Just How Serious Is Dwyane Wade’s Bone Bruise?
Update (11/17/13): The bone bruises in Dwyane Wade’s right knee have now fully healed. While he has continuing issues with both knees, his most significant troubles are with his left knee, from which he had a portion of his lateral meniscus removed in March 2002.
We’ve been through this before – a 30+ year-old Dwyane Wade sustaining injury, and thus being unable to perform at the highest of levels at the most critical of times. Last year, it caused perhaps the worst postseason of his career. This year, it is lowering even that standard.
Last time around, it was further structural damage to an already surgically repaired left knee, which required the joint to be drained of excess fluid in May and then an arthroscopic procedure to clean out the area in July. This time around, it’s a bone bruise in the right knee. Three, in fact.
The term “bone bruise” perhaps makes the injury seem less serious than it is. People often think of a bruise as a black-and-blue mark on the skin, which is often nothing more than a minor nuisance. But bones can also be bruised. In fact, bone bruises can be quite severe and extremely painful. They’re not all that uncommon in basketball circles. And the knee is particularly susceptible.
A bone bruise is a colloquial term, rather than a medical term, and is something of a misnomer. It is actually a break in the inner layer of bone, accompanied by bleeding from which it gets its name.
Bones are composed of two different types of bony tissue:
- Cortical (or compact) bone is very dense and extremely strong tissue arranged in concentric layers that, as the name implies, it makes up the outer layer, or cortex, of most bones. It also runs down the shaft of long bones. It contributes about 80% of the weight of a human skeleton. The primary functions it serves are support and protection.
- Cancellous (or spongy) bone has a much higher surface area to mass ratio because it is less dense than cortical bone. This gives it softer, weaker, and more flexible characteristics. Spongy bone is typically found at the core of vertebral bones in the spine and at the ends of long bones. Unlike cortical bone, it is not arranged in concentric layers, but rather in plates of microscopic fibrous tissue, called trabeculae, that crisscross with one another in a honeycomb structure and are filled in with calcium to give them their strength. These fibers are interspersed with irregular cavities that contain bone marrow, the site of production of blood cells.
Contact between the end of the femur (thigh bone) and the top of the tibia (shin bone) occurs at the knee joint. At the end of these long bones in the knee, the outer shell is made of a thin layer of cortical bone and the inner core is made of spongy bone.
A bone bruise is an injury sustained either from highly compressive forces that are repetitively inflicted on a bone or as the result of a direct force trauma, where forces are not strong enough to damage the outer layer but are strong enough to damage the fibers in the spongy bone. When enough of the fibers break, a fracture of the bone occurs. But when a few of the fibers break, the result is a bone bruise. It may therefore be considered as a stage before an actual fracture occurs. Bleeding can occur within the marrow inside the bone as well as outside the bone underneath the bone’s protective membraneous layer, called the periosteum.
When a bone is bruised during injury, the muscles and tissues that surround the affected bone are often also damaged. Tissue damage caused by a deep bone bruise can lead to extensive swelling. This is reportedly happening to Wade.
Bone bruises are notoriously slow to heal. The body must first remove the calcium and damaged fibers from the area and then it can begin to rebuild new fibers and lay down new calcium, a process called remodeling. The process can take weeks, sometimes months, to complete, depending upon the type, severity and location of the injury. The treatment is often a combination of rest, medication to reduce pain, ice to reduce swelling, therapy to break up scar tissue and stimulate healing, and rehab exercises to ensure full range of motion. Unlike structural damage which requires surgical intervention, a properly recuperated bone bruise will typically heal well on its own, with no further consequences.
A bone bruise can feel excruciatingly painful right up until the moment it completely heals, and since it’s not a true fracture, the bone is still safe to utilize. However, any further trauma to the injured area can cause greater injury and/or prolong the healing time. If the lesion is struck again after it is partially healed, the impact could damage new, poorly protected fibers that the body has just rebuilt. Thus, the body would have to stop its rebuilding process in the re-damaged area and again remove the fibers and the associated calcium before it can resume rebuilding. Wade has reportedly re-aggravated his injury several times.
