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NBA Injury Analysis: In Street Clothes...

In Street Clothes...
By Jim Russo
RotoWire Injury Expert

As injuries pile up day by day in the NBA, I'm sure there are a lot of you out there wondering what is going here. From Josh Howard's ankle, to very dicey situations in Houston and Golden State, to the retirement of Cuttino Mobley, you can count me in as well.

Josh Howard

You just can't put a reliable timetable on a lot of these injuries any more -- especially ankle sprains which again seem to dominate the discussion. Josh Howard has been on the verge on returning from the ankle sprain he originally suffered November 18th a few times. Now after repeated MRI's which apparently revealed "no structural damage", and "nothing to indicate surgery", he's been placed in a walking boot and will remain out of the lineup indefinitely. Where did that come from? He was a game time decision just a few days after the injury and then again a week after that. When you hear that, you have to figure it's a mild sprain. You assume he's able to test it out at least somewhat in practice, so he'll be back soon. That was the case December 1st when he went through a full contact practice, only to be on the sideline again the next night when the Mavs were in action against the Clippers.

Now a week and a half later and he's in this boot, which is like being completely non-weight bearing, and a significant step backwards. You can say what you want about the Mavs recent run of success without him, but this is still a guy capable of putting up huge numbers and someone fantasy leaguers will undoubtedly miss. As far as his return at this point, anyone's guess is a good as mine.

Zydrunas Ilgauskas and Daniel Gibson

And we have word from Cleveland that Zydrunas Ilgauskas will join Cleveland teammate Daniel Gibson on the bench for a few games after spraining his ankle Wednesday night during another Cavs win, this one in Philly. It was described as a moderate sprain of the left ankle but the first estimates I heard was that he would only miss two games. Needless to say, if you're watching the trends at all with these ankle injuries, that is optimistic to say the least.

Gibson will be sidelined at least two weeks himself with a sprained left big toe. Sometimes this injury is described as turf toe, basically a hyperextension injury of the big toe that used to be very common on the old Astroturf fields used in the NFL. But it's definitely not an injury confined to that sport or to that surface. A big toe sprain can be extremely painful, and makes running and especially jumping virtually impossible. These two injuries might be the first real test for the Cavs this season, so it will be interesting to see how they respond.

Kevin Martin

Now back to that ankle question. Kevin Martin returned December 2nd from his sprained ankle, originally suffered November 9th, to play 33 minutes, scoring 22 points in a Kings loss versus Utah. Initial estimates had him missing about a week but it turned out to be close to a month, 12 games in all. But no worries…he came back and came back strong. Until he played the Kings next game this past Saturday, and had an awful time against the Nuggets, needing to come out after 30 minutes and only 8 points. It was described as a sore ankle, but now we're hearing that his Achilles' tendon may be involved as well. Either way, there again is no timetable for his return so we will have to wait and see. Could the Achilles issue simply be swelling from the ankle sprain? Sure. Could it be another muscle strain that may or may not be related to the original injury? Yes. Could he have some instability in the ankle joint resulting from multiple sprains over years and years of playing basketball? Hopefully not, but maybe.

I suppose the lesson is that no matter how much they are downplayed, no matter how many MRI's reveal "no structural damage", we should never expect less than a month on the shelf when players go down with these injuries. Sometimes you will get lucky, sure, but more often than not, caution will be the rule.

Ron Artest

As for the Houston Rockets, Ron Artest isn't traveling with the team on their upcoming two game road trip to rest a sore ankle that has been bothering him since mid-November. This is after he played 39 minutes Tuesday night in a win over the Hawks, the night after he had to sit one out due to pain in the same ankle. The team's medical staff feels this is something he can play with, but Artest apparently needs the time off to rest and rehab the ankle. If you have read the reports of his recent MRI, you see there are partially torn ligaments in there, which is the case with every recurring ankle sprain you have in the NBA. That's not a surprise…its part of the injury. The issue is what percentage of the ligaments in question are torn, and what type of pain he's willing to play with. My guess is if this were the NBA finals, he'd be out there. Now a two game trip to the west coast in December is obviously not the playoffs, but it still can be frustrating to Rockets fans and to fantasy owners alike. Either way you have to figure he'll be back soon, but again, you never know.

Tracy McGrady

On top of that scenario we have Tracy McGrady back in the column again. McGrady will make the trip to California with the team this weekend and apparently is questionable to play. This comes only a week after we heard that he would be sidelined for at least the next three to rest his ailing left knee.

My question is: "Who exactly is calling the shots there?" It seems the medical staff is taking a back seat to the players' whims and for me, that is never a good thing. I'm not saying the players, coaches, and front office shouldn't be involved in these decisions…they absolutely should, but it is the job of the medical staff to make decisions in the best interest of the player and the team and not to waver on those decisions. In my mind it's the responsibility of the coaching staff and the team to support those decisions and keep the players on board. The players need to trust those professionals and do whatever is necessary to get back on the floor the healthiest way possible.

Now it may not be the case here, but when you put those decisions in the hands of the players, or in the hands of a front office that wants to see W's night after night, that's when you see this type of confusion.

