The Celtics received a critical blow on Wednesday evening when they revealed an MRI taken on Marcus Smart on Wednesday showed a partial avulsion of his left oblique abdominal muscle off of his iliac crest. The team has placed a return timetable of 4-6 weeks for basketball activities for Smart, but clearly, every day will be crucial in the midst of Boston's postseason run.
There is no questioning Smart's toughness on the floor and his desire to be out there but what can be considered reasonable expectations for Smart to get back out there if the Celtics advance out of the first round? To get a better sense of what the point guard is dealing with and what his rehab and recovery timetable might look like, I caught up with BSJ medical expert Dr. Jessica Flynn in an interview Thursday morning.
BSJ: So the diagnosis (partial avulsion of his left oblique abdominal muscle off of his iliac crest) is a mouthful. Can you simplify things a little bit for us with what happened here?
Dr. Flynn: In the video, it looked like Smart took some contact on his hip at the same time he was pushing off and pivoting. That can cause bruising at the attachment of those core muscles and oblique muscles. That’s called a hip pointer, but if the muscle is contracting at the same time, you can get some tearing. What happened is the muscle attachment, which is a tendon, actually pulled partly off the bone. Some of the tendon is still attached but some of it is not. It’s an injury we commonly see in young athletes, especially soccer players who are forcefully shooting the ball. We can see they pull a tendon off the pelvic brim. We don’t see it often in adult athletes.
BSJ: There has been some criticism of the C's medical staff for allowing Smart back into the game. Is that valid? Could he have made it worse by going back out there?
Dr. Flynn: I think it is highly doubtful that he made the injury worse. The injury had already happened and he likely felt he could push through it. The Celtics allowed him to go back out there and try and it just didn’t work. I don’t think it was dangerous trying to go back out there and I don’t think he will miss more time because he did go back out there.
BSJ: The timetable for Smart's return is basketball activities is 4-6 weeks. What can he do right now to help with the rehab or is just resting up so it can heal? How soon can he realistically get back on the floor in a playoff setting?
Dr. Flynn: I think the hardest thing for an athlete to do, the hardest treatment is rest and unfortunately that’s what he needs to do right now. He needs to let the tissue heal, let scar tissue build up in that area and let the tendon attach to the bone. That’s a tough thing, especially during the playoffs. The unfortunate thing about the timing of this injury and the fact it is an avulsion injury is I don’t think we are going to see Marcus Smart in the playoffs.
I think a 4-to-6 week return to play window is a return to some semblance of basketball activities, it’s not a return to a playoff atmosphere. I will be very happily surprised if we see him on the court this playoff season.
BSJ: If he does try to return ahead of the schedule, where would he be limited? Will it be apparent that he can’t move as well or is the pain the bigger issue?
Dr. Flynn: This is more than just a pain tolerance issue. The muscle is partly not attached to the bone, so when he tries to use that muscle, it’s not only incredibly painful, but the power just isn’t there. Even though we are dealing with a very headstrong and tough athlete, there are some things you just can’t just push through or power through. Unfortunately, I think this is one of those injuries.
BSJ: What’s the best-case scenario then? How will the training staff handle Smart in the meantime?
Dr. Flynn: I think the best-case scenario is in four weeks he starts to shoot around and starts to participate in some drills and feels good enough to return to play in six weeks. I think that’s sort of the best case scenario typically with an injury like this. The training staff can help for sure and I am sure they are already working with him to strengthen things around the area, to keep the muscle loose, to control the pain, but this first period of healing, which is 2-4 weeks, really requires rest of that attachment, which means not much in the way of basketball.
Any reason why the Celtics may have waited until Wednesday to conduct an MRI on Smart?
Dr. Flynn: This is an incredibly painful injury. For an MRI, you have to sit still for 30 minutes. I do have situations where patients are in too much pain to lay still to have an MRI and we have to use medication to make them comfortable or we have to wait. That does happen.
Is there any potential for him to beat the timetable? Any reason to be optimistic?
Dr. Flynn: Celtics fans can be happy that Jayson Tatum’s MRI came back normal. That’s the only good news in this situation. It shouldn’t be a long-term issue for Smart. As long as they let this heal, it shouldn’t be a problem next season or going forward.