Will Dwight Howard Be 100 Percent When Houston Rockets Need Him Most?

HOUSTON — The Houston Rockets made the announcement with the fewest words, inspiring the most distress possible.

Dwight Howard had missed the Rockets’ previous two games after the team’s announcement on Wednesday night that he had edema on his right knee while he considered his treatment options. The two-sentence press release that followed announced that Howard had “a bone marrow aspirate injection” on his right knee.

Few knew what “a bone marrow aspirate injection” was, but it appeared ominous and foreboding, as if the announcement was designed to make Howard’s condition sound as dire as possible.

It turned out that the procedure is a more technologically advanced version of treating a cold with chicken soup. It couldn’t hurt.

Rockets doctors had recommended weeks of rest and therapy to treat the fluid on the bone in his right knee. As long as he was going to be out anyway, he had the injection to maybe speed the healing in the area.

But Dr. Walt Lowe, who performed the procedure, told the Houston Chronicle that to expect cartilage growth in a month would be selling “snake oil.”

More to the point, after hours of assumptions spread that Howard would never be the same and was spiraling toward microfracture surgery, Lowe said the cartilage loss in the area was actually “tiny.”

Howard has never had damage requiring arthroscopic surgery to remove portions of his cartilage. He had said in December that the knee is “bone-on-bone,” which Lowe said is not actually true, having studied the MRI that showed almost no cartilage loss at all.

Howard’s problem, Lowe said, was that he pushed himself too hard through the soreness when he came back from the injury, leading to the swelling. Howard assumed he could tough it out.

This was a version of the mistake he made in Los Angeles, when he played as a diminished version of himself after back surgery. In hindsight, he’d have been better off getting closer to 100 percent.

According to Lowe, Howard wanted to keep playing again. Those five days between the announcement that he had edema on the knee and the Tuesday meeting when the team, doctors and Howard agreed to the procedure and time off were spent largely convincing Howard to sit out.

If nothing else, Howard seems convinced. In chatting with the media before Sunday’s game, he cited a timetable to return between six and eight weeks. That turned out to be the worst-case scenario.

Lowe seemed surprised to hear that schedule and said Howard might return in four weeks.

Unlike a broken bone—where doctors schedule a timetable to consider it healed—or an ankle sprain—where they have plenty of precedent to predict a rehab schedule—Lowe won’t know how long it will take Howard to be back until he can see how Howard’s knee reacts to the tests to come.

Mark J. Terrill/Associated Press

If it takes six to eight weeks, that could be because of the time needed after Howard is cleared for full workouts, rather than the time needed to clear him.

Rockets coach Kevin McHale had marveled in training camp and again in December at Howard’s ability to go from out to full speed. “He’s a freak,” McHale said repeatedly. But this time, the Rockets won’t count on that.

“This isn’t one of those deals where you get well and play the next day,” Lowe said. “You get well and then you transition back to the court. So that’s a reasonable timeframe when Dwight can be Dwight.

“He is pretty pain-free walking. Now we need pain-free running, then pain-free jumping then pain-free playing and pain-free big guys pushing him around on the court all night and those things.”

Howard and Lowe said again and again that the primary treatment for the edema—a fluid buildup in the bone, rather than in an area that can be drained or treated medically—is rest. Howard had begun workouts and will continue to gradually increase the workload as long as the pain does not return.

The Rockets had announced that Howard would be reevaluated in four weeks, but he actually will be reevaluated throughout the process in what Lowe called a weekly “Spanish inquisition.”

Another MRI was scheduled for four weeks because that is how long it would take for an MRI to show improvement. But Lowe said that the only information that will really matter will come from Howard reporting how he feels.

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“I think that’s the most important thing, that I am playing pain-free,” Howard said. “There are some things that were tolerable, but for me this season I just wasn’t there. And I could feel it every single night.

“I would feel really, really good and then there were the nights where I couldn’t perform to the best of my ability. I will be back and ready to go and I am looking forward to it.”

The Rockets are confident that he will be 100 percent this season. When the MRI showed so little cartilage loss, they had reason to believe Howard could overcome the pain from the fluid on his knee.

There is, however, another question that no MRI or surgeon can answer.

If Howard was so diminished from a season spent going in and out of the lineup, how will he perform after missing another six to eight weeks?

When Howard began his most recent time out, then because of a sprained ankle in Phoenix that might have led to the flare-up of the knee pain, McHale’s description of how Howard had played was centered on how often he could not play at all.

“He hasn’t been able to play as much as we’d like,” McHale said. “He missed most of training camp. He missed a bunch of games early in the year (11 with the knee pain). We were just trying to get him back. He hasn’t had surgery or anything, just bad luck with nagging stuff that seems to keep coming.”

Even if Howard gets the knee right, other “stuff” could keep coming. After 800 NBA games, that is always a possibility.

But for now, the question for the Rockets is whether he can be at his best when his best is needed most.

Lowe seems convinced that the knee won’t hold Howard back. No matter when Howard returns, he will head into a postseason after a regular season spent just trying to stay on the court.

It would take a “freak” to be at his best after that, but as pessimistic as Howard was with his timetable the Rockets sounded with their announcements of his treatment, Howard’s expectations for his return have not changed.

“I don’t think I was able to give everything I could on a night-in and night-out basis,” Howard said. “This is going to be a great time for me really to get my body back in line, get my head in line so I can go out there and dominate and help this team win a championship.”