The 2017 RBS 6 Nations is around the corner. England will go into the tournament as favourites but there can be no doubt about the big story during the build-up. Its Joe Marler’s miracle come back from a broken leg, and how? Milk apparently…….
With Mako Vunipola injured, Marler had been the obvious choice to start at Loosehead. However, after picking up what he thought was a calf strain against Worcester in a game at the start of the year and subsequently being unable to recover, he was diagnosed with a stress fracture.
It is worth noting that although still a fracture, a stress fracture is a reasonably common condition accounting for roughly 10% of sports injuries (Graham et al, 2015). General prognosis would see athletes making a return in four to six weeks, rather than the months associated with a full fracture.
If the fracture had been diagnosed following the Worcester game, he would have had 5 weeks until running out at Twickenham this weekend, putting his recovery in line with the general prognosis. But Marler has admitted he continued to train and once the problem was diagnosed, just over a week later, the medical team were not expecting him to return until the middle of February. His recovery is, therefore, well ahead of schedule and no doubt welcome to Eddie Jones and the rest of the England team.
But did his well-publicised milk consumption really assist this rapid comeback?
Bone development happens when we are young. The key is to build up as much bone mass as possible via a mixture of calcium ingestion and physical activity (other factors play a role but are beyond the scope of this article). Rapid bone mass development takes place during adolescence, it’s at this point that calcium intake requirements are at their maximum, between 1000 and 1500 mg per day (Soliman et al, 2016). Following this ‘growth phase’ and into young adulthood the body moves to maintain bone density, this is obtained by ensuring adequate calcium, other vitamins and minerals and physical activity, particularly weight bearing. From this point on, calcium is used to inhibit any bone loss that is typically associated with aging.
Stress fractures can be treated in a number of ways, from rest through to Ultrasound therapy. Marler made reference to potentially using a hyperbaric chamber, made famous by David Beckham’s metatarsal. A small study by Stewart and his team in the USA back in 2005 even showed that treatment with Biophosphonates could return athletes to training within a week.
Certainly, during a stress fracture injury period, adequate calcium levels would be important to ensure the bone doesn’t suffer any density loss. Not only that, to limit any drop in lean body mass, it would be advisable to ensure a high level of protein intake (Wall et al, 2015). To that end milk would seem a sensible option. However we have not been able to find any evidence to suggest a high calcium intake via milk, full fat or otherwise, supports rapid bone recovery.
Depressingly for the headline writers I think this one comes down to quality injury management. In Phil Pask, England has one of the most experienced rugby physiotherapists in the world. He has worked within the England system for 20 years and also supported a number of Lion’s tours. Marler himself thanked Pask for the work he had put in when describing how he had “rehabbed the crap out of it”. Any physio or team doctor will tell you that player ‘buy in’ and compliance to the process is the most important part of rehabilitation. It seems rather than any mystery healing powers in a bottle of gold top, Joe Marler simply bought into the process and did everything his expert medical team asked of him.
Joe’s Mum told him when he was a boy that drinking milk was important and back then as his bones were developing she was exactly right. It seems she may also have told him to listen to people trying to help him. In this case that person was Phil Pask. He deserves plenty of credit for getting Marler fit and ready for Saturday.
I am sure Joe's Milkman is a nice guy, but he can't take the credit for this one.......