the club Dr. This practice is now the norm after a report from the Australian Resuscitation Council was handed to the NRL last year recommending against the use of a cervical collar (neck brace). It was found that the benefits of wearing a cervical collar were outweighed by the risks, such as increased pressure inside the skull, pressure injuries and pain/unnecessary movements. Another point to consider with McCullough’s case is trying to grade or predict a concussion prognosis in the early stages of injury is no longer an accepted practice. Wayne Bennett was quoted after the game stating “You don’t see those occasions have too many great consequences apart from a bit of a headache and loss of consciousness”. Whilst he no doubt had the best of intentions, this statement was used prematurely and only downplays the unpredictable nature of mild traumatic brain injuries. The severe traumatic blow along with McCullough’s symptoms immediately post match are not indicative of the path his concussion injury would take.

To use an excerpt from an article I wrote earlier in the season:

Concussions used to be graded, but as more has been discovered about the course of symptoms and risk of long term complications these grading systems have been abandoned in favour of more individualised management. Many grading systems centred on loss of consciousness (LOC); if the athlete suffered LOC they were considered to have a higher grading concussion than those that did not. But medical professionals were finding LOC did not determine length of recovery. Athletes who were knocked unconscious sometimes recovered quicker than who did not lose consciousness at all. When making decisions about return to footy for players suffering concussion clinicians will treat each case individually, using tools to assess the clinical signs and symptoms, cognitive dysfunction and physical deficits.

McCullough has been ruled out for this week’s game, and the question many will want an answer to is “how long will he be out for?”. This is quite impossible to answer at this stage. It will be in the hands of the treating doctor, and with the unpredictability of concussions it would even be difficult for them to produce a definite timeline.

 

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook.

 

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

Round 10 Injury Wrap-up

Injury tests on the field – Corey Norman

Occasionally coaches do give an indication of the suspected diagnosis of an injured player post game. When asked about Corey Norman’s injury Brad Arthur said he thought it was a “grade 2 medial” and that the recovery time was “maybe 4 weeks”. This is actually quite accurate if the suspected diagnosis is confirmed, but how did Arthur know these details when Norman was not able to get scans until Monday? There are many tools used to assess an injury on game day, with one of the most important being the physical examination.

Any player who has suffered an injury on the field should be assessed by a member of the medical staff quickly, either on the field or if severe enough in the dressing sheds. It is ideal for this to happen quickly as muscle guarding (tensing) can set in around an injury and interfere with the physical examination results. Initially the player may be asked some questions about the mechanism of injury, and particularly with the knee this will often revolve around contact. If the injury was non-contact, knowing he position of the joint or limb is relevant. For contact injuries it is important to know the location and direction of force.

The on field testing usually includes some/all of the following:

  • looking for bony deformities or a loss of skin integrity which could indicate fractures or dislocations
  • sensation/strength/pulse testing to assess nerve or vascular involvement
  • range of movement tests (comparing to the uninjured side)
  • special tests assessing ligament laxity (looseness), isolated muscle strength, cartilage integrity/damage, and neural sensitivity (some of these test will be performed on the sideline/in the dressing sheds as a more controlled setting is preferable)

Accurate and comprehensive physical testing done on field can give valuable information on the location and severity of an injury. Making a decision regarding if the player is fit to return to play is of vital importance, and information from these tests allow the medical professional to protect the short and long term health of the player.

For Corey Norman, it was shown that the trainer was performing a valgus stress test on his knee to test the laxity (looseness) of his medial collateral ligament (MCL). Many skilled/experienced medical professionals will be able to gain a fair idea of the severity of an MCL strain with this test by observing the amount which the joint line opens on the inside of the knee when pressure is applied to the outside. In this case the valgus stress test (and other signs/symptoms) would have given the medical staff a suspected diagnosis to pass onto Brad Arthur, which will either be confirmed or altered (damage to other structures?) pending scan results in the next few days. The video below shows on field testing performed on Norman (MCL), Greg Inglis (ACL) and Lachlan Fitzgibbon (meniscus).

These early indications for Norman suggest an approximate four week recovery time, and the majority of grade 2 MCL injuries in the NRL cause 2-5 missed games. Some recent examples of grade 2 MCL injuries and recovery times include:

James Segeyaro (2015) – 3 weeks

Sam Perrett (2014) – 5 weeks

Paul Gallen (2013) – 4 weeks

 

Tom Trbojevic

Considering the traumatic injury mechanism for Trbojevic, 6-8 weeks is considered good news and was almost best case scenario after he was tackled mid-air and came down heavily on his right leg. With this recovery time frame scans likely revealed a grade 2 syndesmosis injury and grade 1-2 MCL sprain. Neither of these injuries will require surgery which is a big relief for Trbojevic and the Sea Eagles. If he had suffered further damage to his syndesmosis (a grade 3 injury requiring surgery is a 12-14 week recovery) or to other ligaments in his knee (ACL rupture is 6+ months recovery) this would have likely ended his season. Trbojevic had surgery in the off season on his right ankle, so this new injury is to his “good” ankle.