Corey Maggette

But the situation in Houston seems trivial to what I've been reading out of Golden State, who ironically, the Rockets are on their way to play tonight. The Monta Ellis story has been covered here and elsewhere so that's not the issue today. Corey Maggette has been battling a hamstring injury for some time now and has missed the last two games for the Warriors. We have discussed this injury before. It can be debilitating to a basketball player…that isn't the question. The question seems to be how to treat it. I expect that the medical staff there has a little more experience with it than Maggette does, but it doesn't look like they're getting much support. From an outsiders point of view, it looks like the medical people have told him to shut it down for a while to give the muscle a chance to heal, but Maggette doesn't think this is the best option because it doesn't eliminate the chance that he can re-injure himself.

You can never guarantee that someone won't get hurt, no matter how much time you rest. What the athletic trainers and doctors are trying to do is give him the best possible scenario to return healthy. One of his quotes was, "there really is no rhyme or reason to what I'm supposed to do." Well my feeling is simple…there absolutely is a rhyme or reason to how these things are taken care of. You just have to listen and again, trust that the medical people calling the shots know what they're doing. It really is that simple.

Stephen Jackson

Maggette's teammate Stephen Jackson ripped the Warriors medical staff over a sprained wrist that he suffered the end of November. He missed some time again last weekend, eventually getting an MRI on December 7th, which revealed no torn ligaments or fractures, just a sprain. Jackson though was not convinced, stating that he doesn't know how long he's going to be out or the best method of treatment. He went on to say when questioned "ask Tom (Warriors Athletic Trainer Tom Abdenour). I'm not the doctor. I don't think he knows either. I'm on my own. I'm just on my own." He also mentioned getting a second opinion, which is standard practice for most doctors, but he should at least give his people a chance first.

All this and then he goes out and plays 45 minutes in a game December 10th, scoring 21 points on 7 of 23 shooting. It's always hard to predict how players will respond to injuries, especially when the information is so protected these days. But my guess is this. He has a sprained left wrist. It's painful…anyone who has had an injury like this knows that it's painful….and that every time he gets hit there it will aggravate it. That contact tends to happen a lot in the NBA. But the bottom line is it's his non-shooting hand, the first thing you look for with hand or wrist injuries, and again, he played 45 minutes a few days ago, throwing up 23 shots. Of course he could hear something completely different if he sees another specialist, but did someone in Golden State forget that you're making a ton of money to play basketball for a living and just might have to play in pain once in a while?

Dwight Howard

We also have to mention Dwight Howard for a minute. He suffered a strained oblique muscle during the Magic's Tuesday night game versus the Blazers. The obliques are located in the midsection of our flanks, basically the sides of our ribcage and their action is to turn the body and assist respiration. Any baseball fan I'm sure has heard of this injury as they're very common in that sport for hitters who spend so much time forcefully twisting their bodies. Howard feels it's a relatively minor injury and he'll be a game time decision for tonight's contest in Phoenix, but I wouldn't be surprised if this thing lingers a bit longer than that. In baseball, this is a month long injury at least, and there is not much you can do to treat it except medication, ice, and rest. Howard is a physical specimen, and he may feel ready to go, but this injury could limit him at times. Unfortunately, this is a situation that bears watching.

Cuttino Mobley

As for Cuttino Mobley, I'll be the first one to admit that a few weeks I said he would make his debut for the Knicks soon. Then word came down of his retirement from a heart condition called hypertrophic cardiomyopathy (HCM). I'm not surprised that he made that decision, but I am surprised that his two former teams allowed him to play with it, waiver or not. Few that were around at the time will ever forget the terrifying scene when Loyola Marymount star Hank Gathers crumbled to the court during an NCAA basketball game and eventually died. The same can be said for Reggie Lewis, who was not on the national stage when he succumbed to this congenital heart condition, but still caused sadness throughout the country. They both had the same condition that plagues Mobley and it is a very real threat, the leading cause of sudden cardiac death in young athletes. HCM, simply, is a condition in which the heart muscle itself becomes thickened and the normal vessels that supply blood to the heart cannot keep up with the demand of a bigger muscle. During athletic activity, the demand of the heart increases, like any muscle, and eventually the heart becomes a ticking time bomb due to the lack of efficient blood making it to the tissue. Depending on the exact location -- sometimes it is localized is specific regions of the heart - HCM can also cause disruptions in the amount of blood leaving the heart with each contraction, making the situation even worse. There are often symptoms for people with HCM like pain in the chest, dizziness, fainting episodes, and palpitations.

Often physicians will hear heart murmurs and find high blood pressure in patients, leading to EKG's and echocardiagrams that can diagnose HCM. Other times the first symptom you will see is a young athlete suddenly collapsing during exercise and eventually dying. For this reason, Mobley is lucky he played as long as he did, and obviously made the right decision to retire.

Stephen Jackson should read a little about HCM and some of the athletes that have died from it. Maybe then he would realize that a sprained wrist and some swelling in his hand is definitely not the end of the world.

Jim Russo is a certified athletic trainer with a Master's Degree in Exercise Physiology.

Article first appeared on 12/12/08