Notable injuries heading into 2012-13
Anyone who follows basketball at any level, from high school to professional, knows what the most common injuries are. There's the lateral ankle sprain -- sometimes referred to as a "basketball sprain" because of its frequent association with the sport -- which happens when a player rolls his ankle, often as the result of landing on another player's foot. There are the meniscus tears and minor cartilage injuries associated with the repeated pounding, twisting and torqueing that the knees endure as a function of running up and down the court, stopping sharply, pivoting abruptly and, intermittently, falling. There are the "itis-es," particularly Achilles tendinitis and patellar tendinitis, inflammation (and often chronic changes) of the large tendons at the ankle and the knee as a consequence of repetitive jumping and acceleration/deceleration. And then there are the sprains, dislocations and fractures of the fingers, thumb and hand, the obvious by-product of playing a sport in which ballhandling, shot-blocking and the occasional (or not so occasional) extracurricular physical contact is involved.
No one is surprised when these injuries occur, certainly not at the NBA level. And while we may be disappointed if they happen to one of "our" players, we expect them to miss time here and there with some of these more common basketball-related ailments. We also expect them to fully recover. While the injuries make for interesting discussion around the water cooler during the course of any given season, they don't tend to linger and give us little to talk about as a new season approaches.
We tend to worry more, however, when one of two things happens: If a player starts showing signs of increased frequency of injury or if the nature of the injury reflects cumulative wear and tear, the concern that the body is breaking down grows. We wonder about the future of a player and whether he will be able to withstand the physical demands of the sport going forward. Whether he is young in his career, like Greg Oden, or further along, like Ray Allen, the signs of progressive physical decline are undeniable. The second alarm bell is raised when a player suffers a major traumatic injury or an injury unusual for the sport, the kind that ends a season prematurely and takes months to recover from, leaving us to wonder if he can ever return to form or if a single event was enough to undo his career.
During the 2011-12 season, we witnessed more of the latter than ever before. Whether that was due, in part, to the altered training and playing schedules associated with a shortened season, whether it is simply a reflection of the increased strength, size and speed of contemporary players or whether it is a combination of these and other factors is debatable. What is hard to argue, however, is that more key players enter this season with question marks surrounding their health and what can be expected of them than perhaps any season in recent memory.
And this gives us plenty to talk about as the tipoff to the 2012-13 season approaches.
Here are some of the key players we're concerned about as we enter the 2012-13 season. We'll continue to update this list and their condition as the season approaches.
Derrick Rose, G, Chicago Bulls
Injury: Torn left ACL
When it happened: Rose tore his ACL on April 28, with just minutes remaining in the Bulls' first game of their playoff series against the Philadelphia 76ers. He underwent reconstructive surgery on May 12.
Status: The ACL was the obvious devastating injury for Rose and the Bulls (there's even an entire commercial that begins by depicting how time stopped in Chicago when he went down on the court in pain), but it's important to remember that prior to that event, Rose had missed nearly 40 percent of the regular season with various ailments. While it's entirely possible that Rose could have torn his ACL even without the other injuries preceding it, it is not possible to ignore the fact they existed. The body of an elite athlete is an amazing, fine-tuned machine with interdependent, coordinated functions. Athletes speak all the time of compensating, even unknowingly, for injuries that may not be serious enough to sideline them, but often force them to change how they play. That compensation can lead to other injuries, either directly or indirectly, and it is difficult to dismiss the back, groin, foot and ankle problems that plagued Rose before the ACL injury ever happened.
The focus of everyone's attention has been on Rose's ACL rehabilitation, and rightfully so, but one of the side benefits to the extensive time away from the game and the intensive rehab effort is the opportunity to get his entire body right. Last season, Rose had only just returned to play following his groin injury when he sprained his ankle. Days later he was sidelined by the right foot. A frustrated Rose told the Chicago Tribune, "For someone to not miss more than six games in (my first three seasons) to miss 20-something, 30-something, it hurts." And that was before he tore his ACL.
ACL injuries have not typically been as common in the NBA as in other professional leagues, like the NFL, for instance, so there are fewer players for comparison. The window for recovery is often listed as six to nine months, but the actual return time is based on multiple factors specific to the individual, including how he heals, his overall health and fitness, the nature of the activity to which he plans to return (in this case very high level in terms of directional change, rapid acceleration/deceleration and frequent pivoting/twisting/cutting) and his confidence in his knee. All in charge of Rose's care have been cautious with his recovery timetable and with good reason, as it removes the pressure of potentially dashing expectations should there be a delay.
Rose has ventured back to the court, as he began shooting drills in mid-September. As of October, Rose is reportedly "doing great and he's right on schedule," according to Bulls general manager Gar Forman, who spoke of Rose's recovery on "The Waddle and Silvy Show" on ESPN 1000.