 

Lachlan Coote

Coote appeared to roll his ankle in the last minute of the game last week. Paul Green was quoted after the game clearing Coote of injury, and with the video of the injury mechanism not appearing severe I would expect him to be fine for this week’s game.

 

Jarryd Hayne

Hayne copped a blow to the outside of the knee, causing his foot to “go dead” and him struggle to run. This was likely due to the trauma causing injury to the peroneal nerve, or the “funny bone” of the knee. The peroneal nerve works to pull the foot upward and outward, and runs very close to the skin near the knee. If the traumatic blow occurs near the nerve it can cause pins and needles, weakness, numbness and in severe cases foot drop (where the foot cannot be lifted to clear the ground when walking). These are often short term injuries, and the Titans indicated Hayne was “80% right” by post match. Barring any aggravation at training this week he should be fine for round 11.

 

Euan Aitken, Simon Mannering, James Fisher-Harris

Aitken, Mannering and Fisher-Harris all suffered hamstring injuries last week. Mannering and Fisher-Harris both are reported to be minor (grade 1) strains, which usually carry a 2-4 week recovery. Aitken has unfortunately suffered a grade 2 hamstring tendon strain. Tendon injuries tend to have a slightly longer recovery than muscles in the hamstring, and he will be looking at 6-8 weeks on the sideline.

 

Dan Sarginson and Chris Grevsmuhl

Interesting to note for shoulder dislocations, the prognosis (likely course of injury/recovery time) is not always obvious right away. For Grevsmuhl, it is now three weeks since he dislocated his shoulder and the Titans are still letting the injury settle before deciding on conservative (rehab/physio) or surgical treatment. As indicated last week, scan results don’t always tell the full story so it is important to assess function and pain thoroughly. For Sarginson, even a “clean dislocation” (popped out and straight back in, no major damage) will still require 2-4 weeks’ recovery. If there is labrum (cartilage) or extensive rotator cuff damage and surgery is required, the recovery time extends to 4-6 months.

 

Ryan Simpkins

There has been no confirmation for the Titans yet, but considering the non-contact mechanism of injury with valgus (knee collapses in) force it is highly likely Simpkins has suffered an ACL rupture. If so he will undergo reconstructive surgery and return in 7-12 months time (pending ACL graft type).

 

Solomone Kata

Solomone Kata only played 70 minutes for the Warriors before coming off with a suspected calf strain. No official word on severity yet, but he has been ruled out by Stephen Kearney for this week and by video looked minor (grade 1) which usually involves a 1-3 week recovery.

 

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook.

 

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

Rep Round Injury Wrap-up

The importance of scans – Johnathan Thurston

 

“We’ll wait for the scans”.

Almost every potentially serious injury during a game of NRL is followed by this statement post match from any one of the coach, medical staff or team mate of the injured player. Often we are provided with an idea of what the player may have injured (“he’s done a shoulder”) without too much detail. The agonising wait then begins as the player, team and fans all brace for the scan results.

These results can provide answers to three very important questions:

  1. How long will the recovery be for the player?
  2. When they return, how limited will they be?
  3. 3) Do they have a high risk of re-injury?

 

There are three main types of scans used in the NRL:

  1. X-Ray: to keep it simple, they look at the bones. Most fractures/joint dislocations can be diagnosed using X-rays.
  2. CT: Essentially thousands of X-rays taken from different angles. Quite common after a blow to the head to look for signs of a bleed within the skull. Allows radiologists to examine bones (particularly of the spine and skull) in much finer detail
  3. MRI: Best used for examination of soft tissues (ligaments/tendons) as well as cartilage. MRI’s are quite complex, and diagnosis can often not become clear from the imaging alone. Second opinions, repeat imagine and further physical examination is sometimes required, and this appeared to be the case with Thurston.

 

Medical staff will often be fairly confident post game of the nature of injury the player has suffered, as they will perform any number of orthopaedic/physical tests and be aware of the injury mechanism. But it is not until the scan results come back that a specific diagnosis and time frame is provided by the club. It would be easy to assume that the bottom of Thurston’s MRI report reads “grade 2 rotator cuff strain, 4-6 weeks out”, but this is not the case.

