For Jonathan Isaac, every cut to the basket, each jump for a rebound, any step he takes on the court, seems to come with risk.
It was the first quarter of the Magic’s first preseason game when the ankle injuries that limited Isaac to 27 games during his rookie season resurfaced. Isaac stepped on the foot of an opponent, suffered a sprain on his troublesome ankle, and was ultimately forced to leave the game. He would go on to miss the next two games, putting at least a temporary damper on his encouraging summer league performance and the growing expectations for his sophomore season.
Isaac returned for the final two preseason games, and made it eight games into the regular season before suffering yet another ankle sprain. This sprain cost him the next six games, meaning Isaac missed 61 of his first 96 games in the NBA because of his ankles.
During the Magic’s 111-106 win over the Sixers on Wednesday, Isaac made his return to the lineup. The challenge now comes in making sure he remains there.
The importance of Isaac’s presence, particularly on the defensive end, was demonstrated by his momentum-shifting block on Joel Embiid....
J.I. in Red. Dead. Rejection. pic.twitter.com/jk6ZHJE1nw— Orlando Magic (@OrlandoMagic) November 15, 2018
Seeing a promising, and otherwise healthy, 20-something-year-old professional basketball player plagued by recurrent ankle sprains is nothing new to Richard D. Ferkel, the director of sports medicine fellowship at Southern California Orthopedic Institute, who has performed surgeries on hundreds of athletes.
One patient of Ferkel’s in particular offers hope that Isaac can indeed overcome his ankle issues and go on to have a prosperous career in the NBA.
His name is Stephen Curry.
Ferkel performed Curry’s second ankle surgery, an arthroscopic procedure, after the Warriors guard played in just 26 games during the 2011-2012 season. In the years following, Curry played in at least 78 games in each of the next five seasons, collecting championships and MVP awards along the way.
While ankle sprains are one of the common hazards of the job for NBA players, the rate at which Isaac has experienced them early in his career raises some concern.
“He’s a young guy,” Ferkel said during a phone interview with Orlando Pinstriped Post. “There’s no reason something can’t be done to ultimately get him back on the court without recurring injuries. If he’s been out this many times, I would certainly be very concerned where he is at and what the long-term solution is to his problem would be. Not the short term solution because he is only 20. If something needs to be done surgically, should it be done now with the idea that he still has a long career ahead of him and not risk additional injuries? Or is it safe for him, assuming he does his rehab properly, to go back and play. That’s always the question.”
Ferkel said there could be a number of reasons why Isaac could be suffering recurring ankle injuries. Each sprain further stretches the ligaments, which he compared to stretching out a sweater.
“Once you stretch your sweater out, it really doesn’t ever stretch back into exactly the same tightness. The same thing happens with a lot of ankle ligaments,” he said. “They’ll stretch out so much from recurring injuries that they get too loose. And if they get too loose, often times, no matter how strong the ankle is in terms of strength, sometimes rehab isn’t enough.”
Ferkel - who has also operated on Ricky Rubio, DeMarcus Cousins, Joel Embiid and others - says ankle sprains at Isaac’s age are quite common in athletes, particularly basketball players.
“Most of these guys have been playing on teams since they were five years old or younger, and they may have had a number of ankle sprains by the time they get up to being a pro,” Ferkel said. “Maybe they never rehabilitate properly in high school or college. Or maybe the ligaments are so loose that they have tried to get by over the years but it gets worse when they are in the pros because you play a lot more games against a higher level of competition and it puts a lot of strain on the joints.”
Isaac is listed as 6-10 and 210 pounds, although photo evidence seems to suggest he has eclipsed the 7-foot mark. The larger the player, Ferkel says, the more potential damage to the ankle during each sprain.
“If you are bigger, the stress on that ankle as it rolls will have more force each time you have this roll,” Ferkel says.
Another issue related to ankle injuries is the development of problems with proprioception, which Ferkel describes in this instance as the ability to feel your foot and move freely without consciously thinking about it.
“So, in other words, when you are dribbling and going to the basket and cutting, you’re not looking at your feet and thinking about where they’re going,” he said. “The foot feels itself and adjusts as we do everything. But when you don’t rehabilitate and have proper proprioception, then your ankle can roll much easier because it’s not able to adjust for all the various changes in direction, and stopping and starting.”
The proper diagnosis, and the appropriate rehab, are key in recovery, Ferkel says. The need for surgery depends on the severity of the ligament damage and other associated injuries.
“Rehab certainly is the first key, but if he’s had that many recurrences then you have to be very suspicious that rehab alone may not be enough,” Ferkel says.
If the stretched ligaments have been identified, and rehab has proved ineffective, the ligaments will need to be re-tightened, Ferkel says, with the most common surgery being a Modified Brostrom Procedure.
“All I can say is, if I was advising him, I would tell him to come in, have a real careful exam, review all the studies to see what has been done so far and if other studies or evaluations need to be done, or whether some kind of force plate analysis needs to be done, Ferkel said.”
Ferkel also suggests both taping the ankles and wearing a brace for double the protection, and also wearing mid-top or high-top sneakers and custom orthotic inserts. John Denton of OrlandoMagic.com recently reported that Isaac will be wearing the same ankle brace that Curry wore.
Like Curry, a majority of players who suffer from recurring ankle injuries are able to recover, whether through rehab or surgery, Ferkel said.
“There aren’t too many career-ending problems, but there can be,” he said. “The key thing in the ankle that leads to more career-ending problems or long-lasting problems deal with damage to the articular cartilage, the cartilage coating the bone. That’s what is the hardest for us to replace and get back to normal again. Some guys in the NBA have had their careers ended because of those kind of issues.”
Ferkel says that the NBA has long expressed concern with ankle sprains and that there are a number of research projects underway to identify preventative measures. He said the ligament tightening procedures may ultimately become more arthroscopic than open procedures and future issues may be more easily solved with the transplant materials being developed.
“We’re still a ways away from that,” he said. “But a lot of time and effort and money is going into it and hopefully we’ll have some better solutions in the future so we’ll have fewer of these problems,”
Unit then, if Jonathan Isaac wants Ferkel to exam his ankles, what’s the best way to reach him?
“Call me,” Ferkel said. “I talk to NBA guys all the time.”