NRL casualty ward Round 21

Robbie Farah may have played his last NRL game after being diagnosed with a fractured tibia, while a back injury to Adam Reynolds has derailed South Sydney’s top four push.

Andrew Fifita suffered an injury on the weekend.

Wests Tigers hooker Robbie Farah has a broken bone in his leg but will visit a specialist on Tuesday morning as he refuses to concede defeat in his quest to play again this season.

Farah has a crack in his tibia just below his knee and will miss Thursday night’s match against Manly at Lottoland.

Most such injuries require six-plus weeks’ recovery time.

But Farah is refusing to concede his season — and as a result his career — are over given history has shown he has remarkable mental resolve and capacity to endure pain.

Confirmation of fracture at top of tibia for Robbie Farah. Usually signifies fracture of tibial plateau, which is the weight bearing surface of the knee. Most req minimum ~ 6wks recovery, but comes down to severity of the fracture. If surface/hairline could push to return early pic.twitter.com/LCvQMCpaZt

— NRL PHYSIO (@nrlphysio) August 11, 2019

Tigers coach Michael Maguire said he still harboured hope that Farah would be able to add his weight to their finals push.

“It is Robbie Farah,” Maguire said.

“If anyone can get himself right, it is Robbie. He has proved that many times. He definitely doesn’t want to go out in this way.”

- Full story by Brent Read here

Robbie Farah down injured for the Tigers.

Multiple concerns by video for Robbie Farah with right knee injury. MCL sprain of main concern with knee collapsing in (fibula contusion also possible). Rotational component can cause meniscal injury. Fingers crossed no ACL involvement or fibula fracture #NRLBulldogsTigers pic.twitter.com/LH8IQRw8aX

— NRL PHYSIO (@nrlphysio) August 10, 2019

Wounded halfback Adam Reynolds will have further scans on a painful back injury that is now threatening to derail South Sydney’s charge for a top four finish. The Daily Telegraph can reveal there is even a concern the injury may not be the original back fracture Reynolds initially suffered two months ago.

Although he played out Sunday’s 26-16 loss to Melbourne at Central Coast Stadium, Reynolds was in severe discomfort and only stayed on the field because Souths didn’t have remaining interchanges. With only four rounds of the regular season remaining, the last thing the Rabbitohs need is to have their star halfback spending more time on the sidelines, especially given Manly and Parramatta are both within one win of the fourth-placed Bunnies. It’s no secret Reynolds has been playing in pain since he suffered the back fracture in the round 12 loss to Parramatta before the opening State of Origin.

Full story by Paul Crawley here

Adam Reynolds struggles with a back injury. Picture: Brett Costello

Moses Mbye went off early after suffering a quadriceps or hip flexor strain. Vision pre-game showed the Tigers’ captain receiving treatment in the moments before kick-off and it was revealed he suffered the injury during the warm up. Once out on the field he certainly looked restricted, and after just eight minutes he collapsed untouched after providing a pass for Paul Momirovski to score.

UPDATE 11am MONDAY: Fortunately, Mbye suffered a low grade injury with the club saying he will be “given every opportunity to prove his fitness for the side’s Round 22 clash against the Manly-Warringah Sea Eagles on Thursday night.” A general recovery guide for low grade quad strains is:

Grade 1: 1-3 weeks

Grade 2: 3-6 weeks

Moses Mbye struggled through a hip injury.

The Rabbitohs and Storm were hit with some key late outs before their Top 4 clash at Central Coast Stadium. Sam Burgess’s let off at the judiciary this week was all for naught after he pulled up with quadriceps soreness at training on Thursday. Thankfully for the Rabbitohs it appears to only be a minor strain, with the expectation he will miss just 1-2 weeks.

Of more concern was the scratching of Braidon Burns, who was ruled out on Saturday due to a hamstring issue. Whilst this is hopefully minor it is Burns’ history with a significant hamstring injury earlier this season which raises concern for his short term future. The Rabbitohs medical staff will no doubt be conservative with a return to the field for Burns, particularly after he suffered multiple setbacks in his initial hamstring strain rehabilitation. With the high recurrence rate of hamstring injuries (up to 30%) it would not be surprising to see Burns spend at least two weeks on the sideline.

