NRL Physio’s casualty ward Round 1

Parramatta lock Nathan Brown is set for a long stint on the sideline, while Tyson Frizell has been sent for surgery on a ruptured testicle.

Tyson Frizell in hospital following surgery on a ruptured testicle.

NRL Physio, aka Brien Seeney, gives his expert analysis of all the Round 1 injuries.

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There are fears Parramatta lock Nathan Brown is out long-term with a pectoral injury. Brown left the field in serious pain after just 19 minutes against the Panthers at Penrith Stadium.

Now Eels coach Bead Arthur has said he thinks “it’s his pec” in regards to forward Nathan Brown, with an expected 3 month recovery period. Clarification will no doubt come from the Eels in Tuesday’s injury report

— NRL PHYSIO (@nrlphysio) March 17, 2019

In the same game, Penrith club debutant Hame Sele left the field with a suspected broken arm, while Isaah Yeo went off with concussion. Michael Jennings was sinbinned for the hit on Yeo and could face suspension.

Ashley Taylor (quad) was a pre-game withdrawal for the Titans.

Tyson Frizell had surgery on Saturday night after a copping a heavy blow to his testes in the game against the Cowboys.

Tyson Frizell appears to have been admitted to hospital after posting this picture today. No specifics on the injury as yet, but he did cop a heavy blow to the groin in last night’s game. Fingers crossed everything is OK pic.twitter.com/Gcdfhuoahd

— NRL PHYSIO (@nrlphysio) March 16, 2019

Surgery is usually required when a testicle rupture occurs. Most require 4-6 weeks recovery, though there are some cases of early return. Kurt Capewell only missed one week last year after a similar surgery and returned wearing a protective guard on his groin.

“On Saturday night in our game against the North Queensland Cowboys, Tyson Frizell copped a blow to his testes,” Dragons head of performance Nathan Pickworth said.

“Following the game, we investigated further with follow up scans which unfortunately resulted in surgery being performedin Townsville.

“Tyson this morning is in a good condition and in good spirits. We will update as more news comes to hand later in the week.”

Tyson Frizell had surgery last night after a blow to his testes. Surgery is usually required when a testicle rupture occurs. Most require 4-6 weeks recovery, though there are some cases of early return. Kurt Capewell only missed 1 week last year after a similar surgery

— NRL PHYSIO (@nrlphysio) March 16, 2019

James Roberts played just six minutes in his first game of the season before coming from the field with a lower back issue.

By the time he reached the dressing sheds he could barely walk, and even post-game was hesitant to lie down or walk around due to the severity of his pain.

Word from the Broncos camp was that Roberts’ pain was due to a disc issue, but they were hopeful there was no structural damage and it was more an acute neural (nerve) irritation.

Coach Anthony Seibold said that Roberts felt the pain after his very first run, and that he hadn’t carried a back injury into the match.

Discs provide shock absorption in the spine, whilst also assisting with stability of movement between the vertebrae.

Injuries involving the discs and nerves in the lower back can be quite varied in their presentation, and therefore involve more unpredictable recovery times.

Brien Seeney, aka NRL Physio.

Return to play is guided by symptoms as much as scan results, and even a “bulging disc” can result in a short absence if symptoms settle quickly.

How Roberts’ symptoms settle in the coming days will be influential on overall recovery, whilst he will also go for scans in this time. Worst case scenario is an injury to the disc (e.g. herniation) that causes intense and prolonged neurological symptoms (pain, weakness, numbness etc).

This can require several weeks’ rehab and even surgery in severe cases (surgical recovery usually 2-4 months). Thankfully early reports suggest there is hope Roberts only suffered an acute nerve irritation and associated muscle spasm, with no structural issues.

If confirmed, whilst he would be unlikely to play next weekend once the spasm settles, most players are able to return in 1-3 weeks.

James Roberts still in some pain, avoiding standing up straight. The latest expectation from the Broncos is good news though; they think it’s just a minor muscle spasm/nerve irritation. Wouldn’t expect him to play next week, but most return in 1-3 weeks pic.twitter.com/Tj8xDWFtxt

— NRL PHYSIO (@nrlphysio) March 15, 2019

Daniel Saifiti went down early in the second half due to some friendly fire as a Newcastle teammate swung onto his lower leg during an attempted tackle.

