Injury management

[liz]

I don't have a strong view either way on whether the club should try to get Buddy out on the field again this season. On the one hand, he's a joy to watch so the more opportunities to watch him the better. And if he can chip a few goals off that 60 that he still needs to reach the 1000 goal mark, all the better - it reduces the risk of us having to wait for the 2020 Grand Final for him to do so (and thus eliminating the chance for fans to run out onto the ground - assuming they'll let that happen in any other game).

On the other hand, it would be great for him to actually have a pre-season for once, and not have to recover from knee or shoulder or groin operations. He might pick up an injury during pre-season but it would be nice if he doesn't in the final (meaningless) games of 2019.

If he doesn't make it back, it will give the AFL a whole spring to ponder the opening fixture of 2020, in anticipation of his 300th game. Will they fixture us against Hawthorn? Will it persuade them to give us an SCG game to open the season so that his adoring home crowd get to witness his 300th? Or will they decide that the Melbourne public is more deserving of that privilege?

[dejavoodoo44]

Sorry haven’t checked in for a couple of days

Pretty good Deja!

Ok, a while ago, a common diagnosis on player omission was “back related hamstring issues”. Essentially this was sciatica - tension on the sciatic nerve. Symptomatically, it presents as discomfort and/or tightness along the distribution of the sciatic nerve ... which traverses the back of the thigh ... the hamstring region.

The sciatic nerve is the largest nerve in the body, comprised of the union of 5 nerve roots originating from the lumbar spine. It traverses deep in the buttock region, down the back of the thigh, to the heel and sole of the foot, supplying the skin and posterior muscles of the leg (the hamstrings being prominent).

The conundrum is that the sciatic nerve can be irritated in a number of regions. The neural pathway essentially extends from the lumbar spine to the foot. It can be encroached upon by disc protrusion or narrowing of the foramen (the holes between the vertebrae from which the nerve roots emerge) causing mechanical compression of the sciatic nerve at these levels. Then the sciatic nerve passes through the muscular buttock region either deep to the piriformis muscle or in a proportion of people through the piriformis muscle - in either instance piriformis can cause compression of the sciatic nerve. Then, as the nerve traverses the leg, any relative tightness of the nerve relative to the leg length will apply tension to the sciatic nerve - again yielding discomfort at the back of the thigh.

Add to this, while the sciatic nerve emerges from the lumbar spine, the spinal column extends up to the head potentially there can be a proximal component at the head.

The advantage of such a lengthy nerve that supplies a specific region is that this very feature can be used to differentially diagnose the probable level of the irritating region. This is called the slump test. When you sit with your knee straight, ankle dorsiflexed (bent up), thorax flexed, and neck flexed (chin to chest) - the sciatic nerve is on full stretch (it’s a wee bit more complicated than that, but that’s the basics). It will almost always recreate the symptoms in the case of sciatica. Then by releasing different elements (eg straighten the thorax; extending the neck; bending the knee; plantar flexing the ankle) the symptoms may be relieved indicating at which region the sciatic nerve might be problematic.

In the case of piriformis, deep palpation will likely elicit symptoms (usually comparing sides). The discs are assessed by symptoms & mobilising the lumbar spine. Facet joints by a different type of spinal mobilising.

There’s more to it than that but it’s a start.

Right, that should give you an idea that treatment becomes a complicated issue, as it really depends on where the pathology is. Neural stretches and mobilising, piriformis stretching and massage (it’s a very specific stretch), traction may help if these is a doscogenic component, lumbar mobilising for facet joint involvement.

Also, while the sciatic nerve pain is neural in nature, there can be a genuine hamstring component. If the sciatic nerve is causing pain, the body might respond by limiting movement to reduce pain. This can result in muscles becoming tight in their own right. Again, we need to differentiate between hamstring tightness and muscle tears (a hamstring stretch with neck and ankle dorsiflexion assists this differentiation.

These are general manual tests. Scans are also very helpful.

While hamstring damage and sciatica can be mutually exclusive, they can also be interrelated, and treatment is modified accordingly. It can be effectively treated, however, this can be time consuming and require diligence. Quick fixes are (IMO) unlikely as if exacerbated before it is “fixed” it tends to set the player back. Additionally, often treatment can make the player asymptotic with general low intensity movement, however, extreme movements (end range kicking, long strides or ballistic contraction with running) can be the actions that will exacerbate the sciatica. I’d hope/expect that a well managed sciatic condition could/should have a positive outcome both short & long term. Getting onto it early can definitely help.

Disclaimer: general information not medical advice

Ta; your medical information is always interesting.

- - - Updated - - -

I don't have a strong view either way on whether the club should try to get Buddy out on the field again this season. On the one hand, he's a joy to watch so the more opportunities to watch him the better. And if he can chip a few goals off that 60 that he still needs to reach the 1000 goal mark, all the better - it reduces the risk of us having to wait for the 2020 Grand Final for him to do so (and thus eliminating the chance for fans to run out onto the ground - assuming they'll let that happen in any other game).

On the other hand, it would be great for him to actually have a pre-season for once, and not have to recover from knee or shoulder or groin operations. He might pick up an injury during pre-season but it would be nice if he doesn't in the final (meaningless) games of 2019.

If he doesn't make it back, it will give the AFL a whole spring to ponder the opening fixture of 2020, in anticipation of his 300th game. Will they fixture us against Hawthorn? Will it persuade them to give us an SCG game to open the season so that his adoring home crowd get to witness his 300th? Or will they decide that the Melbourne public is more deserving of that privilege?

Of course, if the AFL want to give the Suns an early season boost, then they could opt for Metricon. Seems like a good idea to me: and not at all influenced by self interest.

