Casualty Ward: Double blow for struggling Dragons

St George Illawarra have copped a huge blow with James Graham set to miss two months, plus all the latest Round 11 injury news analysis from NRL Physio.

Adam Reynolds was injured in the Rabbitohs’ win over Wests Tigers. Picture: AAP

Brisbane-based physiotherapist Brien Seeney, aka NRL Physio, gives his expert analysis of all the Round 4 injuries.

St George Illawarra are reeling from last weekend’s loss to Cronulla, with James Graham to miss two months with a broken leg and Tim Lafai out with an ankle injury.

Graham has been ruled out for eight weeks after scans revealed a fractured fibula, whle Lafai suffered a syndesmosis injury and his recovery is yet to be assessed.

The defeat to the Sharks was thge Dragons’ seventh loss of the season and saw Paul McGregor side fall to 13th place.

Confirmation from the Dragons that James Graham unfortunately did suffer a fractured fibula, with the expectation he will miss 8 weeks. The usual recovery range is 6-10 weeks in the NRL

— NRL PHYSIO (@nrlphysio) May 27, 2019

Graham‘s injury a massive for the Dragons. Image: Matt King/Getty Images

Canberra co-captain Josh Hodgson requires surgery on a fractured thumb and will miss up to eight weeks of NRL action.

Hodgson was injured in the Raiders’ loss to North Queensland in Canberra on Saturday and didn’t feature in the second half.

The hooker missed 13 games with a knee injury last season and Canberra struggled without the England international.

Hodgson joins a growing injury list at the Raiders with fellow internationals Jordan Rapana, Joey Leilua and John Bateman sidelined.

Meanwhile, Cowboys centre Justin O’Neill was reportedly rushed to hospital in Canberra after rupturing his spleen on Sunday.

Tyson Frizell, Josh Dugan and Dale Finucane all suffered head knocks on Sunday anf ailed to finish their clashes.

Fortunately none of the three clubs are playing in Round 12, however Frizell will take part in State of Origin on Wednesday week.

Quick concussion thread:
Often much too early to refer to a concussion as minor or clear a player for the following week the same day he/she suffers a concussion. Whilst ~70% of players are able to return in 7-10 days, concussion symptoms can be delayed & intermittent

— NRL PHYSIO (@nrlphysio) May 26, 2019

Josh Dugan and Tyson Frizell collide in a heavy tackle. (AAP Image/Dean Lewins)

Fantastic news after scans cleared Adam Reynolds of a fractured fibula (bone on the outside of the lower leg).

After having his lower leg twisted in a tackle he initially tried to walk it off, but succumbed to the injury a short time later.

The fibula only bears about 15-20% of body weight, so it is still possible to walk even if a fracture is present. Reynolds was seen in the sheds with his lower leg heavily iced and on crutches, which had many nervous for his chances of playing for the Rabbitohs or NSW in the next month.

Justin O’Neill reportedly suffered a ruptured spleen and has been rushed to hospital. Usually caused by a blow to the left hand side of the lower chest/stomach, a spleen injury is considered a medical emergency (spleen injuries often bleed significantly). Fingers crossed for him

— NRL PHYSIO (@nrlphysio) May 26, 2019

Thankfully the best-case scenario for Reynolds has been realised as he has likely escaped with just a contusion (cork/bruise) to the muscles on the lower leg and/or fibula.

With this the likely case the required recovery would almost certainly have him available for the Rabbitohs in Round 12 or NSW in Origin 1; he would be sore for a few days but should be running by mid-week.

Adam Reynolds injured his leg in the Rabbitohs’ clash with Wests Tigers. Picture: AAP

It was revealed on Saturday that Luke Keary won’t be fit for selection in Origin 1 after suffering a concussion in the Roosters’ Friday night loss.

This is Keary’s second concussion this season, while he has also been removed from the field three times for a head injury assessment (HIA). The Roosters half has a history of prolonged concussion symptoms; last year after breaking his jaw in the pre-season he suffered lingering headaches.

