Guest written by Dan Sieczkiewicz of our Financial District clinic as commentary to the NBA.com article "Boston Celtics' Gordon Hayward suffers fractured ankle in season opener," October 18, 2017.
On Tuesday night, the Boston Celtics opened their 2017-2018 season on the road against the Cleveland Cavaliers. It was the Celtics fans’ first opportunity to see Gordon Hayward, a key off-season acquisition, play in a regular season game for his new team. Approximately 5 minutes into the first quarter, however, Hayward sustained a gruesome ankle injury as he landed awkwardly from an alley oop, and his leg twisted underneath him. We later learned the diagnosis to be a fractured tibia and dislocated ankle. We reached out to Dan Sieczkiewicz, Physical Therapist at our ProEx Financial District clinic in Boston, to provide some insight about Gordon’s injury and what recovery could look like.
The ankle joint, as with many other joints, is made stable by both bone and soft tissue restraints. Therefore, when the ankle is able to dislocate, it typically results in failure of these stabilizing tissues. This includes fractures of the tibia and/or fibula, as well as ligamentous injuries. While we know Hayward sustained a fracture of the tibia (the long bone in the lower leg), we do not know the extent of any potential soft tissue injury. This can be revealed with advanced diagnostic imaging such as an MRI, and will ultimately be determined during surgery.
Surgical management through fixation is common for this type of injury and carries a variable time table for rehabilitation. Prognosis is determined by the cleanliness of the break, amount of soft tissue injury, and the presence or absence of any accessory tissue damage to blood vessels or nerves. It has been reported that Hayward’s injury is a “clean break” leading Celtics officials to be “cautiously optimistic.” This is supported by the footage where medical staff appeared to be able to reduce (or re-align) the joint while still on the court.
While it is possible for Hayward to return to play this season, he will have a lengthy rehabilitation ahead of him. Paul George of the Oklahoma City Thunder sustained a similar injury in August 2014 and missed all but the final 6 games of the 2014-2015 season, averaging just over 15 minutes per game. While no two injuries or athletes are the same, this does give some general insight into the prognosis which is favorable for a full recovery.
The rehabilitation process will likely commence with the primary goals of swelling reduction and protective weight bearing to preserve the integrity of the fixation. This should then transition toward gentle mobility exercises while slowly advancing weight bearing status. The next step is typically progressing to strengthening, and ultimately sport-specific activities at slow speeds prior to resuming competitive play. While Bone healing should occur by 8 weeks, Hayward will likely need at least that long, potentially longer, to then condition the injured tissues to tolerate the demands of an NBA game.
Dan Sieczkiewicz, DPTPhysical Therapist, Financial District - Boston Clinic
Note: ProEx Physical Therapy has not treated Gordon Hayward. While each person and injury is unique, the information above reflects general guidelines.