Tyrese Haliburton, even with a strained right calf that raised questions about his availability for Game 6 of the NBA Finals, has managed to keep the basketball world on its heels.
“If I can walk, then I want to play,” Haliburton said Monday after the calf injury he aggravated in Game 5 clearly affected him during the Indiana Pacers’ loss to the Oklahoma City Thunder, which left the Pacers trailing 3-2 in the best-of-7 series.
The day before Game 6, set for Thursday, June 19, Haliburton said he is a competitor and wants to play yet also remarked: “I have to understand the risks, ask the right questions…”
Cynics may think Haliburton is trying to keep the Thunder guessing (his coach said he ‘probably will be a game-time decision for Game 6’). But two orthopedic surgeons who have worked with NBA teams told USA TODAY Sports that decisions about whether to play with an injury are complex.
“An ankle sprain can be two hours of conversation,’’ said Brian Cole, head team physician for the Chicago Bulls since 2005. “X-rays, X-rays, repeated MRIs. Talking to different levels of trainers, the family, the agent.
“Especially at a time where you’re dealing like this, where it matters more than ever.’’
Why it matters: The Pacers are trying to win their first NBA championship in franchise history. It’s hard to imagine them doing it without Haliburton, their All-Star point guard.
But it’s unlikely Haliburton will play without conferring with his agent, said Robert Anderson, a member of the NBA’s committee studying ankle sprains and team orthopedist for the NFL’s Green Bay Packers.
Anderson said an MRI, which the Pacers said Haliburton had, usually will go to two consultants. Then the risks of playing with the injury are assessed, said Anderson, who said the player and agent then likely will discuss the risks involving the injury.
“It also becomes a business decision,’’ Anderson said.
The role of the pain threshold
Willis Reed limped out of the locker room with a leg injury before Game 7 of the 1970 NBA Finals between the Los Angeles Lakers and New York Knicks.
Reed, then the Knicks’ star center, gritted through the pain and helped the Knicks win the NBA championship. Fifty-five years later, the story epitomizes toughness.
Fair or not, the ‘pain threshold’ likely will become part of the conversation regarding whether or not Haliburton plays.
“Athletes play in pain all the time,’’ Cole said. “It’s an issue of what they can tolerate and if their mechanics are compromised in any meaningful way.’’
William McGarvey, an orthopedic surgeon who worked for the Houston Rockets, pointed out that pain depends on how a player functions. McGarvey also noted that Haliburton is a triple threat, with the Pacers star averaging 17.9 points, 9.1 assists and 5.8 rebounds during the playoffs.
“If he’s just bringing the ball up, distributing or in a position where he is just jumping up and down, trying to grab a rebound, it’s a little more controlled,’’ McGarvey told USA TODAY Sports. “But if he’s jumping for a rebound, if he’s going up for a layup or a dunk, he’s got to push off. He could hurt himself on landing. He could hurt himself if he’s going up against another player. These guys get in awkward positions and they have to be fairly agile to be able to land effectively and things like that.
“The other issue here is how the injury is affecting him. Is it causing him to just have pain when he pushes off or is it because it’s irritated? Is it causing him spasms so that even when he’s sitting and resting, he’s getting a crampy feeling in his leg?’
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Treating the injury
Keith Jones, an athletic trainer who has worked for the Orlando Magic, Los Angeles Clippers and Houston Rockets, said of a muscle sprain: “Normally you’d do seven days of really not much, and then you reassess.’’
No such luck for the Pacers, who had less than 72 hours after Game 5 to potentially get Haliburton ready for Game 6.
Jones said he would prescribe hands-on therapy, be it massage or other manipulation of the muscle or muscle tissue.
“But a lot of ice, a lot of rest,’’ he said. “You could put someone in a boot just to take the strain off of it so … they’re walking on a boot instead of the heel-toe motion. Really isolate it and let it rest. Keep it elevated. Try to avoid inflammation, (there’s) anti-inflammatory medications you can take. But the main thing is the body heals on its own.
“You can’t speed it up. You can do things to create a better environment for healing to take place. But it’s going to heal when it’s supposed to heal.’
Cole said the treatment options are limited.
“If it’s a calf strain, a true muscle strain, not a tendon, but muscle strain, they take a while to heal and there’s no magic,’’ he said. “You can’t inject anything in there. You can’t give any kind of medications. There’s no special hyperbaric oxygen or anything that’s going to cure this thing in that period of time.
“So, it’s just, is he a good healer? How bad is the strain? I haven’t seen the MRI, so I don’t know. … There’s just not a lot of time to let a muscle injury recover if that’s where it is.”
Haliburton said he expected treatment to be near-constant.
‘I think just around-the-clock stuff as much as I can,’ Haliburton said. ‘Massage, needles, hyperbaric, H waves. Everything you can do to get as comfortable as you can going into it. The right tape and stuff while I am performing. I’m sure there’s a bunch of medical professionals who could give you a better answer. Just doing everything I’m told. Trying to do everything I can.’
What are the risks?
The mention of Kevin Durant might create fear for Pacer fans, if not Haliburton.
During the 2019 playoffs, Durant, then playing for the Golden State Warriors, missed nine games with a calf injury. He returned to action during Game 5 of the 2019 Finals, with the Warriors trailing the Toronto Raptors 3-1.
Two minutes into the second quarter, Durant ruptured his Achilles tendon, which sidelined him for about 18 months.
The three orthopedic surgeons who spoke to USA TODAY Sports said there is no evidence that a strained calf can lead to a ruptured Achilles tendon.
“I would argue that playing with the strained calf just runs the risk of getting an escalation of symptoms related to the strained calf,’’ Cole said. “But … an Achilles tendon ruptures in a very different location. A strained calf injury is a little bit higher up.
“So, I think that we would typically let a player play if they can tolerate the ability to play basketball, cut, pivot, change direction, and so forth. If they can tolerate all that, then we let them play.’’
Anderson said Durant had preexisting issues with his Achilles tendon. He said an MRI would provide the Pacers clear evidence of whether the injury stems from the Achilles tendon or muscles above the tendon associated with calf strains.
“So when you have a calf strain, if it’s in the muscle, there’s absolutely no increased risk of Achilles tendon rupture,’’ Anderson said.
While talking about Haliburton, McGarvey said was he reminded of Michael Jordan playing with the flu during Game 5 of the 1997 Finals. Jordan scored 38 points and led the Chicago Bulls to a victory over the Utah Jazz.
“If you know your injury isn’t going to be a career threatening thing, then it’s really up to the individual as to how much they can tolerate and how much they want to go out there,’’ McGarvey said. “And leaders tend to get out and deal with it.’’
