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NBA Injury Analysis: The More You Know

Jeff Stotts

Jeff Stotts

Jeff Stotts works as a Certified Athletic Trainer (MAT, ATC, PES, CES). He won the 2011 Best Fantasy Football Article in Print from the Fantasy Sports Trade Association.

Chris Paul
The Clippers will have to navigate the rocky waters of the Western Conference without their floor general for at least six weeks after Paul suffered a shoulder injury. The injury occurred in a game against the Mavericks when Paul's right arm hit the ground after getting tangled up with Dallas' Monta Ellis and teammate DeAndre Jordan. Following the game, coach Doc Rivers referred to the injury as a separated shoulder, a diagnosis later confirmed by MRI.

Rivers' usage of the word separation is a good indicator of what area of the shoulder has been injured. Separation, rather than dislocation, is most commonly used to describe an injury to the acromioclavicular (AC) joint of the shoulder. Located where the clavicle (collarbone) connects to the shoulder blade at an area known as the acromion, the AC joint acts as a strut for the arm. It is stabilized by two specific ligaments, the acromioclavicular (AC) and coracoclavicular (CC) ligaments, which are particularly vulnerable to injury.

AC sprains have their own grading scale based on the amount of damage to the aforementioned ligaments as well as the neighboring structures. A Grade 1 sprain is considered minor and involves overstretching and microtearing of the ligaments. A more severe Grade 2 sprain involves a tear of the AC ligament but minimal CC ligament involvement. A Grade 3 injury denotes a rupture of both ligaments with accompanying upward movement of the collarbone. The final three grades are considered severe and each grade is dependent on the degree of movement of the collarbone and the damage done to the surrounding musculature. The Clippers have said that Paul will not require surgery, suggesting the sprain is likely a Grade 2- or 3-type injury.

The initial timeline has been set at six weeks, though other players have returned from AC sprains quicker. Cleveland's Kyrie Irving, who suffered a moderate left AC sprain last season, missed exactly three weeks and eight total games recovering from his injury. However, it's worth noting that Irving's injury occurred to his non-shooting arm, and Paul will need additional time to ensure the shoulder is 100 percent and fully functional. The six-week window seems reasonable, though expect the Clippers medical staff to exhibit extreme caution with their All-Star point guard.

In the meantime, Darren Collison will become the starter, a role in which he's previously flourished and floundered. During the 2009-10 season, Collison served as Paul's backup with the New Orleans Hornets. As Paul battled injury, Collison emerged as a legitimate offensive weapon, averaging 18.8 points, 9.1 assists, 3.5 boards, and 1.4 steals in 37 starts. Collison's first start this go-round was promising as he scored 14 points on 6-of-9 shooting and added six assists and three steals. Look to pick him up if he is still available.

Kyrie Irving
The Cleveland point guard suffered a left knee injury in a loss to the Pacers, and the team feared the worst after he reported feeling a "pop" in the joint. Fortunately, an MRI revealed all ligaments were intact, and the injury was diagnosed as a left knee contusion. While that is definitely a win for the Cavaliers, a knee contusion shouldn't be taken lightly. If the injury is actually a bone contusion, then the outer layer of bone has been damaged. The body repairs bone bruises just like it would a fracture, laying down new bone tissue. The repair site needs time to remodel itself adequately, a process made difficult by the path in which the knee travels during movement. Time is the best weapon to combat a bone contusion, and the Cavaliers seem poised to give Irving as much time off as necessary. He's missed three straight games and should be considered questionable for Tuesday's game against the Sixers. Rookie Matthew Dellavedova started Sunday with backup point guard Jarrett Jack also sidelined with back spasms.

Jordan Farmar
The injury woes for the Lakers continue as the team revealed Farmar is expected to miss a minimum of one month recovering him his second hamstring tear of the season. An MRI revealed the new tear is in a different location on his left hamstring than his previous injury. The description of the strain as a tear suggests it is at least a Grade 2 strain, meaning the damage has occurred to the individual fibers of the muscle. The healing process for these types of injuries is a multi-phase process that often requires a considerable amount of time to complete. The primary phase of the process is the inflammatory phase, which includes the initial swelling and clotting reactions. The next phase, the proliferative phase, overlaps with the inflammatory phase as the body actually begins repairing damaged tissue. As the phase progresses, scar formation begins at the injury site with the introduction of various protein fibers including both collagen and elastin.

The proliferative phase generally takes four-to-six weeks before the last phase, the remodeling phase, is started. The remodeling phase can take as long as a year to complete, but players often return while this phase is ongoing. Collagen fibers are repeatedly broken down and remade to increase strength by properly realigning the injured muscle fibers. However, because it is still undergoing development, the muscle tissue is not as strong as the original muscle tissue. It's likely Farmar's second strain was related to the weakened tissue from his initial injury.

With two areas of the hamstring still healing, it seems likely that Farmar will miss longer than a month, and I would expect his recovery to push closer to six weeks. With Steve Blake and Steve Nash still out, Jodie Meeks, Nick Young, and Kendall Marshall will see a bump in minutes. Marshall appears to have the biggest upside after he handed out 32 assists over the past two games alone.

Fast Breaks

Tyson Chandler: The former Defensive Player of the Year made a brief cameo in Sunday's win over Dallas before departing with an upper respiratory infection. He should be considered day-to-day moving forward. The Knicks play three times this week, including a matchup against the rival Heat.

Tiago Splitter: The Spurs center will be sidelined three-to-five weeks with a shoulder sprain. Look for Tim Duncan to see an increase in responsibilities with Boris Diaw, Aron Baynes, and even Jeff Ayres helping out.

Russell Westbrook: Westbrook has shed his crutches and is making progress in his rehab, but a timetable for his return remains in doubt. With Kevin Durant keeping the Thunder afloat, don't expect the OKC medical staff to rush Westbrook's recovery.