Leg Breaks

[BornInDroopSt'54]

Any medicos out there who can give some insight into leg breaks like Stringer’s, Dale Morris’s and Nathan Brown’s?
Why do they have such a devastating impact on ability to play AFL?
• Is it mainly the lack of confidence and a prolonged discomfort that inhibits players or is it physical inhibition?
• Supposedly the place where a bone breaks becomes the strongest point so is it the tissue/ muscle/nerve damage that is a major factor?
• Is it that the muscles and leg need to ‘relearn’ co-ordination and muscle memory?
It is clear the club has done its due diligence with Stringer although Brown’s break, which seems very similar, clearly wrecked his talented career (pity he wasn’t born with a heart, rather a cold mind) and Dale Morris has yet to prove his recovery. What evidence would the club have that Stringer’s break will not hamper him in the future?

[EasternWest]

Michael Voss recovered well from his, and Barlow at Freo seems to be doing alright. I'm hopeful it's an individual thing and Stringer is able to recover fully.

I'd assume working in his favour is the fact he did it young?

[BornInDroopSt'54]

Michael Voss recovered well from his, and Barlow at Freo seems to be doing alright. I'm hopeful it's an individual thing and Stringer is able to recover fully.

I'd assume working in his favour is the fact he did it young?

So you believe it's an individual thing and as Stringer was only 16 may be trouble free? One aspect of Stringer's and Brown's was that they actually broke their leg violently ( in terms of the effect- a sheer break of one of the strongest bones in the body) simply by kicking it with the other leg. It seems to defy physics, yet the result is a shocking injury.

[SlimPickens]

There are a number of issues with breaking both the tibia and fibula like Stringer,Morris et al have. Post injury you are obviously dealing with many things that will not only effect his gait but also his power etc.

Some facts about breaks- the bone will theretically be stronger if the break is well aligned and was adequately braced during the healing process then it was pre break. Stringer had rods in place which would have allowed for this, the bone will not look like it previously did but will be strong enough to hold up to the rigors of footy.

Obviously over the whole bracing period there would have been a lot of muscle dystrophy (wasting), which would effect his knee, ankle and foot mechanics. This can and has been rehabilitated reasonably well but will be an ongoing process.

The biggest and most often complication with breaks like this is something called compartment syndrome and it's a nasty piece of work. Basically the lower leg has a number of muscles that are separated by fascia, bone etc. When you break a bone you get bleeding and invariable swelling. In the lower leg this can be compartmentalised which is the primary concern of the drs post surgery. If untreated it can lead to muscles death, nerve damage and in severe cases amputation. Stringer obviously didn't have this but I believe Moris may have battled with this, hence we didn't see him this year.

What Stringer will need to overcome is firstly confidence in the leg, secondly restricted movement in the ankle which he'll have worked on (a heap), and foot mechnics. When you have a low ankle fracture you need to work on strength, control and most importantly proprioception (awareness of where your foot is in space)
. The club have people in place who I'm confident will manage what is best for Stringer and will get he best out of him.

Stringer has age and enthusiasm on his side, his leg never concerned me as much as Menzals knee for example.

[Murphy'sLore]

Thanks for that Slim, great to get your expert perspective.

[lemmon]

Great post slim, what about power/speed? Have read Stringer hasn't quite regained these as previously, will they ever come back? Is it even possible to tell at this point?

I guess its a concern for Morris as well, his speed was key in taking the smalls

[BornInDroopSt'54]

The biggest and most often complication with breaks like this is something called compartment syndrome and it's a nasty piece of work. Basically the lower leg has a number of muscles that are separated by fascia, bone etc. When you break a bone you get bleeding and invariable swelling. In the lower leg this can be compartmentalised which is the primary concern of the drs post surgery. If untreated it can lead to muscles death, nerve damage and in severe cases amputation. Stringer obviously didn't have this but I believe Moris may have battled with this, hence we didn't see him this year.
What Stringer will need to overcome is firstly confidence in the leg, secondly restricted movement in the ankle which he'll have worked on (a heap), and foot mechnics. When you have a low ankle fracture you need to work on strength, control and most importantly proprioception (awareness of where your foot is in space)
. The club have people in place who I'm confident will manage what is best for Stringer and will get he best out of him.
Stringer has age and enthusiasm on his side, his leg never concerned me as much as Menzals knee for example.[/QUOTE]

