LAST SUNDAY, BASKETBALL fans everywhere gasped as Steph Curry slipped in a pool of sweat during a routine jog down the court and fell awkwardly to the floor clutching his right knee. As he motioned for help to get up and hobbled around the court, the Golden State Warriors’ record-breaking season suddenly seemed in jeopardy.
Curry’s diagnosis turned out to be a mild medial collateral ligament sprain, which, for most people, is no big deal. But Steph Curry is not “most people.” And this postseason is anything but ordinary—historic even. Every game Curry isn’t on the court could cost the NBA and his sponsorsmillions of dollars. “Healing times might take several weeks,” says Anthony Luke, a sports medicine physician at the UC-San Francisco Medical Center, “and a playoff series might only be a couple of weeks.”
So for an athlete like Curry—or Chris Paul or Blake Griffin, whose recent injuries just as swiftly put into question the LA Clippers’ chance at a championship—team doctors go into overdrive.
After diagnosis, they’ll try to decrease swelling with ice, compression, and anti-inflammatory drugs, and protect the injured area with tape and braces. That might be enough to get the player back on the court if the pain is manageable. But, like in the case of Curry, the physician might call for testing to see if more treatment is necessary. MRIs can estimate the water content in different tissues to create a 3-D image of the body part. For a knee, it provides a picture of a ligament sprain, soft tissue bruise, or cartilage damage.
But MRIs have their own dangers. Many athletes will have knee or back abnormalities that show up in an MRI that aren’t necessarily related to the injury and don’t always need to be treated. “We don’t make decisions based on objective anatomic abnormalities,” says Brian Cole, an orthopaedic surgeon at Midwest Orthopaedics at Rush, and team physician for the Chicago Bulls. “We make decisions based on symptoms in many cases.” In other words, too much treatment could be just as much of a risk for the player as not enough.
That’s all pretty standard—the kind of treatment you might get as an active recreational athlete, just with quicker test turnarounds. But with intense pressure to get back to play as fast as possible, many professionals go a step further, turning to new, rarer therapies. “We may do things with professional athletes that are maybe not proven,” says Cole, “like regenerative medicine.”
The most popular of these therapies is platelet-rich plasma (PRP) injections, which are concentrated with growth factors that might help to speed healing. Doctors also use more invasive stem cell injections, sticking a needle into the hip bone to suck up bone marrow cells and then inserting them into the injured tissue. Cole maintains these injections have shown some benefits for healing and, at the very least, haven’t shown evidence of being harmful.
But others are skeptical. “There are some situations where it’s not utilized in a biologically sound way,” says Luke. “Everyone is always looking for the newest cutting-edge technique that might save a few days or a magic bullet that might fix this.” He cautions athletes from using therapies like PRP injections in the place of giving the body enough time to heal.
After diagnosis, treatment (which in the worst case, like an ACL tear, might mean reconstructive surgery), and rehab, the player has to work with the physician and his team to figure out when he’s ready to come back on the court. Curry will be evaluated after two weeks, but that doesn’t necessarily mean that he will be ready to play. In order to juke his defender before stepping back for a signature three, Curry needs to put all his weight on his right foot. Will he be able to resist doing that if he’s put in the game before his MCL is completely healed?
“The decision to push the envelope can be really complex,” says Cole. The player might feel like he needs more time—but the organization, in a situation like the NBA playoffs, will want him back as soon as possible. Or maybe the player is anxious to get back before he is ready, feeling the weight of his or her team and even career. Amid all of this, a team’s physician has to be clear minded and focused on the best interest of the player. “It takes an enormous amount of humility,” says Cole. “You can never be a fan.”
He would know. One of his patients is Derrick Rose, who was was drafted first overall by the Chicago Bulls in 2008. By his third season Rose became the youngest player in history to win the MVP award, but the next year injury struck. As he drove to the basket during a playoff game and tried to jump stop before putting up a shot, his leg twisted and his ACL popped. He sat a season out, but only lasted a month into his return before tearing his meniscus.
Cole doesn’t discuss individual players’ injuries, but it’s safe to say his treatment was crucial in saving one of the most promising players in history. Rose was back last season, and this season played nearly a full year for the first time in four years. Curry’s injury is less severe—but the stakes are just as high. The Warriors’ season likely depends on his quick return, but the wrong medical decision could spell disaster for his whole career.
source: wired.com by LUKE WHELAN