Can a Long Rest Period Help Kyrie Irving's Knee?

Kyrie Irving missed Game 2 of the Cleveland Cavaliers' series against the Atlanta Hawks last night with his ongoing struggle with patellar tendinitis in his left knee. Irving has battled the injury throughout the playoffs, but hadn't missed a game until last night. He was evaluated by Dr. James Andrews yesterday, and is listed as questionable for Game 3.

Many are hoping the Cavs just keep Kyrie Irving shut down for the rest of the series, as the Hawks are also a walking battlefield hospital with their injuries, and the Cavs have a 2-0 series lead heading back to Cleveland. Rest has been a vital part of Irving's rehabilitation, as he's gotten two extended breaks after the Cavs' series' against the Boston Celtics and Chicago Bulls, and he always seems to look better after a long period of rest. But every time Irving's gotten a rest period, something's happened that has made his knee go right back to where it was before the rest period. Now facing a potential of 10-14 days off before the NBA Finals, is rest itself going to be the difference?

In order to understand what's going on here, we first have to discuss the nature of Irving's injury. Patellar tendinitis itself is pretty simple; the patellar tendon gets inflammed, usually as a result of repetitive stresses, and it becomes very painful to run, jump, or basically do anything athletically. This injury most commonly occurs in younger athletes who go through growth spurts, as a result of Osgood-Schlatter's disease, and your older athletes, as a result of general wear and tear. In pro athletes, it can still occur, but rarely does it affect a young player like it has for Kyrie. Usually, a period of rest and a bout of rehabilitation focusing on quadriceps strengthening does the trick, and in many cases a player can play through tendinitis with no further complications.

But that's not the whole story with patellar tendinitis, and that's why normal treatment hasn't appeared to be totally effective in Irving's case. Patellar tendinitis occurs primarily because of stress to the tendon, but there are always underlying causes for the stress. These can be the result of athletic demands, biomechanics, or past injury history, and with Kyrie, it's likely all three. Patellar tendinitis symptoms can be exacerbated by other inflammation being present at the knee, particularly around the tendon. That's how this most recent flare-up occurred, as Kyrie's knee buckled in Game 6 of the Bulls series, and that triggered the onset of the inflamation again. He also has quite the history of left knee bruises and contusions; I'm sure we all remember the terror we experienced when Irving tweaked his knee against the Oklahoma City Thunder in December, and then again in a game against the Miami Heat on Christmas Day. That lingering inflammation probably contributed to what Kyrie is experiencing. In addition, an alignment abnormality could cause the issue; most commonly a shorter or longer patellar tendon can increase the stresses placed on the tendon during activity. A disparity in muscle strength between the quads could also be a factor, and that's a common thing to see after knee contusions. Throw that cocktail together with playing 100 games in an NBA season, and that's how we've arrived here with Irving.

That's also why rest alone doesn't seem to be doing all it needs to in this case. Tendinitis can be a tricky thing to manage, because there are two things to account for ( the pain and inflammatory symptoms) and the underlying cause. Rest treats the symptoms, primarily, as it gives the inflammatory process, which is actually a beneficial part of injury healing, time to be completed. However, you can't treat the underlying causes with just rest; rest won't fix an elongated patellar tendon or muscle imbalance that predisposes the inflammation coming back. That's why Kyrie has looked good at first when he's come off those breaks between series, but as the series wears on, the inflammation comes back.

In order to fix those factors, Kyrie likely needs a longer rehabilitation of corrective exercise in addition to his symptom management. That corrective exercise can include manual therapy to increase tendon elasticity, quadriceps and hamstring strengthening, orthotics to help correct alignment issues, and neuromuscular control. Usually this is done after a period of rest to calm down the symptoms before treating the underlying causes, in order to make sure that the knee is given time to calm down and that the exercise will have its greatest effect. Obviously, since that can't happen until the season's over, we probably won't see Kyrie at 100 percent again this year.

For the next two weeks, if the Cavs do plan to rest Kyrie for the rest of the Hawks series, that will still be beneficial for treating his pain symptoms. Reducing the inflammation will also be key, as it prevents that cascade of inflammation from getting stronger if the knee does get bumped again. The Cavs' medical staff can also introduce some of this corrective exercise, which I'm sure has already happened. With those two things taken care of, it's not a given that Kyrie will begin feeling the same symptoms again. It is, however, likely for that to happen again, given that the underlying causes haven't been fully addressed, and the misfortune of the magnet in Kyrie's knee that seems to draw knee-to-knee contact to him doesn't help here, either. Ultimately we will have to see what the Cavs decide to do; do they shelve Kyrie for the Finals, or have him try to play as able. That probably depends on how the series goes; just because the Cavs have a 2-0 lead doesn't mean the series is over.

Tendinitis is a cruel mistress, and we will just have to wait and see how Irving's management plan works out. Either way, I don't expect Kyrie to truly look 100 percent until we see him play next season.