By Abby Sims
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Nets point guard Deron Williams, who is sitting out this week because of a recently re-sprained left ankle, reportedly received cortisone and PRP (platelet-rich plasma) injections in both ankles. He is apparently in a walking boot to rest the more acute injury. This is not a new course of care for the oft-injured star, who evidently underwent three cortisone injections and PRP treatment for bilateral ankle issues last season as well.
It is no wonder the right ankle has been plaguing Williams — he also sustained a sprain and contusion to it during the offseason. He has undoubtedly pushed the right ankle beyond its limits while playing hurt due to recurrent injuries to the left ankle.
Williams’ ankle saga included two left-ankle sprains only five days apart in the month of November. We can see how much sitting out a couple of games in the interim allowed the first of those injuries to heal. No surprise there. What was amazing, though, was how well Williams performed in the second half of last season in spite of the issues he’d faced earlier. But did he play without pain or soreness? Unlikely.
There is much debate about the efficacy of PRP and the types of injuries for which it might best be utilized. In an informative discussion, four highly-regarded sports-medicine specialists noted that there are a variety of different preparations of the plasma used in treatment and that the procedure appears most useful for chronic degenerative injuries that have been unresponsive to care. They cautioned against the use of PRP for acute injuries such as ankle sprains and concluded that there is a need for more detailed clinical research to verify outcomes and appropriate applications.
As for cortisone, it, too, has a split personality. An anti-inflammatory that has the ability to profoundly reduce pain, its benefit may last for a brief period or for a number of months. Some recent studies have shown that over the long-term — at least for some degenerative tendon conditions (like tennis or golf elbow) — though cortisone may control pain, it may also impede the healing process, leading to higher incidence of recurrence.
I believe this to be especially so when, in the absence of symptoms (or with significant pain reduction), an athlete continues to place demand on the involved area. With cortisone alone (or cortisone and PRP), the underlying causes of the problem — whether or not it involves inflammation — have not been addressed. It is rehab and time — in some instances along with surgery — that play the most vital role.
Note, too, that repeated cortisone injections to soft tissue in an isolated area are generally frowned upon because of possible side effects weakening that tissue over the long-term. This could predispose to more frequent or involved injury.
Ligament injuries take time to heal — a long time. Returning too soon — as most do in the pro ranks — predisposes to exacerbation, re-injury or the occurrence of new injuries. Swelling, a normal part of the healing process of soft-tissue injuries, inhibits muscle strength, and the resulting weakness is compounded by the disuse that occurs with rest. This further impacts power and function.
Joint range of motion and muscle flexibility may become issues as well — particularly if an area is immobilized during the healing process. For lower-body injuries, balance also becomes impaired. Resting an injury also reduces muscle as well as cardiovascular endurance, leading to more rapid fatigue with subsequent activity. If endurance is not adequately restored before returning to competition, the risk for further injury is heightened. Keep in mind that a ligament isn’t truly healed for a full year — its tensile strength is about 30 percent of normal at the three-week mark post-injury, and at approximately 80 percent after three months.
So, back to Williams. Will he be able to repeat his second-half performance of last year? Don’t count on it.
Follow Abby on Twitter @abcsims.
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