The old fashion cork

Recent injury to Brownlow favourite Nat Fyfe, has reminded me of the importance of managing an old fashion cork. It’s been widely reported that Fyfe received a knee to the quad in a controversial incident with Sam Mitchell when the Dockers played the reigning premier three weeks ago. Fyfe, soldiered on for two weeks before missing Freo’s most recent clash with GWS due to a documented groin injury. We can only speculate whether there is a relationship between the two injuries but nevertheless it’s reminds me of the common perception that, ‘it’s a corkie… it’ll be alright’.

Most people know that a cork is the result of direct contact to the muscle by an external force. Whether this is an errant elbow or knee or landing awkwardly on the ground, a lot of us can relate to that numbing moment when you’ve received a cork. As a result of the trauma, the muscle bleeds and a haematoma develops within the tissue. (For ease, I will refer to the haematoma as a cork for the rest of this blog.) Bruising develops, often within the hours and days following and the feeling of a very stiff muscle to touch is there for days and sometimes weeks.

I’m sure many of us have heard the stories of how corks used to be managed. Heck I’m sure there are many of you that as your reading this, are getting flashbacks to the time when you were on the bench, digging your fingernails into the rickety old physio table, as the trainer did their best to inflict as much pain as physically possible, lathering the decorub and stripping the muscle to within an inch of it’s life, attempting to rid you of the dreaded ‘corkie’. I’ve been told many a time in the past to ‘run it out’ and push through, but my more recent experiences with corks, have made me realise the management of these type of injuries has changed and for the better.

I’ve seen some horror stories. Players that have thought it would be best to self manage their cork, failing to report to me until they have already returned to the training track. I remember on one occasion a footballer reported feeling a strain after they went back to training too soon without consulting anyone first. Even after a strain was diagnosed they failed to follow instruction. A week later I was sending them for an ultrasound of their quad, which revealed a cavity a cool 22cm long. The cork had bled again after the strain, essentially splitting the muscle, leaving a long cavity full of fluid to collect. In the case of corks this is a train wreck and extremely rare. And although my aim is not to scare readers, it highlights the importance of at least getting it checked by a trainer or health care professional.

So how is a cork best managed? Should we be continuing to run? In some cases this is ok but in the interest of preventing further injury, always get an opinion first. In general, ice should be applied immediately and can be repeated every two hours, for 20 mins. How long you use ice for is still under conjecture, but using ice for 72 hours post injury is generally accepted. Compression can be applied but be sure to remove it overnight.  Elevate the leg when possible to help remove swelling and keep the area moving in the most pain free way. Avoid stretching the muscle until you’ve sought the advice of a trainer or physiotherapist and have a confirmed diagnosis. Avoid massage in the early stage as this will make the muscle bleed more and hold yourself back from heading out on the town and getting on the drink.

Returning to training or playing depends on many factors such as your strength and muscle length, so have these tested before getting back into it. If you come back too early, running around with a muscle that is not functioning properly, could predispose you to overload in other areas and muscles. Is this the case with Fyfe? Unfortunately we can’t say it is because we don’t have the inside word and the reality is he would have received the best standard of care, so there is every chance his groin injury is completely separate. But it has reminded me of times when it has been the case so again make sure the muscle is working well before returning to play.

As always, my advice would be to seek professional advice and treatment to make sure your dealing with a ‘cork’ and not something else such as an intermuscular haemotoma, which is a little different to a cork, whereby the bleed happens between the layers of muscles instead of within the muscle itself. Remember good management in the early stage will help prevent further injury.