LeBron James loves overcoming challenges and he is setting himself up for another opportunity.
The recent injury to Joel Embiid provided an open lane for Lebron James to capture his 5th MVP, one he feels should have been added to his trophy case a while ago. James evened the playing field again after suffering his own injury.
During the second quarter of a March 20 matchup between the Lakers and Hawks, James collided with opponent Solomon Hill, who was diving for a loose ball. James rolled his ankle and immediately fell to the floor.
James was diagnosed with a high ankle sprain. James will return to MVP form this year – whether that is before the playoffs or not remains to be seen. High ankle sprains are tricky and given the Lakers' current position in the standings and quest for a title, the timeline for returning to the court is murky.
What is significant about a high ankle sprain?
The good news about James’ injury is that the x-rays were negative, the bad news is high ankle sprains require more time to rehabilitate than a low ankle sprain.
High ankle sprains are injuries to the ankle syndesmosis – a thick web of ligaments and membranes that hold the two lower leg bones together (tibia and fibula) when weight-bearing. The nature of the injury and demands on the structures lend to a differing healing time than lateral ankle sprains.
Research shows general safe timelines for return to sport after high ankle sprains and grade II lateral ankle sprains are within 4-6 weeks. For sprains that result in minimal function loss, full return within two weeks is common. When we think of ankle sprains, the later timeline often comes to mind. That makes sense as lateral ankle sprains are more common than high-ankle.
A “traditional” ankle sprain – referred to as a lateral ankle sprain – is often a sprain of the anterior talofibular ligament (ATFL) – found on the outside or lateral portion of the ankle. The timeline for return from ATFL sprains largely depends on the severity of the sprain, which is measured as follows:
· Grade I: no loss of function, no ligamentous laxity, little or no bruising, no tenderness with physical pressure, minimal swelling. (source)
· Grade II: some loss of function, mild to moderate ligamentous laxity, bruising, tenderness to physical pressure, a small reduction in ankle mobility, and mild to moderate swelling. (source)
· Grade III: near-total loss of function, moderate to severe ligamentous laxity, bruising, very tender to physical pressure, moderate to a severe loss of ankle mobility, severe swelling. (source)
Grade I sprains typically resolve in a few days. When I say resolve, I mean the pain is gone and the player can play near 100%. Strength, power, and potentially mobility may still be restricted, increasing the risk for future injury. Players are often taped and use a brace for added control. While rehabilitation would still be beneficial, the player can return to the court rapidly.
Grade II sprains typically require a couple of weeks to recover. More healing time is needed before intense activity can be performed.
Grade III sprains often require complete immobilization (a boot or cast) or surgery. Both options will keep a player off the court for months. These injuries are uncommon.
Recent research compared lateral ankle sprains to high-ankle sprains in professional football players. Lateral ankle sprains kept players off the field for 1.25 weeks compared to 2.5 weeks for the syndesmotic injuries. The timeline is even longer for basketball.
A 2019 study assessing injury rates in the NBA found players missed an average of 5 games over 24 days following a high ankle sprain. Lateral ankle sprains only cost 2 games and 8 days on average.
Common complaints of athletes suffering a high ankle sprain are difficulty with “pushing off” and a feeling of “lacking power.” Quickly stopping, starting, jumping, and cutting are vital in basketball. A lack of power is a big problem that can’t be solved with ankle tape.
So how long with it take James to restore MVP level power?
James’ rehabilitations plan
There are two parts to this. First, the timeline to return from a high ankle sprain and play NBA-level basketball. Two, adjusting the timeline based on the current NBA schedule and playoffs.
On the surface, high ankle sprains typically take 4-6 weeks for professional athletes. The demands of the sport matter here – basketball is more demanding on the ankle than playing goalie in soccer – but most athletes that suffer high ankle sprains participate in sports that require sprinting, cutting, and jumping.
Professional athletes have the advantage of sports being their primary focus. James will receive 24/7 rehabilitation. His exercise, sleep, and diet will all be fine-tuned to facilitate rapid recovery. Furthermore, James is a genetic machine that provides him a tremendous physical foundation to work with. You cannot compare professional athlete timelines to most people entering physical therapy clinics.
James has previously displayed his healing prowess and returned to the court quicker than conventional timelines would dictate, but will the Lakers push for a rapid return?
Championship or Bust
James and the Lakers have one overarching goal this year: win the NBA championship. While James feels he has been robbed of MVPs in previous years and would love to add a fifth MVP trophy to his overflowing case, I doubt he will jeopardize a championship run for the individual award.
For this reason, James will likely be eased back into competition and miss at least a month’s worth of games. There is little reason to rush him back.
The number one risk factor for ankle sprains is a history of ankle sprains. Many people rush back from injury, strictly using pain as a guide for return to sport.
This reasoning is problematic.
Strength and power deficits will remain after pain resolves. James should – and likely will – ensure he is 100% ready for the playoffs and well-rested. With Anthony Davis nursing a significant injury as well, the Lakers cannot afford to have an 80% James on the court. He may need to carry the team will Davis returns to form.
Should All Athletes Take this Approach?
There is no one-size-fits-all plan for rehabilitation. If the playoffs started next week, James would likely return during the first series. The physical therapists and athletic trainers would design the plan to maintain performance at a ‘good enough level’ for the playoffs and then fully rehabilitate him in the offseason.
Ideally, provided there is no time crunch, an athlete who suffers an ankle sprain would ensure full resolution of all athletic measures. As a physical therapist, my initial focus is on protection to allow the ligaments to heal.
In most cases, weight-bearing movements are ok – I want to minimize muscle atrophy – but running and jumping will be prohibited, regardless of pain or use of bracing. As the ligaments strengthen after a 1-2 week period, exercise and weight-bearing activity are gradually progressed.
Keep in mind, upper body and non-weight bearing lower body exercise can remain intense to maintain some level of fitness. James is still working hard, he just isn’t running, jumping, or squatting.
As activity is progressed, strength and power are added. Athletes need to be able to rapidly contract muscles and move joints (running and jumping) and control the movement (landing from a jump). As strength and power are normalized, I want to integrate multi-planar movement – meaning side-to-side cutting and pivoting.
Last, but not least, sport-specific activities should be completed in a controlled environment before practice and game. In the clinic, the physical therapist and patient can plan for the movement and activity. On the court, the player has to quickly adapt to an opponent. This is a much greater demand on the body.
Throughout the whole process, psychological readiness to return must be assessed. In a recent study in the Journal of Athletic Training, researchers found psychological readiness displayed a predictive ability for return to preinjury level of sports, while conventional RTS tests did not.
Emotions related to returning (e.g., fear and frustration), confidence in sports performance, and appraisal of reinjury risk must be assessed. Traditional return to sport measures of strength, power, education, range of motion, and functional testing - such as triple hop test, broad jump, and single-leg hop – are not enough.
It may take James time to return to his dominating self as he builds confidence in his leg. There is no precise timeline. Regardless, it is unlikely he returns in time to win the MVP. I wouldn’t bet against him—or the Lakers as repeat NBA champs