Stephania Bell is a licensed physical therapist who has been helping us understand and better estimate the injury absences and return prognostications for professional athletes for more than a decade.
I sat down with her during the preseason to discuss several NBA players who were on the mend. We're back again, this time rapping about Kristaps Porzingis, DeMarcus Cousins, Gordon Hayward and Lauri Markkanen.
Porzingis underwent surgery to repair a torn anterior cruciate ligament (ACL) in his left knee on Feb. 13. Dr. David Altchek of the Hospital for Special Surgery performed the surgery, according to Ian Begley. The standard return time for a torn ACL is roughly 10-12 months, but as Porzingis pointed out in September, "[T]here is no protocol for a 7-foot-3 guy. There is no timetable for my type of body, my size and all that."
How long is Porzingis likely to be out? Might he sit out the entire season? Is it bad news that the Knicks haven't released any type of declaration as to Porzingis' return estimate?
To answer, we must look at context. Neither Porzingis nor the Knicks have any motivation to push Porzingis to return before he is fully healthy. The Knicks are expected to be a lottery team this season, and Porzingis is potentially up for a big contract as a restricted free agent this offseason.
As such, it should not be considered ominous that the Knicks haven't released a timetable, because ... why should they? There is no need for them to rush or make artificial timelines for his return. The team is in position to wait, monitor Porzingis' recovery and decide accordingly.
There is a risk that Porzingis could miss the entire season because both sides are likely to be cautious with his health. However, Dr. Altchek said Porzingis' ACL tear type had "the best prognosis" for healing because there was no additional cartilage or ligament damage.
This makes Stephania believe that Porzingis will likely return at some point this season because once his surgical graft matures and he rehabs, he should have time to return to full health. And as she put it, playing even limited minutes would be good for his confidence going into next season.
Bottom line: Porzingis suffered a relatively clean ACL tear in February, and a standard return prognosis would have him back between December and February of this season. Although his size, the team's likely lottery status and his impending free agency all suggest that caution will be exercised, the nature of the injury suggests that he should return to health in time to play some minutes this season.
Cousins ruptured his left Achilles tendon Jan. 26 and had it surgically repaired Jan. 31. Stephania said the standard return time for this type of injury is 10-12 months and context is again needed to make a more specific projection.
The Warriors are at the complete opposite end of the spectrum from the Knicks in that they are currently in the midst of a historic championship dynasty. However, one similarity here is that the Warriors also have no reason to rush Cousins back. In their case, it's because they already have a dominant team that doesn't really need Cousins in the regular season.
Cousins, on the other hand, has motivation to push the pace as much as he can because he will be an unrestricted free agent during the offseason and needs to prove himself healthy and productive in order to get a max deal.
Regardless of motivation, Stephania pointed out that there are two stages of recovery from an Achilles tendon rupture:
1. Initially, one must respect the repair. Cousins' activity needed to be restricted early on so that the repair would take.
2. Past that point, the next phase is to get the full range of motion and strength back. There is a lot of stiffness and tightness for the player to work out, and it takes a lot of grinding work to get the power, mobility and ability to accelerate back.
Cousins' performance prognosis this season is complicated. He is just past the 10-month mark since surgery and has just been cleared for 5-on-5 scrimmaging. The Warriors have not yet released a concrete timetable for his return, but it appears to be on the horizon. However, the team is absolutely rolling without him, and when he does return, it will likely be to a much smaller role than he is used to.
Plus, Stephania points out that in most cases, a player returning from Achilles surgery is not fully himself until about a year after he gets back on the court. It would also not be surprising for the Warriors to put Cousins on some sort of minutes restriction early on.
Bottom line: When healthy and on a team that featured him, Cousins was a first-round fantasy prospect. He has been cleared to scrimmage 5-on-5 and is in the two-month window when his return could reasonably be expected. However, when he returns, he is likely to be partially physically limited, possibly under a minutes restriction, and he will have a much smaller role than he's used to. He can still be productive, but his fantasy upside seems to be as a flex starter as opposed to franchise centerpiece.
I've already had some of my Twitter followers (@ProfessorDrz) ask me if they should cut Hayward due to his slow start. I told them no, and Stephania's opinion backs me up. Hayward hadn't played meaningful basketball since the end of the 2016-17 season before this season began, and his injury was so horrific that it inspired him to keep a detailed recovery blog and star in a really cool video game commercial.
Through the first few weeks of the season, Hayward has clearly been on a 25-minute restriction and has not been allowed to play both halves of back-to-backs. His production has been up-and-down, as he has alternated between single- and double-digit scoring in his past five games.
Stephania sees positives in his play thus far, though, and reason to believe good things are in store.
First, Hayward's broken leg and subsequent surgery do not come with worry about recurrence, which might be the case with a muscle such as a hamstring. Second, stiffness and rust are hallmarks of this sort of long-term recovery, but both get better with more play. Third, and perhaps most importantly, is the mental part of recovery.
Hayward got injured on a play on which he jumped high in traffic and fell awkwardly. Thus, one of the keys is that Hayward needed to go through all-out situations in which he had to go up in traffic and fall to prove to himself that he could still do it. Stephania wanted to see him do those things and fall or land awkwardly because only by doing so can the athlete start to believe that he's fine. He got that out of the way in Game 1 and has since done it multiple times, which is very positive for his recovery.
Bottom line: Hayward had a gruesome injury but one with a fairly clean and standard repair and recovery process. It was expected that he would be rusty, but he should continue to improve as the season progresses, and ultimately, it's more likely that his role on a talented Celtics team is riskier to his fantasy upside this season than his injury will be.
Markkanen injured his elbow on Sept. 28, and the injury was described as a high-grade lateral elbow sprain. Stephania pointed out that the word "sprain" refers to a ligament injury, but there has been no public indication of the severity. The injury didn't require surgery, but without more detail, the available information was unique. The lateral part of the elbow is the outside, on the thumb side. Elbow injuries due to contact often injure the inner or medial part of the elbow, so Markkanen's injury is a bit unusual.
There are three grades of elbow injury, and a higher-end Grade 2 injury would have a timeline consistent with the two months estimated immediately after the injury. The initial treatment involves limiting motion to allow tissue healing, so once the soft tissue heals, Markkanen has to do the work to recover both strength and range of motion. The Bulls reported that Markkanen packed on 17 pounds of muscle this summer, but a lot of that will go away with the extended convalescence.
Bottom line: On Oct. 31, Bulls coach Fred Hoiberg said Markkanen was still "a couple weeks away" from contact, but in a positive sign on Nov. 5, he added that Markkanen was able to "do more than he has" in recent conditioning work. This is consistent with a return in the window between mid-November and early December, a timeline that Stephania finds to be reasonable, given what is known on the injury.