Injury Update on Jonathan Brown

[Happy_Neale]

Well he must be a liar then.
There was an article about Chris in yesterdays Courier Mail page 58..He said that his career was ended in 2007 by a similar injury.
He also stated that if Browny was to play next year, he would need to rest it now and allow it to heal properly.
He stated that Browny has a higher pain threshold than most.however.
He said his final season 2007 was plagued by the plantar fascia problem..it put an end to his career.
He and Scott played a final token game together before they both retired.

He has no pain now,because he doesnt train all week.

Could have been planter fasciitis ceebee which is slightly different (but still pretty similar). Basically an inflammation of the same tissue but no tear/snapping of the connective tissue.

Edit: it's actually caused by microscopic tears at the cellular level over time. Sort of an accumulative injury I guess.

 

[Lace Out]

Didn't look like a bloke on the bench who thought his career might be over.

Reckon he might have committed to going on already.

 

[Ceebee]

Could have been planter fasciitis ceebee which is slightly different (but still pretty similar). Basically an inflammation of the same tissue but no tear/snapping of the connective tissue.

Edit: it's actually caused by microscopic tears at the cellular level over time. Sort of an accumulative injury I guess.

In the article. Chris said it ended his career, but,doesn't mean the end for Browny.
His pain threshold, is above anyone elses.
Tough boy our Browny.

 

[Dylan12]

If it is torn enough ie a major tear then snapping becomes an option. Doctors won't snap it.
If the reality is that it may snap easily enough then Brown is exactly the type to do it I reckon.

Perhaps Browny could possibly give TFS an exclusive and do it live on air tomorrow night.

 

[BigEasyPeasy]

Hey guys, long long long term reader, first time poster.

I get the feeling there may be some uncertainty amongst posters regarding the nature and outlook of Browny's injury and I'm hoping I can shed some light (hoping to be as brief as possible.) In short, I really don't think the big fella will be running out again this year and here's why...

Anatomy:

The plantar fascia has similar qualities to ligaments and tendons and is basically a solid 'blanket' that covers the muscles, nerves and other structures on the soul of the foot. Without going into depth of gait biomechanics, suffice to say the plantar fascia has a fundamental role in providing structure for the foot (maintaining the height and stability of the medial or inner arch) and contributing to force production/conservation and stability during motion.

Type of injury:

Many people have heard (as Lionheart mentions) about plantar fasciitis- this is often used to broadly classify heal pain or pain on the soul of the foot often experienced by distance runners. What I propose to you is this; heal pain that pertains specifically to injury of the plantar fascia with a gradual onset lies somewhere on a continuum. This continuum starts with minor stressing and minor tearing of the plantar fascia which stimulates an inflammatory response (fasciitis), which overtime may develop into a more chronic condition known as plantar 'fasciosis'. In this later stage, instead of inflammation being the issue, cellular changes are noted at the site of injury, resulting in thickening and weakening of the tissue. The naming difference comes from the underlying biological factors at play ('itis' refers to an inflammatory process, where as 'osis' refers to a degenerative condition whereby inflammation is not present). These issues tend to come about over time and are known as overuse injuries, which may be caused by predisposing foot and ankle biomechanical issues.

This type of injury isn't Browny. Or at least, I am ASSUMING that these conditions do not relate to Browny and that he has sustained an acute tear in their absence (despite research suggesting that plantar fasciitis/osis is a risk factor for plantar fascia ruptures).

What happened on the weekend was seemingly a more sudden incident. When taking off to run, the foot must push down suddenly (known as plantar flexion). At the same time the toes remain in a relatively extended position to provide a 'push off' force. During this time the plantar fascia is maximally stretched (you can mimick this yourself by doing a calf stretch whilst simultaneously lifting your big toe from the ground) and may suddenly tear; much more like Browny's injury. The result is some pretty significant pain but something that will heal over time.

The contentious issue I'd really like to talk about is the the tear versus snapped scenario.

Firstly to Robert Harvey. I have no idea if Harvey's injury was of the repetitive/ overuse / first type (fasciitis/fasciosis) of injury or similar to Browny's. What I will say is that I understand he had some trouble with it for a period of time before taking drastic action. Inadvertently, his Jackie Chan style jump from the table somewhat resembled the more controlled surgical operation that is used to treat some cases of chronic fasciosis; surgical release of the fascia to relieve built-up tension.

