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NBA Injury Analysis: Rough Week for Centers

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.

Roy Hibbert took to Twitter to confirm last week was "not a good week" for centers around the league. The Indiana center was referring to the injuries to both Tyson Chandler and JaVale McGee who will be sidelined indefinitely with lower leg fractures.

Tyson Chandler
The lower leg consists of two long bones, the tibia and the fibula. Together the two create a connection between the knee and ankle while serving as a site for multiple muscle attachments. The fibula is the smaller of the two bones and runs on the outside portion of the leg. Though the fibula is not considered a weight-bearing bone, the stability of both the knee and ankle is compromised following a fracture. Nerve complications are another concern with fibula fractures, given the proximity of the bone to nerves that control foot and ankle motion.

The fibula is precisely the bone Chandler fractured last week following a collision with Charlotte's Kemba Walker. Fortunately imaging performed on the injury site revealed no ligament or nerve involvement, and Chandler's recovery will depend solely on the rate at which his body can repair the damaged bone. Specialized cells known as osteoblasts and chondroblasts will create and lay down new cartilage and bony tissue around the location of the break, forming a mass known as a callus. The tissue within the callus will then be gradually assimilated and fortified with stronger bone tissue until the gap has been filled in the final stages of what is referred to as ossification. Following ossification, the bone is considered healed though the final remodeling phase has not been completed. The remodeling stage occurs in the months and even years following the injury as the area is shaped by the various stresses placed on and through the bone.

In Chandler's case his recovery is straightforward. Since the bone did not displace upon breaking, surgery will not be required. Instead, Chandler must simply wait for the ossification of the fracture to occur. This generally takes between four-to-six weeks to mend to the point where basketball-related activity will be possible. As Chandler returns to the court, the repaired bone will continue to complete the aforementioned remodeling phase until the bone displays the same biomechanical properties as a completely healthy bone. This doesn't mean Chandler will be out for the next several months, but it does mean that his risk of reinjury will be slightly elevated for at least six weeks following his return. Fantasy owners should shelf the former Defensive Player of the Year for the immediate future and hope for no setbacks in recovery. The Knicks will turn to Amar'e Stoudemire and Kenyon Martin to help fill the hole left by Chandler's absence, though both have plenty of injury concerns of their own. Andrea Bargnani should also see an increase in minutes when the Knicks elect to play small-ball, though he is still adjusting to his new surroundings.

JaVale McGee
With the fibula thoroughly dissected let's turn our attention to the tibia, better known as the shinbone. The tibia is bigger than the fibula and has a plateau-shaped proximal end designed to support and stabilize the menisci and ligament of the knee. Despite its importance, the tibia is poorly protected by surrounding muscle and other tissue, leaving it vulnerable to injury. Tibia fractures usually occur following a direct impact, though that's not what happened with McGee.

McGee is suffering from a stress fracture in his tibia. As previously discussed, bone tissue is constantly remodeling itself to handle the various stresses placed on it. Excessive workloads from constant or repetitive exercise can overwhelm the process and leave the osteoblasts unable to keep up with the body's demands. As a result, the tissue can crack, creating a stress-induced fracture in the bone. Tibia stress fractures are common due to the various amounts of strain placed on the area while running and jumping. To address the problem, all weight-bearing activity must be stopped to allow for the healing process to reset and fix the damaged tissue. Like Chandler, McGee simply must wait for the process to be completed before being allowed to return to activity.

A four-to-six week window is a fair timeframe for this type of recovery, and fantasy owners should plan accordingly. During this time off, Denver would be wise to examine the muscle synergy of McGee's lower legs. Often, muscle imbalances and weakness can be a contributing factor in the development of stress fractures, particularly in the lower legs. This isn't the first time McGee has had issues with his left tibia, missing three games last season with what was described as tibia irritation. This pattern of injury should be carefully examined to prevent the injury from reoccurring in the future. In the meantime, Denver will turn to J.J. Hickson and Timofey Mozgov at center.

Fast Breaks

Stephen Curry: Curry survived a brief scare with his often-injured left ankle. He turned the ankle in a collision with Ricky Rubio but was diagnosed with a left ankle contusion and not a sprain. He missed one game, a blowout loss to the Spurs, before returning Saturday against the Grizzlies. Curry looked fine, scoring a team-high 22 points in the loss. Any time Curry's left ankle is involved, there's cause for concern, though it appears he will be fine moving forward.

Carlos Delfino: The Bucks forward will likely miss the remainder of the season after suffering a setback in his surgically repaired foot. A recent exam revealed the fracture did not heal, and additional surgery will be required. Unfortunately this isn't too surprising as foot fractures have a high incident of non-union. As a result Caron Butler and the currently injured Ersan Ilyasova will see more minutes moving forward.

James Harden: The Houston guard is dealing with issues in both his feet. He has a bone bruise in his left foot and has developed soreness in his right. Harden is sitting out practice but is expected to play Monday against the Raptors.

LeBron James: James has been dealing with back spasms recently though he has yet to miss a game. Fantasy owners should closely monitor the situation but ease up on pressing the panic button just yet. James does not have a history of back problems, and the minor issue has not yet appeared to affect his elite abilities.

Steve Nash: Nash's health continues to decline. The former MVP has been a shell of himself as he battles nerve problems associated with his previously broken leg as well as his chronic back injury. As hard as it is to believe, he's not worth rostering at this point as his productivity and health wane.
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