Any progression of activity always requires an assessment afterward to see how the athlete's knee responded and whether the program needs to be adjusted up or down. For that reason it is still impossible to offer a specific date as to when we will see Rose on the court (the initial time frame was projected at eight to 12 months). When he returns initially, it may take a few weeks for him to transition to the point of being fully confident on his knee. His playing time may be limited early on, then steadily increased as he progresses. The final phase of rehab is always a return to actual competition. The athlete needs to build up his exposure, including absorbing contact and discovering the knee will hold up, as well as making the same non-contact moves that may have led to injury, as was the case with Rose, to experience the absence of instability and gain confidence.
It may take him a breaking-in period to get there, but once Rose gets past the re-initiation phase to playing competitive basketball, there's every reason to believe he can return to elite player status.
Ricky Rubio, G, Minnesota Timberwolves
Injury: Torn left ACL, LCL
When it happened: Rubio injured his knee on March 9, then underwent surgery in mid-March.
Status: Rubio underwent reconstructive surgery on both his ACL and LCL. Like Rose, his injury ended his season and dashed his hopes of representing Spain in the Olympics. Even shortly after surgery, Rubio was tempering expectations, telling reporters he was not sure he'd be ready for training camp. He began running in late September and began shooting in mid-October. Rubio told the Minneapolis Star-Tribune that he hopes to begin 5-on-5 (non-contact) drills by late November. He has said he would like to return by December, but the timetable will remain fluid based on how he progresses.
Many of the issues for Rose's recovery apply to Rubio, as well. Like Rose, Rubio's road to recovery is highly individualized. Like Rose, Rubio has youth on his side (2011 was his rookie season and he is just 22 years old). Rubio was early enough in his career that we may not have witnessed all his potential before his story was interrupted by injury. The good news is that he should still be able to achieve that potential once he returns.
Dwight Howard, C, Los Angeles Lakers
Injury: Herniated disc, lumbar spine (low back)
When it happened: It's not necessarily possible to pinpoint when a disc begins to structurally decline, but Howard began having symptoms in the form of spasms and missed his first game because of it on April 1. He returned to play four days later but was ineffective. A better performance two days later was encouraging, but two days later Howard was out again, this time for good. Howard was found to have a herniated disc at the L5-S1 level (between the fifth, or lowest, lumbar vertebrae and the first sacral one). The disc and inflammation associated with it were compromising the nerve root that exits from the space between those two vertebrae, leading to weakness and numbness in his calf. As Howard recently told reporters, he got to the point where he could not do a calf raise. "What a lot of people don't know is, when I hurt my back, it affected my nerves to the point where my whole left leg went dead," Howard said.
Status: Howard underwent surgery on April 20 to remove the problematic disc fragment and alleviate pressure on the affected nerve. The procedure, a microdiscectomy, is a minimally invasive procedure designed to cause minimal trauma to the surrounding soft tissues. Howard's season ended with the injury, which also kept him out of the Olympics. He has been on a structured, supervised rehab program directed primarily at training the core abdominal musculature that supports the spine. Howard has been closely guarded in his return to basketball activity with the primary goal being avoiding a recurrence of symptoms. He did not begin running until just prior to the start of training camp. While many athletes do well after such procedures, it is also not uncommon for symptoms to recur, hence the focus on intensively addressing core strength and flexibility in an effort to prevent such recurrence. He made his preseason debut Oct. 21 and logged 33 minutes. He is likely to get intermittent rest and gradually increase his endurance. The biggest test will not necessarily be how Howard starts the season, but how well he holds up as the lengthy season progresses. If he maintains his regimen, his overall fitness and youth are in his favor. An extra bonus? His new home base in Los Angeles has him located right up the road from those who treated him for this episode.
Stephen Curry, G, Golden State Warriors
Injury: Chronic right ankle instability
When it happened: There is more than one incident of Curry's ankle giving him trouble, which factors into the overall outlook for his health. Most recently he underwent arthroscopic surgery on his right ankle in April with the goal of being healthy to start the season.
Status: With the preseason barely underway, Curry had yet another incident with his ankle. This time, he was rolled on by another player during a preseason game Oct. 19. The team has decided to hold him out for the remainder of the preseason as a precautionary measure. The Contra Costa Times reports Curry is expected to be ready for the season opener.
Curry has dealt with chronic instability in his ankle, the result of repeated sprains imposing damage on the soft tissue structures that reinforce the lateral aspect of the joint. He underwent surgery in May prior to the 2011 season to surgically repair ligaments yet still dealt with repeated episodes of rolling his ankle, ultimately playing in only 26 games. He then underwent a procedure in April to remove debris and scar tissue, according to the San Francisco Chronicle. Whether his ankle can be a non-issue going forward has yet to be seen. Until he gets through a season without a major incident, the underlying questions will be there.
Blake Griffin, F, Los Angeles Clippers
Injury: Meniscus tear, left knee
When it happened: July, while practicing with the U.S. Olympic team.
Status: As of now, Griffin appears ready to take on the season. Griffin originally injured his left knee during the Clippers' playoff series against the Memphis Grizzlies when he landed awkwardly. He stayed in that game but was clearly hindered by the knee for the rest of the contest. He managed to continue through the remainder of the Clippers' postseason run. Then, while training for the Olympics in July he tweaked the knee, creating just the right mechanical situation to aggravate the injury. It quickly became apparent that this was not the time to push through the injury as it could lead to more significant issues.
