Kobe will come back Sunday against the Toronto Raptors after missing 19 games. Now the question is: How effective will he be?
Bryant ruptured his Achilles tendon against the Golden State Warriors on April 12, 2013. It's a significant but not uncommon injury. The tendon itself is very stressed and, given the physical demands of the NBA game—plus Bryant's age (35) and health history—this isn't uncommon.
Other players, such as Elton Brand, Chauncey Billups and both Wilkins brothers* have returned from similar injuries. We've also seen advances in both the surgery and the rehab techniques used, which is causing more positive outcomes and shorter rehabs.
*Having both Dominique and Gerald Wilkins suffering Achilles ruptures is fascinating from an injury standpoint. While it's easy to assume some genetic proclivity or weakness, it's impossible to say for certain since the mechanisms of injury and their skill sets were different.
The Lakers are hanging their hopes on some of these new advances helping them escape past results. Research done by Kevin Pelton in 2012 shows a decidedly negative outcome for returning players. Billups returned last season after the injury and has had a number of other minor issues that have kept him out, but there's no evidence that he'll return to his previous production.
The age comparison is certainly worrisome.
However, the Dominique Wilkins comparison makes more sense. While Kobe's all-around play puts him above even a Hall of Famer like Wilkins, their physicality and skills are closer than any of the others.
While Bryant is older and has more years in the league than Wilkins did at the time of his injury, Wilkins showed that it's possible. Not only is there veteran savvy, but there's more of a margin of error. Eighty percent of Wilkins or Bryant is probably still an All-Star.
One key is a technical change in how Kobe's Achilles tendon was reconstructed.
Dr. Neal ElAttrache is one of the top surgeons working in sports today, with successes ranging from Tom Brady's knee to Zack Greinke's collarbone. ElAttrache's April surgery was immediately hailed as successful, but there has been a great deal of surprise at how quickly Bryant has returned to function.
While specific details on the surgical technique are not public, surgeons have speculated that ElAttrache used a procedure that could be described as "minimalist," according to one orthopaedist. "The less you do, the easier the healing," he explained.
It is key that the tendon was repaired and not replaced. As long as the strength of the tendon is returned, the function should follow. The difference is whether ElAttrache was able to do that with both minimum disturbance to nearby tissue and re-establish balance of tension and flexibility in the muscle-tendon complex.
ElAttrache is also likely to have used platelet-rich plasma during the repair. The technique is very common in sports. ElAttrache was on a panel in 2012 where I saw Dr. James Andrews say that he intended to make PRP a standard part of his surgeries.
Kobe has used similar techniques, including trips to Germany for Orthokine therapy on his degenerative knees.
Bryant has used Instagram, Facebook and Twitter as much as he has traditional rehab tools. He's broken the wall, using technology to take his fans along on his rehab process. Many got their first look at an Alter-G treadmill when Bryant tweeted out a picture of it. There's no question that he has had every technological advantage, but the key seems to be his own drive.
"He started with an amazing base," said one medical professional with knowledge of Bryant's rehab plan, "and then he exceeded every goal. He never overdid things, but he did everything with such a professional approach. With many athletes, they'll push too hard and have a setback. Kobe knows himself so well that I think it will serve him well once he gets back on the court."
Kobe is going to have to make adjustments. He's done this before, going from a player who relied on sheer physical gifts at the start of his career to a savvy veteran who can still beat most physically. He's got a full bag of tricks and moves, but some of those might be an issue.
In fact, his signature fadeaway might be one of his biggest tests.
Think about the sheer physical demands on Kobe's fadeaway. He sets, spins, jumps and lands. All four of these physical moves will tax the repaired tendon. Try it at home, and you'll see just how much stress it places, especially on the jump and landing.
While the Lakers medical staff is comfortable with the structural integrity of the newly reconstructed tendon, there are still questions about how confident Bryant will be.
"It's one thing to see him in practice running and jumping and dunking," said an NBA athletic trainer whose teams have played Bryant's Lakers for years. "Games are a different gear for special players like Kobe. He's going to have to be more aware of what he can and can't do, and I think that will be a learning process for him over the next few months. While he's learning, he's thinking and when he's thinking, he's not in that zone where he can dominate."
One of the keys there will be stability.
Bryant is famous for being one of few players that wear low-top shoes. At a recent practice, he was wearing those same shoes and did not have any apparent hard brace. It's not even clear that he had any tape under his socks, but it's likely that he did. Watch to see if Kobe wears higher shoes, such as his new Nike shoe that features "sutures" as part of the design, or if he seems concerned with the stability of his ankle.
There's no real issue with the ankle, but Kobe is likely to be hesitant to get into situations where he is forced to put the ankle and Achilles to the test. I would expect him to stay out of the crowded paint and the feet that he could step on. He's unlikely to vie for rebounds, to avoid the kind of plyometric jumps that could overtax the Achilles.
During Kobe's rehab process, he showed a Vine where he jumped off a 10-meter platform. People around the sports world were stunned. Water is not soft and doesn't compress. Bryant's foot would have been pushed back (dorsiflexed) by the impact, placing a lot of stress on the Achilles.
It's precisely the kind of test that most would be reluctant to do, but it's also a calculated risk. Force is easy to calculate—height, gravity, weight—and Bryant obviously came out of it well. Interestingly, he was wearing shoes for the jump, which leads many to think that while this wasn't a fake like jumping over a car, there may have been more precautions than they showed.
He'll also play a little "slower." The NBA athletic trainer thinks that Bryant will be smart enough to let the game come to him.
"He doesn't have to have those Derrick Rose stops and starts. I expect he'll play on the outside for the first few weeks and very literally get his feet under him. He's probably got a checklist in his head. Do this, and can I do this. Check off one a game, figure out where he is and what he can do."
Bryant has been doing some of this in rehab and in practice. The quest now will be to see how he does at speed and at what point he gets back to not having to think about it. Following along with the process, as Bleacher Report's David Murphy did in this excellent article, shows just how difficult and extended this rehab has been.
It's important to remember that a return to the court is a step, not an end. Kobe Bryant is not going to immediately establish himself as an elite player. One game against the Raptors is just another step in what was a long rehab process that will continue for the rest of his career. Just as Kobe has learned to manage his knee conditions, he'll have to add the Achilles to that holistic process.
What we don't know yet is how the Lakers will manage this process in-game. It's reasonable to think that Bryant will play limited minutes, but there is some question about the stop/start of taking him in and out. That could lead to specific scenarios of usage. His minutes will be limited and expanded slowly, though injuries to other Lakers, such as the hamstring strain to Jordan Farmar, may complicate the process for Mike D'Antoni.
We'll know more on Sunday night when Bryant laces up new shoes, puts on his Lakers uniform again and shows us all what he's done for the last eight months. While Bryant didn't make it back by opening night as was his goal (and my expectation), he's well ahead of the standard timeline of 10 to 12 months.
Then again, nothing Kobe has ever done has been average. Why start now? My expectations for his return are very positive.
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