Reports containing scan results will not include recommendations on a player’s recovery time; it will provide information on the location and severity of injury whilst ruling out potential damage in secondary (surrounding) structures. Whilst the scan results are a vital part of determining the recovery time frame, other factors such as function, pain, physical exam testing, past history and associated injuries are always part of the equation. It is problematic to make time-fame recommendations based on scan results alone, which is why it can take anywhere from a couple of days to a few weeks after the scans have been performed for recovery details to become available.

With Thurston’s extensive history of shoulder problems, if he had scans of his shoulder in a “healthy” state, say a week ago, he would have had considerable scar tissue from past injuries/shoulder reconstructions which makes diagnosis of a new injury complex. Thurston had his shoulder scanned on Saturday (with the images available that morning) but needed to wait for a review with his specialist on Monday to determine the full extent of the damage.

That’s why it was premature to treat any reports on JT’s recovery time frame that came through on Saturday as gospel, and also why his time on the sideline may not be set in stone just yet. The first two weeks of rehab are extremely important for a complex injury such as this. If he responds well to treatment over this time I would expect Thurston to miss somewhere in the 4-6 week range, which will have him return for the Cowboys in Rd 13-15 and possibly be fit for Origin II.

 

Josh Dugan

Dugan suffered a depressed fracture (when a portion of the skull “sinks” in) of his cheekbone in the Test on Friday night. When a fracture becomes depressed it will always require surgery, however this does not always mean considerable time on the sideline. Surgery can often decrease the time on the sideline, and this is no doubt the case with Dugan as he is only predicted to miss 3 weeks.

 

Aaron Woods

The “wishbone” tackle Woods was on the receiving end of resulted in a suspected grade 2 hamstring injury, ruling him out from what he states as “4-8 weeks”. With that timeframe suggesting a grade 2 strain, it is likely his recovery will fall in the 4-6 week range unless he suffers an early setback with rehab.

 .

Josh Reynolds

Whilst initially being reported as a grade 1 hamstring strain and 2-4 weeks out, it was revealed today Reynolds will be expected to miss five weeks of NRL action for the Bulldogs. This would suggest either more significant damage was found in Reynolds’ hamstring, or he responded poorly to rehab in the first few weeks resulting in a revised recovery timeframe.

 

Nelson Asofa-Solomona

NAS suffered a fractured metacarpal in his hand which required surgery, ruling him out for 4-6 weeks. The metacarpal is a long bone that makes up the palm of the hand. Similar to Dugan, the plates and screws inserted during surgery can often mean a quicker return. There have been cases of players with this fracture returning in 2-4 weeks, so he will be one to watch for a possible early return over the next month.

 

James Roberts


After copping a direct blow to his knee, Roberts collapsed to the turf of Suncorp Stadium and had to be carried off the field. This ended up being a surprising injury source, as Roberts had in fact rolled his ankle when his knee was hit from the inside. This was a surprise to everyone (me included), as even the trainer had performed tests on Roberts’ knee when he rushed to him on the field. This is likely because the blow to the knee caused considerable pain initially (contusion/cork), but as this had not caused any significant damage it wore off and he was left with the considerable lateral ankle pain. Roberts was cleared of fractures, and the soft tissue damage to his ankle will only hold him out for 2-4 weeks. Like all players listed here the rep round came at the right time for Roberts, and he should be back in the next week or two for the Broncos.

 

Gareth Widdop

Just an update from two weeks ago, Widdop’s scans came back revealing “significant” damage to his MCL and a 6-week timeframe for recovery. As he was able to stay on the field (albeit momentarily) when he suffered the injury this could suggest a grade 2 injury (as opposed to a grade 3/complete rupture). Many grade 2 MCL sprains return in the 2-4-week range, but Widdop will only just be coming out of a knee brace this week. I would not be surprised to see him return sooner than the initial six week reports.

 

Shannon Boyd

Shannon Boyd was cleared of a fracture in his leg, however did suffer some soft tissue damage. Grade 1 strains usually involve a 2-4 week recovery, and Boyd is expected back between Rd 12-13.

 

David Nofoaluma

Unfortunately there have been no concrete reports on Nofoaluma’s injury, just that the Tigers’ will monitor how he responds to treatment. His status will of course become clearer when team lists come out this Tuesday, but it was a good sign he was able to play through the injury for the full 80 minutes two weeks ago.

 

Christian Welch

Unfortunately for Welch from the first viewing of his injury mechanism the news was not going to be good. Non contact, changing direction and knee injuries do not go well together and he unfortunately ruptured his ACL. He will have reconstructive surgery and be out for the rest of the 2017 season.

 

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook.

 

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

Round 8 Injury Wrap-up

Which club has been most affected by injury/suspension?