Sam Burgess picked up a quad injury at training. Picture: Brett Costello

Meanwhile the Storm’s two preferred options at fullback Jahrome Hughes (back spasms), Ryan Papenhuyzen (midfoot sprain) and super-sub Brandon Smith (ankle sprain) were all ruled out late in the week, which required the NRL to approve Nicho Hynes to be brought into the 21 man squad to make his NRL debut.

This is the second time this season Hughes has been ruled out late in the week due to back issues. Back spasms are not usually considered significant, and are unlikely to require an extended recovery period. However they are known to linger and be easily aggravated, so Hughes may be at increased risk of a re-aggravation over the remainder of the season.

Papenhuyzen suffered his midfoot sprain when he was stepped on during the win over the Broncos last week. Whilst he was able to finish the game the injury only became obvious a few days later. This usually signifies a minor issue, but with the midfoot bearing so much load during the activities required from an NRL fullback (running, changing direction, jumping and landing) it won’t be one he will be able to rush back from. Whilst he will be given every chance to prove his fitness for next week, a return in Round 23-24 is sounding more likely.

Ryan Papenhuyzen was ruled out with a foot injury.

The player looking at the longest layoff appears to be Smith, who went down with an ankle sprain during the captain’s run on Saturday. He is yet to have scans but the early indication from the Storm is he is expected to miss at least 3-4 weeks, and possibly more if scans show more damage than first hoped.

It is rare for the more common lateral ankle sprain to require a lengthy recovery, so there is concern that Smith may have suffered a moderate grade syndesmosis injury. This can require 3-6 weeks recovery, and if surgery is required this extends out to 6-10 weeks. Hopefully scans come back with good news for Smith and the Storm.

Concussion was at the forefront of NRL news this week with Matt Moylan ruled out for Round 21 after presenting to Sharks training with delayed concussion symptoms on Monday, and Keegan Hipgrave ruled out for the remainder of 2019 due to a concussion suffered in Round 13.

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 but play the following week, pass the HIA but suffer delayed symptoms days later, or symptoms can also be persistent or prolonged resulting in multiple weeks on the sideline. It is important to understand that the “severity” or traumatic nature of the hit that caused the concussion does not necessarily correlate with the recovery time required.

Concussions used to be graded, but as more has been discovered about the course of symptoms and risk of long term complications these grading systems have been abandoned in favour of more individualised management.

Keegan Hipgrave has been ruled out for the season as a precautionary measure under concussion protocols after suffering a concussion in Rd13. Example of unpredictable nature of concussion, the “severity” of the hit/early signs from player aren’t always predictive of recovery time pic.twitter.com/KkYCqCuSba

— NRL PHYSIO (@nrlphysio) August 9, 2019

Many grading systems centred on loss of consciousness; if the athlete was “knocked out” they were considered to have a higher grading concussion than those that did not. But medical professionals were finding this did not determine length of recovery. Athletes who were knocked unconscious sometimes recovered quicker than who did not lose consciousness at all.

Hipgrave was caught by what appeared to be an innocuous high tackle from Matt Lodge in Round 13, but rose from the ground immediately and indicated to the trainer he was OK to continue. He subsequently failed his HIA, and on advice from specialists he will now take the rest of the season off with the expectation he will be ready to go for the 2020 preseason.

Moylan on the other hand was taken out by an extremely heavy hit from Sam Burgess, and whilst his concussion symptoms did not present until the next day he has been progressing through the NRL’s concussion protocol and is expected to play next week.

Clinicians will treat each case individually when making decisions about a return to the field for players who have suffered a concussion, using tools to assess the clinical signs and symptoms, cognitive dysfunction and physical deficits.

Leading Sharks forwards Andrew Fifita (knee) and Matt Prior (ribs) were unable to finish their Round 20 game. Coach John Morris was hopeful Fifita’s injury was a minor concern as he has been dealing with chronic issues in his knee for the past two seasons. Fifita has no PCL in his left knee, which he is able to manage with ongoing rehab and heavy strapping for each game. This can still cause some instability in the knee and make it more susceptible to aggravation.