There are a number of comments I'd like to make on this/ other stray thoughts on the topic:

• Although the fascia may be weakened in a certain area by injury, there is no guarantee that by jumping from a table you will 'snap' the fascia in the desired location. Plus there's a significant chance of injury to other structures (whether bodily or otherwise ).
• It is common for minor tears to hurt more than complete ruptures because the nerves that process pain in the damaged tissue are simply broken when the entire ligament/ structure is snapped. However, the underlying instability is key to the prognosis. For example, it is not uncommon for people who have suffered complete ACL tears in the knee to report less pain than those with minor sprains, despite the obvious structural deficiency they now possess.
• Furthermore, potential plantar fascia surgical complications are similar to complications of plantar fascia ruptures- decreased medial arch stability, altered biomechanics resulting in midfoot strains, stress fractures, nerve entrapment, swelling, plus general surgical complications (from anaesthesia, infection etc.).
• There is a reason that (depending on the surgeon) a common requirement prior to surgery for plantar fasciitis is having symptoms for at least 6-12 months-the risk of complication (as noted above and similar for that of ruptures) in the context of a 70% success rate for an injury that has been proven to resolve naturally with time simply does not add up. Basically, if you have time to let the tear/tears heal themselves (difficult considering the poor blood supply = slow recovery), you're better off.

Tears versus ruptures- Yes ruptures may hurt less. Yes the ruptured tissue will heal, but it's not a quick process- one study looking at plantar fascia rupture prognosis suggested that return to 'normal activities' took place after 9 weeks +/- 6weeks. During this healing process there is evidence that shows the healed fascia simply does not structurally support the arch as well, nor does it contribute as well to force production, nor does it allow the foot to maintain the same biomechanic characteristics it once had. This means abnormal loading and predisposition to other foot problems. Tears on the other hand may be more painful, but with time, can heal in a way that the structural integrity of the foot is if not maintained, then at least optimised.

Having considered these thoughts and others (I feel I've gone on enough), there is no reason for me to believe the 'self snapping' option offers an improved prognosis, and even if Browny did it, there is very little chance he would be fit to return this year. As someone else mentioned, if I see him being rushed back to make the last round, I fear it's his last year...

Keep in mind I have no knowledge of Browny's medical history or prior foot issues/ biomechanics so take everything with a grain of salt. Just my observations

Any questions or if I've been unclear just let me know.

 

[Haso]

Amazing and super informative first post BigEasyPeasy

Glad that you have decided to post. Welcome

 

[BigEasyPeasy]

Amazing and super informative first post BigEasyPeasy

Glad that you have decided to post. Welcome

Cheers mate

 

[Requiem]

Amazing and super informative first post BigEasyPeasy

Glad that you have decided to post. Welcome

Ditto, BigEasyPeasy at least someone knows what they are talking about.

 

[Always a Lion]

Wow, fantastic post BigEasyPeasy. Thank you!

 

[Grimreepah]

Holy crap, someone who knows what they're talking about. Someone tell Brown to abort the chair jump. Repeat - do NOT jump off the chair.

 

[Caiphus]

Top post, highly detailed on a complex subject, but easy to read and understand.

Should we be worried is all downhill from here? ;-)

 

[3KZ is Football]

What a great opening post BigEasyPeasy! Having established yourself as our resident expert in sports medicine and human biomechanics, could you now make an attempt to fit in on the Lions board. I suggest a few posts in quick succession after this weekend's game along the lines of:

- Richmond supporters are the biggest flogs going around.
- Voss needs more time to develop as a coach.
- Cornelius and Karnezis haven't been given a fair go at the Lions.
- Voss never should have got rid of Hawksley.

Also, can you please start using wtf, meh and imo in future posts. I'd also encourage you to use more emoticons, especially this one , because it is the most ambivalent and controversial.

Please bear all this in mind.

 

[Skoob]

What a great opening post BigEasyPeasy! Having established yourself as our resident expert in sports medicine and human biomechanics, could you now make an attempt to fit in on the Lions board. I suggest a few posts in quick succession after this weekend's game along the lines of:

- Richmond supporters are the biggest flogs going around.
- Voss needs more time to develop as a coach.
- Cornelius and Karnezis haven't been given a fair go at the Lions.
- Voss never should have got rid of Hawksley.

Also, can you please start using wtf, meh and imo in future posts. I'd also encourage you to use more emoticons, especially this one , because it is the most ambivalent and controversial.

Please bear all this in mind.

 

[POBT]

Cheers BigEasyPeasy

 

[jackess]

Love the respect Browny gets from the media. Wish it was the same here on Bigfooty on the other boards.

 

[BigEasyPeasy]

Haha thanks guys, feelin the love!

3KZ, duly noted

 

[Eons]

We all know Browny isn't human so that info isn't relative Expect him to line up this weekend and kick 6.

Great post mate, very informative

 

[Tairy Greene]

Hey guys, long long long term reader, first time poster.
*snip*
Any questions or if I've been unclear just let me know.