Brilliant thanks Slim, your insight and understanding must have been hard earned and address the curiosity about these cases. That compartmentalisation sounds vile and it's so good that Stringer has escaped it. The critical bracing of the healing break reminds me of the work I'm doing with the hotface of my wood fired oven- a clay/sand/cement mix that has to withstand 600* C yet has cracked and I'm bracing it. Hope with all my heart that Dale Morris has limited prob's with his lower leg being compartmentalised.
The process of proprioception is a fascinating concept and although I'd never heard of it I suppose I'd imagined it being active. I guess the break puts a process that is normally instinctive (spatio/temporal relationship and awareness) out of kilter and the conscious mind and other aspects of the psyche need to play a hand to intervene, like learning to steer,change gears and brake in a car. Repetition no doubt could build up 'muscle memory' (probably a misnomer from your pov) and hopefully Jake and Dale can become proprioceptually proficient.
Tales of people who lose a leg still feeling things in it - like part of the psyche still can't accept the change- spooky stuff.

[Dancin' Douggy]

Thanks Slim, good insights.

Does the fact that he was not fully grown (he may still be growing as well) when he broke it have any positive or negative impact on the healing process.

Will a badly broken leg bone grow at the same rate as an undamaged one?

[LongWait]

Thanks Slim - fascinating contribution. The club has spoken about assisting Jake to make biomechanical adjustments to his gait. Any comments on what that entails and degree of difficulty?

[SlimPickens]

Thanks Slim, good insights.

Does the fact that he was not fully grown (he may still be growing as well) when he broke it have any positive or negative impact on the healing process.

Will a badly broken leg bone grow at the same rate as an undamaged one?

Will only have implications if he broke his growth plates, which i suggest the break would have been too high for that. To answer your question, it should but if blood supply is effected and remember he would of been bolted into place for six months then it may mean he is out of whack. That being said you would think that the fracture leg side may be longer as more bone would have been laid down during he healing process.

Males don't mature skeletally till they're 25, meaning his bone density will get better and stronger and yes he may still grow.

[EasternWest]

So you believe it's an individual thing and as Stringer was only 16 may be trouble free? One aspect of Stringer's and Brown's was that they actually broke their leg violently ( in terms of the effect- a sheer break of one of the strongest bones in the body) simply by kicking it with the other leg. It seems to defy physics, yet the result is a shocking injury.

No I don't believe that, I'm hopeful of that. I have no expertise etc, just hopeful that's how it pans out. Sorry should have clarified that. Part of my reasoning is that my broken bones as a youth healed much more quickly and better than my broken bones as an adult.

Also, Voss' injury was easily as severe as Brown's. His occurred when his leg hit another guys leg midair (Voss was on a lead IIRC). I remember vividly his leg flopping around after the impact. Awful to watch.

[chef]

Thanks Slim.

[BornInDroopSt'54]

No I don't believe that, I'm hopeful of that. I have no expertise etc, just hopeful that's how it pans out. Sorry should have clarified that. Part of my reasoning is that my broken bones as a youth healed much more quickly and better than my broken bones as an adult.

Also, Voss' injury was easily as severe as Brown's. His occurred when his leg hit another guys leg midair (Voss was on a lead IIRC). I remember vividly his leg flopping around after the impact. Awful to watch.

Voss's break in midair was freakish as I suppose all these guys breaks are. It's great that Voss and Barlow made it back and augurs well for Stringer. Dale Morris we can only wait and see but if anyone can, Dale can.

[Cyberdoggie]

I liked how Carlton after drafting Menzel were trying to explain how Troy's injuries didn't concern them because they were totally unrelated to his brothers.

