Swans chat Injury management

[Ralph Dawg]

When Cal did his shoulder, I defended the medical staff. As I said at the time, these guys are highly qualified, motivated health professionals who are passionate about their jobs.
I have subsequently discussed his injury with 2 prominent shoulder surgeons, one who has worked with Canadian Ice Hockey and Gridiron teams as their orthopaedic surgeon. Both have said the decision to send Cal back out, on face value, after his first dislocation was unusual. They both couldn't think of any reason to send him back out in the particular context of the game. Grand Final yes. Match against team coming last with so much of a regular season left - definite no. I posed the argument that he couldn't do anymore damage after the first dislocation and both just laughed at the suggestion. In their experiences (combined > 30 years), both said he was at high risk to further damage the shoulder. They felt that any chance he had of returning this season, would've been significantly reduced by the second dislocation.
Now my disclaimer to the above is that none of us know the full story or Cal's medical history. In short we weren't there and thus have not spoken to him or had the chance to examine the injury. But coupled with the latest set backs to Macca and Harry, Smith's inability to recover from his hamstring, Reynolds barely playing, Darcy re injuring his quad, Buddy, Sam, AJ and Hanners on going issues, I do find it all a bit perplexing.

[caj23]

Great post Ralph, I was considering starting a similar thread myself.

I understand that every team has injuries, its the nature of the game, but from an unqualified outsiders perspective there just seem to be so many missteps in this area at our club in recent seasons.

In addition to the players you listed, there's also Ling and Durack Tucker who have barely been on the park in their time at the Swans.

Naismith and Tucker have lost 2 full seasons on knee reconstructions in an age when players are getting back on the park faster than ever

[barry]

Well done Ralph in getting expert opinion. It drives me made the blind faith some on here have.

Not to derail the thread, but how many times have we heard "I have faith in the list management team", and even after Mitchel, Dunkley, and 13th on the ladder and others, they still have blind unquestionable faith. No evidence will away them.

[jono2707]

I agree that there appear to be some issues, particularly considering Harry and Macca both went down this week with very similar injuries that they'd supposedly just recovered from.

[rb4x]

I don't think our management of injuries has been optimum since Dave Misson left as High Performance Manager at the end of 2007. He is leaving Melbourne to go to Canada at the end of this year. I cannot say whether the implosion of the Demons this year is at all related. Maybe drawing a long bow but I rated Dave Misson as being the best in the business.

[goswannies]

Ralph D, I’m pleased that you discussed it. I think I might have been an early poster after the injury - not deriding our medical staff - but expressing my concern, particularly in light of non-elite athletes using this management as an example. I have spoken to a couple of surgeons who concur with those that you have spoken to.
I always premise medical posts with I have no insider knowledge of specific incidents, and I am also a little more conservative as I tend to holistically consider the long term big picture.

[MattW]

Hey goswannies, are you able to assist with some indication of how Franklin's hamstring injury could have developed into complications with his sciatic nerve? See here: Franklin aims for return in 2019 - sydneyswans.com.au.

How might a sciatic nerve be treated? What can we infer from this complication? Is it likely to have lasting effects? Thanks!

[S.S. Bleeder]

I don't think our management of injuries has been optimum since Dave Misson left as High Performance Manager at the end of 2007. He is leaving Melbourne to go to Canada at the end of this year. I cannot say whether the implosion of the Demons this year is at all related. Maybe drawing a long bow but I rated Dave Misson as being the best in the business.

+1

[dejavoodoo44]

Hey goswannies, are you able to assist with some indication of how Franklin's hamstring injury could have developed into complications with his sciatic nerve? See here: Franklin aims for return in 2019 - sydneyswans.com.au.

How might a sciatic nerve be treated? What can we infer from this complication? Is it likely to have lasting effects? Thanks!

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.

[MattW]

Cheers Deja!

[Ralph Dawg]

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.

Has Buddy had low back issues in the past? Certainly if he has, then this is a very plausible situation and also of concern for his ability to string together games and also his longevity.

[dimelb]

I hope the club can ignore the 300th and focus on sorting out the sciatic nerve or the hamstring muscle or whatever is not functioning. I don't care if we don't see Buddy on the field again until next year.

[Mel_C]

Has Buddy had low back issues in the past? Certainly if he has, then this is a very plausible situation and also of concern for his ability to string together games and also his longevity.

Yes I remember he had back issues towards the end of 2015.

I have had sciatica and it is very very painful ????. Lots of physio and exercises to correct it.

[goswannies]

Hey goswannies, are you able to assist with some indication of how Franklin's hamstring injury could have developed into complications with his sciatic nerve? See here: Franklin aims for return in 2019 - sydneyswans.com.au.

How might a sciatic nerve be treated? What can we infer from this complication? Is it likely to have lasting effects? Thanks!

Sorry haven’t checked in for a couple of days

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.

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

[Swanny40519]

I hope the club can ignore the 300th and focus on sorting out the sciatic nerve or the hamstring muscle or whatever is not functioning. I don't care if we don't see Buddy on the field again until next year.

I agree. Why stuff up a whole pre season for just 1 or 2 games this year.

We need - Buddy needs a full pre season for 2020 to give us some forward power and to also set up his whole year.