Stephania Bell is a licensed physical therapist who has been helping us understand and better estimate the injury absences and return prognostications for professional athletes for more than a decade.
On Monday, I was lucky enough to sit down with her to discuss the prognosis of several injured and/or recovering NBA stars as we approach the start of the upcoming season.
Westbrook underwent arthroscopic surgery on his right knee on Sept. 12 and was immediately ruled out for the preseason. Thunder GM Sam Presti stated the week before camp began that the Thunder will take a cautious approach with Westbrook, will not rush him back and that he could conceivably miss the start of the season while recovering.
How bad is the injury? How long is Westbrook likely to be out? When he returns, will he be himself? How likely is it that this will become a lingering/recurring issue for him this season?
To answer, let's look back. Westbrook had the lateral meniscus of his right knee repaired in 2013 after an awkward collision with Patrick Beverley, a process that required three surgeries at the time. According to Bell, it is normal for periodic cleanup surgeries to be required in cases like this.
Further, she says Westbrook needing a procedure like this is not overly alarming and there is no reason to think he can't come all the way back to his explosive self. The historically proven approach would be for Westbrook to take his time and rehab fully, and if he does so, he has a great chance to return healthy.
Bottom line: The Thunder brought in Dennis Schroder this offseason, so they have a high-quality backup who should be able to help the team compete if Westbrook is forced to miss some game action.
Westbrook is the franchise and is signed to max money for years to come, so it behooves the Thunder to be cautious with him and let him fully recover. It wouldn't be surprising if Westbrook misses some games to start the season, but when he returns, he is likely to return as himself with no real long-term limitations.
Leonard laughed during the Raptors' media day, and it broke the internet. This followed a summer of media frenzy, during which Leonard had a publicly nasty split from the San Antonio Spurs and was traded to the Raptors in a huge deal involving DeMar DeRozan. Here's what I wrote about the Raptors' championship prospects immediately after the trade:
But make no mistake: If Leonard is locked in and returns to his 2016-17 form, the Raptors should project as favorites to make the Finals and be a legitimate threat to challenge the Golden State Warriors."
So, then, one of the most important questions of this NBA offseason is: Just how healthy is Leonard? In the fantasy world, Leonard was a sure-fire top-10 prospect prior to his injury-filled 2017-18 campaign. Is he ready to be that again?
Leonard has been dealing with quadriceps tendinopathy, which Stephania indicated is the correct term to use for his injury, instead of the more commonly referenced tendinitis (which technically refers to an acute inflammatory condition). Tendinopathy is a broader term that refers to disease or disorder of the tendon resulting in recurring pain and potentially weakness, often in response to repetitive loading.
Stephania noted that the quadriceps muscles, the quadriceps tendon and the patellar tendon work together to straighten the knee. Quadriceps tendinopathy would very likely be associated with chronic pain in the area above and around the kneecap, which would make it very difficult to play through with any sort of confidence.
This is consistent with the way last season played out, with the very public disagreement between Leonard and the Spurs as to whether Leonard was healthy enough to play. Stephania told me that returning from tendinopathy is difficult to predict, in part because confidence in the leg may be lacking, especially if the symptoms have been present for an extended period.
Even as the athlete is able to demonstrate strength gains, there is still the matter of overcoming the fear that the symptoms will return or that the demand of the sport will cause the tendon to fail. Controlled progressive loading is central to successful recovery both physically and mentally.
Leonard played in only nine games last season before shutting it down, which means he has had more than a full year since the initial injury and quite a bit of time to rehab the injury. Raptors coach Nick Nurse was asked about Leonard's health, and he said he hasn't seen any issue, though the team plans to monitor it.
Leonard participated in 5-on-5 drills with no limitations to start camp, his first 5-on-5 work since January. While it's too soon to deem him completely healthy, the nature of the injury, the amount of recovery time and the importance of confidence in the recovery process would suggest a positive outlook.
Bottom line: Leonard has top-10 fantasy upside if healthy and motivated. While there are still some questions that can't be fully answered until it plays out, there are reasons to believe his health has moved significantly in the right direction since the last time we saw him play last season.
Irving had surgery in early April to remove two screws from his previously surgically repaired left knee. The screws had reportedly caused a bacterial infection in the knee. The procedure came with a projected four-to-five-month recovery estimate, which would have had Irving back by camp.
