From Wounded Warriors to Grounded Rockets:
The NBA Injury Report
By Stephania BellPT, MS, OCS, CSCS
Orthopedic Clinical Specialist
Certified Strength and Conditioning Specialist
It's safe to say that big bodies moving at high speeds which then collide into one another, trip over each other, or crash to the floor like giant redwoods toppling to the ground -well, those bodies are bound to get hurt. And so it is that the NBA player sustains injury over the course of a season, sometimes enough to cost him a good chunk of playing time, sometimes just a minor annoyance to the athlete and, of course, his fantasy owner.
The most common injuries in the NBA seem to fit into one of three categories: Acute Contact, Acute Non-Contact and Chronic Wear and Tear - with the occasional combination of acute and chronic. Acute Contact Injuries are the ones the fans see most often because most acute injuries in basketball occur as a result of contact. Whoever said basketball was a non-contact sport anyway?
Among these contact-related injuries are the shoulder subluxations/dislocations that happen during shot blocking or when the athlete gets hung up on the basket. There are the hand and finger sprains that result from fingers getting jammed while going for the ball or being awkwardly bent during contact with another player. Even most sprained ankles involve either a single player landing awkwardly on another player's foot under the basket, or many players' legs being tangled while scrambling for a loose ball. Facial injuries (eye pokes, broken noses) are usually the result, intentional or otherwise, of a hand or elbow to the face.
Acute non-contact injuries tend to be the freak injuries in basketball, the kind that rarely occur yet get your attention when they do. You can count on a handful of these each year. Last season, it was the unforgettable image of Shaun Livingston of the Clippers running down the court untouched, going for a lay-up, then collapsing to the ground in pain as a result of a multi-ligament tear and dislocation of his knee. Ankle sprains, though less dramatic, are always a possibility if an athlete lands awkwardly from a jump shot, particularly if he already has weak ankles that are prone to rolling. Regular garden-variety muscle strains (hamstring strain, calf strain) could fall under this category too, until and unless the athlete sustains them repeatedly, at which point they become chronic.
The chronic wear and tear injuries are the ones the veterans start to accumulate. When you combine the oversize nature of the humans who play this sport with the repeated pounding their joints take from running up and down the court, jumping in the air, and, yes, falling to the ground, they are destined for some enduring aches and pains. Arthritis, the hallmark cartilage breakdown that signals wear and tear within a joint, can set in, especially in the knees, and we see the athletes turning to arthroscopic surgery, including microfracture, to extend their basketball lifespan. Foot problems such as plantar fasciitis (irritation of the tissue on the sole of the foot that helps to form the arch) or ligamentous insufficiency as a result of chronic sprains begin to crop up. And the long, tall spines of the NBA player make them more susceptible to a variety of spine conditions including disc problems, pinched nerves and muscle strains, all of which can contribute to recurrent muscle spasms in the athlete.
So how do you know which of these injuries from seasons past will affect the players you want to draft? You keep reading, that's how, and learn how you can gauge whether Dwayne Wade's acute shoulder dislocation or Tracy McGrady's chronic back problems should have you running from them or snatching them up at a discount in your fantasy draft.
Acute Contact Injuries
Dwayne Wade: The standout shooting guard of the Miami Heat painfully dislocated his left shoulder in February and even when he returned to action in April it was clear he was still apprehensive. This tentativeness is very typical for an athlete once he experiences the agony of having a bone completely come out of the joint. In addition to the acute shoulder injury, Wade was dealing with a chronic case of patellar tendonitis - essentially inflammation of the tendon that anchors the large quadriceps muscle on the front of the thigh, across the patella (kneecap) to the leg bone. Also known as jumper's knee, this condition is common in basketball players, for obvious reasons. During the season it becomes very difficult to manage since the primary treatment is rest and the two most aggravating activities are jumping, and to a lesser degree, running. Wade actually had surgery in May to address both issues: a reinforcement surgery on the shoulder to help stabilize it and a debridement (clean-up) for the patellar tendon. Wade's shoulder rehab is the longer of the two and is projected to last about 6 months, which should put him back on the court a few weeks after the start of the season. The shoulder should not give him any further problems as the surgery and subsequent rehab will give him the stability he needs to play with confidence. The knee however is more complex. These tendon conditions are variable in their response to surgery, but working in Wade's favor is the fact that he has had to rest for an extended period, and he will be brought back in a way that gradually increases stress on the tendon, thus improving the overall health of the tissue. Wade is still young and clearly one of the best talents in the league. He was disappointed with the way last season ended so expect him to come back healthy, solid and with something to prove.
