Understanding Chris Paul’s Hamstring Strain & the Issues Moving Forward

The Spurs and Clippers seven game series was a first-round matchup for the ages that was ultimately decided by Chris Paul hitting an impossible bank shot off of his left leg. What made the shot particularly impressive was Paul elevated off the same leg in which he had sustained a hamstring strain earlier in the game. The All-Star point guard first indicated the muscle was an issue late in the first quarter and eventually went to the locker room to be worked on by the Clippers medical team. He did return and was noticeably limping throughout the contest, including just prior to his decisive game-winner. Now with the Rockets on tap for Monday, the Clippers have to begin wondering about the availability of their floor general.

Hamstring strains are common in the NBA. This season alone over 200 games were lost to hamstring-related problems, the most for any muscle-related injury. InStreetClothes.com previously detailed why these types of injuries are so problematic in the NBA, but let’s once again review.

Whenever a muscle is stressed beyond its yield point, a strain occurs. Strains are graded based on the severity of the accrued damage. A Grade I injury is the least severe strain and is considered minor. In these injuries, microtearing of the tissue occurs though the individual experiences little to no loss of function. A Grade II is considered moderate and involves damage to actual muscle fibers. These injuries are often called partial tears. Anything given a Grade III or higher is considered severe and the tear is complete. Grade III injuries are accompanied by a loss of both stability and function and in some cases require surgery.

Regardless of the severity, the manner in which muscle tissue heals is a detailed process. The healing process occurs in multiple stages that begins with the inflammatory phase and includes the initial swelling and clotting reactions at the injury site. As the inflammatory phase progresses the second phase, the proliferative phase, will start. The proliferative phase is the beginning of the body’s actually repair work of the damaged tissue. Scar tissue is formed at the injury site as specialized cells begin repairing the strain using protein fibers, including collagen and elastin.

The proliferative phase requires a considerable amount of time but must be completed before the final phase, the remodeling phase, can begin. The remodeling phase varies in length and depends on the aforementioned grade assigned. During the remodeling phase, collagen fibers within the newly developed scar tissue are repeatedly broken down and remade. By doing so the strength of the scar tissue progressively improves and will begin to resemble healthy muscle tissue. However the body’s natural way of healing doesn’t normally occur in the appropriate pattern. Instead the protein fibers are aimlessly and unsystematically laid down. This random approach can have a negative impact on the athlete. Fortunately, an athletic trainer or physical therapist can help fight this pattern by loading the injured muscle in a specific way during rehabilitation.

Unfortunately even the best treatment doesn’t guarantee the new tissue will be as strong as the original and the risk of re-injury will loom. A functional muscle doesn’t equate to a healthy muscle. The hamstring muscle complex is a dynamic muscle and must be able to withstand high amounts of force. For this reason, hamstring injuries often require long periods of rest and why these injuries strains are easily aggravated. If aggressive movement disrupts the newly laid down scar tissue, the effected individual must begin the intricate process of tissue repair all over again.

Paul’s been down this road before. Over the course of the last four seasons, Paul has strained his right hamstring twice and left hamstring once. The right hamstring was an issue last year costing him a game early in the regular season and flaring up again in the postseason. His previous left hamstring strain occurred during the lockout-shortened 2011-12 season and sidelined the point guard for five games. While he’s avoided hamstring problems this season, extra care will be needed to insure his current injury doesn’t have a cascade effect on the rest of his left leg. It’s particularly important since this is the same leg that required meniscus surgery back in 2010.

The Clippers will utilize every treatment option at their disposal over the next 48 hours but it’s hard to imagine Paul will be 100 percent entering Game 1 against the Rockets. While he’s proven he’s capable of delivering a monster performance with the injury, Paul’s health will be key if Los Angeles is to advance to the first Western Conference Finals in franchise history.

Breaking Down Kevin Love’s Dislocated Shoulder

The NBA playoffs are often defined by an injury that alters the fate of a championship contender. Derrick Rose’ ACL in 2012. Kevin Garnett’s knee in 2009. On Sunday, the first significant injury of the 2015 NBA playoffs occurred when Cleveland Cavaliers forward Kevin Love became entangled with Boston Celtics center Kelly Olynyk as the two grappled for a rebound. As Olynyk pulled away, he took Love’s arm with him and the Cleveland forward instantly reacted in pain. Love headed straight to the locker room where he was diagnosed with a shoulder dislocation. His availability moving forward is now in question, as he will return to Cleveland for further evaluation.

