This article is part of our NBA Injury Analysis series.
Ricky Rubio and Marcus Smart
Two young point guards needed help off the court Friday after suffering ankle injuries. Evaluations performed on both Rubio and Smart revealed they had each succumb to the most common injury in the NBA: the ankle sprain. Every season, hundreds of ankle sprains and "tweaks" will occur. However, like snowflakes, no two ankle sprains are exactly alike. The injury can vary in location, severity of damage, and symptoms.
The ankle joint is more complex than it appears. While its structure looks simple, the ankle as a functional unit is made up of three different joints, the talocrural joint, the subtalar joint, and the distal tibiofibular joint.
The talocrural joint or the "true" ankle joint is formed from the tibia and fibula (the lower leg bones) and the talus of the foot. Here, up and down movement is made possible. The talocrural joint has ligaments on both sides of the joint to help stabilize the area. On the inside, or medial aspect, of the joint sits the deltoid ligament complex. It has a unique shape that allows for additional stability and helps prevent excessive inward movement. Three more ligaments are located on the lateral or outside of the ankle. These ligaments, the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL), and the calcaneofibular ligament, (CFL) are the most vulnerable to injury and are sprained when the ankle is forced into inversion following an awkward step or when landing on the foot of another player. These
Ricky Rubio and Marcus Smart
Two young point guards needed help off the court Friday after suffering ankle injuries. Evaluations performed on both Rubio and Smart revealed they had each succumb to the most common injury in the NBA: the ankle sprain. Every season, hundreds of ankle sprains and "tweaks" will occur. However, like snowflakes, no two ankle sprains are exactly alike. The injury can vary in location, severity of damage, and symptoms.
The ankle joint is more complex than it appears. While its structure looks simple, the ankle as a functional unit is made up of three different joints, the talocrural joint, the subtalar joint, and the distal tibiofibular joint.
The talocrural joint or the "true" ankle joint is formed from the tibia and fibula (the lower leg bones) and the talus of the foot. Here, up and down movement is made possible. The talocrural joint has ligaments on both sides of the joint to help stabilize the area. On the inside, or medial aspect, of the joint sits the deltoid ligament complex. It has a unique shape that allows for additional stability and helps prevent excessive inward movement. Three more ligaments are located on the lateral or outside of the ankle. These ligaments, the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL), and the calcaneofibular ligament, (CFL) are the most vulnerable to injury and are sprained when the ankle is forced into inversion following an awkward step or when landing on the foot of another player. These ligaments, most notable the ATFL, are the most commonly sprained ligaments and are what is injured when someone suffers the standard ankle sprain.
If the damage occurs to the distal tibiofibular joint, the injury is considered a "high ankle" or syndesmotic sprain. Multiple ligaments stretch across this area to connect the two lower leg bones and stabilize the ankle mortise. High ankle sprains often occur when the talus is forced upward and generally take more time to heal.
Each ligament in the body has a very specific yield point and failure point. When the amount of stress applied surpasses the ligament's yield point, a sprain occurs. Microtrauma to the fibers that make up the ligament is considered a mild or Grade I ankle sprain. Basically the ligament has been overstretched but remains largely intact. Players with Grade I sprains need to properly manage the associated symptoms but often miss little to no time.
A Grade II sprain occurs when particular fibers of the ligament fail and is better known as a partial tear. Grade II sprains are often more painful and limiting and usually require rigorous treatment and extended rest. Any sprain graded three or higher is a severe injury. These sprains result in a total loss of function and stability and may require surgical intervention to fix.
Fantasy owners should keep in mind that Grade II or III sprains are more likely to have long-term ramifications, primarily on the stability of the involved joint and the likelihood of reoccurrence. In these injuries, the ligaments have passed their yield point. Once this has occurred, its strength and integrity remains forever altered. The concept is similar to a rubber band. When a rubber band is new, it is stretchy yet strong. As it is used over and over again, the rubber band is slowly worn down, moving past its yield point. The rubber band becomes stretched out, decreases in strength, and loses its elasticity. A sprained ligament acts in similar fashion. Once a ligament has been stressed past its yield point, its physical makeup remains perpetually effected, though various treatments and rehab protocols can return the ankle close to its original state. Still once an ankle has been sprained, it remains more susceptible to being aggravated and re-sprained.
In Rubio's case, the injury appears isolated to his lateral ligaments. The Spanish point guard will be on crutches for up to two weeks to minimize the stress placed on and through the joint. He will then be reevaluated, and a better timeline established, though early reports suggest he will miss up to eight weeks. He could need extra time in rehab to ensure the ankle is able to hold up to the high amount of lateral movement performed while he is on the court. It's also worth mentioning that this is the same leg in which he previously tore his ACL. Special attention to the biomechanics in Rubio's leg will be necessary to prevent placing undue stress on the previously injured joint. In the meantime, rookie Zach LaVine has entered the starting lineup, though veteran Mo Williams will likely he see the biggest uptick in minutes.
Smart's timeline isn't quite as drastic with the rookie hoping to be back in a few weeks. However, he did suffered a bone bruise as well, and that may extended his recovery process. Bone bruises heal similarly to actual fractures, with new bone tissue filling in the damaged outer layer of bone. Smart's minutes will go to Avery Bradley, Phil Pressey, and potentially Evan Turner. Aside from Bradley, the overall value of these fill-ins is low.
Fast Breaks
Roy Hibbert: The Pacers can ill-afford another injury, and fortunately, it appears Hibbert's knee contusion is not serious. He has been upgraded to probable for Monday's game against the Jazz.
Terrence Jones: Jones will continue to miss time after suffering a contusion to a nerve in his knee. The peroneal nerve sits on the outside of the knee and is vulnerable to injury due to its superficial location. The last two players to miss time with this type of injury averaged eight games missed, and Jones should be sent to the bench for the immediate future in all formats.
David Lee: Lee is expected to miss an extended period of time after aggravating his previously strained left hamstring. Draymond Green will remain the starting power forward and suddenly has staying fantasy power. Lee owners may want to start shopping the former All-Star while you can still get value on his name alone.
Nerlens Noel: The Sixers center has missed two consecutive games with an ankle sprain, and his status remains day-to-day. Philadelphia has shown a propensity to play it safe with their young players, so don't be surprised if he sits a few more outings.
Rajon Rondo: Rondo was absent from Saturday's win over the Bulls after undergoing a minor surgical procedure to remove the hardware in his hand. Rondo fractured the fifth metacarpal in his left hand during preseason and had been experiencing some lingering inflammation. He should be fine for Wednesday's matchup against the Thunder.
Tiago Splitter: The Spurs center is set to visit with a specialist on Monday to see if there is any connection to his lower back issues and his chronically ailing calf. Splitter is currently dealing with an inflamed lumbar disc that could be impinging on a nerve. Keep an eye out for the results, as the Spurs are generally good at revealing specific information regarding injuries to the players.
Klay Thompson: The sprain to Thompson's shooting hand appears minor, and he anticipates returning Tuesday against the Spurs. You may want to scale back your expectations for Thompson until he proves the injury will not affect his shooting stroke.
