Chris Paul vs. Stephen Curry: Who will return first?

April 27, 2016

Which player is more likely to play the entire season without injury?

With the news on Chris Paul starting off so bleak, I know many will think this is a silly question. However I would make the case that this is a very interesting question as the recovery time for these 2 superstars is a lot closer than many of you think.

image from bleacherreport.com
bleacherreport.com

(Micheal Buffer voice: Lets get ready to Rumblllllllllllllleeeeeeeee)

Chris Paul

In the red corner we have the future hall of fame CP3. Chris Paul is reported to have undergone surgery to his fractured 3rd metacarpal on Tuesday morning and the reports have him being re-evaluated in 4-6 weeks. The advantage that Chris Paul has in this match up that may seem one-sided is that his recovery is very predictable. The surgeon went in and fixated the bone in a position that will allow healing and now Paul simply has to keep the hand immobilized and see how fast he can start the healing process. I say start the healing process as it is not necessary that Chris Paul completely heal in order for him to get back on the court. His pre-requisites will likely be that the fracture site is stable and not at risk for re-injury and that he can tolerate the pain that may occur with contact. This does not require that he go through all 3 stages of healing and reach 100 percent, especially considering that any attempts at a comeback this season would have to mean the Clippers are deep in a playoff run. While Paul is the obvious under dog here, he is definitely a live bet when you consider that orthopedic surgeons are constantly improving their techniques, Physical Therapist are using modalities and techniques that improve healing times and manage pain better than ever, and the supplement world is always coming up with items that we can ingest to make our bodies heal as quickly as possible. If the L. A. Clippers can show that they can get to the second round, I could see Paul beating the odds and returning in 4 weeks.

Stephen Curry

In the Yellow corner, we have the baby face assassin. Stephen Curry is reported to have a grade 1 MCL sprain as well as a right ankle sprain that I suspect is still in the healing phases as well. Steph has been the one that everyone seems to believe will be back with no problem, but as I outlined in my earlier post; Stephen Curry’s right leg is infested. The disadvantage for Steph is that his injury is to his foundation. There is nothing he will be able to do on the basketball court that will allow him to ignore his injured right leg. In fact his actual rehab program has to be managed carefully so that the efforts to rehabilitate the injured structures in his right leg do not backfire and cause those same structures to fail. There is a fine line between rehabilitating an ankle and fatiguing an ankle; there is also a fine line between strengthening the structures around a knee and overworking the knee to the point that it fails once tested during game conditions. The fine line of repetitive treatment and re-assessment that Steph is undergoing now is why Physical Therapist are now at a mandatory Doctorate level and Athletic Trainers are making big bucks to basically eat, breathe and sleep rehab with these players. I have confidence that the Golden State Warriors training staff is up to the challenge with Steph Curry, but at the end of the day his right leg will have to go out and take every force, every impact, and every minute of workload. Although I consider Steph to be the favorite in this matchup; I would have a hard time picking him with confidence because of the multitude of variables.

In the end we have 2 very determined players that I am sure will do everything they can to get back on the court. This matchup may be actually mimic a real boxing matchup as there is a good chance that we will not get to see it play out; thanks to Blake Griffin’s quad and the Portland Trail Blazers. But if they do somehow meet in the second round, don’t be surprised if CP3 is suiting up within a week of Stephen Curry’s return. I would be even less surprised if Steph suffers another injury to his right side or at this point to the left side that is likely starting to compensate for the plagued right leg. If both of these things occur, we would likely have a competitive series. It will be interesting to see it all play out.

In any case answer the survey above and tell me what your think.

Golden State Warrior Stephen Curry’s Leg Is INFESTED!

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.

South Philly
South Philly

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.