Andrew Fifita off with left knee injury, concern by video for MCL sprain/fibula contusion as struck on outside of lower leg causing knee to collapse in. Fibula fracture/internal ligament injury less likely, Fifita did seem keen to stay on so likely minor issue #NRLPanthersSharks pic.twitter.com/O910OCR3wu

— NRL PHYSIO (@nrlphysio) August 9, 2019

Andrew Fifita suffered an injury on the weekend.

Prior went off early in the game after a heavy blow to the ribs. Once again scan results will help guide recovery expectations. If he is able to avoid a fractured rib, these injuries are usually considered pain tolerance issues, with most players able to return within 1-3 weeks. However time for adequate bone healing is required if a fracture is present, extending the expected recovery time to 3-6 weeks.

Jordan McLean was ruled out for the Cowboys after picking up a calf injury in the captain’s run. Whilst there has been no word on severity as yet, McLean was pictured on the sidelines without walking aids (crutches etc) which likely indicates a minor strain. A general recovery guide for minor calf strains:

Grade 1: 1-3 weeks

Grade 2: 3-6 weeks

In one of the more bizarre injury mechanisms this year, Brad Parker had to be assisted from the field after appearing to suffer a right knee injury whilst tapping the ball. The Manly centre’s knee appeared to lock up as he lifted his leg to tap the ball and he went down in considerable pain. While this was certainly surprising at first, Parker’s history with knee issues bring some clarity to the situation.

Just last year he went down in similar discomfort after simply rising from the ground to play the ball, with scans later revealing a meniscus tear in his right knee. The meniscus is cartilage within the knee that acts as a shock absorber, and a tear in the meniscus can cause the knee to lock in certain ranges of movement. What appears to have happened in Parker’s case is another meniscus tear, or even an aggravation of his old meniscus injury. Sea Eagles coach Des Hasler indicated post-game that it did appear to be a meniscus injury, and if surgery is required Parker would be facing 4-6 weeks on the sideline.

UPDATE 11am Monday: Parker has avoided a meniscus injury and will miss 1-2 weeks.

One of the strangest injury mechanisms I can remember with Brad Parker carried off with right leg injury. Main concern for meniscus injury with knee locking up + inability to weight bear, Parker also has history. Possible injury occurred prior to this but nothing obvious on video pic.twitter.com/slrGF9BfKf

— NRL PHYSIO (@nrlphysio) August 9, 2019

Hasler also reported some concern for Curtis Sironen, who came from the field with just seven minutes to go with what was initially thought to be a hamstring cramp. However on further examination there was some concern a strain may have occurred.

UPDATE 11am Monday: Sironen has suffered a low grade hamstring injury and will miss 1-2 weeks.

Knights forward Tim Glasby (concussion) is out for at least a week. “In terms of the actual head knock over the weekend, it was not of a serious nature, but due to the amount of head knocks Tim’s had over the past few weeks, he’s had two in three games now, as per NRL protocol, he’ll have a stand down period for this week’s game against the Cows,” said Newcastle Knights Head of Physical Performance Balin Cupples.

Tim Glasby has copped repeated head knocks.

ALSO INJURED IN ROUND 21

• Sam Verrills (thigh) - Roosters hooker failed to finish but has been cleared of serious injury.

• Alex Glenn (knee) pre-game

• Blake Ayshford - pre-game

• Josh Aloiai (hand)- pre-game

• Daly Cherry-Evans (ankle) finished against the Warriors but hobbled through much of the match. He has been cleared for Thursday’s game.

JUDICIARY REPORT

* Cowboys forward Josh McGuire has taken the early guilty plea and is suspended for three weeks for his facial on David Fifita.

* Tigers backrower Luke Garner (dangerous contact) is facing a one-game ban for a late hit on Bulldogs playmaker Lachlan Lewis. He needs to challenge the charge and win to be free for next week.

* Titans centre Brian Kelly (dangerous throw), Bulldogs forward Chris Smith (dangerous contact) and Raiders back rower Elliott Whitehead (dangerous contact) can escape bans with early guilty pleas.

* Cronulla winger Ronaldo Mulitalo (contrary conduct) and Titans utility Tyrone Peachey (high tackle) will escape with fines.