When an important player misses time due to injury it will affect a team’s performance. Some team’s win/loss ratio changes drastically if a star player is in or out of the line-up that particular weekend. I looked into 10 important players from each team for each season over the past three years. What percentage of games were those 10 players able to play in each season to help their team win the premiership? The results:

I tried to take into account mid-season transfers, as well as giving players credit for games missed due to Origin duties. Now this isn’t perfect; I picked those 10 players subjectively. So even though I tried to stay as neutral with my opinion on players as possible, there will be slight bias there. Nonetheless I think it gives an interesting insight into how losing an “top” player can affect each team, and how going through relatively injury free can be of great benefit. To touch quickly on the high and low:

 

The Low – Penrith 2015

Just a disaster of a season for Penrith injury wise. Jamal Idris (ACL, missed 18 games), Brent Kite (broken leg/shoulder injuries, missed 18 games and retired midway through season), Matt Moylan (foot ligament damage, missed 13 games), Josh Mansour (MCL tear, missed 12 games), James Segeyaro (MCL tear, missed 9 games), Jamie Soward (back surgery, missed 8 games), Peter Wallace (ACL, missed 11 games) and Dean Whare (multiple injuries, missed 11 games) all spent significant time on the sideline due to injury. This was with players like Nigel Plum (concussions, retired mid season) and Dallin Watene Zelezniak (collapsed lung, missed 6 games) not included in the analysis! No other team has come close to numbers like this in the past three years, and the Panthers still managed to finish in 11th place.

 

The High – Cronulla 2016

With few clubs scoring above 90% for a season, I don’t think it’s any coincidence the Sharks claimed their maiden premiership in the same year there was a 97% play rate from 10 of their top players.

 

I am by no means saying this is the sole reason the Sharks were Premiers last year, but having such stability in their line-up with a talented group of players would have been a significant factor.

It is also worth mentioning the Cowboys here; to have back to back seasons above 94% in 2015 and 2016 no doubt contributed to their success in this time.

 

Injury Roundup for Round 7 and 8

Ben Hunt

Ben Hunt has returned to light running as he continues his rehab for a grade 2 hamstring strain. With the rep round effectively giving him a “free week” of recovery, I would expect round 10-11 to be a realistic return for him. That would be a 5-6 week recovery

 

Gareth Widdop

Widdop has a suspected “moderate to high grade” MCL sprain, with scans to confirm on Wednesday. These scans will also be used to rule out any further damage (eg meniscus), but if the MCL damage is isolated the approximate recovery times for MCL sprains are as follows: Grade 2: 2-4 weeks, Grade 3: 4-8 weeks

 

Brad Takairangi

Takairangi went down with a suspected PCL injury in the Eels match on the weekend. At the time of writing scan results are unavailable, but hopefully these come back with no other structural damage to the knee. It has been said his expected time out will be 4-6 weeks, which would correlate with a grade 2 PCL sprain.

 

Chris Grevsmuhl

Grevsmuhl suffered a dislocated shoulder which by reports was relocated quickly and smoothly by the medical staff. This is a good sign, and if he did not suffer any further damage (labrum(cartilage) or rotator cuff tear) his return should be in the 3-6 week range. If there is further damage this can involve surgery to repair and recovery time extends to months on the sideline.

 

James Segeyaro

On his first tackle of the Sharks’ round 6 game Segeyaro fractured his radius (forearm bone). Unfortunately it was in the same location as the fracture he suffered in the 2016 season (from which he still has a metal plate in his arm). Segeyaro had surgery 2 weeks ago, and his recovery should be 6-8 weeks. I would expect him back after the Sharks round 13 bye.

 

Darcy Lussick

Lussick suffered a fracture in his elbow which he claims was from a collision with Jake Trbojevic’s head. He did not require surgery, and a 4-6 week recovery will have him aiming for a round 10 return.

 

David Bhana

David Bhana is suspected to have suffered one of the most gruesome injuries to happen on a rugby league field; a dislocated knee. Different to a dislocated patella (kneecap), a dislocated knee involves a dislocation of the tibia (shin bone) and the femur (thigh bone). This injury comes with ruptures of the ACL, PCL, MCL and often other damage as well. Bhana had the first of a two-part surgical reconstruction of his knee this week, and although this injury can be career ending it is possible to return in 12-24 months. Good luck to Bhana with his surgery and subsequent recovery.

 

Jamie Buhrer

Reports came out late last week that Buhrer had suffered a foot fracture at training and would be out 6-8 weeks. There was no detail given on which bone in his foot he fractured (of which there are 26), but with a 6-8 week recovery timetable it is unlikely he required surgery.

