All of Philadelphia froze for close to twelve hours. The vivid memory of Joel Embiid’s left knee hyperextending violently, him laying on the Wizards’ floor writhing in pain and clutching his knee, and then his limping into the tunnel never to return recycled through their minds. Twenty minutes later, a report was published–a Twitter notification for most NBA loyalists. Embiid would be receiving an MRI on the knee upon returning to Philadelphia that evening, according to ESPN’s Adrian Wojnarowski. Supporters of the team performed literary operations on every vague word to determine what was to play out. Wojnarowski reported that those with direct knowledge were terming it a ‘hyperextended knee’, which viewers could gather themselves from the images on their televisions.
“He’s in pretty good spirits, so let’s just hope for the best.”
In the throes of victory, a somber Doc Rivers stepped in front of the media covering the team. Even if he wanted to provide good news, there was simply too much still unknown. “I’m not going to speculate. Tomorrow we’ll know, we’ll have all the information for you. Hoping for the best,” Rivers said. “I did talk to him, he was in the locker room. He’s in pretty good spirits, so let’s just hope for the best.”
Of course, the words ‘he’s in pretty good spirits’ draw the oxygen back into the Sixers’ lungs. But Rivers’ body language and the words ‘let’s just hope for the best’ paint an equally agonizing picture. The city of Philadelphia went to sleep–or tried to, at least–with a hollowness in its stomach.
Shortly after 8 AM EST, the Sixers’ season rediscovered its pulse. According to Wojnarowski and ESPN’s Ramona Shelburne, Embiid’s MRI showed no structural damage. But, a ‘deep’ bone bruise on the left knee would keep the MVP favorite sidelined for at least two weeks.
Following that report, I spoke to two doctors in the sports medicine field about the context of this injury and what the timeline could look like. One spoke under the condition of anonymity. The other was Dr. Jeffrey Malumed, the President and founder of Premier Orthopaedics in Ridley Park, PA. Malumed was the physician for the US Olympic Ski Team for more than nine years and served as the physician for the Philadelphia Bulldogs. It should be noted that the doctors with whom I spoke do not have direct knowledge of Embiid’s specific situation and are in no way affiliated with the Sixers.
The consensus was that Embiid, the Sixers, and the fans are looking at a two-week absence, at minimum.
“Typically about 2 weeks but there’s significant variance on returning from a bone bruise.”
The first doctor with whom I spoke said that, in essence, cases vary. “Typically about 2 weeks but there’s significant variance on returning from a bone bruise,” he said. But that two-week frame doesn’t mean that Embiid will be suiting up for a game in exactly two weeks.
There’s still a rehabilitation step bridging the gap between healing and returning to the court. From that point, Embiid still has to get back into game shape. “There’s always a rehab process,” the doctor said. “But in terms of conditioning, it depends on the severity of the bone bruise. You have to allow it to heal some and then start testing the waters with what he can tolerate in terms of load-bearing.”
The physical healing is one aspect of the injury. Lingering pain, according to Dr. Malumed, is another aspect.
“The problem is they can hurt for a while. It can hurt for six to eight weeks.”
“Every bone bruise is not created equal, but I would say two to three weeks would probably be the minimum for a moderate-sized bone bruise,” Dr. Malumed told me. “The problem is they can hurt for a while. It can hurt for six to eight weeks. So really, it depends on how much he wants to put up. If it was like the Finals of the playoffs and next week doesn’t make a difference, they’re gonna put up a lot more. If he got a whole season and the playoffs to go, you could come back in two to three weeks. But, you might want to wait a little bit longer depending on what you’re looking for and the rest of the season and all that. So, I would say two to three weeks, and, usually by six weeks, it should be healed.”
A two-to-three-week absence may be survivable for the Sixers. The eight games they’re projected to play in those two weeks won’t be kind, but they have two star-caliber players and, as of late, a strong supporting cast to help hold down the fort. Six to eight weeks, however, could dramatically alter the team’s outlook at playoff time. Even then, you still have to account for the ramp-up period to prepare the body for NBA games. Fortunately, Malumed says there are things Embiid can do to keep the rest of his body in shape.
“You can still do strengthening activities, but you want to limit his weight-bearing activities.”
“You can still do activity, you can still do strengthening activities. But, you want to limit his weight-bearing activities,” Dr. Malumed said. “So again, if you’re weight-bearing all the time, all you’re doing is upsetting the bone bruise. You’re irritating, you’re aggravating it. So, you could still do leg extensions and leg curls. You wouldn’t want to do squats or lunges, but you can still work out.”
Malumed recommended some other activities, too. “You can certainly still work out and stomach that, you could work out your legs, you could stretch, you just don’t want to do a lot of weight-bearing stuff. You could do some aerobics and have, like, running on water, running aerobics, non-weight-bearing aerobics,” Malumed said.
“There’s things you can do, but you want to keep your weight off of it. The more you keep your weight off, the quicker it heals. Or, you walk on it, the longer it takes to heal because you keep on aggravating it. So, you can stay in shape, you just have to modify what you do.”
Obviously, you want Embiid to stay off of his feet as much as possible. But, you also want him doing what he can to get back to health as soon as possible. That isn’t to say that Embiid should rush back. But, the sooner he comes back, the stronger the team is as it vies for the top seed in the East. The sooner he comes back, the more they can establish chemistry and rhythm with any other additions that are to come in the next few weeks before the playoffs start.
Of course, as with any injury, you wonder if there’ll be nagging issues that will precipitate Embiid missing random games to manage his body as it recovers from the injury. According to Dr. Malumed, that shouldn’t be a concern.
“Once it heals, it’s going to be healed.”
“It’s kind of like a fracture, but not really a fracture. Once it heals, it’s going to be healed. He was missing games anyway. So, I do anticipate he’s gonna come back before six weeks. He’ll try to come back in that two-to-three-week frame. He’ll probably take games off to give it a rest in between because it’s really based on your weight-bearing activities,” Malumed told me.
“Obviously, he’s a big guy running up and down, jumping. If they want to come back earlier, he’s gonna probably have to take off more games. If they want to come back later, he’ll take off less games. Again, it depends on what they’re looking for in the season. You know they’re going to make the playoffs. They’re going to monitor that way [with the playoffs coming up]. So, once it’s healed, it’s healed. It doesn’t come back. You’re not prone to it again, you don’t have to worry about it unless you do something again. Once it’s healed, it’s healed, but you’ve got to modify what you do until it gets healed.”
Contrary to what speculators outside of the medical field would voice, much of the context behind these injuries is not black and white. Reflecting on a similar bend of the knee for a different athlete is hardly relevant. It doesn’t mean that Embiid is going to draw the same luck or fate as that athlete did. Everything is touch-and-go. Right now, you hope that some additional time off his feet will allow Embiid to start preparing his body to return, and maybe he can draw closer to the two-week side of the estimated time frame.
For now, of course, Embiid, the Sixers, and the fans can be happy that their prayers were answered, at least relative to the worst case scenario.