Commentary

No early timetable for Ginobili return

Updated: August 30, 2008, 3:14 PM ET
By Stephania Bell | ESPN.com

The San Antonio Spurs announced on their official Web site Friday that Manu Ginobili will undergo surgery to correct a posterior impingement of his left ankle. He is expected to have the surgery next week, and his timetable to return will be announced by the team afterward.

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The injury to Ginobili is not a new one. He originally injured his ankle during the Spurs-Suns series in the 2008 NBA playoffs. The ankle bothered him for what was left of the season and also hampered his effectiveness. Ginobili underwent a trial of conservative rehabilitation that included an injection into the painful area, immobilization of the ankle in a walking boot and structured activity designed to regain strength to support the ankle. It was no secret that there was concern on the part of the Spurs regarding Ginobili's decision to play in the Olympics, given the recent problems with his ankle. However, Ginobili was determined to represent his native Argentina if his ankle was no worse, and he did so with great pride, even carrying his country's flag in the opening ceremonies.

But the residual effects of the original ankle injury made themselves known during Ginobili's efforts in the semifinal game between Argentina and, of all teams, the United States. In the first quarter, Ginobili appeared to aggravate the injury as he rolled out on a play. The play was fairly unremarkable in that there was no hard contact and it did not result from an awkward landing -- suggesting that Ginobili's setback was perhaps inevitable, a result of instability still present in the ankle.

Ginobili explained his decision to undergo surgery to Argentina's La Nacion newspaper Friday. "It's the same as it was two months ago, when they did the first [MRI] exam," Ginobili said. "It's not worse, which is important. Now, the thing is, it's not better either, and it seems like the only way to repair it completely is arthroscopic surgery."

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So what is a "posterior ankle impingement" and what is reasonable to expect from Ginobili afterward? Posterior impingement is actually a condition in which the name pretty well explains the problem. The impingement, or "pinching," results from injury to the soft and bony tissue in the posterior ankle region. Compression of the soft tissue in the posterior (back) of the ankle occurs during repeated plantar flexion, or pointing of the foot (which happens during pushing off, running and jumping), as the soft tissue gets pinched between the two bones that form the joint surfaces. This repeated pinching can lead to pain, inflammation and thickening of any of the associated tissues. Impingement can occur for a variety of reasons, including ankle instability resulting from prior sprains, which cause excessive motion within the joint and place strain on nearby tissues.

The timetable for return ultimately depends on exactly what transpires during surgery. That's why the Spurs are likely reserving a timetable announcement until surgery is complete. Various reports have Ginobili missing six to eight weeks, which is a reasonable timeframe, assuming surgery and rehabilitation proceed without incident. The timetable will be dependent upon how quickly he recovers his range of motion and then progresses through activity that will return him to readiness to play. Keeping in mind that Ginobili's explosiveness and power had been limited for some time by the condition, it might take additional time, once he is back on the court, for him to return to pre-injury form.

Stephania Bell is an injury expert for ESPN Fantasy. She is a physical therapist who is a board-certified orthopedic clinical specialist and a certified strength and conditioning specialist.

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