Doctors preview Kristaps Porzingis' return from a calf injury: "If he were a baseball player, he'd be back already" (Exclusive)
Following five weeks of frustration over nursing a strained right calf, Boston Celtics center Kristaps Porzingis clarified his availability against the Dallas Mavericks on Thursday for Game 1 of the NBA Finals.
“I’ll play,” Porzingis told reporters during media availability on Wednesday.
How exactly, though, will Porzingis play?
Since the Celtics acquired him last offseason, Porzingis has fit in seamlessly with Boston’s Jayson Tatum and Jaylen Brown as an additional scoring threat (20.1 points per game), passer (2.0 assists) and floor spacer. After missing the Celtics past 10 playoff games since injuring his right calf in Game 4 of their first-round series against Boston, however, Porzingis conceded uncertainty on both his conditioning and his anticipated minutes restriction.
“It’s tough to say. I haven’t played for a while,” Porzingis told reporters.
“It’ll be tough to jump into the Finals like this. But I did everything I could to prepare for it.”
Medical experts preview Kristaps Porzingis' comeback
Sportskeeda spoke with three independent medical experts who have familiarity with calf injuries. They have not worked with Porzingis and the Celtics directly, and have not viewed any of Porzingis’ medical results and rehab exercises. They at least offered an overview, however, on Porzingis’ injury and their expectations on his return.
The panel included:
Dr. Alan Beyer, executive medical director of Hoag Orthopedic Institute
Shaheen Jadidi, primary care sports medicine physician at Endeavor Health
Jason Koh, Mark Neaman Family Chair of Orthopedic Surgery at Endeavor Health
All three medical experts also addressed whether Kevin Durant should serve as a cautionary tale. With the Golden State Warriors, Durant ruptured his right Achilles tendon in Game 5 of the 2019 NBA Finals against the Toronto Raptors after missing the previous nine playoff games with a right calf strain.
Durant and the Warriors both maintained they didn’t mishandle the injury considering he received clearance from both the team’s training staff and medical doctors.
Editor’s note: The following one-on-one conversation has been edited and condensed. Their interviews with Sportskeeda were also conducted separately.
What are your expectations on what Kristaps Porzingis’ return will look like?
Beyer: “It’s likely going to happen from what I’ve been reading and hearing. We all remember the saga with Kevin Durant [in the 2019 NBA Finals] and that he came back after a calf injury and then ruptured his Achilles tendon. I don’t know exactly in Porzingis’ case at what level his calf was torn on whether it was down near the ankle or higher up mid calf closer to his knee. That obviously makes some difference with how fast he comes back. You have to protect him longer if the injury is down near the Achilles tendon because the width, depth and strength of the muscle at that level is much lower and thinner. So you have to be more careful if it’s further down the calf. Muscle, tendon and ligament injuries are all graded at Grade 1, Grade 2 or Grade 3. Grade 1 means some of the fibers were stretched out, nothing was torn and those don’t take a month to come back from. This clearly was not a Grade 1 injury. Grade 2 means 50% of the muscle or area were torn. Grade 3 was a complete tear. He didn’t have a complete tear because he wouldn’t be practicing now or getting ready to come back if he had a complete tear. So I hypothesize that this is a Grade 2 tear."
"I go by a 3-to-1 rule. If you shut down for a week, it takes you three weeks to get back to where you were before the injury. Depending on how long he has kept him out of muscle use, that will determine whether he’s ready to come back now after five weeks for Game 1. If he were a golfer, he would be back already. If he were a baseball player, he’d be back already. Even if he were an NFL football player, he’d be back already. But basketball is inherently a jumping sport, and your calf muscle is critical for your ability to jump. That’s what is keeping him out longer, what will significantly limit his minutes when he does come back and probably somewhat limit his effectiveness. When Kobe [Bryant] ruptured his Achilles tendon [in 2013], I expected his scoring average would go down because he wouldn’t be able to leap quite as high. Even if you lose a quarter inch of vertical leap after a calf or Achilles injury, that will change your shooting trajectory. You’re going to miss a lot of shots off the front of the rim. I predict that is going to happen here too, somewhat. He’s not going to be the same shooter as he was before this happened. He probably won’t be effective for the first game or two as he was preinjury. This is something his coach has to think long and hard about: ‘Am I better off with an 80% Porzingis because it will disrupt the other team or am I better off not using him if he's not close to 100%?’” You have to be Socrates to figure out that one.”
