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 the 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.
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 6 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.
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 timeframe. 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.
A trio of calf strains; with Cordner returning after a 3-week recovery for Origin 3, Hodgson named to start this weekend after missing 1 game for Canberra, and Vaughan a chance to return this weekend (but more likely Rd20) after straining his calf in Rd16. 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% 4 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 he plays out the rest of the season with the Roosters.
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.
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.
A bit outside a physio's scope of practice, Oates has been out of action the past 2 weeks with a staph infection. Staph bacteria live 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 2 games.
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 pre season 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
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 4 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: 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.