Injury Review: Nat Fyfe - Why did he break his leg TWICE?

Was he just unlucky? Did he go back too soon?

Last weekends clash between Fremantle and Carlton saw star Fremantle player Nat Fyfe sidelined with a second fracture to his left leg (fibula). Fyfe previously fractured his leg during the 2015 preliminary final against Hawthorn and underwent surgery at season end to return for beginning the pre-season December 1st. Fyfe will now have a second surgery to repair the fracture which we will see him sidelined indefinitely until he is “100% fit” for play, Lyon.

Why did he get another fracture?

Lets take a look back on Fyfe’s 2015 season. During round 15 Fyfe received a massive corky to his quad, while battling this injury he returned to play and resultantly strained his groin due to changes in his running technique, over-working and over loading other areas to compensate for his painful quad.

On return from his groin strain, 2 weeks, Fyfe developed pain in his left leg and was diagnosed with inflammation of his fibula, a condition called periositis, an over-use type injury, similar to shin splints but this time occurring on the outside of his lower leg just below his knee. This inflammation can lead to micro-trauma or stress fractures in the bone if it is not given time to heal.

Fyfe continued to play putting him at risk of fracture. During the preliminary final Fyfe was involved in a collision and caused increased pain around his fibula. He continued to play, rotating on and off the bench, in considerable pain. It is hard to say when exactly the fracture occurred whether that be during the collision or result of him playing on - but one thing can be certain, he was at high risk due to the inflammatory stress reaction occurring in the bones in his leg. Fyfe did not play out the season and had surgery to help with the fracture healing process, having plates and screws inserted into the fibula. He was advised he would be ready for beginning of pre-season.

Fyfe underwent open-reduction internal fixation of his fibula. Given the fibula is a very narrow and thin bone there is a increased risk of fracture post surgery around the screws or at places of increased stress above and below the plate.

Fyfe, as expected, returned for pre-season raring to go. Unfortunately he did not complete a full pre-season due to sustaining a back injury during a training incident.

He entered round one returning from injury.

Incompleteness of pre-season and returning from injury presents another risk for further injury. There is high demand and pressure on the AFL star as he is one of Fremantle’s greatest assets. The rush to get him back for round 1 may have seen him return too early and putting undue strain on his body.

AFL doctors voiced their long-term concerns about Ffye continuing to play on his stress fractures as they may lead to more significant injury and poor bone healing. During round 5 Fyfe was slung to the ground knocking the outside of his left leg. Given the vulnerability of his fibula, post insertion of screws this lead to the second fracture just above the plate inserted - an area of increased stress.

Fyfe attempted to play the second half, lasting only 3 minutes until he was no longer able to continue to play due to the pain. Doctors reported Fyfe will undergo a second surgery. This will involve removing the original plate and screws to look at how well the previous fracture healed and re-inserting a longer plate extending over the new fracture site. This immediately suggests an 8 week recovery period until he will be able to return to activity, but given this is the second operation, in the same spot, in seven months it is highly likely he will undergo extensive and prolonged rehabilitation.

The hardest part for an athlete, or anyone recovering from injury, is battling the urge to get back to pre-injury state tomorrow.

Often people push too hard too soon leading to poor healing, further injury and extending their rehab. Fyfe, being the Fremantle great and very in the public eye may be feeling the heat of the pressure to get back to his A-game ASAP this can lead to too short of rehab, decreased motivation and feelings of disappointment as he may not meet the demands he places on himself.

It is vital for anyone from suffering from injury to take their time, address and treat all underlying causes of their injury and allow the injury sufficient time to heal. This can help ensure longevity if your sporting career and keep you injury free. It is in this period of recovery that athletes may focus on other weaknesses in their game, skills and so on.

So many times I have seen so many dedicated athletes in their rehab return to a pre-injury state, stronger than ever before and a much better athlete!

During Fyfe’s recovery from surgery he will have to meet set criteria and progress through a rigorous program which will be devised in collaboration with the medical team and Surgeon at Fremantle. The program will involve a period of modified weight bearing - with use of crutches and moon boot.

The key to his recovery will be early mobilisation and physiotherapy.

Generally bone healing and union requires 8 weeks and it will be from this stage that more advance strengthening and functional exercises can be commenced. After 12 weeks more high level and impact activities may begin to be introduced along with football specific drills. He will be continually monitored throughout his rehab and tested on a series of functional measures to ensure he is fit to progress his rehab and ultimately return to play. It may be as early as 3-4 months that he is able to return but given his history and other contributing factors he may be sidelined for longer to ensure he is 100% fit to return to football. During this time to help maintain his fitness, Fyfe may use swimming and bike riding as good low impact substitutes for running. He may also focus on other specific areas of his game and weaknesses he hasn’t been able to address. Physiotherapy will supplement and facilitate his progress consisting of release work, mobilisation, strengthening and conditioning and addressing muscle imbalances. As he progresses treatment may focus on his technique and biomechanics of running, kicking and so on to help ensure optimal, injury free performance.

The key message in all of this is to listen to your body!

It is very easy to rush recovery in eagerness to return our pre-injury level but we must learn to step back work out what is going on and why and then work on those factors. Use your period of recovery to address you weaknesses, hoan in on your focus, motivation and drive and allow it to benefit you performance becoming a better, stronger and wiser athlete in the long term!

If you want to address a new or old injury, we will take you through a thorough and extensive recovery process to get you back to 100%.

To book in to see Megan, or one of our other physiotherapists at Aspire Physiotherapy, click here.

18 Partridge St Glenelg

8376 8816

References

BRUKNER, P., KHAN, K., & BRUKNER, P. (2012). Brukner & Khan's clinical sports medicine. Sydney, McGraw-Hill.

Charles C. Lind, MD, 2015, “ORIF Fibular Fracture Post-Operative Protocol,” Rosenberg Cooley Metcalf, The Orthopaedic Clinic at Park City, UT

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8376 8816

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