 

Mitch Barnett

Barnett had a fairly unique injury mechanism, as he was falling to the ground his foot was forced into end of range plantar-flexion (foot pointing to the floor). This can cause impingement (pinching) of structures in the ankle, or can also sprain the ligaments at the top of the ankle. It has not been reported as yet the specific source of Barnett’s injury, however he will require surgery and is looking at 6-8 weeks on the sidelines.

 

Tevita Pangai Junior

TPJ was initially thought to have only suffered a broken finger, however scans revealed damage to his flexor tendon that runs on the palm side of his finger. This is a much tougher injury to recover from, and has required surgery to repair. Depending on the severity of injury and where along the tendon this has occurred (mid tendon, or where the tendon attaches to the bone) TPJ will be looking at 8-12 weeks on the sideline. Scott Bolton suffered a similar injury in 2015 after cutting his flexor tendon whilst fishing, and with this being a simple repair he was able to return in 8 weeks (but with only 40% range of movement on return).

 

Ryan Matterson

Matterson looked like he was “shot by a sniper” getting back into the defensive line 2 weeks ago. By video this was a high ankle ligament sprain which was later confirmed by reports from the club.  The degree of injury was less than initially expected and Matterson should only spend 4-6 weeks on the sidelines

 

Tim Grant

Tim Grant suffered a nerve traction injury when James Graham’s hip drove into the soft tissue between Grant’s neck and shoulder. If the force is significant enough this can cause injury to the nerves (brachial plexus) that run into the armpit and all the way down the arm. It was initially confused with a wrist injury by some, as an injury to the brachial plexus can cause painful symptoms down into the arm and hand. When you hear of a player suffering a “burner” or “stinger” in their shoulder this is a mild form a brachial plexus injury which players often miss no time for. The more severe injuries to this area can cause tearing/rupturing, and this is a much more significant recovery process (think Simon Dwyer). Grant has been named for this week however, so hopefully his is a mild case.

 

Peni Terepo

Terepo suffered a “torn pec” when he collared James Tedesco late in the round 6 game. Like Buhrer and Barnett the club has not given much away, but with a reported 16 week recovery timetable it is likely he has ruptured his pec tendon and has required surgery to repair it. Pectoral muscle tears rarely require surgery or a recovery timeframe upwards of 4 months.

 

Jordan Kahu and Adam Reynolds

Minor soft tissue strains for Kahu (groin) and Reynolds (hip flexor) ruled them out of Round 7. With both players required to explosively change direction and accelerate (and to a lesser extent goal kick for their sides as well) it was smart for them to sit out with strains to muscles used extensively during these actions. After being named for Roundd 9 I expect them both to be fine for this week.

 

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook: https://www.facebook.com/nrlphysio/

 

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

Round 6 Injury Wrap-up

He’s just “injury prone”…

When a player is labelled as “injury prone”, what does that actually mean?

Obviously a player who misses large parts of each season due to injury will be given this tag. But are some players more prone to injury than others? How many games do they have to miss/injuries do they have to suffer before they are labelled injury prone? Can a player not miss many games and still be injury prone? Some players seem to get injured more than others, but it isn’t always easy to identify those at higher risk of injury.

When discussing injury prediction there are a few factors that can have some influence:

  • Past injury in the same area (most significant predictor, scar tissue/weakness/overuse)
  • Poor strength/conditioning
  • Poor technique/biomechanics (particularly in sports with repetitive movements)
  • Genetic/hereditary factors (poor bone density, collagen production)
  • Overly stiff or lax (loose) joints
  • Poor reaction time
  • A tendency to take chances or put yourself in a position to get injured (little hesitation)
  • High pain tolerance (more likely to play through pain)

 

The list could go on, but even being able to identify these factors in a player it is extremely difficult to quantify the likelihood of future injury.

When first looking into this I put the question out to Twitter and Facebook: past or present who comes to mind when talking about the most injury prone NRL player?

Suggestions came in fast, with some players gaining several nominations quite quickly. I decided to look into the stats (not my area of expertise so apologies in advance for any calculation errors) of the most commonly suggested players. I tried to include suspensions where obvious and took into account reserve grade stints where I could find accurate reporting. Origin players were given a 1.5 game discount for every 3 Origins played (usually an player will miss 1-2 club games a year due to Origin duty or rest post Origin).