Jadidi: “It would be one thing if he injured his upper body, and he could get away with relying on the other limb. But when you’re talking about a lower injury for a basketball player, it’s really important to be running and jumping. It’s going to be tough to get to either side of the court. He’s a big guy. He’s an important player in a lot of ways. He’s not really expected to do sharp movements. That is something that is on his side. He’s not expected to sprint across the court within a matter of seconds. But it can definitely affect his ability with aspects of the game – creating power in his feet to get up there, catch rebounds and with defensive aspects of the game. He's been out for over four weeks. So he has had time on his side.”
"But I think he’ll be good to go. He’s been scrimmaging and looks like he’s done full contact. He also has had extra time to recover with how the playoffs have gone. I don’t think he’ll have much issue with having over four weeks to recover. The main thing is he doesn’t need any assisted ankle devices or compression sleeves to support the muscle and push through pain. It appears he’s had complete unrestricted game play and has been performing well. I doubt he’ll skip a beat. I think he caught a break with getting extra time to recover.”
Koh: “It sounds like he had a significant injury that caused him to miss so much time. There are different grades of muscle strain. A Grade 1 shows some fibers have some damage. Grade 2, there is some tearing of the muscle tissue. Grade 3 is a complete tear. My guess is if he had something like that, he would’ve had surgery right away. Judging from what happened, he probably had a fairly significant Grade 2 strain. Calf strains are concerning for an athlete because calves allow you to push off of your foot. If you’re trying to jump, explode or run, you’re pushing off your foot. The team is obviously going to report what it needs to report. But clearly they were concerned enough to keep him out of some high-stakes situations. He’s coming back and has been out for about five weeks. A lot of times these injuries take about four to six weeks to heal. He's at about that six-week mark. But those are averages over a group of people, and there can be different kind of strains.”
From the time he is injured until he returns to play, what are the critical benchmarks he would’ve needed to complete?
Beyer: “That comes down to muscle testing. Where is his strength at, and is he as strong with that calf when he tries to push against you? Or is he still impaired? I’d have him run up and down the court and take some vertical leaps and see how he does. Is he a little hesitant? Is he pulling up a bit? Even if he says he’s good and ready to go, he’s not ready to go if he can’t leap. Bob Cousy could shoot without jumping at all. But that’s not today’s player. But shooting is different than pulling up short on a fast break after a full run. Just shooting in practice is a lot different than shooting in a game situation."
"I’m sure they have done this even if they haven’t told us about this. But they need to have him out there in contact practices with his teammates to see how he’s doing it in a real-game situation and not just doing static shooting by himself on the court. If he’s able to keep up with his teammates and perform the way he normally performs in contact practice, then I’m good with letting him go. But I would certainly keep a very close eye on his minutes.”
Jadidi: “It can be a difficult injury to recover from without time, physical therapy and rest. Obviously, NBA players in the postseason are putting their bodies to the limits and it can be tough to get that adequate healing. But my peripheral reading is that this injury isn’t something that needed surgery, which are reserved for full tears. He would be amenable to conservative management. Injuries like that can take four to six weeks to heal with proper, care and management with physical therapy. There could also be PRP, which is a regenerative medicine to accelerate the healing. A month recovery is typical for a calf injury like that."
"The two minimum criteria are having full pain-free range of motion and then having at least 80 to 90% strength. Basketball players put a lot of force through that muscle with running, jumping and coming down on it. It’s one thing to have a range of motion. But you want to simulate that a little bit in practice. As long as those checkmarks are met with simulating a practice, shooting drills and cutting drills without pain, then it’s good to clear him to participate in a game.”
Koh: “They’re going to want to see if he can run, jump and explode. One of the things they’ve probably been doing is to see if he can run. He’s got a lot of skills and a lot of talent. So my guess is they want to see how he does. But one of the concerns is if that you come back a little quickly, there is a chance for reinjury. A lot of times when they come back from these things, teams will limit the players’ minutes.”
Kevin Durant injured his Achilles in the 2019 NBA Finals after missing nine games with a right calf injury. Even considering Durant had a higher talent level and had a bigger role with the Warriors, how apt is that incident as a parallel to Porzingis’ situation?
Beyer: “Everybody second-guessed that one after it happened and said. ‘Oh, he was injured and had a calf strain so obviously this happened because they let him go too soon.’ No, nothing is quite that obvious. This could be a comparable situation, though, because he’s been out for a longer amount of time than you’ve seen a guy be out with a calf injury. I hope it doesn’t. But this could turn out to a situation very much like Kevin Durant’s situation because he’s not quite running at his normal gait and he could be off because the calf is still healing and he winds up doing further damage. The first sign there’s a twinge of pain, he should get off the court and sit down.”
