Injury experts talk about Luka Doncic’s load-bearing scenarios and ‘complex’ risk-reward of playoff returns

Welcome to day 1 of doom-scrolling for updates on Luka Doncic’s potentially playoff-compromising left leg.

For the few Mavericks fans who are unaware of the superstar’s injury, here’s the basics:

Doncic strained his calf by planting his left leg to change direction after making a pass on offense with 2:24 left in the third quarter Sunday night, the regular season finale against the San Antonio Spurs.

He bent down and then limped off the field directly to the locker room with player health director and staff Casey Smith. He did not return to the bench and the Mavericks did not give an update while receiving treatment after the match.

The results of MRI exams Monday afternoon will show the Mavericks’ severity and location of Doncic’s load and dictate their rehabilitation plan up to Saturday afternoon’s start in the playoffs against the Utah Jazz.

But answers about Doncic’s availability and prospects after this week are unlikely to be as straightforward.

Dallas Morning News interviewed a trio of sports medicine experts on Monday who said muscle tension remains the most “stick” and “complex” injury for athletes due to the variation in severity, location and treatment options.

Donic’s risk of re-injury due to increased playoff physique, and his team’s response to 24-7 treatment in a recovery window shorter than after typical loads, will affect the Mavericks’ approach and factor in whether their All-Star will be available to start what appeared to be the franchise’s most promising postseason race since the 2011 championship.

“Muscle injuries are very difficult for us to treat because we do not have a quick fix,” TIL Souryal, the Mavericks’ team doctor, said from 1993 to 2015. “We have made tremendous progress in ACL surgery and ankle and Tommy John, but we have not really made too much progress when it comes to a muscle injury.

“Because we do not have a pill against a muscle strain, and because we do not have a brace for a muscle strain, we literally throw the kitchen sink after them.”

Experts classify calf strains at three levels:

  • Grade 1 involves “microscopic injury,” according to injury analyst Jeff Stotts, showing that fibers in the muscle have been overstretched and typically need seven to 10 days to heal.
  • Grade 2 represents a partial tear of the muscle and a several-week rehabilitation process.
  • Grade 3 involves full fractures and months of recovery, which analysts consider unlikely in Doncic’s case because he left the field without assistance.

Stotts, who runs the sports injury tracking site InStreetClothes, said the location of the strain could affect recovery. Strains in the meaty “muscle stomach” of the calf tend to heal faster due to proximity to the blood flow, while problems around the muscle tendons may take longer.

Should Doncic’s MRI scan reveal a crack to a lesser degree, experts predict he will begin a treatment plan around the clock with Saturday’s Game 1 at the American Airlines Center as his first benchmark.

No time to waste.

Souryal said that treatment for muscle tension can include hyperbaric, compression and muscle-stimulating approaches – multiple modalities in play at the same time.

Although adequate sleep remains a key factor, Souryal said it would not be unusual for Doncic to wear a NormaTec leg recovery boot or connect to a shoal machine while resting, or to wake up at odd times to ice.

“The biggest thing will be: How do they now build that lay up so it doesn’t get damaged again when he goes back and plays?” said physiotherapist and sports researcher Rajpal Brar. “A lot of it just comes down to what you see, of course, in imaging, and then what you see when you’re actually doing physiotherapy. When you test some of his movements and his strength, what do you see then?

“You’ve probably heard the term day to day, but it really is day to day because you have to see how he reacts and how his pain, how his function develops, literally day to day.”

Good news for the Mavericks?

The team’s medical staff has a track record of helping players recover from muscle tension faster than the NBA average.

Stotts said the average time lost for calf strains in the league this season was 16 days – not specific to class or placement.

In his database, which accounts for every NBA injury since the 2005-06 season, Stotts said Mavericks scores with calf loads – minus preseason and season-ending injuries that provide less timeline clarity – have returned on average in about seven days.

The list includes Frank Ntilikina this season – out in four games in November with a strain on the right calf – and some players later in their careers, such as Jason Kidd, Deron Williams, Wes Matthews and Shawn Marion.

“Age is a big factor in improvement and is a help,” Stotts said, “so it’s not surprising to see some of these veterans take a little longer and some of the older guys return a little faster.”

Never has Mavericks fans had greater reason to appreciate Doncic’s youthful dominance.

But Doncic’s current parameters still create unique obstacles.

He will face more intense physicality and movement in this wind-or-go-home, seven-game playoff series against the Jazz than he would typically do in the regular season.

He averaged 35.4 minutes per game this season – 1.1 more than last year – and 38.2 minutes during his first two playoff series. Doncic recorded at least 38 minutes in all six playoff games last season, finishing within 15 points – and exceeding 40 out of four.

“Now you put even more strain on that calf,” said Brar, “so it’s really here, it’s getting thinner.”

The only time Souryal received a game ball during his more than two decades with the Mavericks came after Game 3 of their second-round playoff series against the San Antonio Spurs in 2006.

Former coach Avery Johnson wanted to highlight Souryal’s exhaustive work to help protect Devin Harris from overcoming the quadriceps strain he suffered at the end of the regular season and return to lock Tony Parker in the playoffs.

Without a doubt, the Mavericks hope they can soon reward the current staff in the same way.

“Casey Smith, [head trainer] Dionne Calhoun, their staff is amazing, “Stotts said.” Truly one of the best in the NBA. Numbers always support it statistically, [and] they are considered a top-level medical staff in the NBA, so Luka is in good hands. “

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