A common saying is concussions are like snowflakes; no two are the same. Any injury to the brain should be considered serious but the signs and symptoms can vary greatly. As we have seen in the NRL a player can fail a HIA during the game and not return that day but play the following week, while symptoms can also be persistent or prolonged resulting in multiple weeks on the sideline. When making decisions about a return to the field for players suffering concussion, clinicians will treat each case individually, using tools to assess the clinical signs and symptoms, cognitive dysfunction and physical deficits.

Considering Keary’s recent concussion history he may require a review from an independent neurologist, and despite Origin 1 being 10 days away trying to pass Keary through the 6 stage concussion protocol in these circumstances would be extremely challenging. Hopefully Keary suffers no ongoing symptoms and can return to the field for the Roosters in Round 13.

Roosters star Luke Keary suffered his second concussion this season. Picture: Brett Costello

Matt Scott confirmed after the Cowboys game he had subluxed his shoulder. A subluxation is a partial dislocation where the humerus (upper arm bone) doesn’t completely “pop out” of the shoulder socket, but does shift momentarily which can cause damage to the structures both within and surrounding the shoulder joint. Similar to a shoulder dislocation both scans and a physical examination will determine the appropriate treatment:

— if there is minimal structural damage and the shoulder feels stable conservative strengthening rehab is usually required for 2-6 weeks before a return to play

— if there is significant damage and the shoulder feels unstable, shoulder reconstruction surgery usually occurs with a 3-6 month recovery period

Matt Scott faces a stint on the sidelines. Picture: AAP

Jai Arrow suffered a minor hip flexor/quadriceps muscle strain at training on Thursday and subsequently missed the Titans’ win on Friday night. Attention then turns to his Origin availability, and luckily many minor hip flexor strains allow a return in 1-2 weeks. The hip flexor and quadriceps are important muscles for power running and kicking, so while he might not be taking the kick-offs for the Maroons Arrow will have to work hard in rehab over the next week in order to regain his leg power for Game 1.

Three Origin hopefuls in Moses Mbye, Coen Hess and Mitchell Pearce were all affected by groin issues this week. Mbye and Hess are in doubt for Queensland selection after missing their respective Round 11 games, while Pearce is unlikely to be considered for NSW selection after an ongoing groin issue flared up in the Knights win over the Roosters. While minor groin issues often result in a player being considered “day to day” and don’t require extended stints on the sideline, they are notorious for lingering and commonly flare up over time.

Mitchell Pearce has been grounded a groin injury. Picture: Getty Images

There was unfortunate news from the Panthers with both starting centres suffering injuries in Round 11. Dean Whare suffered a grade 2 (partial tear) hamstring injury, with an expected recovery time of 4-6 weeks. Waqa Blake suffered a grade 3 (complete rupture) MCL injury with the club expecting him to miss up to 10 weeks. The usual recovery time in the NRL is 6-10 weeks, and we have seen Jason Taumalolo (6 weeks) and Manu Ma’u (8 weeks) return in this time frame in 2019.

The syndesmosis injuries continued this weekend with Danny Levi (Knights) and Jazz Tevaga (Warriors) both having their games cut short after having their ankles twist awkwardly. There is yet to be news on the severity of their syndesmosis injuries (high ankle sprains), in some encouraging news Nathan Brown was hopeful Levi’s was only minor. A general recovery guide for the different severities of syndesmosis injury:

Grade 1: 1-3 weeks

Grade 2: 3-6 weeks

Grade 3: 6-10 weeks

If a fracture also present: 10+ weeks

There was an extremely brave effort from Manly centre Brad Parker, who played much of the game on Friday night with a broken jaw. Early indications suggest he will require 4-6 weeks recovery, with the usual range being 4-8 weeks depending on the severity of the fracture.

