The San Antonio Spurs shut down Kawhi Leonard on Wednesday indefinitely for his right quadriceps. It’s listed as a right quadriceps tendinopathy. SB Nation had a timeline of Kawhi’s injury since the start of preseason, which you can read here.
Tendinopathy is a generalized term that refers to inflammation of a muscle tendon that can last from a few days to several months. The tendon connects the belly of the muscle to the attachment site of the bone.
A tendinopathy can be broken down into:
Tendonitis – refers to an acute injury of the tendon accompanied with inflammation.
Tendonosis – refers to a chronic injury of the tendon accompanied with inflammation.
While Kawhi is dealing with a right quadriceps tendinopathy, I wouldn’t consider it a quadriceps a tendonitis and more of a tendinosis. He has been dealing with the injury, initially occurring during the NBA Playoffs against the Golden State Warriors, back in May 2017. Some may consider six months the longest of a tendonitis, I think by six months you’re dealing with more of a tendinosis.
The unfortunate situation with Kawhi is that he spent several months rehabbing his quadriceps back in the early part of the season, since September. Coach Popovich talked about Kawhi missing the preseason in early September rehabbing from his injury. “We’re still rehabbing his thigh. He’ll miss the beginning of preseason or a good deal of preseason, and we’re not going to put a timetable (on a return). But he’s working at it, and we’ll get him back as soon as we can…….I don’t gauge it. He’s still rehabbing and when he’s ready, he’ll be ready. I try not to qualify it.”
You can see back in October, Kawhi was struggling to even walk up a flight of stairs.
— Larry Ramirez (@LRam2) October 20, 2017
Commonly tendinopathy injuries can be caused from a variety of sources and reasons. It is too broad to say it’s an overuse injury. While wear and tear is a factor there are usually underlying reasons for the wear and tear can lead to injury. Common factors may include: altered mechanics of the joints in question that lead to improper loading patterns, muscular imbalances that can stress the joint and the tendons involved, muscular weakness in adjacent body parts that affect the joints, lack of proper rest and recovery.
The muscles in question are the quadriceps. The quadriceps muscles are made up of four muscles and one of the primary functions of the quadriceps is extension of the knee:
Rectus Femoris – most superficial quadriceps muscle that attaches at the hip and the knee. It’s the only quadriceps muscles that also doubles as a hip flexor
Vastus Lateralis – the lateral head of the quadriceps muscle
Vastus Medialis – the medial head of the quadriceps muscle
Vastus Intermedius – the deepest head of the quadriceps muscle
Quadriceps Tendon – the tendon that results of all four quadriceps converging to attach to the Patella.
Patellar Ligament – the ligament that is a continuation of the quadriceps tendon that connects the Patella to the Tibia.
Aside from just standardized knee extension the quadriceps is really important for stabilization of the knee during sport. It’s important for jumping, cutting, running, slowing down, lateral moving. It’s not just for doing leg extensions at the gym.
What Could I Do?
What I would do is probably not much different to what the San Antonio Spurs have already done. Through a combination of a lot of manual therapy, passive modality use, exercise rehabilitation, and sports specific training.
The manual component would emphasize the muscles of the hip, thigh, and knee. We’ll work connective tissue of the knee as well. While the benefits may be short-term, the manual component allows us to hopefully influence how we rehab and get the athlete stronger.
The exercise component…that’s the challenging part because I don’t know what bothers him and what doesn’t bother him. Also, exercise selection is more than just saying let’s do squats or leg press or lunges. He may be able to back squat or front squat but not able to squat to 90 degrees but only to 45 degrees without pain. So the exercise selection component is a challenging piece. But for me it’s starting him with two-legged exercises before progressing to one-legged exercises. One thing I can promise you, I’m not having him on the leg extension machine…
His sports-specific rehabilitation won’t start until he can do the basic movements without pain and soreness. I think he should be able to one-legged squats and lunges before he even considers taking jump shots and doing defensive slides. While we can program exercises to mimic those movements, he’s not doing those movements until he feels complete confidence in the more traditional physical therapy rehabilitation setting first.
It’s unfortunate. It’s tricky because Coach Gregg Popovich and his staff are also confused as well.
Pop on Kawhi's slow progress: "He’s just coming along more slowly, for whatever reason. It’s just been more difficult for him to get through the rehab routine. His body hasn’t reacted the same way."
— Tom Orsborn (@tom_orsborn) November 7, 2017
The severity of the injury is clear, it’s severe but also puzzling an entire medical staff. What is also interesting is what Coach Popovich said in regards to a similar injury: “What’s really strange is that Tony (Parker) has the same injury, but even worse. They had to go operate on his quad tendon and put it back together or whatever they did to it. So to have two guys, that’s pretty incredible. I had never seen it before those guys.”
While Kawhi hasn’t undergone the knife yet, who is to say that him getting surgery on something that isn’t torn would help. Also, Tony parker ruptured his quadriceps tendon, Kawhi has not. Right now given the information that’s available I would say he doesn’t play for at least the next month.
He may not play again until March and that’s just being cautious and hesitant about the earliest he could play. Given that quadriceps tendinosis could take over six months for full recovery. We all can believe that he’s working hard to get back and play but until he also develops confidence in his leg, it could be several months until we see Kawhi Leonard back on the court and hopefully the San Antonio Spurs are able to still make noise in the Western Conference otherwise they could shut him down for the entire season.