Has the rehab team let Buckley and the Pie's down?

[Danny]

Two areas have been identified by the Collingwood club this week (10/5/2004) that need urgent attention:

(i) LEADERSHIP on the field

(ii) Injury management

Nathan Buckley has re-injured his Hamstring and the Pies are scrambling to ensure that this kind of thing is not repeated. A physio's worst nightmare! After all the rehab and hard work Buckley will need to start again. Not only a stressful time for the club with one of their best players out, it is a stresful time for him personally.

What do you think?

Has the rehabilitation team let Buckley and the Pie's down?

[injuryupdate]

Hamstring recurrences can always happen with AFL players who are constantly trying to come back in under the full recovery time for a hamstring injury.

A good summary of the scientific evidence on return is at:
http://www.injuryupdate.com.au/images/research/CJSMeditstrains.pdf

A good summary of the problems in the Buckley situation is at:
http://www.realfooty.theage.com.au/realfooty/articles/2004/05/10/1084041335846.html

[injuryupdate]

Peter Larkins' view

Damned if you do, cursed if you don't
12 May 2004 Herald Sun
Peter Larkins

WOULD there have been less risk of recurrence if Nathan Buckley had waited longer before returning from his hamstring injury? Definitely.

Would Collingwood or Nathan Buckley have been prepared to wait up to 10 weeks to minimise that risk? Definitely not.

Given its time over again, Collingwood's medical panel probably wouldn't change anything in the way Buckley was managed.

But herein lies the dilemma for players and medical staff.

How long should an elite athlete, who sprints when fatigued, kicks off balance and bends over at full speed, wait before competing after a hamstring injury?

I want to put something straight. There is no such thing as a "standard" hamstring recovery time and there are no infallible tests that guarantee a player has recovered 100 per cent.

Muscle tears are generally graded one, two or three, according to the amount of tissue damage.

In general, a grade one would be one to two weeks, grade two three to six weeks, and more serious grade three tears considerably longer.

Recovery times are complicated by factors such as a player's age and the presence of other injury problems. In Buckley's case a lower back condition seems to be contributing.

After re-injuring his hamstring against Carlton on Saturday, Buckley admitted in the Sunday Herald Sun there had been a risk with his return.

"It's always a risk coming back and apparently athletes take eight weeks. It had been three weeks. But it goes to show, you can't test for match-day intensity," Buckley said.

Australian sprinters Patrick Johnson (January 10) and Matt Shirvington (January 31) both injured hamstrings this year and neither has competed since at top level. Significantly, both were non-starters at the February 26-29 national titles, which doubled as the Olympic selection trials, the athletic equivalent of the Grand Final.

Should we now begin to treat our elite footballers as athletes?

This is a major dilemma for clubs with the pressures of a 38-player squad and a 22-week home-and-away season.

When Mick Malthouse was challenged after the match on the decision to play Buckley, he said: "Doctors don't gamble."

Unfortunately, Mick, doctors often do have to gamble with soft-tissue injury decisions.

Data shows the risk of hamstring re-injury goes beyond the mythical 21 days popularised by legendary Demon coach Norm Smith in the 1950s.

The gamble diminishes during the first month after returning, but the risk remains for the entire season and AFL data shows almost 31 per cent will recur in the same season.

Dr John Orchard's study reveals that the average time missed is 3.4 matches (24 days) and this is slowly increasing as clubs adopt a more conservative approach.

People often ask me: "Don't MRI scans help in deciding how bad a muscle a tear is?"

The answer is a qualified yes. Sometimes a scan will be clear because the hamstring pain is coming from an inflamed nerve or disc in the back.

When a true tear is present, a scan will show its location, (83 per cent are in biceps), size and amount of bleeding.

If a player has a previous injury, the scan can show if the recurrence is in scar tissue or a new location.

The problem is that damage indicators on the scan persist long after a player returns, so most players resume well before tissue healing is complete.

Most clubs have a standardised rehabilitation program in which they have confidence.

Some clubs keep their programs a secret. A player will return to play once he has completed several training sessions at full intensity without pulling up sore.

While that may not seem scientific, there is no fail-safe way to know when the time is right. A match is the ultimate fitness test.

Collingwood has had a good run of avoiding soft-tissue injuries in recent years and the current problems (Buckley, Scott Burns, Josh Fraser and Chris Tarrant) would be frustrating for all at the club.

The solutions are not obvious as bad luck plays a big role.

Hamstring injuries are unavoidable. They are already the No. 1 injury in the 2004 season and there will be more recurrences in coming weeks.

Players generally miss more games the second time as, apart from overcoming the pain of the injury, they must deal with the emotional scars and fear of returning.

Buckley is nearing 32. It will be a nervous road back.

Dr Peter Larkins is a sports physician at the Melbourne Sports Medicine Centre and Lifecare Prahran. A former Olympic runner, he was also a medical officer with Geelong and Adelaide.