Shoulder injuries aren’t uncommon in the NBA and come in a wide variety of degrees with an assortment of associated problems. An injury classified as a dislocation generally refers to an injury to the alignment of the glenohumeral joint. The glenohumeral is the ball and socket joint of the shoulder and loosely resembles a golf ball sitting on a tee. The joint is made up of the head of the humerus (the golf ball) articulating in a groove of the shoulder blade known as the glenoid cavity (the tee). The ball (head of the humerus) can freely pivot on the tee (glenoid) allowing for a large degree of motion. A fibrocartilaginous ring known as the labrum widens the glenoid to insure stability of the ball on the tee. Additional muscles, ligaments, and soft tissue reinforce the glenohumeral joint and helped keep the shoulder in place.

However, excessive force, like the arm being pulled violently downward, can displace the humerus from the glenoid. If the surrounding structures are able to naturally realign the joint, the injury is referred to as a subluxation or partial dislocation. A true dislocation occurs when the displacement of the joint is complete. Following an injury of this magnitude, the joint must often be realigned by medical personnel and is considered a much more serious injury.

The return to play time following shoulder dislocation appears to be dependent on the amount of damage to the surrounding tissues, particularly the labrum. If the tear is small and the instability is minimal, general rehab can improve the area with a focus on improving the musculature surrounding the joint. Surgery may still be warranted down the road but it can be delayed. Still the associated pain and swelling often requires time to heal. Additionally, even if this ends up being an option for Love, the risk for re-injury would be considerable for the remainder of the postseason. A significant labrum tear would likely require immediate surgery and force Love to miss a substantial amount of time.

As previously mentioned, pinning down the specifics surrounding a potential return to play is largely dependent on what Love’s future evaluation reveals. However the numbers do not paint a particularly promising picture for Cavaliers fans. Looking through the InStreetClothes.com injury database, there have been 18 in-season injuries classified as complete dislocations. It does not include shoulder subluxations, even if the injury involved labrum damage (ie. Eric Gordon earlier this season). Only two players, Glen Davis and DeMarcus Cousins, suffered an injury reported as a dislocation and did not miss any subsequent games. After that, the best-case scenario is Channing Frye, who missed five games over a 14-day stretch of the 2010-11 season. However even that appears a bit misleading as Frye would sublux the shoulder the following season and undergo surgery on the troublesome joint in the summer of 2012.

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More information will surface over the next 48 hours and Love’s availability for the second round hinges on the results of his impending MRI. In the meantime, the Cavaliers and their fans may want to start cheering for the Bucks as a prolonged matchup with the Bulls would at least buy their starting forward some time.

2014-15 Western Conference Playoffs Injury Primer

#1 Golden State Warriors Vs. #8 New Orleans Pelicans

Two MVP-caliber players lead their teams in what could be an exciting first-round matchup. Unlike the previous two seasons, the Warriors enter the playoffs healthy and ready to make their run at a title. Their regular season success allowed first-year coach Steve Kerr to judiciously manage minutes and hand out days off. As a result minutes played were down for key contributors like Steph Curry and Klay Thompson as well as veterans Andrew Bogut and Andre Iguodala. Curry logged nearly 200 fewer minutes than last season despite appearing in two more games.

Bogut’s health remains the key as he’s limped through Golden State’s previous two postseason disappointments. In 2012-13, he received Toridol injections in order to play though a painful ankle sprain and he missed all seven of last season’s first-round matchup with the Clippers nursing a fractured fifth rib. While he did missed 12 straight games in the early part of the season with chondromalacia and tendinitis in his right knee, Bogut has avoided the injury bug and will man the middle against Anthony Davis. Reserve David Lee did sit the regular season finale with a lower back strain and is questionable for Game 1.

The Pelicans were able to outlast the Thunder and secure the eighth seed largely in part to better health. However that doesn’t mean they were injury-free. Davis missed 14 games with a laundry list of injuries, including a left ankle sprain, an acromioclavicular (AC) sprain, and a sprained big toe. Backcourt mates Jrue Holiday and Eric Gordon combined to miss 63 games with injuries of their own and Ryan Anderson missed 18 games with a significant medial collateral ligament (MCL) sprain in his right knee. However they enter the postseason with every player available.

The lack of back-to-backs in the playoffs should help New Orleans, particularly Holiday. The former All-Star is still working his way back after missing 46 of 47 games due to a stress reaction in his surgically repaired tibia. Holiday’s defense will be a necessary component of the Pelicans’ attempt to slow the Golden State juggernaut.

