Embiid Updates/Discussion

[snoopdogg88]

people , you don't sit your 1st round pick two seasons in a row and expect him to magically come back ready to play NBA basketball.
especially a raw prospect like Embiid who needs as much experience as possible.

how in the world can anyone even pretend to suggest thats a good plan?
if he sits out this season, it's because he isn't healthy. period.

[LongLiveHinkie]

people , you don't sit your 1st round pick two seasons in a row and expect him to magically come back ready to play NBA basketball.
especially a raw prospect like Embiid who needs as much experience as possible.

how in the world can anyone even pretend to suggest thats a good plan?
if he sits out this season, it's because he isn't healthy. period.

If he needs another surgery, then they have no choice. They are 100% committed to Embiid, because with health in limbo he has no value elsewhere. So you wait it until if/when he can play.

[Unbreakable99]

people , you don't sit your 1st round pick two seasons in a row and expect him to magically come back ready to play NBA basketball.
especially a raw prospect like Embiid who needs as much experience as possible.

how in the world can anyone even pretend to suggest thats a good plan?
if he sits out this season, it's because he isn't healthy. period.

Well that's obvious. If he's not on the court then that's not good. We still need to wait for more info.

[Unbreakable99]

A doctor tweeted out that this is bad news, and he most likely will need another surgery, plus no basketball again.

Not the doctor who is examining him though so take FWIW

Who is the doctor? Where is the tweet?

[LongLiveHinkie]

A doctor tweeted out that this is bad news, and he most likely will need another surgery, plus no basketball again.

Not the doctor who is examining him though so take FWIW

Who is the doctor? Where is the tweet?

Nicholas DiNubile MD
‏@drnickUSA

@howardeskin IF Embiid fracture not healed 1 year post-op, big problem. Navicular stress fractures can be bad actors. MoreSurgery & NoHoops

https://twitter.com/drnickUSA

[James40]

A doctor tweeted out that this is bad news, and he most likely will need another surgery, plus no basketball again.

Not the doctor who is examining him though so take FWIW

Who is the doctor? Where is the tweet?

There is a Dr on CSN that said the same thing but it really doesn't make sense because he was cleared back in March, by his Dr I believe. The main point of concern was that's it's been year.

[Stanford]

[youtube]https://www.youtube.com/watch?v=YlmECL2ED2I[/youtube]

Sounds legit. The dude's twitter feed is clickbait central.

[Sixerscan]

Wait he actually calls himself Dr. Nick

[LongLiveHinkie]

Indeed he does

[tk76]

Quick primer on Navicular Fractures and my best guess (as a doctor but no an orthopod) of what is going on (I posted this on a similar LB thread)

The bone healed a while ago. The screw held the bone in alignment to help it heal, but the screw does not in itself strengthen the joint. But if stress in you foot leads to a navicular fracture once, then there is a risk it will recur once you put stress on it again. There is no getting around this with proper orthotics or strengthening exercise… it is just a matter of physiology.

So the rehab has various stages. Early on you avoid weight bearing in order to allow the bone to heal. Then you go slow to allow it to fully mineralize. But after that you ramp up activity while periodically checking to see if there is a stress reaction so you catch it before a fracture recurs. You also monitor bone mineralization and the condition of the screw in relation to the bone. If one of these things are an issue then you halt activity and troubleshoot (This appears to be the stage they are at now.) Sometimes that is as simple as resting until the stress reaction subsides… and sometimes you are headed for surgery. But either way, it is concerning if you are seeing any issue with activity at this point, because it suggests that the physiology of the foot is leading to unhealthy stress and it is less likely that the initial surgery was a permanent fix.

Foot issues are quite different than knee issues. Cartilage and excess fluid don’t really play the type of role in your foot as they do with a bad knee. So the range of options is a lot less. There are things that promote cartilage health and growth, but if you navicular bone has a poor blood supply then you are sort of SOL. You can do what you can to reduce the stress and support healing, but at some point you transmit you body weight through the bone and it either has the blood supply to stay healthy or it doesn’t. Fortunately, 85% of the time you do well (by letting it heal and then carefully monitoring so you catch a problem before it is to late.) But the main "treatment" at this point is at the first sign of a stress reaction you halt activity until things calm down. because if you wait to long you are out another year.

