Brien Seeney, AKA NRL Physio.
Brien Seeney, AKA NRL Physio.

Casualty Ward: Keary’s challenge to be cleared

Brisbane-based physiotherapist Brien Seeney, AKA NRL physio, reviews the injuries from Roun6 6 of the NRL.

Luke Keary missed the final 19 minutes of the Roosters' win over the Storm after suffering a blow to the head and subsequently failing his HIA.

The Roosters have a six-day turnaround until their Round 7 clash, and Keary will have to pass through the NRL's concussion protocol to be cleared to play. The concussion protocol involves a six-stage graded return to sport program, and usually looks something like this:

Stage 1: Rest and symptom-limited activity - physical rest and only daily activities that do not provoke or worsen symptoms.

Stage 2: Light Aerobic Exercise - e.g., walk/swim/exercise bike, with heart rate less than ~70% of max (no resistance/weight training).

Stage 3: Sport Specific Exercise - e.g. running drills without risk of head contact.

Stage 4: Non-contact training and start resistance (weight) training.

Stage 5: Full contact training - ONLY after medical clearance by a doctor - coaching staff will assess tackling technique and other skills.

Stage 6: Return to play/game.

 

 

 

To progress through each stage the player must be symptom free at each activity level, and if symptoms return at any point they must drop back to the last symptom free stage. Each of these stages usually requires 24 hours duration, so for Keary to return in the Roosters' Round 7 match (on day six of his recovery) he will likely need to pass through each stage symptom free without any setbacks.

The good news for Keary is the 78 concussions suffered by NRL players in 2018 only caused a total of 14 missed games. Most NRL players are able to safely pass through concussion protocol in time to play the next week.

However recovery from concussion is a very individualised process, in terms of recovery time there is no "one size fits all". A common saying is concussions are like snowflakes; no two are the same.

Hopefully Keary recovers quickly, but this will be one to keep an eye on as the week progresses.

 

Brien Seeney, AKA NRL Physio.
Brien Seeney, AKA NRL Physio.

 

Briton Nikora waved away trainers shortly before half-time in the Sharks game after being caught in an awkward position during a tackle. This caused him to "pull something" in his back, and he was moments from being interchanged as the pain kept him on the ground. However he was able to tough it out until half-time, and returned after the break to play a pivotal role in the Sharks' comeback win. Hopefully the issue was only a minor muscular strain, hence his ability to play on, which would have him in little doubt for next week.

 

Briton Nikora played on despite a back complaint. Picture: AAP
Briton Nikora played on despite a back complaint. Picture: AAP

 

Bulldogs forward Adam Elliott and Warriors winger David Fusitu'a both failed to finish their respective games due to rib injuries.

 

David Fusitu’a injured his ribs in the loss to North Queensland. Picture: Getty Images
David Fusitu’a injured his ribs in the loss to North Queensland. Picture: Getty Images

 

Elliott was said to be dealing with a similar issue for the past few weeks, and was to go for scans over the weekend to further assess the issue. Warriors coach Stephen Kearney was doubtful Fusitu'a would be available for the Warriors' Anzac Day clash, with such a short turnaround (five days) he feared the injury wouldn't not have enough time to settle.

Rib injuries can be some of the most painful in rugby league, but the good news is if these players have avoided a fracture it often becomes mostly a pain tolerance issue. In most cases this allows a return in 1-3 weeks with pain relief medication and/or chest padding. If a fracture is present extra time can be required for healing, pushing the general recovery time out to 3-6 weeks.

Bulldogs fullback Nick Meaney suffered a severe laceration (cut) to his hand after he was stepped on while fielding a kick. The reports were that the cut was so deep that Meaney could see the tendons and bone in his finger. After having running repairs on the field he was kept in the sheds after half-time to have the wound stitched up. He returned midway through the second half and finished the game, but is still in some doubt for next week. The Bulldogs will need to rule out any significant injury to the tendons or nerves in his finger, which could result in a multiple weeks on the sideline. However if as hoped he has avoided significant damage to these structures the main concern will be infection control for the wound, and this can usually be managed well enough to allow a return within a week.

 

Dean Whare is the latest player struck down by a hamstring injury. Picture: Getty Images
Dean Whare is the latest player struck down by a hamstring injury. Picture: Getty Images

 

Unfortunately the hamstring strains keep coming, with Dean Whare suffering one in the second half of Penrith's game. The early reports were the Panthers medical staff expected it was a moderate strain (grade two). If this is confirmed it usually comes with a 4-6 week recovery period.

Sio Siua Taukeiaho was ruled out of the Roosters game during the warm-up after suffering a back injury. The early indications are it was only back spasms, and the Roosters are hopeful of having him available for Anzac Day.

Blake Green missed his second straight week for the Warriors as he was unable to recover from a minor groin strain suffered in the warm up last week. It is common for niggling groin strains to linger, so it can be a frustrating injury to overcome. Still Warriors coach Stephen Kearney was confident of having Green available on Anzac Day.