[Nico]

Even though gs could obviously provide a much more professional answer, than my semi-educated opinion, I might have a go at some of that question.
It's probably worth briefly describing what sciatica is. Usually its main symptom is nerve pain, that seems to arise chiefly from the back of the thigh. Though it's generally not caused by thigh damage. Instead it is caused by damage to, or misalignment of, the lumbar area of the spine; where the root of the sciatic nerve is situated. This means that there is pressure on the nerve and the sensory transmission to the brain is interfered with. Because the main sensory area of the sciatic nerve is the posterior thigh and not the spine, the brain then mistakenly believes that the problem originates in the thigh. The sciatic nerve also innervates the muscles of the posterior thigh. For example, nerve impulses that stimulate the contraction of the hamstring, are delivered by the sciatic nerve.

So, anyway, I think it's possible hamstring damage can contribute to sciatica; and vice versa. I suspect that the main way it could contribute, is that with hamstring damage, the person is not going to be walking normally. Instead, they're likely to have an unbalanced stride, which could contribute to a misalignment, which in turn pressures the sciatic nerve. I guess that it could work the other way. With sciatica, the person may not be getting accurate information about what the hamstring is doing and/or there is erratic innervation of the muscle. If this means that the hamstring is not functioning correctly, then this could lead to a strain?

As far as treatment goes, I really don't know.

Sounds like he needs to see a decent chiropractor.

[Ralph Dawg]

Goswannie, what do you do professionally? Anatomy lecturer? That is a very good summary of the sciatic nerve, actually better than anything I was taught at university. Anatomy was never a strong point of mine, hence a career in Anaesthesia, not surgery or sports medicine, even though I would've loved to have been a sports doc - that was actually my main motivation for a career in medicine.

[Legs Akimbo]

Go swannies, great description and very interesting. Thank you. I have had sciatica and it wasn't fun. Felt like I was about to do a hammy or calf every time I exercised. Tight and painful. Almost as frustrating as shin splints which Papa had. That sucks too. Poor bugger had a
fasciotomy IIRC. Gruesome.

I reckon take the pressure off (forgive the pun) put bud on ice and get him the coaches box for the rest of the year. If he is good in the last round play him and celebrate the milestone. Great way to end the season.

[The Big Cat]

Sounds like he needs to see a decent chiropractor.

"Good Chiropractor" is an Oxymoron.

Somewhere between quackery and snake oil. Can't believe uni's are allowed to offer it. And with two daughters who are medical doctors, it's an insult to them that these charlatans put "Doctor " before their names.

[cherub]

"Good Chiropractor" is an Oxymoron.

Somewhere between quackery and snake oil. Can't believe uni's are allowed to offer it. And with two daughters who are medical doctors, it's an insult to them that these charlatans put "Doctor " before their names.

Absolutely. There's a reason you don't see chiropractors on AFL club staff. They believe in science.

[0918330512]

Absolutely. There's a reason you don't see chiropractors on AFL club staff. They believe in science.

WADA & Essendon beg to differ

[0918330512]

"Good Chiropractor" is an Oxymoron.

Somewhere between quackery and snake oil. Can't believe uni's are allowed to offer it. And with two daughters who are medical doctors, it's an insult to them that these charlatans put "Doctor " before their names.

And Eddie McGuire :

[S.S. Bleeder]

I said this a number of weeks ago. It's time to put Buddy on ice in preparation for 2020. He's a competitor and hates sitting games out but at his age and with the body issues starting to occur we need to do our best to ensure that he can play until the end of his contract. It would also be great to prove wrong those who said we were making a bad decision giving him such a lengthy contract.

[Ralph Dawg]

I said this a number of weeks ago. It's time to put Buddy on ice in preparation for 2020. He's a competitor and hates sitting games out but at his age and with the body issues starting to occur we need to do our best to ensure that he can play until the end of his contract. It would also be great to prove wrong those who said we were making a bad decision giving him such a lengthy contract.

https://www.smh.com.au/sport/afl/athletic-explosive-franklin-far-from-gone-says-premiership-coach-20190726-p52b62.html

[0918330512]

https://www.smh.com.au/sport/afl/ath...26-p52b62.html

When Buddy’s 9 years are up, will he retire, or continue with 1 year contract extensions? For mine, on current (albeit injury interrupted) form, he’d be a handy forward pocket/HFF along side Reid, McCartin, Blakey

[jono2707]

Given what's happened with Sinclair and Cunningham, and particularly the case of Dale Morris over the weekend, I hope we don't rush Naismith back into the 1s prematurely. I rate him and want to see him back out there asap, but I feel the risks by far outweigh the benefit of bringing him back in this week.

[Hotpotato]

"Good Chiropractor" is an Oxymoron.

Somewhere between quackery and snake oil. Can't believe uni's are allowed to offer it. And with two daughters who are medical doctors, it's an insult to them that these charlatans put "Doctor " before their names.

With due respect to your wonderful daughters (there are several docs in our our family as well) I actually disagree with this blanket statement about Chiros.

This morning (after a good sleep) I could barely walk or bend without significant pain, and I have to be physically very fit and able to do my active job in tourism.

I swung past my Chiropractor, and he corrected my issues in under 5 mins and I was over 60% pain free to go to my job. I don’t know of any other Practitioner who could have achieved this.

[Meg]

When Buddy’s 9 years are up, will he retire, or continue with 1 year contract extensions? For mine, on current (albeit injury interrupted) form, he’d be a handy forward pocket/HFF along side Reid, McCartin, Blakey

Alistair Lynch played one more year (2004) after his 10-year contract (1994 to 2003) was complete. He was 36 yo in that last year, and Buddy will be 35 when his contract finishes in 2022.

So there is precedent.

Mind you, I hope Buddy doesn’t ‘play’ in the same manner as Lynch in his last match!