April 26, 2016
Golden State Warriors fans will be sad to hear this, but it is true. Stephen Curry has an infestation in his right leg that will threaten their historic season. Being from the city of brotherly love, I have often given my patients the analogy of injuries to row houses. For those who are not from the Tri-State area and have been blessed to not know what a row house is; I will explain. Where I grew up the houses on either side of a block were connected. In a row house you literally share a wall with your neighbor. This is similar to how some condos or apartments are built, but with less of a luxury feel. For an example, just go back and look at the Rocky movies…Rocky thought he was the man when he bought that house for Adria in Rocky 1….that is a row house.
Back to Steph Curry. Imagine Steph’s right leg as the block of row houses. His foot would be a house, his ankle would be a house, his knee another, his hip another, his lumbar spine being 5 houses to represent each lumbar segment, and on and on until you reach his cervical spine/neck area. Each of these areas of the body represents a house that is its own entity, but also very affected by the other homes.
The unfortunate aspect of living in a row house was that you were always at the mercy of your neighbor. With walls that are connected, it was really as if your side of the block was one big house with 30 adjacent rooms. I found this out the hard way when a supermarket at the corner was shut down and the neighborhood became infested with mice. The challenge with this is that no matter how clean you are or how much you do to deter the infestation, the mice simply move up and down the segment of row houses back and forth.
For Stephen Curry, we saw a mini infestation that has been recurrent in his right ankle. He appears to have managed this fairly well in the past and confined the issue to one joint. I am afraid that his quick return without fully healing that right ankle may have allowed his mini infestation in his ankle to spread to his knee. Some may look at his knee injury and call it a “freak injury” and dispel the correlation between the 2 injuries, but this is something I have preached to my patients for a long time–“always watch the neighboring joints”.
That old song about your hip bone is connected to your thigh bone and your thigh bone is connected to your knee bone is somewhat silly but does highlight a good point. It’s all connected. Our bodies work together to achieve almost everything we do and when one link becomes weak, it puts the other links at risk. Most often it is the adjacent or neighboring joint that will experience symptoms first. When one row home gets mice it usually spreads to the neighbors, and eventually it puts all the rest of the block at risk for getting mice…unless that first home gets rid of the mice completely.
The ankle joint is one of the first responders to perturbations or uneven surfaces. If you pay close attention when you walk on uneven grass or a trampoline floor; it is your ankle that is turning in and out or forward and backward to stabilize you. If the surface is even more unsteady, you will sense that your knees will bend and straighten to further stabilize you. As the challenges continue, the amount of joints that work together for stabilization increases. When any of those joints or the muscles around those joints do not do their job, the next joint must act earlier than anticipated and do more work than anticipated. In Steph Curry’s case, his right ankle either did not react fast enough or did not exert enough force to stabilize him before he slipped and his knee attempted to compensate but failed to act in time. This is not only the likely thing that happen with Steph but also is a very common occurrence with people who return a little too soon from a particular injury.
Joints have mechanoreceptors in them that tell you what the joint is doing and what position the joint is in. After injury those mechanoreceptors are often damaged and unable to work as efficiently as they do when they are healthy. For many who suffer multiple ankle sprains, this is much of the reason. When you step, jump, or even get pushed in a particular direction; your mechanoreceptors in your ankle send signals to your brain that gauge whether your foot is flat and ready to land or turned inward which would cause the ankle to land awkwardly and sprain. In a healthy ankle, this message is sent quickly and the mechanoreceptors allow the foot to get flat and the ankle to get to neutral for safe landing. With an injured ankle, these signals can be slow or they can be wrong. The ankle sprain can be one of the more recurrent injuries because while those mechanoreceptors are injured or in the process of being rehabilitated, they may tell the brain that the foot is flat when it is not, or they may not figure out where the foot is before it hits the ground. Many of these scenarios end with your foot landing in a non flat position, which puts force on structures that are not supposed to have the force. With the multitude of injuries that Stephen Curry has had to that right ankle, I would guess that the mechanoreceptors in that ankle were already at a disadvantage. It is not a coincidence that Steph just happened to have a weird slip on his first game back. Injury Science is real and can explain what most consider to be coincidence or unlucky.
Anyone who is counting on StephenCurry to take the Warriors to another championship better hope they can get through the second round without him. I would even be hoping that the Rockets pushed this series out, if it meant they would buy more time for Steph to heal. I would bring him back in no less than 3 weeks and would squeeze every day of recovery I could out of him. The fact is that his right foot and right hip are at great risk for the infestation to spread. The only remedy is to completely let that ankle and knee heal before allowing him to return to play and soft tissue injuries of this nature are generally going to need at least 3 weeks to heal. If you see Steph or the training staff push for an earlier return and succeed, I think it would be the end of their run as a return in earlier than 3 weeks smells like re-injury to me.