Cameron Smith is another player suffering from a minor groin strain, and while he is able to play through it at this stage he has relinquished the goal-kicking duties in an attempt to help it settle quickly. Would expect this is only a short-term arrangement for the NRL's all-time leading points-scorer.

Matt Lodge had difficulty breathing after a blow to the throat in Brisbane's Round 5 game. He will visit a specialist next week and is hopeful of getting cleared to play in Round 7. If no fracture is present the main recovery factor will be giving the inflammation time to settle. Most are able to return in 1-4 weeks.

Isaac Liu missed Round 6 with a broken finger. If the fracture is minor and there is minimal tendon/ligament damage NRL players are often able to return in as little as 2-3 weeks, with the Roosters hopeful he will be available in Round 7 or 8.

AJ Brimson had surgery this week after suffering a broken thumb and is expected to miss at least the next two weeks. Surgery helps stabilise the fracture and allows for adequate healing. While this can often assist with an early return, thumb fractures often require a few more weeks healing time than finger fractures. Most require 3-6 weeks before allowing a return to play.

FULL NRL CASUALTY WARD

BRONCOS

Matt Lodge (Throat, TBC)

Tevita Pangai Jr (Suspension, Round 7)

James Roberts (Achilles, Indefinite)

BULLDOGS

Dylan Napa (Syndesmosis, Round 9-11)

Kieran Foran (Ankle, Round 16)

Sauaso Sue (Suspension, Round 8)

Nick Meaney (Finger, TBC)

Adam Elliot (Ribs, TBC)

COWBOYS

Nene MacDonald (Ankle, Round 21-season)

Jason Taumalolo (Knee, Round 8-12)

Kyle Feldt (Groin, Round 6-7)

DRAGONS

Korbin Sims (Arm, Round 10-12)

Gareth Widdop (Shoulder, Indefinite)

Jack de Belin (Stood down, Indefinite)

EELS

Dylan Brown (Back, indefinite)

Nathan Brown (Pectoral, Round 14)

Will Smith (Broken arm, Round 8)

Kaysa Pritchard (Personal leave, Indefinite)

Manu Ma'u (Knee, Round 7)

George Jennings (Suspension, Round 7)

Stefano Utoikamanu (Ankle, Round 9)

Blake Ferguson (Ribs/nose, TBC)

KNIGHTS

Slade Griffin (Knee, Indefinite)

Jacob Saifiti (Leg, Indefinite)

Aidan Guerra (Ankle, Round 20-23)

Kurt Mann (Sternum, Round 7)

Sione Mata'utia (Stinger, Round 6)

Nathan Ross (Foot, Retired)

PANTHERS

Dean Whare (Hamstring, TBC)

Sam McKendry (Knee, Indefinite)

Tyrone May (Stood Down, Indefinite)

Frank Winterstein (Knee, Round 8-10)

RABBITOHS

Greg Inglis (Shoulder, Retired)

Adam Doueihi (Knee, TBC)

Braidon Burns (Hamstring, Round 8)

Cory Denniss (shoulder, round 20)

RAIDERS

Michael Oldfield (Groin, Round 7)

Brad Abbey (Knee, Round 8-10)

Joseph Tapine (Ankle, Round 17-19)

ROOSTERS

Brett Morris (Knee, Round 7)

Ryan Hall (Knee, Round 8)

Jake Friend (Shoulder, Round 7)

Joseph Manu (Suspension, Round 7)

Luke Keary (Concussion, TBC)

Isaac Liu (Finger, Round 7-8)

Sio Siua Taukeiaho (Back, TBC)

SHARKS

Aaron Woods (Foot, Round 16)

Matt Moylan (Hamstring, Round 10)

Wade Graham (Knee, Round 9-12)

Briton Nikora (Back, TBC)

SEA EAGLES

Addin Fonua-Blake (Suspension, Round 8)

Dylan Walker (Stood down, Indefininte)

Tom Trbojevic (Hamstring, Round 12)

Albert Hopoate (ACL, Season)

STORM

Scott Drinkwater (Pectoral, Round 8-12)

Tom Eisenhuth (Throat, Indefinite)

TIGERS

Benji Marshall (Hamstring, Round 7)

Chris Lawrence (Broken jaw, Round 8)

Jacob Liddle (Ankle, Round 7)

Robert Jennings (Concussion, Round 6)

TITANS

Nathan Peats (Pectoral, Round 16)

AJ Brimson (Thumb, Round 9-11)

Jarrod Wallace (Facing suspension, Round 8)

Keegan Hipgrave (Back, TBC)

WARRIORS

David Fusitu'a (Ribs, TBC)

Blake Green (Groin, Round 8)

News Corp Australia


GALLERY: The week celebrating Gladstone's kids

premium_icon GALLERY: The week celebrating Gladstone's kids

The important reason behind the annual event

LARC! Tours celebrate 25 years of 'larcing around'

premium_icon LARC! Tours celebrate 25 years of 'larcing around'

Owner reveals what their secret to 25 years of success is.