They basically said Troy had a PCL and then LARS from collision injuries, and not the 2 ACL's his brother had where his knee just gave way.

Dress it up all you want his knees still gave way. 2 brothers with 4 knee related injuries is more than coincidence, it's a trend.

[Ghost Dog]

Ah well. He was pretty close to coming to us. I wish the kid well.

[BornInDroopSt'54]

I liked how Carlton after drafting Menzel were trying to explain how Troy's injuries didn't concern them because they were totally unrelated to his brothers.

They basically said Troy had a PCL and then LARS from collision injuries, and not the 2 ACL's his brother had where his knee just gave way.

Dress it up all you want his knees still gave way. 2 brothers with 4 knee related injuries is more than coincidence, it's a trend.

You'd have to guess they have a genetic predisposition to knee injuries. I hope he has a great career nonetheless but after he leaves Carlton.

[Ozza]

Love reading Slim's expert analysis these days......our little Slim is all grown up!

[Ghost Dog]

Will only have implications if he broke his growth plates, which i suggest the break would have been too high for that. To answer your question, it should but if blood supply is effected and remember he would of been bolted into place for six months then it may mean he is out of whack. That being said you would think that the fracture leg side may be longer as more bone would have been laid down during he healing process.

Males don't mature skeletally till they're 25, meaning his bone density will get better and stronger and yes he may still grow.

Thanks for the diagnosis Slim. Do you bulk bill by any chance? :D

[Go_Dogs]

Great read, thanks a lot Slim.

[Greystache]

Good stuff Slim, but I'm more interested in hearing your thoughts on corporate catering! :D

[boydogs]

Great thread :)


Some facts about breaks- the bone will theretically be stronger if the break is well aligned and was adequately braced during the healing process then it was pre break. Stringer had rods in place which would have allowed for this, the bone will not look like it previously did but will be strong enough to hold up to the rigors of footy.

Without particularly highlighting it, you've made an important point. The strength of the heal of the bone is not the issue, it is the surrounding tissue and his mechanics. So it's all just a matter of time for him to get back to his best.

The recruiters at the combine made a medical judgment call on him they weren't qualified to make.

[SlimPickens]

Great thread :)



Without particularly highlighting it, you've made an important point. The strength of the heal of the bone is not the issue, it is the surrounding tissue and his mechanics. So it's all just a matter of time for him to get back to his best.

The recruiters at the combine made a medical judgment call on him they weren't qualified to make.

Gary Zimmerman was there, he would have been all across it.

[Remi Moses]

I liked how Carlton after drafting Menzel were trying to explain how Troy's injuries didn't concern them because they were totally unrelated to his brothers.

They basically said Troy had a PCL and then LARS from collision injuries, and not the 2 ACL's his brother had where his knee just gave way.

Dress it up all you want his knees still gave way. 2 brothers with 4 knee related injuries is more than coincidence, it's a trend.

Lee Walker at Collingwood was similar.

[boydogs]

Gary Zimmerman was there, he would have been all across it.

Hence why we picked him up :)

You can see how it unfolded, recruiters watching them go around and writing him off in their minds as too big a risk as his running style is out of whack.


Recruiters described the 191cm goalkicker's running gait as "atrocious" in the 3km time-trial at last month's AFL draft combine.

Another said it was like he was running on "one leg".

http://www.heraldsun.com.au/afl/geelong-set-to-pounce-on-jake-stringer-if-his-complications-from-leg-break-are-behind-him/story-fn7shx05-1226516980560

Some other articles on Jake:

http://www.watoday.com.au/afl/afl-news/character-is-draft-buzz-word-20121122-29te1.html
http://www.afl.com.au/news/newsarticle/tabid/208/newsid/147459/default.aspx
http://www.weeklytimesnow.com.au/article/2011/04/20/321681_country-footy.html
http://www.theage.com.au/afl/afl-news/stringer-finally-has-a-leg-to-stand-on-20121118-29k99.html
http://www.afl.com.au/news/newsarticle/tabid/208/newsid/150967/default.aspx

[Remi Moses]

Gary Zimmerman was there, he would have been all across it.