Griffin underwent arthroscopic surgery to repair a medial meniscus tear just days later and has had a smooth recovery since then. In fact, Griffin declared himself 100 percent healthy in late September and his participation in the preseason supports his statement. The good news is that this injury was completely unrelated to the injury that pre-empted his rookie season, a patellar fracture which required surgical repair. Griffin rehabbed diligently and upon his return earned the title of Rookie of the Year. Griffin's hard physical play puts him at perhaps a bit more injury risk than others, but it is not as if he's missed any time since that initial redshirt rookie year. He is still only 23 years old and appears poised for another strong season.
Amar'e Stoudemire, C, New York Knicks
Injury: Ruptured popliteal cyst, bone bruise in left knee; bulging disc, lumbar spine
When it happened: Stoudemire suffered the bone bruise during a mid-October practice session.
Status: Stoudemire missed two preseason games with the bruise. Several days later, after going for further evaluation of his knee, the ruptured cyst was reported and the team announced Stoudemire would miss the next two to three weeks. The time frame indicates Stoudemire is expected to miss the start of the 2012 season. The bigger question is just how much of an issue the knee will be going forward.
The cyst in and of itself is not serious, nor is it altogether uncommon, but it is reflective of an underlying condition in the knee which is causing it to form in the first place. If the irritation within the knee joint persists, the cyst can recur. Given Stoudemire's history of microfracture surgery in this knee in 2005, it does raise a bit more concern. Stoudemire has done well post-microfracture, playing at a high level for multiple years following a procedure that does not offer uniform longevity (just ask Greg Oden).
Stoudemire has also dealt with pain associated with a bulging disc in his back. As noted with Dwight Howard, there is no way to definitively pinpoint when the actual structure of the disc becomes compromised but Stoudemire's troubles this season began with back spasms in late March. He received an epidural injection (a steroid injection directly into the involved area in the spine to help combat inflammation) and underwent physical therapy. After sitting out for 13 games he was able to return on April 20 and play the final four games of the regular season. Stoudemire has dealt with several episodes of back pain in the past and given the tendency for recurrence, there's always the possibility it flares up again.
Andrew Bynum, C, Philadelphia 76ers
Injury: Bone bruise, right knee
Status: According to ESPN's Marc Stein, the 76ers -- who acquired Bynum this offseason after the big man spent seven seasons with the Los Angeles Lakers -- state Bynum has a bone bruise in his right knee, although no specific injury incident was cited. Bone bruises can be the result of direct trauma such as a fall to the floor or from the knees of two players colliding or they can result from repeat impact loading over time. When an athlete has a history of cartilage damage in his knee, the presence of a bone bruise is more concerning. Of note, Bynum did seek Orthokine treatment in Germany because of the positive results reported by then-teammate Kobe Bryant.
We did not hear much about Bynum's specific experience with the procedure but it was reported that he traveled to Germany in mid-September to receive it. By late September a report on Phillyburbs.com stated Bynum was feeling "very good" following the treatment. He also wasn't doing much in the way of activity. The 76ers announced in early October that Bynum would be held out of basketball activities for three weeks as a "precautionary measure." The team is still hopeful he can begin the season on time but it remains to be seen whether that will indeed happen.
At just 24 years old, Bynum is no stranger to injury when it comes to his knees, having had two different seasons cut short as a result. His 2007 season was limited to just 35 games when he dislocated his kneecap. The following year he tore his MCL and again had an injury-shortened season. He has undergone surgeries on both knees.
The jury is still out on the long-term benefits of biologic therapies such as Orthokine and it is possible that Bynum will surprise us and get through the season without incident. But that seems unlikely. Although he is coming off a season where he played in all but six games, Bynum's history of bilateral chronic knee issues combined with his size (7-foot, 300 pounds), the repeated pounding to his knees that come with the profession and the fact he is being held back before the season even gets underway are not a good recipe for future knee health. Perhaps he will turn a corner once this "precautionary" phase passes, but it's hard to imagine a scenario in which the history of his knees does not impact his future.
Dwyane Wade, G, Miami Heat
Injury: Left knee, chronic
When it happened: Late last season, arthroscopic surgery in July.
Status: Wade was another original member of the U.S. Olympic squad who surrendered his spot because of injury. Not only was his knee becoming more problematic late last season and into the playoffs, but Wade's interest in ensuring his readiness for this season was a factor.
Since surgery, Wade has been progressively rehabbing his knee and given that he has already played in preseason games, he appears to be in line to start the season on time. The bigger issue with Wade may be his general durability combined with age (he turns 31 in January). The game has taken a physical toll on him over his eight seasons as he has racked up a variety of injuries, some more significant than others (including a shoulder dislocation that later required surgery). Wade has no red-flag injury concerns coming into the season and keeps himself in good shape, but we should not be surprised if he misses time intermittently.
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