No word of a lie I was just about to post the exact same thing, thanks for saving me the time.

 

[Last of the Roys]

So BigEasyPeasy,

You obviously know what your talking about - I have a few questions:

- how long do you think Brown will need to rest his foot for to enable the partial tear to completely heal?
- would it be right to worry about the injury's impact on him if he plays on next year? Could it restrict him? Is it likely to happen again?

Obviously you don't have all the info that his doctor has - but that hasn't stopped the rest of us speculating either.

 

[Happy_Neale]

No word of a lie I was just about to post the exact same thing, thanks for saving me the time.

Rubbish. You're not a first time poster.

 

[BigEasyPeasy]

Last of the Roys, you're right, without any information regarding his specific case it is difficult, nigh impossible to give an accurate time frame.

Having said that I'll do my best. Depending on the severity, the type of tissue healing we're looking at is generally thought to take around 6 weeks, give or take depending on individual differences, set backs, etc. I don't know what treatment plan the Lions will use, but generally speaking some time in a moon boot is required to initiate the healing process. Beyond and during that time, a key part of rehabilitation is strengthening the intrinsic muscles of the foot, other local muscles, stretching, perhaps use of orthotics, etc. All in all 'complete' recovery is usually anywhere from 7 - 12 weeks.

More detail:

As a mainly structural and energy storage 'ligament' the fact that scar tissue will replace much of the torn fascial tissue is not as bad a thing as say for muscles. What I mean by this is say you have a torn hamstring or pec, the scar tissue that replaces the original muscle tissue is very different in terms of cellular structure and function, and can lead to quite a decrease in the ability of that muscle to contract as it once could. Because the plantar fascia is tissue that does not actively 'contract' per se, the replacement scar tissue is not as much of an issue. To this end, the tissue in itself should function 'normally' despite being slightly weaker (again depending on extent of damage).

What is an issue, and what I alluded to previously, is the fact that the fascia will heal in an elongated position. Where it was once tight and stable, the 'healed' fascia won't support as it once did (and obviously this is worse following complete rupture). Additionally this structure is known to have poor blood supply, and thus it can take a longer time then similar tissue in different parts of the body to heal.

The rehab elements of intrinsic muscle training (basically strengthening muscles that lie solely in the foot, the really small ones) focus on maintaining the structural shape of the foot and compensating for any weakness. Orthotics are another option for some people which give passive support to the foot, among a plethora of other treatment options.

Why is this important? One risk for Jono after this injury is the predisposition to ongoing plantar fascitiis/osis (read my long previous post) troubles, brought about by a change in biomechanics as a result of a structurally different foot. Again, this is influenced by the severity and nature of his particular tear.

So to answer your question fully, the truth is he may go on to have no issues at all, or it may plague him sooner or later. The interesting aspect to consider is what made it happen at all? Does he already have predisposing biomechanic issues? Has this been a problem monitored for a long period in private? All these things will influence his treatment and ultimately prognosis.

Additionally I think it is worth briefly mentioning corticosteroids. There is some evidence that suggests 'getting a jab' as they call it is beneficial for people with this type of injury up to a certain point (from memory something like up to the 4 week mark); as in they report less pain. This does not however contribute to the health of the tissue, and in fact, strong evidence shows that local injections of corticosteroids in fact deteriorate and degenerate local tissue. Part of the reason many people are denied or at least put off having corticosteroid shots in their shoulder for rotator cuff injuries after the age of about 50 is because a) the pain relief doesn't seem for last for that long, and b) the corticosteroids further deteriorate the tendons of rotator cuff.

What's more is that evidence indicates one downside of corticosteroid injections for plantar fasciitis is the greatly increased risk of complete tears/ ruptures occurring down the track. Now we have no idea if this has been or will be a longer term thing for Browny, but you can understand the danger in getting him up week in week out based largely on cortisone jabs. It really makes me wonder what the guy's body will be like in 30 years.

In short, I reckon 7-12 weeks (I reserve the right to alter that once more is known about the injury/ treatment course chosen ), potential for ongoing 'nagging' issues and reoccurences but they are heavily related to the specific nature of his background and injury which I simply have no clue.

 

[PattyKwasagun]

I think the average IQ of the Lions board has risen about 50% in the past 24 hours thanks to @BigEasyPeasy's contributions

 

[MacMum]

Doc Larkins??...welcome by the way...am impressed by the spectacular entrance (please note all my emoticons, just like 3KZ said)

 

[Last of the Roys]

Thanks heaps BigEasyPeasy, great info.

 

[Voss the boss]

I think the average IQ of the Lions board has risen about 50% in the past 24 hours thanks to @BigEasyPeasy's contributions [/

Our starting point wasn't all that high to begin with though PK