Jorge Garbajosa: Garbajosa suffered one of the more gruesome injuries you will ever see when he fell awkwardly after a collision with the Celtics' Al Jefferson under the basket. As Garbajosa's left ankle rolled inward during his landing, his full body weight tilted laterally, meaning the 6-9, 245-pound mass, accelerated by the force of gravity, all came bearing down on one ankle joint. The result? An ankle dislocation, torn ligaments and a fractured fibula (the skinny bone on the outer part of the leg). Ankle dislocations are fairly easy to recognize because, as with Garbajosa, the player's foot ends up facing in an unnatural direction (in his case the ankle was twisted such that his toes pointed at a 90 degree angle to his leg). The Raptors' rookie forward underwent reconstructive surgery on the ankle and was projected to be out for 6 months, which would have him potentially returning during training camp. He can make a full recovery from this injury and come back to play, but traumatic injuries such as this often render a joint more susceptible to arthritis. Garbajosa will likely be dealing with stiffness and soreness in this joint throughout his career and beyond, the effects of which may not become pronounced until later.
Gilbert Arenas: The Wizards guard collided with Bobcats forward Gerald Wallace in April, resulting in a lateral meniscus tear in Arenas' left knee. The surgery that took place shortly thereafter was not terribly complex (the surgeon removes the offending piece of the meniscus and cleans any debris in the joint), and the projected recovery of 2-3 months is reasonable. The next phase of strengthening should have Arenas at full speed in October. The only issue for Arenas is whether the absence of a portion of the meniscus will accelerate joint problems in the knee. If so, he may eventually be headed for microfracture surgery, where the surgeon induces bone bleeding to stimulate some fibrous cartilage resurfacing. For the upcoming season though, Arenas should be in good shape and can be drafted with confidence, especially considering that he will become a free agent.
Lamar Odom: Odom is one of the most talented big men in the NBA because of his all-around skills - and nothing should change going into this season. Odom suffered a labral tear in March, after which he missed 5 games, but he then returned to finish out the season. Surgery in mid-May to repair the damage went well, and Odom is rehabbing with the intent of being ready for training camp in October. It is worth noting that Odom had a similar surgery on this shoulder in April, 2005 and was not quite ready when the season rolled around. Given that he has a month less to recover this episode, it is possible that he will not make his October deadline. However, sometimes recovery from a second surgery moves a little bit faster, and Odom knows what to expect this time around. Even if his return is slightly delayed, expect him to come back strong.
Charlie Villanueva: Villanueva's season began to fall apart - literally - when he sprained his left elbow in November after a hard fall during a game. He missed a month with the elbow, but within a couple weeks of returning to the line-up, his right shoulder began to act up. Across the season, the Bucks were without their young forward for 43 games. By late March, Villanueva's torn labrum was in need of season-ending surgery. Reports are that he is progressing well, and as of late June, he had begun using the right hand to shoot. He projected that he would feel 100 percent by August, which still nets him a couple extra months before training camp. Villanueva should be good to go in 2007.
Acute Non-Contact Injuries
Shaun Livingston: If you saw the video, you knew it was bad even if you didn't know what happened. In February, Livingston, the 21-year-old Clippers guard who missed 39 games of his rookie season after dislocating his right patella (kneecap), came down awkwardly from a simple layup and collapsed in a heap of agony. Livingston had dislocated his left knee joint, a la Daunte Culpepper of the NFL, a result of tearing three of the the four primary ligaments of the left knee (ACL, PCL, MCL), the lateral meniscus and, as if that weren't enough, dislocating his patella. Usually this is the type of injury that results from trauma, but oddly, there was no one near Livingston when he went down. Livingston underwent surgery with the renowned Dr. James Andrews in mid-March to reconstruct the knee, but this is no easy rehab. Sticking with the Culpepper analogy, one can simply examine how he performed in the NFL the year after his reconstructive surgery. In case you missed it, he did not fare too well, and it appeared that he attempted to do too much too soon. This is a tough injury to recover from just to get back to the business of living, much less to playing a sport, and at the professional level, to boot. Let's look at the bright side for Livingston though. He is just 21 years old, meaning his ability to heal is much better than if he were 10 years older. He suffered no artery or nerve damage, often side complications of a knee dislocation, and this also bodes well for the health of his tissue and the healing process. Livingston has been given an initial projected return time of 8-12 months but that is a very fluid timeline in this case, depending on how his rehab progresses. Given the extent of his injuries, it would be a surprise if he actually returns this season, and to ensure that he does come back strong, it's likely that his rehab will be extended. Keep in mind, Livingston has had other joint instability problems (the aforementioned right patellar dislocation, along with a previously subluxed right shoulder). He will need to add some muscle bulk to his frame to protect his joints and train to prevent against similar injuries to other joints in the future. Until he has demonstrated that he can come back strong, he is a risky prospect, even after this season.
