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Injury Updates 

Round 3 Injury Wrap-up

NRL Physio

The NRL Physio is back for another week to give you the wrap up on injuries and recoveries from Round 3 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.

 

Concussions (Again)

Well it seems I can’t go a week without concussion being a hot topic with plenty of questions to be answered. This week we saw three substantial fines handed down to the Titans, Knights and Dragons over their failure to follow the NRL’s concussion rules in the Round 3 games. All three clubs have indicated they will be contesting these fines.


Deciding what should or should not have happened in each of these incidents on the weekend is and always should be in the hands of the NRL and the club medical staff who are on the field/sideline. It is inaccurate to try and judge or diagnose concussion via video alone (except for loss of consciousness, which I cover later) and is best left to the treating medical staff who can assess player’s symptoms first hand.
However, some concussion issues I have yet to cover did arise so thought I would address them here.

 

If a player is knocked unconscious, do they suffer a concussion?

100% yes, every time. A concussion is a temporary loss of brain function, which is exactly what happens if a player suffers loss of consciousness. This is the one indicator you can use to accurately predict if a player has suffered a concussion or not via video. It is usually not hard to spot a player who has been knocked out cold, with the biggest indicators being their bodies going limp and not bracing for impact when they fall. It is that definite that a player who has been knocked unconscious is not allowed to return to the field of play for the rest of the game.

 

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Can a blow to jaw cause concussion?

There have been a few instances of players/coaches attributing suspected concussion injuries to the “just the jaw” in the past few days. Whether or not this was the case for them, I think it is important to point out that trauma to the jaw can absolutely cause concussion. There are three common injury mechanisms that can cause concussion. They are:

  1. Traumatic impact directly to the head
  2. Sudden acceleration or deceleration of the head (whiplash)
  3. Impact to the lower jaw

Blows to the lower jaw can drive this bone up and back, creating a transfer of traumatic forces to the base of the skull. It is often estimated that 70-90% of athletic concussions resulting in unconsciousness are caused by blows to the lower jaw.

The use of mouth guards is often pointed to as a preventative measure against concussions; this has little evidence. The protective effect of a mouth guard is limited to forces applied in a vertical nature only. With the majority of blows to the jaw in rugby league arriving from the front and side, they carry significant horizontal forces which are not protected against by mouth guards.

 

Is there a need for an independent doctor/head trauma specialist?

I can see it only being a matter of time until this is a reality. The NRL has such an investment in the duty of care of the players, and having an independent medical specialist on the sideline (preferably) or in the bunker (acting as a spotter) only seeks to promote this. The main argument against this is that the club doctor’s know the players’ personalities so would be able to tell if a player is showing concussive symptoms/acting different to normal. This has some merit, but the ideal scenario would have both the club Dr and independent medical specialist to working together for the maximum benefit of the player. The best of both worlds.

 

What if a player is just “lying down/milking it for a penalty”?

Medically I don’t have much to offer to this question. I am sure simulation happens on the footy field, and it is the role of the on field medical staff to determine if the way the player is acting is deliberate or the result of a concussion. This is one problem I think will be solved through the use of an independent doctor, as if they see any “signs or symptoms” of concussion they will pull the player from the field whether they are faking it or not.

Why do players have to go off for 15 minutes?

This is all to do with accurately assessing and diagnosing potential concussion symptoms. When a player is removed from play, the HIA cannot begin until a player has had five minutes rest. During this time the medical staff will review a video of the incident. Then the HIA itself takes between 8-10 minutes.

 

Should there be a five man bench to allow concussed players to be replaced?

I thought Nathan Brown raised some really good points on the weekend, as duty of care should not just be afforded to players who have suffered head injuries. If a player suffers a serious knee injury, but there has been three of his teammates ruled out for the day with concussion, he should not have to stay on the field and risk lifelong damage because there is no specific rule saying he must come off. I think this must be limited to players ruled out with concussion only; it could be easily used by teams to gain a competitive advantage if it was allowed for any injury. A lot of tired players would suddenly suffer late game hamstring tears that miraculously recover by the following week. But for instances of concussion I think the use of an 18th man will only promote duty of care being upheld for all players.

