One of my favorite times of the year is around the middle of April when playoff basketball begins. It’s going to be different this year since my team has been eliminated from the playoffs.
Nevertheless, the NBA playoffs set the stage where unforgettable moments occur and new rivariles bud. For those in the playoffs, getting all of their players healthy is priority number one. The untold secret for a successful championship run is to have more healthy players than the other team. One team in particular appears to be falling apart from the seams as we speak. The Golden State Warrior have injuries to Kevin Durant(rib soreness), Klay Thompson(thumb injury) and Stephen Curry(Grade 2 MCL sprain) as seen below.
Anytime we see a star player go out with a knee injury it is safe to assume that he is going to miss some time prior to returning to the court. Steve Kerr(Golden State’s head coach) commented on ESPN in regards to Curry’s injury, “there is no way he is playing in the first round of the playoffs”.
Uh, oh this doesn’t sound good for the Warriors.
When asked about the severity of his injury, Curry stated that he plans on doing his job in rehabbing his knee and prove his coach wrong.
Wait, what?!? You(Curry) just sustained a sprain of a knee ligament and you want to return early for what to play the Suns? That doesn’t sound smart.
Who is right in this situation? Would you risk another injury to a player who was a 2x MVP? What exactly is the MCL?
What is the MCL and its role with athletic performance
Complications associated with early return to sport
Exercise ideas to address loss of sensorimotor function
The MCL is one of two collateral ligaments of the knee as seen in the picture below.
The MCL is thin ribbon like ligament that has access to a rich blood supply which aids in healing without the necessity of surgery(pending specific grade of sprain). The MCL acts to prevent excessive valgus(inward) stress on the knee. For the basketball player, the ability to move laterally and resist rotatory movements are important to close out the offensive player or to allow for space creation with various dribbling maneuvers. A player of Steph Curry’s caliber relies on his crossover to create scoring opportunities for himself as well as his teammates.
Using Curry as an example to determine return to sport criteria we must look at a sample of his injury history.
2011-Right ankle ligament repair
2012-Right foot tendon strain
2016 Right MCL sprain
2018-Right ankle sprain
2018-Left MCL sprain
The biggest thing that jumps out at me is his extensive history of right sided leg injuries. Granted his most recent injury was a result of trauma, we can’t overlook the fact that he has a long history of instability issues. One of the rules with any structure that requires a strong amount of proprioception is that dynamic stabilization is crucial in reducing the risk of reinjury. Whenever a static stability structure is comprised(think ligament sprain), developing strong dynamic stabilizers(muscles around the joint) can compensate for the lack of proprioception of that ligament.
Let’s play a game since every sports fan enjoys coming up with the best decision for their favorite team(thats what makes the game even more fun!).
Your star player is hurt and could potentially miss some playoff time
The coach wants him to sit out until the end of the first round of the playoffs(if they make it past the first round)
The star player wants to return to action on the last game of the season(is anyone thinking Derrick Rose)
The research states that 1) the highest predictor of injury risk is a previous injury to that site and 2) typical recovery time is around 4-6 weeks and the first round of the playoffs begin within the next 2 weeks.
What do you do?
There are a lot of variables in this specific scenario. The great thing about MVP caliber players(and his 35 million dollar a year salary) is the fact he has the resources to expedite the healing process through a myriad of recovery tools, nutrition, and expert healthcare professionals. The other side of the equations is that the human body still can not out smart the healing process within the body. Even though Curry may meet a few markers for return to sport: Full ROM, Full muscular strength compared to non affected limb, and no joint effusion, its hard to prevent injuries in events that are fatigue producing and unpredictable.
Given a lengthy history of ankle and knee injuries, adding proprioception activities can help develop strong dynamic stability. A few basic ideas include:
The exercises listed above are a sample of proprioceptive activities to improve dynamic stability of the ankle/knee. Here the musculature around the ankle/knee/hip need to co-contract to maintain stability in the position that the athlete is in. By closing the eyes, the organelles within the muscle have to work harder to give feedback to the brain concerning positioning of the lower limb.
One of the words of advice I was given during my physical therapy education was to never skip steps. Hopefully Curry will heed the advice of his trainers and coaches in order to get back in time for the playoffs. Let's face it nobody wants to see a first round match up without their star player on the court.
“The two hardest tests on the spiritual road are the patience to wait for the right moment and the courage not to be disappointed with what we encounter.”
― Paulo Coelho
Gabe is a physical therapist in Brunswick, Ga who has a specialization in orthopedic and sports rehabilitation. Gabe has certifications in strength and conditioning(CSCS), weightlifting performance(USAW-SPC Lv1), selective movement screening(SFMA Lv1 Cert), extensive training in trigger point dry needling, and blood flow restriction training. In addition to treating postoperative orthopedic conditions and general orthopedic injuries, Gabe specializes in getting his patients back to the sport/activity they love.
While not treating in clinic, Gabe enjoys olympic weightlifting, playing basketball, and keeping up with MMA fights.