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Clearing injured athletes to play an inexact science, doctors say

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Ever since Kevin Durant limped off the court in Toronto on Monday night, fans have been asking whether the Warriors star should have been there in the first place.

Team doctors had cleared Durant to return to play. But he lasted only a few minutes in Game 5 before suffering another injury, leading to speculation that perhaps Golden State officials allowed Durant, 30, to return too fast when the team was trailing 3-1 in the best-of-seven series.

Sports medical experts said Tuesday, however, that no one could have predicted what happened.

“This is no perfect science,” said Dr. Travis G. Maak, Utah Jazz team physician and an associate professor in the Department of Orthopaedics at the University of Utah. “It is called the art of medicine.”

Maak, who has been part of many discussions about when a player could return to the court, said “the optics of this are terrible” but added that he has never seen a physician compromise a player’s health.

The Warriors have not released the results of an MRI exam of Durant’s foot, but it is believed that he tore an Achilles tendon. Maak described a complete Achilles tendon tear as the worst injury for an NBA player.

A study he conducted, Maak said, showed that 20-30% of players who suffered Achilles tears were not able to play again. Those who did make it back suffered a dramatic decrease in performance.

“Kevin may come back at 100%,” Maak added. “If anyone can get back, it will be him.”

Athletes are vulnerable to re-injury no matter how much treatment they receive, because of the unpredictability of putting the body through extreme physical challenges. Durant tried to return a month after suffering a right calf muscle strain May 8 in the Western Conference semifinals against the Houston Rockets. He lasted 12 minutes in Game 5 in Toronto before limping off with help.

But physicians said Durant probably was susceptible to another injury because the leg tends to overload other muscles when recovering from a calf-related issue. Dr. Nirav Pandya, an associate professor of orthopedic surgery at UC San Francisco, said when there is a weakness in a calf muscle, patients often add pressure to the Achilles tendon to generate force.

“It is not surprising there is going to be an injury on that side,” he said.

Durant’s situation highlighted the debate about how professional sports teams handle injured players, including when it is prudent to allow them to return, especially in the heat of championship competition.

A Warriors official, who asked not to be identified because he is not authorized to discuss medical issues, said Tuesday, “No team is ever going to allow a player to get on the court without having multiple doctors clear him. Team doctors, specialists, a players’ personal doctor, etc. It is a collaborative effort with many involved.”

He added that if Warriors officials knew there any chance of another injury, they would never have allowed him to play.

“It’s a basketball game. It’s not that important,” he said.

Sports medicine experts said such decisions are not made without careful calculations to ensure a player minimizes the risk of re-injury.

“You roll the dice sometimes,” Pandya said. “Unfortunately, the dice rolled the wrong way.”

It’s difficult to predict such an outcome, he said, because whatever Durant did during practices and drills was not the same as the kind of physical pressures he would experience during a high-intensity basketball game.

Pandya said calf muscle strains are especially difficult to treat because physicians do not have good studies showing a timeline for athletes’ return to play, the way they do with broken bones or torn knee ligaments. A lot depends on how a patient feels or performs, he said.

“Ultimately, you want everyone to have a long, successful career,” Maak said. “The big misconception is that teams pressure doctors to get players back. I’m usually the one saying they are ready to go, and the Jazz say, ‘Are you sure? We can keep him out longer.’”

Durant is not the first celebrity player to have his return from injury scrutinized by fans, media and other players in the locker room.

Kawhi Leonard, the Raptors star, landed in Toronto after feuding with San Antonio Spurs officials last season over whether he could play after suffering a right quadriceps muscle injury. Leonard played in nine games after he was injured and did not play the rest of the season, even though the Spurs’ medical staff had cleared him.

In a comeback attempt that went wrong, NFL quarterback Robert Griffin III tried to play in a 2013 wild-card game against the Seattle Seahawks, despite knee issues at the end of the season. He suffered a torn lateral collateral ligament, anterior cruciate ligament and meniscus during the game and had to undergo reconstructive surgery.

UC San Francisco’s Pandya said he understands why elite players try to return before being completely recovered from an injury. In Durant’s case, he said, the forward might have felt internal pressure to return after seeing teammates Klay Thompson, Kevon Looney and DeMarcus Cousins appear in the NBA Finals after suffering injuries.

But Dr. Michael Mellman, the Los Angeles Kings’ team physician since 1981 who also has served similar in roles with the L.A. Lakers and Dodgers, said medical staff would never leave the decision up to a player.

“It’s a very complex picture,” he said. “We’re dealing with a major asset of an organization, so no one that has any sense at all would think the team or medical staff or a player would want to jeopardize a long-term career,” he said. “It was a calculated risk on everyone’s part. The calculation was well made before he went back on the court.”

In an interview earlier this year, Rick Celebrini, the Warriors’ director of sports medicine and performance, said he told Golden State star Stephen Curry: “You’re never going to be in a situation where we say, ‘You came back too late.’ But you can always say, ‘You came back too early.’”

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