 

The “leaderboard” is below:

Player Games % played
Brett Papworth 7 of possible 66 11%
Kyle Stanley 46 of possible 131 35%
Ben Henry 52 of possible 120 43%
Tim Moltzen 90 of possible 180 50%
David Woods 160 of possible 293 54%
Adam MacDougall 195 of possible 355 55%
James Tedesco 74 of possible 126 59%
Terry Campese 139 of possible 216 64%
Justin Hodges 251 of possible 370 68%
Manu Vatuvei 226 of possible 325 69%
Brett Stewart 233 of possible 332 70%
Brent Tate 229 of possible 328 70%
Nathan Peats 103 of possible 144 72%
Steve Matai 230 of possible 309 74%
Josh Dugan 142 of possible 192 74%
Jarrod Mullen 211 of possible 275 76%
Paul Gallen 286 of possible 366 78%
Adam Reynolds 118 of possible 134 88%
Johnathan Thurston
(Cowboys years)
269 of possible 302 89%
Cameron Smith 341 of possible 362 94%
Jarrod Croker 195 of possible 205 95%
James Maloney 189 of possible 193 98%

* Note: Cameron Smith, Jarrod Croker and James Maloney were included as “durable” players over the past few years for comparison)

 

This obviously is fairly heavily weighted to those who have suffered season ending injuries; ACL’s, shoulder reconstructions etc. But I guess that is what I wanted to look at, should a player who has suffered 1-2 season ending injuries be considered more injury prone than another who has had countless soft tissue strains throughout their career? I had often looked at Jarrod Mullen as injury prone; any time he hit full pace I worried his hamstring could go at any moment. Manu Vatuvei was another, he has been amazing to score 10+ tries in so many season for the Warriors. Yet I felt he could always find a niggling injury each year. 2 of the most nominated players were Dugan and Matai, and whilst 74% is nothing to brag about for their supporters I’m sure most of us expected that figure to be lower.

Ask any physio or team Dr and they will tell you there are players who are more likely to get injured than others. But ask them to identify these players in their team and I doubt you would get many definitive answers. Medical staff need to rely on players to accurately report symptoms that may not be obvious externally, which doesn’t always occur. It has long been a badge of honour in the NRL to play through pain without complaint. But as the professionalism in the game has increased players are realising the importance of trusting in the medical staff at their disposal.

I have always found accurate information on the severity of a player’s injury, how their recovery is progressing and when they are due back on the field is hard to come by. A player will often predict they will be back before even the earliest estimates. A coach can give little to no information at all, or may oversell the severity of an injury so when a player recovers it is an “early return”. Teams can be aware of an issue that could increase a player’s injury risk (e.g. lingering tightness/weakness, joint stiffness, poor conditioning), but punters/fans and even reporters/media analysts are often none the wiser.

That’s what makes injury prediction so difficult, and almost impossible, particularly for anyone not directly involved with treating the player. The biggest predictor of future injury is previous injury, so it makes sense that a player who has been injured recently could be at higher risk of injury now. But if he has recovered completely often the risk isn’t that much higher than that of any NRL player running out on a given weekend. Whether a player is considered “injury prone” really comes down to each individual’s criteria for the label, but be careful not to use it as a vague term reacting to a player’s recent injuries rather than examining how the player was injured in the first place.

 

Injury Roundup

Johnathan Thurston and Lachlan Coote

 Embed from Getty Images

JT suffered a grade 1 calf strain on the weekend and is expected to be out for 2-3 weeks. As I wrote with Lachlan Coote a few weeks ago, this is not an injury you want to take chances coming back early from as it is very easily aggravated if not 100%. This has proven true with Coote as he is set to miss his second week after aggravating the injury in his first game back. The Cowboys will no doubt be cautious with Thurston particularly with what happened with Coote.

Bevan French

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French suffered a grade 2 PCL sprain at training last week and will be out for 4-6 weeks. He will not require surgery, as even grade 3 (complete rupture) PCL injuries often don’t require surgery. The PCL (unlike the ACL) has a great ability to heal itself, which is why even the most severe PCL injuries can recover in 6-8 weeks.

 

Ben Hunt

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Hunt suffered a hamstring strain on Thursday night that will reportedly keep him out for 6-8 weeks. This likely suggests he suffered a grade 2 strain, and may be in a location on the hamstring that requires a longer recovery (eg join between the tendon and muscle) as most grade 2 strains will fall somewhere in the 4-6-week recovery range. The hamstring strain, like the calf, is an injury that is easily aggravated if not 100%.

 

David Klemmer

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Klemmer suffered an ankle sprain which he was able to play through for 20 minutes plus in the game on the weekend. He has had scans that showed no major damage, and whilst he has not been named this week if the inflammation settles over the next few days he should be fit for the Bulldogs round 8 clash.

 

Rory Kostjasyn

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Is 1-2 weeks away from a return after having throat surgery to repair fractured cartilage and damaged vocal cords. He is yet to complete contact work at training; this will be his final test before gaining clearance to return to NRL action.