Slim, are knee issues ( Menzel brothers) hereditary?

[SlimPickens]

Slim, are knee issues ( Menzel brothers) hereditary?

Hard to say but the facts are that a Lars ligaments shelf life is approx 7 yrs, considering he had it at 16 you can do the maths.

As I've said the Stringer "risk" is no where near as high as the Menzal "risk"

[LostDoggy]

A major concern with a major break/s in the lower leg is having different breaks for the Tibia and Fibula , a Spiral Fracture in one and Compound or Avulsion Fracture in the other

http://en.wikipedia.org/wiki/Spiral_fracture
http://en.wikipedia.org/wiki/Avulsion_fracture

( Compound Fracture of course is a traumatic bone shear where the bone comes through the skin )

.

[stefoid]

yeah, like Im going to clic on those links

(weak stomach)

[jazzadogs]

If any of you wanted to read more about compound fractures/recovery, I would recommend Hoppenfeld & Murthy - Treatment & Rehabilitation of Fractures. Chapter 9 is all about compound fractures, accessible on Google Books. LINK (http://books.google.com.au/books?id=bxhycwgJUtQC&pg=PA69&lpg=PA69&dq=rehabilitation+compound+tibial+fracture&source=bl&ots=h1hjkgSzxn&sig=jC6vavbJfrX0AZRVIrv7ob_pgDU&hl=en&sa=X&ei=0C-0UJGFBYaYiAeZjIDgAg&ved=0CDQQ6AEwAA#v=onepage&q=rehabilitation%20compound%20tibial%20fracture&f=false)

I used that through uni whenever I wanted info about fractures and found it helpful.

Brukner and Khan is a great sports medicine book for anyone interested in that area as well (couldn't find an online version of that though), doesn't have as much info about fractures but is basically the physiotherapist bible.

As far as his rehabilitation goes, the fact that he was able to get back to play some matches this year is a great sign for his recovery. That shows that his strength and mobility is at a reasonable level. I'd be confident that the issues with his gait can be fixed, but it's hard to definitively say without knowing exactly what the impairments are.

One of the most difficult things will be Stringer's anxiety about the leg. He said in one interview that he has started wearing a shin guard, which has helped, so hopefully he continues to use that with continued results. He doesn't seem like the sort of guy to shy away from a contest, so hopefully he pushes it at training and will become used to it and not fear contact to his shin/the fracture site anymore.

[BornInDroopSt'54]

If any of you wanted to read more about compound fractures/recovery, I would recommend Hoppenfeld & Murthy - Treatment & Rehabilitation of Fractures. Chapter 9 is all about compound fractures, accessible on Google Books. LINK (http://books.google.com.au/books?id=bxhycwgJUtQC&pg=PA69&lpg=PA69&dq=rehabilitation+compound+tibial+fracture&source=bl&ots=h1hjkgSzxn&sig=jC6vavbJfrX0AZRVIrv7ob_pgDU&hl=en&sa=X&ei=0C-0UJGFBYaYiAeZjIDgAg&ved=0CDQQ6AEwAA#v=onepage&q=rehabilitation%20compound%20tibial%20fracture&f=false)

I used that through uni whenever I wanted info about fractures and found it helpful.

Brukner and Khan is a great sports medicine book for anyone interested in that area as well (couldn't find an online version of that though), doesn't have as much info about fractures but is basically the physiotherapist bible.

As far as his rehabilitation goes, the fact that he was able to get back to play some matches this year is a great sign for his recovery. That shows that his strength and mobility is at a reasonable level. I'd be confident that the issues with his gait can be fixed, but it's hard to definitively say without knowing exactly what the impairments are.

One of the most difficult things will be Stringer's anxiety about the leg. He said in one interview that he has started wearing a shin guard, which has helped, so hopefully he continues to use that with continued results. He doesn't seem like the sort of guy to shy away from a contest, so hopefully he pushes it at training and will become used to it and not fear contact to his shin/the fracture site anymore.

