Hi there, Kendrew here, Lakers Outsiders’ resident almost physical therapist. Lonzo Ball is hurt. He sustained a grade 3 ankle sprain in the third quarter of the Lakers’ loss against the Rockets.
Here you can see his ankle inverting after stepping on James Ennis’ foot.
So what happened here?
This is pretty common in basketball as you see players landing on other players’ feet all the time. Sometimes unintentionally, or by someone intentionally putting a foot out like we saw LaMarcus Aldridge do to Brandon Ingram earlier this year.
With the way his ankle went, the lateral ankle ligaments have most likely been affected. Below is a picture from Netters’ Atlas of Human Anatomy showing some of the ligaments that are implicated with this sort of ankle sprain, primarily, the Posterior talofibular ligament, Calcaneofibular ligament, and Anterior talofibular ligament. The anterior talofibular ligament is the most common to be ligament of the bunch that is affected.
If I was a betting man (which I’m not because I have a severe lack of money and am indeed a broke grad school student), I would say that the ATFL is the one that’s most injured.
The different grades indicate the damage done to the ankle. Lonzo has a grade 3 sprain. Grade 3 is the most severe, and that typically means that the ligament is completely ruptured.
In 1940, British orthopedic surgeon Sir Reginald Watson-Jones said it was worse to sprain your ankle than to break it (for reference, Watson-Jones created a way to repair ankle ligaments surgically). Why is this? Bones can repair themselves. Ligaments cannot unless some sort of intervention is taken. Ligaments can be scarred down with collagen but it must be implemented by proper loading. Cyclic loading can help with scar proliferaion. This type of loading can make the scar stronger. With ligaments’ sole purpose to provide stability to the joint, there is fear that further damage can occur after previous ankle injuries due to laxity in the joint (recall that Lonzo injured that ankle earlier in the season).
In layman’s terms, imagine the Golden Gate Bridge. You know the wires that hold the bridge up? Those provide stability to the bridge even with the weight of the cars and runners, and bay area wind, the bridge stay stable. Ligaments are necessary for structural stability and with any of them impaired, it can lead to the ankle and foot moving outside of its normal range of motion, stretching and potentially tearing other structures.
According to Tania Ganguli of the L.A. Times, the Lakers are going with the nonsurgical route.
A Grade 3 sprain, which Lonzo Ball has in his ankle, involves a ligament tear, but Ball's will not require surgery.
— Tania Ganguli (@taniaganguli) January 20, 2019
That’s not to say there are other ways to manage it. Conservative treatments are a way for those with ankle sprains to maintain better control and help provide stability to the joint when structural changes occur. Neuromuscular training can be done to improve the strength, coordination, and stability to the joint. By training the surrounding muscles around the joint, such as the peroneal muscles or calf muscles to fire at specific times, the contraction can help with stability and movement. Training can range from single leg balancing (to help the joint get used to loading) to calf raises, all the way to running and changing directions within 5 to 6 weeks. Other exercises that are implemented can be centered on improving balance and mobility of the ankle. Mobility is as important as strengthening the joint as a stiff joint can cause things higher up the biokinetic chain (knee or hip, more likely the knee) to be predisposed to further injury due to the ankle not being able to move properly. Everything is connected and that ankle, if not treated correctly can cause more injury as movements would cause the body to compensate more.
Muscles can also be used to help provide control of the joint as well. In an article from 2011, De Vries et. all came to the conclusion that those with chronic ankle instability have a short-term advantage with conservative treatment, although more research would need to be provided to see the long term benefits. Those who do not respond to conservative treatment, however, may need to opt for surgical intervention. Another article from Powden and Hoch from 2017 stated that conservative treatment is beneficial for those with chronic ankle instability to improve their quality of life.
So what does this mean for the recovery process?
Given the fact that Lonzo is an athlete, his body is better equipped for injuries. He’s stronger than the average person, he has the best care he can get from the Lakers, and I’m sure he’ll get back to continue his level of play (which has been the best of his career), but 4-6 weeks seems short given how conservative the Lakers training staff is. The normal timeframe would probably closer to 3 months but with the playoff picture being such a mess in the west, the Lakers will want to bring him back as soon as possible.
Here’s hoping he gets better soon, as, without LeBron, Lonzo, and Rondo, things could get messy for an already inept Lakers offense.