That does not mean Embiid is destined to have foot issues his entire career. But it is a concern and I’m sure they will be super careful going forward to try and catch any future stress reaction early. I would not be surprised if that means missed games during his career. But even if that is the case, that does not mean he will be hobbled by the foot or that it would limit his play while active.

In some ways it is similar to having a runner who gets shin splints often. If they don’t take care then they end up with stress fractures. But if they take it easy early in a flare then the periosteal reaction can heal before you get a stress fracture. The foot is trickier because you are dealing with greater stress, worse blood supply and less overt warning signals. But the basic premise is the same. If they can detect a stress reaction early then they likely can reverse the process with rest prior to another debilitating fracture and the resultant surgery and rehab.

But the big question has always been whether Embiid is likely to get multiple stress reactions due to his physiology, or after healing will his foot be fairly resilient and be easy to keep from trouble. We really won't know that for a long time. But if this episode is a stress reaction, then it certainly is worrisome- but does not preclude him from having a long and dominant career (with maybe some enforced periods of rest.)

[ExplosionsInDaSky]

Gonna wait until we get the full report and expected time off before I freak out and stick my head in a deep fryer.
I think this is simple, he'll either work out for us or he won't. The show must go on with or without him.
We have Noel, Saric is possibly coming over, we have an opportunity to draft a superstar level talent in this draft and we have a crap ton of cap space. To me Embiid was never "the chosen one", mainly because he has yet to prove a damn thing. The big overall picture is a lot bigger than just Embiid. I hope this is just a minor setback and he's ready to go by preseason.

[XtremeDunkz]

I am getting very sad. Bynum and now Embiid. Just horrible for the fan inside me.

[Los5782]

I wouldn't be surprised if they're genuinely putting out reasoning as to why he won't be playing in SL, maybe even a portion of/entire upcoming season. There legit is going to be at least ONE more season of (a) lottery pick(s), this upcoming season. I don't think there's ANY setbacks, nor has such been stated. In fact, Embiid's was cleared to, & proceeded to ramp up his workouts drastically; as has been reported, he's been looking explosive & dominant in recent workouts. Hinkie & co. I think is prepared to enter year 3, & likely final year of the "tank", there's going to be major growing pains with such a young team, & more incoming youth... so why play Joel? All the official FO statement said was the Embiid was not recovering at the pace they expected. We're not contending for anything... give his surgically repaired foot another several months, skipping SL, or maybe even the season. Full 2 seasons to heal the foot, wouldn't seem like unreasonable logic, we all agree that Joel has franchise potential, so why not theoretically give him the max % chance to succeed while the rebuild is still ongoing, maybe they want Dario to come over for obvious reasons (giving Brett more to work with/develop in the meanwhile, & also giving the fans more too.) I have several points though, excuse all the rambling I'm tired but:

1. Joel is our prospect with franchise potential, we all know that, Hinkie & co. want to give him more than enough time to solidify that surgically repaired foot, so they want to drop the bomb (which really wasn't much of a bomb, more like a firecracker) now, people are already down in the dumps disappointed & feeling hopeless, let the fans lose all expectations they had now; by the time draft time comes around, & we draft our players... & IF + DARIO comes over... fans are already looking on the bright side, the narrative will then be yeah I've lost hope for Embiid, but we still have _______ & now we have ______ also and Dario? Solid foundation, our rebuild is still very very good & promising. In the meanwhile Embiid will go on to sit SL & potentially the upcoming season, people will have 0 expectations of Embiid, yet he'll come in following 2 seasons of post surgery recovery & potentially be that franchise player we all envisioned initially.