Thanks Jazza, Yes that shin guard made him feel, he said, like before the break, with no fear of hurting it. Unfortunately these unconscious fears can be very powerful and restrict freedom so hopefully the shin guard allays any overprotectiveness.

[Mofra]

Will his gait ever be fixed though? By all accounts Stringer didn't have a smooth running style to start with. Grant has a bit of an awkward running style as well yet he is lightning quick.

[BornInDroopSt'54]

Will his gait ever be fixed though? By all accounts Stringer didn't have a smooth running style to start with. Grant has a bit of an awkward running style as well yet he is lightning quick.

Griffen has a lopsided gait too when he walks but burns the grass when he runs.

[jeemak]

I don't think I've ever seen or heard the word gait in my entire life, as often as I have over the last few weeks!

Possibly a sign of the times, I suppose.

Unfortunately when I was 16 years old I broke the top end of my arm and dislocated my shoulder on the same side playing a school game in Wodonga (in September, after regular season games). I didn't have the same level of surgery or rehabilitation put in to me that Stringer has had (most likely because I was only a bit of a battler as a footballer rather than elite) and as such, when I started preseason at the Chargers in November I was extremely tentative about any contact drills I had to participate in.

As the post Christmas period rolled around, I gained more and more confidence throwing myself into contests, and with repetition coupled with trial and error I got that confidence back with sufficient time for preseaon trial games. Of course, if I wasn't such a fat bastard after a solid Christmas holidays on the food and probably too much beer I might have gotten better results, but suffice to say I didn't have any questions about my ability to head into a contest with confidence.

I know the arm and shoulder injury isn't as significant as the leg break Stringer suffered, I suppose what I'm trying to say though is that after an initial trial and error period I'd be surprised if Stringer didn't ditch the leg gaurd and just get on with things.

Potential setbacks aside, I really see no pscological issues for a player so young if all of his rehabilitation goes well. By the time he's 22 and four years into his AFL career, the leg break will be a thing of the past and irrelevant to him.

[jazzadogs]

Will his gait ever be fixed though? By all accounts Stringer didn't have a smooth running style to start with. Grant has a bit of an awkward running style as well yet he is lightning quick.
I typed out a big post then accidentally pressed 'back', and it all got deleted. :(

I don't know that his gait will ever be 'fixed' in terms of returning to normal/pre-fracture gait, but they will be able to adapt it into an effective style. The main concern would be preventing overuse injuries that are caused by bad technique, but I haven't actually seen him run so don't know if this is a worry at the moment.

The biggest issue with gait training in an athlete is that it is a largely automatic action, so even if Jake performs really well during treatment when he can concentrate fully on his gait, he will most likely revert to his 'automatic' action during match simulation when he has other things to worry about. If it is just about strengthening muscle groups, that should be relatively quick and simple. But if it is about muscle control, making sure he activates the right muscles at the right times, making sure he is putting equal weight through both legs etc., this might take a little bit longer. I would be confident though, that if he is being seen every/almost every day by our physios/doctors/sports scientists, these changes will happen sooner rather than later.

[boydogs]

The biggest issue with gait training in an athlete is that it is a largely automatic action, so even if Jake performs really well during treatment when he can concentrate fully on his gait, he will most likely revert to his 'automatic' action during match simulation when he has other things to worry about.

My left arm comes across in front of me when I'm running as I have one leg slightly longer than the other. 3 weeks of swinging your arms correctly in front of a mirror fixes it up, but then if you don't keep practicing it can go back how it was again.

[Ghost Dog]

Wayne Carey had one leg longer than the other! Never bothered him much on the field!!

[bulldogtragic]

Wayne Carey had one leg longer than the other! Never bothered him much on the field!!
It was what was between them that was his problem.

[KT31]

Wayne Carey had one leg longer than the other! Never bothered him much on the field!!

That explains it all, Kelli Stevens was just making sure he didn't tip over in the bathroom by holding him by the handle.:D