Warriors’ Stephen Curry: A slip in Houston, a fall to Cleveland

We all know what happened. With less than four seconds left in the first half of Game 4 of the 2015-2016 playoff series between the Golden State Warriors and the Houston Rockets, James Harden, in what may be his most impactful playoff moment, trips up his own teammate, Donatas Motiejūnas. Motiejūnas, in turn, begins falling at halfcourt and ends up at the top of the key, a whopping 23+ feet from where he started.

Meanwhile, Stephen Curry, fresh off a right ankle sprain, is backpedaling and defending a last second three from Trevor Ariza when he steps into the slip-and-slide sweat trail left behind by Motiejūnas. Curry’s left leg slides out from under him while his other leg catches and his right knee buckles inward. Dub Nation has a heart attack. ESPN would later report that Curry suffered a grade 1 MCL sprain in his right knee.

In a recent interview with ESPN Senior Writer Darren Rovell, Stephen Curry, when asked about last season’s NBA Finals, admitted that he “wasn’t 100 percent, but who cares?”

Well, as it turns out, I do. Not in the sense of trying to find an excuse for the heartbreaking loss. There are no excuses. We lost and we live to fight another day.

But as a sports fan, it’s fun to dive into the what ifs. What if Michael Jordan didn’t retire to play baseball? What if Shaquille O’Neal stayed with the Lakers? What if LeBron James never left Cleveland? What if Thunder was still our mascot? All fascinating questions with no real answers, but fun to talk about nonetheless!

Lots of what ifs surround the MCL sprain Curry sustained in Game 4 of the Warrior’s first round series against the Houston Rockets. To better educate myself about that injury and its consequences, I spoke with with Dr. Elliot Yoo, a physical medicine and rehabilitation physician and pain medicine fellow at Massachusetts General Hospital. Read below to see our discussion on typical treatment, playing through pain, and the effect that injury could have on a basketball player.

DISCLAIMER: The discussion below is general in nature. Golden State of Mind and Dr. Yoo are not providing any medical diagnoses and are certainly not giving you medical advice. If you’re hurt, stop reading and go to your doctor.

Jason Lee: Stephen Curry was diagnosed with a grade 1 MCL sprain during last year’s playoffs. What is the typical protocol for treating such a sprain?

Dr. Elliot Yoo: In an ideal world, you would want around 4 weeks of recovery time. Week 1 the patient could walk and start stretches to maintain flexibility of the knee but should take it easy overall to reduce swelling. Week 2 they could be more aggressive with stretching, as limited by pain, with the goal of regaining full flexibility. Week 3, if pain is minimal to none, they could start light jogging and strength training. And week 4 they could start to test the knee out with sport specific drills to see how the knee reacts to more dynamic movements.

Return to play would happen once he or she is almost pain free and is at at 90% strength compared to the other healthy limb. But judging when someone can return to play is very subjective and situation dependent, as everyone heals differently.

J.L.: You always hear about how athletes are pushed to play through pain. Is that something you could do with this kind of injury?

Dr. Yoo: As you could tell through the treatment protocol, pain is an important guide when treating sprains and strains. By definition, there is no structural damage from a grade 1 MCL sprain and we wouldn’t use serial MRI studies to follow recovery unless there is a setback. So we rely on pain to tell us what’s going on with the injury. Again, in an ideal world, you would want to take it easy on the injured leg long enough to do some healing. If I were dealing with a weekend warrior or a high-school athlete, I would tell them to avoid returning to play until they’re fully healed. But the fact of the matter is, right or wrong, today’s professional athletes are modern-day gladiators that are part of multi-billion dollar businesses. With so much “on the line”, players will often play through pain so long as the benefits outweigh the risks. I remember even I played basketball on two sprained ankles in high school with nothing more than a Gatorade and bragging rights on the line. I can’t imagine how much pressure these guys are under to play.

J.L.: How would a grade 1 MCL sprain affect a basketball player’s movement?