Stephania told me that hardware removal is a fairly common procedure following this particular surgery. The screws had been used to stabilize the fracture site at the time of the original injury, but once it healed, the screws were no longer necessary. With the patella so close to the surface and the proximity of the screws to the soft tissue, the screws have a propensity to irritate the area. Removing the hardware does leave small holes in the bone where the screws were, though, and those holes need time to fill with bone.
Just as with any fracture, recovery depends on not loading the area until time allows the bone to fill back in. This shouldn't be an issue, given the amount of recovery time Irving has had, and the healing can be monitored through imaging.
Irving had the whole offseason to adequately rest, and he reportedly was fully healthy for a month before practice began. He was a full participant in the Celtics' first practice, and this shouldn't be a problem going forward.
Bottom line: Irving's procedure is fairly common and straight-forward. He had plenty of time to recover, and he should be fully healthy entering the season.
Booker underwent surgery on Sept. 10 to repair an injury to the fifth metacarpophalangeal (MCP) joint in his right (shooting) hand. The recovery time was reported as approximately six weeks.
Bell showed me on my hand where the fifth MCP is located. The metacarpals are the long bones of the hand that run between the wrist and the knuckle. The metacarpals are numbered from the thumb to the pinkie, so the fifth MCP is the knuckle joint that articulates the pinkie finger.
Booker initially injured the finger when he jammed it last spring, which caused him to miss the final 12 games of the regular season. Bell says that Booker having surgery months later indicates there were some residual chronic issues such as pain or swelling, possibly ligament damage that rest didn't fix.
Booker's surgery was performed by Dr. Steve Shin, who operated on Chris Paul when he suffered a similar injury to the first MCP a few years ago. Bell said that the goal of the procedure and rehab is to get full motion and strength back in the digit, and Shin is known for a surgical approach that allows the athlete to aggressively pursue those goals.
Booker's recovery relies on keeping the pinkie stable in its resting position, and his initial cast immobilized both the pinkie and ring finger. It would be reasonable to think that Booker could return to play with some type of subtle protection that should not affect his ability to shoot. If all goes well, it is possible Booker could be back by opening day, but Stephania suggests it's more likely that he'll return somewhere around the end of October or beginning of November.
Bottom line: Booker is the young franchise player for the Suns and just earned a huge contract extension during the offseason based on his potential. He's a shooter/scorer foremost, and it's in the team's best interest that his injury be handled well. The Suns are likely to side toward caution, but once he returns, he should be ready to go at full speed. He has already been practicing on the court with his opposite hand and knocking down jumpers without touching the net.
Ball underwent arthroscopic surgery on his left knee on July 17. He missed 24 of the last 40 games during the 2017-18 season due to a torn meniscus, and his offseason surgery involved partial removal of the meniscus.
While we don't know exactly how much of the meniscus was taken out, Stephania says that typically removing the meniscus leads to a quicker recovery than trying to surgically repair it. Ball echoed that this summer on his Facebook series "Ball in the Family." He stated that the repair would have entailed a six-month recovery, whereas the partial removal came with a recovery timeline of six weeks.
Stephania does caution, though, that since the meniscus is the fibrocartilage pad that protects the knee, removing a portion of that pad could potentially be worth noting for the long-term health of the knee. The amount and location within the meniscus of the component that was removed would factor into the level of long-term concern.
Stephania says that the recovery process involved getting the swelling down, rehabbing to get muscle strength back, then building back to basketball activities. The rehab process itself shouldn't have been too lengthy, and this was confirmed by the announcement on Sept. 20 that Ball had been medically cleared to return to full basketball activity. With that said, the Lakers are taking it slowly with Ball, as he has been held out of contact drills to begin training camp, and it has already been announced that Ball will come off the bench to begin the season.
Bottom line: Ball had a partially torn meniscus in his left knee and chose the surgical option that would allow him to return to the court sooner. However, he is considered a vital part of the Lakers' future, and with Rajon Rondo in the fold, the team is going to take Ball's recovery process slowly. He is expected to begin the season off the bench, which lowers his short-term production potential, but once fully healthy, there is no reason that he should not be physically able to resume starter's minutes.