#2 Houston Rockets Vs. #7 Dallas Mavericks

The fact that the Rockets secured the second-seed in the West despite losing 180 games to injury is a major part of James Harden’s compelling case for league MVP. The total is second only to the Bucks for games missed amongst playoff teams and includes 37 games lost for All-Star center Dwight Howard.

While the record is impressive, it will be interesting to see if the demands of carrying a team catch up to Harden in the postseason. No one in the NBA played more minutes than the three-time All-Star and he will continue to dominate the ball with Patrick Beverley out for the rest of the year with a wrist injury. The Rockets will need Howard to step up and assume a bigger role but that comes at the risk of aggravating his troublesome right knee. A healthy Howard is even more important to the Rockets with reserve Donatas Motiejunas out following a lumbar discectomy to relieve lower back pain. It’s also worth noting the team’s depth took another hit when rookie KJ McDaniels suffered a non-displaced fracture to his right elbow in the final game of the regular season.

Houston’s in-state rival has injury concerns as well with a familiar face from the Mavericks atop the list. Former Rocket Chandler Parsons missed Dallas’ final six games of the year with reoccurring soreness in his right knee. He remains on track to play in Game 1 and will have to shake off any accumulated rust quickly.

Reserve point guard Devin Harris is also questionable to start the series after hyperextending the big toe on his left foot. This case of turf toe required a cortisone injection to combat the inflammation but is fortunately unrelated to the previous toe problems that forced him to miss 41 games last season.

Coach Rick Carlisle attempted to keep his players’ minutes down over the course of the season even when injuries did occur. Former Finals MVP Dirk Nowitzki played less than 30 minutes a game for the first time since his rookie campaign and has shown signs of life down the stretch. Point guard Rajon Rondo’s integration into the team was slowed by a facial fracture and the team struggled when Monta Ellis played through a painful hip injury. However both guards appear healthy and enter the postseason looking to elevate their numbers.

This Texas tussle should be fun to watch with plenty of story-lines shaping the narrative. The Rockets remain the favorites but injuries could help shift the series towards an opportunistic Mavericks squad.

#3 Los Angeles Clippers Vs. #6 San Antonio Spurs

Two of the top three team considered favorites in the tough Western Conference will square off in the first round after the Spurs lost to the Pelicans on the last night of the season. Limited early in the season by injuries to Kawhi Leonard (sprained hand), Tony Parker (hamstring), and Tiago Spliiter (calf), the suddenly healthy Spurs ran through the second half of the season on a 30-11 tear. Head coach Gregg Popovich was once again able to limit his player’s playing time with Leonard the only Spur to average more than 30 minutes a game. The rest should help fuel their title defense moving forward.

Unfortunately even the Spurs and their elite medical staff aren’t immune to late season injuries as Splitter is once again having problems with his right calf. He missed the team’s final six games of the season with tightness in the muscle complex. Splitter’s calf has been an off-and-on problem for a while now and has cost him 40 games over the past five years, including 27 games this season alone. Splitter needs to be healthy to help control Los Angeles’ monster frontcourt of DeAndre Jordan and Blake Griffin.

The Clippers currently have their injury problems under control but have several players with potential red flags. Former Sixth Man of the Year Jamal Crawford is still working his way back from a severe calf contusion that needed to be drained. The injury sidelined him for 16 consecutive games and he has clearly struggled since returning. In his four games back from injury, Crawford shot 27.8 percent from the field, including 21.1 percent from behind the arc. Griffin’s elbow also remains a concern. While the staph infection that forced him out of 15 games has cleared, the lingering bursitis will remain an issue. If he gets hit in the area, he could be dealing with a painful and limiting injury.

The series promises to be a tight one with both the Clippers and Spurs playing at an elite level. As a result, one legitimate title contender will be staring at a first-round exit and a lengthy summer to tend to their wounds.

#4 Portland Trail Blazers Vs. #5 Memphis Grizzlies

Once thought to be serious title threats, the Blazers and the Grizzlies limp into the postseason. While both teams have succumbed to the injury bug as of late, it’s Portland that has more to overcome. The Trail Blazers lost their the sharp-shooting defensive specialist when Wesley Matthews crumpled to the court with a torn Achilles. Arron Afflalo replaced Matthews in the starting lineup but lasted just 19 games before straining his shoulder. His availability entering Game 1 remains unknown. Second-year guard CJ McCollum emerged down the stretch after missing 14 games in November and December with a fractured index finger. However McCollum is now managing a sprained ankle and he too remains limited. Starters Nicolas Batum (knee) and LaMarcus Aldridge (foot and both thumbs) are expected to play but are less than 100 percent. Factor in Dorell Wright’s fractured hand and Chris Kaman’s balky back and it is easy to understand why Portland is considered to be the underdog in the series.