To end on a positive note, despite the heavy injury toll in the NRL this season the incidence rate of ACL injuries has been well down this season compared to previous years. There had only been 4 ACL ruptures in NRL players by the start of Round 11, while in previous years this number is often higher than 10. Hopefully this trend continues for the rest of 2019

FULL NRL CASUALTY WARD

BRONCOS

Jack Bird (ACL, Season)

Andrew McCullough (Knee, Round 14-16)

Thomas Flegler (Back, TBC)

BULLDOGS

Jayden Okunbor (Foot, Round 15-17)

COWBOYS

Ben Hampton (Biceps, Round 22-25)

Enari Tuala (Quad, Round 13)

Te Maire Martin (Bleed on brain, Indefinite)

Nene MacDonald (Ankle, Season)

Matt Scott (Shoulder, Round 15-17)

Justin O’Neill (Spleen, TBC)

DRAGONS

Gareth Widdop (Shoulder, Round 20)

Jack de Belin (Stood down, Indefinite)

Corey Norman (Cheekbone, Round 13-14)

James Graham (Leg, Round 19-20)

Tim Lafai (Ankle, TBC)

EELS

Dylan Brown (Back, Indefinite)

Nathan Brown (Pectoral, Round 14)

Kaysa Pritchard (Personal leave, Indefinite)

KNIGHTS

Mitchell Pearce (Groin, TBC)

Danny Levi (Ankle, TBC)

Slade Griffin (Knee, Indefinite)

Aidan Guerra (Ankle, Round 20-23)

Nathan Ross (Foot, Retired)

PANTHERS

Dean Whare (Hamstring, Round 15-17)

Waqa Blake (Knee, Round 16-20)

Malakai Watene-Zelezniak (Rib cartilage, Round 13)

Tyrone May (Stood Down, Indefinite)

Wayde Egan (Shoulder, Round 13)

Jed Cartwright (Shoulder, Round 14)

RABBITOHS

Greg Inglis (Shoulder, Retired)

Braidon Burns (Hamstring, Round 13-15)

Kyle Turner (Toe, Round 14-15)

Alex Johnston (Knee, Round 13-14)

Cory Denniss (Shoulder, round 20)

Kurt Dillon (Ankle, Indefenite)

RAIDERS

Joey Leilua (Bulging disc, Season)

Jordan Rapana (Knee, Round 13-14)

Josh Hodgson (Thumb, Round 16-19)

Brad Abbey (Knee, Season)

Luke Bateman (Knee, Round 13)

ROOSTERS

Luke Keary (Concussion, TBC)

Brett Morris (Knee, Round 13)

Jake Friend (Biceps, Round 19-22)

Lachlan Lam (Wrist, Round 14-16)

SHARKS

Aaron Woods (Foot, Round 16)

Wade Graham (Knee, Round 13)

Shaun Johnson (Hamstring, Round 13)

SEA EAGLES

Lachlan Croker (Hamstring, Round 13)

Moses Suli (Finger, Round 13-15)

Toafofoa Sipley (Knee, Season)

Tom Trbojevic (Hamstring, Round 13)

Albert Hopoate (ACL, Season)

Trent Hodkinson (Knee, Round 13)

Brad Parker (Borken jaw, Round 16-18)

STORM

Christian Welch (Knee, Round 14-16)

Curtis Scott (Foot, Round 22)

Scott Drinkwater (Pectoral, Round 14)

Tom Eisenhuth (Throat, Indefinite)

Dale Finucane (Concussion, Round 13)

TIGERS

Chris Lawrence (Broken jaw, Round 14)

Josh Reynolds (Knee, Round 13)

TITANS

Michael Gordon (Leg, Round 13)

Philip Sami (Ankle, Indefinite)

Nathan Peats (Pectoral, Round 14-16)

Ryan James (ACL, season)

WARRIORS

Nathaniel Roache (Back, Round 13)

Agnatius Paasi (Suspension, Round 13)

Jazz Tevaga (Ankle, TBC)

Originally published as Casualty Ward: Double blow for struggling Dragons