Trial Injury Wrap-up with the NRL Physio
So a little background on me. I am a physio working in a private practice dealing with musculoskeletal and sports injuries and I love rugby league. That pretty much sums it up. I don’t have any inside sources or insider information (and when it comes to medical information sharing this would be illegal), but I saw that there wasn’t too much insight into footy injuries past general recovery times (and Freddy asking Blake Ferguson how his bursa was during sideline commentary) so thought I would have a crack.
I, of course, can’t be factual with some things discussed here; I am not examining or treating the players and most of the time what I write comes from my analysis of what I see on TV or read in the injury reports, but hopefully I can be an external source of information to help translate what an injury diagnosis actually means, and what the outlook for specific players is depending on their injury.
As a first run I thought I would try and tackle a couple of players who have an injury of interest at the moment. I feel like most sites already have an injury list a few pages long of one word injury descriptions and return times.
Before we kick off just a little disclaimer:
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.
Tohu Harris
The freshest injury of them all. A top two rounds NRLCEO draft pick for me and tragedy for plenty. Tohu Harris has a stress fracture in his foot and will be out for 8-10 weeks. Some bones in the foot have poor blood supply so there may be extended healing time. For Tohu, the bone that poses the greatest threat is navicular. Very poor healing supply fails to respond even to surgery, but there is no word of surgery for him yet. Hopefully he has avoided navicular – more common is 5th metatarsal (the base of the fifth toe).
Tohu Harris out 8-10 weeks with stress fracture in foot. Some bones in foot have poor blood supply so extended healing time.
— NRL PHYSIO (@nrlphysio) February 24, 2017
Adam Reynolds
The Rabbitohs play maker will miss about a month of football with appendicitis. Usually this is a 3-4 week recovery but that doesn’t necessarily mean when he comes back he will kick for goal straight away. With Cody Walker and Bryson Goodwin back up he doesn’t need to rush it.
Ben Matulino
As hard as it is to get injury information out of NRL clubs, I think the Warriors still come out on the bottom. There is still no word on the type of surgery Ben Matulino had on his knee; it was initially said to have his long term interests in mind and rule him out for 10-12 weeks (approx. return Round 6). With his history of cartilage issues I would lean towards this being the problematic structure.
Details came out this week that he had suffered a post-operative infection and was currently on a course of IV antibiotics. This can commonly last six weeks, and will restrict his training significantly whilst the infection is present. If the infection does not settle, not only can this cause permanent cartilage damage, Matulino may have to undergo a washout surgery/multiple surgeries which would set him back a further 2-4 weeks at best. He will do well to return on schedule in Round 6.
Nathan Peats
I’m writing this with only Channel 7 having reported the results of Peats scans; a broken collarbone and dislocated shoulder. With two main joints in the shoulder; the gleno-humeral (ball and socket) and acromio-clavicular (point of the shoulder where the collarbone and acromion meet), if reports are correct it would appear Peats dislocated his AC joint and fractured his clavicle (collarbone) in the process. There was also some talk that if Peats had to have surgery his season was over. This would only have been the case if scans showed up significant damage in his rotator cuff or labrum (cartilage). Surgery to repair a broken collarbone would only put him out for 8-12 weeks.
With Peats’ collarbone fracture treated conservatively (no surgery) he should be fit to return in 6-8 weeks (Round 4-6). Although healing will be adequate enough by this point to return to footy, the bone will still be weaker up to four months after the initial injury. If Peats makes it to 6+ months post injury the bone will then be as strong, and sometimes stronger, than before.
Jarrod Croker
As we all no doubt saw there was some squeamish vision of Jarrod Croker’s patella (knee cap) dislocating/subluxing in the first prime time rugby league match for 2017, the NRL All Stars. The key in recovery time for any subluxation/dislocation is the damage to the medial patellofemoral ligament (MPFL) which provides stability to the knee cap; particularly by restricting movement to the outside of the knee. Croker initially was initially designated with an expected 4-6 week recovery (return Round 3) which was pushed out recently to 7-8 weeks (Round 5 at the earliest). He must have only partially damaged his MPFL; a complete tear would result in surgery and an approximate 6 month recovery time.
There were reports Croker was wearing a brace and having physio up to 6 times a day in an effort to return quickly and safely. With the re-dislocation risk being as high as 50% if there is not enough recovery time allowed or insufficient rehabilitation performed, Croker is playing it smart here. Even if it results in a few extra weeks of recovery initially, the cost of dealing with repetitive dislocations and MPFL reconstruction surgery would be much greater.
In terms of the goal-kicking duties when he returns the main activities of concern will be cutting/direction change and load bearing through a slightly flexed knee (the mechanism of injury during the All Stars game). So in essence if he is fit to play he should be fit to kick. However with Sezer kicking an alright ball and the Raiders approaching this fairly conservatively, they may ease him back with no kicking for a few weeks to be certain.
Rory Kostjasyn
Fox Sports have reported that Rory Kostjasyn is scheduled for throat surgery on 3 March 2017. If this is the case, depending on the damage he is looking at 6-8 to be cleared for contact. Shouldn’t be long after that until he can play so it should be a 6-10 round recovery.
Josh Mansour/Sam McKendry/Matt Ballin
I grouped these players together because of the interesting trend in Rugby League at the moment; ACL reconstructions using a donor graft (allograft). This involves harvesting the Achilles or patellar tendon from a cadaver as opposed to an autograft (more traditional) which uses a patient’s own tissue (usually from their own hamstring or patellar tendon). Going with a donor graft means a shorter surgery time (no second surgical site to remove part of own hamstring/patellar tendon), less post-operative discomfort and a shorter recovery time (6-9 months vs 9-12 months for autograft). However many studies have shown a higher failure (re-rupture) rate in donor grafts vs the traditional autografts.
Josh Mansour has been progressing well in his rehab for a donor graft, and is aiming for a return in late May/Early June (Rd 12-14, 6.5 months post surgery!). This is not out of reach but comes with a sense of calculated risk. Sam McKendry recently returned from ACL reconstruction in just over 7 months (with what I assume was a donor graft) only to suffer a partially torn ACL in the same knee his first game back (side note: it has been reported that McKendry has a stable knee, so with rehab could return in 4-8 weeks). Matt Ballin had his 2015 ACL surgery with a donor graft and only lasted 3 games in 2016 before succumbing to another ACL rupture. He has opted for a more traditional patellar tendon autograft this time round. Yet Aaron Rodgers, quarterback for the Green Bay Packers in the NFL, has been tearing up defences for the last 12 years with a donor graft in his knee and even claims it made him faster. So real life examples will always exist to support/refute both techniques.
It is a numbers game in the first 18 months no matter the type of surgery; biologically it takes this long for full maturation of the graft. From 9-18 months it has been shown you are more likely to re-rupture the same ACL, but from 18 months + there is evidence you are more likely to tear the other ACL (meaning repaired ACL is at its strongest). Surgeons will only advise a player on options that are best for that specific player, so if they have opted to go with a donor graft I can guarantee it is the ideal option for them. It is just something interesting to monitor as we see traditional autograft reconstructions (Roger Tuivasa-Sheck, Kane Elgey) and allograft reconstructions (Mansour, McKendry) return this season.
Hopefully there was a few interesting words in there and I didn’t throw too much medical jargon around. If you have any specific questions about injured players throw a comment down below or hit me up on Twitter @nrlphysio
NRL Physio
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