Duke Williamson Basketball

Duke's Zion Williamson sits on the floor following an injury during the first half against North Carolina on Wednesday in Durham, N.C. As his Nike shoe blew out, Williamson sprained his right knee.

Since Duke’s Zion Williamson suffered a first-degree sprain to the medial collateral ligament in his right knee on Wednesday night, there have been various concerns expressed in the media.

Would or should Williamson sue Nike?

Would or should Williamson give up playing for the remainder of the season to protect his status as the presumed top pick in the NBA draft?

When will Williamson return to play?

It is entirely doubtful that Williamson will sue Nike. What would his damages be? Grade 1 MCL sprains are the most common knee injury and heal relatively quickly, with no long-term consequences. His presumed draft status has not been impacted adversely.

However, Nike’s financial health has been, with the company’s stock value taking a $1.1 billion hit Thursday.

The question regarding Williamson giving up the college game has seemingly been answered. Unlike several high-profile college football players who walked away from their teams at bowl time, Williamson plans on returning. He is committed to his team — a refreshing thought. For those focused on the cash, Williamson is apparently protected by an $8 million insurance policy, should he fall below the 16th pick in the draft due to injury.

So, all that remains is his return status, which has been described as “day-to-day” by Duke officials. However, that is a bit optimistic and avoids answering the question of when he “should” return.

A diagnosis of first degree MCL sprain indicates damage to the ligament insufficient to cause laxity or instability. However, swelling, tenderness, stiffness and weakness still occur. Consequently, range of motion requires restoration, swelling needs to dissipate, normal strength must return and function should be back to normal before resuming competition.

How long does all that take?

While there is ample recent medical literature concerning the treatment of third-degree MCL sprains, a complete tear of the ligament, the definitive article on the mildest sprains, such as Williamson’s, dates back nearly four decades.

Published in the American Journal of Sports Medicine in November 1981, the study looked at 51 Grade I or II MCL sprains suffered between 1974 and 1978 among football players at an NCAA Division I university. Those sidelined by a second-degree sprain were back playing without restriction in an average of 19.5 days. Those with a first-degree sprain needed an average of 10.6 days.

The Blue Devils have already won by 10 at Syracuse on Saturday without Williamson. Duke is next scheduled to play Tuesday at Virginia Tech and Duke announced Monday that Williamson would not be playing. A sub-.500 Miami visits Cameron Indoor on Saturday, which would be 10 days post-injury.

Wake Forest, another sub.-500 squad, follows on March 5, before the regular season ends when North Carolina hosts a rematch on March 9. Playing any sooner than one of these two games would be foolish.

Coming back too soon can have consequences. Think back to Redskins quarterback Robert Griffin III and Notre Dame forward Bonzie Colson.

Griffin injured his right knee in December 2012. He came back in two weeks from his mild lateral collateral ligament sprain wearing a brace but wasn’t moving well. Then, despite the brace, he re-injured the ligament worse than originally while also tearing the anterior cruciate ligament in the same knee. He has never been the same, being out of the NFL in 2015 and 2017 before serving as a backup with the Ravens in 2018.

Colson broke his left foot in January of last year. Surgery ensued and, despite the medical literature showing recovery requires 20 weeks, Colson returned in eight weeks, only to re-break the foot during an NIT game in March. He subsequently went undrafted but has since resumed his career, currently on a two-way contract with the Milwaukee Bucks and their G-League affiliate.

When Williamson does return, it will be interesting to see if he has a brace on the injured knee. There are pros and cons. Studies show that commercial knee braces do reduce MCL injuries by as much as 50 percent in football. However, the primary beneficiaries tend to be linemen and linebackers rather than backs and receivers. Furthermore, knee braces reduce range of motion and overall performance and have a tendency to slide down, requiring frequent re-adjustment.

My guess, if Williamson ends up wearing a brace, it won’t be for long.

John Doherty is a licensed athletic trainer and physical therapist. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.