 

Jarryd Hayne

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Many reports have Hayne a chance of returning for round 8, however Tony Webeck from nrl.com has indicated Hayne is still only running on an anti-gravity treadmill. This is a treadmill that allows you to control how much of your body weight goes down through your legs as you run, a bit like running in a pool without the resistance of the water. This would indicate he is at least 2-3 weeks away from returning, as he would still need to complete rehab steps of normal running, direction change and simulated gameplay before considering returning to an NRL game.

 

Martin Taupau

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His diagnosis revealed today, Taupau has unfortunately fractured his ribs. As I said with Peachey last week, this is not a rib injury you can “needle up” and play through. A fractured rib poses a threat to the internal organs, so must be given time to adequately heal before a player can return to play. Taupau should fall somewhere in the 4-6 week recovery range, however as we have seen with Peachey this can be as quick as 2 weeks in rare cases.

 

Tyson Frizell

 Embed from Getty Images

Initially thought to have suffered an intercostal injury, a diagnosis of oblique strain is unfortunate for Frizell as this is often a tougher injury to recover from. He has been named to start this week which is a great sign and means he only suffered a grade 1 strain, however even grade 1 strains can linger for 2-4 weeks. Watch the training/injury reports for further clarification on his status for this week.

 

James Segeyaro

 Embed from Getty Images

Segeyaro fractured his forearm in his first tackle of the game on the weekend and played through it. Scans on Tuesday revealed a small fracture near the metal plate he had inserted the last time he fractured his arm in 2016 which cost him 8 weeks on the sideline. With initial scans being inconclusive, it would appear he did not suffer a large or complete fracture. Even though an injury around a metal plate can linger (see Bryce Cartwright) I would expect Segeyaro to return in 4-6 weeks.

 

As always if you have any questions, throw a comment down below or hit me up on Twitter @nrlphysio or Facebook.

 

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

Round 5 Injury Wrap-up

The NRL Physio is back for another week to give you the wrap up on injuries and recoveries from Round 5 of the 2017 NRL season.

The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.

 

What is the HIA?

The piece of the concussion puzzle that I have not yet covered; on field concussion recognition and the subsequent sideline Head Injury Assessment (HIA). It is very important to recognise a player does not have to lose consciousness (LOC, get “knocked out cold”) to have concussion. In fact, most lack a LOC so these tests/screens are vital in identifying instances of concussion in most cases

The Concussion Recognition Tool is used on field to help screen for possible instances of concussion. If a player shows one or more of the signs, symptoms or errors in memory questions on field it is the job of the trainer/club doctor to remove them from play and put them through the more thorough HIA.

Briefly, the Concussion Recognition Tool helps to assess:

  1. Visible clues of suspected concussion
  • Examples include LOC, lying motionless on ground/slow to get up, unsteady on feet, clutching at head, dazed look, confused
  1. Signs and symptoms of suspected concussion
  • Examples include LOC, seizures, balance problems, headache, dizziness, confusion, pressure in head, blurred vision, light sensitivity, neck pain, amnesia
  1. Memory function
  • Questions include:
    • What venue are we at today?
    • Which half is it now?
    • Who scored last in this game?
    • Which team did you play last week?

If a player shows one or more of these signs and symptoms and is removed from play, that does not mean they are ruled out for the rest of the game. They must then undergo the 15 minute HIA performed by the club doctor. This is the Sport Concussion Assessment Tool (SCAT3).

The SCAT3 must be performed within 15 minutes of the player being presented to the doctor. Initially the player must rest for 5 minutes, as this is when the test is most accurate, before starting the test itself which takes between 8-10 minutes. There are 7 main segments to the SCAT3:

  1. Glasgow coma scale (GCS) – an assessment of eye response (eyes opening), verbal response (not confused) and motor response (obeys commands) to give a score out of 15
  2. Maddocks score – Memory function questions similar to those performed on field (What venue are we at today etc)
  3. Subjective symptom evaluation (how does the player feel) – player is questioned on signs and symptoms of concussions
  4. Cognitive assessment – orientation (what date is it), immediate memory (given a list of words to remember), concentration (numbers/months in reverse order)
  5. Neck examination – range of movement, tenderness, strength and sensation of arms
  6. Balance examination – Player stands with feet together, single leg and tandem stance
  7. Co-ordination – player touches finer to nose/doctors finger in quick succession

If it is deemed after that examination that the player has suffered a concussion then that player is not allowed to return to the field of play for the remainder of that game. A great video on the HIA was put together by Channel 9 and Dr Ameer Ibrahim, Sydney Roosters chief medical officer.

