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In Street Clothes

Covering sports injuries from the perspective of a certified athletic trainer and backed by analytics.

Understanding Cade Cunningham’s Stress Injury

Pistons guard Cade Cunningham is reportedly mulling surgery to address a lingering shin injury. Cunningham has not played in Detroit’s last five games with what the team has called left shin soreness. However, the Athletic’s Shams Charania reported Saturday that Cunningham is dealing with a stress injury in the area and is considering all possible options for treatment, including surgery.

The reports suggest Cunningham is dealing with a stress injury to his tibia. Stress injuries are relatively common in sports due to the high amounts of force these intense activities require. Whenever stress is applied to the skeleton, the body attempts to respond accordingly. Bone subjected to constant or repetitive stress looks to strengthen the area of concern by fortifying and remodeling it with new bone tissue. In the process, new bone tissue is used to fill any developing gaps while damaged and worn-out bone is broken down and absorbed by the body. However, a stress injury can develop if the area of concern remains under constant stress and the body’s natural remodeling process is unable to keep up with these demands.

Initially, a stress reaction occurs and is marked by localized pain and swelling. Stress reactions are often treated conservatively with rest in hopes that the remodeling process can catch back up and the bone can return to full strength. However, if improperly treated or enough time off is not allowed, a stress reaction can easily develop into a stress fracture. These injuries generally require longer periods of rest and, in some cases, surgical intervention.

The bones of the foot, the back, and the lower leg are the areas most likely to develop a stress-related injury. In the lower leg, the tibia, also known as the shinbone, is the bone most likely to endure a stress fracture as it bears a higher percentage of the body’s weight during activity. 

Multiple players in the NBA have suffered stress-related injuries involving the tibia, including Seth Curry, Jrue Holiday, JaVale McGee, and Tim Hardaway Jr. Surgery was not needed in every case but those that did ultimately go under the knife missed substantial amounts of time. The average time lost for stress-related tibia injuries that required surgery is 61 games. Most players that opted for in-season surgery for stress-related tibia injuries were unable to play again that season with former NBA guard Rodney McGruder the lone exception. McGruder underwent his surgery in October of 2017 and returned to action 139 days later after missing 60 games for the Heat.

Fortunately, these types of injuries are not career-altering. A 2017 study on bony stress injuries in the NBA showed that individuals who suffer these injuries often return to their pre-injury level of play. As a result, Cunningham should be back to his usual self when he ultimately returns. When that will happen remains to be seen and the Pistons will likely seek multiple opinions to ensure the future of the franchise is not negatively impacted by this setback. The 3-and-14 Pistons would likely find themselves well positioned in the draft lottery if Cunningham is unable to play again this season, setting up the possibility of landing phenom Victor Wembanyama or the highly touted Scoot Henderson.