What does third break mean for Yao?

Yao Ming must feel like he is experiencing deja vu all over again. It is often said that things happen in threes, and Yao must hope that this latest event signals the end of this streak for him. For the third time in three years, he is dealing with a broken bone. In April 2006, he broke the fifth metatarsal (long bone of the forefoot that connects to the fifth toe) in his left foot. In 2007, he suffered a serious tibial plateau fracture in his right leg and missed 32 games. Now he has yet another break, again located in his left foot.

Specifically, Yao has a stress fracture in the tarsal navicular bone, one of the bones of the midfoot on the inner aspect of the foot, just anterior to the ankle joint. This bone is a key landmark in the foot as it forms part of the medial arch. A stress fracture is the microscopic breakdown of bone in response to the stresses placed on it, and it occurs when the bone cannot heal itself at a fast enough rate to keep up with those demands. Jumpers and sprinters, particularly in track and field, are most at risk for stress fractures in this body region, but other activities such as ballet, gymnastics, rugby, military training and yes, you guessed it, basketball, can also place athletes at a higher risk for this type of injury. Combine the repeated stress of impact loading with the sizable frame and mass of Yao Ming, and it becomes easier to understand why he seems to be particularly susceptible to these types of injuries.

Yao began having some pain and soreness in the ankle/foot area around the time of the All-Star game. As is usually the case with these types of injuries, there was no specific incident or trauma that anyone could point to as the "cause" of injury. Rather, it was likely developing over a period of time. Thanks to the scrutiny of the medical staff and the thoroughness of their examinations, the imaging (CT and MRI, X-ray typically does not reveal this type of injury) of Yao's foot allowed them to visualize the stress fracture at this stage, which is fairly early in the big scheme of things. These injuries are often not discovered until much later, sometimes after months, when they can become non-union (where the bone fails to come together) which is, of course, more problematic. Rockets' team physician Thomas Clanton emphasized in a report in the Houston Chronicle that non-union is not the case here. Ultimately, the overall prognosis for Yao is likely better in terms of his long-term health because of the early discovery of the stress fracture.

Clanton is recommending surgery for Yao to place screws in the navicular, which would create reinforcement to help strengthen the bone. Clanton draws the analogy of screws in the foot to rebar in a patio. The patio is functional without the rebar, but the reinforcement with the rebar provides additional security. Another option is for Yao to forego the surgery, allowing the bone to heal with the foot in a cast, while using crutches and allowing the leg to rest. Both treatment options cover an approximate four-month time frame for the navicular to heal. Clanton is supporting and encouraging Yao to get other opinions to help him make his decision. There are pluses and minuses to each approach, as there are in nearly any medical situation. The most obvious plus to the surgery would be the reinforcement of the bone; one of the negatives being that surgery is an invasive procedure, and as such, carries a real, albeit minute, risk of infection. With the "rest" treatment approach, the healing may not be as efficient, but that is not a foregone conclusion, either. In the end, both methods are acceptable forms of treatment, and it ultimately comes down to professional opinion as to what is the best choice for Yao. So, as nice as it would be for this matter to be clear cut, it is not a black-and-white decision. Yao, of course, wants to be able to participate in the Olympics in his native homeland, and he wants to minimize the risk of future recurrence of injury. These things, combined with the professional opinions he will gather during the next few days, will all factor into his final decision as to the course of treatment he will seek.

At this stage, it appears that Yao could make it back in time to compete in the Olympics, yet be out long enough to avoid the practice sessions leading up to the games. As ESPN's Chris Sheridan points out, if you do the rehab timetable math, Yao should be able to skip about 60 days worth of two-a-day pre-Olympic practices. That intense practice schedule, coming on the heels of a full NBA season, could have been devastating to Yao. He has shown a propensity for breakdown in the latter half of the regular season as it is; this schedule might well have done him in near the playoffs (which would fit the timetable of how long it often takes to uncover these stress fractures) and prevented him from playing in the Olympics altogether. Yao can now take it lightly and let his body heal, either with or without surgery, while he continues to work on his strength and overall fitness. Then maybe, hopefully, there will not be a fourth chapter in the Yao Ming injury saga in 2009.