2. Killing 2 birds with one stone, whilst getting point 1 ^ above accomplished, we're also posturing for the draft, Hinkie could end up getting 2 prospects in this upcoming lottery. People are now under the impression that Philly's in code red panic, with our prized big man prospect again going down. This upcoming draft consist of 2-3 premier big men, depending on who you are & your perception of KP6. All together this draft is likely considered to be 3-4 elite prospect deep. KAT, Oak, & Russ, and NOW potentially maybe KP6. A lot of people say Russ & Kat are tier 1A, with Oak being a notch below, now KP6 is being talked about being in those upper 2 tiers. Hinkie could possibly end up doing what he did in last years draft, which is trading back a spot or 2 while getting additional assets. Rumors of potentially trading Noel to get the NY or Orlando pick, depending how the draft goes. Could end up with Russ & one of the big men, likely KP6. Personally, regardless of what people will say, IMO I wouldn't be totally opposed to this. There's been a lot of well wishing with the Noel situation, that he'll fill out, he'll develop an offensive/face up game, that he'd work with Joel in a pairing. If we could leave the draft with KP6, or another big AND one of the other lotto picks I wouldn't be opposed to the idea at all.

Either way, I think the FO is seriously prepping us for a longer Joel wait (not because of setbacks, but because of precautionary measures), also potentially looking to head into this upcoming & final 'tank' year with 2-3 new prospects to keep fans satisfied, & just because it really boosts our chances as a franchise for success.

Fu***ng spot on, good sir. Even the Noel part, which I disagree with, I could totally see Hinkie do.

So I'm not a nut, & If I am, I'm not alone!

[TorturedFan76]

Well, you actually can help foot mechanics with the proper orthotic inserts. Something with a high arch, and maybe medial posted rear foot as well. Depends on the type of foot Embiid has. And you can do rehab to strengthen some intrinsic and extrensic foot muscles that help support the arch. Especially the tibialis posterior which has an attachment at the bottom of the navicular. Strengthening that muscle helps hold the navicular up, holding the arch up.

Those things can definitely help distribute stresses more evenly up the kinetic chain and reduce the stress on that particular bone. Problem is, this is where ortho and sports medicine diverge. Those treatments are great for the lay person. They will help with proper gait patterns making sure the foot hits the ground and rolls through properly as you push off. Great! But Embiid isnt just trying to walk. He is trying to play basketball. This is where sports medicine comes in and goes beyond the scope of just general orthopedics. In basketball, hes going up on his toes. Defensive slides. Jumping, landing, etc...
When you go on your toes, now instead of the navicular acting as a keystone at the apex of an arch, sending forces away from it, it is actually just another bone in a stack of a bunch of bones on top of it. Getting compressed. Getting pinched in between the talus and medial cuneiform, and bearing all of the bodies weight. Or, the bodys weight x 1.5 while running. Or the bodies weight times 3+ while jumping.
How do you prevent that? Well, not playing basketball and not putting your foot in that position. Not a realistic plan for Embiid. He is a basketball player.
So, we wait. Wait until that bone is fully healed.

Fractures are usually strong enough to play after a few weeks. Tricky ones like a jones fracture or a navicular fracture in the hand or foot take longer because of watershed areas with little blood supply. But with any fracture, youll see increased bone activity on a bone scan up to 2 years. It doesnt mean they arent strong enough before that. But if the 6ers are being super cautions, dont be surprised to see the timetable pushed back further.

I wouldnt panic at this point. Id panic if he hasnt played a game after 2 years. Because at that point not only should the bone have been strong enough long ago, but the healing/remodeling phase should be complete by then as well.

I really hope he gets back on the court much sooner than that though.

[James40]

I am getting very sad. Bynum and now Embiid. Just horrible for the fan inside me.

Ehh, Bynum was an as swipe pure and simple. Look what happened when he went to Cleveland, chucking half court shots during practice. His knees weren't great, but neither was his attitude. The Sixers could of saved themselves a lot of headaches by coming out in Nobember of that year and said " this dude is a pos" end of story. Instead they decided to string along fans which turned a bunch of them (us) against the team.

[tk76]

Good info Torturedfan76. It is amazing the stress an athlete puts on their bodies. Even more amazing to see some 7 footers or 300 pounders have long careers. And pitchers...

[LongLiveHinkie]

Could just be throwing stuff out there from people not in the know, but Keith Pompey saying a source told him Embiid could miss the entire season.

