NRL Casualty Ward Round 6: Luke Keary must pass concussion protocol

Gold Coast’s worst fears confirmed, plus the latest news on when Tom Trbojevic and Braidon Burns will return. NRL Physio analyses all the latest injury news from around the competition.

Brien Seeney, AKA NRL Physio.

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

Manly star Tom Trbojevic is all but resigned to the fact he will miss the State of Origin series opener for NSW as he races the clock to recover from a hamstring injury.

Trbojevic hasn’t played since he was injured in round four of the NRL and has revealed he’s still expected to miss another six weeks.

That would put the Manly flyer on track to return the round after Origin game one on June 5, meaning he’d have to come back two weeks early for Manly to prove his match fitness before the Blues squad is named.

While he hasn’t given up on pushing for an earlier return, the 22-year-old Trbojevic conceded it was unlikely he would play against Queensland in the series opener.

“I think if you’re back in eight weeks (from the injury) you’re not playing obviously,” Trbojevic said.

Tom Trbojevic faces another six weeks on the sidelines. Picture: Getty Images

“You think about (Origin) but when it comes down to it you can’t really. “You’ve got to be back on the footy field playing good footy to get picked in those sides.

“At the moment, I have definitely come to terms with that.

“I’ve got to get my hammy right, I don’t want to do it again.

“Get it right, play some good footy for Manly and go from there.”

Told by Blues coach Brad Fittler to get his fitness right before he even considers a return, Trbojevic is back running on a treadmill but is yet to begin field work.

His anticipated return date for round 13 against North Queensland will, however, give him two games to push his case for selection in Game II in Perth.

But Trbojevic is well aware he won’t be allowed to rush back too early, given he suffered a non-related injury to the same hamstring in February.

“I’ve got to take that extra time,” he said.

“The physios will talk to me about that and I’m really confident in the medical staff we have got here to get back fully fit.

“They won’t be taking any shortcuts, they’ll be doing everything they can to get it right.”

Gold Coast’s worst fears have been confirmed after scans revealed their NRL captain Ryan James had ruptured his ACL and will be sidelined for six months.

The inspirational forward injured his right knee just 12 minutes into the Titans’ 38-14 win over Newcastle on Sunday.

“Unfortunately Ryan James has suffered an ACL tear. We’ve had scans to confirm that today and he’ll have surgery this week and commence his rehab,” Titans head of performance Dan Ferris said.

Initial fears confirmed with Ryan James out for the rest of the season after suffering an ACL injury. Will undergo surgery & usual recovery period of 6-9 months, should be fit for Rd1 2020. Just the 2nd NRL ACL injury for the 2019 season. Wish James the best with surgery & rehab

— NRL PHYSIO (@nrlphysio) April 23, 2019

Ryan James will miss the rest of the season. Photo by Chris Hyde/Getty Images.

South Sydney centre Braidon Burns had been slated for a Round 8 comeback from a hamstring injury, but looks set for a delayed return.

Braidon Burns has progressed onto running & conditioning training, plans to continue this for the next 2 weeks before moving to high speed running. By these reports sounds as if Round 9-11 much more likely as a return date considering risks associated with returning too soon.

— NRL PHYSIO (@nrlphysio) April 23, 2019

Titans captain Ryan James lasted just 12 minutes of his sid’s win over Newcastle, going down in severe pain after suffering a knee injury. The early hope was the injury was due to contact, which would usually bring with it a risk of a contusion or PCL sprain. Unfortunately it appears that James actually suffered the injury prior to contact as he changed direction to complete the tackle.

Non-contact change of direction injuries bring a great concern for ACL injury, and Garth Brennan said post game that the Titans doctors were “very concerned” about the nature of the injury.

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.

Luke Keary is in doubt for the Roosters’ Anzac Day clash. Picture: AAP

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.

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

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

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 looks in the clear despite a severe laceration (cut) to his hand after he was stepped on while fielding a kick.

Nick Meaney avoided any damage to nerve, bone or tendon after his severe finger laceration over the weekend. He has already returned to training and is looking good to play in Round 7

— NRL PHYSIO (@nrlphysio) April 23, 2019

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 Panthers centre will spend up to four weeks on the sidelines.

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)

BULLDOGS

Dylan Napa (Syndesmosis, Round 9-11)

Kieran Foran (Ankle, Round 16)

Sauaso Sue (Suspension, Round 8)

Nick Meaney (Finger, TBC)

Adam Elliott (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, Round 10-11)

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 9-11)

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)

Ryan James (Knee, TBC)

Kevin Proctor (Quad/hip, TBC)

WARRIORS

David Fusitu’a (Ribs, TBC)

Blake Green (Groin, Round 8)

Originally published as NRL Casualty Ward Round 6: Luke Keary must pass concussion protocol