 

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‪Muscle strain vs tear, what is the difference?‬‬

‪With the muscle injuries piling up, the reporting in the media is quite varied in how these injuries are described. The most common variance is the use of strain, tear and rupture to describe a muscle injury.‬‬
‪All muscle strains (Grade 1-3) involve some tearing of fibres. A general guide is:‬‬

‪Grade 1: damage to <5% muscle fibres (micro-tearing), 1-3 weeks recovery‬‬
‪Grade 2: partial tear of muscle (more fibres) 3-6 weeks recovery ‬‬
‪Grade 3: complete rupture of all fibres, 6+ weeks recovery and often surgery ‬‬

‪With this information in mind, the term “strain” more accurately describes the mechanism of injury, whereas “tear” describes the structural injury to the muscle fibres‬. ‬

In terms of how it is reported, I have found that commonly in footy circles “tear” can be used to describe Grade 2+ injuries (more severe strains). However this isn’t the case all the time, so the most accurate reporting is when a grading of the injury is provided.

 

Quick injury hits:

Kaysa Pritchard – lateral ankle sprain, looked a pretty significant mechanism at the time. Has been named this week, and if he has escaped with only a grade 1 sprain, usual recovery is 0-2 weeks so he could be a chance.


Kieran Foran – has been named this week to return after a shoulder reconstruction last year. The line has been rolled out many times “he just has to tick a couple of boxes”, but what are these boxes? Firstly there would be tests he would have to complete that show adequate strength and stability in his shoulder without pain. Then contact during controlled (pads) and uncontrolled (simulated game play) settings. After such a long rehab process it would be preferable for Foran to have a couple of weeks of pain free contact training under his belt before he returns.

Nathan Ross – medial/high ankle sprain. Different to Pritchard’s injury, Ross’ foot rolled out stretching the structures on the inside of his ankle. This injury can be extremely painful at first but often can be strapped up and played through. There is a possibility he had some minor high ankle damage (happens when the shin bone rotates outwards), but once again when minor will not cost him time.

James Fisher-Harris – fractured cheekbone. Gus Gould has tweeted JFH will be out for 6-8 weeks depending on surgery. Fractured cheekbones commonly return quicker than eye sockets (Will Hopoate), with many that are not depressed fractures (cheek doesn’t have a sunken look) only costing a player 2-4 weeks on the sideline. The tweet from Gus seems to suggest JFH has a significant fracture, but watch this space for a possible early return.

Justin O’Neill – hamstring strain. This was an interesting one in that the mechanism of injury was different to the usual hamstring strain. As Paul Green said post match “I’ve never seen anyone do a hammy when they get spear tackled”. Most hamstring strains occur during running, however when O’Neill was being tipped forward his left leg became planted. This would not only put his hamstring on stretch, he would’ve automatically contracted his hamstring to try and slow his descent, resulting in a strain. Even grade 1 hamstring strains usually cost a player 2-4 weeks on the sideline, and seeing it wasn’t an explosive mechanism of injury I would say that would be the expectation for O’Neill’s return.


Kurt Baptiste – ruptured achilles in early December, started light running two weeks ago. On track for return in expected 6-9 month range (June-September). Quickest recovery I have seen from a ruptured achilles in recent times is Darius Boyd, 5 months and 3 days.

Cameron Munster – broken jaw, 4-6 weeks. I have not seen reports if he required surgery or not, but regardless recovery usually falls in this time frame unless it is a complete fracture (bone snapped in 2), which by reports it was not.

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

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NRL Physio

The "NRL Physio" is a qualified and practicing physiotherapist. He tweets from @NRLPhysio and writes for us about injuries to NRL players and their recovery times.

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NRL Physio

The "NRL Physio" is a qualified and practicing physiotherapist. He tweets from @NRLPhysio and writes for us about injuries to NRL players and their recovery times.