Dr. Yoo: Your MCL prevents your knee from bending inwards, prevents hyperextension, and resists what we call axial rotation. So movements that cause rotations in the knee are going to be affected by an MCL injury. Running in a straight line might not be so bad but planting a foot, cutting, lateral movement, those would all be affected by this type of injury. Basketball movements like crossing over, sharply squaring up to shoot, and sliding behind a pick, among others, could be limited with an MCL sprain.

For Curry, he had a right knee MCL sprain. As a result, he would likely be more comfortable planting on his left leg. This means on offense, he would want to drive towards his right. On defense, Curry would likely benefit from forcing the player he was defending to drive to their left so that Curry could plant on his left leg. I think defense would be particularly difficult because defense requires you to constantly cut from side to side, rotate your hips, and react to the opposing player. Teams tailor their game plans to him, so I wouldn’t be surprised if the Cavaliers took advantage of Curry’s injury by trying to force him to drive left and defend left.

J.L.: Curry tweaked his ankle in game 1 of the Rockets series and sat out until game 4, which is when he sprained his MCL. Can weakness in ankles contribute to the risk of MCL sprains or other knee injuries?

Dr. Yoo: Our bodies are built to move as a chain reaction. When you have an injury to one part, it can cause the remainder of that limb to move unnaturally to compensate. For example, we have patients who come in with foot pain as a result of plantar faciitis. Those same patients sometimes come back later and complain of back pain even though they didn’t experience any specific injuries to their back. So even a slight change in your biomechanics can have huge impact elsewhere.

But when I watch the replay of Curry’s fall, it really just seems like a freak injury. If we saw his ankle buckle or any kind of indication that there was instability there, you might be able to attribute his knee injury to his ankle. But it seems pretty clear that he slipped on a wet spot. I think it was just bad luck.

J.L.: Highly speculative question coming up. Curry ended up sitting from game 4 of the Rockets series until game 4 against Portland. That’s 15 days. What if he sat out the entire Portland series and it went seven games? That’s twenty-plus days of rest before playing Oklahoma City. Would that extra week have made any difference with this kind of injury?

Dr. Yoo: An extra week could be a significant amount of time for this type of injury. Simply put, the body reacts to injury by swelling and bringing healing factors to the affected area. But along with that swelling comes a number of chemicals that cause pain. As the body begins to heal, swelling reduces and inflammatory cells and those chemicals that cause pain begin to lessen. An additional week off could have given Curry a significant reduction in pain, which is huge because along with that is a rise in confidence in the leg.

But purely from a sports standpoint, Curry probably did the right thing by playing. He wanted to play and the fans wanted him back. As much as you don’t want players to have long term injuries, there is that expectation for players to play through pain and here the risk was probably minimal. You never know how a series can turn so getting your superstar back on the court as soon as possible is a priority. We’ll never know if resting more would have helped Curry win against the Cavs.

J.L.: You’re bursting my bubble. Okay, last question. It’s been more than four months since the injury and the regular season doesn’t start until late October. Is that sufficient time to recover? Any lasting effects or mental hurdles?

Dr. Yoo: He should be good. His grade 1 MCL sprain shouldn’t have a long lasting impact on his knees, especially given the mechanism of his injury. But I will note that some people may have biomechanical issues that put them at risk for knee injuries. For example, Robert Griffin III has had his fair share of knee problems. Someone recently looked at footage from his combine performance and noticed that he exhibited a valgus knee collapse when jumping. Basically, he would bow his knees inwards. It’s possible that years of poor knee mechanics has put him at risk for knee injuries.

But with Curry, honestly, if anything I’d be more worried about his ankles. Once you have a couple severe injuries with the ankle, it’s never as strong as it was and you’re always at risk. Ankles will always be his Achilles’ heel, no pun intended. As for his knee, he should be healed and ready to go.

Our thanks to Dr. Yoo. We will be checking in with him periodically throughout the season as injuries pop up.