That being said, Memphis isn’t exactly a model of good health at the moment. Despite finishing with the fewest lost games to injury among Western Conference playoffs teams, the timing with injuries is everything. Guard Tony Allen missed the final nine games of the regular season with a left hamstring strain while Mike Conley missed the final four with right foot problems. The Grizzlies have classified Conley’s injury as foot sprain but reports of plantar fasciitis have also emerged. This is a very limiting injury, especially for a guard dependent on his speed. If Conley is at all affected by the ailment, look for Damian Lillard to have a big series.

Injuries aren’t limited to the backcourt as Marc Gasol sustained a sprained left ankle in a late season matchup against the Clippers. He gutted through the team’s final two contests but will need to be mobile to handle Aldridge and Portland’s Robin Lopez. Jeff Green’s back is also an area of concern though he has yet to miss a game.

The winner of the series may want to do so quickly in order to rest their wounded in anticipation of a likely second-round matchup against the Warriors.

2014-15 Eastern Conference Playoffs Injury Primer

#1 Atlanta Hawks Vs. #8 Brooklyn Nets

The Hawks won a franchise record 60 games this year, fueled by a run of good health. Overall the team lost 91 games to injury, second best amongst Eastern Conference playoff teams. However they enter the postseason without the services of Thabo Selfolosha as he recovers from a fractured fibula sustained in the now infamous circumstances surrounding the stabbing of Indiana’s Chris Copeland. The off-the-court injury is a big blow for the Hawks who struggled during Sefolosha’s previous extended absence recovering from a calf strain. On the year, Atlanta was 17-13 (.556) without Sefolosha in the lineup and 43-9 (.827) when he played. It may not affect them against Brooklyn but his defensive presence will hurt the deeper into the playoffs they go. Paul Millsap’s sprained shoulder is also a concern despite his return to the lineup. Millsap is still experiencing soreness in the area and looked limited in the regular season finale, scoring five points on 2-of-9 shooting.

The Nets enter the matchup short-handed as well. Both Sergey Karasev (knee dislocation and MCL sprain) and Mirza Teletovic (pulmonary embolus) will not initially suit up, though Teletovic has been cleared to return to basketball activities and could make an appearance if Brooklyn can extend the series. The team’s depth will be further tested if Alan Anderson’s sprained left ankle limits his productivity. Anderson missed the team’s final seven regular season games but is expected to play in Game 1. Still the Nets’ starting five enters the matchup healthy and will be the center of a potential upset.

#2 Cleveland Cavaliers Vs. #7 Boston Celtics

LeBron James gets a chance to extend his personal rivalry with one of the NBA’s storied franchises. James has played like a MVP candidate after taking an eight-game break to rest an ailing back and knee, but concerns about the health of his two All-Star teammates remain. Kyrie Irving did not play in two of Cleveland’s final four games due to lingering soreness in his right hip while Kevin Love has battled a nagging back injury for a majority of the season. If either player is limited by their current ailment, the Cavaliers may not run over Boston quite as easily as some are predicting. Cleveland center Anderson Varejao remains out after tearing his Achilles in December.

The plucky Celtics lost 127 games to injury this season, three more than their first-round opponent. However nearly half of those games are attributed to players no longer on their roster including Vitor Faverani, Marcus Thornton, Rajon Rondo, and Shavlik Randolph. A surprisingly difficult back contusion slowed Isaiah Thomas’s impressive run in March though he appears to have moved past the injury. The team also got a nice late season boost from the return of Jared Sullinger. Sullinger was sidelined 24 games with a stress fracture in his fourth metatarsal but was back in action for the final seven games of the regular season. Jae Crowder’s right ankle will be worth monitoring as his versatility on defense should be a key component of any scheme coach Brad Stevens opts to utilize against the Cavaliers.

#3 Chicago Bulls Vs. #6 Milwaukee Bucks

The Bulls and Bucks face off as the two Eastern Conference playoffs teams most decimated by injury during the regular season. The Bulls missed nearly 150 games throughout the season as Derrick Rose, Joakim Noah, Taj Gibson, and Jimmy Butler all missed extended time with an assortment of injuries. Chicago will get little sympathy from Milwaukee who dealt with multiple significant injuries throughout the season, including a season-ending ACL tear for rookie Jabari Parker. In the end, the Bucks lost 258 games to injury or illness.