FULL NRL CASUALTY WARD

BRONCOS

Alex Glenn (Knee, TBC)

Matt Gillett (Groin/back, Indefinite)

Richie Kennar (Shoulder, Season)

Jack Bird (ACL, Season)

Tom Dearden (Ankle, Indefinite)

BULLDOGS

Marcelo Montoya (Knee, Season)

Sauaso Sue (ACL, Season)

Kieran Foran (Calf, Round 22-23)

Adam Elliott (Finger, Round 22-23)

Christian Crichton (Ankle, Finals)

COWBOYS

Josh McGuire (Suspension, Round 25)

Jordan McLean (Calf, TBC)

Jordan Kahu (Eye socket, Round 23)

Kurt Baptiste (ACL, Season)

Ben Hampton (Biceps, Round 22-25)

Justin O’Neill (Spleen, Indefinite)

Mitch Dunn (Shoulder, Season)

Te Marie Martin (Bleed on brain, Season)

DRAGONS

Jack de Belin (Stood down, Indefinite)

Zac Lomax (Hamstring, Round 22)

Jordan Pereira (Neck/head, Indefinite)

EELS

Kane Evans (Illness, Round 22)

George Jennings (Calf, Round 22)

Josh Hoffman (Shoulder, Indefinite)

Blake Ferguson (Knee, Indefinite)

Kaysa Pritchard (Retired)

Ray Stone (Ankle, Round 24)

KNIGHTS

Tim Glasby(Concussion, Round 23)

Edrick Lee (Broken arm, Finals)

Slade Griffin (Knee, Indefinite)

Nathan Ross (Foot, Retired)

PANTHERS

James Maloney (Suspension, Round 22)

Jarome Luai (Eye, Indefinite)

Wayde Egan (Shoulder, Indefinite)

Tyrone May (Stood Down, Indefinite)

Tim Grant (Pectoral, Season)

Jack Hetherington (Sternum, Indefinite)

Caleb Aekins (Foot, Season)

RABBITOHS

Adam Reynolds (Back, TBC)

Sam Burgess (Quad, Round 22)

Braidon Burns (Hamstring, TBC)

Alex Johnston (Knee, Round 23)

George Burgess (Suspension, Finals)

Greg Inglis (Shoulder, Retired)

RAIDERS

Brad Abbey (Knee, Season)

Luke Bateman (Knee, Indefinite)

ROOSTERS

Sam Verrills (Thigh, Round 22)

Ryan Hall (Knee, Round 22)

Sio Siua Taukeiaho (Calf, Round 22)

Boyd Cordner (Calf, Round 22)

Jake Friend (Fractured forearm, Finals)

SHARKS

Matt Moylan (Concussion, Round 22)

Andrew Fifita (Knee, TBC)

Matt Prior (Ribs, TBC)

SEA EAGLES

Daly Cherry-Evans (Ankle, Round 22)

Brad Parker (Knee, Round 23-24)

Curtis Sironen (Hamstring, Round 23-24)

Toafofoa Sipley (Knee, Round 23-24)

Albert Hopoate (ACL, Season)

STORM

Jahrome Hughes (Back, TBC)

Ryan Papenhuyzen (Foot, TBC)

Brandon Smith (Ankle, Finals)

Christian Welch (ACL, Season)

Albert Vete (Shoulder, Indefinite)

TIGERS

Luke Garner (Facing suspension, TBC)

Josh Aloiai (Hand, TBC)

Moses Mbye (Hip, Round 22)

Robbie Farah (Knee, TBC)

Mahe Fonua (Foot, Round 23)

Ben Matulino (Knee, Indefinite)

TITANS

Michael Gordon (Hamstring, TBC)

Keegan Hipgrave (Concussion, Season)

Shannon Boyd (Shoulder, Season)

Dale Copley (Hamstring, Indefinite)

Ryan James (ACL, season)

WARRIORS

Blake Ayshford (TBC)

Karl Lawton (Shoulder, Round 23-24)

Kodi Nikorima (Ankle, Round 22)

Issac Luke (Suspension, Round 23)

David Fusitu’a (Hamstring, Round 23)

Nathaniel Roache (ACL, Season)

Tohu Harris (Knee, Season)

Originally published as NRL casualty ward Round 21