Nenad Krstic: Late December 2006 as the New Jersey Nets faced the Los Angeles Lakers, Krstic tore his ACL all by himself. Krstic was making a spin move, and he said he felt his knee twist and "heard a pop." That sound is never a good thing and is often one of the hallmarks that suggest significant ligament damage. Non-contact ACL tears occur in all sports and are perhaps more common than contact ACL injuries. No matter what the sport, the healing parameters are essentially the same. Krstic has been undergoing rehab and is expected to be ready for the season opener. The biggest challenge when coming back from this injury is regaining confidence in the leg, much of which occurs when the athlete is back on the court, playing in competition. Based on the type of year he was having when he was injured, expect him to come back solid. He may be a bit tentative at first, but as he continues to play, that can only improve.
Brandan Wright: He strained a hip flexor back in April - something that came as a bit of a surprise to the team that drafted him. Wright reportedly injured the muscle (which is located deep in the abdomen on the front side of the hip) during an informal workout with teammates after the NCAA tournament. Wright managed to perform well enough despite the injury to impress the Warriors who acquired him in a draft day trade with Charlotte. They no doubt were disappointed by the fact that this injury kept Wright out of the summer league. According to Wright, he never really rested from April to July, thus his plan was to take it "real slow" to be ready for the season. Muscle strains do usually improve with rest, so this may be the simple solution. At only 19 years old, he has the quick healing powers of youth on his side, so expect him to be 100 percent (the Warriors certainly do) when training camp begins.
Elton Brand: Bam! And just like that, in an off-season split second, the Clippers have a second athlete in the non-contact freak injury category. Brand was participating in a routine workout in August when he suddenly tore his left Achilles tendon. The Achilles, the long tendon that attaches the calf muscle to the heel, is the springboard for every jump shot, every rebound, and every dunk. When it fails, the athlete simply can't push forward off the ground, even for regular walking. Consequently, in cases like Brand's, the tendon is surgically re-attached, and after a period of immobilization in a cast or splint, the tendon is gradually stressed to increase range of motion and strength. Return to competition typically takes about six months, so the majority of the 2007 season is not looking great for Brand. Fortunately, Brand has not previously dealt with much in the way of injury, so once he gets past this episode, he should return to form.
Tracy McGrady: Despite assurances in December from his rehab specialist that McGrady would never again suffer a non-contact back spasm, he continued to have issues with his back intermittently during the season. After all, that's the nature of back pain, it tends to be chronic and recurrent - and though there are certainly treatments (in particular, stabilization and flexibility exercises) that can help to maintain back health and prevent future recurrences, there are no guarantees. McGrady missed 35 games during the 2005 season as a result of his back, and even when he did play, he appeared tentative and a step off his pace. He did look more like his old self at times last season, perhaps as much a result of confidence in his treatment as the treatment itself. His complaints in December of being unable to fully straighten and the recurrent spasms have a familiar ring - back pain is an every man's injury. And just as it is for the rest of us, there is no magic solution to McGrady's condition, only his willingness to rehab proactively with the expectation that it will give him difficulty from time to time. McGrady is a big-time talent - and if you can put up with his intermittent absences when the back flares up, then he is worth taking on - but have a backup ready.
Ray Allen: The former Sonics turned Celtics guard had been dealing with painful bone spurs in both ankles for some time, the result of repeated stress on the joints from impact and torsion, and was planning to have post-season surgery to address the issue. But in late March, the pain from the spurs in his left ankle began to affect Allen's jumping, so much so that the compensations he was making started to aggravate his knee. In early April he called it a season and went under the knife to remove spurs in both ankles. Normal recovery time is about 2-3 months, which should leave Allen with plenty of time to be ready for the start of the season. In fact, the trade to Boston in June, two months after surgery, should support the idea that Allen's on track since the Celtics no doubt took this into consideration when dealing for him.