Both teams have issues entering the series with injuries to key reserves lingering. The Bulls remain unsure if veteran guard Kirk Hinrich will be available for Game 1 as he continues to battle problems with a hyperextended left knee. His absence could force he team to overextend Rose, who still is working his way back from a meniscectomy. Problems in the front court exist as well with forward Taj Gibson needing a cortisone injection in his ailing shoulder to make it through the regular season finale. Joakim Noah’s left hamstring and remain a serious concern as well. The Bucks know Parker won’t be suiting up but they are optimistic veterans Jared Dudley (lower back) and Jerryd Bayless (neck) will be available after resting their injuries in the regular season finale. The Bulls remain the favorite but the series could shift the Bucks’ way if one of the multiple issues Chicago is facing goes poorly.

#4 Toronto Raptors Vs. #5 Washington Wizards

Both teams literally and metaphorically limp into the first round of the postseason. After starting the year off well, the Raptors and Wizards have each struggled down the stretch. The Wizards finished 18-23 in the second half of the season, including a 0-6 stretch while Bradley Beal missed time with the third stress reaction in his fibula of his career. John Wall has been slowed by a persistent right ankle issue and veteran center Nene is once again battling plantar fasciitis in his right foot. Second year forward Otto Porter Jr. sprained his ankle in the final game of the regular season but is likely to be available for Game 1. Porter’s availability will be key as the Wizards will be without the services of Garrett Temple, who aggravated his hamstring strain and is expected to miss the first round of the playoffs.

Toronto missed the fewest number games to injury of any team in the postseason with 61 games lost. However healthy remains an x-factor as All-Star guard Kyle Lowry missed nine of the team’s final 14 regular season contests recovering from a back contusion and the resulting spasms. He looked rusty in his first four games back but was impressive in his last start, scoring 26 points on 8-of-15 shooting, including six made three-pointers. Defensive catalyst Amir Johnson has also been limited by an injury though his recently sprained ankle isn’t expected to keep him off the court. The Raptors appear to have a slight edge health-wise though Lowry’s back is a looming threat. If he is it all limited in mobility, Lowry could find himself struggling to stay in front of Washington’s Wall.

Understanding Kevin Durant’s Bone Graft

The worst case scenario for Kevin Durant and the Thunder has finally emerged. The lingering soreness in his problematic right foot has been diagnosed as a regression in the healing process and a third surgery will required. The reigning MVP will not play again this year and is expected to miss at least four-to-six months recovering.

When the injury was first reported, InStreetClothes.com detailed the problems associated with the Jones fracture and presented a list of those to suffer setbacks following their initial surgery. Durant will now be included on the list as he heads under the knife for the third time.

In his first surgery, a surgical screw was inserted into the fractured fifth metatarsal. The screw is intended to unite the bone fragments and help promote the formation of a true union. However a second procedure was required to replace the screw as its head had begun to rub against the neighboring cuboid bone, causing Durant pain and soreness. At the time Oklahoma City stated that the bone formation at the fifth metatarsal was progressing nicely. However the pain persisted and Durant was removed from basketball activities. Now, specialists have determined that the metatarsal has regressed and the best treatment option will be a proactive approach. Durant is slated to undergo a bone graft procedure at some point next week.

In the bone graft procedure, a portion of bone taken from elsewhere in the body (likely the tibia) will be grafted over the fracture site. The graft will help stimulate the growth of new bony tissue in the area as bone is capable of regeneration. Clippers forward Glen Davis underwent a similar procedure when the hardware in his fifth metatarsal fracture failed.

With the graft in place the Thunder medical team will spend the next six months analyzing the injury site and Durant’s biomechanics. The treatment and, more importantly, the time off should allow Durant to return to a high level of play. In the two seasons since Davis’ graft, he has not reported problems in his foot. However like the initial surgery, nothing is guaranteed and only time will determine Durant’s fate. Brooklyn center Brook Lopez suffered multiple hardware failures in his fifth metatarsal before opting for a first metatarsal osteotomy. In this procedure, bones in Lopez’ foot were surgically reshaped to divert force and stress away from the outside of his foot and reduce the odds of a re-injury. While this is an extreme case, nothing has come easy for Durant throughout this process and now the Thunder simply have to wait to see how the face of their franchise responds to treatment.