How concerning is Joel Embiid’s back injury?

Joel Embiid has quickly emerged as one of the top targets for the Cleveland Cavaliers to select with the number one pick in this year’s NBA Draft. He’s perhaps the best center prospect to enter the draft in the last five years, and fits all the needs the Cavs have in the middle. You can read more analysis of his game here and here. The biggest question mark with Embiid, however, has nothing to do with his game. Embiid’s back injury suffered late in the college season has many questioning whether he has any future in the NBA, or if he will go down as a great potential talent that we lost to chronic injury. This is an attempt to answer some of the questions surrounding Embiid’s injury, and determine how much of a risk the injury is for Embiid’s long-term health.

So…..What’s wrong with Joel Embiid’s back, exactly?

Embiid’s condition is called spondylolysis. Essentially, a spondylolysis is a defect in the pars interarticularis, an area of the vertebrae that connects the vertebral facets, or joints that adjoin vertebrae together. A spondylolysis occurs most commonly in the lumbar spine, and presents on an X-Ray as a gap between the facet joints, with a possible forward shifting of the vertebral body. A good example of a spondylolysis image can be found here. Essentially, it’s a stress fracture in the joint, similar to an “ankle fracture,” which is usually a fracture of the tibia or fibula around the ankle.

A spondylolysis typically presents as an achy pain in the low back, which may radiate into the legs. Typically, pain is present during spine extension, and a catching sensation may be felt as the person returns to an upright position after bending forward. Pain may also occur in side-bending or rotation to the same side. In a basketball sense, pain is going to be most present during activities that require extension of the spine: shooting, contesting shots, and rebounding = basicallyeverything that Joel Embiid does on the basketball court. A spondylolysis can also be asymptomatic at the time of injury, which can make this injury difficult to manage.

How do these injuries occur?

A spondylolysis occurs as the result of repeated extension of the spine, along with other predisposing factors. These can include a more pronounced anterior curvature of the spine in the lumbar region, muscular imbalances, and heredity. Women are more likely to suffer the condition than men, and adolescents more commonly suffer the injury than adults. Gymnasts and offensive linemen are your most likely athletes to suffer the condition, due to the amount of spinal extension demanded from these activities. In basketball, this is not exactly a common injury, but a few notable cases have been reported, including Andrew Bogut and Andre Drummond.

How are these injuries treated?

Generally these injuries are treated conservatively with rehabilitative exercise and rest, in order to let the bone heal and correct factors that could protect the back from further injury. Typically, exercises to improve posture are included, and that’s something that will be very important for Embiid, given that at his size, poor posture is a major risk factor in injury. Muscular strengthening focuses on the hamstrings and abdominals, and correcting pelvic position. Extension of the spine is avoided like the plague, for obvious reasons. Typically, this regiment takes about 12 weeks for the injury to heal.

Is this how Embiid’s injury is being managed?

Per Bill Self, this was exactly the plan that the medical staff Embiid was under followed. Every report has been that Embiid shut it down until he was symptom-free, and his rehabilitation showed to have good results, if his workout this week was any indication. That’s promising, because it’s when rushed back from treatment that players continue to have issues with this type of injury.

What complications can result from this injury?

When a spondylolysis is left untreated, it continues to become unstable. As the injury is repeatedly stressed, the separation between the fracture can increase, and eventually the pair of facet joints on the other side of the vertebrae will fracture. This causes a total separation of the pars interarticularis, and results in a forward slipping of the vertebrae, known as a spondylolisthesis. This injury is much more problematic, due to the complete instability of the vertebrae. The injury also heals poorly, due to the degree of separation between the pieces of the pars interarticularis, and can require surgical fixation. This is the injury that has plagued Steve Nash throughout his career, although Nash’s is congenital, unlike Embiid’s injury.

Apr 4, 2014; Brooklyn, NY, USA; Detroit Pistons center Andre Drummond (0) dunks against the Brooklyn Nets during the second half at Barclays Center. The Nets won 116-104. Mandatory Credit: Joe Camporeale-USA TODAY Sports

What are some examples of players who have had this type of injury?

Bogut suffered this injury during the 2008-2009 basketball season. He missed about 30 games, and has continued to have back issues since that time. However, Bogut’s issues are believed to be more stemmed from a protruding intervertebral disc that was discovered after the injury, and the two are likely not linked. Andre Drummond missed about a month of his rookie season with this injury, and has had no issues since returning in late March. Emeka Okafor also suffered the injury famously while at Connecticut, and made a return after conservative treatment to win a national title. He too has had no further complications from that specific injury throughout his NBA career. In fact, the physician group that worked with Embiid is the same one that treated Okafor.

So what’s the likelihood that this injury has any long-term complications for Embiid?

Based on prior examples and the method of treatment for Embiid’s injury, I don’t think there’s much of a precedent for concern surrounding Embiid’s injury. The possibility is there, of course, but everything Embiid has done has been done the right way for this injury to heal. A lot of the concern around this has clearly come from problems involving a limited understanding of back injury. This isn’t a disc problem, which can be a very debilitating and career-ending injury. It’s also not like an ankle or foot stress fracture, which are more due to foot shape and running mechanics and are much more difficult to prevent. This is an injury that more often than not, will not lead to any further issues if treated correctly. The small chance is there for it to bother him in the future, but with the way his situation has been handled, the possibility of Embiid becoming a Greg Oden redux is very low.

Who decided to give these injuries such bizarre names?

There’s a reason Latin is a dead language.

Examination of Orthopedic and Athletic Injuries: Edition 3 (Starkey, Brown, & Ryan, 2010) was used as a reference for injury information.