Eight days ago, University of Kansas men’s basketball coach Bill Self announced that seven-foot freshman Joel Embiid would miss the Big 12 tournament and most likely the first weekend of the NCAA tournament due to a stress fracture in his low back.
Minus the Big 12 Defensive Player of the Year, the Jayhawk’s second round loss on Friday to Iowa State was fairly predictable.
When Embiid will return to the line-up, though, is far less certain.
Initially diagnosed with a muscle strain — at least publicly — two weeks ago, Embiid had been suffering low back pain for nearly a month. As late as the morning of March 10, Self expressed confidence that his star center would be ready for the NCAA tournament. What or who gave him that confidence is baffling.
Apparently, Embiid’s family was baffled as well, insisting on a second opinion elsewhere. Who arranged that second opinion isn’t clear but the teenager ended up in the office of an unidentified “back specialist” in Los Angeles.
Upon Embiid’s return to Lawrence, the university announced that the specialist had confirmed the original diagnosis. Huh?
Was the previously announced "strain" a mistake or intentionally misleading?
Regardless of its intent, it was unlikely.
Roughly 90% of persistent low back pain in young athletes is caused by a disc injury or a stress fracture. It is never or hardly ever a strained muscle. Any such diagnosis is wishful thinking.
So is any plan to have Embiid playing in any part of the NCAA tournament. Stress fractures don’t heal that fast.
And contrary to any claim by Self, Embiid is risking more, and possibly permanent, damage by coming back too soon.
Stress fractures usually occur on one side of a vertebra (spinal bone), where it articulates with the vertebra below it. Left untreated too long, the fracture may give up healing and become permanent.
Worse is the possibility that the opposite side, now taking on the all of the stress intended to be dispersed equally between right and left, will develop a stress fracture of its own. If both sides of the same vertebra break completely through, then that segment becomes unstable. If the instability and resultant pressure on nerve roots and spinal cord becomes great enough, surgery becomes necessary.
The most aggressive published protocol for return to play from a lumbar stress fracture would sideline Embiid for the remainder of this season. It allows beginning a progressive return to sport 4-6 weeks AFTER becoming pain-free and as long as a follow-up CT scan shows full healing. Other protocols cited by Medscape range from eight weeks to nine months.
Still, given the example of the NBA, one can hardly blame Kansas for its optimistic front. Back in December, Kobe Bryant was just six games into his comeback from a reconstruction of his left Achilles tendon, when he suffered a tibial plateau fracture in his left knee. At the time, I wrote that the Lakers claim that Bryant would be back in six weeks “simply isn’t realistic.”
Just last week, the Lakers finally admitted the obvious and announced Bryant’s season is over.
Kansas should do the right thing by Embiid and do the same.
John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at email@example.com. Follow him on Twitter @JDohertyATCPT