Jadidi: “It seems as if Porzingis’ injury is what Kevin Durant went through five years ago. That’s exactly the worry if you’re too aggressive with an injury. The body has ways of compensating. If you rush an injury, you’re exposing yourself to potentially other injuries, not just with the calf and the Achilles, but the neighboring knee. If you don’t have a full range of motion, you can start compensating with the knee and putting more stress on it. You’re increasing risk with having an ACL or MCL tear and other types of injuries. But that’s really tough. You can’t really blame the calf injury on the Achilles injury [with Durant]. But generally that’s a typical pattern if you don’t let something heal fully. That’s the reality of professional sports.”
Koh: “That’s really good question. The Achilles is part of the whole calf-muscle complex. If this calf strain is more of a lower-type strain, there could be some risk. For the athletes’ privacy and for the team, they may want to be careful on how much they want to disclose. But I think there is some risk. If it’s more of a muscular injury, it’s more likely there would be an aggravation of the muscular injury rather than a tendon tear. So that’s obviously a concern. But I’m sure what they will be doing is monitoring his situation very closely with imaging and functional tests to see how things are healing up.”
Porzingis’ durability has relatively improved the past two years. But to what extent does his overall injury history increase your level of concern with his return?
Beyer: “That is getting into the concept of ‘injury prone.’ Is Mike Trout injury prone? Some would say yes because the last four seasons he has been out with various injuries, but unrelated. Is there such a thing as ‘injury prone?’ Yes, there is. But usually it’s not because it’s a players’ fault, but because of their own doing on if they weren’t training properly. If guys are injured too often, they need to be changing their training regimen in what they’re doing. But not having examined the player and having personal knowledge on that, I’m going out on a limb here. The key is whether they give him an adequate time enough to heal and, more importantly, did they give him enough time to rehabilitate? We’re not going to know that until we see how he performs.”
Jadidi: “It’s a complicated answer. Your question reminds me of research I did in undergrad with looking at the anatomy and biomechanics of different athletes. You’re talking about somebody that’s tall, has a high center of gravity and large length of limbs. Someone like him is more prone to stress those structures because they’re going through 10, 20 or 50 times more force than a shorter person. Those guys do end up getting more injuries and have a tougher time to recover from them. Injuries are always a risk. But this injury and how mild it sounds and since he’s being given adequate time to recover and practice, he’s done everything he could to minimize the risk.”
Koh: “It’s different from his other injuries. So you can take this one with relative isolation. He’s a veteran and has managed to come back from a lot of stuff. Usually when we have older players, there’s more wear and tear in general. All of us as we get older don’t quite bounce back as quickly as we used to. But on the other hand, the fact that he’s had fewer issues, one of the things that everybody is taking advantage of in professional sports is thinking about load management, tracking health, monitoring how fatigued people are and avoiding overtraining and doing more things for preventative and maintenance purposes. It’s not exactly a parallel. But Tom Brady was playing at a very high level for a very long time. He spent a lot of time trying to work on preventative stuff to keep himself flexible and strong.”
What’s your outlook that Porzingis can still offer value as a third option, floor spacing and passing even if he’s limited?
Beyer: “He definitely does. But here’s the deal. The Celtics only lost two games in the whole playoffs. They had a whole week to rest now. It’s not like they really need him. They can win without him. But this is the Finals. Dallas has watched a lot of video on their games up until now. By bringing in a new piece that you haven’t used in the playoffs, you can create some unease and unfamiliarity. That’s always a plus for the Celtics. I think this is going to be a good series. I think it’ll go a full seven games.”
Jadidi: “That’s where he’s going to have to go. A smart player will realize that’s where he’s really going to have to capitalize on his game and make sure that he executes when he’s got those opportunities. That’s probably going to be the best place for him to shine for his teammates.”
Koh: “Everybody is pretty hyped up for playoff games and things like that. So everybody will be playing with significant intensity. But my sense is from that recent interview when he was asked how he was doing and he didn’t jump right into saying “I’m great,” my guess is that he may have a little bit of caution. When you’re coming back from this injury, it takes a little bit of time to get that explosiveness back. Having worked with a lot of professional athletes and teams over the years, I find it remarkable that a lot of players, including the veterans, can play through a lot of stuff. He may come out and look really great. These guys are incredibly tough. Stuff that would slow down or stop most folks, they still show grit and go right through it. It’ll be interesting to watch. I certainly hope that he stays healthy.”
Mark Medina is an NBA insider with Sportskeeda. Follow him on X, Instagram, Facebook and Threads.