Al Jefferson's Injury Raises an Old Debate: To Play or Not to Play Through Pain

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Al Jefferson's Injury Raises an Old Debate: To Play or Not to Play Through Pain
Lynne Sladky

CHARLOTTE — Heard the expression "mind over matter"?

When it comes to high-level sports, there comes a point at which athletes completely shut off their minds, because they've decided that only one thing matters. This came to mind while watching Al Jefferson try to play through excruciating pain, due to left foot plantar fasciitis, for the first two games of the Bobcats' first-round series with the Miami Heat—a series that continues Saturday in Charlotte.

And it also brought to mind Isiah Thomas' choice back in 1988 after grotesquely spraining an ankle in the third quarter of Game 6 of the NBA Finals. The Pistons point guard sat for all of 35 seconds, then hobbled, winced and willed his way to 25 points in the third quarter alone, losing the game by one but furthering his legend exponentially.

Thomas did plenty of damage to the Lakers.

Did he worry about the damage he might do to himself?

"I never thought about the long-term ramifications," the NBA TV analyst told Bleacher Report this week. "I was only thinking about just trying to win the game. Not saying it was the wisest thing to do, but that was my frame of mind at the time."

But at least, with an off day prior to Game 7, there was some time to reflect, reconsider, choose caution.

"All the doctors who saw my ankle definitely warned me of all the ramifications of playing," Thomas said. "And if I was to play on it, and injure it again, it could have been a career-ending injury. My ankle could have been displaced, fractured and everything else if I had played on it and twisted it again. So I had all the doomsday scenarios."

And yet...

Nathaniel S. Butler/Getty Images

"I never actually embraced those doomsday scenarios," Thomas said. "I heard the doctor talking, but it's like in the cartoons, 'wah, wah, wah, wah.' I was like, 'Yeah, I hear you, but I've got my mind made up, but this is what I'm doing. I'm playing, I'm giving it my all, and I'm trying to win.' At the end of the day, I went against what the doctors were saying."

He played in Game 7.

"Again, was it the wisest thing to do?" Thomas said. "Probably not."

He laughed. He can do that now, because even though the Pistons lost the deciding contest by three, he didn't pay an additional price. He healed well enough in the offseason to lead the Pistons to a championship the following June.

The Bobcats have adamantly insisted that Jefferson is running no long-term risks by playing, even as analysts such as TNT's Charles Barkley have called for Jefferson to sit.

After Jefferson said that the tissue snapped completely in Game 2, Charlotte coach Steve Clifford told Jim Rome, "We have our team doctors with us at all times, and they were on top of things. What I’ve been told is that, with this particular injury, he’s not in danger of making it worse or having another injury that would be more significant to another part of his body."

Jefferson certainly won't be the last injured player who is faced with a choice of whether to push through or pull back this postseason.

Already, Golden State's Andrew Bogut has made it known that he won't take a chance with a cracked rib, because the rib is dangerously close to his lung. Others are certain to take the other approach, the more celebrated approach, the one taken by the likes of Isiah Thomas and Willis Reed.

They'll try to tough it out.

As Shane Battier put it, the common attitude among elite athletes is "shoot first and ask questions later. And by that, I don't mean shoot at the basket."

Battier wasn't a part of the Heat in 2011, when Udonis Haslem put the pain—and perhaps some better judgment—aside to rejoin his teammates for a title chase.

Haslem tore a ligament in the 13th game of the 2010-11 season, having surgery and missing nearly six months of action. He returned for Game 4 of the Eastern Conference semifinals in Boston but was exceedingly rusty, missing everything on his one shot and sitting after two minutes and 46 seconds.

Issac Baldizon/Getty Images

Erik Spoelstra kept him on the bench as the Heat closed out the Celtics in Game 5 and yanked him after five rough minutes in Game 1 of the Eastern Conference Finals against Chicago.

No one was expecting what Haslem did in Game 2, playing 23 minutes and igniting a victory with 13 points and five rebounds.

What about the worst-case scenarios?

"It's hard. I thought about it," Haslem said. "But once I made up my mind that I wanted to come back, that's all I was focused on. That whole season, I devoted all my time and my energy to get myself healthy and get myself ready to come back.

"I went through a lot of extensive workouts on the floor before I was actually able to step out and play. So I felt pretty good about it. I knew I was going to be dealing with some pain issues, but I had that pretty solid screw in there at that time, so I had a lot of stability in there."

A lot. But the doctors couldn't rule anything out.

"They told me I'd be going through some pain and some swelling," Haslem said. "And that it was unlikely, but I could break the screw. And if I break the screw, then I'm back to square one."

Would Haslem do it again?

"Yup," Haslem said. "Even though we didn't win (the championship), I still would do it again."

Haslem has had up-and-down stretches with the Heat since and has acknowledged at times—especially when it comes to the balance on his jumper—that the foot lingered as an issue. But he's still playing, and starting, three years later at a level somewhere close to his old self.

