As LeBron James hints of an early return, medical experts say he’s not falling to Father Time yet

As he screamed in pain, Los Angeles Lakers star LeBron James no longer appeared indestructible.

Nearly three weeks ago, Atlanta Hawks guard Solomon Hill dove for a loose ball and struck James’ right ankle. Moments after staying on the floor and making a 3-pointer, James left the floor, limped toward the locker room and winced with every step. The Lakers diagnosed James with a high ankle sprain, and he has not played since.

Does this mean that Father Time has finally delivered a knockout punch to the 36-year-old James during his 18th NBA season? Some pundits suggested so immediately following James' injury. On Thursday, however, James posted a cryptic Instagram message with various weather metaphors possibly related to his eventual return, "the weatherman says the weather is changing soon and it predicts a thunderstorm."

USA TODAY Sports also talked to various outside medical experts that expressed more optimism than concern about James' injury.  

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“I expect when he completely heals, he should be just like who he was before he got hurt,” said Dr. David Geier, an orthopedic surgeon, sports medicine specialist and author of ‘That’s Gotta Hurt: The injuries that changed sports forever.’  “So short term, bad news. Long term, good news.”

The Lakers have largely struggled without James on-court production and leadership. 

The Lakers (32-20) are No. 5 in the Western Conference and have gone 4-6 during James’ absence. That has coincided with Lakers forward Anthony Davis also missing the past 24 games after straining his right calf on Feb. 14. The Lakers have not offered an official timetable on when James and Davis will return.

Though the Lakers may lose home-court advantage for most or all of the playoffs, most NBA teams will only host games in front of limited fans because of ongoing restrictions with the coronavirus pandemic. With The Athletic reporting recently that James was expected to miss four to six weeks following his injury, medical experts considered that timeline as reasonable to heal his ankle.

“Once you rehab these injuries, there’s typically very little disability,” said Dr. Michael Castro, an orthopedic surgeon and foot/ankle specialist with Summit Orthopedics. “For the garden variety without any overlying instability, high ankle sprains can heal and not really result in any prolonged disability. The best you can do is give it adequate time to heal and for it to become stable.”

Granted, the medical experts that USA TODAY Sports spoke to have not worked with James or the Lakers and don’t have access to his medical records. The Lakers have not provided any detail about James’ progress with his rehab, either. But even if those outside medical experts stressed those caveats along with the uncertainties with healing from an injury, they mostly sounded bullish on James' return. 

“In the long run, players can usually come back and can eventually get back to their previous level of activity,” said Dr. Jonathan Kaplan, a foot and ankle surgeon with the Hoag Orthopedic Institute. “It’s not like an Achilles rupture where we would worry they may not be the same player. So with a high ankle sprain, I’m strongly optimistic he can get back and be highly skilled and talented to his previous level.”

The reason for the optimism? The medical experts mostly pointed to the Lakers’ long-term approach and James’ body of work.

LeBron James has not played since suffering a high ankle sprain against the Atlanta Hawks on March 20. (Photo: Michael Owens, Getty Images)

Outside of the rare cases in which a person needs surgery to treat a high ankle sprain, medical experts said athletes have a high success rate with returning. The only exceptions point back to players that rushed back shortly after injury.  Former New England Patriots tight end Rob Gronkowski played in Super Bowl XLVI with mixed results two weeks after suffering a high left ankle sprain. New York Giants wide receiver Saquon Barkley admitted feeling limited in the 2019 season after missing only three weeks while healing his high right ankle sprain. Though injuries are always more frequent in football than basketball, James also could assumes less risk because of his conservative approach.

“You have to let everything quiet down,” said Dr. James Gladstone, Chief of Sports Medicine at The Mount Sinai Health System. “You want to calm the inflammation and you want to let the tissues rest. If you work them too quickly or too hard initially, you’re just going to keep them inflamed.”

Since his injury, James attended the Lakers’ game in Phoenix on March 21 and sat on the team bench while wearing a walking boot. Four days later, James posted a video of himself receiving treatment on his right ankle.

Though the Lakers said James is traveling with them on their current trip to Miami (Thursday), Brooklyn (Saturday), New York (April 12) and Charlotte (April 13), it is not clear what the medical staff has cleared James to do. Typically, medical experts said the next stages involve conditioning drills and weight-bearing exercises to test out the ankle’s strength and durability. After that, most players then complete basketball specific workouts, such as shooting drills and scrimmaging.

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Medical experts did not dismiss James’ age in determining how well he progresses with that rehab. But they expressed more optimism than concern about that variable. Though he missed a combined 27 games in the 2018-19 season because of a strained left groin, James returned last season without any major injuries.

“The older the athlete is, the longer it’s going to take them to improve. But I think LeBron has done a great job in taking care of his health,” Kaplan said. “There’s no secret in how much he invests in his recovery and his health. Because of that investment, it will allow him to rehab and improve quicker. For him, I don’t think his age will be much of a factor.”

Kaplan added, “I’m more optimistic for LeBron, than I would be for other professional athletes.”

The biggest factor: how James sheds his rust and improves his conditioning without compromising his left ankle. Medical experts consider a high ankle sprain to be more serious than a regular ankle sprain because it involves torn ligaments above the ankle as opposed to below it. Therefore, those ligaments could influence how James runs, cuts and jumps.

“If you’re putting weight on the leg, that area gets a lot of force especially when you do anything with impact,” said Dr. Alexis Colvin, orthopedic sports medicine surgeon at Mount Sinai High. “It essentially serves as a shock absorber. It absorbs a lot of force, especially when you’re doing things like running or making quick changes in direction.”

Fortunately for the Lakers, they might have time for James to figure out those adjustments. If The Athletic’s report on the Lakers’ timeline bears out, James could return anywhere between April 16 to April 30. The Lakers have nine regular-season games in May before the playoffs start.  

Follow USA TODAY NBA writer Mark Medina on Twitter, Facebook and Instagram. 

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