Unfortunately the contact was to the outside of Saifiti’s lower leg as his foot was planted, causing his knee to collapse inward and rotate.

This is a position of concern for an MCL injury, and can also place the ACL at risk in some cases. Forwards Viliame Kikau and Manu Ma’u suffered injuries in similar circumstances over the past month, both coming away with MCL sprains.

In good news the early reports had no mention of a season ending ACL injury for Saifiti, but he was still held out for the rest of the game with a suspected MCL sprain. If confirmed via scans, a general return to play guide for the different severities of MCL sprain is:

Grade 1: 1-3 weeks

Grade 2: 3-6 weeks

Grade 3: 6-10 weeks

Reported MCL sprain for Daniel Saifiti. Per video worry would be for right MCL sprain, also high ankle sprain risk but less likely. Would hope no ACL involvement. If MCL sprain confirmed general recovery guide:
Gr1: 1-3wks
Gr2: 3-6wks
Gr3: 6+ wks#NRLKnightsSharks pic.twitter.com/HWODq3qUbi

— NRL PHYSIO (@nrlphysio) March 15, 2019

Des Hasler indicated that it may be at least a few more weeks before we see Manly’s star fullback back on the park. Whilst Tom Trbojevic himself has been pushing for a Round 2 return and Sea Eagles medical staff said Round 3 was the expectation, Hasler suggested after the Sea Eagles loss on Saturday that Trbojevic would not be back until Round 4.

This would mark six weeks since he suffered a grade 1 hamstring strain, which would be a slightly longer than usual recovery for a minor hamstring strain (generally 2-4 weeks). With vision of Trbojevic completing agility drills at training last week, it is very possible Hasler is downplaying expectations.

But with a long season ahead, and the high recurrence rate of hamstring strains, the Sea Eagles could opt to go the conservative route with Turbo’s return.

Des Hasler said tonight they now aren’t expecting Tom Trbojevic back until Round 4 as he recovers from a low grade hamstring strain suffered in the trial games

— NRL PHYSIO (@nrlphysio) March 16, 2019

Moses Mbye was unable to recover from a knee injury to line up in Round 1. Mbye reportedly suffered a ruptured PCL in the preseason and returned to play in the Tigers’ final trial match after five weeks recovery.

Even though surgery usually isn’t required for a complete rupture of the PCL, there can be some instability in the short term. However the Tigers have said the issue that has kept Mbye out is unrelated to his previous knee injury.

Coach Michael Maguire said that Mbye ran well on Friday, and will undergo further assessment next week before a decision is made on his availability for the Round 2 clash with the Warriors.

Junior Paulo did not recover from a minor hamstring in time to take his place in the Eels side this weekend. Paulo suffered the injury just over 2 weeks ago, and whilst he was initially expected to return in Round 1 this is not an uncommon scenario in the management of hamstring strains.

As with Trbojevic above, hamstring strains this early in the season are often better left that extra week to ensure the risk of re-injury is as low as possible. Providing no setbacks in his rehab I would still expect Paulo back in the next week or two.

Junior Paulo has a hamstring issue. Picture: Brett Costello

Panthers hooker Sione Katoa suffered a concussion at training this week and was ruled out of contention for the Round 1 clash with the Eels. Recovery from concussion is a very individualised process; a common saying is concussions are like snowflakes, no two are the same.

Symptoms can be delayed, intermittent (go away and come back), and vary in severity. In good news for Katoa most concussions will resolve in 7-10 days, which gives him time to pass through the concussion protocol before Round 2.

Kyle Feldt was ruled out of Round 1 after suffering a groin strain last week. There unfortunately has been no word on an expected return date. It is common to be day to day with low grade groin strains, but it is an injury that can be frustrating to rehab and symptoms can linger. A general recovery guide for low grade groin strains:

Grade 1: 0-2 weeks

Grade 2: 2-4 weeks

Tom Eisenhuth spent Thursday night in hospital after suffering breathing difficulties post-match. The Melbourne interchange forward suffered a blow to the throat in the closing stages of the game, but was able to play on until full time. He remained in hospital on Friday and was still being assessed by medical professionals. Hopefully he has avoided any fracture of the cartilage in his throat and is just dealing with a contusion/bruising. Will hope for good news in an update from the Storm soon.

