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.
Jarryd Hayne & Tevita Pangai Jr
Jarryd Hayne suffered a syndesmosis (high ankle) injury on Saturday whilst jumping for a bomb. He went straight from the field and did not return to the game, leaving the ground in a moon boot and on crutches. Many injury aware footy fans will fear a high ankle sprain means significantly more time on the sidelines than a traditional lateral ankle sprain; this is not always the case.
The most common ankle sprain is of the lateral (outside) ligaments and frequently occurs when a player “rolls” his ankle. The foot rolls in, stretching the ligaments on the outside of the ankle that are responsible for lateral stability in the ankle joint. Despite the swelling, tenderness and bruising that can come with this injury it is often a quick return to play (usually 2-6 weeks).
The dreaded syndesmosis injury is so significant because of the important role these ligaments play in the stability of the ankle. The syndesmosis is a set of ligaments that sit above the ankle joint and holds your tibia and fibula (lower leg bones) together. Every time you take a step the tibia and fibula 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. If the syndesmosis is sprained or torn every single step can be painful.
In terms of treatment options, as always it depends on the degree of damage. As a general guide:
- Grade 1: 1-6 week recovery, no surgery
- Grade 2: 6-12 week recovery (dependant on amount of damage and if surgery is needed to repair)
- Grade 3: 3-6 month recovery and surgery.
- Grade 2 and 3 sprains are often accompanied by associated fractures/other soft tissue damage and this is why the suggested recovery periods are so variable.
Tevita Pangai Jr is a good example of low-grade syndesmosis injuries not always costing players multiple weeks on the sideline. A call is set to be made on him later in the week regarding his availability for Rd 3, and I have seen some players finish the game with minor high ankle injuries. Neil Henry revealed today that Hayne will not require surgery but still has significant ligament damage. It would appear he has suffered a lower grade syndesmosis injury (grade 1 or 2). I would expect his absence to be somewhere in the 3-6 week range.
Will Hopoate suffered multiple orbital fractures (eye socket) and a concussion after a collision on Thursday night. Orbital fractures can have implication to the patient’s vision, so recovery periods are often slightly longer to negate this risk. I still remember news stories from a few years ago; “Corey Parker willing to risk his eyesight for Origin”. Sounds sensationalised but if he had played the risk would have been very real. Origin would have been 10 days after his eye socket fracture.
Hopoate is still to see a specialist this week to determine if surgery is required, but either way, I see him missing between 4-6 weeks of footy. Surgery can sometimes speed up the return from these fractures (as little as 2 weeks), but with multiple fractures present, it would still be very optimistic for him to return in the next month.
Touching on my concussion comments from last week, it was widely reported Hopoate had suffered a “severe concussion”. Once again my issue with this terminology is it implies some concussions can be graded more severely than others in the early stages of the injury. The mechanism of injury can be severe (Hopoate’s certainly was) and his early symptoms can also be severe in nature. But it is only appropriate to discuss overall concussion severity in retrospect, once all concussion symptoms have subsided. Neurological testing needs to be normalised and cognitive function returned to baseline (pre-concussion levels). I fear the use of a “severe” grading, in this case, could be quickly followed by other concussions being given a “mild” tagline based purely on the lack of trauma in the collision, rather than the symptoms the player may then suffer.
It was initially feared Bryce cartwright had dislodged a metal plate from a previous surgery on his fibula (lateral lower leg bone) or suffered a fracture around the site. Thankfully today scans came back clear of fractures, however, some bone bruising was present. Bone bruising sounds minor, but can be quite debilitating depending on the location of the injury. Luckily for Cartwright, the fibula is a non-weight bearing bone; the tibia (shin bone) is responsible for weight bearing in your lower leg. The bruising is also not on a joint surface which can cause longer recovery times. Imagine a bruise underneath your heel vs the middle of your bicep; the bruise under the heel likely hangs around longer because every step you take aggravates it slightly. This is the same with joint surfaces, bone bruising in these areas is constantly aggravated and takes longer to settle. With the location of Cartwright’s bone bruising I am optimistic about him playing this week.
I’ll finish off with some quick hits, as there was an endless stream of injuries this round.
- Blake Ferguson: 2-3 weeks with rib cartilage damage (you will see reports of popped ribs). Rib cartilage injuries are extremely painful, hurt with breathing/every twist and turn. Ferguson will need a few weeks for adequate healing to occur, and his return will then be largely pain guided (players may have pain killing injections for this type of issue)
- Antonio Winterstein: 4-6 weeks with a broken arm. Had surgery earlier in the week due to complete fracture (snapped bone in 2), should have no troubles with return
- Kerrod Holland: 4-6 weeks with AC joint sprain (point of shoulder). With that timeframe, it is a grade 2-3 injury, and interestingly a complete tear of the AC joint ligaments (grade 3) often does not require surgery. Grade 2 injuries (partial but not complete tear of ligaments) can be quite painful as the ends of the acromion (point of shoulder) and clavicular (collarbone) are inflamed and in contact with each other. Players who suffer a grade 3 injury often look and feel worse initially, but suffer less pain throughout recovery as these bones are no longer in contact (ligaments completely torn). Stability is the key here, and with a complete tearing of the AC joint ligaments this can take time to build back up
- Lachlan Coote: 2-3 weeks with a calf strain. The calf is one of the easiest muscles to repetitively strain, so Coote will want to be very cautious in his return. If it is only a grade 1 strain like reported 2-3 weeks is accurate for recovery
- Jarrod Croker: Reportedly returning this weekend, 2 weeks earlier than expected. With the re-dislocation rate up to 50% for athletes who return too quickly from a patella dislocation, Croker must be showing full strength and stability in his patello-femoral joint for the Raiders to be confident in his return this week. I will be watching this with great interest, as it is a very impressive recovery from the Raiders medical staff and Jarrod Croker
- Matt Scott: ACL, out for the season. I have written at length about ACL injuries over the past 2 weeks. Once again I would hope Scott opts for a traditional graft, and we see him back bigger and better next season
- Jordan Kahu: Cork, to be assessed later in the week. Kahu made it through the game on Friday night but will be very restricted at training this week. This is very common for severe corks; players can often play out the game by keeping warm. But it is the next week at training they are most affected
- Billy Slater: Not too much analysis here, just glad to see Slater returning after almost 2 years solid of rehab. Will have my fingers crossed for a successful return for him