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Asking some questions about John Wall's injury

John Wall's most recent press conference discussing his injured left knee yielded more questions than answers. We discuss some of the critical questions in this post.

Tom Szczerbowski-US PRESSWIRE

Amin's wonderful transcript of John Wall's post-injury press conference on Monday reveals plenty, but there are so many details in here that don't quite add up. Body parts often respond to injury in mysterious ways, but as we push towards month three of Wall's rehab, it's hard to feel confident that things will dramatically improve in the near future.

After reading Wall's words, a number of questions raced through my mind. Here are the most pertinent ones.

What was the injury, exactly?

The very first thing I noticed was that Wall used far different language than the Wizards originally did when characterizing his injury. Wall referred to his injury as a "fracture" four different times during the transcript, and the first two times were unprompted. Here are the quotes (emphasis mine).

I think mine was just a stress fracture where I was in the beginning stages of breaking my kneecap. It was lucky I caught it before it broke, and I would already know what my timetable is: I would miss the whole season. And I had a little bit of cartilage problems. Underneath my kneecap it's kind of rough.

Reporter: What's the biggest concern about coming back too early?

Wall: Going back to the beginning stages. Probably breaking my kneecap, anything like that, since it started off with a stress fracture. You don't want to go back and re-injure that and have to miss a whole 'nother--I'm not trying to think that far ahead.

This is significant because the very reason for shutting him down in September was to ensure the injury didn't become a fracture. Here's what Randy Wittman said at the time of the injury:

"We're very lucky we took the precautionary steps to make sure nothing was there. We had thought bursitis or something like that, and we were lucky we came and saw it before it was any type of fracture. Those are the precautions we're taking."

What explains the discrepancy? When I asked a Wizards spokesman to juxtapose the two comments, he was adamant that Wall never had a stress fracture, despite Wall's wording in this press conference. So, perhaps the explanation is simply that Wall used a different codeword than the actual diagnosis. Then again, why would Wall use the word "fracture" so many times if it wasn't being repeated to him during these medical checkups? Also, how can one determine that a small fracture is about to happen, but hasn't happened yet?

In some respects, the "fracture" debate is water under the bridge. That part of the injury has healed, and regardless, it's not a broken kneecap like Blake Griffin suffered. But it certainly raises some questions about the initial diagnosis and makes you wonder if the team has been fully up front about the severity of the injury.

Where did his cartilage problems come from?

This is much tougher to pin down. Everyone's knee reacts differently, even with the best-laid plans. Andrew Bynum was supposed to be fine by now after offseason surgery, and he's out. Dirk Nowitzki was supposed to be back by now from his arthroscopic knee surgery, and he's still out. In that sense, Wall is not the only player who suffered some sort of setback in his recovery. Pinpointing exactly what happened to cause that setback is really difficult for anyone to do, much less folks like us who aren't routinely involved in his recovery.

Cartilage problems, though, are a significant concern and they don't really go away so easily. The hope, obviously, is that the cartilage can be repaired naturally, but if not, it seems to me like surgery is the next option.

What are these shots supposed to do?

As noted in the initial press release, Wall received three lubricating Synvisc injections to his knee over the past few weeks, the final of which came during his visit to New York last Friday. What are Synvisc injections? Some quick research indicates that they are usually done to repair pain for folks who have some form of osteoarthritis, which obviously is somewhat alarming on the surface. They usually are done three times, and after each shot, the patient is supposed to stay completely off the knee for a couple days (this explains why Wall said he was waiting for "the swelling to go down"). From my limited understanding of medicine, the shots inject nutrients that a normal, healthy knee has.

It is possible, and frankly, likely, that Wall's arthritis is treatable since it's in its early stages. But you always have to worry whenever you hear "arthritis" connected to a 22-year-old.

Is this connected to his issues as a rookie?

Those who have a good memory of recent Wizards history may remember then-Wizards coach Flip Saunders giving this fatalistic quote when Wall had some knee issues as a rookie.

"I don't think, with his situation, having tendonitis, that he's ever going to be pain free from that," said Saunders. "So I think what we're going to do is we're going to monitor it. That's the approach we're taking, but the reason we say day-to-day is because these things, when you go through them, all of a sudden you might wake up the next day and they might be good to go. That's why we're handling it that way."

That quote rang in my mind as I read the transcript from yesterday. Wall has played through tendonitis before and reiterated yesterday that it's a smaller issue than the initial injury, but when this last happened, he overcompensated and suffered a bone bruise in his right kneecap. One could easily argue that Wall overcompensated again to cause this mysterious stress injury.

Perhaps these injections are a way to solve the root of the issue once and for all. Or, perhaps the tendonitis is always going to be there, and there's always room for more injuries to occur from Wall overcompensating. That would be very problematic, of course.

Should he switch up his training routine?

This is the one element of this story that scares me the most. The reason this injury happened in the first place is that Wall suffered discomfort over the summer during his intense training routine, took some time off, resumed his training in D.C. and discovered the injury during a pre-training camp checkup. It's reasonable to wonder if Wall's training routine was in part to blame for the injury getting worse.

And yet, here's Wall when asked that question.

I did everything the same way, just working out the same way. I just switched different people, but it wasn't a different type of workout. Playing basketball on the court and lifting weights. I'm not doing too much lower body [to avoid] wear and tear.

Wall certainly stepped up his seriousness this summer by training with Rob McClanaghan, the same person that helped transform Kevin Love and Russell Westbrook into NBA stars, but it's possible that Wall pushed his body too far trying to make up for lost time. Maybe he worked hard, but did he work smartly? Given his history of knee troubles, maybe he needs to do more preventative work.

Regardless, approaching rehab the same way he approached working out this summer seems unwise. This seems like as good a time as any for a change.

Is he eventually going to need surgery?

This is the million dollar question. As noted above, if the cartilage doesn't heal correctly, this may be the only option. And that leads us to our final question, which is...

Should the Wizards just shut him down at this point?

The Wizards aren't going anywhere this season, with or without Wall. Given Wall's words, it's also looking more and more likely that he won't even be at 100 percent even if he returns. There will be some time where he's on a minutes limit, and even when he is ready to play more, the organization needs to keep an eye on him to make sure he doesn't reaggravate the injury. The absolute worst thing that can happen is for Wall to come back too soon and just make the injury worse.

Given that, is there a reason to even play Wall this season?

I initially thought that he should play as soon as he's healthy, but now, I'm not so sure. Yes, the Wizards need to see whether he's improved as a player. Yes, the Wizards could use some time watching how Wall's teammates interact with him. But if all that does is delay the inevitable surgery to fix that cartilage issue, then it's a waste of time. Better to fix this issue once and for all rather than letting it linger.

I'm not saying shut Wall down this second, of course. It's worth seeing if all these treatments he's already gone through will work. But if they don't, the Wizards should waste no time putting Wall under the knife. Then, everyone involved needs to learn lessons from this botched rehab and training and strive to correct those issues going forward.

Otherwise, we might be in this same spot again in the near future.