Training Guru Details What Dwight Howard Faces in Long Return from Back Surgery

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Training Guru Details What Dwight Howard Faces in Long Return from Back Surgery
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The Los Angeles Lakers knew Dwight Howard would still be recovering from back surgery long before they traded for him. What remains unknown is just how long it will take him to return and what happens after that.

Sports performance manager Mackie Shilstone didn't let Hurricane Isaac keep him from talking to Bleacher Report from his home in New Orleans. His insights shed some light on the ongoing recovery process Howard and the Lakers now face.

Howard had surgery back in April to repair a herniated disc in his back and remove bone fragments, correcting a condition that was causing him a great deal of pain. 

The subsequent recovery period kept Howard from seeing action in the playoffs, but it didn't keep him off the trade market.

A doctor explains why D12 needed surgery.

Lakers fans will no doubt be chomping at the bit to see their new prize in action (and at full strength), but some patience is in order.

"The surgeon is the one who sets the criteria, and of course [Dr. Robert] Watkins–doing this for so many years–kind of wrote the book on this stuff," Shilstone said, "He's a brilliant surgeon. He's just not going to bring someone back who, first of all, is not meeting his criteria and timelines."

While Howard's timetable for return is out of his hands, he still has plenty of work to do in the meantime.

Lakers fans are waiting eagerly for some double-doubles like this.

He began a core stabilization program a few weeks after the April 20 surgery, but that's only the beginning of what will be a long and ongoing road.

"You're going to go from a rehab program to a prehab program, and normally prehabilitation is done to prevent rehabilitation," Shilstone explained.

Keeping Howard's back pain-free will require a multifaceted approach that includes aerobic exercises, hamstring flexibility and keeping his weight down. It's not merely a matter of abdominal strength.

It's a matter of staying in the best possible shape, something that shouldn't be too much of a problem for a rare athletic specimen working under the guidance of the world's best doctors and trainers.

"The biggest thing he's got going against him is fatigue...Fatigue will cause Howard and anybody to change their biomechanics, and as he changes biomechanics, so goes pain in the back," Shilstone said.

Howard's back takes its toll prior to surgery.

And, in the short term, it's that pain that will dictate when (and if) Howard plays this season.

"In this particular case, the real moderator in this whole thing is going to be pain. If he's in pain or he has pain, they're going to hold him back or take him out. Because, he's got the past mindset of what it is, so he's going to take himself out."

The good news for Lakers fans is that Howard doesn't have a chronic condition that puts him at high risk of future injury.

Had that been the case, you can be fairly certain General Manager Mitch Kupchak would have been a bit more reluctant to pull the trigger (though there were reportedly some concerns about the status of his recovery prior to the deal).

In many respects, Howard will have to do the same kind of things every other player does. He just might have to be a bit more diligent about them, especially in the short-term.

Of course, he'll have plenty of help while he's at it. 

"That's what's going to have to happen: a total involvement with great communication between the athletic trainer, the strength coach and the physical therapist," said Shilstone.

Howard's first press conference as a Laker.

The other good news is that Howard only missed seven games over the course of his first six seasons. But except for the recent back issues, he's been a picture of health (and dominant physical tools).

You can see why Kupchak was optimistic about the long-term (via the Orange County Register's Kevin Ding):

"We feel very assured he's going to be back," Lakers general manager Mitch Kupchak said. "We're hopeful he's back for camp; we're hopeful he's back to start the season. But we know he's going to be back and playing at a high level at some point in time."

Some of those hopes probably won't be realized, but it's certainly fair to assume Howard will "be back and playing at a high level at some point in time."

Until then, the rest of us will just have to be patient.

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