 

Injury Roundup

Bodene Thompson

Thompson did not come back out after half time of the game on the weekend after aggravating an Achilles tendinopathy (tendonitis) injury he has been suffering from since the pre-season. A tendinopathy is an overuse injury that includes inflammation and micro-tears of the tendon. Your Achilles it the tough rope like structure that attaches your calf muscles to the back of your heel, and over time repetitive actions involved with running must have caused either inflammation or micro-tearing of Thompson’s.

Unfortunately this is not a problem that has a set X weeks recovery period. It is an injury that can linger for months, but can be managed quite well with exercises and training load modification. This may mean his game time is varied week to week. He could go the rest of the season with no issues, yet could also have an acute aggravation and spend a week or two on the sidelines. He has been named to start this week which is a good sign the pain and inflammation has settled well from the weekend.

 

Josh Dugan

Not much to report here, Dugan suffered a grade 1 hamstring strain on the weekend which will see him out for between 2-4 weeks. The main point I wanted to cover here is the reporting of a “grade 1.5 hamstring strain” by some media outlets. A grade 1.5 muscle strain does not exist; it is not even a shorthand or layman term. Grade 1+ is on rare occasions used as an unofficial way to indicate a higher end grade 1 strain, but the grading system is already very specific and does not officially include half grades.

 

Tyrone Peachey

Tyrone Peachey unfortunately fractured a rib in the past weekend’s game against the storm. This is different to Blake Ferguson’s injury (rib cartilage), as a fracture is more than a pain tolerance issue. A fractured rib poses a threat to the internal organs, so must be given time to adequately heal before a player can return to play. Peachey should fall somewhere in the 4-6 week recovery range.

 

Dylan Napa

Dr Ibrahim (the Roosters Team Doctor) has confirmed on Twitter Napa suffered a syndesmosis injury and could be out for up to a month. This indicates a grade 1 syndesmosis injury. Every time you take a step the tibia and fibula (lower leg bones) are exposed to forces that want to spread these bones apart, and the syndesmosis acts as a shock absorber to hold them together. These forces are only increased with running, and increased further still with cutting and jumping. Considering the alternatives (higher grade, possibility of fracture) this is a good result for Napa, and I would not be surprised to see him back sooner than four weeks.

 

James Roberts

James Roberts played through a hamstring strain on the weekend, which is something I have not seen done in the past. Usually a player with a muscle strain particularly of the hamstring or calf are removed from play due to the increased risk of further damage. He has been named this week but is yet to train, and there is no guarantee he will play with even the most minor of hamstring strains needing 1-2 weeks to recover.

 

Robbie Farah

Farah didn’t last long in the game on the weekend with back spasms. This can be either muscular in nature or due to a nerve/disc injury in his lumbar (lower) spine. No details have been reported on the source as yet, however Farah has been named to play this week and by reports should play. This would suggest it is purely muscular tightness/spasm (usually a quick return of 1-2 weeks), however if there is an underlying injury (disc/nerve) it would hold him out for 4+ weeks.

 

Tyrone Roberts

Roberts suffered a suspected PCL sprain/tear after hyper-extending his knee whilst landing. The PCL is a ligament inside your knee, like the ACL, that helps provide important stability to the knee joint. A general guideline for PCL sprain recovery:

  • Grade 1 – 1-4 weeks
  • Grade 2 – 4-6 weeks
  • Grade 3 – 6-8 weeks

Even with a grade 3 (complete rupture) PCL injuries often don’t require surgery. The PCL (unlike the ACL) has a great ability to heal itself, which is why even the most severe PCL injuries can recover in 6-8 weeks. The worry would be if any other meniscus or ligament damage is present, as functionally the knee is often very unstable and requires surgery to recover adequately.

 

Jake Granville

Granville believed he had only suffered a cork in the final moments of Friday night’s game, however scans have since showed a fracture in his fibula (outside lower leg bone). Recovery for this is usually in the 4-6 week range, and rarely has complications with the fibula being a non-weight bearing bone.

 

Sam McKendry

I wrote in more detail on Sam McKendry in the pre season, and I was shattered to hear he had to undergo season ending ACL reconstruction surgery last week. For those who missed it, McKendry suffered a partial tear of his ACL in his first game back from ACL reconstruction this pre-season. A partial ACL tear can sometimes avoid surgery if the knee is still functionally stable (doesn’t give way while running/changing direction). Unfortunately, this must not have been the case for McKendry, and he will now be aiming to be fit for 2018. Best wishes to Sam in his recovery.

 

As always if you have any questions, throw a comment down below or hit me up on Twitter (@nrlphysio) or on Facebook.