The first of Wade’s bruises occurred on March 6, when he took a hit in a game against the Orlando Magic. With the Heat in the midst of a historic 27-game winning streak, rather than rest, he played through the pain. Another blow to the knee came on March 18 against the Celtics in Boston, resulting in a second bruise. A third bruise occurred at New Orleans against the Hornets on March 29.
Whether his two additional bruises were the result of a lack of proper rehabilitation is unknown, but one thing is certain – if he were properly rehabbing his March 6 injury, he very likely would not have been playing for the rest of March.
“I think that winning streak played a role in me playing a little too long,” Wade said at the time.
On March 6, there were 46 days remaining in the regular season. The Heat had an 8-game lead over the Knicks and Pacers. They had a fully healthy shooting guard tandem in Ray Allen and Mike Miller. They had one of the easiest remaining schedules in the league. They had a nearly flawless record with Wade as a DNP. The conference title was a foregone conclusion. That’s 46 consecutive days of potential rest.
The specific prognosis for Wade is not a matter of public record. The logical conclusion, however, is that 46 days would have given him the best possible shot to properly heal the wound in full, just in time for the only truly important part of the season for a team which measures success by nothing less than titles.
And, as it turns out, the Heat’s first round opponent became the sub-.500 Milwaukee Bucks, an opponent for which the Heat did not need Wade to dominate, or even perform, in order to comfortably advance. That’s another 16 days until the start of the Conference Semifinals, or 62 days total. Two full months.
The Heat had up to two full months with which to allow Wade to rest and recuperate from his lone bone bruise. It’s difficult to imagine that up to two full months of rest, recuperation, and rehabilitation would not have returned to the Heat, for its second round match-up, a perhaps rusty but completely healthy Dwyane Wade with a fully explosive game at just the point in time when the Heat needed it most.
Why a medical, front-office and coaching staff would all clear Wade to play at less than full health, knowing full well the implications of his injury and after having witnessed what had happened the season prior, can only be speculated. It is an unfortunate situation, undoubtedly motivated by an injured player’s desire to help his team succeed (and, no doubt, in part by a refusal to step out of the limelight for too long). But in doing so, a single, relatively minor bone bruise became three separate bone bruises that have essentially surrounded his kneecap. As a result, ironically, success will be harder to come by when it matters most.
Wade missed no playoff games last year, although the left knee injury clearly prevented him from playing at peak performance. He’s already missed one this year. He has yet to be cleared for play in Game 1 of the Eastern Conference Semifinals. And even if he is, it remains to be seen just how effective, and consistent, he can be.
Rest is no longer a solution, not during the playoffs anyway. The right knee simply doesn’t have the necessary time to heal. The pain will keep returning no matter how much rest he gets. It’s often a searing pain that can be even more debilitating than, say, a damaged left knee that requires an arthroscopic procedure to clean it out. But all that can be done now is a series of treatments, tons of ice, and possibly some anti-inflammatory medications to reduce swelling and ibuprofen or acetaminophen to reduce pain.
Wade has a tendency to deliver some of his best performances when he’s doubted the most. For the sake of Wade and the Heat, let’s hope he can do so again. If not, his true value to the team can be questioned. An explosive Wade penetrating the lane with reckless abandon breaks down the defense, creating open looks for his teammates or simple shots at the rim. An injured Wade provides neither the explosiveness to break down the defense nor the floor-spacing outside shooting that the Heat thrives upon. That puts more pressure on LeBron James to exclusively handle the penetration duties, and calls into question whether the Heat’s two reserve shooting guards, Ray Allen and Mike Miller, both wonderful shooters, should see increased minutes as floor spacing alternatives to a hobbled South Florida icon.