Tom Eisenhuth (Storm #19) was sent to the hospital post game last night after suffering breathing difficulties. He appears to suffer a blow to the throat below in the final stages of the game, but was able to play through to full time. pic.twitter.com/ELyWnIiMHx

— NRL PHYSIO (@nrlphysio) March 15, 2019

David Nofoaluma is expected to return in Round 2-3 with a shoulder injury, whilst George Jennings will also be on the sidelines until Round 3 with a knee injury.

In some positive injury news Tautau Moga had a successful return to the field via NSW Cup on Friday afternoon, 11.5 months after his 4th ACL reconstruction. He had a 30 minute stint, with the Knights hoping to build up his game time via NSW Cup in the coming weeks. I hope we see Moga back in the NRL very soon.

JUDICIARY REOPRT

* Controversial prop Matt Lodge will be banned for Brisbane’s next two games unless he can beat a charge at the NRL judiciary stemming from the opening minute of the season. Lodge was on Friday hit with a grade-two dangerous contact charge for attacking Cameron Munster’s legs when the Melbourne five-eighth kicked at the end of the first set on Friday night.

* Addin Fonua-Blake is facing two weeks all up for separate dangerous contact charges. He faces a week for each charge. He would miss one week of he plead guilty to both charges.

* Latrell Mitchell (carless high tackle) and Joel Thompson (tripping) have copped fines.

FULL NRL CASUALTY WARD

BRONCOS

Payne Haas (Disciplinary, Round 5)

Matt Lodge (Facing suspension, Round 2-4)

James Roberts (Back, TBC)

BULLDOGS

Fa’amanu Brown (Leg, Round 4)

COWBOYS

Kyle Feldt (Groin, TBC)

Scott Bolton (Suspension, Round 6)

DRAGONS

Jack De Belin (Stood down, Indefinite)

Korbin Sims (Suspension, Round 3)

Tyson Frizell (Ruptured testicle, TBC)

EELS

Nathan Brown (Pectoral, TBC)

Kaysa Pritchard (Personal leave, Indefinite)

Manu Ma’u (Knee, Round 6)

George Jennings (Knee, Round 3)

Junior Paulo (Hamstring, Round 2)

Jaeman Salmon (Disciplinary, Round 2)

Peni Terepo (Stood down, Indefinite)

KNIGHTS

Daniel Saifiti (Knee, TBC)

Slade Griffin (Knee, TBC)

Nathan Ross (Finger, Round 5)

Jacob Saifiti (Leg, Indefinite)

Mason Lino (Knee, Round 3)

ROOSTERS

Ryan Hall (Knee, Round 8)

PANTHERS

Hame Sele (Suspected broken arm, TBC)

Sam McKendry (Knee, TBC)

Viliame Kikau (Knee, Round 3-5)

Tyrone May (Stood down, Indefinite)

Sione Katoa (Concussion, Round 2)

Isaah Yeo (Concussion, TBC)

RABBITOHS

Adam Doueihi (Knee, Round 4-5)

George Burgess (Suspension, Round 4)

Kurt Dillon (Achilles, Round 3)

RAIDERS

Jordan Rapana (Shoulder, Round 7-10)

Michael Oldfield (Ground, Round 2)

SHARKS

Wade Graham (Knee, Round 9-12)

Ava Seumanufagai (PCL, Round 4)

SEA EAGLES

Tom Trbojevic (Hamstring, Round 3)

Kelepi Tanginoa (Knee, Round 2)

Taniela Paseka (Knee, Round 2)

Dylan Walker (Stood down, Indefinite)

Addin Fonua-Blake (Facing suspension, Round 2-4)

STORM

Scott Drinkwater (Pectoral, Round 8-12)

Joe Stimson (Back, Round 2)

Tom Eisenhuth (Throat, TBC)

TIGERS

Chris Lawrence (Broken jaw, Indefinite)

David Nofoaluma (Shoulder, Round 3)

Moses Mbye (Knee, Round 2)

TITANS

Will Matthews (Achilles, Round 2)

Ashley Taylor (Quad, TBC)

WARRIORS

Isaiah Papali’i (Disciplinary, Round 2)

Issac Luke (Shoulder, Round 2)

Originally published as NRL Physio’s casualty ward Round 1