One of his teammates, Chris Bosh, isn't asked anymore about the abdominal muscle that he tore in Game 1 of the 2012 second round. But at the time, there was some question whether he would return that postseason at all, let alone in Game 5 of the next round against the Boston Celtics.

Bosh wasn't among those questioning it.

"Nope," he said. "No sir. I wanted that 'chip,' man. I wanted that chip. The only thing going through my mind was playing. I walked out of the doctor's office, after they said, 'You don't need surgery, but the best case scenario is three weeks.' I was all right, 'Three weeks, that's all I need to know. I don't need to hear anything else.'"

What if the doctor had told him that he was risking long-term trouble, as Thomas was told?

"It depends on the situation," Bosh said. "Is it a regular season game or is it a championship? That's the unique thing about being an athlete, is that we literally put our bodies on the line for a sport. Whether it's right or wrong, the only right thing at the time is winning. Isiah was close, man, they could feel it, they could taste it. It's like, hey, we've come too far for me to give up now. Sometimes, it's just a test to see how bad you want it."

Bosh, though, does add a caveat.

"I say this with no offense to anybody who has played with pain," Bosh said. "I played because we were trying to win a championship. Isiah played because he was trying to win a championship. If it's the first round.... you've got to be smart with it. It's got to be a calculated risk."

******

Grant Hill wasn't expected to win a championship when the first round started in 2000, even though he had just won a scoring title.

Firmly in his prime at age 28 and about to become a prized free agent, he had sprained his left ankle a week prior to the start of those playoffs. His Pistons, like the current Bobcats, were a seventh seed facing the second-seeded Heat, prohibitive underdogs. He played in the first two games, scoring 22 points, but clearly in agony, before shutting it down prior to the Heat sweeping Detroit out in Game 3.

Grant Hill Career Turning Point
MPG PPG RPG APG
Pre-2000 playoffs 39.1 21.6 7.9 6.3
Post-2000 playoffs 30.1 13.1 4.7 2.6

Basketball-Reference.com

"I wish I would have been there to tell him not to play," Thomas said. "Because Grant Hill did displace his ankle. And he injured it even more. And it cost him in terms of being injured and everything else."

It didn't cost Hill on the open market, as he still got a maximum contract from Orlando. But he played in only 47 total games in his first four years with the Magic.

In 2003, doctors re-fractured his ankle to align it with his leg bone, and he suffered an MRSA infection during the complex procedure. He would return and play several more years as a valuable role player, but his superstar days were done.

Now Hill and Thomas work together at NBA TV.

Doug Benc/Getty Images

"He and I have talked, and I wish I would have been sitting on the bench with him that day," Thomas said. "Because I hate that it happened to him. But athletes, we do put it all on the line. And the fans, and the organization, they want to see us put it all on the line. But at the same time, where do you draw the line?"

Thomas has thought quite a bit about this philosophical question. Last March, he even penned a piece for NBA.com, in which he pondered the decisions made by the Washington Nationals, Washington Redskins and Chicago Bulls to rest, play and rest Stephen Strasburg, Robert Griffin III and Derrick Rose, respectively.

He pulled from the work of German philosopher Immanuel Kant, who believed that human beings should not allow themselves to be used for the benefit of others. 

"The big philosophical question is: 'Is it ever OK for the athlete to look at himself as a means to an end?'" Thomas said. "Because the fans, the organization, sometimes they look at the athlete as a means to an end in terms of you've got to play to win the championship; the championship is at stake.

"But when your health is at stake, when does your health supersede the championship? That's the philosophical question that Kant posed towards humanity, and it plays out every day in sports." 

Should Al Jefferson play through his injury?

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It doesn't appear to be playing out with Jefferson, at least not in any way other than the pain he is enduring, and the painkilling shots he is taking.

Thomas didn't go as far as Barkley, in suggesting that Jefferson sit.

"With Al, it's about what the doctors are saying," Thomas said. "We're not there, we don't know the severity, and definitely the doctors have much better perspective than anything we can offer, just looking in.

"The only thing we can do is admire his competitiveness and speak to the effectiveness or ineffectiveness that he's having out there on the floor. We know that he is a dominant player when he's healthy, and Miami has no answer for him when he's healthy.

"Seeing him unhealthy, we all admire his competitive spirit, but we know he's not playing at 100 percent, so therefore he hasn't been able to dominate the way we've seen him dominate." 

It's clear, however, that one mission is dominating Jefferson's thoughts, the same way it dominated Thomas' 26 years ago: helping his team win. 

And, on that, Thomas recognizes that athletes need to let other voices, and thoughts, creep in. 

"This is where the doctors and the team and everyone around you, you need help protecting yourself against yourself," Thomas said. "Everyone else is thinking, career, long term, and they're thinking right. And you're only thinking about the present, about winning the next game, or winning this round. You really do need help protecting yourself against yourself."

Especially when it hurts to watch you get up and down the floor. 

 

Ethan Skolnick covers the Heat for Bleacher Report.

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