Predrag Stojakovic: Stojakovic underwent a discectomy (surgery to remove a portion of one of the spinal discs) in December of last year to alleviate leg pain he was having as a result of a pinched nerve. He was initially projected to be out 12 weeks, but was never able to make it back during the season. There are many reasons why that could happen, not the least of which is the team's assessment of the risk vs reward of hustling a player back to the game for only a few remaining weeks. The extra time allows Stojakovic to really strengthen and condition for this season, which according to Hornets GM Jeff Bower is exactly what he is doing. As of late June, Bower stated that Stojakovic was feeling good and had been working on his "total fitness." Back problems can recur, but repeat disc herniation after surgery is relatively infrequent. Stojakovic must maintain his "total fitness" regimen though to keep himself on the court.
Brad Miller: The 7-foot center for the Sacramento Kings was plagued throughout the season by plantar fasciitis (inflammation of the tissue that helps to form the arch) in his left foot. The problem originally cropped up during November of last year when Miller was forced to leave a game due to pain that put him in a walking boot for several days. From there on out, he was forced to miss periods of time throughout the season when the foot gave him trouble. In April, he announced that he would rest the foot until it healed, and he was told at that point to stay off the foot for three months. Of note, three months later Miller did not attend the Team USA minicamp, which made some nervous that the problem was lingering. There has been no official word to that effect, and the more likely scenario is that Miller is cautiously continuing to rest the foot to ensure his health for the season. This is another one of those conditions that is best addressed with rest, and Miller has had enough time that he should start off the season well. Unfortunately, this is also a condition that can recur, particularly if underlying contributing factors (tight calf muscles, for example) are not sufficiently addressed.
Larry Hughes: Hughes dealt with a myriad of injuries throughout the season, many of which he attempted to play through, shedding light on his toughness. The problem is that, as a result, Hughes altered his mechanics enough to start creating additional stresses elsewhere. A high ankle sprain on his right foot last November was followed by left quadriceps tendonitis in January. The final straw was an injury to his left foot when the Cavaliers faced the Pistons in the playoffs. Hughes got pain so severe in his left foot during that game in May that he could hardly put pressure on it. The pain persisted for weeks, and when it came to the NBA finals, Hughes limped through the first two games before being deactivated for the third, the pain so severe at that point that even walking was a challenge. It turned out Hughes had gone from a strained plantar fascia, to a partial tear of the tissue. It did not warrant surgery, but by exacerbating the condition, the healing time increased. Hughes has likely spent a good deal of the off-season just resting and recovering which helps him going into camp. Given his prior injury history, however, and the difficulties he encountered last year, Hughes' durability for the 2007 season remains questionable.
Andrei Kirilenko: The Jazz forward falls into this category not because he has a chronic problem per se, but he had so many acute injuries during the course of last season, that he was chronically absent from the team. Being chronically injured can be a sign of underlying concerns (weak soft tissue such as easily sprained ligaments or pulled muscles, poor core fitness) or it can simply be random bad luck. Kirilenko may be dealing with a little of all of these as he sustained multiple sprains, back spasms (which also caused him to miss multiple games in the 2005 season), and randomly suffered a concussion and a thumb fracture at two different points. Nonetheless, none of his injuries appear too serious, other than the aforementioned back problems, which could crop up again at any time. Still, until Kirilenko shows that he can string together a few weeks without any setbacks, consider him a big risk to miss time during the season.
Gerald Wallace: Here is another athletic stat-sheet filler with a number of little injuries. The 2006 season saw the Bobcats forward suffer sore knees, a strained groin, a shoulder sprain, a bruised quad and a cut under his eye. Each of these injuries happened acutely, either as a result of contact or simple overuse, but led to Wallace being chronically injured, particularly in the early part of the season. He did bounce back nicely down the stretch, and the Bobcats must have confidence in his longer-term health since they signed him to a substantial six-year deal. Wallace's injuries are less concerning than Kirilenko's, and he's a strong pick heading into the 2007 season.
Article first appeared on 8/9/07