Not sure how anyone would know that yet, so I'm guessing the source literally is stressing "could" as in Steph Curry could score 100 points in game 6.

[XtremeDunkz]

I have been pro rebuild since the beginning but if Embiid is out the entire season I need Saric here this year along with #3 or I won't even watch games next season. Definitely won't buy merch or tickets.

[Ericb5]

Could just be throwing stuff out there from people not in the know, but Keith Pompey saying a source told him Embiid could miss the entire season.

Not sure how anyone would know that yet, so I'm guessing the source literally is stressing "could" as in Steph Curry could score 100 points in game 6.

There are a lot of people repackaging the same information with various things emphasized. Saying that he "could" miss the entire season is the same thing as "we don't know what kind of impact this will have".

Nobody knows what is going on outside of the Sixers and their doctors right now.


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[Ericb5]

Quick primer on Navicular Fractures and my best guess (as a doctor but no an orthopod) of what is going on (I posted this on a similar LB thread)

The bone healed a while ago. The screw held the bone in alignment to help it heal, but the screw does not in itself strengthen the joint. But if stress in you foot leads to a navicular fracture once, then there is a risk it will recur once you put stress on it again. There is no getting around this with proper orthotics or strengthening exercise… it is just a matter of physiology.

So the rehab has various stages. Early on you avoid weight bearing in order to allow the bone to heal. Then you go slow to allow it to fully mineralize. But after that you ramp up activity while periodically checking to see if there is a stress reaction so you catch it before a fracture recurs. You also monitor bone mineralization and the condition of the screw in relation to the bone. If one of these things are an issue then you halt activity and troubleshoot (This appears to be the stage they are at now.) Sometimes that is as simple as resting until the stress reaction subsides… and sometimes you are headed for surgery. But either way, it is concerning if you are seeing any issue with activity at this point, because it suggests that the physiology of the foot is leading to unhealthy stress and it is less likely that the initial surgery was a permanent fix.

Foot issues are quite different than knee issues. Cartilage and excess fluid don’t really play the type of role in your foot as they do with a bad knee. So the range of options is a lot less. There are things that promote cartilage health and growth, but if you navicular bone has a poor blood supply then you are sort of SOL. You can do what you can to reduce the stress and support healing, but at some point you transmit you body weight through the bone and it either has the blood supply to stay healthy or it doesn’t. Fortunately, 85% of the time you do well (by letting it heal and then carefully monitoring so you catch a problem before it is to late.) But the main "treatment" at this point is at the first sign of a stress reaction you halt activity until things calm down. because if you wait to long you are out another year.

That does not mean Embiid is destined to have foot issues his entire career. But it is a concern and I’m sure they will be super careful going forward to try and catch any future stress reaction early. I would not be surprised if that means missed games during his career. But even if that is the case, that does not mean he will be hobbled by the foot or that it would limit his play while active.

In some ways it is similar to having a runner who gets shin splints often. If they don’t take care then they end up with stress fractures. But if they take it easy early in a flare then the periosteal reaction can heal before you get a stress fracture. The foot is trickier because you are dealing with greater stress, worse blood supply and less overt warning signals. But the basic premise is the same. If they can detect a stress reaction early then they likely can reverse the process with rest prior to another debilitating fracture and the resultant surgery and rehab.

But the big question has always been whether Embiid is likely to get multiple stress reactions due to his physiology, or after healing will his foot be fairly resilient and be easy to keep from trouble. We really won't know that for a long time. But if this episode is a stress reaction, then it certainly is worrisome- but does not preclude him from having a long and dominant career (with maybe some enforced periods of rest.)

Great post.

I didn't know that you could monitor for a stress reaction in this way, but I suppose that makes sense.

If we stay diligent on that then we should be able to stay on top of this, and theoretically prevent a recurrence of the issue.

Only time will tell how long he can go without creating these stress reactions though, and I suppose that that is dependent on a number of factors that we don't currently know and may not have much control over.

I just hope he doesn't require more surgery, and that we are dealing with what you mentioned, and just noticing a stress reaction.



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