Dime Q&A: Expert Surgeon Talks Manu Ginobili & Hand Injuries

Manu Ginobili

Already this season, we’ve seen star players go down. Zach Randolph is out for a long time. So is Al Horford. No one knows how Manu Ginobili will play when he comes back. And no one really knows how much injuries are affecting Kobe Bryant, Chris Paul and Gerald Wallace. A part of me wants to say it’s the shortened season, but face the facts: Injuries happen every year.

No one is feeling the pain more than the Spurs though. They’re sitting on the edge of the playoffs at 12-9, playing just .500 ball in their last 10. Without the best player in the NBA – he may not be, but he was undoubtedly playing like perhaps the best player before getting hurt – the Spurs go from being a threat to just a bump in the road. But even some of the West’s elite are having trouble. Chris Paul could be dealing with a nagging hamstring injury all season. Over the summer, we caught up with a surgeon, Dr. Bal Raj, to help break down some of the game’s most important injuries. We’ve done it again.

I caught back up with Dr. Raj – who was named one of the “Top Orthopedic Surgeons in Los Angeles and a Leading Physician of the World” by the International Association of Orthopedic Surgeons, and someone who has a lot of experience with high-profile athletes – to talk injuries. Ginobili should be back sometime in March, but hand injuries are different for everyone. And if you think those are unpredictable, just ask someone like CP3 what having a strained hammy is like.

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Dime: We’ve had a lot of finger/hand injuries already this season (Kobe Bryant, Manu Ginobili, Gerald Wallace). But there are a lot of different ways a bone in your finger or hand can break correct?
Dr. Bal Raj: Yeah. You can have dislocations, tendon ruptures. You can have fractures outside of the joint or involving the joint. You also have different joints in your fingers. The question, number one, is is this a stable fracture? And number two is, can you actually play with this?

Dime: What do you mean by a stable fracture?
DBR: You can have fractures that are undisplaced, meaning it is just a hairline crack so that type of fracture, there’s no displacement of the bone. And when there’s no displacement, it’s because generally your ligaments and most of the bone are still intact. That’s considered a stable fracture. What you’ll see is maybe bruising around the finger but you won’t see any deformity.

Dime: What happens if you keep trying to play through that?
DBR: Let’s say you have a hairline fracture and you don’t protect it, number one you’re at a high chance that it, through a simple or minimal mechanism which could be catching a basketball, become a complete fracture and displacing. So it definitely can get worse.

Number two, once you have a fracture, the secret is to mobilize it because what’s happening is your body is bringing in all of its mediators around for inflammation, bone healing and bone repair. If you’re active on that fracture, you will significantly slow that process because you’re causing repeated damage to that area.

Dime: Ginobili had surgery on his fifth metacarpal. Are there any bones in your hand that are more troublesome to hurt?
DBR: The general rule of thumb is anything around the metacarpals involving the joint are usually bad. Whenever anything involves a joint… if you have a fracture that’s outside of a joint, that’s a much better prognosis because fractures are real and if they don’t heal, we can make them heal with plates and screws. But the point is if it’s outside of the joint, it won’t cause any restriction or range of motion or stiffness in the joint or arthritis. The worst type of fractures are ones that involve a joint.

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Chris Paul

Chris Paul (photo. Daymon Gardner)

Dime: To go to the Clippers, Chris Paul missed some time with a strained hamstring. That seems like the type of injury that can be easily hurt again...
DBR: Yeah, the strain of a hamstring is so easy to reoccur. If you don’t adequately rehab it, you can easily hurt it again because what happens is after you strain a hamstring, it causes all of these micro-tears. Micro-tears cause an area to scar, and cause inflammation. It causes a tightness in the hamstring. So when you go back to the level that Chris Paul is playing at or any NBA player, you’re very likely to re-strain it. It’s so important to rehab it properly by stretching it and strengthening your hamstrings to help avoid those reoccurrences.

Dime: Is it one of those injuries that you can’t really tell is all the way healed until there is no tightness at all?
DBR: You are absolutely right. We are all created differently. We all challenge ourselves on different levels. On a basic level, we can say it takes four to six weeks to heal, and that’s a generic number, but four to six weeks may work for a person who doesn’t play competitive basketball or another sport. But for someone who does play competitively, realistically if you’re looking for full healing we’re talking about up to three months. Within that time – and I’m not saying you have to be off of it – this is an injury that you have to be constantly rehabbing and stretching it to maintain the range of motion. You also have to be stimulating that muscle, especially with fast-twitch fibers so that you can heal a lot quicker.

Dime: When you strain a hamstring, is that a problem that someone has or is it strictly random?
DBR: The reason is happens is because usually people’s hamstrings are tight, they’re not stretched and their quads are a lot stronger. What happens is there’s an inequality, so a hyperextension motion or a quick contraction can cause the sprain to occur. That’s the most likely cause. Again on the same level, we’re all created differently. Some people may have stronger quads or more defined quads, which makes the hamstrings more susceptible to injury. Your quads have to equal your hamstrings in terms of strength in order to avert injury.

Dime: I’ve heard people say sometimes that it’s better to tear something than spraining it…
DBR: A tear is a higher degree of a sprain. The problem with a sprain is that you can still function on a sprain so people do not generally take care of themselves after a lower-degree injury. You watch them go back and play, and that’s the type of issue that can linger because they don’t stop and say “Hey listen, I need to take care of this issue” because it’s not severe enough.

With a tear, you actually stop. You see a doctor. You get it taken care of. You get it immobilized. And because you’ve been compliant with the treatment, you’re less likely to have secondary issues afterwards or a reoccurrence.

What do you think?

Follow Sean on Twitter at @SEANesweeney.

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